Establishing a linkage between a family practice residency and a local health department

Involvement in service-education linkages by family practice residencies is increasing. In the late 1980s, Swedish Hospital Family Practice Residency in Seattle sought to expand into a new site. At the same time, the Seattle-King County Department of Public Health (SKCDPH) identified the Denny Regrade area of Seattle as medically underserved.

A new clinic was established in the Denny Regrade area through a collaborative effort between Swedish Family Practice Residency and the SKCDPH. The clinic, Downtown Family Medicine, provides the family practice center training for six additional residents, expanding the Swedish Family Practice Residency from 18 to 24 residents. Swedish Hospital finances faculty and residents' salaries and capital equipment at the new clinic, whereas SKCDPH covers ancillary staff and overhead expenses.

The new linkage clinic offers a unique educational setting, direct service to medically indigent patients, and shared financing. Problems encountered included cost, control, adequate staffing, and availability of specialty physician services. Through negotiation and flexibility, solutions were found to many of these problems.

The present linkage demonstrates that training residents in a health department setting is a viable option for expanding a residency and providing care to underserved patients.