Having received initial accreditation for its graduate medical education program, Washington State University’s Elson S. Floyd College of Medicine is moving quickly to establish its own residency programs.

In December, WSU hired Dr. Jonathan Espenschied to lead the development of the graduate medical education program. Espenschied previously served as director of graduate medical education and clinical training for City of Hope National Medical Center, in Duarte, Calif. 

He says he’s already begun the process of reaching out to facilities that may be interested in creating residency or fellowship programs.

“We’re just starting the process of building out WSU’s residency program, with the goal of having spots ready for the first graduating class in 2021,” he says. “We are anticipating the first class will have 60 students graduating.”

The process of creating a graduate medical education program and the residencies within it is long and difficult, he says.

“Different levels of medical education are accredited through different committees and have different requirements to obtain accreditation,” he says.

Medical schools are considered undergraduate medical education and are therefore accredited through the Liaison Committee of Medical Education, Espenschied says.

“Once a student has completed medical school, they continue their education in a medical specialty of their choosing,” he says. “This further training, which includes hospital-sponsored or hospital-based training, such as internships, residencies, and subspecialty fellowships, is all part of what we call graduate medical education.”

Espenschied says graduate programs are accredited through the Accreditation Council for Graduate Medical Education, which also has to approve each individual residency and fellowship within the program.

He says WSU’s graduate medical education program received its initial accreditation as an institution this fall and is now working to create individual residencies and fellowships, which will each need to be accredited.  

Espenschied explains that most medical schools also own or operate a hospital or medical center called a university hospital. 

“The medical school then develops residency programs within that university hospital and the majority, or all of the training takes place in that center,” he says. 

“A community-based medical school, like the Elson S. Floyd College of Medicine, does not own or operate a hospital and therefore relies on other community affiliate partners, hospitals, clinics, and care facilities to help provide the clinical training needed in residency programs.”

He says the community-based model allows partners to be more involved in the training of residents and also involve them into their specific urban or rural communities.

“As a community-based medical school, for us to be able to train students, residents, and fellows, we’re relying on community partnerships,” he says. 

“This makes it difficult to estimate just how many residencies our graduate medical education program will have available, as we need to first establish those relationships and verify their qualifications.”

Espenschied says multiple hospitals and health care organizations across the state already have expressed interest in developing residency programs with WSU. 

“We’ve seen a lot of interest, and so far have two to four possible programs we’re discussing for possible 2021 start dates,” he says. “That may not seem like a lot, but keep in mind, these programs are being developed where there aren’t any currently. This means that the infrastructure needs to also be developed, and funding is limited.”

Espenschied says each program will be able to train anywhere from 12 to 50 residents, depending on the resources available.

He says it’s possible the WSU’s graduate medical education program could one day have more than 100 residencies with different niche focus areas, but that will take quite some time.

“The process of developing a program takes two to three years, depending on what is needed to create, from development, to accreditation, to the first residents entering the program,” he says. 

“An initial assessment of the resources and viability of a community site is not guaranteed, so due diligence needs to be done to assure a proper teaching environment according to the accreditation requirements and sustainability.”

While he maintains it would be financially impossible to implement 10 programs to start in 2021, Espenschied says WSU does have certain niche areas it wants to focus on based on the needs it has identified in various communities. 

In considering health providers that could host residency programs, he says, WSU is keeping several factors in mind, one of which is the increasing need for care on the eastern side of the state.

Last month, researchers at the WSU medical school released a report that showed Eastern Washington counties suffer from higher mortality rates than West Side counties in nine out of the 10 leading causes of death.

Espenschied says longstanding evidence is clear that medical students who are educated in the state and go into residency here are more likely to stay here to begin practicing.

“According to the Association of American Medical Colleges’ 2017 workforce data report, for Washington state, it’s estimated that seventy percent of medical school students who study and train here, decide to stay and practice,” he says. “So, if we can develop more residency programs in those areas, we may have the potential to reduce those mortality rates significantly by bringing more physicians here.”

Espenschied says that Washington currently has about 168 accredited graduate training programs, 78 of which are specialty residency programs, with the remaining 90 being subspecialty fellowship programs.

Of those programs, only 10 are located east of the Cascades, he says.

“So, in creating residencies and fellowships, we are looking at opportunities all over the state, but we do want to address the critical need for more programs here on the east side.”

Espenschied says WSU likely will begin by establishing residencies in the four communities where it has clinical campuses: Spokane, Vancouver, Everett, and the Tri-Cities area.

“Obviously, we’ll be looking to those four areas to start, but a big part will be considering areas of need that have been identified through studies and data,” he says. “We’ll be asking ourselves what kinds of programs we can develop and which institutions we could involve to help ease the care burdens in those communities.”

Espenschied says that whether a program will be developed in an area will depend on community infrastructure and the ability to provide a good clinical learning environment, as well as the ability to meet accreditation requirements.

To have a better chance of being approved for a residency program, Espenschied says a facility usually needs three major things: a good mix of patients, faculty, and financing.

“If you have all three of those things, it’s usually easier to set up residency program,” he says. “But we still encourage anyone who’s interested to reach out, because even if your area or facility doesn’t qualify, we can still work on developing network relationships.”

Funding is a big challenge, he adds.

“Usually the Centers for Medicare & Medicaid Services is the largest reimbursement entity for residencies, but rural residencies are difficult to get reimbursement for,” he says. “We’re still working on ways to try to improve that.”

Espenschied says a medical student’s residency defines which specialty they plan to practice in. Residencies can last between three and seven years depending on whether the student chooses to pursue fellowships for subspecialty training, he says.

The top specialties that WSU’s initial resident physicians likely would focus on include family medicine, internal medicine, psychiatry, pediatrics, and surgery.

“The biggest need we’ve identified is for primary care, which includes those top five specialties,” he says. “It’d be great to be able to develop all five types in communities that can handle that many residencies, but there are many requirements that could hinder that.”