A new medical residency program sponsored by the University of Montana kicked off this month and seeks to keep doctors in the state’s rural areas and bolster the availability and quality of care.

After a monthlong orientation, residents with Family Medicine Residency of Western Montana are getting into the swing of their rotations during their first week on the job.

The Missoula program is only the second in a state that program organizers say is woefully lacking in medical training and providers.

Fifty-four of 56 Montana counties are at least underserved, while 11 counties don’t have a physician at all, according to the 2011 Montana Healthcare Workforce Statewide Strategic Plan, said Nerissa Koehn, associate program director.

And Montana ranks last in the nation for graduate medical education, Koehn added.

The new, three-year residency program helps fill both those needs by creating a training opportunity for physicians who have demonstrated their desire to practice in rural Montana, she said.

The program is sponsored by the University of Montana and is under the University of Washington Family Medicine Residency Network. Area hospitals, clinics and medical professionals are part of the program as well.

To gain a variety of skills, residents will spend time with local physicians, university staff and program employees, do rounds at Community Medical Center and Providence St. Patrick Hospital, see patients through Partnership Health Center, and do research. Three residents will spend their last two years in Kalispell, working through the Kalispell Regional Medical Center and Flathead Community Health Center.

Each of the first 10 participants’ background is different. One went to medical school at Dartmouth, one to Brown. One resident is from India, others are from closer to home, including Montana and Washington

The one thing they all have in common is a passion for rural medicine – and they have demonstrated that passion, with four signing up for an extra rural rotation in place of an elective, Koehn said.


Already, residents have gotten a dose of what being a general care physician means in Montana, she said.

They underwent some neonatal training in Plains, where there is no neonatal intensive care unit. Lots of rural facilities are similar, in that they don’t have as many resources – technological or human – as larger medical centers.

“I think it’s really valuable to get exposure to that early on,” Koehn said.

Part of the new program’s mission is to keep doctors in Montana, said Ned Vasquez, the residency program’s director.

More than 70 percent of the residents who go through the Billings program, the state’s other residency program, remain in the state, proving that residents are likely to stay in the area where they do their final training, Vasquez said.

First-year residents for the Missoula program were chosen based on their credentials, but also on their desire to be a family physician in rural Montana, Vasquez said.

The sheer vastness of what one must know as a family doctor can be daunting, Vasquez said.

However, that’s also a draw for residents because they know they must be able to use all their skills.

“So it’s that option of practicing the whole breadth of family medicine,” Vasquez said.

As family doctors, the residents will be the frontline for patients, and must know when to treat a patient and when to stabilize a patient and get them to more specialized care, he said.

In addition to time in local hospitals and clinics, rotations in Superior, Plains and Ronan will expose residents to what working in rural Montana is actually like, he said, adding the program would like to work with as many medical facilities as possible.


While Sarah Zuger doesn’t know where in Montana she would ideally land, she knows she wants to stay in the state.

“I think this program will help me figure that out,” the resident said.

Zuger said she decided to practice medicine in a rural area after a stint at a clinic in West Africa during her time in the Peace Corps.

The Washington native went to medical school at the University of Washington through the Washington, Wyoming, Alaska, Montana and Idaho program, better known as WWAMI, and did some rotations in Montana.

Although Missoula’s is a fledgling residency program, Zuger was impressed with the confidence and energy organizers conveyed when she interviewed. A new program presents opportunities to shape it to what she most needs and wants, including emergency and wilderness medicine, she said.

The program will help her learn by placing her in everyday situations.

“I think this model really mirrors what you see in actual practice,” she said.

Zuger said she felt prepared for her first full day Monday.

“I feel well prepared and well backed up,” she said.

Like Zuger, Scot Swanson, has no doubts about where he wants to spend his medical career.

“Montana’s home, and it’s the only place I want to be,” said the Great Falls native.

Montana has a lack of primary care, which is his interest, he said.

“And that’s a need I want to help with,” he added.

Many skills are needed to be a primary care physician, Swanson said, adding doctors must practice evidence-based medicine.

“And I’m confident I’ll get that here,” he said.

Program residents aren’t the only ones benefiting from the new program.

“We have a lot more access now,” said John Miller, medical director at Partnership Health and a clinical assistant professor of medicine at the university.

He added that Partnership Health Clinic offered 50 percent more appointments Monday because of the 10 residents.

Residents’ energy is infectious and, by asking questions, they prompt research and ultimately evidence-based medicine, he said.

While residents are in training, a physician also is on each case, meaning patients benefit by having two doctors, he said.

For more on the program, visit fmrwm.umt.edu.

Reporter Alice Miller can be reached at 523-5251 or at alice.miller@missoulian.com.