Primary Care Track

Annually, four residency positions are dedicated to more intensive primary care training. There are unique outpatient electives, retreats, specialized curricula, and mentorship dedicated to this training.

Residents in the primary care program are preferentially assigned to the Eastgate clinic for their weekly, full-day continuity clinic. Eastgate is a King County public health clinic that has partnered with Virginia Mason since 2008 to serve the health care needs of the community and improve resident education. Residents at Eastgate quickly establish continuity with their panel of patients and serve as the patients' primary physicians. Residents learn to manage a stunning diversity of illness presentations in a resource-limited setting with the assistance of Virginia Mason teaching faculty. The partnership between Eastgate and Virginia Mason allows for expanded access to primary care for underserved patients, all while providing a rich educational opportunity for our residents.

“Everyone here helps keep Eastgate open. It’s staffed by the same attendings as our downtown clinics, which means you get to care for truly underserved patients but with the same excellent educators we get at the other sites.” - Erika Cunningham, MD, class of 2016

First-year primary care residents complete a second month of outpatient general internal medicine (GIM), at a Virginia Mason regional medical center. This allows interns to have more up-front immersion in primary care practice and experience in multiple clinic settings. This block is in lieu of an inpatient month, allowing residents to focus more time on outpatient medicine during their intern year.

In second and third year, residents are assigned a one-month advanced general internal medicine block each year for immersive primary care training. Categorical Residents do not have further GIM blocks after their intern year. These blocks are one-month condensed continuity clinic experiences at highly functional Virginia Mason regional primary care sites, allowing residents to experience daily practice as primary care internists in a more focused manner.

Through dedicated training at Primary Care Retreats and practice at Eastgate Public Health, primary care residents receive training and supervision by Virginia Mason and Public Health faculty in outpatient procedures including:

  • Knee arthrocentesis and injection
  • Subacromial bursa injection
  • Skin biopsies: Shave and punch
  • Toenail wedge resection and partial ablation
  • Trigger finger injection
  • Endometrial biopsy – for those interested
  • IUD placement – program in development, for those interested

An advantage of Virginia Mason for residents interested in primary care is that most of our subspecialty rotations have an outpatient focus (with the option of managing hospital consults, for those interested). Because of this, most subspecialty rotations are directly applicable to a career in primary care. In addition, there is a subset of two-week elective rotations tailored to residents interested in practicing outpatient general medicine, including outpatient gynecology/women’s health, outpatient general surgery, hyperbaric medicine, orthopedics/sports medicine, ophthalmology, otolaryngology, physical medicine and rehabilitation and urology. These electives are open to all residents but are preferentially assigned to residents in the primary care program.

Full-day retreats twice yearly for all primary care residents and multiple half-day “mini-retreats” for residents available (schedules depending) offer additional time for teaching and discussion of primary care topics, often followed by social/networking time. Retreats are special times for bonding within the program and support of future primary care careers.

Topics and activities have included:

  • Field trips:
    • Pharmacy: Over-the-counter medications and treatments
    • Durable medical supply
    • Physical and occupational therapy
    • Skilled nursing facility and assisted living (canceled due to COVID-19)
  • Musculoskeletal exam advanced skills practice sessions
    • Shoulder and knee exam
    • Common hand conditions
  • Procedural practice on outpatient procedures listed above using simulation models
  • Primary care practice
    • Working “in-flow” - discussion followed by shadowing skilled Virginia Mason primary care physicians
    • “Chart review” - small group sessions with primary care faculty reviewing recent clinic patients
  • Medical knowledge topics
    • Insomnia treatment: Cognitive behavioral therapy for insomnia
    • Understanding therapy for depression and anxiety
    • Complicated depression and anxiety cases – with Virginia Mason psychiatrist
  • Anti-racism curriculum: Systemic Bias
  • Career development topics
    • Curriculum vitae review and 1:1 feedback
    • Visualizing your future career

The fall primary care retreat is followed by an evening Primary Care Career dinner with current primary care residents and Virginia Mason primary care physicians, many of them graduates of the residency, and our primary care faculty. Residents benefit from career advice and networking and the graduates enjoy the “reunion.” We discuss the benefits and realities of careers in primary care and the process of applying for primary care careers including salaries and contract negotiation advice.

Every spring (with the exception of the COVID-19 disruption of 2020), we gather at an attending’s house for social time and celebration of graduating Primary Care residents.

Each primary care resident is assigned primary care faculty member mentor who facilitates a group mentorship program involving members of all classes.

Primary care residents meet with the Primary Care program director formally three times (R1s) and twice (R2s and R3s) per year for formal performance reviews and career development discussions.

In addition to the program-specific activities above, all residents participate in weekly didactics on clinic-specific topics. These didactics are led by our excellent primary care faculty who also serve as clinical preceptors. Our primary care faculty are consistently rated by residents as some of the best teachers in the program. Many have also been recognized by their colleagues and patients as among the top doctors in Seattle. All residents, primary care and otherwise, benefit from their expertise and enthusiasm for teaching.

As career pathways develop, residents may transfer in or out of the primary care track, usually prior to schedules being set for second or third year. Individualizing the residency experience is a core mission of the program. In 2020, we currently have more residents than allotted in the primary care track given high level of interest in the program and primary care.