FamilyMed Program to Avoid

[Foxglove]

I'm a former resident of the malignant program at Cabarrus Family Medicine in Concord, NC. I posted a review on Scutwork.com, which I will repost here for those of you who need to have this info before match day. Sadly the admin at Scutwork deleted it after someone else, a supposed intern there posted a glowing review. Seems like they only want to post the good reviews & not let people know the downisde to a program.Evidently this poor soul doesn't want to get stuck with all the scutwork next year when the program doesn't fill. Either that or it's one of the administration trying to cover-up & continue filling their program so they can continue buisness as usual, abusing residents. If it was such a great program you would expect more of the residents to have posted singing the praises of the most wonderful program in the world, but you can guess why they don't. wouldn't be surprised to see more glowing reviews pop up to try and counter the truth......Best of luck to all in the interview season.


The typical day on inpatient service starts at 7 am where you have
"lightening rounds." Discussion usually centers around what mistakes in admission or treatment orders were made. Not so much to get you thinking as to try and inflate the egos of some of the insecure attendings. They seem to think they will look more important and intelligent if they can pick a treatment plan apart. No suggestions just attacks. Make sure you don't show up late even by a minute. That is unless you like even more abuse. Reasons don't matter to this group you are either there or you get crapped on. If patient care plan questions are asked then it is seen as a sign of weakness. The usual response is "you need to look that up", "why don't you know that??" or "it's your patient, you better find out." There are 2 interns 1-2 second years and 1-2 third years with one of the third years acting as chief. Along with 2 attendings and a "Overflow attending" you get to take care of an inpatient census that can and does run between 30 and 60! They say that they are trying to cut those numbers down but the program makes so much money using the residents as cheap labor, I'll believe it when I see it. For some in the chief position it is an opportunity to abuse lower level residents, try and look good to the attendings while not really doing any work (a malignant, graduate from last year was great at this "yes sir I'll get right on that" then dump the work in an interns lap, The program actually HIRED this guy to work in the residency. So good luck if he's supervising YOU.) This kind of behavior by upper level residents is far from discouraged, it's actually rewarded. After the non-learning lightening rounds which get over at 8, you get to round on your patients (Up to 10 for a first year) & be done by 11 for another useless lightening round meeting. God help you if you haven't finished rounding & writing orders on your patients by then. It's advertized that there is teaching at these 11am meetings but it's kind of hit or miss. There's one (recent graduate, recently hired attending) who actually thought it was teaching to print an UptoDate article & then read it to us. (Thanks we can read.) Occasionally there is something worthwhile taught but not as often as you would hope. Call is Q3. You may or may not get any sleep. As a lower level you answer all in-house pages for the 30 to 60 patients this can be up to 50 calls a night. Along with an upper level (who may or may not be helpful) you admit thru the ER. The worst night I can remember was 9 admits. Most of the time the attendings show up to look over your admit notes. One notable incident, the intern paged the attending about a patient she was worried about, the attending just gave a few orders to be written but didn't even get out of the call room bed. The patient just about died....and ....you guessed it....the intern got reamed....Lazy attending, reamed intern.
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Teaching: 2
The program advertises bed-side teaching...in your dreams, never saw it, never heard of it happening by attendings at the program. The outside attendings of other rotations were usually very supportive. There is a noon conference on Wednesday that can be good though, when outside specialists come in. Pediatricts, cardiology, urology, ENT and the in program PharmD Sandy are all excellent. In program attendings are hit or miss, some excellent some....not.
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Moral: 1
Check the list of current and past resisdents and you will see there are spots vacant every year or so. This is because people quit due to the malignant nature of this program. Over half of my class were sent to the psychiatrist for evaluation by the insecure program director. His explanation in a conversation I had with him was "I have this need to fix people" Maybe he's sending the wrong person! Every year the program feels the need to form a group and ride 2 or 3 residents to the point where it's not unusual for someone to quit (I did). More residents would quit but most buy houses & selling after one year would kill them financially. I didn't care, lifes too short to put up with this kind of treatment. The reason there isn't more vacant spots is the residency recruits in whoever & however they can to fill the vacancies. This years class didn't fill even though there were numerous 4th year med students who rotated thru. One 4th year quit the rotation after being ridiculed and called stupid by one of the recently hired graduate/attendings. After seeing & hearing the treatment the residents get only 2 of the med students applied and not one of them ranked the program!
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Research: 1
Avoid this malignant program. There are too many good programs out there who see teaching as an opportunity not a burden and know how to treat their residents with respect.

