FAQs
How much time is devoted to primary care in each of the three years of training?
Internship:
All interns have at least one month of primary care ambulatory time; those who join the primary care track at the time of the match have an additional two weeks of ambulatory. The additional intern elective can also be focused in primary care.
Junior and Senior Residency:
Junior and senior residents spend 1/3 to 1/2 of those years in elective time. Primary care residents can choose from a wide array of primary care electives (list of electives). Residents may choose to apply to work internationally, in Indian Health Service, as VA chief medical resident, or on an AOC project in lieu of standard electives. Weighting of primary care time in the JAR and SAR years allows primary care residents to optimize their elective time to meet specific learning goals as their career plans mature.
Am I guaranteed a position in the primary care program?
The primary care program has always enrolled all residents who wish to join. If you know that you want to do primary care, you are guaranteed a slot. If you are unsure now as you are applying for residency, our policy allows for maximal flexibility.
Why doesn't the primary care program begin in internship?
Although we have never had a separate match for our primary care track, we graduate more primary care residents who enter primary care careers than most programs in the country. We believe that many medical students have not yet had enough experience in primary care internal medicine or in outpatient practice to know enough about this career option to declare that interest as fourth year students. We believe that the success of our primary care program is due to the prominent role played by faculty in the Division of General Medicine who are excellent role models, mentors, and teachers.
Interns who are committed to primary care from the outset of internship are considered members of the track from the start of their training and are invited to all special primary care functions and career development events.
How many housestaff are in the primary care track?
We have accommodated as many as 18 people in a given year of training. In recent years, we have had 8-16 residents per year of training.
How many residents in the track actually enter careers in primary care medicine?
Historically, ~70% of the track's graduates have entered primary care careers. Of those who chose to pursue specialty fellowships, several now practice a mix of subspecialty and general medicine.
What types of jobs do people get after training?
Our residents work in the full spectrum of primary care careers. Each year, we have 1-3 residents who go on to general medicine fellowships and then enter academics as general medicine research faculty. Each year, at least one graduate enters academic medicine as a clinician-educator. Our graduates are on faculty at Beth Israel Deaconess Medical Center, Massachusetts General Hospital, Boston Medical Center, Tufts, Yale University, Mt Sinai School of Medicine, New York University, Maine Medical Center, the University of Chicago, Northwestern University, Indiana University, the University of California at San Francisco, Stanford University, the University of Southern California, Oregon Health Sciences, George Washington University, Georgetown University, Vanderbilt, the University of Alabama, the University of Connecticut, the University of South Dakota, and the University of Florida. Our graduates also work in community health centers including Bowdoin Street, Dimock, South Cove, and Fenway Community Health Centers affiliated with BIDMC and in Chelsea and Revere at centers affiliated with Massachusetts General Hospital. Other graduates are in practice in a variety of groups in Massachusetts, New York, New Hampshire, Vermont, Maine, New York, Pennsylvania, Maryland, North Carolina, Minnesota, Wisconsin, Texas, California, and Oregon.
Can I do research as a primary care resident?
Many of our residents do research projects. There have been projects in health services research, clinical epidemiology, medical education, and clinical research. Areas of research interest within the Division of General Medicine include but are not limited to: obesity, HIV, disabilities, chronic disease management, delirium, geriatrics, and health policy. For a list of current research projects, see our separate document listing projects and research faculty. It is also possible as a primary care resident to do research with faculty outside of the Division of General Medicine.
Many of our primary care residents have presented their research at regional and national Society of General Internal Medicine meeting.
I'm interested in underserved populations. Can I get this exposure?
Historically, Beth Israel Hospital was founded in order to provide care to underserved populations in Boston. Healthcare Associates, our hospital-based practice, cares for a wide variety of patients. At least 20% of housestaff patients are indigent. Several of our faculty are interested in health disparities and cross-cultural medicine. We have a diverse faculty in the Division of General Medicine. Residents may also work in continuity or in ambulatory block rotations in a range of Community Health Centers (see below).
Is there a primary care curriculum?
Yes! We continually review and revise our curriculum based upon feedback and graduate surveys. Our curriculum is delivered primarily during Practice Week when residents are focused on outpatient medicine. The curriculum is taught primarily by general medicine faculty. There is particular focus on prevention, women's health, geriatrics, health economics, behavioral health, and evidence based medicine. We have small group skills based sessions focused on advanced interviewing, primary care procedures, and other topics in greater depth than our standard curriculum. A separate curriculum for interns focuses on common medical problems and systems of care within the practice.
I'm interested in a career as an educator. How might the program prepare me for that?
All housestaff are given the chance to serve as "resident-as-teacher" during the three year program. In this role, residents lead case-based seminars to students and interns; they work as apprentice preceptors alongside our faculty in practice; and they observe interns in practice and provide feedback on those skills. Residents may also choose to serve as VA primary chief resident at the West Roxbury VA service. Finally, residents may choose to do an education project in their senior years focused on an aspect of curriculum development or education research.
I'm interested in women's health. What opportunities exist for this training?
Continuity options:
The women's health practice within Healthcare Associates opened in 2004 and is a model teaching practice. As an added service, consultations focused on female sexual dysfunction, obesity, and disabled women are available within the practice. There is additional expertise and interest in women's health amongst Healthcare Associates faculty based throughout the larger practice.
