Rear Adm. David Lane, Director, National Region Medical Directorate, shares memories with retired Navy Capt., Dr. Ronald Dommermuth, Family Medicine Faculty Advisor, and Capt. David Weiss, Naval Hospital Bremerton Commanding Officer, following the Puget Sound Family Residency graduation and decommissioning ceremony at Naval Hospital Bremerton. The Puget Sound Family Residency program was decommissioned after 25 years. The initial program began in 1982 to 1987 and then became Puget Sound Family Medicine Residency (PSFMR) in 1990 with three interns and two second year resident training officers. From that initial group, there have been a total of 197 residents and 133 graduates. (U.S. Navy photo by Mass Communication Specialist 1st Class Gretchen M. Albrecht/Released)
Story by Douglas Stutz
Naval Hospital Bremerton
Douglas H Stutz, Naval Hospital Bremerton Public Affairs — It was an end of an era at Naval Hospital Bremerton (NHB) as the Puget Sound Family Medicine Residency (PSFMR) program held a combined final graduation and decommissioning ceremony on July 1, 2016.
“On behalf of the Family Medicine Residency, it is my privilege to welcome you to our final graduation ceremony,” said Capt. Erik Schweitzer, Medical Corps, family physician, program director and master of ceremonies.
This year’s graduating class is the last to be honored at NHB for the program. The decision was based on a Bureau of Medicine and Surgery (BUMED) hospital study conducted from 2011 to 2013 on nine Navy Military Treatment Facilities (MTF) across the U.S. The study showed that advances in clinical medicine resulted in predominately outpatient services with the need to have the correct mix of personnel and services in place for active duty service members, family members and retirees.
“This ceremony will celebrate the success of our graduating residents and the success of the program in completing one of the hospital’s missions, which is to train the world’s finest family physicians. It is a bittersweet day. These outstanding young officers have reached a milestone in their careers, and that is indeed worthy of celebration. They are all moving on from here and our hospital will have no residency program. Our future is changing and uncertain in many ways. Although that change is painful at times, I am comforted by the fact that these Navy doctors will help shape the future,” Schweitzer said.
“The residents have been humbled and inspired. The days have been long and the years short during their residency. They have been trustworthy and hardworking in following the Navy’s core values and they have always been a patient’s best advocate,” said Capt. David K. Weiss, NHB Commanding Officer.
The initial program began in 1982 to 1987 and then became Puget Sound Family Medicine Residency (PSFMR) in 1990 with three interns and two second year resident training officers. From that initial group, there have been a total of 197 residents and 133 graduates.
“In the Navy, it is rare for every intern in a program to be allowed to continue straight through training. Initially, breaking up the team was the plan for this class, too. Through their persistence, and with our continued appeals to the highest levels, we were able to keep this class intact thus forming the largest class of residents in the history of this program. This class’s experience has been unique. Through it all, they have never stopped working together, advocating for each other, or working hard to be the best doctors and officers they can be,” shared Schweitzer, also thanking Capt. Eli McGuigan, Director of Navy Graduate Medical Education in attendance for making the program’s completion stay on track.
The residency program has traditionally had a total of 18 residents, averaging six per year per group. There are eight graduating in this finale with Lt. Bryan Wooldridge assigned to NHB’s Branch Health Clinic (BHC) Bangor; Lt. Tim Wilcox, assigned to submarine tender USS Emory S. Land (AS 39), homeported, Guam; Lt. Andrew Peters, assigned to BHC Naval Weapons Station, China Lake, Calif.; Lt. Jeremy Kenison, assigned to 3rd Marine Regiment, Kaneohe Bay, Hawai’i; Lt. Cmdr. Eamon Keleher, assigned to BHC Kearny Mesa, San Diego, Calif.; Lt. Janelle Riley, assigned to BHC Naval Air Station, Fallon, Nev.; Lt. Hy Pham, assigned to Fleet Surgical Team 3, San Diego, Calif.; and Lt. Cmdr. Ray Portier, assigned to 1st Marine Air Wing, Okinawa, Japan.
“I came into the program from Okinawa so have not really established the emotional tie like the others, but as justifiably proud as we are to graduate from the program, we all are equally saddened to see it closing,” shared Portier.
After the final class was formally graduated, the ceremony focus shifted to the closure of the residency program.
Schweitzer explained to those attending that in the fall of 2013, the announcement was made across Navy Medicine that changes were due to be implemented at numerous medical facilities across the United States. The goal was to redistribute resources to align more closely with regional needs. NHB was significantly impacted, as the Emergency Department transitioned to an Urgent Care Center and the Intensive Care Unit was closed. Both moves brought about a decrease the volume and complexity of patients admitted to NHB.
