Community-based FM residencies: opinions?

[primadonna22274]

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Hi all:

I will be applying for residencies this fall as a very nontrad DO student (first graduating class of an accelerated 3-yr track for PAs at LECOM). I practiced FM and EM as a PA and taught PAs as well. My favorite jobs have been full-spectrum rural family medicine and PA education.

There are a few new FM residencies (and probably more down the pike) sponsored by a HRSA grant linked to ACA health education reforms that are housed in community health centers with hospital linkage. I spoke with reps from 2 of these programs last week and am interested.

My concerns are primarily 1) new programs and 2) strength of hospital training. I always felt a deficit of my PA training was that I didn't get enough inpatient exposure. I like taking care of sick folks and can see myself functioning as a hospitalist at some point so I need this, but I am not so keen on doing a straight IM residency as I enjoy kids and families too. Ultimately my goal is medical education, perhaps a DME position. I am interested in the PCMH that these CHCs offer.

Would appreciate hearing the opinions of you seasoned FM physicians. There are options to pre-match into these programs which is somewhat enticing to me as an almost-40-year-old woman who likes to know what's next.

Thanks!

Lisa

 

[septoplasty]

Not sure if my opinion will matter but:

Choosing a community based program can have benefits like:
1. Unopposed (especially if you wanted more experience/independence in Inpatient)
2. More exposure to "zebras" because again lack of #1 = more experience.

 

[primadonna22274]

All opinions are welcome! And not just on my listed concerns. Thank you.

 

[cabinbuilder]

Not sure what your question is? If you want a great residency program in FM, look into where I went in Corpus Christi, TX. Unopposed, can set up many elective rotations, autonomy, LOTS OF INPATIENT/ICU rotations, heavy ER rotations. They take at least one LECOM student every year.

You walk out of there knowing how to be a hospitalist for sure.

 

[primadonna22274]

Thanks Cabin, but if I have to go thru the match I would try for FM in my hometown where I already have a house. It is unopposed (McLeod FM, Florence, SC) and well-respected.
My curiosity is there is a new movement of FM residencies housed in CHCs--not hospital based--with hospital affiliation.
I would like to know what folks think about that kind of training. On one hand, most of FM happens outside of the hospital, and I really DO like clinic, and I find it an intriguing twist on traditional GME. OTOH I am a bit unsure about being a guinea pig although I have a track record of starting with new programs--I was also in my PA program's 2nd graduating class.

 

[cheruka]

I am a non-trad DO. I did my last 2 yrs of rotations in a community hospital. I would warn you about the following:
1. Weak Peds, NICU
2. Weak Internal Medicine floor, not-so-great hospitalists
2. While they say it is unopposed, I have not seen the residents do a ton of procedures. The specialists come from private clinics and sometimes accept residents (surgery, ENT, cardiology) from a nearby University hospital. I have never seen a FM resident do chest tubes or actively help a general surgeon in the ER.
3. While the residency claims they are OB-track, the OBs at the hospital did not seem to be all that interested in training the FM residents.

If you want to get good internal medicine training and a Level 1 ER, University hospitals may not be a bad idea. Also, the unviersities are always in the business of trianing students and residents/fellows as opposed to private hospitals where the staff does not necesssarily work for the hospital but rather have privilieges to do surgeries.
Just my two cents.

 

[SnakeOil]

I am a non-trad DO. I did my last 2 yrs of rotations in a community hospital. I would warn you about the following:
1. Weak Peds, NICU
2. Weak Internal Medicine floor, not-so-great hospitalists
2. While they say it is unopposed, I have not seen the residents do a ton of procedures. The specialists come from private clinics and sometimes accept residents (surgery, ENT, cardiology) from a nearby University hospital. I have never seen a FM resident do chest tubes or actively help a general surgeon in the ER.
3. While the residency claims they are OB-track, the OBs at the hospital did not seem to be all that interested in training the FM residents.

If you want to get good internal medicine training and a Level 1 ER, University hospitals may not be a bad idea. Also, the unviersities are always in the business of trianing students and residents/fellows as opposed to private hospitals where the staff does not necesssarily work for the hospital but rather have privilieges to do surgeries.
Just my two cents.

