Soldotna!

Soldotna: as Elena told me before I went, it really does live up to the hype!

The physicians at Peninsula Internal Medicine are all incredibly smart and thoughtful, and they practice so deep into the Internal Medicine subspecialties, even as more specialty physicians have arrived to practice in the central peninsula. As a result, their patients are diverse, with interesting/challenging medical problems, and they are as expert in managing anxiety and hospice care as they as they are in IBD, complex diabetes, and procedures (including EGDs, colonoscopies, cardiac stress tests, cardioversion, reading TTEs, endometrial biopsy, paracenteses). They keep up with multiple journals and subspecialty literature, they watch UW grand rounds (broadcast live from the hospital across the street), they are very involved in work at the hospital across the street. Despite this, they have incredible work/life balance, and their backgrounds are full of global travel (and Iditarod!), which makes for lots of interesting life/medical experiences. They all have different clinical interests and strengths that are very complementary, and although residents work mostly with Dr. Bramante (who is fantastic), there are opportunities to learn from everyone. And the clinic itself is perhaps the most high-functioning primary care clinic I have ever seen! It’s hard to overstate how friendly and welcoming everyone is.

Outside of clinic (which is usually 4 days a week), there are a multitude of things to do in town (coffee galore, cross country skiing or running on an extensive network of well-maintained trails, yoga, climbing wall) and stunning hikes and day/overnight trips outside of town to Seward, Homer, the Portage Glacier, and more. I ate so much moose (that Dr. Kelley had personally hunted and prepared!). You are close enough to Anchorage that you could sightsee on weekends with the resident at ANMC, if you wanted to. They maintain a ‘Get a Life!’ list for the Kenai peninsula.

I learned a lot this month, and left with a lot of professional inspiration, but the whole thing felt like a wonderful vacation among really nice people. Enjoy!!

Resurrection Bay, Seward
Portage Glacier preview (I can’t ruin the surprise!)

ANMC Round 2

This was my second winter solstice at ANMC, so I must be into the darkness….but actually, I had such a great time my first go round that I wanted to come back! For both of my rotations, I spent all 4 weeks in the ICU. I’m in the primary care track, and wanted more time in the ICU so that I’ll feel comfortable in independent practice after residency; ANMC certainly helped me get there. The attendings are universally excited about having residents around, and love teaching about critical care and procedures. You will certainly have lots of opportunities for lines, intubations, thoras, paras, and I placed my first chest tube at ANMC.

The patients come from across Alaska, and are truly critically ill, with a wide range of medical problems. Lots of patients with cirrhosis (often devastatingly young people), garden variety sepsis, and some rare and intriguing diseases. I took care of a young woman with newly diagnosed sarcoid, and another patient with newly diagnosed lupus. You will have lots of opportunities to have long conversations with families, to get to know patients, and to “run the show” as much as you are comfortable, with backup if needed.

You will be struck by tremendous health disparities, and will notice that despite the cold, Anchorage has a sizable homeless population, many of whom are Alaska Native, and some of whom you will care for in the ICU.  I’d recommend taking the time to read recent journal articles that discuss the social determinants of health and structural racism to put into context some of the poor health that you will see. You may find that you’ll want to come back to ANMC, and you will surely connect with lovely patients and families who will appreciate your care!

On the enjoying Alaska front, there is a ton to do in Anchorage, and you’ll definitely not be bored! Skiing at Alyeska is fun, some decent steep skiing, and fantastic views out onto the Turnagain Arm. There is great backcountry skiing up at Hatcher Pass and Turnagain too!

I cannot recommend this rotation highly enough! You’ll learn a ton, and have time to explore Alaska too!

View from Alyeska looking down onto Turnagain Arm

 

Frozen River and the base of Denali in the clouds
Homer, AK
Alyeska!

Soldotna or Bust!

I had the pleasure of rotating in Soldotna in late September-October 2017 and it has been a dream! One of the best experiences of residency by far. I came to UW hoping that I would be able to do a WWAMI rotation in Alaska and it has vastly surpassed my expectations.

Like other residents have mentioned, your work in Soldotna is at an internal medicine clinic that functions like a referral center.  You see an incredible breadth  of primary care. In my month, I’ve diagnosed myasthenia gravis, carcinoid syndrome, in addition to managing pulmonary hypertension and post-CVA care after a 30 year old had an embolic event from an atrial myxoma.  It has been quite the learning experience and has solidified my decision to go into primary care!

The doctors here have incredible work/life balance. Dr. Bramante and I would often go on long runs together after work and go dog-sledding. Like other residents have written, there’s a ton of outdoor activities to do on your three days off per week! My favorites included hiking on glaciers, watching sea otters in Seward harbor, and seeing grizzly bears fishing in the wild (though also terrifying!).

