Medical white-coat ceremonies don't usually get much media attention. But when the Billings (Mont.) Clinic held its white-coat ceremony this past July to welcome its inaugural class of 12 internal medicine residents, “our mayor was there, our board was there, all the papers, radio and TV stations were there,” said Dr. Roger Bush, the program's director. “That doesn't happen in Boston.”
The ceremony was an important occasion for Billings, an integrated health system that includes a 240-physician group practice, a 285-bed hospital, a network of rural clinics and a nursing home. For the residents' first year, they'll spend most of their time close to the mother ship in Billings. But second- and third-year residents will spend more time at rural affiliates including a satellite clinic in Miles City, a farming community about 150 miles east.
The program aims to train new doctors to practice medicine in rural areas, using telehealth tools combined with a do-it-yourself attitude. It requires a different approach from urban academic medical centers, where residents tend to refer patients to subspecialists for basic treatment. “Our program is specifically designed and structured to train primary-care doctors how to practice in this region,” Bush said.
Dr. Clint Seger, Billings Clinic's director of regional medicine, said the Miles City facility has six full-time primary-care physicians supported by other clinicians, including nurse practitioners and physician assistants. Physician specialists from Billings drop by regularly. Patients come from a 60-mile radius, and the facility has one of the few infusion centers and CT scanners in the region. Scans are analyzed remotely by radiologists in Billings.
The Billings program is a model of the type of community-based training recommended in the Institute of Medicine's controversial report released in July on graduate medical education, Graduate Medical Education That Meets the Nation's Health Needs. The report triggered sharp criticism from the academic medical establishment for its recommendations to substantially change how the federal government funds physician training. The report suggested that the problem isn't an overall shortage of doctors, but rather a maldistribution of doctors by geographic area and specialty.