Category Archives: Soldotna

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!

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!

Soldotna. Do it.

Literally one of the best months of residency… literally.   I recommend using two wishes.  I think you can do that.   The clinical experience is diverse.  A sample day can include EGDs, colonoscopies, stress tests, reading echos, and doing primary care with limited resources for subspecialty care.  The physicians at PIM are fantastic educators.  You’ll spend most of your time with #GHITKU legend, John Bramante.  If he or Dr. Mitchell have inpatient responsibilities spend a few days seeing what the hospital is like.  There is so much to do in the evenings/weekends.  Seriously, this month is the best.

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Soldotna so awesome

Reading back further into this blog, it’s apparent that plenty has already been said about how wonderful the clinical [and natural!] environment in Soldotna is. I’ll just confirm that every bit of praise lavished at this WWAMI site is justly deserved.

No Virginia, there is no Santa Claus, but what does exist is a magical primary care practice called Peninsula Internal Medicine where you can find in abundance those qualities of being a doctor – the independence, the impact, the close relationships with patients and other providers alike – that we all crave yet find oh so elusive in residency.

Personally, as someone interested in health care systems, a month at PIM gave me the opportunity to step outside the academic bubble and see first-hand how things work in the private practice world. Whether you want to gain procedural skills, experience different models of health care delivery, or just spot some moose, this rotation is not to be missed.

Welcome to nirvana.
What awaits you on the drive out of Anchorage.
Nirvana.
Nirvana.
Denali.
Denali.
Mountains beyond mountains.
Mountains beyond mountains.
Great name for a boat.
Great name for a boat.
Bush flying.
Bush flying.
Annual migration of the common Winnebago species.
Annual migration of the common Winnebago species.
Playing in paradise.
Playing in paradise.

Halloween in Soldotna

I had to pick a holiday to identify the season rather than saying that I spent a month in Alaska in that awkward in-between time after summer and before the first snows. A sort of weather that shouldn’t feel foreign after a year in Seattle. But that said, there was no lack of activity. It was perfect weather for jogs through local parks. Dr. Bramante’s sled dogs seemed just as happy to be hooked up to an ATV for a trot down the beach. (And I can’t help think pleased to cover me in mud in the process.) There were some beautiful views of the mountains from Dr. Kelly’s bush plane. Not to forget the title, the halloween celebration included my being pulled out of clinic to crawl through the local hay maze. Incidentally also teaching me why the docs tend to wear clinic casual.

I spent that clinic time mostly with Dr. Kelly and McDonald during a year when Dr. Bramante has been living the dream in Italy with his family. The patients were a representative sampling of the town and surrounding region ranging in age and background, but if I had to compare, remind me of the VA population. Living in Alaska takes a sturdiness that sometimes causes people to present late with disease. Young guys came straight from the “slope” oil drill, middle-aged folks boast about living without power in the wilderness, professional fisherman come with stories (and sometimes fish), and I was surprised at the number of zebras that showed up with them. While some are sent to Anchorage or Seattle for further work up, the majority are evaluated by the very capable crew of docs in town. Dr. Kelly reads all of the cardiac echos for the hospital and does a fair share of the colonoscopies and EGDs (I decided they’re just like playing video games).

All this I could have taken as a great experience making me more aware of the docs that practice “out there” far from where I might ever find myself. The more surprising and wonderful part was that I would love to go back. The practice in Soldotna is unique in that the docs there have trained and worked in big cities – most with stints at UW and UCSF – and made the thoughtful decision to continue an intellectual and progressive practice in a small town far from home. Whether by instinct related to living in relative isolation or just out of goodness of heart, the community is the most welcoming I’ve ever experienced. I got to know and spent time with the docs, clinic staff, their kids, friends of the family and even was on a first name basis with one of the grocers. It was hard to leave that kind of connection and even more amazing to think that these folks make it over and over with generations of residents.

