Category Archives: Montana

Rural Primary Care in Dillon

I had a great month working with Dr. McIntyre in Dillon, Montana. My month there was all outpatient, but the doctors all do several weeks of inpatient medicine a year so I think sometimes that is mixed in. The average day consisted of seeing about 10 patients in the clinic. There were typically 2 yearly physicals and the remainder were problem-based follow up. Dr. McIntyre definitely made an effort to get patients to follow up while I was still in town so that I could follow cases along. We suspected temporal arteritis in a patient while I was there and managed to get her to Butte for a temporal artery biopsy and get the results back all while I was still in town . I probably saw her 5 times during the month and I think that gives you a flavor for the type of devoted care that is given to the community. All of the patients were so nice and appreciative of the care they received. We also went into the hospital for personal visits to see Dr. McIntyre’s own patients and also to do procedures like EGDs. I also shadowed the orthopedist and OBGYN who worked across the hall for a few days as well. I think Dr. McIntyre makes an effort to let you do things like that if you are interested at all. It was never a matter if you seeing patients to “take work off of her hands” or anything like that, it was all catered to what experience you wanted and how to make that happen.

As for the Montana piece, I thought it was awesome. I had every weekend off and got to travel to Missoula, Bozeman, Livingston, Helena, and all the hot springs in between. For someone who had only driven through Montana, it was such a fun way to experience a new scenery and culture. I thought Dillon was a super cute and affordable community. The provided housing was great, the taco bus was delicious, and then there is the Patagonia outlet – which has new things on sale every week… Meghan Johnston can tell you more about because evidently she used to work there.

Anyways, go to Dillon!

Beaverhead Rock

Four weeks in Livingston

Livingston in November
Livingston in November
I had the opportunity to spend four weeks in Livingston this November and it was great! I was expecting to have bad weather, but it was mostly sunny and the snow was just starting to fall. The hospital and clinic experience was so enlightening. My first day there in the ED, I saw a woman with a femur fracture, a child with urinary retention and another child with a BB up the nose– all things I had not seen in my first two years of residency! In all of these cases, you take the lead on evaluating and figuring out how you are going to treat it. Thankfully, the nurses are kind and helpful! The ER was busy, but it was so much fun.
My schedule was similar to that described previously– a couple of hours of hospital medicine in the morning and then clinic afterward. I did more general primary care this month than in all of my residency! It was exciting and refreshing. The patients really wanted to hear your advice and were happy with your care. I realized how much I had to learn. Dr. Wadle and his nurse are fun and cheerful. I would recommend this rotation to anyone who wants to see the complete spectrum of general internal medicine.

August in Livingston

I can’t say enough positive things about my experience in Livingston, MT! It gave me a great taste for rural medicine and was a nice balance between the inpatient and clinic worlds.

Clinical experience:

Livingston Health Center is a small hospital with about 25 medical beds and 4 ICU beds. The physicians and staff are a close knit group who are all extremely friendly and supportive. I worked closely with Dr. Wadle during my 4 weeks and had an amazing experience! UW trained, he is passionate about his work, extremely knowledgeable, and eager to teach. He clearly loves practicing rural medicine and is generous and welcoming.

On an average day, I showed up at the hospital around 7:30 or 8 to round on any patients on the floor or in the ICU. The number of patients varied, but ranged between 2-5 on any given day. The mornings might be filled with procedures like colonoscopies or stress tests. And then, clinic started around 9:30. The clinic is right next door to the hospital and during lunch, we sometimes ran over to check on patients. Most afternoons were filled with clinic, but once a month you accompany Dr. Wadle on nursing home rounds or rehabilitation center rounds. Every Tuesday, Dr. Wadle takes a 2 hour lunch to make time for a 5 mile run through the town to his favorite lunch spots, which I’d recommend definitely joining! Clinic offers ample learning opportunities and procedures (joint injections, biopsies, etc). As a rural medicine physician, Dr. Wadle often fills in where we would typically refer to a specialist.

One of the great things about the Livingston experience is that it is very flexible. Because there are a number of internal medicine doctors working in a group, you are free to do as little or as much inpatient work as you are interested in. I only worked one ER shift (essentially 28 hour call), but I saw everything from COPD exacerbation, symptomatic bradycardia, broken bones, screaming babies, and on and on. Working in the ER is a great experience because it is just you and the ER nurse covering 6 beds. Livingston is well situated in the sense that it is the biggest medical center to the North entrance of Yellowstone, so you end up seeing patients from around the world with a variety of medical issues.

