Cheryl Martin (Host): There is an exciting new program here at Palmdale Regional Medical Center. It's taken many steps to get here, but we now have a Family Medicine Residency Program. Here to tell us all about it is Dr. Romeo Castillo, a Family Practice Physician and Program Director of the new Family Medicine Residency Program, along with Ben Gocke, Director of Business Development, and Jody Pienta, the Director of Program Development.

 This is Palmdale Regional Radio, a podcast from Palmdale Regional Medical Center. I'm Cheryl Martin. On this episode, we're learning about the new medicine residency program. Dr. Castillo, let me begin with you. Let's start at the beginning and briefly explain what a residency program is and who joins the program and why.

Romeo C. Castillo, MD: We are so excited that we have a new program in Palmdale and the residency program in general is a training environment where newly graduate MDs or DOs will begin their specialization in specific specialty. In our case, we are a family medicine specialty.

We are looking for candidates that will fit within our mission, which is a holistic, comprehensive culturally sensitive curriculum that will serve the underserved area, especially in the Antelope Valley area.

Host: Thank you so much. Jody, tell us the story of reaching the point of having a residency program at Palmdale Regional. When did you start planning for this program? And what was involved in seeing it come to fruition?

Jody Pienta, MBA, MHA: Okay. I'd love to tell our story, and this has been quite a journey, but an exciting journey. We really realized the need for family medicine physicians and knew how important it was for the community and also the hospital. So we started this journey, it'll be two years ago in October. So there's a lot of planning to get this program started.

 We wanted to establish a great foundation that included all the resources and the providers not only interested in teaching, but engaged with the new residents to provide the best education possible. So two years of planning, and I can tell you that not only were we excited, the community excited, but I could not walk through the facility without a provider stopping me and asking me, when are the residents coming?

So a lot of planning, it's here. The residents are here and we're very excited about the program.

Host: That's great. Why did you all decide to focus on a family physician?

Jody Pienta, MBA, MHA: We could see the need. We knew the need was for family medicine providers, how impacted our emergency room was. Patients in the community just don't have family medicine providers. I know Dr. Castillo or Ben could elaborate, they come to the emergency room because they just don't have, we don't have family medicine providers in the community.

So it's a great need and we're hoping to just retain our residents here, so they'll stay in the community. Dr Castillo, can you elaborate on that?

Romeo C. Castillo, MD: Sure. I will. Family medicine is a gateway for health care. It's a primary care where all patients should have a primary care doctor and we identified a need. This area in the Antelope Valley has a lot of unmet needs. There's a lot of disparities and health issues that a family medicine doctor can address.

Which will serve the community in so many ways to improve their healthcare, their lives in general. So family medicine is very important, especially in healthcare because we are the gateway to maintain, preventative and maintenance of healthcare.

Host: Ben, I'd love for you to take the lead on this one. What did you expect from your outreach to applicants and how many actually responded to the opportunity?

Ben Gocke, MHA, MPH: We had mixed emotions about what our outreach was going to be, where we were with the program being a new program. We weren't quite sure how it would be received from medical students, wanting to come to a new program.

So we really knew we needed a certain type of candidate to come in, somebody with leadership that wanted to be more of a trailblazer starting a program. They don't have those senior residents to look up to and get mentorship from so it takes a special sort of candidate and weren't sure what we were going to find and where we were in the application cycle. We had to do some very quick, fast recruitment. And what we found was there was an overwhelming response to join the program. Of the eight spots that we did fill, there were over 400 applications and nearly 50 interviews that we did. So it was an overwhelming response, which was really great because it really does justice to the kinds of things that Dr. Castillo and Jody have mentioned the need in the community. And so it was really a uplifting experience to see the outreach from the resident side because we knew how excited the community was and there was an excitement out there in the medical school communities that here's this new program that we can join and we can really make a program of our own, which is fantastic for the downstream effects of having these residents stay in the community and hopefully start their own practices. They're in that element already. That's in their mind frame that they want to start something new and be the leaders and innovators in these new programs. So that was really an exciting experience to go through that whole recruitment and onboarding of these residents.

Host: Jody, what was that experience like for you to see the outpouring of applicants?

Jody Pienta, MBA, MHA: It was a lot of work, I'm not gonna lie, but it was so exciting to be part of the interview session. We really got to know and listen to the interviews and listen to the residents and everything they've been through to get to this part. So, I think it's really changed the relationship now working with these lucky eight as, they've been identified, just an amazing experience and now to just watch them then grow and become part of the provider in the facilities.

Host: So, what were you looking for when you interviewed the applicants? What was the biggest challenge in selecting the lucky eight?

Romeo C. Castillo, MD: Well it's challenging because of the pool of applicants. There's so many and there are very competitive, highly competitive, but which among those candidates fit the mission of an institution? We're looking for a candidate that will fit our mission. A mission of serving our community, especially the underserved.