Having done all my med school clinical rotations at tertiary centers and being a current resident at a community hospital, here are my 2 cents.

I would agree with #1. Most community programs are not the strongest in the inpatient peds/PICU/NICU department. Our hospital doesn't even have a PICU or a required PICU rotation. I'm actually fine with this as I don't plan on setting foot in a NICU/PICU once I'm done with residency. Low-acuity inpatient peds is straightforward enough that I don't feel you need a 3-year peds residency to feel comfortable handling most peds admissions.

As far as ob and procedures go, these things seem to be program dependent. Our program has tons of ob, and we do have attendings who are willing to teach the FM residents c-section skills if they are interested. Our program has IR which does make it tough with regards to procedures, however, we have the opportunity to moonlight in the ER which somewhat makes up for this. And the IR docs are usually willing to teach if you ask them. The intensivists at our hospital will also teach residents to place lines/tubes if you seek these opportunities out.

In a community program, you need to be more proactive to get procedures but the opportunities are there. At a university-based program, the opportunity doesn't even exist. In the ICU the medicine resident is going to be placing all the lines and tubes. In the ER, the ER resident is going to be placing airways and reducing dislocations. Same goes for the NICU, peds floor, etc. FM residents are the last on the list for these sorts of things at the tertiary centers, that's just the way it is.

There's no question that community programs offer more in terms of breadth of experience and training offered. That is the advantage of community programs. University based programs offer more in terms of research and opportunities for future practice in academic medicine. It's a trade-off. There are few if any programs that truly offer both. Which, in my experience, most people are ok with. You're either interested in academic medicine or you're not. I wasn't, so I chose a community program.

 

[primadonna22274]

Thanks for the thoughtful replies.
Curiously, I am interested in teaching, but not in traditional academic medicine per se. I would much rather be a working physician educator--in a residency program. This is why this setup appeals to me.
Is it ridiculous that I'm a little anxious about it being housed in a CHC?

 

[VenturaResident]

I am a non-trad DO. I did my last 2 yrs of rotations in a community hospital. I would warn you about the following:
1. Weak Peds, NICU
2. Weak Internal Medicine floor, not-so-great hospitalists
2. While they say it is unopposed, I have not seen the residents do a ton of procedures. The specialists come from private clinics and sometimes accept residents (surgery, ENT, cardiology) from a nearby University hospital. I have never seen a FM resident do chest tubes or actively help a general surgeon in the ER.
3. While the residency claims they are OB-track, the OBs at the hospital did not seem to be all that interested in training the FM residents.

If you want to get good internal medicine training and a Level 1 ER, University hospitals may not be a bad idea. Also, the unviersities are always in the business of trianing students and residents/fellows as opposed to private hospitals where the staff does not necesssarily work for the hospital but rather have privilieges to do surgeries.
Just my two cents.

Obviously with 500+ programs there are going to be a range of different experiences. But I just wanted to say that here in Ventura we are a FM residency based at a county (aka "community") hospital and *all* of our residents are routinely trained in c-sections (as the primary, not as the first assist). *All* of our FM residents are expected to be able to (and routinely do) put in chest tubes in addition to numerous other procedures. *All* our residents learn and routinely put in deep lines. Residents are first assist on essentially every general surgery case in the hospital day and night. These aren't things that we have to seek out - they are a fundamental part of our program from the first day of internship. Our hospitalists on adult and peds are stellar and author clinical medicine books used across the country. We are a Level 2 trauma center (no burn services or peds neuro) and our residents run the Trauma Codes in addition to ACLS Cardiac Codes. We have a PICU and a level 3 NICU (top level, reverse of trauma codes), though to be fair we aren't currently rotating there (though that might change next year). I would caution Cheruka about judging all FM community programs by your medical school experience - there is a large range of what community FM looks like out there.

 

[Bernie3144]

I'm biased so here is my biased opinion - join us in the Navy!