Everyday Life:

  • Livingston Health Center rents a 3 bedroom vacation home for you, which is 1 block from the hospital and clinic and is very convenient.
  • Livingston is driving distance to Jackson Hole, Grand Teton National Park, Gallatin National Forest, and Yellowstone National Park. With most weekends off, there is ample opportunity for outdoor fun!
  • Livingston is a small town, but there are cute cafes and restaurants, as well as a farmer’s market. Also, Bozeman is only 25 minutes away and has a Portland feel with fun festivals, ethnic food and shopping.
Mammoth Hot Springs, Yellowstone National Park
Mammoth Hot Springs, Yellowstone National Park
Grand Teton National Park
Grand Teton National Park
Yellowstone Lake, Yellowstone National Park
Yellowstone Lake, Yellowstone National Park
Pine Creek Falls, Gallatin National Forest, Livingston
Pine Creek Falls, Gallatin National Forest, Livingston
Sunrise over Yellowstone National Park
Sunrise over Yellowstone National Park

Livingston December 2010

Overlooking Livingston and Livingston Peak

My month in Livingston was wonderful.  The small town (~7000) is in a beautiful setting…”A River Runs Through It” was filmed there for reference.  Dr. Wadle is a great doc and good teacher.  The entire staff at the clinic, nursing home, and hospital are welcoming and really make you feel like you belong.

Nuts and Bolts:  The 25 bed hospital has a med-surg floor and a 4 bed ICU.  I had a bit lighter month with only a few inpatients at a time and no ICU patients.  You round on them each morning and stop back in the pm if there are any active issues.  Then head over to clinic for a usually pretty full day of patients.  Easy to go back and forth b/c the clinic is right next door to the hospital.  Also run over to the hospital for stress tests throughout the week and colonoscopies every other friday alternating with nursing home visits.  There are also 24 hr ER shifts…I saw ortho stuff and kids which was a bit different than usual but great.  I had a ton of continuity between the ER, inpatients, clinic, and nursing home visits.  Was on one weekend to round but otherwise had weekends free.   The patients are great, all ridiculously friendly and welcoming.

Despite the various work activities that keep it interesting, the pace  is  more laid back and there is plenty of time for fun especially if you are into outdoor activities.  Yellowstone is only 50 miles away and is gorgeous any time of year.  Spent a few days snowshoeing and exploring the wildlife.  Dr. Wadle is big into cross country skiing and running so took me out for both of those activities and even provided the ski equipment.  There is also a fair bit of downhill skiing close by that is supposedly wonderful ( i was too chicken to try and too busy with other fun activities).  In addition, because it is somewhat of a tourist area, the restaurants in Livingston are actually pretty darn good, as is the local gym I joined for super cheap.  There are also a ton of small art galleries downtown (big artist community).  And, of course, can not forget the hot springs of which there are many, but I recommend Chico just south of town.

I could say so many more wonderful things.  I highly recommend this rotation and would be happy to answer any specific questions.

Lookout point from a snowshoe/ski trail in yellowstone
Moose on the snowshoe trail at yellowstone

Dillon, MT

make hay while the sun shines (a field near town)

I went to Dillon early in my R2 year and very much enjoyed my month there. I spent the first half working with Dr Ron Loge and the rest with Dr Sandra McIntyre. They are both wonderful (and beloved) internists who completed their residencies at UW–about 25 years apart. We rounded in the (20 bed) hospital in the mornings, spent the days in clinic, then rounded again in the evenings. We saw a broad range of medical problems and it was great being able to follow patients closely because I was in one place all day, every day.
I highly recommend this site to anyone interested in an experience of real rural primary care that is mostly outpatient with a bit of inpatient, procedures, nursing home visits, and home visits.

It was an unseasonably warm Sept/Oct and I hiked in the mountains around Dillon and went on weekend trips to both Yellowstone (3 hours away) and Glacier (about 6 hours). It was a great month! Email me if you have questions.

Lauren Carpenter

March in Livingston

Livingston Memorial Hospital

I’ve gotten pretty comfortable working in Livingston over the past month.  I’ve learned an enormous amount by working with Dr. Wadle.    His clinic patients are some of the nicest people I’ve ever met, and they have different problems than many of my continuity clinic patients at Harborview.  Dr. Wadle takes care of his patients in the clinic and the hospital in addition to doing his own screening EGDs and colonoscopies every two weeks.  I also enjoyed visiting one of the local nursing homes with him.  Working in all of these settings allowed me to get to know Dr. Wadle’s patients very well; the continuity of care here is amazing. 

