FM Residency Reviews 2011-2012

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I'm going to post some of my notes from the interview trail as a way of helping students who are just beginning the search. I'd encourage everyone who just matched (and residents with time on their hands) to do the same. FM is not like other specialties in that there really are a variety of approaches to training, and you can't go by name recognition or rankings when looking for that good fit. If you are interviewing out of your med school region, like I was, you may have very little information to go on when picking programs, and these reviews can be very helpful. I can say that I would have been happy to match anywhere I interviewed at and feel I would have gotten a great education at any of the places. I'm going to write way more about the place I matched at (MAHEC-Asheville) than the others, but I took detailed notes everywhere, so PM me if you have more questions about any of the places. Also ask me about research and underserved curriculums since these were some aspects I focused on in my search, although they turned out to be less important in my final decision than I had expected. After MAHEC, I'll list programs in alphabetical order.

Some notes for 4th years:
-I really recommend doing AI's at places you are interested in. For me, it was a great way of seeing how FM is done at programs that aren't big-city university hospitals. It also changed what I thought I wanted from a program.
-Try to get to National Conference in KC if you can. It's a great opportunity to meet people from programs and it's pretty fun.
-Keep an open mind about opposed vs unopposed. It really is case dependent.
-Be aware of upcoming changes in OB requirements. Programs will be given the option of being OB heavy, OB light, or offering both tracks (I think based on # deliveries, continuity patients, etc). The OB light tracks are in recognition of the fact that not many FM are practicing OB and the precious curriculum time could go to something else. If you are interested in OB, be sure to seek out programs with that certification.
-NC is a great state for FM! Many FM hold positions of state and national leadership, and two big universities (UNC and Duke) have strong departments with big names. You should be able to find community based/full spectrum/suburban/whatever you're looking for.
-If you have special interests, keep in mind that 3 years is a very short time to learn all of family medicine, and make sure the programs you are looking at cover the bases of generalist medicine in addition to their areas of focus.

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MAHEC-Asheville

Overview- I did an AI here on the senior FM service, which admits adults, children, and laboring moms from the clinic. Seeing how competently and independently the 3rd year residents managed this wide variety of patients is what ultimately sold me on MAHEC. They did a great job, despite the fact that an admission could literally be just about anything. And they were fun, happy people. In a way, the other details were almost inconsequential for me, since you can’t argue with the finished product, but I’ll include what I observed for students starting their residency search. If anyone is really interested, I’d recommend scheduling an AI or a couple weeks in the clinic to see for yourself.

Faculty/teaching- Awesome. Not only knowledgeable and compassionate, but friendly and down-to-earth. Everything you would want from a good family doctor and great role models for future practice. Most residents call faculty by their first names. They really feel more like senior residents than bosses. I have heard only good things about teaching from peds, medicine, and OB attendings as well. I saw firsthand the relationship between FM residents and OB residents/faculty and it is truly great—a very different learning experience from what I was exposed to in med school. I think the OB education benefits from having the OB residency in-house, because you can always curbside OB attendings and seniors. Many MAHEC grads practice OB in the area and manage their laboring patients with the help of the FM service, which tells me that the OB education is definitely adequate. Of note, the strength of OB at MAHEC was initially a negative for me, since I didn’t plan on practicing in it and didn’t want to spend all that time learning it, but I enjoyed it so much there that I’m having second thoughts about an OB practice. Peds is also very strong as the clinic has a good percentage of peds patients (by maintaining their strong OB) and the hospital itself is the Western NC referral center for all peds.

Residents- fun, down-to-earth, outdoorsy, extremely competent. Everyone I met really knew their stuff. Let’s be honest and admit that this is not always the case in FM residencies, unfortunately. But in my experience, MAHEC residents could have gone into anything and are really passionate about FM. One intern did leave the program while I was there, but it was a highly personal set of circumstances, was entirely that intern’s decision, and had nothing to do with performance issues.

