Frequently Asked Questions About the Family Medicine Residency

Here are some answers to questions we often hear. You also can find more information about Group Health by browsing the Group Health website.

If you do not find your question here or need more information, you can contact us directly at GHCFPR@ghc.org.

Does this residency program prepare me for a career anywhere other than with Group Health?

Yes. With Group Health, you will work in a primary care clinic that covers broad-spectrum outpatient family medicine. You will be supervised by faculty with varying backgrounds who maintain active practices in area clinics. You will also have rotations in hospitals, community primary care clinics, and specialty clinics with different affiliations, affording you the opportunity to see a wide range of clinical settings. This program will prepare you for a practice in urban, rural, and international settings, and academic and community practices. And it offers opportunities for personal growth with leadership, teaching, innovation, and informatics. Graduates from our program have gone to various locations and types of practices. (See the answer to, "Where have recent graduates gone on to practice?")

What is the relationship like between family medicine and specialty medicine?

In a word, it is excellent! Group Health is built on the family medicine model. The specialists who work here understand both the role of family medicine and how they can best assist. Specialists are readily available by e-mail, phone, and in person to help us learn. Our mutual goal is to provide the highest quality care at the point of contact, so it is in everyone's interest that the family physician be able to identify and treat most common issues and refer only for true specialized procedures and care. And when those referrals are necessary, our patients have quick access.

What does the obstetrics training involve?

Residents will have four dedicated months on labor and delivery with Group Health obstetricians, family physicians, and midwives, as well as with family physicians from four local community health centers. In addition, we have continuity prenatal care and deliveries through our Family Health Center, and a longitudinal second and third-year experience in our Teen Pregnancy and Parenting Clinic for underserved populations. Residents typically graduate with at least 80 to 100 deliveries. There are plenty of opportunities for more obstetrics experience, both locally and away, with elective time if more experience is desired.

Are there enough residents in each class to share the load and provide support?

Because of the small size of the program and the ability to bring most residents back routinely for weekly didactics, the residents typically develop close bonds with their shared experiences. A monthly Balint group meeting provides opportunity for formal discussion of provider-patient relationships among peers. Informally, this happens in hallways, offices, homes, and cafes. Every resident is assigned a "buddy group" (made up of an R1, R2, and R3) to ensure readily available support from the beginning, but our residents certainly don't feel limited to this, and our small class sizes ensure that everyone quickly gets to know one another well.

For sharing the load and covering for each other, with our program very few services are dependent on the residents. This gives us valuable flexibility and minimizes the impact on fellow residents if someone becomes ill or requires a leave of absence.

Are there opportunities for teaching?

We work with medical students in our family medicine clinic, teen pregnancy clinic, at Seattle Children's Hospital, and in the obstetrics rotation. Additionally, seniors play a key educational role for the new residents.

What is it like to work in a hospital system that is not dependent on residents?

This is an ideal training center for motivated, independent learners. Residents are not required to take every admission that comes in just because someone has to. Instead, the majority of cases will be selected for their learning and teaching value. Residents here enjoy one-on-one interactions with attendings who are chosen by residents for their skill and interest in teaching.

Another benefit of this model is that the residents are not dependent upon each other. If someone is ill or needs to take a leave of absence, the other residents do not have to shift over to cover additional services. Additionally, residents can leave most services to deliver a continuity obstetrics patient without having to arrange coverage.

Where have recent graduates gone on to practice?

Recent grads have gone on to practice in a variety of settings, including rural practice, urban clinics, inner-city underserved, community health centers, health maintenance organizations (HMOs), academics, and fellowships. Some graduates have specialized their scope in urgent care, occupational medicine, leadership, or health administration. Our unopposed, full-spectrum training program is designed to ensure that graduates have the ability and the confidence to excel in whatever practice environment they choose. The vast majority of graduates have chosen to stay in the greater Seattle area and Washington, but our graduates are practicing all over the country.

Are there limitations working in an HMO?