Please drop me a line with any thoughts or questions about the rotation. Clearly happy to talk about one of my favorite experiences of residency.

March in Soldotna

No surprise here – I had an incredible time in Soldotna.  The rotation exceeded my expectations and I checked more than a few things off of my clinical and life bucket list (snare a colonic polyp, see the northern lights, etc).

Peninsula Internal Medicine

PIM is a practice of 6+ attendings who are passionate about primary care and know way more about medicine than I can ever hope to know.  By the end of the rotation I was still surprised when I could ask questions about everything from central hypothyroidism to treatment of metastatic esophageal cancer to echocardiograms and get detailed answers backed by the latest evidence.  Most people have traditionally worked with John Bramante, a UW grad and former chief, who will welcome you to the PIM and his own family with enthusiasm.  He’ll be spending most of the 2013-2014 academic year in Florence on sabbatical though, which means you’ll work with Bill Kelley, one of the original founders of the practice, who is equally experienced and devoted to his patients and teaching.

Most mornings there are colonoscopies/EGDs to be done – after you’ve tried your hand at the controls a few times, you can sit these out and prepare for the patients that are mixed in between cases.  Afternoons are filled with more clinic.  Lots of general internal medicine but many interesting cases too.  I initiated one of Bramante’s UC patients on infliximab/azathioprine, took care of a patient with leprosy, had a discussion re:sorafenib with a stage IV HCC patient, and also saw a patient with MAI.  I also was involved in a few stress tests and TEE cardioversions.

In and Around Soldotna

March was a perfect time to be in Soldotna – there was an abundance of snow and sunshine.  Among the things I did:

  • rented XC Skate skis for a week ($80) at Beemun’s True Value/Variety store and skied at Tsalteshi Trails, just 5 min from the apt
  • hiked Hideout Trail at Skilak Lake, perfect on a clear day, 45 min from Soldotna
  • snowshoed Homestead Trail just outside Homer, and more locally at Kenai National Wildlife Refuge in Soldotna where moose can be found
  • watched a Kenai Bears hockey game
  • dog sledded with Bramante
  • went to Homer a bunch of times and: explored around the Wynn Nature Center, went to the Two Sisters Bakery which has amazing things called Boca bites which are perfect with coffee, wandered around art galleries.  Make sure you go to Homer on a clear day because it’s one of the most beautiful places you’ll ever see. also in Homer checked out Pratt Museum and Alaska Islands and Oceans Visitor Center both of which are worth the visit

The Perks

  • Free lunch every day at Central Peninsula Hospital – pretty tasty.  Halibut, jumbo shrimp and ribs are just a couple of my favorites.  Get the mozzarella sticks too.  Cookies are addictive (just squish them a little first to make sure they’re chewy…)
  • PIM will arrange housing for you in a 1-BR apartment right on the Kenai river.  Sue and Dale Cain take good care of you if there are any issues that arise.
  • PIM also provides a sweet 2008 Subaru Outback with studded tires.

Northern Lights from Soldotna Dogsledding with John Bramante! Kenai River right in your backyard! Bishop Beach at Homer Hike at Skilak Lake Moose up close and personal at the Kenai Wildlife Refuge Bald Eagles outside your apartment Peninsula Internal Medicine

December in Soldotna

To be honest, I was nervous about Soldotna in the winter, but it was one of the best months I’ve had yet in my whole medical education. The clinic is amazing, as others have explained. The docs up there are top notch, I think I saw more complex patients up in a day there than I would in a week in Seattle, and all being completely managed by internists! It’s awesome. I have prescribed triple-therapy for a patient with MAI pneumonia, high dose steroids for a UC flare, and amio-loaded someone for refractory a-fib in clinic without any specialist help. The clinic runs smoothly, they have a fully functioning EMR and laptops for everyone. The support staff is wonderful and I became friends with several of the nurses and MAs.