Several other second continuity options focus on women's health. We have affiliations with student health centers in Boston and with female physicians in local practices. One such faculty member has a wealth of experience with eating disorders.
Didactic curriculum:
Women's health is an important curricular theme. Topics include but are not limited to: contraception, pre-conception counseling, menopause, menstrual disorders, breast disease (screening, abnormal mammograms, mastalgia, breast masses), domestic violence, and a host of mental health issues.
Electives:
We offer elective experiences in gynecology, breast disease, Planned parenthood, bone and mineral metabolism, urology (with some focus on incontinence). We have a new affiliation with Planned Parenthood as an ambulatory elective.
I'm interested in Latino health. What opportunities exist for this training?
We have several Latino faculty who receive many referrals and can direct patients into practices of interested residents. Residents may work with these preceptors for the entirety of their training. Many of these faculty are also interested more generally in cross-cultural medicine. Two affiliated continuity practice sites (Dimock Community Health Center and Medical Care Center North in Chelsea) have significant Latino populations.
I'm interested in international health. What opportunities exist?
Many of our residents work in international settings. Residents have recently worked in India, Nepal, Taiwan, and Africa. While the Indian Health Service is not international, many of our residents choose to work in IHS to gain experience in relatively resource poor and remote settings. Several of our faculty in the Division of General Medicine have major commitments to international health. Lachlan Forrow, MD, is past president of the US Schweitzer Fellowship Program. Howard Libman, MD, directs an HIV program in Vietnam.
I'm interested in HIV medicine. What opportunities exist?
Healthcare Associates pioneered the integration of HIV care within a primary care practice. There are HIV ID consultations that occur within our practice. All interns on ambulatory block rotation rotate through this consultation service. Housestaff have HIV patients within their practice; upon resident graduation we strive to apportion HIV patients amongst new housestaff providers. Residents have access to on-site multi-disciplinary practice supports to help care for HIV patients.
Our ID elective focuses in part on HIV medicine. Dimock and Fenway Community Health Centers have many HIV patients; they are continuity and ambulatory elective options. Interested residents might also choose to do an elective with Outer Cape Community Health Center in Provincetown which provides care primarily to gay and lesbian patients.
What are the options for continuity practice?
Most housestaff practice in Healthcare Associates (HCA), a model academic teaching practice. All preceptors are members of the Division of General Medicine who have their personal practices in HCA as well. The practice has integrated mental health providers in addition to nurse practitioners who help physicians care for their patients. HCA prides itself on the diverse racial, ethnic and socioeconomic composition of the patient population. Areas of faculty interest include but are not limited to HIV, women's health, geriatrics, student health, and Latino health care. There is a women's health practice integrated within HCA that serves as a separate continuity option for primary care residents.
Dimock Community Health Center, located in Roxbury, serves largely African American and Latino patients. Dimock has special programs in HIV and addiction treatment. It is located just a few miles from BIDMC.
The VA Medical Center in West Roxbury is a very popular training site. Residents assigned to WRVA will also have a women's health experience integrated into their continuity practices. Fenway Community Health Center
is focused on gay, lesbian, bisexual and transgender care; it also
provides care for several local colleges. It is a great place for
trainees interested in HIV medicine and/or GLBT care and is one of our
most popular sites.
Primary care residents may have any of these four sites as their primary continuity site for their three years of training. Primary care residents add a second continuity site for their final two years of training which could be one of the sites listed above or any of the following:
- Medical Care Center North in Chelsea is owned by BIDMC and uses the same medical record systems and radiology systems as does the hospital. About 50% of the patient population at Chelsea is Latino.
- There are several options in student or adolescent health including the adolescent medicine practice at Children's Hospital, Brandeis University Student Health Center, and Simmons College Student Health Center.
- There are several faculty in BIDMC affiliated practices who enthusiastically host resident continuity practices in Boston, Brookline, and Lexington. Some of these faculty have particular areas of expertise in women's health and in eating disorders.
Is there anything else that I should know about the primary care faculty or training?
Many of our faculty are leaders within academic general internal medicine. Faculty have had numerous leadership positions and have won regional and national education and research awards from the Society of General Internal Medicine. Faculty are active participants and course leaders at Harvard Medical School. They are well recognized for their exemplary teaching skills.
Our program has participated in several leading edge educational initiatives.
Achieving Competence Today (ACT) was a national initiative focused on learning in System-Based Practice and Practice-Based Learning. We were the only participating program in Boston and one of 19 programs nationally.
In 2004-2005, we were one of fifteen residency programs selected by the American Board of Internal medicine (ABIM) to pilot a residency practice improvement initiative focused on the core competencies of system-based practice and practice-based learning. Our residents evaluated care in HCA using the ABIM's preventive cardiology practice improvement module. Our most recent innovations have been program wide through the Education Innovation Project.
What if I change my mind and want to do a fellowship?
While the primary care program is designed to prepare residents for careers in primary care, we do allow any interested resident to join the program. Our graduates have pursued the full range of specialties including cardiology, gastroenterology, pulmonary, oncology, endocrinology, rheumatology, infectious disease, and allergy immunology. Our primary care residents have been equally competitive in fellowship matches.