Schedule- I don’t remember the details of call. I noticed that no one was really complaining about it, and that was good enough for me. I wouldn’t be surprised if interns used their 80 hours pretty frequently, because the inpatient schedule seems intense, but I didn’t catch a whiff of work hour violations. Of note, intern year is almost entirely inpatient, but I talked to a lot of cheerful interns in the dead of winter, so it can’t be that bad. The year is divided into 6 week blocks of medicine, peds, OB, and a primarily outpatient surgery/FM clinic block. You go through each of these in the first half of the year and then repeat them in the second half. Like most places, focus shifts to outpatient after intern year with the exception of senior months on peds/medicine and the senior FM service.

Facilities- It’s a really nice hospital. Ancillary staff members are so great. I was continually surprised at how nice they were to me. A random resp tech and PICU nurse—neither of whom were affiliated with the residency--walked me through a neonatal resuscitation out of the goodness of their hearts. I am sure that being nice to me didn’t add anything to their paycheck; they just wanted to teach me something. Very different from my inner city safety net hospital experience in med school. The residency has a nice outpatient clinic that they’re outgrowing with the upcoming addition of some fellowships. A new one is slated for construction in the next year or so.

Perks- unlimited free food all the time in the hospital! And it’s pretty decent, too. It may seem like a silly thing to get excited about, but not having to pack lunches x 3 years is a huge savings. Also, you get to wear scrubs on any inpatient rotation. I hate having to wear nice stuff in the hospital when you’re checking diabetic foot ulcers. Protected didactics on Wednesday afternoon with protected volleyball time right afterwards. (The fact that there is a resident/faculty-only volleyball court behind the clinic speaks volumes about how MAHEC feels about resident well-being.) Salary and insurance stuff is standard. I think there are a lot of global health opportunities, but I’m not too interested so I didn’t ask about it. Asheville is the best place ever, IMO. Mountains, outdoors stuff, young/progressive population, great food, great beer, great nightlife, manageably small and walkable, very close to where I grew up.

Cons
Underserved- I have a big interest in underserved populations, and although you will encounter underserved patients here (including a growing Hispanic population), it’s not built into the curriculum. Of course, everyone is sensitive to the needs of the underserved and some individual residents and faculty have a particular interest in it, but it’s just not emphasized with FQHC rotations, etc. like it is in a few other residencies I interviewed at. I think this is because FM residencies are still only 3 years and at MAHEC, a program leaning towards the full-scope FM side of things, these 3 years are jam-packed with clinical stuff already. Anyway, the faculty will accommodate you if you create your own opportunities.
Research- it’s a major interest of mine, but like most FM residencies, it isn’t really a focus of MAHEC. There are individual faculty members with publications. I do plan to go into academics and have a research career, but I decided that the clinical strength of MAHEC outweighed the lack of research opportunites by far. There are always fellowships for research, but you really need to nail down clinical competency in residency.
Elective time- Not as much as I’ve seen in other places. Like I said, the three years here are pretty full. There is an option (as in many FM residencies now) to stay an extra year as a junior faculty while making your own curriculum.

I ranked MAHEC #1 and was ecstatic to match there. I’ll learn more as I start intern year, so PM me if you have any questions.

 

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.Ball Memorial/IU.

.This was the fullest-spectrum program I applied to. It ended up being a little too “cowboy” for me, but that’s because I know I won’t end up in that type of practice. If you are interested in full scope FM, I’d encourage you to take a look (give Muncie a chance!). Residents do colonoscopies, endoscopies, surgical OB, wacky OB (I heard a tale of a vaginal delivery of twins in breech), global health, lots of procedures, and sports medicine. The Muncie community allows people to do these things in practice, too. The clinic is nice and new and the hospital facilities are good. The faculty is really great. They’re all called directors and each has their area of focus. Many are Ball grads who returned after some time in practice. All are friendly and approachable. The perks at this program are insane. Something like a 5k primary care bonus plus a 3k “moving” bonus that you can use for whatever in addition to a competitive salary in an area with low COL. Also, directors pay for an annual trip to Gatlinburg, Mexico, or somewhere with money out of their own pocket for residents..

