In 1989, after six years running a private family medicine practice, Dr. Mike Maples was ready to move on from Yakima.
Both he and wife, Dr. Marjorie Henderson, struggled to balance their packed physician practice schedules with raising two kids under age 3.
“It was the primary care shortage in this community that drove us out,” he said. “We’re both workaholics. It was totally unmanageable.”
They found an out: Henderson decided to pursue a residency in physical medicine and rehabilitation in Seattle. Maples found a job working on the faculty of Group Health Cooperative’s family practice residency program.
The couple’s time in Yakima may have ended at that time, if not for conversations Maples had with Rick Linneweh, then CEO of Yakima Valley Memorial Hospital, now Virginia Mason Memorial, and with Sister Karin Dufault, administrator of St. Elizabeth’s Medical Center, now Astria Regional Medical Center.
Maples, who had served patients at both hospitals, urged the two hospital executives to look into the primary care provider shortage that was driving overworked doctors, like himself, away.
They listened: Within a year, both hospital executives decided to create a primary care task force. Maples returned to Yakima to develop a new residency program to train future generations of physicians.
Nearly 30 years later, Dr. Mike Maples is finally making his exit.
Maples, 66, retires Monday as CEO of Community Health of Central Washington. The Yakima-based organization, which primarily started as a residency program and clinic at 1806 Lincoln Ave., now serves more than 45,000 Central Washington patients, regardless of their ability to pay, annually.
The Central Washington Family Medicine Residency now has 169 graduates, including many doctors who have stayed in the Yakima Valley.
Maples has been well-regarded in the local and statewide medical community for his problem-solving ability, calm but confident handling of information and desire to make sure that every aspect of health care was provided, whether it came from his organization or not.
“Mike is truly a visionary,” said Elizabeth Herres Miller, board chairwoman for Community Health of Central Washington. “He’s a person that’s really open to possibility and very cognizant of the needs and how to match resources with needs in a prudent matter.”
Responding to a need
When Maples and Henderson, both fresh from residency programs at the University of Washington, arrived in Yakima in 1983, there was some uncertainty from the medical community about whether there was room for additional providers, Maples recalled.
“There were well-meaning physicians who came to us and said, ‘We just don’t know how Yakima can absorb two primary care physicians.’”
In hindsight, the reaction was not surprising. Back in 1983, the country was coming out of recession. The Yakima Valley suffered from high unemployment and population decline.
Things changed quickly: “We went from a perceived situation of having a surplus of providers to a severe shortage of providers,” Maples said.
By 1990, the provider shortage was apparent to both local hospitals.
Russ Myers, who was then a management analyst for Yakima Valley Memorial Hospital, worked with Maples on the residency program. The pair sent reports to the primary care task force, which included representatives from the two hospitals.
When the residency effort was being formed, the hospitals quibbled over the location. Not surprisingly, both advocated to put the program near their respective hospital campuses.
Eventually, the hospitals finally agreed on a site at 1806 W. Lincoln Ave., where the Central Washington Family Medicine Residency remains today.
The building was completed in May 1993, a month before the program brought in its first class.
It was one of many obstacles that Maples would encounter in the residency’s formation. If he was frustrated, he didn’t show it, Myers said. He was far more focused on reminding people of the importance of the residency program to the local medical community.
“Mike had internal fire and drive, but you couldn’t see it from the outside,” said Myers, who is now CEO of Virginia Mason Memorial. “What you could see from the outside was his command of the information, his command of the facts, and his cool delivery of the information.”
Adapting for the mission
For nearly a decade, the Central Washington Family Medicine Residency and clinic operated as a joint venture of Memorial and St. Elizabeth’s.
By 2002, Maples knew the arrangement was financially unsustainable. Maples encountered research that said that any medical care provider that had at least 19 percent of its payer mix that was a combination of uninsured, Medicare and Medicaid patients was probably insolvent.
“We had 75 percent,” Maples recalled.
During that year, Maples said he had to use about $500,000 designated for the residency program to supplement the cost of uninsured and underinsured patient care.
“Those were just the cold, hard facts,” he said. “(The organization) was too important to fail, but it (was going to) fail.”
While the organization was training family medicine doctors, it also had a mission to serve the poor and underserved.
Maples remembers presenting three choices to the hospitals: Get a supplement from the hospitals to keep operating the clinic; change the mission or find a business model that worked better with the organization’s mission.
