Kaiser launches residency program to train new doctors in Sonoma County

Dr. Tricia Hiserote, a Kaiser family medicine physician, sat at a small wooden conference table Monday morning, peppering medical student Jonathan Tran with extensive questions about a patient’s care.

The questions come one after the other: What medication was the patient taking? What was the reaction? How long has the patient had the chronic illness? What would be a good treatment plan?

Tran, a third-year med student from Touro University California in Vallejo, answered with confidence the questions he knew, and those he didn’t he answered honestly, with a slightly nervous smile. This exchange between med student and attending physician can get pretty harsh for the student - to the point of humiliation - depending on the doctor.

But Hiserote’s tactic was respectful, not rooted in a need to demonstrate her superiority.

“We want to grow our physicians, we don’t want to just rip them to shreds,” said Hiserote, explaining how she and other Kaiser doctors treat visiting medical students on rotation at Kaiser facilities in Santa Rosa.

That same approach will be used in a new, recently accredited family medicine residency program based at Kaiser Permanente Santa Rosa Medical Center. The three-year program, which was approved by the Accreditation Council for Graduate Medical Education in February, is scheduled to host its first group of six residents in July 2018.

By 2020, the program will have 18 residents in the “pipeline,” said Hiserote, who has been named the residency’s program director. Those primary care doctors, she said, will become increasingly in demand in Sonoma County and the rest of the nation as the baby boom generation continues to age.

“We are experiencing the primary care physician shortage that was predicted 25 years ago,” said Hiserote.

The cause of the shortage is simple, she said. Medical students, who often face student loans the size of a home mortgage, are entering medical specialties that fetch more generous paychecks than family medicine, she said.

“It’s like a mortgage payment that’s anywhere from $2,000 to $5,000 a month,” she said. “ … Unfortunately, this is influencing what residencies new doctors are entering.”

According to the most recent County Health Rankings by the Robert Wood Johnson Foundation, Sonoma County has one primary care physician for every 1,020 county residents. Although that ratio compares favorably with rural parts of the state and country, it is far from ideal, said Dr. Karen Milman, the county’s public health officer.

“If you look at other countries, we have far fewer primary care providers,” she said. “We definitely need more primary care physicians as the health care system shifts toward really trying to improve patient outcomes at lower costs.”

Milman said primary care doctors are key players in achieving those two goals.

“The fact that this is going to be a new residency program in the county is fantastic news, particularly because most of physicians stay in the area where they do their residency training,” she said.

As with other residencies, including the more venerable Santa Rosa Family Medicine Residency program, which has been a training ground for family doctors since 1938, once residents complete the program they can go wherever they want.

Traditionally, about half the graduates of a residency program remain in the community where they train, Hiserote said.

The Santa Rosa Family Medicine Residency Program is sponsored by Sutter Health and affiliated with the University of California, San Francisco. Those residents also do “rotation” at Kaiser, which also provides faculty for the program.

Kaiser’s Santa Rosa residency, which has been in the works since 2010, is among the latest Kaiser residencies in Northern California. In 2014, Kaiser established the Napa-Solano Family Medicine Residency Program, which graduates its first residents in June.

Kaiser has 13 residencies in Northern California.

The benefit to the local community is clear, said Hiserote.

“The community with the most primary care physicians wins,” she said.

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @renofish.