By KC Bolton CEO, Aviva Health We recently celebrated the graduation of the first cohort of resident doctors who in 2020 began their journeys with Roseburg Family Medicine Residency. Great job to Drs Amal Alyusuf, MD, MPH, Gabrielle Bosworth, MD, Seemal Kumar, MD, MPH, MBA, Melissa Snell, DO, Ashley Sparks, DO, Christy Sunny, MD, Simran Waller, MD, MPH, and Eric Wong, MD, MPH! We wish you success in the next phase of your journey and thank you for your service to our community these past three years. Roughly eight years ago, some leaders in healthcare and the community accurately read the tea leaves of what was imminent: a perfect storm of several retiring or departing primary care physicians coupled with the consistent increase in retirees to the community that wanted to take advantage of all that Douglas County has to offer. Spearheaded by Kelly Morgan, Mercy Medical Centers CEO, and Dr. Chip Taylor, a retired Navy Captain and local physician leader, the healthcare community decided to address the shortage directly by establishing a family medicine residency in Roseburg. Key requirements of having sufficient rotational experiences include inpatient coverage (local providers, Mercy), a host continuity clinic; where the residents homebase from (Aviva Health, VA), and an academic oversight agent (Opti-West) partnered to form the Roseburg Family Medicine Residency or RFMR. I mention the historical background because such things often get lost in the enormity of the accomplishment and subsequent routine operation of a major project like this. Our first cohort of eight residents, mentioned at the start of the article, is the inaugural class of what is referred to as an 8-8-8 program, where eight new physicians join each year and for the next three years get additional hands-on clinical experience and refine their medical knowledge base. From this point forward, the 24 physicians in RFMR will make Douglas County their home for the three years of the program and potentially longer for some. Becoming a resident involves an undergraduate degree and then applying to a medical school. Based on the timing of undergraduate education and the cycle for application to medical school, there is usually a gap year.” This is one of many filtering points in a doctors career, where their undergrad GPA and scores on the Medical College Admissions Test (MCAT) are often the difference between entering medical school or not. At Aviva Health, we host a program to use gap-year students as scribes in the exam room called the ReConnect Gap-Year Fellowship. While incredibly turbulent for Aviva, the healthcare system’s payoff is worth it; over 75% of our ReConnect fellows get accepted into medical school or physicians assistant programs. Adding up the time spent in undergraduate education, application and acceptance to medical school, and then the medical school itself, each doctor has been in at least nine years of education focused on becoming a physician before they head to their residency. One way to think of residencies is that they are extended, intensive clinical rotations coupled with a smattering of in-classroom (aka didactics) training. Each residency type has a primary focal point in medicine, with a few exceptions; family medicine residencies are one of the exceptions. For family medicine board-certified physicians, they may practice in an isolated area and have fewer specialists to consult with locally. A family medicine physician must be exposed to a wider variety of patient experiences and be as concerned about the scope of their knowledge as the depth. The program’s primary goal is to recruit and retain these doctors locally. I’m proud to report that two of our graduating residents will stay in Roseburg, one here at Aviva Health and the other at Adapt. A third resident will put down roots in the Portland area, and possibly a fourth in Medford. The benefit of a local residency program for provider recruitment is that these doctors get Douglas County, or more broadly, rural life, because they've lived here three years. In other words, cultural and professional fit is already baked in. The positive impact of RFMR on our community cannot be overstated. Over their tenure, the first eight residents alone were responsible for nearly 11,000 patient visits. As the Covid pandemic swept through our county, these frontline physicians played a pivotal role in caring for hospitalized patients, filling gaps in coverage in the Intensive Care Unit, ER, and other areas of Mercy. They also provided support during Covid that allowed my organization to take care of about 30% of ER patients in a mobile clinic adjacent to the ER so the sickest were seen immediately by Mercy staff. Our fourth cohort of family medicine residents will join us later this month and are charged with building upon the foundation that was put in place and nurtured by this year’s graduates. We hope you warmly welcome them and thank them for serving our community as residents in the Roseburg Family Medicine Residency.