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[ryann04]

Usually, I keep my thoughts to myself. I understand that people have different reasons for liking or not liking something. However, I feel that the program is being wrongfully slandered. Most of us in the program just thought that you, Foxglove, would just go away but you continue to linger. Perhaps, you are just upset that you changed programs and regret the decision. What ever your reason, I feel that I must talk about the program. There is no need to defend it. The program does that for itself.

I am an intern at the Cabarrus Family Medicine program. I encourage anyone to send me an e-mail directly so that I can verify who I am. First, I have been nothing but pleased with the program. I have seen amazing patients and have worked under many great physicians. In medical school, I can honestly say that I never spend more than 4 weeks at any hospital. (My school did not have a hospital that belonged to us.) The caliber of most the physicians here matches that of any top physician I have worked with. I say this under my own free will. The teaching is great and I already feel that I am well on my way to become a competent FP.

Second, I have never felt more welcomed and this continued even after interview season and the contracts were signed. Everyday I feel more like a collegue and not just another resident. This is refreshing because I have seen many programs where the line is so distinct between attending and resident. Also, I have never felt scuted. I realize that residency is a time for learning. Having to admit multiple chest pains and dictating patients is a part of that. Besides, it is only for 3 years. Foxglove, I am curious to know what scutwork you are talking about? Maybe it exists but I am not seeing it.

Third, this year my class did not fill. We had only six; however, starting in Jan we will be getting a new collegue and yet another in the summer. Amazing how things work out. That will make us a full class. So, if our program does not fill, oh well. I will still go to work and do my job. If I have to take a couple of additional calls, yeah I might not be happy but it is a part of learning. In the end, I will be a better FP.

Fourth, I will admit this program is not for everyone. If you need your hand held, don't even consider this program. I can say that 99% of the time you are making the decisions for a patient's care without the attending standing over you. Sure, they follow-up behind you to make sure your not going to kill someone. Likewise, you can always call an attending and ask a question if you need help.

Fifth, I will agree that the inpatient service is very busy. I prefer this and not a day goes by that I don't feel I made a difference in someones life. Once again, this program is not for everyone. Procedures: I have done many thus far. Derm procedures, circs, LP's, intubation, lac repairs (OB and trauma), casting. Many more to come; however, I am still a first year. With this said, they will not just fall into your lap. If you want them, they are there but you will need to go out and get them. Once again, this program is not for everyone.

I can go on but I will wait for a reply from Foxglove or anyone else and will try to answer all questions as best as I can. Would I sign to this program again, absolutely. If future residents don't come and look at the program, then it is their loss. I feel that with so many good programs around the area, that Cabarrus still remains a great secret. Maybe the word will get out one day, the program is only a couple of years old. If Foxglove actually could see through the yellow that clouded his vision, he might have realized he was at a terrific program.

Please send me messages through this site. I would love to hear from anyone, including you G.

 

[Laryngospasm]

You realize you just described a typical IM intern year, I dont know about FP though. 50 pages a night? I went past that many times as an intern. I feel your pain though, if id had to do it for more than one year I would have quit.

 

[Foxglove]

Just a quick update kids....
This residency has managed to have another resident quit. Make sure you ask about it if you decide to interview here...I can see it's business as usual...
LOL

 

[NCdoc]

Just to clear up a few things. The posting Foxglove speaks of was removed because it was, in large part, an ad hominem attack on our residency. The criticism that was valid was marred by slanderous and unprofessional remarks, as well as riddled with inaccuracies. As to the "malignancy" of our inpatient service, we have been fortunate enough to already sign a medical student that rotated on this service last summer. Take the wrath of Foxglove with a grain of salt.

I wish to take his review point by point, but first, in the interest of full disclosure, I am a third year resident, and although the program is not perfect, I am proud of it, and I am confident in my inpatient and outpatient skills.

To start, what he refers to as “lightning” rounds, are actually “checkout”. That is, significant overnight events and new admissions are discussed, and then we break for actual “rounds”. Checkout is a time to discuss management of patients when most everyone is sleeping and thus a time to focus on managing patients independently, but this never involves the degradation of another resident. As to timeliness, guilty as charged. As residents and physicians we have respect for the time of others, especially that of the post-call team, which either needs to finish checkout and then round, or may go home immediately afterwards. Punctuality is important.