Navy Programs:

Unopposed, community, academically affiliated with USUHS (with great access to resources from USUHS and all military service resources).

Everyone has insurance in our single-payer system. Other things: Better salary ($60+k per year, some tax-free), great health care coverage for your family, a diverse patient population (healthy active duty, dependents/spouses/children, lots of pregnant women, lots of deliveries [approaching 100 as a 2nd year at a facility that averages 40-50 per month], retirees/VA patients (see chronic diseases, behavioral issues and plenty of zebras), broad scope (procedures, procedures, procedures!). Research opportunities are plentiful at each residency program. And, of course, amazing sea stories from our veterans!

Non-deployable during residency. Finish residency, do a tour, maybe get deployed for several months, see amazing presentations of disease around the world, travel around the world. After your commitment, weigh the options of staying.... or going back to the wild 🙂

 

[rbnsafsadgf]

OP -- I don't think most people are understanding what you are asking.

Correct me if I am wrong, but you are asking about community health center based residencies (which are new) versus hospital based ones (NOT community vs. academic within this realm).

Read about these new residencies here: http://www.aafp.org/online/en/home/...ional-development/20130307ntlfmresidency.html

 

[primadonna22274]

Yes Hobbes, this is exactly what I'm referencing. Still very much on the fence myself.

 

[Bacchus]

I honestly do not like the "community" residency idea. I want a program with strong camaraderie and to me, not working with my co-residents day in and out (so to speak), would not make me a happy camper. Also, by working in a resident clinic your learning is standardized. Going to private preceptor offices will probably vary in how you're taught, available resources and cases, etc.

 

[primadonna22274]

It isn't private offices though. The clinic is the CHC and residency faculty are doctors at the facility. The linkage hospital is still strongly involved, but the difference is the clinic is situated off-site. Some of these CHCs the hospital is directly across the street (Virginia Garcia Memorial Health Center in Hillsboro, OR; Tuality Hospital). The group is together but instead of the funding going to the hospital it goes to the CHC to be administrated.

 

[VA Hopeful Dr]

It isn't private offices though. The clinic is the CHC and residency faculty are doctors at the facility. The linkage hospital is still strongly involved, but the difference is the clinic is situated off-site. Some of these CHCs the hospital is directly across the street (Virginia Garcia Memorial Health Center in Hillsboro, OR; Tuality Hospital). The group is together but instead of the funding going to the hospital it goes to the CHC to be administrated.

I think, in my mind, it boils down to one notion. I never want to be in the first few groups doing anything new. This CHC idea might be fantastic... but I wouldn't want to get in on the ground floor.

 

[Smokemont]

I think, in my mind, it boils down to one notion. I never want to be in the first few groups doing anything new. This CHC idea might be fantastic... but I wouldn't want to get in on the ground floor.

Agreed. Perhaps you will be superior to a typical intern given your PA background but residency is where you get the training needed for the rest of your life and personally I wouldn't want the setting up of a new model to interfere with my training.

 

[VenusinFurs]

I honestly do not like the "community" residency idea. I want a program with strong camaraderie and to me, not working with my co-residents day in and out (so to speak), would not make me a happy camper. Also, by working in a resident clinic your learning is standardized. Going to private preceptor offices will probably vary in how you're taught, available resources and cases, etc.

In most of the community based programs I interviewed at the clinics were resident clinics and you'd not usually be the only resident on service (unless you were on surgery months or what have you). I think that tends to be an issue mostly when you're in a tiny residency program.

 

[Bacchus]

In most of the community based programs I interviewed at the clinics were resident clinics and you'd not usually be the only resident on service (unless you were on surgery months or what have you). I think that tends to be an issue mostly when you're in a tiny residency program.

Ok, thanks.

 

[primadonna22274]

Thanks y'all. Honestly I'm still leaning toward my first choice, an unopposed community FM program in a tertiary center with 30+ yr history of putting out well-rounded docs. (Southerndoc, it's McLeod in Florence, SC--10 min from my house--no minor consideration.)
I just like to consider my options.
I wish there was still the option to prematch--would make life so much easier!