.Cons: Muncie is cold and far from home. I also didn’t like their inpatient rounding system, which is designed to mirror rounding on hospitalized patients in the real world. Instead of the team based inpatient approach, you go one-on-one with faculty on the clinic patients that are in the hospital in the morning before whatever your 9-5 is on that particular rotation. I’m sure it’s good prep for the real world, but I prefer being able to bounce ideas off a lot of people in an inpatient team..

 

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.Carolinas Medical Center.

.I was really intrigued by the Urban Underserved track offered at CMC and did an outpatient rotation with them to check it out. It was a great experience. If you have worked in the underserved care world, you're probably used to unmaintained facilities, inadequate support staff, and funding issues. But CMC has really funded the Biddle Point clinic (the urban underserved site) in an effort to promote health in the predominantly African-American neighborhood after identifying it as a "hot spot" for avoidable ER visits and admissions. It's nice to finally see low-income populations get great care. Most of the faculty at that site are themselves Biddle Point grads and are extremely competent at dealing with a sometimes difficult population. I loved the patients, too. I also got exposure to local community advocacy organizations and there are substantial opportunities to get involved with these as a resident. The program is adding residents to Biddle Point and starting an underserved Hispanic site with 2 residents at NorthPark in the next few years. These tracks only differ from the main CMC program in that your continuity clinic is at one of the sites. Everything else is done with CMC-Main residents..

.The main CMC program is also very strong. It's not what you'd expect from a opposed program in a big city. CMC-Main is massive and is the site of a lot of intern year rotations, but the only complaint I heard about it was for the surgery rotation, which will be moving to one of CMC's community hospitals (CMC-Mercy) as a result of the complaints. Mercy is already the site of the FM inpatient service and is unopposed. It's Planetree designated and a great place to work. The main clinic is brand new and extremely fancy. There's video precepting, procedure rooms, EMR, and a bunch of other stuff. There's a strong Sports Medicine fellowship and the practice is PCMH and an NCQA diabetes something or other. CMC is another UNC umbrella program and there are options to stay and get an MPH in a 4th year or things like that..

.I think that CMC has an exciting program. It was already very strong and has been turning out great residents for years, based on my experience with faculty graduates. Now they have a national leader as chair in the form of Dr. Dulin. He's an MD/PhD with an interest in research and underserved care, and he has been raking in NIH funding at a clip that few FM faculty achieve. I met with his research coordinator and they are doing some really great and innovative work with community based participatory research in the local Hispanic community. The institutional support of FM and primary care from CMC is very strong, despite it not being a research university program. They have really put money in the idea that strong and comprehensive primary care prevents bad outcomes and more expensive care down the line. Definitely check this place out if you are interested in underserved care. It would have been a very difficult decision for me if my fiancé had been at all willing to move to Charlotte. (Nothing wrong with Charlotte, he just doesn't like big cities.).

 

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.Duke.

.Note: You may or may not be familiar with the rocky period Duke went through a few years back (early/mid 2000’s?). Basically a number of residents/faculty left the program en masse due to dissatisfaction with the direction of the program and the training. They have since rebuilt the program from scratch with a new PD and a bunch of new faculty. The chair is the same, but I didn’t hear anything negative about him while I was there. Duke is now an extremely innovative (albeit unorthodox) program and if you are not interested in full-scope or rural practice, I encourage you to give it a chance. It was eventually my #2 choice, and it would have been a much tougher decision if it weren’t for geography..

