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.
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.
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
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.
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!!
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!
John Bramante was kind enough to let me help him harvest honey from his bee hive. Here’s his daughter helping out too.
This is a pink or humpback salmon I caught. They run in large numbers on even numbered years. Locals don’t fish for them much here as they’re not great for sport fishing and don’t taste as good as sockeye, but they’re easy to catch and fun for kids. This one is a male I caught from the shore while fishing for silvers (Coho salmon).
The top of Exit Glacier, with the Harding Ice Field beyond.
Exit Glacier, as seen from the hike up to the Harding Ice Field.
A beautiful tidal glacier flowing into the fjord.
This is a sockeye salmon, aka “red.” They come up the Kenai and head into the Russian River to spawn.
Tiffany and I hiking along the lake, which flows as glacial run off from the Kenai Mountains, shown in the background.
Glacial silt gives the river its characteristic color. The silt is called “stone flour” because it is incredibly fine, leaving the river unusually cloudy.
A shot of crow berries at the top of the ridge line.
The ridgeline at Grace Ridge. This hike requires a water taxi to get to. We were dropped off at Kayak Beach and picked up at the other end, back at sea level. I think the winds were ~40 mph sustained.
Glacial silt gives the river its characteristic color. The silt is called “stone flour” because it is incredibly fine, leaving the river unusually cloudy.
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.
I hadn’t seen the comments about Soldotna before I went. The rotation had just been highly recommended by other residents so I went. The other reason I chose Soldotna was because my girlfriend, who is a family med resident, was able to join me and work with a family doc in Soldotna. After reading the comments on this blog, there isn’t a lot for me to add. The rotation is a great one and I would also recommend going to any resident. If anyone has any questions about the rotation, feel free to contact me.
I just spent a month in wonderful Soldotna, AK and highly recommend it for anyone considering a WWAMI month. It’s great opportunity to experience rural medicine at it’s finest. Over half of the attendings are UW graduates and display a range of practice styles that are all top notch. An average day entails arriving at the hospital at 7:00 or 7:30 depending on the day for one of various conferences/meetings. The rest of the morning was spent rounding on patients. I had anywhere from 1-4 at any time that represented some of the more interesting admits from the previous night or during the day. There’s a different attending on call each day and I checked in with them throughout the day to see if there were any new admits.
If not admitting patients, I spent the afternoons helping see patients in the clinic. I had the chance to help read echos and perform endoscopies throughout the day as well. This is one of the coolest things about practicing in a small community. Without a cardiologist or gastroenterolgist in Soldotna, the generalist have trained to do these procedures themselves. This also meant that for consults, patients at times have to be airlifted to Anchorage. If that happens, I highly recommend talking with the flight nurses and pilot about accompanying your patient in flight to see the transport process first hand. The helicopter sits just outside the ED and as it lifts off, you have an incredible aerial view of the Kenai Peninsula en route to Anchorage.
Aside from work, there is plenty of time to enjoy all that Alaska has to offer. I was on call only one weekend, but had the rest of the weekends and all evenings free to explore The Wilderness. There are two fishing villages: Homer and Seward that are magical and only 2 or so hours away. Spend your weekend evenings at a bed and breakfast and your days exploring the water for whales, sea otters, and shorebirds in a kayak or on a boat tour. If you’re here during the Spring you might be invited to watch Dr. Kelly, a commercial fisherman in his other life, unload his latest catch of halibut. Dr. Bramante, a dog musher in his other life, will introduce you to his 30 dogs and take you on a run with them. The attendings here really embrace the work hard play hard mentality and their passion for both is infectious! Come and see.
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