Brintha Vasagar, MD, MPH, achieved a unique feat in a very short period of time: establishing a successful residency program and attracting young doctors in a state with no medical school.
Medicine doesn’t get better if you keep doing the same thing over and over, said Dr. Vasagar. As the founding director of the Bayhealth Family Medicine Program, Dr. Vasagar has dreamed big and achieved a great deal. Since its first class of family and internal medicine residents in 2021, it has grown into a robust program, comprising three classes and 21 resident doctors. Bayhealth now has a total of 71 residents.
Bayhealth has truly embraced the concept of trying new things, said Dr. Vasagar. “And it has made a world of difference to our patients.”
In November 2023, Dr. Vasagar received the Mid-Career Faculty Achievement Award from the Family Medicine Education Consortium for demonstrating significant contributions to family medicine and primary care. She also helped secure a large Health Resources and Services Administration (HRSA) grant to support the startup of new residencies that support rural communities.
Bayhealth is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
In an interview with the AMA, Dr. Vasagar discussed how she built and advanced graduate medical education (GME) at Bayhealth and worked to address two key health concerns.
AMA: Tell us about your journey in family medicine and what inspired you to become a program director at Bayhealth.
Dr. Vasagar: I got my start in academics at the Tidelands Health MUSC Family Medicine Residency Program in Murrells Inlet, South Carolina. And if you know the AMA leadership well, you'll know that that is the home of Gerald E. Harmon, MD, who is the former president of the AMA. It’s a small, small world.
I ended up in family medicine, much like most family doctors because I love doing everything. I loved all ages and inpatient, outpatient procedures, obstetrics. I was doing deliveries at the time and academics really is the best way to be able to keep all those things within your practice.
Before I knew it, I was thinking it was time to become a program director somewhere. I was recruited to Bayhealth in Delaware to start something new, to grow GME as a strategy for bringing more physicians to the workforce. We’re one of a few states that doesn't have a medical school. There's no natural pipeline of physicians that can be grown and stay in the area.
So, GME has really been a strategy, particularly in the southern half of the state, to bring young doctors to the area so that they stay here long-term and care for our aging population.
AMA: How did your public health background contribute to your approach in creating a residency program that addresses the specific health care needs of the community?
Dr. Vasagar: When I came to Delaware, I really spent a lot of time listening and talking to people directly about what they felt the biggest health care needs were within the state and where the residents could meet some of that need. Like many places in the United States, Delaware's top two health care concerns revolved around addiction and mental health. So, those really became our lightning rods of what we wanted to focus on as our top two priorities in making our outpatient practice and serving this community specifically.
AMA: What is the significance of the Mid-Career Faculty Achievement Award and how does it feel to be recognized?
Dr. Vasagar: Family doctors have an uphill battle that they face every day, and I am so honored to know that I'm moving the needle a little bit. I am excited to see what we're able to do in the coming years and how we're able to continue to grow this program.
We don't want to be the type of program that says, “Oh, we've hit it. We've done everything we promised.” We want to continue to dream big and to try to change health care one person at a time.
AMA: What challenges did you face in establishing the residency program, and how did you overcome them?
Dr. Vasagar: Anytime you start new programming, there's an inherent risk that people won't be supportive, that the community won't come to a new practice. We were asking the average patient to come see a resident physician as their primary care doctor. And family medicine is a relationship that's built on trust. So, we were really asking a lot of the community to trust us with their health care.
I am very, very blessed that this community embraced the residents, embraced me and said, “We'll give you a chance. We see what you're trying to do here. We will trust you with our health and if you're able to do it, we will continue to come here. We'll continue to recommend the practice and the program to our friends and relatives and people that we love.”
We are so busy that we now have a waiting list. We really would not be able to have a residency program if the community didn't believe in what we were trying to do.
AMA: How has the residency program changed the landscape of medical education in Delaware?
Dr. Vasagar: Delaware is a small state—we only have three counties. Many of the areas in Kent and Sussex counties were medically underserved with less than one doctor for every 2,000 people. And when you don't have a medical school, there's not an innate pull for going to Delaware for medical school, to fall in love with the area and stay there. We really didn't have that working in our benefit.
So, the residency program really became the way that we could bring these young physicians from all over the country to this area. And obviously, we all hope that they stay.
We're getting ready to graduate our first class this July and two of our residents have already made a commitment to stay here at our institution. There are at least two others who plan on staying within the state of Delaware, which is amazing.
Those are great percentages for a first-year class, and we hope that that continues to happen. There’s certainly a need here, and we know that we're training excellent physicians, so we hope that they want to stay here and continue to care for these specific patients.
AMA: How did you secure the HRSA grant to support the startup of new residencies, especially those serving rural communities?
Dr. Vasagar: Delaware isn't what most people think of when they think of rural. But based on the need for physicians, this area is rural. The HRSA grant was one of a series of federal grants available to grow graduate medical education residency spots in areas that had a need and would serve rural communities—places where the access to physicians was low.
When we think about primary care, that’s oftentimes the first interaction people have with the health care system. Being able to get to a primary care doctor becomes incredibly critical, not just in preventive care, but when your primary care doctor recognizes a problem, the ability to refer to someone else and having those touch points, which is part of your training as a family physician, is incredibly important for providing the care that our patients need.
It's not easy to bring all the people and all the planning that's needed to start a new program. You never want to train a physician to be the bare minimum … because this is somebody who's going to care for your family members. You really want to provide excellent training and that'll cost money. So, we were very blessed that the HRSA grant was something that we were able to get.
For this community, it was really one of the key pieces that allowed us to start a new program so successfully.
AMA: How do you address social drivers of health, addiction and mental health in the residency program?
Dr. Vasagar: We have a multidisciplinary team, and I think that's the wave of the future in medicine. We rely not just on one doctor, one patient, but a whole team of people who can make sure that our patients are getting everything they need to be successful.
We have a pharmacist that's part of our team, who can review medications with our patients or help them figure out strategies for remembering to take their medicines at the right times, help them understand what the side effects look like and what things to be looking out for.
We have a behavioral health counselor who can see our patients for counseling appointments. They can talk about the different drivers that are propelling their mental health. We have case management and social workers and nurse managers, all of whom can help our patients find ways to do everything from getting a ride to be able to attend an appointment to figuring out where the cheapest place is to fill their medications so we can make sure they're getting the things that we prescribe.
It really takes all parts of the team to be able to be successful, and more and more in the coming years, we'll see how important that is in making sure patients are well cared for.