.Duke is casting itself as an “outpatient specialist” program. I think this is laudable, because outpatient is hard and it’s what most of us FM will wind up in. To emphasize the outpatient experience, they’ve eliminated their inpatient service and clinic patients are admitted to Medicine. They rotate with UNC’s excellent inpatient service to get the knowledge, but by not having their own service to cover, there is a great deal less inpatient call required, freeing residents up to do their own thing. (As an additional way of compensating for the lack of an inpatient service, residents take turns doing kind of observational morning inpatient rounds on FM clinic patients that are admitted to the Duke medicine service so they can see what the inpatient management is and leave input for the inpatient team without the responsibility of managing them.) The PD really feels that this is the way of the future for FM programs that don’t intend on producing graduates who admit their own patients and deliver babies. Let’s face it, this is a lot of us. But he will tell you up front that if you have any aspirations of full time hospitalist work or full spectrum, you should probably look elsewhere..

.What this leaves time for is a lot of cool stuff. Rotations in health policy, state medical associations, research, community health centers, and whatever else residents can think of and arrange. Your weekends and nights on call will be a lot less, although the PD will tell you should fill this time with work on independent projects that you have an interest in. The clinical stuff that you need to be good at in the outpatient world is still there, and probably more emphasized because of how much time is freed up by the cutting of the inpatient service—there is a lot of time spent in the ED, urgent care, and procedure clinics/simulations. Also a lot of practice management and PCMH. Research opportunities are abundant. They have a really great underserved setup. In addition to your regular clinic time, you start working in community health centers once a week and help set up community improvement projects with them. This program is relatively new, but they have already managed to accomplish some interesting things..

.Cons: Obviously, it’s not for everyone. In addition, the Duke system has a bit of a malignant rep. I got the feeling that a few off service rotations (surgery and cardiology were mentioned as offenders) were scutwork experiences or had people with anti-FM attitudes. Duke is still a specialist-dominated, tertiary care hospital, although higher ups are trying to change that and get into the public health/primary care dept. But keep in mind that most of your residency will be in friendlier areas, including the local community hospitals..

 

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.Moses Cone.
. .
.An amazing program! This shot way up my list from the bottom after interviewing there (I knew nothing about it beforehand except that everyone was nice at National Conference). It was my #1 for a time. This is one of the oldest FM residencies in the country and its status in the Greensboro community is well-established. It would prepare you well for just about any clinical practice you can imagine. There is an IM residency, but it is much less well thought of than the FM residency and I think the ability to share some call with them was actually cited as an advantage. You will run codes, manage ICU patients, and do whatever you want to in the ER. Faculty are really great and the PD is awesome. There is a lot of exposure to practice management and population management, and the clinic is a PCMH with onsite psych, pharm, nutrition, etc. Sports Medicine is run by a nationally known faculty member and there is a fellowship. Lots of procedures, including endoscopy. Lots of peds patients. They plan on offering both OB heavy and light tracks. There’s a good underserved curriculum as the clinic population is primarily underserved (including Hispanic) and you can train in medical Spanish with one of the interpreters in weekly Hispanic clinic. There are also rural health rotations available. Lots of flexibility in the curriculum for electives, and Moses Cone is under UNC’s umbrella so you should be able to find anything you want..
. .
.Cons: Greensboro is not the most exciting place, though I hear it’s great if you have a family and the COL is certainly low. The hospital is a bit dated—not a big deal..

 

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.University of Cincinnati/Christ Hospital.
. .
.This is definitely a program to look at if you are interested in care of the underserved. Most of the residents and faculty I met picked the program for that reason. The underserved curriculum is integral to the program, but not at the cost of solid FM teaching. Like Duke, you can add a continuity experience in a FQHC or free clinic to your regular clinic time. Also a leader in global health with a history of being involved long before it was so popular. Even interns get to go on global health rotations. Several faculty members are extremely prominent in health policy research (Robert Graham of the Robert Graham Center and its current director Andrew Bazemore, for example). The chair, Dr. Diller, is also an interesting guy (one of the most enjoyable and thought-provoking interviews I’ve had) and is highly respected. The PD and clinical faculty are young, energetic, and competent with lots of focus on EBM and cost-effective care. Christ Hospital is a highly ranked community hospital that is building the FM residency a new clinic on campus, and it seems to be highly supportive of the residency. There is an IM program there that doesn’t seem to affect FM at all (it’s less respected). And the resident dinner I went to the night before was hands-down the most fun I had all season. They attract some really clinically strong residents with a passion for underserved care, and their option of a dual Psych/FM residency makes that aspect of the education very strong as well..
. .
.Cons: I don’t like Cincinnati, but a lot of other people do..