I also had some time to explore the surrounding areas.  I went hiking and snowshoeing in Yellowstone, swimming in the Boiling River (you MUST do this in Yellowstone), dog sledding, skiing and snowboarding.  I also went running with Dr. Wadle on Tuesdays at lunch; he goes rain or shine with one of the family practice doctors from the hospital.

Livingston itself is pretty small, so I ventured out to Bozeman few times (it’s only 25 miles away).  Working in Livingston for the month has been amazing – I highly recommend it!

Dillon, Montana

The reason I chose to go to Dillon was to have the opportunity to experience what it is really like to be a small town rural doctor who does it all, and that is exactly what I found.  I worked mainly with Dr. Sandra Mcintyre who is a smart, dedicated, charismatic graduate from the UW program who is deeply loved by her patients.  Our days were spent going between clinic and the hospital to check on our inpatients.  On Monday afternoons we would do stress testing, and on many mornings she performs her own endoscopies.  One of the most rewarding parts of the month was seeing patients who I took care on in the hospital back in clinic after their discharge.  There were patients I saw 4-5 times during the month, true continuity!  Of course, you cant beat the location, so close to yellowstone, world class fly fishing, and miles of open beautiful prarie.  If you go in September you will also get to experience the big rodeo that comes through town…this is one of the truest cowboy towns in the country and a must see!

Missoula, Land of Opportunity

Missoula was my second WWAMI month and quite different from the first.  Missoula is a university town and significantly bigger than Livingston.   There are multiple hospitals, plenty of subspecialists, and even some UW students running around;  it has less of the “small town doctor” feel.  That said it’s quite different from Seattle, and the exceedingly well-connected Dr. Schlesinger is eager to customize the rotation – I did two weeks of sports medicine and two weeks at a Community Health Center.  But one gets the sense Dr. S could arrange anything from the ICU to podiatry, probably with someone not used to having a resident and excited to do some teaching.   Go to Missoula to get away, see a different place, do some hiking/skiing, and all of that, but also take advantage of the opportunity to learn whatever you want.

Dillon’s Famous Cherry Pie

As someone who was uncertain in what field of medicine to enter, I decided to take advantage of the WWAMI experience. The reason I picked Dillon was based on a chance conversation that I had with my clinic preceptor who had went out to Dillon and still reminiscing Mrs. Loge’s cherry pie and the beautiful Montana landscape. Being in a small town for the first time, I didn’t know what to expect. Everyone whom I met were warm, helpful and extremely friendly. The patients were real “salt of the earth” especially the ranchers. The experience is unique in that we follow patients in all aspects of their care–from the clinic to the ER to the inpatient side and to the procedure room. Because of the limited access to specialists, Drs. Loge and McIntyre perform most of the procedures that we routinely fill out a requisition or refer to specialists. They perform bone marrow biopsy, thyroid biopsy, EGD, colonoscopy, treadmills and all routine primary care procedures. Both Drs. Loge and McIntyre were amazing preceptors and clinicians. On the weekend off, Dr. Loge invited me to his beautiful cabin and spend time cross country skiing and finding then chopping down a Christmas tree. It was the first time for me to do both. Lastly, Mrs. Loge’s cherry pie was as good as it was rumored to be and certainly worth the drive to Dillon.

Livingston, MT

I never saw a grizzly bear during my month in Livingston, even though I spent the entire time reading about them and keeping an eye out for them on hikes.  This was probably a good thing.  There were 9 grizzly attacks in Montana this year; two of the victims came to Livingston Hospital while i was there and I got to help care for a Hunter who had been severely mauled (had his face torn off).  I heard about the attack on NPR the next morning. 

The mountains surrounding Livingston are amazing (the Absorokas, the Bridgers, the Crazies).  I spent my free time hiking among these mountain ranges and exploring Yellowstone.  The Paradise Valley is literally a two minute drive from the house and is breathtaking.  Be careful not to drive off the road while you ogle at the Absoroka Mountains.

The clinical experience is priceless, no matter what you go into, ranging from clinic, to inpatient, to ER.  The main preceptor (Dr. Wadle) was a great teacher and host.  The hospital staff treated me like one of the family.  Pop me an email if you have questions about this experience; I can’t say enough about it.