Outpatient Family Medicine

The heart and soul of our Family Medicine Residency is the FMP. This is where residents do their continuity clinics, seeing patients assigned to their patient panel, which they will develop throughout their residency. Continuity clinics will be held primarily at our Marysville clinic, with  roughly 25% of total continuity clinic time spent at our Everett clinic. These clinic sites are just 20 minutes apart. Residents will learn how to work with a medical team to optimize patient care. Upon graduation they will be capable of handling the daily clinical patient encounter volume expected for a typical clinic provider.

During the R-1 year residents will average 1-2 half days of clinic each week. During the R-2 year this will increase to 2-3 half days per week. During the R-3 year they will average 3-4 half days per week. These averages include time spent at the Everett clinic site, where residents will have a continuity clinic experience focused on prenatal care. Continuity clinic schedules will vary according to the demands of inpatient rotation schedules.

INPATIENT ROTATIONS

All inpatient rotations will be at Providence Regional Medical Center in Everett (PRMCE), just 15 minutes from the FMP clinics. The only exception is the 4 week Inpatient Pediatrics rotation at Seattle Children’s Hospital in Seattle. While rotating at PRMCE our residents will be “unopposed.” This means there is no other residency competing for patients, attendings, and procedures. There is plentiful volume, allowing for some resident/faculty selection of patient types that will be optimal for the Internal Medicine resident service and the Inpatient Family Medicine Intensive rotations. We have extra Internal Medicine and Obstetrics rotations, so the residents will be well trained in these areas, graduating with the confidence to practice Inpatient Family Medicine and Obstetrics.

Core-Rotations

In order to provide residents with robust training in inpatient medicine the residency program has developed an Internal Medicine Resident Service which will be complemented by Inpatient Family Medicine Intensive rotations in the second and third years. The Internal Medicine Service is managed by Dr. Matt Hansen, an IM hospitalist at PRMCE. Program Director Dr. Greg Sanders will manage the Inpatient Family Medicine Intensive.

There are approximately 45 hospitalists at PRMCE. Our residents will be working with a subset of these physicians who have elected to work with the residents and have a strong desire to teach and mentor. Residents will work and round with the IM hospitalists. Residents will be paired on this service during the R-1 year, in subsequent years this will grow to teams of 3-4 residents with senior residents supervising. Core IM didactics will be given regularly each week during the rotation, and also during the weekly didactics session at Sea Mar Marysville.

The Obstetrical Service is managed by Dr. Jose Mata FP/OB, the Associate Program Director. Dr. Mata did a fellowship in Obstetrics.  Residents will achieve first assist competency in caesarian sections. Labor and delivery management will include their own patients, faculty patients, and patients from other providers. Patients from other providers include other CHC FP/OB providers, other FP/OBs, hospital laborist patients, obstetricians’ patients, and Nurse Midwife patients. The exposure to a variety of obstetrical practitioner types will enhance this experience for residents. Core OB didactics will be given regularly each week during the rotation, and also during the weekly block didactics at the FMP. The didactics are usually case based. Residents will be trained in basic obstetrical ultrasounds.

Residents spend one block during their first year rotating with the surgical hospitalists and outpatient surgeons. They have a busy surgical service. Residents will round, consult, and admit emergency room patients; they will also assist with surgeries (inpatient and outpatient).

Residents will spend 2 blocks doing inpatient pediatrics at Seattle Children’s Hospital. They will rotate at Seattle Children’s in the R-2 and R-3 years for Inpatient Pediatrics and Pediatrics Emergency Medicine. These are the only “away” inpatient rotations (26 miles from Everett). We chose to include rotations at Seattle Children’s to maximize inpatient pediatric exposure. At Children’s, residents are on a resident team that manages typical hospitalized children. There will also be regular didactic presentations. Dr. Cor Van Neil, a senior Sea Mar pediatrician, will liaise with Seattle Children’s for this rotation. He will also present core pediatric didactics at the Marysville clinic over the 3 year residency.

Residents spend two blocks in the R-2 and R-3 years rotating in the ER at PRMCE. This is the busiest ER in the state. The high patient volume on these rotations will allow the residents to see the most appropriate patients for FM residents, which will enhance the learning experience.

All outpatient rotations are in Everett and the local surrounding area. The main multi-specialty clinics hosting these rotations are Providence Medical Group and Western Washington Medical Group. These clinics have well-respected and experienced specialists who have a strong interest in teaching and working with our residents. Each rotation has written goals and objectives, to achieve appropriate knowledge and experience germane to that area. All of the typically 2-4 week specialty rotations are with the aforementioned clinics, with a few exceptions, where there are other specialty rotations set up locally. We want the residents to have the best possible experience with each rotation.

Over the course of the residency residents will have a total of 26 weeks for electives. Elective options are still under development but so far they include ENT, Outpatient , Endocrinology, Gastroenterology, Nephrology, Pulmonary/Asthma, Rheumatology, and Urology.