Montana’s first psychiatry residency program is preparing to graduate three residents. 

Up until a few years ago, Montana was one of only three states to not have a resident program to train soon-to-be psychiatrists. The other states lacking a similar program are Wyoming and Alaska. 

With a $3 million grant awarded by The Leona M. and Harry B. Helmsley Charitable Trust, Billings Clinic created Montana’s first-ever psychiatry residency program called the Montana Track at Billings Clinic. The Helmsley Trust is a global philanthropic organization working across six program areas, with rural healthcare being one of them.

Sarah Watson, the program coordinator at Billings Clinic, said the four-year program is currently divided into two years spent at the University of Washington’s Psychiatry Residency in Seattle followed by two years in Billings. 

“This gives them opportunities to train at large urban medical centers as well as in a smaller, more intimate setting,” she told the Daily Yonder. “We welcome three new residents each summer. The residents who have matched with us have a strong interest in rural healthcare and helping underserved communities. The goal of our program is to train psychiatrist-leaders in the communities they serve.”

She said given Montana’s large size and smaller population, many Montanans do not have a psychiatrist or other mental health professional in their communities.

“Our psychiatry residents have received extensive training and experience in telepsychiatry to improve access for patients so that patients don’t have to drive across the state to receive care,” she said. “We’ve also asked our residents to obtain their Wyoming medical licenses while they are residents to improve access for patients in that state, as well.”

Walter Panzirer, a Trustee for the Helmsley Charitable Trust, said the idea stemmed from the success of an internal medicine program started in Montana. 

“We saw that the graduation rates were great on that program,” he told the Daily Yonder. “That they had 60% placement into rural areas post-graduate, so it was really hitting the targets. And so we decided to move on to the psychiatric residency program up at the Billings Clinic under the same model because of our great successes we had with internal medicine.”

Panzirer said some of the states only have a few psychiatrists in the entire state.

“When you’re looking at trying to manage 500,000 people or more, depending on the size of the state up to a million people, you’re looking at your physician to population shortage ratio is extreme in a lot of these upper Midwestern states,” he added. 

Watson said she is hopeful the program can help change some of the statistics: Montana is currently 45th among all states in terms of access to psychiatrists. The states of Wyoming, Montana and Alaska are the states with the highest suicide rates per capita. Additionally, 5.5% of adults in Montana have a serious mental illness. One in ten Montanans is dependent on or misusing alcohol or drugs. 

“By increasing the number of psychiatrists in the state and improving patient access, I’m optimistic that we will address the mental health needs of the population in our region with evidence-based care that’s delivered with kindness and compassion,” she said. 

One of the residents, Brian Schlidt, is returning to his home state of Wyoming to practice. 

“Given that I’m from there, and I really love the state, love the people, and it’s horrifically underserved, I was looking to do something else. I looked at joining a practice…but if we’re being honest, I couldn’t really find something that fully fit my practice goals,” he said. 

So he’s opening up his own practice. He told the Daily Yonder his practice will focus on collaborative medicine, which is partnering with primary care providers who already provide mental health care to patients and helping with tailored recommendations. It can also help identify people who may need to see a psychiatrist. 

The biggest barriers to access for many in rural settings is availability when it comes to psychiatry, he said. 

“In general, access to care is extremely, extremely difficult,” he said. “We’re doing a quite a bit better job across the board. addressing some of the stigma associated with care, and so really reaching out and feeling comfortable accessing mental health care is something that’s been improving across the board.”

Schlidt and the others think programs like the one now in Montana will help with these barriers to access.

“It’s a really cool program,” he said.”It has a very, very strong focus on that telemedicine component and has a strong focus on improving those rural health outcomes.”

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