Teaching future doctors keeps him fresh

Growing up on the Colville Indian Reservation, Andy Castrodale had no intention of staying in rural Eastern Washington.

"I was going to get out and I wasn't coming back," he said.

And yet, for 21 years he's been practicing family medicine in Grand Coulee.

Castrodale laughed.

"I also hadn't planned to be a physician."

He studied microbiology as an undergrad at the University of Washington, thinking he might pursue physical therapy.

"I spent the first three years trying to survive, feeling like the dumbest person on campus," he said. "I worked as I went along. I have a special place in my heart for students working their way through school."

He said physical therapy programs were highly competitive and seemed unattainable to him. Castrodale decided to take his Medical College Admission Test and apply for medical school.

The only school he applied to? The University of Washington School of Medicine. He'd just gotten married and was amazed when he was quickly accepted.

"It's not normal to only apply to one school," he explained.

He found family medicine was the perfect fit, and did his residency training in Spokane, followed by a one-year, high-risk fellowship in obstetrics. The residency and fellowship were part of the UW School of Medicine's robust network of family medicine residencies and fellowships in Washington, Wyoming, Alaska, Montana, Idaho, referred to as WWAMI.

"I was one of the first people from our residency program to do the fellowship," said Castrodale, who was ready to return to his roots after 12 years in the bustling city of Seattle.

"I grew up where you could ride a horse for 20 miles and not see another person," he said. "I wanted to return to a small town."

Coulee Medical Center in Grand Coulee, not far from where he was raised, was eager to have him join their staff.

His practice area encompasses more than 1.4 million acres, and when he moved to Grand Coulee with his family in 1998, there was only one midwife delivering babies.

"I worked with her for a long time," he said. "I knew I'd have to hit the ground running."

Indeed. During his first six years, he was on-call 24/7.

Rural family physicians do it all - deliver babies, set broken bones, suture wounds and care for chronically ill elders.

"I got a partner six years into my practice, but I'm still the only physician here who can do C-sections," Castrodale said.

Not only did he hit the ground running with patient care, but also with teaching.

"In rural medicine, you're always teaching," he said. "I had RUOP (Rural Underserved Opportunities Program) students within a year or two of my arrival."

UW medical students frequently come to Grand Coulee as part of that RUOP - a four-week, elective immersion experience in community medicine for students between their first and second years of medical school.

Castrodale also mentors TRUST (Targeted Rural and Underserved Track) students through an optional program that prepares students for careers working in underserved rural areas and underserved small cities.

Erin Boland is one of those students.

"Dr. Castrodale and I have worked together since the summer of 2017 when I was here for my first summer experience as a TRUST student," she said. "Since then, I have spent time in Grand Coulee roughly one to two times a month, and for four weeks last summer. Currently I'm here for almost six months for WRITE (WWAMI Rural Integrated Training Experience)." That's a clinical medical education program developed by UW's School of Medicine to help meet the need for more rural primary care physicians in the WWAMI region.

Boland says Castrodale offers a unique educational opportunity in Grand Coulee.

"If you want to be on call in the ED or for OB, you're welcome to do that. If internal medicine is interesting, we can show up in the mornings for rounds every day," she explained. "What I most like about working with Dr. Castrodale is that he takes the time to get to know students as individuals. He tries to find us opportunities for our future career goals. He is very supportive no matter what area of medicine you would like to go into."

Castrodale relishes mentoring the next generation of physicians, and exposing them to the rigors and joys of rural medicine.

All the health care providers at CMC also help teach the many students who try out rural medicine there, he said. He's responsible for all the grading, but the students' education is something all of CMC's providers work to further.

"I would go so far as to say that we interact as team members out here," Boland said, "with all employees - from people who are in the lab to people taking care of long-term patients, the ER staff, OB staff, everyone."

"I enjoy teaching," Castrodale said. "It keeps me fresh and up to speed."

And he knows spending time in Grand Coulee may inspire some students to return after graduation.

In fact, when looking at graduates from 2003 to 2013, data shows that RUOP students were more than twice as likely to enter rural practice than their classmates who didn't participate in the program.

Castrodale believes hosting RUOP and TRUST students is healthy for Coulee Medical Center, the region's 25-bed, critical access hospital, where he served as chief of staff for 17 years.

"If you're not doing obstetrics and teaching students, you're dying," he said. "We're thriving here."

So much so, the hospital is looking at establishing their own daycare to aid in recruiting more physicians with families.

In 2014, Castrodale's work was honored when he received the Dr. John Anderson Memorial Award for Outstanding Rural Health Practitioner.

The award, presented by the Washington Rural Health Association, came as a surprise to him.

"It completely caught me off guard," he said. "But I'm very proud of it. It's nice to be recognized."

Castrodale also served as the president of the Washington State Obstetrical Association in 2010.

When asked what kind of temperament a physician needs to practice in a rural setting, he chuckled.

"Mostly, I'm just stubborn," he said. "But it also takes a lot of humility. You have to do what needs to be done, even if you're uncomfortable."

In rural medicine, there's no specialist just down the hall. For Castrodale's patients the closest specialists are 100 miles away.

He's never regretted choosing family medicine.

"It's usually happy medicine," he said. "I have the ability to build relationships with entire families, from newborns to their grandmothers."

Spending time in the small vineyard he planted within a year or two of his arrival in Grand Coulee offers him an escape from the pressures of work.

"I like growing things," he said.

The vineyard produces several types of grapes, and Castrodale enjoys making wine for friends and family.

"I make a cab franc, cab sauv, merlot blend, a syrah/barbera blend and a semillon/muscat blend," he said.

Raising his family in the shrub-steppe of Grand Coulee on the banks of the Columbia River may not be what he'd envisioned as a teenager, but he wouldn't trade it for the world.

"In many ways, I still feel like a resident (physician)," he said. "I still like coming to work every day. I really enjoy rural medicine."

Scott Hunter contributed

to this report.