For those of you lucky enough to come to Soldotna, good luck exploring the 49th state!

Courtney Tuegel (R3)

 

Soldotna

I am writing this from Soldotna, where I am wrapping up a really great month here. This is a great rotation, which I would sum up as a superb and unique primary care experience with plenty of time to explore one of the most beautiful places on earth.

Clinically you work primarily with Dr. John Bramante, a former UW resident and chief, and see patients with him at a private group practice affiliated with the major hospital for the Kenai Peninsula. He is great to work with, and extremely knowledgeable and supportive. Because this is a rural site with limited access to specialists, you get to manage a very wide range of medical conditions and often patients are referred from PAs/NPs or family medicine doctors with interesting problems or diagnoses. There are also plenty of people with bread and  butter medical issues who are presenting for their annual visit and need someone to work with them on their DM, HTN, CAD, etc and tweak their medicines. The best part is that the schedule is set up so that you can usually take your time to really talk to the patients to get to know them a bit and do good counseling and education.

The hours are very reasonable and flexible, leaving lots of time to explore. My month here has been in September, and the days are still really long. On the weekends I went to nearby Homer (1st picture), kayaked to and hiked on a glacier (2nd picture), went white water rafting on class IV and V rapids, and did lots of superb hikes. The third picture below is of a beach that is 20 minutes from the apartment here, and on nice days the sunsets are amazing and there are firepits to have bonfires.

This is a special place with really good doctors, warm and welcoming people, and stunning scenery. Check it out!

wenatchee

From a professional standpoint, I think this is a good rotation. Dr. Smith (the oncologist who both runs the practice and coordinates with you) has made sure the rotation is well-organized. The 5 attendings all seem to enjoy working with residents, and the workflow is very straightforward. I’ve seen a good variety of general Hem/Onc – I would estimate my patients have been approximately 5-10% benign hem, about 30% leukemia/lymphoma, and 60% solid oncology (breast is most common, but they see everything including GYN onc). Especially in comparison to the UW inpatient Hem/Onc rotations, it is refreshing to see how upbeat and generally happy the outpatient oncology world is. Having spent most of my medical training in academic hospitals in cities, this was also an interesting window into community medicine. 4 days a week are spent in Wenatchee and you spend the 5th traveling with an attending to clinic in Moses Lake.

Work-life balance here is also good. Like most ambulatory blocks, weekends and holidays are off and rarely am I in clinic past 6 PM. The logistics of the rotation itself are easy – they take care of most of the paperwork/ID badge stuff, an apartment is provided directly across the street from the clinic, and it is not a far drive (2.5 hrs) from Seattle. Nestled in the foothills of the eastern Cascades, the town is beautiful. It is surrounded by foothills on all sides and the Columbia and Wenatchee rivers slice through town. There is lots of great Mexican food (for a city of 30,000 people, there must be 20+ Mexican restaurants). There are all the typical Cascasdes outdoors activities (camping, hiking, mountain biking, climbing, skiing/snowboarding) which tend to be less crowded than in the Seattle area. Leavenworth is just 30 minutes away. For a WWAMI rotation, the ease and convenience of the rotation cannot be beat.

ICU at ANMC in Anchorage in June

Anchorage, Alaska. Home to bears, moose, liver dialysis and abundant subclavian central venous access. I chose to spend all 4 weeks of the rotation in the ICU and would definitely recommend the experience (although I hear that residents enjoy their time with all specialties up here).

At ANMC all critically ill patients end up in one unit under the care of the ICU team, so you will see patients admitted with trauma and other “surgical problems” (NSTI, ICH requiring craniectomy etc.) in addition to the things we are more used to managing. If the variety doesn’t interest you it’s possible to pick up only the more classic medicine patients, but you will at least have the opportunity to manage a broader spectrum of critical illness. You will probably get to do lots of procedures (all manner of central lines, bronchoscopy) and intubate relatively often if you are so inclined. A more unique thing you will see here is MARS “liver dialysis” which gets used for acute liver failure and Tylenol overdose. The attendings and other hospital staff are very friendly and a lot of fun to work with.

At least in the summer there is lots to do here, four weekends is just not enough time to see all the cool stuff in the area. The hiking/wildlife is incredible. Homer and Seward make great weekend trips. This also seems like the place to be if you like fishing.

real sign at Kenai Fjords National Park
if this kind of bear attacks you, fight back
If this kind of bear attacks you, only fight back if it literally starts to eat you
seriously though, get bear mace if you are going to be hiking here in the summer
moose chowin’ down at Kincaid park

ANMC/Anchorage!