 

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.UNC-Chapel Hill.
. .
.UNC is a giant in FM research, policy, and advocacy. The faculty here are some of the movers and shakers of primary care on both a state and national level. The FM chair is the Dean of Students or something at UNC’s med school, and numerous other FM faculty hold important positions in UNC’s hospital/GME/school system. If you are at all interested in policy, systems research, or underserved care, you should definitely check them out. They also just started an underserved track similar to CMC’s where your continuity experience is in a Hispanic rural FQHC, and a number of graduates practice in rural or underserved areas. The sheer number of faculty is huge and you should be able to find something tailored to your interest. I was actually very surprised at how well-rounded this program is, given its academic/research reputation. I have no doubt that the clinical education would prepare you for just about anything short of full spectrum, and you can do electives that would you set you up for that if you wanted. Not all residents are research minded either—a good percentage of them plan on entering private practice in a variety of settings, including hospitalist work and OB. The inpatient teaching is very strong—even Duke mentioned it as a pro in selling their inpatient experience (which they share with UNC). There is also a nice amount of diversity in the class for the South. Of course, the clinic is certified PCMH/Diabetes/everything, since the faculty were probably some of the people who came up with those various initiatives. .
. .
.Cons: You have to do a bit of driving to get to WakeMed in Raleigh for some of the intern year rotations, depending on where you live. Housing market is more expensive than other areas in the South..

 

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.UT-Chattanooga.
. .
.A hidden gem, in my opinion. Chattanooga is a great town close to the mountains and Erlanger/UTC is a nice mix of academic and community hospital. The FM department under Dr. Worthington has really increased its standing among the other residencies. For example, various surgical services consult the FM service (not IM) for medical management of their inpatients. Also, FM manages their own ICU patients (open ICU). No one had anything bad to say about their treatment on off services, and you can tailor your ER/surgery experiences to be as intense as you want them to be. Teaching under Dr. Adams (the PD) is highly praised. He seems to be a great guy with an eye for resident satisfaction and education and is hiring new faculty with interests in clinical publications, etc. I liked all the residents I met, and the program went out of its way to interview me on an off day. The clinic was specially designed by Dr Worthington to have everything an FM could want in a nice layout, and its design has been copied by others. There’s xray, U/S, a procedure room, and it’s currently seeking NCQA PCMH certification..
. .
.Cons: there is some question about the future of the OB education as the low-income clinic they got patients from is changing its insurance policies in some way that makes it difficult for FM to work with them. Most likely this will become an OB lite program..
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.Wake Forest.
. .
.This is a very solid program. There isn’t anything wrong with it, but for some reason, it didn’t reach out and grab me on my interview day. Interview fatigue was likely to blame. It’s well established with a big clinic and large resident classes. Of course, WFU is an opposed academic center, but they attract really good FM residents and I doubt respect is an issue. You’ll have the opportunity to rotate through a major ER and work with well-respected specialists on your rotations. The clinic has moved off the WFU campus and seems to have benefitted from the additional space and sense of independence—nice clinic facilities. Everyone was very friendly and there were a lot of interns hanging out at the dinner the night before. The PD is great and approachable (and Mary, the PC, is everyone’s second mom). There are some opportunities to work in free clinics and FQHC’s through certain faculty members with interests in those areas (Dr Cassidy-Vu and Dr Lord), although it is not that well integrated. Winston-Salem is similar to Greensboro, maybe with a bit more night life? I’m not sure. Don’t be turned off by my lukewarm review of this program if you think you might be interested (and don’t schedule 3 interviews in a row if you can help it)..

 

[aterry]

I wanted to say a big THANK YOU for taking the time to put together all of this very helpful information! You rock and congrats on getting your #1 choice!!!!!