“Without adequate learning experiences available, our incredible program could not provide the high quality training needed. The Navy recognized this as well, and directed us to plan a phased closure. Looking back across the decades of our program’s existence, we can take great pride in our history. We have long been the Navy’s finest Family Medicine Residency. Our graduates and faculty have and do lead Navy Medicine. As any Family Physician will tell you, it’s not just about the numbers. It’s about the quality of care, the relationships, the leadership, and the family,” explained Schweitzer.
The program leaves a unique history where the residents trained to become family physicians in NHB’s community hospital setting. They became primary physicians for their patients on all inpatient and outpatient services, and received additional experience at Madigan Army Medical Center and on the Pediatric Wards and Emergency Room at Mary Bridge Children’s Hospital, both in Tacoma, Wash. The residency program also partnered with the University of Washington (UW) Family Medicine Network which is consistently rated the top training program in the country. In addition, PSFMR was rated as the top rotation site by UW medical students.
The Family Medicine staff at NHB also received additional training in faculty development at the two-year (U.S. Army) Madigan Fellowship, were recognized by the Uniformed Services Academy of Family Physicians for their research efforts, and have been published in such noted medical journals as American Family Physician, The Journal of the American Board of Family Medicine, The Journal of Family Medicine and Military Medicine.
Schweitzer attests that the distinctive professional nature of the residency program is a direct result of the many staff members and future Navy family physicians who invested their time and effort over the years.
“This program is special because of the people, including those directly in the program and those surrounding us in the hospital. For over half its existence, PSFMR has had the most applicants for internship rank it first among the Navy programs, and has had the lion’s share of top tier applicants. This has also attracted outstanding faculty and built a culture of excellence. The size of the program, smaller than others and in a hospital without other residencies, has made it truly feel like a family. While I knew the hospital staff as a whole felt this was ‘their program,’ it became overwhelmingly obvious with the news that we would close. Staff from throughout the hospital came together to express their sense of loss, and to ensure our residents remained well-supported through the phases of closure,” said Schweitzer.
Perhaps no one epitomizes the program more than Dr. Ron Dommermuth. The retired Navy captain and physician has the longest tenure associated with the program. He went through his residency as a young Navy lieutenant from 1991to1994, and then returned as a staff physician, followed by duty as assistant program director, program director, director of medical services and currently as a faculty physician in civilian capacity.
“Dr. Dommermuth has also been here for a clear majority of PSFMR’s existence. He, too, maintains deep knowledge of the program’s history, successes and failures of various changes over the years. He has laser focus on advocating for the residents in every possible way. Of course, his unique humor and mischievous nature have added a lot to our morale! His knowledge and scope of practice is one of the broadest in Navy Medicine. He also recently earned a perfect score on his board recertification exam. That’s unheard of,” exclaimed Schweitzer.
Dommermuth also was guest speaker at the graduation ceremony for the third time in his tenure with the program.
“It is an honor to be here for this milestone. This particular group of residents is unique like all those before and they will continue the ethos of sacrifice. They have demonstrated unrivaled commitment and devotion to their patients,” said Dommermuth, also sharing a lengthy tongue-in-cheek synopsis of each graduate that illuminated their skill set, qualities and capabilities as the Navy’s new family physicians.
The PSFMR program legacy almost completely overlaps with Dommermuth’s own involvement. He estimates that he’s spent at least two years of his life sleeping at the hospital, trying to catch a few hours of shuteye after a long shift or time-consuming caseload. His office is known as an incomparable chaotic jumble, so much so that one night after habitually working late, with papers strewn all over, covering every available space, when he finally departed, he left the door unlocked. Later in the evening he received a call from the command’s Security department informing him that it appeared that someone had broken into his office and ransacked the place.
After having them describe what his office looked like, Dommermuth calmly told the Security dispatcher that his office always looks like that after a long day at work.
“So if anyone can match that…,” said Dommermuth.
Another staff member who provided a bulk of professional support – and unmatched matriarch assistance – was Lina Mendiola, who recently retired after a lengthy career in federal service.
“Lina has been the sole team-member present from 1990 until this year. She’s been the corporate memory for faculty and program directors that change every 3-5 years, and has kept us on track about administrative tasks and with a consistent voice of advocacy for the residents as leadership worked to navigate turbulent times. Without Lina, we would not have been able to maintain Accreditation Council for Graduate Medical Education accreditation,” commented Schweitzer.
“Even when it was closed the first time in ’87, these residents have always been my babies,” Mendiola said.
