‘We’re handcuffed’: Medical students, residencies forced to wait idly for Congressional action

A congressional bill to add what sponsors say is 14,000 medical residency slots could affect the number of doctors in training across Spokane.

The proposal comes after medical educators in Spokane said last week they were worried the region is set to train fewer physicians because of funding problems.

Residency is a multiyear program in which new doctors practice in clinic and hospital settings with supervising physicians before specializing and practicing independently.

In 2024 and unrelated to any partisan policy, Providence announced cuts to its family medicine residency, the transitional one-year program and the sports medicine fellowship.

“The Family Medicine Residency Program went from 10 to six,” said Allie Hyams, senior manager of communication at Providence. The transitional residency program was reduced from 11 to eight, and as of August 2024, the sports medicine fellowship was cut entirely.

Spokane is also home to internal medicine, pediatrics and rural medicine residencies, all of which were not affected.

Graduate medical education programs rely on Congress to allocate residency slots and funding. The number of those slots has not changed since an initial cap set by Congress in 1996, according to the AMA.

“The caps pose difficulties for administrators,” Dr. Rebecca Mallo, chief medical officer for Providence Clinical Network, wrote in an email.

Those difficulties arise from stagnant funding, she said.

During the past 15 years, reimbursement for residency programs has increased once, while the costs to train and pay medical residents have risen, Mallo said. The Providence cuts are estimated to save $2 to $3 million, according to previous Spokesman-Review reporting.

“Congress had made it very difficult to expand residency programs,” said Dr. Darryl Potyk, associate dean for the University of Washington’s School of Medicine program in Eastern Washington who help oversee UW-Gonzaga University medical education partnership.

Unless the funding problems are fixed, there could come a time when the number of medical school graduates outpaces the availability of new residency programs, he said.

“(Essentially) we’re handcuffed,” Potyk said.

In early July new medical students across the country started the next chapter of their academic careers. In Spokane, 60 new UW medical school students where presented with a stethoscope during a ceremony. After medical school they will seek a residency slot.

Carolyn LaBerge was among the stethoscope recipients. Her rural upbringing instilled in her a passion for caring for the people who supported her journey.

“My ‘why medicine’ comes from a patient-centered, altruistic focus,” LaBerge, 24, said.

She identified UW’s commitment to rural primary care as unusual and important to her medical training.

They “teach students the beauty of family medicine,” she noted.

Leonidas De La O, 32, also donned a stethoscope Thursday, but it wasn’t his first time doing so. A nurse for seven years, his goal was always to pursue a medical degree.

“Once I became a nurse and started working for a few years, I felt like I wanted to know more,” he said. “I could learn on my own, but I couldn’t really apply what I learned.”

De La O is interested in critical care medicine, pulmonology, anesthesia and possibly emergency medicine – most of which are not offered locally.

In four years’ time, the stethoscopes LaBerge and De La O received will serve as one of the many tools used to practice medicine. Their postmedical school life will begin with residency if the slots exist.

Before medical students begin their residencies, they go through a placement process called the National Resident Matching Program.

Students apply, interview and rank their preferred programs in a given specialty. Those programs reciprocate the ranking.A mathematical algorithm then decides if and where applicants will complete their training.

It’s a competitive, complicated system exacerbated by the residency funding cuts.

To bring more opportunities to Spokane, MultiCare Health and Washington State University are working to start and grow new graduate medical education programs.

MultiCare spokesman Kevin Maloney said the group “is establishing an internal medicine residency program in Spokane, intended to start in July 2027, to address our region’s significant shortage of primary care physicians.”

WSU currently hosts a pediatrics residency with six students, though they are working to boost that to 18. Other WSU-sponsored opportunities are opening across the state, she added.

Considering the “stalemate in Congress” inhibiting significant growth, Potyk hopes a bill with these provisions might bring new medical opportunities to Spokane, creating “an inviting opportunity to stay” and practice.

“The power of the residencies as a recruiting tool is often underestimated,” Potyk said.