There is still plenty to do in Soldotna wintertime, though I will say it’s the coldest weather I’ve ever been in. The scenery is just incredible. We went to Homer and Seward, like others have posted about, but it was a cool different feel to be there in the dead of winter with only the locals and the awe-inspiring views. We went cross country skiing (right out of the backyard if you want!), snowshoing, dogsledding, and ate wonderful meals at all of the doctors houses.
Don’t pass this rotation up!!

August in Soldotna

 

I spent mid August through early September in Soldotna.  My wife, Tiffany (pediatrics), joined me to work in Katy Sheradon’s Family Practice during that time.  I think plenty has been said about the quality of the rotation, but I’ll add my perspective.  John Bramante is the main doc with whom residents work.  He is in a practice with ~5 other docs called Peninsula Internal Medicine.  They are a private practice across the street from the hospital, but also provide hospitalist coverage.  During my month, that actually stopped, as the hospital hired some hospitalists, but things may change again.  I spent 3 weeks mostly in clinic.  I worked closely with John Bramante and also Bill Kelley.  They are both excellent docs (UW and UCSF trained, respectively) and do a surprising amount of speciality care (cardiac stress tests, EGDs, colonoscopies, HCV treatment, chemotherapy, rheumatology).  Their patients were also quite interesting and wonderful to treat.  I spent one week working as a hospitalist as well. 

The most memorable part of the month was my time away from work.  There is quite a bit to do in the area, particularly if you like the outdoors.  August on the Kenai Peninsula is popular with many of the locals, as the weather is still nice but the tourists are gone.  By the end of my month, fall was in full swing (with a pretty brilliant color change).  I went out fishing with Bill Kelley on various stretches of the Kenai on multiple occasions.  He took me drift boat fishing down the upper Kenai for rainbow trout, where we saw several brown bear fishing from the shores.  We also fished the lower river for silver salmon and trolled the middle river/Skilak lake for rainbows.  I have been to a lot of rivers and this one is one of the most beautiful anywhere.  The fishing is also excellent, if that’s your thing. 

On weekends, Tiff and I did a lot of the usual trips to Homer and Seward.  Homer is a quirky town SW on Soldotna on the coast.  There are some good restaurants and great hikes – see the Grace Ridge photos below.  Seward is a smaller town with not as much going on, but nearby Kenai Fjords National Park is amazing.  All of the glacier shots are from that area. 

We didn’t make it to Denali, given the distance, but I know some others have made the trek.  I think the experience is highly weather dependent, as the mountain is only out 1/3 of the time.

The best part of this rotation were the people.  We were invited to dinner and fun activities with so many docs and their families.  Indeed we were made to feel part of their families.  Tiffany got to eat moose heart once too! 

Glacial silt gives the river its characteristic color. The silt is called “stone flour” because it is incredibly fine, leaving the river unusually cloudy.

Soldotna, December 2010

I loved my month in Soldotna, couldn’t have asked for a better experience! December was a lovely time to be there–the days weren’t as short as it would seem, due to extended dusk and dawn, and the fresh snow was beautiful. Peninsula Internal Medicine is a very special clinic–the docs and patients are wonderful. The hospital, which is across the street, has recently gone to a hospitalist system–a big change for everyone, and one that is still playing out.  I spent most mornings at the hospital following a few patients, then went to clinic in the afternoon, and worked primarily with John Bramante, who is a fabulous individual and doctor and community leader. The division of time between inpatient and outpatient is flexible, depending on the resident’s interests. I found the clinic time so valuable and fun that I ended up slanting things that direction.

The apartment residents stay in is feet away from the Kenai river, and is very nice and cozy. Currently one of the hospitalists and his wife live next door. There is cross-country skiing just outside of town, with groomed trails that are lit until 9pm. The beach in Kenai is a short drive, and Homer is about an hour and a half away. The doctors and clinic staff are very welcoming.

I recommend this rotation highly and would be happy to talk more–feel free to contact me.

Jocelyn James, R2