As to structure, it’s 2-3 interns, 1-2 second years, and always, and only, one third year, who is responsible for all in-house calls and admissions while the rest of the team is rounding, and rarely does this job entail lounging on the couch and certainly not unless everyone else is lounging as well. Yes, inpatient service is busy, at times too busy. But again, after second year, all of us are comfortable rounding on 10 patients each morning. As for the much maligned attending, the previous ex-intern knew him for perhaps, 8 months. I’ve known him for almost three years and consider him a good friend. I’ve also worked with him many times this year as a first time attending and he does his job professionally and I honestly have not heard a single complaint against him. In addition, he works as “overflow” and thus never supervises residents.

Back to checkout, it’s over at 7:30 at the latest, not 8. Teaching is at 11:00 everyday except conference day (each Wednesday) and is conducted by the third year resident or by various attendings. Call is not Q3, it averages Q4 (that is 7-8 calls per calendar month). We work two weekends (a Friday/Sunday and a Saturday), which allows 2 weekends off a month. Some residents do not like Friday/Sundays and easily swap with other residents. As far as sleep goes, I’ve done about 75 calls, and only once have I not lain down. Call is exhausting and usually busy, but that is the nature of our profession, and I’m certain, much worse for other specialties. I’ve never had an attending refuse to get out of bed, there is always one in-house, 24/7, and he is always willing to see a patient. However, he can not read minds, and if one is concerned, one needs to ask him to see the patient. However, an intern is always on with an upper-level, who will always see that patient if the intern is uncomfortable. As residents we handle as much as we can on our own.

As to teaching, some faculty are good, some are great, and some are fair at best, but how else could this be?

Yes, we have had at least one resident leave from 2 of the last 3 classes. And yes, one is leaving soon. Surely this fact alone, taken out of context, is concerning, but their reasons for their leaving are not sinister, and can be easily discovered. I would urge any interested candidate to discuss this matter further with our program director, as well as current residents, and the the more the better. This program is simply not malignant.

Malignancy? Call on other rotations is very benign and unless on inpatient or OB you can expect to work about 40 hours a week. The faculty, especially the program director, is responsive to resident concerns. We’ve recently allowed third year residents who will not be practicing OB to opt out of a third month and instead spend it on elective time. The chief residents are sent, all expenses paid, to two leadership conferences; last year in Kansas City and San Francisco. Every October we have a resident retreat, paid for in large part by the hospital. This is a time all of us have off to spend relaxing and getting to know each other better. We are all off because our faculty cover the inpatient service for that weekend by themselves. Part of the new intern orientation is a party at an attending’s lake house. Scheduling could not be more flexible.

Downsides to the program. The OB experience here is fair at best. Procedural skills require “go-getting”, but are not difficult to obtain. Inpatient is busy.

Upsides to the program. If you come here you’ll develop inpatient skills that I would put against the best family medicine or internal medicine residency in the nation. We easily exceed requirements in our outpatient settings as well. As an intern you will be discussing your patients with attending surgeons, cardiologists, etc, without a go-between fellow or resident. The program is exceedingly flexible, and is very family oriented. There are things that could use improvement, but the attitudes of the faculty and staff are not one of them.

 

[NCdoc]

A few rules posted by SDN that must be agreed to before registering on this site :

Be courteous. It goes a long way.
Harassment and Flame-Wars burn everyone. Again, be courteous. Just ignore those guests that can't discuss topics professionally.

Just a quick update kids....
This residency has managed to have another resident quit. Make sure you ask about it if you decide to interview here...I can see it's business as usual...
LOL

 

[cfm intern]

I am the Cabarrus Family Medicine intern who wrote the response on scutwork.com. As I invited you previously, please contact our program any time with questions from me. To make it perfectly clear that I am no imposter, my names is Bobby and I am extremely proud of our program. I looked long and hard before I decided on this quality program and have had my expectations exceeded.

