Highlights | Partnering with the Boise VA
- Idaho has a physician shortage.
- Residency programs in Idaho are helping bring more physicians since residents often practice where they train.
- The UW School of Medicine partners with the Boise VA for two residency programs and one fellowship program to expand student and trainee learning opportunities and increase the physician population in Idaho.
The Boise VA is doing it all: improving the lives of veterans and their families, providing top-tier medical education, increasing the physician workforce and being recognized by VA employees as the “Best Place to Work” out of all VA hospitals.
The Boise VA is a key affiliate and academic partner to UW Medicine, with School of Medicine programs like Internal Medicine Residency and Psychiatry Residency, and is a significant partner of the UW School of Medicine’s five-state Washington, Wyoming, Alaska, Montana, Idaho (WWAMI) region training program.
Program directors Melissa (Moe) Hagman, MD, and Kirsten Aaland, MD, for the UW Boise Internal Medicine Residency and the Boise Psychiatry Residency, respectively, share more about their programs and how the UW School of Medicine and Boise VA are working together to create unique opportunities in medical education.
Internal Medicine Residency
The UW School of Medicine has sent medical students and residents to Boise since the ’70s for training and to help increase the number of practicing physicians in Idaho.
Currently, residents in the UW Boise Internal Medicine Residency spend all three years of their training in Boise, with 50% of their training completed at the Boise VA and the other 50% split between St. Luke’s, Saint Alphonsus, UW Medicine hospitals in Seattle and other community practices throughout Idaho.
“We like to think of UW School of Medicine as our academic home,” says Hagman.
Before 2011, residents spent two years training in Seattle and one in Boise. Hagman has seen both sides of the program; she spent her second year of residency in 2000 at the Boise VA.
She returned to Boise in 2011, after working at UW Medical Center, for an associate program director job right as the program was undergoing its change to become a second residency under the UW umbrella with all three years of training in Idaho.
“Now that I’m here, I wouldn’t want to work anywhere else,” says Hagman.
The 2011 change to a Boise-focused program highlights a dedication to training physicians for Idaho and its neighboring states — and the shift seems to be working, with 60% of residents in the program staying in Idaho to practice and 15% practicing in neighboring states.
Statistically, most physicians work close to where they trained, so for states like Idaho with low numbers of physicians to population, it’s especially important.
What makes the internal medicine program thrive are the residents that choose to come here, says Hagman.
“It sounds kind of corny, but I get up in the morning and I’m like ‘Whoo-hoo, I get to go teach,’” she says.
The opportunities for residents training at the VA are also unique. The VA is a managed care system in which a patient and their clinician can decide what a patient would like to have for their care and then make it happen.
A patient can get lab work, medications, a ride to their appointments, a bathroom scale, a blood pressure cuff and a walker or other assistive device, for example, all without systemic barriers in the way, thanks to the VA.
“About half of the residents’ education is in the VA system where they can test out being a doctor in a system where the patient can get the care they agree upon,” says Hagman. “The other half of their education is in the ‘real world,’ where they can make a plan with a patient, but if the patient or healthcare system can’t pay for the lab test or medication, or if there is no mental health provider in the area with availability, they are testing out what the healthcare system will let them do.”
Training substantially in both systems, being a doctor without systematic barriers versus navigating the healthcare system, is a rare learning opportunity.
Psychiatry Residency
Like the Internal Medicine Residency program, the Psychiatry Residency program at the Boise VA was created to help bring psychiatrists to Idaho. In the early 2000s, the Track program, which allows residents to focus their education in a specific city or area throughout the WWAMI region, included two years of training in Seattle and two years in Boise.
“Before, when we were a Track program, we would meet the residents when they applied for residency and they would match with us and then move to Seattle, so we wouldn’t see them here in Boise for two years after they matched,” says Aaland, who was also part of this Track program when she started her own psychiatry residency in 2010.
In 2021, the Psychiatry Residency expanded to a four-year Idaho-based program, and the inaugural residents are in their first year of training. The move from a two-year Idaho-based track to a full program in Idaho is part of a 10-year Graduate Medical Education expansion plan for Psychiatry and a dedication to bringing more psychiatric and behavioral healthcare physicians to Idaho.
“Now, as a full program, we will get to know our trainees over the course of their entire training,” says Aaland. “We were able to recruit residents that have strong ties to Idaho who want to train here, stay here and provide care to Idahoans after graduation.”
The program is small, with four residents per class, but that allows the faculty and residents to spend more time one-on-one. Aaland says there is a deep sense of commitment from faculty since they are not only training residents to become good psychiatrists, but they are also training their future colleagues.
“The family feel is unique to our program; we have a 67% retention rate for people who stay in Idaho post-graduation, while the national average is 55%,” says Aaland.
One of the program’s draws is its telepsychiatry training and services, even before the pandemic.
“One of the reasons we have been doing telepsychiatry for so long is because Idaho is so underserved. Telepsychiatry allows us to broaden our reach,” says Aaland. “We teach our trainees how to increase the number of patients for whom they provide care.”
The VA has a robust telepsychiatry program in place, but most of their training comes from spending one day per week for an entire year at Saint Alphonsus, seeing patients virtually all over Idaho and in rural areas and providing consultations for primary care providers.
Another unique aspect of the program is that residents work at the Idaho State Hospital South in Blackfoot, where they provide telepsychiatry services to the inpatients. This is a model very few psychiatric hospitals have, according to Aaland.
“When I brag about this program, I like to highlight that we only have 105 licensed psychiatrists in Idaho, and our program has graduated 23 of those — about a quarter of the psychiatrists in Idaho trained in our residency program,” she says.
The Boise VA’s relationship with the School of Medicine is a symbiotic one that helps bring clinicians to Idaho and underserved areas, provides community-based medical education, and expands the type of residency training and continued medical education available to trainees.
