Monthly Archives: April 2013

Montesano, Washington

Primary Care in Montesano WA (2hrs from Seattle)

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I didn’t expect anything life-changing by doing a WWAMI rotation, but that’s what I got out of my time in Montesano, WA with Drs. Ki and Clara Shin.

They are a husband and wife duo, UW grads from 16 years ago, who have a fantastic tiny practice in a town of 4000. The experience changed my life because it opened my eyes to a completely different model of primary care than I’ve experienced at the VA (where I have my continuity clinic).

Thanks to Ki’s focus on “the big picture”, I had a chance to learn about the nitty gritty of how his clinic stays afloat (by looking at his quarterly financial reports, hearing about his business decisions regarding hiring PAs, how he handles billing for patients on medicare, how he designed the floor plan of his clinic to improve communication between staff) as well as some exposure to small town medicine (he does his own treadmill tests and places acupuncture needles in some patients with musckuloskeletal pain).

Ki hand-picked patients on his schedule who I would benefit from seeing. Specifically, he grabbed me for any procedure or interesting rash, and consulted me on the most interesting medical mysteries he faced. I have tremendous respect for the Drs. Shin with regards to fund of knowledge, patient rapport and interest in teaching.

I also had a chance to work for a few days in the local hospital and at another IM clinic in Aberdeen. Both of those experiences served to reinforce that Dr. Shin has set up an amazingly high functioning and rewarding clinic.

Ki and Clara are also remarkably generous. They lent me a car for the month, took me mountain biking and gave me eggs from their chickens.

So how was this life-changing? I’m actually thinking of going into private practice. Think that’s crazy? You won’t after seeing how rewarding the practice that Ki and Clara have set up for themselves. It’s a completely different career than I had been considering previously, and I’m excited to have Ki as a mentor to help guide me through it.

I can’t recommend Montesano highly enough for anyone who is into Primary Care.

Alaska, Soldotna

March in Soldotna

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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