20210924-LOC-Peerless

The former Peerless Insurance building on Maple Avenue in Keene, shown last April, is set to house a new primary-care residency program Cheshire Medical Center plans to launch, along with other services relocated from the hospital’s main Court Street campus.

Cheshire Medical Center plans to launch its residency program for new family-medicine doctors in 2024, hospital officials said Thursday.

And that training program — intended to boost the number of local primary-care providers — is just one part of the Keene hospital’s vision for expanding its services and strengthening health care in the region.

Dr. Don Caruso, Cheshire Medical’s president and CEO, and other officials described that vision in an interview with The Sentinel’s editorial board.

It includes expanding to a recently purchased property on Maple Avenue, which will house the residency program along with other services relocated from the hospital’s main Court Street campus. That, in turn, will free up space to expand clinical services on Court Street, including building up the hospital’s surgical capacity.

Caruso said he expects it to be a five-year, $100 million project.

Caruso said he sees Cheshire Medical Center as having two key roles: serving the health needs of Cheshire County and providing more specialized and higher-level care than is possible at smaller nearby hospitals like Monadnock Community Hospital in Peterborough or Valley Regional Hospital in Claremont.

By expanding, Caruso said, Cheshire Medical will be able to offer more services to patients in Keene, sparing them a trip to Dartmouth-Hitchcock Medical Center in Lebanon or an ambulatory surgery center in Concord.

“When we look into the future, we said we need to build on those two expectations,” Caruso said. “One is to take care of the community. The other is to really help support the region for the higher-end care that’s here, or that’s needed.”

Kathy Willbarger, Cheshire Medical’s chief operating officer, said that as executives searched for a facility to house the family-medicine residency, they realized they should think bigger.

In May, Cheshire Medical purchased the former Peerless Insurance building on Maple Avenue in Keene for $4.6 million. When they first saw it, she said, hospital officials thought it was way too big — more than 140,000 square feet, compared to the 25,000 they needed for the residency program.

“You step back, and you think, ‘But what if? What if we could make this work?’ “ she said. “And then our teams here were thinking about, ‘OK, where do we have this huge demand that we can’t meet because we don’t have the space? And what if space was not an issue?’ ”

They soon realized, she said, “We cannot not do this. Our community needs this now, and we know that if we need this now, with an aging community, that demand is going to increase even more.”

Cheshire Medical has engaged a consultant to evaluate its facilities, and plans are still preliminary. But Willbarger and Caruso said the biggest needs include expanding and modernizing the operating rooms, which were designed decades ago and are no longer big enough to handle all the demand and house the latest technology.

That, in turn, can be a barrier to recruiting — for example, urologists today are trained to use robots for surgery.

“We need a robot at Cheshire Medical Center,” Caruso said.

With more space, the hospital could also build up its in-demand orthopedics practice and develop the capability to do spinal surgeries on site, rather than sending patients to Dartmouth-Hitchcock Medical Center, Caruso said.

Officials are also considering putting an ambulatory surgery center — for procedures that don’t require an overnight hospital stay — at the main Cheshire Medical campus. That’s important partly because insurance companies prefer to pay for procedures at ambulatory surgery centers rather than hospitals, forcing some patients to travel to Concord or elsewhere, Caruso said.

But the Court Street campus has no extra space, officials said. To free up room for more clinical services, the idea is to move some functions that don’t have to be there to Maple Avenue. That could include physical therapy, pediatrics and some administrative offices, Willbarger said.

Caruso said the space for the residency program should be ready by October 2022, around the time the program’s director is slated to begin. (To get a residency program up and running and credentialed, he explained, the staff has to be in place 18 months before the first class of residents starts.) The hospital has also begun recruiting the other five physicians who will help train residents.

The timeline for the other components is still being worked out, Willbarger said.

Caruso said the new residency program will address a critical need: a shortage of local primary-care physicians. That has made it hard for patients to access care — even for hospital CEOs who happen to be family doctors.

“It’s really hard to get into primary care,” he said, “even for myself.”

Caruso said Cheshire Medical has the equivalent of 10 full-time, primary-care physicians plus additional nurse practitioners. Willbarger said those primary-care doctors each carry a slate of about 2,300 patients on average, when national standards are around 1,600 to 1,800. Caruso said he thinks a total of about 30 primary-care physicians are needed.

Each year, the three-year residency program will take six residents — newly graduated doctors who practice medicine while continuing their training under more experienced physicians — for a total of 18 at any one time. The residents will each see their own patients, as will the academic attending physicians who train them.

Ultimately, the aim is for many of those newly trained doctors to stick around the Monadnock Region long term, Caruso said, citing statistics showing that more than half of family-medicine graduates stay within 100 miles of their residency to practice.

“Which is really, really important for us in terms of getting that cadre, growing them, having them know what it’s like to practice in a rural community and then staying here,” Caruso said. “And that’s really the goal of what we’re doing.”