The residents are of the highest quality. The residents are a tightly knit group from all over the country. They are diverse, smart and down to earth. We work well together and frequently help each other out with call switches as needed. The intern class is brilliant (a love for the class of 08 The chiefs are outstanding. They are responsive, concerned, and both awesome teachers. They hold a once a month social gathering at a local restaurant. There are frequently kids in our call lounge. And then there is poker night, if you please. One of our residents went down to Louisiana after the hurricane and provided emergency services in a shelter in New Orleans. Talk about an allstar. Our program director excused her from her rotation on short notice without hesitation. Another one of CFM's finest is going on a mission trip to the Dominican Republic in March with two of our attendings. I feel lucky to be training beside such amazing people.

The attendings are great. They all have their unique styles. Many are the true GP's. They do everything. Some are gifted academic teachers. Others are very procedurally oriented and others like for you to learn by doing. The balance provides an ideal learning environment.

The pace on our inpatient service is busy. Everyone agrees that the learning speeds up here. As you know, there is so much about outpatient medicine that you learn from doing inpatient. You do 4 months intern year, 3 months second year, and 6 weeks third year. It's busy but awesome. It is q 4 call with 2 weekends off per month. Because it's a community program you can switch up your calls readily, so you can get all of your call done each month or spread some over the year. The pathology you see is astounding. And the families you get to know and take care of are even more incredible. Specialists will call you on your phone and tell you what a cath or endoscopy showed and what their recommendations are.


Finally, CFM impacts a huge community of patients (around 70,000) that rely heavily of the family medicine model. We take care of kids, adults, women's health, and geriatrics. The hospital is unbelievably well run and nationally recognized. The support staff of the residency takes care of us like we are family. We work hard and play hard. You don't want your residency to be too easy or you won't be prepared when you graduate. You don't want it to be too hard because you want to remain physically and mentally healthy and not become synical during this time. Cabarrus is the perfect blend. I'm very happy here and haven't questioned my choice to come once. I encourage you to think strongly about this program and contact us anytime with questions. Thanks, Bobby

 

[rfan]

I have no connection to North Carolina and had no intention of applying to this program (As if that claim of mine could really be established on the web ), but I find the "rebuttals" just as guilty of being an ad hominem attack as Fox Glove's.

It's disturbing to me that this program is going out of its way to prevent applicants from hearing opposing viewpoints by having scutwork remove the review. All this will lead to further problems with unhappy current residents and possibly lead to unhappy future applicants who didn't get the whole picture prior to match. Definitely, not the way I would have handled this one.

 

[NCdoc]

Reviews are removed when former residents personally attack faculty by name.

Again, all 3 rebuttals have invited prospective applicants to contact them personally. We are very open to discussing the drawbacks of this program, but we simply must dispute falsehoods and inaccuracies.

 

[secondcareer]

I would personally like to thank Fox Glove for choosing to leave the Cabarrus Family Medicine Residency Program. I am the resident who took his vacated spot in the second year class. As may be apparent from my login name, Family Medicine is a second career for me. I was formerly an Anesthesiology resident at a large institution and then worked in an emergency department for 5 years while finishing law school and practicing health care law. I decided to be a doctor with a legal background rather than an attorney with a medical background and sought out a residency program that would enable me to pursuit women's health, hence family medicine.
CFMR is a great program, but it is not for everyone, as no program is. There is no one universally perfect program suited for all adult learners. I would strongly encourage all applicants of any specialty to thoughtfully evaluate his or her personality and learning style prior to choosing any residency program. I was looking for a program where I would not be just a number or "another resident" having already experienced that in my former residency, therefore, I looked only at unopposed programs. CFMR is unique in that it is the only private practice with a residency, with inherent limitations and strengths due to the very nature of the design. There is not likely any other environment in which a resident will be better prepared for life in the "real world" of practice, because that's what this program is. On the other hand, the patients are private patients and "experimenting for practice" doesn't happen very often. I have yet to experience being treated "like a resident" at this program. We are not second class citizens simply because we are still in our residency. The nurses, staff, and other physicians all treat us like doctors. I have never once been out of the loop in the treatment and management of my patients because I wasn't "important" enough to be informed. My patients call themselves my patients. This program allows us to be exactly what we are training to be.
This environment may not be what all applicants are looking for, and afterall, we are not looking for all applicants. As adults and professionals, I am confident that anyone reading through the posted commentary by Fox Glove realizes that there is always two sides to every situation. I am sorry for Fox Glove that he left on his own accord with such a bitter taste in his mouth. I only hope that he is as happy in his new program as I am in his spot here at CFMR. I, too, am open and available for any emails, questions, etc that anyone may have about this program.

