Kaiser Family Medicine Training

[goldrays]

What is the opinion on getting training at a Kaiser? Pros and cons?

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[Natividad Resident]

Pro: training in a well-established functional integrated healthcare system
Con: less exposure to the rest of healthcare and how hard it is when you aren't part of a functional system

Pro: primary care is integral to the model
Con: less exposure to what it takes to survive when primary care isn't integral to the model (or there is no model)

Arguably a con: less exposure to horrifying pathology since almost all patients are insured and have been insured for a long time
Arguably a con: not likely to care for prisoners, undocumented workers, refugees, homeless
Arguably a con: less exposure to non-English speakers
Arguably a con: less exposure to various EMRs, various health insurances, various practice models

Pro: Kaiser has impressive starting salary & benes for FM residency grads, and presumably hires its own grads preferentially

Neutral: every residency has administrative obstacles that every resident has to overcome
Neutral: every residency has holes in training
Neutral: every residency is at the mercy of individual attendings and their teaching talent and/or willingness to teach

I would expect the clinical training at Kaiser to be at least average, more likely above average, for California.

Other opinions?

 

[futurefmdoc]

I think this question would be best answered by Kaiser residents - it's easy to speculate on what it is like just based on interview days but I don't think we have a full grasp unless we are there. Also, what is important to address is that each Kaiser residency has it's own different flavor. Kaiser LA-Sunset is significantly different from Kaiser SD which is also super different from Kaiser Fontana/Riverside.

I would like to address some of Natividad Resident's comments.
Please take my comments with a HUGE grain of salt as I do not attend any of these residency programs and am basing this entirely on my interview experiences:

"less exposure to the rest of healthcare and how hard it is when you aren't part of a functional system"
- This can be a pro as well. You really can learn from a well oiled machine how to effectively run healthcare. Just because you get exposure to a non-functional system doesn't make you better adept at handling other non-functional systems. A terrible system at healthcare group A may be terrible at different things than terrible system at healthcare group B.

less exposure to horrifying pathology since almost all patients are insured and have been insured for a long time
- With the passage of the ACA in 2014, I've been told that Kaiser has seen a tremendous rise in their patient population. We'll see how this plays out in the future with Trump wanting to repeal it...

"not likely to care for prisoners, undocumented workers, refugees, homeless"
- Completely disagree. Kinda. This is dependent on the location. For example, Kaiser LA has a bunch of clinics in underserved areas and I believe does stuff with UCLA's homeless mobile clinic. Their former PD for decades, Dr Hara, is a huge name to underserved medicine and did a bunch of stuff to start free clinics in LA and he still hangs around the residency.

"less exposure to non-English speakers"
- I don't think this is true.

"less exposure to various EMRs, various health insurances, various practice models"
- Completely agree.

Also, what's missing from all this is that Kaiser programs tend to emphasize teaching more than anything. All of the Kaiser programs I've been to emphasized the fact that if the residency disappeared, the hospitals would still run smoothly. This can be a pro or a con depending on who you are and how you learn best. However, it should be noted that Kaiser programs, with the exception of Riverside, do extremely well on their FM boards.

To summarize: talk to Kaiser residents on your interview trail and ask them.