Providence Swedish to trim residency slots, citing looming Medicaid cuts

The state's two largest family medicine residencies will soon merge and lose about a quarter of their resident spots in the process, as Providence Swedish prepares for massive federal Medicaid losses while in the middle of its First Hill campus expansion.

The organization says the decision was difficult but makes financial sense as Providence Swedish faces other big changes in the next few years. In fall 2027, the hospital system expects to move acute care services from its Cherry Hill campus to its First Hill hospital, which will house a new $1.3 billion medical tower.

Providence Swedish is among many healthcare systems in the state and country to cite expected Medicaid cuts as the reason behind layoffs, clinic closures or service reductions in the past year. Still, residents, family medicine leaders and community clinics are voicing concerns about what the changes could mean for patient care and the future of a medical specialty that's already strained.

Cutting family medicine training spots means further exacerbating primary care shortages," said Dr. Becca Wolinsky, who graduated from the Cherry Hill residency program on Saturday. The family physician, who started an addiction medicine fellowship at Brown University this week, criticized the cuts in a Seattle Times op-ed last month.

"Providence Swedish says it has a social justice mission, but I don't know if it's actually living up to that, especially because the family medicine residencies serve some of the most marginalized patients in Seattle," Wolinsky said.

To Bethany Brown, senior director of medical education for Providence Swedish's Puget Sound-area facilities, the consolidation of the First Hill and Cherry Hill residencies doesn't change the hospital system's values.

"I still want family medicine to exist as a cornerstone program at Swedish for some time," Brown said. "We really turned over every rock to say, 'How do we make this least impactful?'"

Washington currently has about 445 family medicine residency positions across 25 programs.

The programs give doctors just out of medical school three years of experience in hospitals and clinics, providing continuous care as people age. Family physicians can administer vaccines, do routine checkups and provide other preventive care, as well as focus on other specialties, like pediatric, obstetric and geriatric medicine.

For almost a decade, the number of family medicine residents in Washington steadily increased as programs grew and multiplied. Between 2014 and 2023, the number of family medicine residents jumped from 285 to a peak of 490, said Dr. Grace Shih, director of the WWAMI Family Medicine Residency Network, which comprises 43 programs across Washington, Wyoming, Alaska, Montana and Idaho.

In the last two years, however, the trend has faltered.

"I really worry about the communities these programs serve," Shih said. "I think it is ominous for the family medicine workforce in Washington, because I don't think this is a one-off."

Another family medicine residency program, at Community Health Care in Tacoma, which typically graduates eight residents per year, also closed this year, Shih said.

Providence Swedish's Cherry Hill and First Hill hospitals have been home to their own separate family medicine residencies for over 50 years, but leaders decided to consolidate them into one program with the First Hill expansion and shift in services, Brown said.

While the expansion has been in the works for years, expected Medicaid cuts prompted Providence Swedish leaders to more urgently look for ways to trim the hospital's budget.

The merger, announced in April, will pare down the cohort of family medicine residents from 69 to 51 over the next four years. All current residents will graduate from their programs, Brown said.

Providence Swedish will recruit the same number of new residents this year. Starting next year, the hospital system will take six fewer residents through 2029.

"We're very committed to training residents in the programs that they matched in, but also to do this in a humane way with our partners," Brown said. "And that's what a four-year runway gives you."

Providence Swedish's family medicine residents typically do rotations at around 50 training sites in the Puget Sound area. But a large portion of the program is centered on community outpatient clinics, where residents have their own patients whom they see on an ongoing basis.

These clinic partners include Sea Mar Community Health Centers, Seattle Indian Health Board, Seattle Roots Community Health's Carolyn Downs Family Medical Center, International Community Health Services and Public Health - Seattle & King County.

Providence Swedish leaders said they've been in contact with the health centers for months about how cutbacks to the family medicine residency will impact patient care, but many details remain up in the air.

The organizations are still sorting out whether all the clinic partnerships will continue, said Dr. Chris Chisholm, chief operating officer for Providence Swedish Central Puget Sound. While capacity at Providence Swedish hospitals and clinics will not decrease, it's possible patients at community clinics could see changes, Chisholm said.

"I don't think there's a way to get around that, which is unfortunate," he said.

Dr. Elizabeth Parks, chief health officer at Seattle Indian Health Board, said this week she doesn't know if her organization's partnership with Providence Swedish's family medicine residency will continue. If it doesn't, there will be a "really detrimental impact" to Native patients the health center serves, Parks said.

Seattle Indian Health Board receives two new residents from the program every year, so it trains six residents at any given time.

"It's particularly problematic because Native folks have disproportionately high rates of bad outcomes," she said, referencing examples like high rates of maternal mortality. "We are training residents to do prenatal care and deliver those people in the hospital, and without this residency, our relatives don't have that safety from that training."

Parks said the Seattle Indian Health Board, along with other community clinics, submitted proposals to Providence Swedish and are waiting to hear which partnerships will potentially be dropped.

"The idea of an institution asking historically disadvantaged communities to compete against each other for a scarcity of resources is just perpetuation of an injustice that we've been dealing with forever," Parks added. "We all really add value and are important to this community."

Even with the merger and reduction, Providence Swedish's family medicine residency will still be the state's largest. The hospital system also runs a rural family medicine residency, which includes a majority of training in Port Angeles.

Providence Swedish COO Chisholm pointed to that data point, saying the hospital system is still contributing "its fair share" in developing the state's family medicine workforce.

"I guess the question is, 'Who else is willing to step up and partner with us to grow it in other areas?'" Chisholm said.

Family medicine experts in the state worry Providence Swedish, as it cuts costs, is not accounting for other losses.

The residencies are a benefit to the community, especially because graduates of Washington state's family medicine programs tend to stay here to practice, said Dr. Russell Maier, associate dean for graduate medical education at Pacific Northwest University of Health Sciences in Yakima.

"They're keeping people out of the emergency room," he said. "They're inherently more expensive to run, but what they're producing is part of the workforce that saves the system money."

Maier credited Providence Swedish for its "clear, long-term plan" on how the programs will gradually combine, which doesn't always happen. He also warned that residencies take years to develop and can take a long time to build back up.

"It's not a spigot you can just turn back on, Maier said.

Correction: An earlier version of this story included incorrect phrasing of the name Seattle Roots Community Health's Carolyn Downs Family Medical Center.

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This story was originally published July 2, 2026 at 6:41 AM.