“All of us owe a great part of our success to Lina,” added Rear Adm. David A. Lane, Director, National Capital Region Medical Directorate, resident of Dommermuth’s graduating class (1994) and the guest speaker for the residency closure portion of the program.
“It is a dubious distinction of speaking here for this program is near and dear to my heart. There is such an impressive resume of the program and it’s not the final chapter, but a chapter, as long as the resident graduates still practice medicine and make a difference,” Lane said.
In his role as master of ceremonies, Schweitzer also extended thanks on behalf of the program to all of NHB’s staff who have supported them throughout the years.
“It is also true that our program could not succeed if we did not enjoy the universal support at all levels of the command, including Capt. Weiss and the rest of the Executive Board, faculty in all specialties, our nurses, medical assistants, corpsmen and civilian staff at every level of our organization,” Schweitzer said.
Schweitzer also singled out numerous contributors who helped with the transitional period of the program’s decommissioning, such as Mr. Mark Boman, Navy Medicine West Chief of Staff; retired Navy Captain and Scripps Mercy Hospital trauma surgeon, Steven Shackford; retired Rear Adm. Michael Anderson, Harrison Medical Center Chief Medical Officer; Dr. Rana Tan, Dr. Nathan Segerson and Dr. Bill Morris, also of Harrison Medical Center; Lt. Col. Hebert Kwon of Madigan Army Medical Center’s Intensive Care Unit; Madigan Army Medical Center’s Neonatal ICU; Dr. Melissa Meyer, medical director of Wash. State Retsil Veteran’s Home; Dr. Robert Kregenow, at Mary Bridge Children’s Hospital; Capt. Suezane Holtzclaw, Branch Health Clinic Puget Sound Naval Shipyard officer in charge and Occupational Health physician; Mr. Keith Grellner, of Kitsap Public Health District; and a decades-long partnership with UW.
Despite the program closing there will be still be training continued for numerous health care professionals as a Family Medicine department, and as a hospital.
“We have begun training Madigan Army Medical Center’s Family Medicine residents in obstetrics, providing them with a community-based experience that will more closely resemble their future duty stations. We continue to train medical students from UW. We have launched as a core site for training Navy Family Nurse Practitioners in the Uniformed Services University of the Health Sciences Doctor of Nursing Practice program, and we’ll have three DNP students on site through this first year, with planned future expansion. NHB also trains students in programs to become podiatrists, physician assistants, pharmacy doctors, medical students from other schools, medical assistants, and other healthcare professionals. Simply put, our staff loves to teach,” said Schweitzer.
The Navy’s newest board certified family physicians from NHB will join the global healthcare network of 63,000 Navy medical personnel around the world who provide high quality health care to more than one million eligible beneficiaries. They will deploy with Sailors and Marines worldwide, providing critical mission support aboard ship, in the air, under the sea and on the battlefield.
“It has been an honor to have served with you. I am humbled and amazed by your intelligence, ability, work ethic and teamwork. Navy Medicine will be in good hands. You are ready to lead, and we need you to lead. We need fresh eyes and smart people unencumbered by years of doing things the same way. We need new ideas and better ways to implement them. I charge you with taking up that cause. You have the skill,” Schweitzer stated.
As the ceremony drew to a close, Schweitzer switched from master of ceremonies to program head as he gave his final orders.
“We have honored this esteemed program’s history and described the contributions and achievements of its members. Following Naval tradition, to mark the completion of the organization’s mission, we will now secure the watch for the Puget Sound Family Medicine Residency. Color Guard, stand by to lower the residency flag. Lt. Cmdr. (Leslie) Waldman, secure the watch,” instructed Schweitzer.
Waldman then directed all residents to report.
“All residents recalled from remote training locations,” said Wooldridge.
“All equipment and computers secured and turned over,” said Wilcox.
“Offices and call rooms secured and repurposed,” said Peters.
“Complicated OB list completed and turned over to staff,” said Kenison.
“All clinical notes completed,” said Keleher.
“OB and newborn service turned over. Watch secured,” said Riley.
“Inpatient service turned over to staff. Watch secured,” said Pham.
“All outpatient panels turned over to staff. Watch secured,” said Portier.
Waldman reported promptly back to Schweitzer that the watch was secured. Schweitzer then turned to Weiss and reported that ‘the Puget Sound Family Medicine Residency has completed its mission. The watch has been secured.’
“Very well. Lower the flag,” ordered Weiss.
All eyes followed the descending path as NHB’s Color Guard lowered the PSFMR flag.
An era had come to an end. But the mission continues.