 

[doc2k6]

I rotated as a medical student. I must say it is very disturbing that a resident/year is leaving and now another resident. If a place can not keep their residents happy, that is a big red flag. The rebuttals are also very unprofessional. That being said,

The most unique quality about the program when I was there is that it is the only program in the country that is a residency within a private practice. However, becasue of this fact, there was a culture there that there is no time for teaching, only time for making the practice money. There also seem to be competiveness between the resident that created a malignant atmosphere. The interns seem close, but the upper level years do not. Most of the residents seemed unhappy there. The inpatient census is too busy. There is no time to read up on patients. Many residents told me it was a sink or swim program, and that the program expects one to be on an attending level once they arrive. I think that is true. And that can be very disturbing and or challenging to say the least.

Also some residents seemed to be treated differently than others for whatever reason. A very judgemental group of residents when I was there. Staff and patients seem to be indifferent to women and people of diverse backgrounds.

The strengths/weaknesses: 1. Nice hospital 2. Heard other rotations very easy with light/home call. Even heard that some rotations have call but not expected to show up. 3. Unable to obtain OB deliveries. 4. Lack of procedural training 5. Little OR experience 6. Little if any inpatient pediatrics.

These were complaints from the residents.
For me these are weakness, for others maybe strengths. Either way, there are just too many programs out there these days to even take a chance.

 

[KatrinaCFM]

I am a new resident here at Cabarrus Family Medicine (CFM) and felt that my program perspective would be of interest to readers of this forum thread. I am actually a Katrina evacuee who transferred to Cabarrus Family Medicine in the late post-hurricane aftermath. After an interview and an opportunity to meet faculty and residents, I was accepted as a transfer to CFM. After a three-month hiatus from medicine and only two pre-Katrina rotations, my perspective is truly one of a new intern.

Right from the start I found the program faculty, staff, residents, and hospital staff to be extremely helpful and accommodating. All rotation schedules were made around my personal schedule, as far as call, vacation, etc. Every Wednesday is protected conference time and you are guaranteed 2 weekends off each month. In addition, resident perks such as PDA, moving stipend, CME stipend, etc., are readily available and given even before I had the opportunity to ask.

This program most certainly does not hold your hand. You work quite independently and are treated as a professional colleague rather than simply a resident, and are expected to act accordingly. Help is always available should you need or want it and your clinical management is followed by the attendings, with discussion of necessary changes in management.

My first rotation in January ’06 was the in-service rotation, which is far from scutwork. The day starts at 7am with rounds regarding any overnight occurrences or admissions. The typical in-patient list is 50-60 patients so rounds move rather quickly. There are typically 5 residents, 2 attendings, and an overflow team (one attending and a nurse practitioner) who care for this patient load. As an intern I am responsible for approximately 6 patients. After the 7am rounds I have until 11am to round on my patients. Again, this is far from scutwork . . . your patients are yours to manage. The attendings round separately and are available on their companion phones as needed for advice or support. At 11am is a 30-minute lecture from the 3rd year resident on the team. At 11:30am are rounds once again. This is the time to update the team and your attending on your patient (if you haven’t discussed the case with him/her already). If the attending happened to make any changes to your plan of care then it is typically discussed at rounds (unless you have been in contact throughout the morning). After rounds the team typically eats lunch together, then the afternoon consists of admissions, discharges, and follow-up care on your patients. Checkout rounds occur at 6pm.

In-service is an extremely busy rotation consisting of long hours (up to 80 hours per week), hectic call (as there are 2 residents and an attending for 50 patients), and excellent learning experiences. My average patient load included a newborn exam, a chest pain patient, a questionable CVA, an oncology patient, and CHF exacerbation. After one month of service I feel confident managing these and a wide variety of conditions and diagnoses.

I wasn’t here when Foxglove was at the program so I cannot comment on his experiences, but clearly ours have been quite different. I am responding to his comments to let others know that not all have had a similar experience here at CFM and I am certain that other CFM residents will feel the same. There is certainly a family atmosphere here that is not apparent on a message board. Any residents interested in our program should take Foxglove’s comments into consideration, come to visit the program, and decide for yourself. There isn’t a program that fits everyone, and I hope Foxglove found his niche. As for me, hurricane Katrina worked out for the best. I am extremely happy and proud to be a part of the Cabarrus Family Medicine Residency Program.