The hospitals agreed to the third option: In September 2003, Central Washington Family Medicine received status as a Federally Qualified Health Center, which would qualify it for higher Medicare and Medicaid reimbursement rates and allow it to purchase medications at reduced costs.
Both the clinic and the residency at Central Washington Family Medicine were now part of a nonprofit corporation, Community Health of Central Washington.
The Yakima Valley was already home to two Federal Qualified Health Centers, Yakima Neighborhood Health Services and Yakima Valley Farm Workers Clinic.
At first, there was some skepticism about a community health center running a residency program, as it wasn’t common then, Maples said.
Over time, community health centers came to see the value of running residency programs.
“You can only care for so many patients yourself. If you train others to do the work, you can greatly multiply the number of individuals you impact through that training,” said Russell Maier, who served as director of the Central Washington Family Medicine Residency until late last year. He now works at the Pacific Northwest University of Health Sciences overseeing its graduate medical education.
A residency program also can serve as a crucial tool to attract providers to a community health center setting, said Anita Monoian, president of Neighborhood Health.
“When you can train a resident in a community health center, all the more chance you’ll be able to recruit that health care provider to stay in the community health center movement,” she said.
Monoian would collaborate with Maples in several ways. When she served as chairwoman of the National Association of Community Health Centers, he agreed to serve on a committee.
For many years, residents from Central Washington Family Medicine have provided obstetric services for Neighborhood Health patients.
“He is interested in what the community needs and what he can do to help with those needs,” Monoian said.
Period of expansion
Community Health of Central Washington underwent significant expansion during the second half of Maples’ tenure, namely as a response to maintain or expand services to underserved populations.
In the mid-2000s, Community Health acquired Yakima Pediatric Associates and Naches Medical Clinic. During that same time, CHCW expanded to Kittitas County and opened a community health center in Ellensburg with the help of a federal grant. Recently, CHCW completed construction of a new medical and dental campus in Ellensburg.
During a board meeting in 2011, Maples pointed out that one doctor was providing medical care for seven out of 10 nursing homes in the Yakima Valley.
“Seventy percent of (nursing home) patients were under his direct care alone,” Maples said, noting that the doctor still was maintaining a part-time family medicine practice.
With the board’s support, CHCW started its senior residential care program in 2012. CHCW physicians, nurse practitioners, and other staff now provide care to 30 nursing homes, adult family homes, and assisted living facilities throughout the Yakima Valley.
“It’s just phenomenal for a community our size to have doctors in those facilities,” said Herres Miller, the CHCW board chair. “We’re able to take care of people where they need to be.”
In 2017, CHCW opened the Highland Clinic in Tieton, bringing medical services to the rural Upper Yakima Valley town of 1,300 people for the first time in several decades. CHCW also runs a clinic at Davis High School.
In the last few years, CHCW has expanded services at its existing primary care clinics, including an opioid treatment program and behavioral health consultation.
Maples said CHCW’s expansion plans always centered on solving a problem, but there’s the other part of the question: Was his organization the best one to respond?
“We’re pretty connected to other providers and services in the community,” he said. “When we identify a problem, we’re probably not the only one seeing it.”
If another provider was better equipped to respond to a medical need in the community, Maples said he would let that provider take the initiative.
Other times, if there wasn’t another provider willing or able to provide a service, CHCW would step in.
Monoian, the Neighborhood Health CEO, said Maples’ willingness to collaborate is one reason three different community health centers have been able to not only co-exist but work together.
“Three community health centers the size of the three we have is very unusual in a community of this size,” she said.
While Maples will retire as CEO as of Monday, he isn’t leaving the organization just yet — he will be staying on as a full-time employee through September. During that time, he’ll be working alongside new CEO Angela Gonzalez.
Maples and the organization’s board have already crafted a master plan. Among the priorities is an updated facility for its clinic in Naches and continuing efforts to integrate additional services at its existing facilities to provide more comprehensive care.
When Maples looks back on his career with Community Health of Central Washington, he’s reluctant to describe himself as a visionary, though others would. Earlier this year, he received the Legacy Award from the Northwest Regional Primary Care Association, recognizing his efforts to address issues in health care, poverty, and human rights.
For Maples, his priority — from the start and right through the end of his career — is to stay present to the community and its health care needs.
“It’s not great vision,” he said. “Just … a lot of hard work and just good problem-solving.”