For over 100 years, Santa Barbara Cottage Hospital has been training physicians in its residency programs. The first general practice residents at the hospital started in 1923, and residents today continue to learn while serving vulnerable populations and working to address some of the barriers these populations face.

This year, there are 89 residents across the four programs at Cottage Hospital — internal medicine, diagnostic radiology, general surgery, and pediatrics — in which residents care for patients both in the hospital and in outpatient clinics.

The three-year internal medicine residency program has 35 residents this year, said program director Dr. Lynn Fitzgibbons.

She said the residency programs have been working to bring more diversity into the programs, particularly as, according to data from the Association of American Medical Colleges, only 6% of physicians in the United States identify as Latino or Hispanic. 

Cottage Health spokesperson Cristina Cortez said that about 29% of residents in this year’s programs identify as Latino or Hispanic.

“We know that it’s important to many people in our community that our physicians represent our community well — physicians that may be able to speak a patient’s language, someone who can understand someone’s culture,” Fitzgibbons said.

“Above all else, we know that providing compassionate care is our priority.”

She said that the most important recruitment strategy to improve diversity across the programs has involved creating a learning environment and clinical care environment that is attractive to applicants from diverse backgrounds, as well as emphasizing how important their voices are in the program.

Addressing the issue of representation and increasing diversity has been an important goal for first-year resident Dr. Jesus Fandiño, who grew up in Santa Barbara as a first-generation Chicano watching his mom go through nursing school.

“I kind of got introduced to medicine at an early age with her. When she put herself through nursing school, it was a period of transitioning when she was pretty much a single mom, and I hung out with her while she was studying,” Fandiño said. “That opened the world of medicine to me.”

He recalled growing up in Santa Barbara, seeing how large the Hispanic population was and how many resources were not easily accessible to that community.

“There were times there were emergencies … and we debated about going to the hospital since it was going to be super expensive,” Fandiño said. “With my mom being a nurse, she knew the dangers of not going, but in reality, that’s what it’s like for Hispanics growing up.”

Now in the internal medicine residency program, Fandiño has been able to offer services to this population and others who can relate to his experiences.

Every six weeks, the internal medicine residents spend a week working in one of the county’s clinics, where Fandiño said he has enjoyed being able to provide care to the most vulnerable populations and those who may be underinsured or uninsured.

“I think my cultural background helps me there,” Fandiño said. “I’ve made it known that my goals are trying to help certain populations, try to start tailoring my care to the most vulnerable and my program has helped me.”

He said another goal of his is encouraging the younger generation to pursue careers in the medical field and other industries that could use more diversity.

“Growing up, I never thought I could be a doctor. It was always the dream, but I didn’t think it would happen,” Fandiño said. “My goal is to focus on minorities and show them that it’s possible.”

Second-year internal medicine resident Paloma Ochoa also emphasized the importance of representing the community in healthcare.

Ochoa said she was the first person in her family born in the United States, while the rest of her family was born in Mexico.

“Being at Cottage, it has been such a blessing — being able to work with Hispanic and Latino patients, being able to do that in such a more personable manner,” Ochoa said. “This is what I was meant to do. This is it — this is everything I’ve worked for and I’m finally helping and giving back to my own people.”

She said that being from the same culture as her Latino patients — who she said make up about 99% of her patients in the county clinic — she can understand things like the diet of the culture and how it can affect health. For example, she said that she can help patients with uncontrolled diabetes by discussing foods in their culture that can help.

In addition to increasing diversity, Fitzgibbons said that the focus of the last few years has been to improve and intensify primary care training, especially as there is a shortage of primary care physicians in Santa Barbara.

“Looking ahead, we see the projected primary care need in the community that we currently don’t have enough primary care access and are looking ahead with that need increasing,” Fitzgibbons said. “With the internal medicine program at Cottage, we have made some efforts … to make sure that residents who may be great candidates for a primary care career have the opportunity to work in that space and try that on during their residency.”

Ochoa said working in the clinics and having that primary care training have completely changed what she wants for her career.

“I never thought I wanted to be a primary care physician. I am so drawn to it now, so focused on how I can be the best physician I can for these patients outside of the hospital setting,” Ochoa said. “I think if we didn’t have that curriculum, I wouldn’t be able to truly experience the life of a primary care physician.”

Another part of Cottage’s residency programs involves workshops and training to ensure residents understand the barriers and impact that health inequities have on patients.

“It’s critically important that our residents understand the effect of social determinants of health,” Fitzgibbons said. 

Some of the recent workshops have focused on Hispanic experiences, the shared experience of Native American communities, the experiences of patients who are insecurely housed, patients who have substance abuse issues, and more.

“There’s still tons and tons of barriers that you try to at least work on with your own patients every single day,” Ochoa said.

“Dr. Fitzgibbons brings up a lot of disparities — opens our eyes to constant reminders that this isn’t your typical population that can always understand. … I just want to touch on how grateful I am for Cottage for really taking a closer lens at the Hispanic population and underserved populations.”

More information on Santa Barbara Cottage Hospital’s residency programs is available on the hospital’s website here.