New Dominican Hospital residency program aims to speed up local health care

Eight doctors-in-training are starting a three-year program this summer at Dominican Hospital to earn their physician’s licenses, representing the first-ever physician residency program in Santa Cruz County. Within the three years, the program is intended to triple in size to 24 active residents, seeing as many as 15,000 patients annually.

The family medicine residency program welcomed its first cohort of recent medical school graduates on June 24, and over the past few weeks they’ve been visiting clinics and doing workshops. On Monday, they’ll start seeing their first patients. 

The program’s intention: to increase the number of local and diverse practicing physicians and improve access to medical care in the county. Waiting for a doctor’s appointment is a frequent topic of conversation, and that sense is borne out by the numbers. 

In Santa Cruz County in 2022, 21.4% of people reported in a California Health Interview Survey that they had delayed medical care or didn’t receive the care they needed, compared to the statewide average of 16.5%. For respondents who identified as Latino and Asian, the rates were higher, at 43.7% and 24.2%, respectively. 

“Our intent in recruiting and training is to retain a significant number of the graduates to have long-term practices here,” Dr. Walt Mills, the program director, told Lookout. “Studies show that in communities that have residency programs, they end up with twice as many primary care physicians as those that don’t.” 

The program is part of a 10-year, $100 million initiative to both expand local medical care and provide increased medical education opportunities for more Black, Indigenous and people of color (BIPOC). In addition to emphasizing residency slots for BIPOC doctors-in-training, the program also aims to increase cultural sensitivity among all its residents. Three of the eight residents identify as BIPOC, five are women, half are fluent in Spanish and the other half are intended to become competent in Spanish upon graduation from the program. 

The project is a partnership announced in 2020 between Atlanta-based Morehouse School of Medicine, a historically Black medical school, and Dignity Health’s parent company, CommonSpirit Health. The partnership, named the More in Common Alliance, plans to create 30 programs across the country as part of the initiative. The alliance is contributing $21 million in seed money in the first two years, according to a media release, and encourages donors and organizations to support the project. 

“The More in Common Alliance will expand representation by increasing medical education opportunities for more Black, Indigenous and people of color – helping Morehouse School of Medicine double undergraduate enrollment and increasing the number of post-graduate residency and fellowship slots,” according to a statement. 

Dominican’s program is the first graduate-level program to launch.

Watsonville Community Hospital CEO Stephen Gray, in an email to Lookout, said the hospital is “thrilled” to welcome the residents. 

“I am hopeful that this program will create a new front door for primary care providers to choose our community for their careers, particularly south Santa Cruz County and the Pajaro Valley, where access to primary care providers is most acutely needed for our young and growing families,” he wrote.  

While the program is backed by Morehouse School of Medicine, the residents aren’t students of the school. The medical school and CommonSpirit Health are sponsors of the program. 

Dominican Hospital will employ them as resident physicians and pay them $71,212 their first year, and $73,598 and $76,063 for their second and third years, respectively. They also receive an $8,000 annual housing stipend. 

About 100 local physicians will be teaching in the program and will be considered adjunct faculty with Morehouse School of Medicine. The residents will spend the majority of their time in the hospital and clinics and use graduate medical education space at Dominican. The residents will also work at several other local facilities: Watsonville Community Hospital, Salud Para La Gente and Santa Cruz Community Health Centers.

Hands-on training

New resident Dr. Dara Lopes, 35, is from Hawaii but grew up in Brazil, and is fluent in Spanish and Portuguese. She said she’s excited to be in Santa Cruz, and potentially to live here long term. 

As family medicine residents, Lopes and the other residents will be training and providing services in a broad range of areas from pediatrics to geriatrics. They’ll deliver babies, and they’ll be doing emergency medicine. 

As residents, they have gone through at least eight years of school, including working full time in hospitals for their last two years of medical school. 

“The last two years, you get a lot of hands-on training, already,” she said. “So by the time you graduate, you do have a certain level of comfort already doing medicine.” 