Of course, we're looking at candidates who have a balance of credentials with good medical knowledge, good background experience prior to being trained, and the attitude of really serving the underserved community. So it's a challenge, but we're able to scout for them when we interview, we're able to make a determination which among those candidates might be the best fit for our program mission.

Host: Ben, anything you want to add regarding the biggest challenge in selecting the lucky eight?

Ben Gocke, MHA, MPH: Absolutely. We talked about the need for family medicine in this community. And so the biggest challenge was actually somewhat professional and personal. Professionally, trying to keep these residents in our community, which resident do I feel like I could work with later down the line when they're done with their training to help them find a position here in the community that they can continue to practice medicine and maybe start a practice or join a practice or, continue to provide the care that they're going to learn about in the residency in this community. And then personally, which of these do I think I might send myself, my family, my kids, my parents, my grandparents, who of this group, would I feel comfortable having my family see. So that, I mean, as a challenge, but it's also exciting for not only myself, but this community that these are residents who we want to stay in the community, serve our underserved, serve our families, serve our friends, as their primary care physician, as that quarterback that we talked about. So, nerve wracking in that that's a lot of pressure and a lot of stress to think about the future of the medical community in this area but also exciting to think that here are these great candidates young in their career, eager to learn and all the good that they're going to do and all the help that they're going to provide in this community. So, mixed emotions, certainly, because it was a little professional and a little personal.

Host: Dr. Castillo, how long is a residency program for each doctor? And then what type of educational opportunities do the residents have in the program?

Romeo C. Castillo, MD: It depends on the specialty. For family medicine, it's required to have 36 months, which is three years of training, in order for them to sit for the board exams. For the opportunity, our curriculum offers a wide array of learning experience. Our hospital, where they will be doing most of their training, and the community clinics that they will be doing their training, has a lot of opportunities for learning.

They offer a wide array of experience and a wide range of pathology where the residents can learn. There is also opportunity for skills development, soft skills development, which is included in our curriculum. There's opportunity for research, that we encourage our residents to be part of. And, of course, opportunity to be retained and have jobs after training in the community.

Jody Pienta, MBA, MHA: I'd like to add to part of that. So when I was speaking about the resources and everything that we needed to establish prior to applying for the residency program, in part of those resources, not only do the residents do their educational and their rotations within the hospital, there's a ton of community resources, they rotate through different clinics outside in the community.

So they have their continuity clinics and some other outpatient rotations. So the education that they're gaining throughout this residency program is just vast and just so many different specialties that they're learning.

Host: So what happens, and we hope this doesn't happen, but what happens if someone ends up leaving the program early for any reason? Do you replace right away? What happens there?

Romeo C. Castillo, MD: That is unfortunate if it does happen. We call it attrition. And God forbid, if we have one, who decided to leave the program, we will have to look for a replacement. And it's a long process to get a replacement. It's a long process where we have to identify a resident that will replace the resident that has left.

And, that could be very, very unfortunate if it does happen.

Ben Gocke, MHA, MPH: If I could add just a little bit to that, Dr. Castillo and Jody have created a wellness program within the residency, which I think is really a benefit to avoidance of that attrition that we're talking about, and making sure that the well being of these residents, because it can be challenging.

It's a very challenging three years. There is a lot of requirements that these residents have to fulfill. It can be very long hours and protecting their wellbeing, I think has been a highlight of one of these programs and I don't know if Dr Castillo wants to discuss any of them, but I really do appreciate and see that making sure that these residents have a positive experience around their educational opportunities, is really a highlight, that I foresee as avoidance of that attrition that we're talking about.

Romeo C. Castillo, MD: There could be many reasons for attrition. In the past, I have some experiences where residents, move from another state because of hardship. There's so many other reason and other reason will most likely be, they're not fit within the program. They're not able to comply with the requirements and they're having hard times that they have to leave the program.

Those are very rare, but, regards to Ben was saying about wellness, a program that provides wellness and a well balanced curriculum where residents can learn and study and at the same time maintain their balance in life is a huge area where we can prevent attrition and we have a very well established wellness program in our residency program where residents are really, encouraged and trained to look at their well being aside from practicing medicine, looking at their private lives, their other lives other than medicine.

Host: Jody, do you expect Palmdale Regional to have more varied residency programs in the future?

Jody Pienta, MBA, MHA: I do. We're currently starting to set up our program for internal medicine. So our plan is to file that application later this year. So we'll not only have additional family medicine residents, we will start our internal medicine residency and also general surgery. So that'll give us the three programs.

 So we will also have transitional year. And we're looking at several other along with fellowships. So residency program is something that we are very excited about. We think it's very important for not only the community, for the hospital. And we'll look at several different residency programs moving forward.