I spent May 2017 in Anchorage and had a great experience at ANMC. I ended up only having 3 weeks there and did 1 week in the ICU, 1 week in a mix of clinics (Rheum, Endo, Pall Care) and 1 week of ID consults. In general if there for 4 weeks I’d recommend 2 weeks in the ICU to get the hang of it and a range of experiences and I think the staff there prefer it for some continuity. Schedule in the ICU was M-F 7am to 7pm for sign out (able to leave early some days). I worked with Dr. Worth who is great and trained at UW! I also really enjoyed the clinic experience – great way to learn more about the native health system and how subspecialty care is delivered to such a broad geographic area. Great teaching too and pretty relaxed schedule. Lastly ID consults was great with really interesting cases and fun attendings who love to teach. I was initially given a pretty short list of options of what to do but when I got there but I found that people were happy to have me in most clinics and if you ask they will make most things work.

As far as Anchorage itself it’s a very livable small city and easy to adapt to quickly. People at the hospital were all really welcoming and eager to provide recommendations for what to do and see. May was a fun time of year there as spring was really just starting but days are long. Be sure to check if hikes in the area are still icy/snowy! For housing AirBnB worked well to find a spot – midtown isn’t the most attractive part of town but halfway between downtown and ANMC. Start housing search early if you want to do a monthlong rental especiall in summer/spring. Enterprise renal car through UW also very easy to do.

I loved visits to homer (halibut fishing!), seward (kenai fjords tour/kayaking), hikes around anchorage (power line trail, eagle river nature park, flat top).

Portage Glacier Hike, at end of Whittier Tunnel
View of Anchorage from Earthquake Park
Otter enjoying Seward!

 

 

 

Soldotna!

The Soldotna rotation was amazing and I would highly recommend it! I was there this past April and had a blast. I worked primarily with John Bramante who is a former UW grad / chief and all around an awesome doc. Good learning in a relaxed environment with opportunities to manage a broad scope of problems. For example, I had a chance to evaluate and manage new hep B, hep C, sarcoidosis, Addison’s disease, possible carcinoid, and a variety of malignancies. You can learn more about doing endoscopy, echos, and stress tests. There is a good mix of conferences. Overall, this rotation has great work/life balance and there is plenty of time to explore Soldontna and surrounding towns. Scenery is breath-taking and there are hikes galore. See rave reviews by other residents as well.

View from backyard of the apartment.

Kenai coast line 

Get Sold on Soldotna!

Spent an incredible 4 weeks here in September/October, and can’t recommend it enough!

You work 4-5 days a week at Peninsula Internal Medicine, an independent practice with 5 MDs and 2NPs but right across the street from Central Peninsula Hospital where you’ll go for some procedures, ECHO reading, and of course, free lunch. You work predominantly with the legendary Dr. Bramante who is an incredible internist and even more incredible human being. Most of my experience was outpatient, alternating seeing patients with him on one of his normally scheduled clinic days. The patients are super interesting from both a social and a medical perspective (you see a fair amount of the standard T2DM, HTN, CAD, COPD/combo of the above but I also diagnosed/helped manage things like IPF, polymyositis, HIV, CML, aldosteronoma and a host of others).  I also spent time working with some of the other physicians in the group including Dr. Kelley, Dr. Pokorney and Dr. Mitchell and even got to do some outpatient clin ed with the med student who was there at the same time. Overall everyone is super awesome, friendly, and smart and all are supportive of you doing the things you want to do and having the experience you want to have. This includes doing a week or two of inpatient if you are so inclined.

Soldotna itself is awesome, as is the Kenai Peninsula in general. Your drive down is breathtaking and just the beginning – activities are limitless! Make sure to spend at least a day if not a weekend in Homer, a beautiful town surrounded by magnificent mountains and nonstop views, good food, and cool art shops. Also journey over to Seward, where they have a nice little aquarium, kayaking in the summer, and you can take a short hike right up to the edge of Exit Glacier. So many amazing hikes and areas to explore like the Skilak wildlife refuge, North Beach in Kenai, and Cooper’s landing.  I was also lucky enough to be there at the right time to go Halibut fishing with the Kelley’s and no doubt JB will invite you over to run with the pups. Truly a once in a lifetime experience to be pulled on the back of a 4 wheeler by a pack of dogs while clutching your attending for dear life. Incredible!

You’re also provided with a cozy apartment right on the Kenai river and a short drive from the clinic. Everyone takes care of you and is more than excited to have you over for dinner and show you all the amazing things Soldotna has to offer. I also had the opportunity to present a grand rounds style lecture for local providers. Definitely prioritize a rotation up here, you won’t regret it!


Black bear at the Alaska wildlife conservation center


Kenai river in your backyard (literally!)


Halibut fishing with the Kelleys!


View from the Homer spit


North beach at Kenai with relaxed resident feet included as proof of ample down time


Exit glacier near Seward


Ready for a run!

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