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Dr. Bob Underwood (Host): Welcome to the Celebrate Health Podcast from San Juan Regional Medical Center. I'm Dr. Bob Underwood, Chief Medical Officer. And today, I'm talking with Dr. Erin Philpott, Director of the new Internal Medicine Residency Program at San Juan Regional Medical Center, about how we're preparing the next generation of primary care physicians, Dr. Philpott, welcome to Celebrate Health.

Dr. Erin Philpott: Hello, Dr. Underwood. Thank you. It's great to be here.

Host: Yeah, absolutely. So, why is it so important for San Juan Regional Medical Center to have its own residency program, and can you help us differentiate what's a residency program and what is an internal medicine residency program?

Dr. Erin Philpott: Yeah, great question, Dr. Underwood. I think it's important to start on a platform of common understanding. So, I'll share a little bit about how you get to residency to start and then why of course we need one here at San Juan Regional. So, to become a doctor in the United States, you have to first complete four years of college or an undergraduate degree with certain pre-medical classes within that.

And then, you go on to complete or take the medical college admission test, or the MCAT it's commonly known as, to get into medical school, which is then an additional four years of training. Typically, the first two include academic like anatomy, physiology, different classes like that. And then, the second two include clinical training. Now, some members in the community may be aware, we already have medical students rotating within our hospital, mostly from Burrell College of Osteopathic Medicine.

So after the completion of medical school, you then go on to complete residency. So, you apply through a nationwide common application service and get placed into a residency of your interest or choice. So specifically, we are starting an internal medicine residency program here at San Juan Regional, which will be three years in duration. Some of them, like neurosurgery for example, can be up to seven years. But for internal medicine, it's three years. So upon completion of an internal medicine residency, you can go one of three routes. So, you can become a hospitalist, which is primarily working in the hospital and attending to hospitalized patients. You could go on to become a subspecialist, so a specialist in cardiology, nephrology, rheumatology, hematology-oncology among many more, or you could go on to become a primary care physician.

And internal medicine primary care physicians are specifically what we call experts in complexity. So, we do things like solve diagnostic conundrums, manage severe chronic illnesses, and concomitantly manage multiple complex conditions. So, that is the essence of internal medicine.

So, why should we have one here at San Juan Regional? So, we are of course, a community-owned and operated hospital serving our entire region. And our goal is to meet the needs of the community we serve. So back in 2020, we completed a community health needs assessment, and we identified the critical importance of improving access to care, but also developing actionable steps to address our local health disparities. So, we specifically found that there were exceedingly long wait times for patients across our town as well as our region to access primary care. And of course, we've long been aware of our medically complex patient population and their needs.

So when looking at how many primary care, specifically internal medicine physicians we might need by 2026, which is of course just around the corner at this point, we found that we would need 64 full-time internal medicine primary care physicians to adequately meet the needs of our medically complex patient population. And to give you an idea of what we currently have here, at the end of 2025, we have about four. So, pretty profound deficit. And this is a nationwide issue as well. We're about 20,000 internal medicine primary care physician short this year.

So, the American Medical Association has pretty good data that shows that residents and medical students who attend in their state will practice in the state of attendance. So specifically, they found about 60% will stay in practice in the state where they went to medical school and completed residency. So, we are hoping to recruit, train, and retain these primary care internal medicine physicians to serve our population.

Host: So, in that introduction, Dr. Philpott, you already really talked about access to care being such a big deal, and that was five years ago we had this discussion about access to care in our community health needs assessment. I remember those discussions. So, how will having medical residents here in Farmington improve the access to care and benefit those patients in our community?

Dr. Erin Philpott: I think there will be a number of ways that residents and having a residency program has the potential to positively impact our hospital, our system, and our community. So, I think it's important to first just point out, residents coming out of medical school will be highly supervised by the attending teaching physician. So, the first six months or so, if you see a resident, you will also see an attending physician. And the ACGME, which we'll talk about shortly, is pretty specific as far as a rigorous multifaceted assessment to allow us to get residents ready for independent practice as primary physicians or as attending physicians.

So rest assured, you will be well taken care of. You'll have multiple minds now thinking about your case and your medical care, which has actually been shown to improve patient outcomes and even reduce mortality and readmission rates at hospitals with residency programs, which is probably due not only to those multiple individuals thinking about one person, but so many other factors as well. Also, we have created a pretty rigorous, I would say, quality improvement program that our residents will go through and they'll be completing quality improvement projects, which will also improve the care of individual patients as well as I believe the whole population.

And then, lastly, as previously touched on, we are hoping that these residents who go through our training program will want to stay and practice primary care within our community and contribute to improving that long-term health and wellness.

Host: So Dr. Philpott, we hear a lot about the shortage of primary care physicians nationwide. So, how will this program help attract and keep more primary care physicians right here in San Juan County?