The Group Health-model HMO, otherwise known as an integrated group practice, is an ideal setting for family medicine because the family physician and the patient are at the center of a large system of support. The family physician provides the majority of care for most patients, coordinates additional care with specialists if needed, and makes decisions about testing, referrals, treatment, follow-up, hospitalizations, and so on. There are no significant restrictions to diagnostic and treatment options.

This is possible because of the quality of the family doctors within the system. It's also possible because of the use of evidence-based medicine and best practice guidelines, created and periodically reviewed by committees of Group Health physicians, which serve as examples of gold-standard care for doctors in the clinic. Our formulary also is managed by a committee made up of clinicians. Rarely will providers need (or want) to prescribe outside the formulary, but in those cases exceptions can be made.

What sort of patient population do you serve?

TThe Family Medicine Residency's patient population reflects the richness of an urban setting. Patients represent the entire spectrum of racial, cultural, age, and socioeconomic diversity. Among our clinic patients, 30 percent are of a race other than white, 26 percent have government-subsidized insurance, and 12 percent speak a language other than English in their home. Interpreters are readily available for the wide range of languages spoken.

Medicare, Medicaid, and Basic Health (a state-funded insurance program for the working poor) are all honored in both the inpatient and outpatient settings. Patients are made aware of a resident's particular interests and language skills through biographical leaflets. New residents are assigned about 150 patients from outgoing third year residents, and build their practices over their three years of training.

What is the call schedule like?

As a result of the new ACGME hours recommendations, the call schedule has recently been updated to ensure compliance. The new system is detailed below.

During two blocks of internal medicine, interns take home call via a pager, but sign out to the Group Health nocturnalist at 10 p.m. They are expected to manage any additional needs for their patients via telephone, but are not expected to drive back into the hospital once they have left for the day. The senior resident provides backup until sign out. The final block of internal medicine includes two weeks of night float working one on one with an attending physician. During the two blocks of obstetrics, residents work 12-hour shifts. The pediatric inpatient rotation during intern year now includes one week of night float and no in-house call. Two blocks of surgery include one weekend each of home call.

Second-year residents have two blocks of obstetrics, and likewise work 12-hour shifts.

During the second and third years, residents take home call as seniors on the medicine service until 10 p.m. They also have five to six weeks per year of family medicine hospital rounding, which includes home call while caring for a service that is capped at three patients. Home call for the teen pregnancy clinic is divided among the 10 senior residents, so it averages every 10th night and often overlaps other responsibilities.

Do you offer part-time or shared positions?

We do not offer part-time or shared positions. Occasionally part-time arrangements have been made for residents with special needs. This requires prior approval of the American Board of Family Practice and is considered on a case-by-case basis. It is not available for the first year. The part-time schedule must include 24 months of continuing care by the resident for her or his continuity panel of patients, with availability to that panel equivalent to that of other (full-time) residents. Also some of the required rotations (ward medicine, intensive care) must be done on a full-time basis.

A shared residency would involve two persons sharing a continuity panel and each of the residents pursuing an approved part-time curriculum as above.

What are your requirements for international medical graduates?

We accept applications from international medical graduates with J-1 visas. Our application procedure is only via the Electronic Residency Application Service® (ERAS). To be considered, an international medical graduate must be certified by the Educational Commission for Foreign Medical Graduates® (ECFMG). If you are still in training, you must have completed all aspects of ECFMG certification with the exception of your graduation in order to be ranked. We consider applicants who have graduated in the last two years or continued to have extensive clinical family practice experience since graduation. Clinical experience within the U.S. health care system is required.

Does it really rain all the time in Seattle?

In Seattle, it rains frequently during the winter, but not heavily. We get 37 inches of rain annually, placing Seattle 44th on the list of U.S. cities for rainfall, behind such notables as Chicago, San Francisco, New York City, Houston, and Miami. On the other hand, it is quite often cloudy, though locals do not usually let that get in their way. Seattle is a surprisingly outdoorsy city considering its reputation for rain.