Residents will see and assess patients and then consult with a supervising physician before prescribing treatment. After talking to the attending (or supervising) physician and agreeing on the diagnosis, they’ll then move forward with the patient on a treatment. 

“I’ll say, ‘I have this patient presenting with this symptom, with this past medical history, I saw this on the physical exam, and I think this is a diagnosis, and I think this is how we treat it,'” said Lopes. “[The supervising physician] listens to you and agrees with you, or disagrees with you, and then he has to approve everything before we diagnose.” 

Lopes said she’ll have her first month-long rotation in obstetrics and gynecology (OB-GYN), where she’ll be focusing on pregnancy, childbirth and the female reproductive system.

She said she chose the Dominican program to be close to family she has in Marin County. She’s looking forward to working with the Hispanic/Latino community.  

“It’s an amazing program, it really stood out amongst all the programs I interviewed at,” Lopes said. “We have amazing attending physicians that are going to help us grow and become the best we can be. I’m really excited to have such great faculty, and to be in Santa Cruz.” 

Santa Cruz becomes a training center

Program director Mills worked at Natividad Medical Center in Salinas in the graduate medical education program there, and said he had always wondered when Santa Cruz would get its own program. He started at Dominican Hospital in 2022, after he was asked to help create it. 

“We’ve wondered for decades, why isn’t there graduate medical education?” he said. “It’s a big challenge. We’re trying to make it look easy. It’s a big challenge to go from nothing, to having a robust residency training program.” 

He said many people go into the medical profession to take care of patients, and if they go into it for teaching, they end up in cities like San Francisco where there are training centers. 

However, Mills added that more than 100 local physicians stepped forward locally saying they wanted to teach. 

The faculty will be teaching 24 residents once the program is in full operation, in three years, according to Mills who is also still a practicing physician at Dominican and will be teaching. Mills is certified in geriatrics and integrative and holistic medicine. 

By the end of that third year, the 24 residents will be seeing a total of 15,000 patients annually from Santa Cruz Community Health Centers alone. Mills said that figure is more than an estimate – it’s a requirement of hours that the residents have to meet as part of the residency. 

Mills hopes that 60% to 80% of the residents will remain in the area once they complete the program. The residents hope that can be the case.

Affordability raises its head

“I would love to stay here,” said Lopes. “I’m really excited, I love Santa Cruz. If I could make this my home, it would be a dream come true.”

Lopes said affordability is a barrier to that. 

“It is extremely expensive,” she said. “Hopefully in the future as an attending physician it will be more affordable. But right now, yes it is really expensive for a resident.” 

Ray Cancino, CEO of local nonprofit Community Bridges, also expressed concerns about how local facilities can retain the residents in the face of affordability challenges in Santa Cruz County, and when neighboring counties can offer competing salaries. 

Still, Cancino talks about the immediate impact he hopes to see, saying he’s “extremely excited” about the potential impact of the residency program.

“I think that we know that health outcomes are improved when it’s culturally appropriate, and we know that people get better served when there’s diversity in medicine,” he said. “I think that in our community, it’s no different in the fact that our community is so heavily people of color – mostly Latino – someone with some level of cultural appropriateness to our struggles, who are in the same situations are going to help improve health outcomes in our community.” 

Cancino added that he hopes that the community will work to ensure the residents stay local, such as creating first-time homebuyer programs for physicians or loan forgiveness to relieve the economic burden.

Larry deGhetaldi, who retired last year from Sutter Health as vice president of governmental medical affairs, said while he thinks it’s great the hospital has the residency program, he echoes Cancino’s concerns of retaining the residents in the long term. 

“The concern is you can train a family physician in Monterey, Santa Cruz, Santa Clara County, Sonoma, etc., as a family medicine resident there, but they can’t afford to live here when they’re done,” he said. “You could train them, but there’s no way that you can be certain that’ll solve our primary care shortage problem.” 

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