Dr. Erin Philpott: So, our goal has been and continues to be to create a balanced and really innovative curriculum to inspire these young doctors to pursue a practice here locally. We have created a very strong academic curriculum where they'll be exposed to the core internal medicine topics needed to practice. And then, they'll of course, no doubt have our high acuity, medically complex patients within both the hospital as well as the clinic to further develop their understanding of managing care and patient. And I think we have created a space where residents feel they will be skilled and capable and have that sense of increasing autonomy as they progress through their training years.

We also have put a strong emphasis on creating a space of belonging in our curriculum. So, residents will hopefully come here feeling a part of something. This has been structured through many different ways. But some examples include, we have a coaching program to ensure residents are getting appropriate, constructive feedback to becoming better, and some other elements to our curriculum to ensure that they feel well-mentored and well-supported in our community, which will hopefully help them anchor here, set roots here, and stay here.

And then, I think lastly and important to everyone in every career is creating meaning in the work you're doing. So, feeling that you have a purpose every day when you show up for work and you see the value in your work. So, those are some of the very important pieces that I am hopeful will draw residents into staying in this area.

Host: Absolutely. Now, you and I think a lot of San Juan Regional Medical Center. And so, what kind of unique experiences will the residents have that make training here especially valuable both for them and for the people they'll be caring for?

Dr. Erin Philpott: I have worked here for eight years, much of the time with you, Dr. Underwood. And it is a place That is hard to leave. And I left for a year and came right back and I think because it is an amazing place to work, and I think the residents will see that too. Fortunately, our center has a pretty robust system of care where residents will be able to complete a majority of their required rotations right here within our health system.

But I think there's also value to rotating outside the system and making those connections. So, places like our local inpatient addiction rehab facility like Cenikor, residents will rotate and be exposed to the practice of addiction medicine; and rheumatology at Northern Navajo Medical Center with Dr. McDougall, who's an exceptional teacher. And we are also developing curriculum to have residents or allow residents opportunities to shadow, rotate, tour different relevant facilities throughout our community to hopefully improve our connection and continuity of care throughout our entire network.

And then, I think very unique to our program is we have arranged during our first month an opportunity to fly with aircare, and visit some of our surrounding referral centers to truly appreciate and tour our vast catchment area in our culturally and geographically, extremely diverse region to see the patients and the people we serve. So, I'm really excited. We have a number of different, very specific opportunities of providing care. But I think the residents will be pleased with the curriculum and excited about it.

Host: Yeah, absolutely. I mean, there's so much unique about this particular region that the residency program's really going to be able to get exposure to, and I do think that it'll be really valuable to them.

And so, the team recently achieved American College of Graduate Medical Education Accreditation, that's ACGME accreditation. Now, congratulations on that. What does that mean? Why is that a vital step? And how does that ensure really high quality patient care?

Dr. Erin Philpott: Yeah. Thank you, Dr. Underwood. It was an incredible amount of work to get to this point and a really exciting next big step. So, yes, ACGME is the council in the United States that ensures high quality graduate medical education, or GME is the acronym for that. They set national standards required for residents to complete residencies. So, they do govern all residencies, all fellowships.

So, back in February, we submitted our nearly 200-page application, and then we had a site visit in April to evaluate our program. And we received accreditation on September 12th, this fall, for initial accreditation for a total of 12 positions for internal medicine residency. So for each year, over the next three years, however, we'll likely grow that to double the size ultimately as the goal. We have already received over 1000 applications for these four positions, and we're currently interviewing applicants. And then, over time, we'll be constantly reviewed to ensure we're meeting high quality training standards. So, we'll have another site visit in 2027, and we'll submit all our curriculum and information each year.

Host: You and I are both really excited about this residency program, the changes it's going to be bringing to this particular region of the state of New Mexico. What excites you the most about the impact that this residency is going to have? So, what do you have on the future of healthcare here at home?

Dr. Erin Philpott: There are so many exciting elements to the introduction of this program. And I think it truly has the potential to revolutionize care in our region, which it sounds maybe overblown. But I do think bringing graduate medical education and new learners into a space creates something new.

And I would say, for me, the most exciting part that keeps coming to mind is just innovation and creativity. Really taking a look at our system, our health system, and how we deliver care and recognizing we don't have to deliver cookie-cutter care. Like, this can be so highly individualized to meet the needs of our patients and population and really feeling like we have a blank slate to create this delivery of care for our patients and understanding how that care is delivered for the residents. So, I'm really excited to create a really creative curriculum to inspire these junior doctors and, along the way, impact care for our community.

Host: Yeah, it's going to be great for our community, there's no doubt about it, and I think really great for the residents. Anything else you'd like to add as we close?

Dr. Erin Philpott: I think I would just say thank you, Dr. Underwood, for having this vision and initiating those first steps and really the entire leadership team for supporting this initiative, which I think is going to be so impactful.

Host: Yeah, I agree. And thank you. To learn more about our region's newest residency program, go to sanjuanregional.com/residency. And if you enjoyed this episode, please share it on your social channels. And for more stories and insights that matter to you and your family, explore our full Celebrate Health podcast library at sanjuanregional.com/podcasts. I'm your host, Dr. Bob Underwood, and this is Celebrate Health from San Juan Regional Medical Center.