Category Archives: Washington

Primary Care in Montesano WA (2hrs from Seattle)

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.

Montesano – Spring 2012

Montesano was a great place for a resident WWAMI experience! I encourage everyone who wants a WWAMI experience, but can’t be away from Seattle for 4 complete weeks (because of family, significant others, etc) to consider Montesano.

Montesano is a tiny little town, west of Olympia, out towards the Washington Coast. Though it brags of a population of 3500, it feels much smaller than this.  There is a grocery store, a few restaurants, a drug store and a coffee shop, most of these things close down by the evening.  There is a state park at the north end of town and a lot of beautiful countryside around Montesano. The town is about 10 miles east of Aberdeen which is, by far, the bigger town. This town has a couple more grocery stores, some bigger drug stores, some nightlife, more restaurants and a couple of museums. Not too much farther away is Ocean Shores which is a neat little beach community.  It is the greenest part of Washington I have personally seen, probably because it gets a very healthy amount of rainfall! Logging used to be the big industry, but Montesano is also home to the county jail, county court and sheriff’s office. The unofficial town slogan, at least according to Wikipedia, is “Come on Vacation, Leave on Probation!”

Housing is provided in the “med student house”. It’s a three bed-room house with a very decent kitchen, two living rooms, a dining room, back deck and large back yard. There is a washer and dryer on site. The house is literally located 1.5 blocks from the clinic and about 5 blocks from the grocery store and “center of town”. Though you need a car to get to Montesano from Seattle or to commute between Montesano and Aberdeen, you definitely can live in Montesano and barely drive at all. There isn’t much public transportation and I think the options are pretty limited in terms of getting to Montesano without a car.  Its about a 1.5-2hour drive from Seattle, depending on traffic. I came home to see my husband each weekend and the drive was very doable at peak traffic times.

The clinical experience is great! You will spend most of your time at the Montesano Internal Medicine Clinic. It is staffed by two, UW-grad, MDs – Ki and Clara Shin. There is also a nurse practitioner and a PA working there part time. It was a great way to experience “real world” primary care away from a tertiary referral center and to learn the skills of how to manage a variety of problems when there isn’t a CT scanner or cardiologist just down the hallway. Grey’s Harbor has limited sub-specialty care and most of those referrals go to Olympia.  Ki and Clara want to make the experience as personalized and as hands on as possible from seeing as many patients as possible to doing as many procedures as possible, while helping to manage the workload to learning is emphasized! In addition to the medical learning, Ki and Clara were also very open about how to start and manage a small practice as well as sharing their philosophic approach to primary care. Those conversations have really changed how I approach primary care as well as how I feel about it as a career option. I also spent time in another clinic in Aberdeen, run by a UW-grad. This MD is “the whole package” from seeing patients in clinic to rounding on his primary care patients who get hospitalized. He has a different approach to the general internist career and lifestyle and I really learned a lot from the week I spent with him.  Finally, I spent a week with the hospitalist service at the Grays Harbor Community Hospital. It feels like Harborview gets a lot of patients transferred from there and it was really interesting to see the other side of that equation. It’s a busy service, with limited sub-specialty backup, but a great way to learn about common hospitalized problems. It’s also an open ICU. My week there was slightly limited as I didn’t have the ability write orders independently, but they are working on that issue so that future residents can have a more independent experience.

All in all, this is a great experience and I would HIGHLY recommend Montesano!!

Community hospitalist in Port Angeles

I had a excellent month at the community hospital in Port Angeles being a hospitalist for a month! I would encourage anyone interested in hospitalist medicine or anyone interested in finding out what it’s like to practice in a community hospital to spend a month in PA. I was truly a hospitalist for a month and had a lot of autonomy with my service. The attendings are great and the patient population is fairly diverse. Lots of great general medicine with the occasional zebra and need for transfer to the big city. You have the opportunity to work in the ICU and with floor patients with consultants easily accessible.  The hospital staff is incredible and very welcoming.

The added bonus to the experience is having weekends off and enjoying the beautiful Olympic National Park which is minutes away. It’s a beautiful scene in the summer with the moutains and water visible from your door.