Host: Ben, what do you hope to achieve through these programs in the long run?

Ben Gocke, MHA, MPH: In the long run, really the need for the residency programs is one, the community, what does the community need? What can the community support for these educational opportunities? I'm not going to lie. It is sort of a badge of honor to have a residency program. It definitely elevates our practice as a hospital. And it is, something that we can be proud of that we are an educational institution. So it really certainly, elevates our status as a hospital providing that educational care. Also, with the work that Dr. Castillo has done and with some of the work that we'll do in internal medicine, the teamwork that it builds around the faculty and the attending providers that are here in the hospital, it starts to elevate our practice, entirely as an organization from the doctors to the nurses, to the radiology and lab and dietary and everything down the line that the hospital has, everything needs to be elevated because now we're an educational institution. So that's certainly one aspect of what we expect in the future.

Going back to kind of what Jody was talking about our future with GME. We have five years to put in all the programs we want. And so we have lofty goals and we're looking at the services that we have in the hospital and where we can continue to grow and sort of give back to this community that's done so much for us and the providers and the physicians that they need and ask for.

So long term, it's what providers can we help to grow. How can we elevate ourselves to meet the needs of an academic institution and providing these good educational experiences for the residents? And how can we give back to the communities and provide the care that is so needed out there? And, really, come together with the community and make sure we have that great continuum of care on along every aspect that the community needs and wants.

Romeo C. Castillo, MD: I would like to add to that, Ben. The ultimate goal of a residency program for training residents is retention. We would like these residents to stay after training so that they can fill unmet needs in the community, especially the type of community we have here. I would say there's a shortage of primary care.

Specifically for the underserved communities and also, I agree with Ben that having a residency program has so many benefits, it can bring that only in the institution to the community to the practitioners. It elevate us because faculty are role modeling. They are role modeling with the residents, so it elevates professionalism and ethics and medical knowledge and so many different areas of the discipline of medicine.

For the community, residents are known, are known to be comprehensive provider. They take care of their patient in comprehensive ways. And, our curriculum is designed to reinforce that attitude of the residents, providing compassionate care. Uh, attitude of a holistic approach in the care of the patients, which are also culturally sensitive type of care.

So there's so many elements in the residency training that benefits so many areas, so many stake taker, communities, doctors, as well as the patient.

Host: Well, it's clear that these residents provide a lot to the hospital during their three years and your hopes are high that they will provide even more afterwards. Just in closing, any final thoughts? Anything else you'd like to add regarding the mission, the goals, or just excitement about this program?

I'll begin with you, Jody. Anything else?

Jody Pienta, MBA, MHA: Like I said, it's very exciting. I see a change in the providers. The providers are excited to work with the residents. The residents are very excited to be here and they'd work 24/7, I think, if we let them. So, it's an exciting program. It's something that I have not done in the past and it's very rewarding. And I think it's something that's going to be great for the community and for the facility.

Host: Dr. Castillo?

Romeo C. Castillo, MD: We started our inaugural cadre of eight residents, and we're hoping that we're able to provide them the training they needed to serve any type of communities, and we're hoping that we will retain most of them. If we retain 50% of them, that's quite an achievement and we're continually looking at our curriculum to develop it so that we can attract a specific type of residents will be best fit with our mission of, serving a community, serving community, especially the underserved community.

So we're very excited. Hopefully it will be part of shaping the future of this first cadre. Eventually we have a total of, we're appropriate to 24, total of 24 compliments of residents. So we're hoping to train them and shape the equip them with tools so that will be good doctors. They will be compassionate and really bring back the real essence, the spirit of primary care in our curriculum so we can train this doctor to become one of those things that we aspire them to become.

Host: Ben, you get the final word.

Ben Gocke, MHA, MPH: Thank you. That's very kind. Again, I want to echo excitement with this program and need that it is going to fill in our community. I'm also very excited and hopeful that in future, interactions like these, we can talk about the success of these programs, how big the program has gotten, the GME program in general, the additional programs that we get to add.

I mean, this is just the very first, building block of a much bigger, exciting program that Palmdale Regional that, the next five years, we're going to, you know, with the help of Dr. Castillo and Jody put together and really, grow the GME program and the practices in the community in general. So I'm looking forward to the opportunity to talk again when it's further down the road and we can really look back and remember fondly this first, program and what it really started and the implications that it's had for us.

Host: Well, a huge thank you to this panel, Dr. Romy Castillo, Ben Gocke, and Jody Pienta for introducing us to the new Family Medicine Residency Program, its mission and goals. May it be a huge success. For more information, go to PalmdaleRegional.com and click on GME Program. This concludes another episode of Palmdale Regional Radio with Palmdale Regional Medical Center.

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