Primary Care Program
Primary Care Training Options
Internal Medicine residency training historically has emphasized inpatient medicine. While internists need to be well-trained in the management of inpatients, internal medicine has evolved and is now primarily practiced in the ambulatory setting. Our “6+2” block model emphasizes the practice of outpatient medicine, and allows flexibility with elective time for residents to emphasize the type of training that best suits their career objectives. A survey of our residents after our first two years in the block model shows very high rates of satisfaction with their ambulatory training, their ability to focus on ambulatory education, and with their training in ambulatory subspecialties.
We have two separate programs for applicants considering a career in primary care—our traditional Categorical Residency Program and our Primary Care Program (note that these 2 programs have different NRMP numbers). We understand that career plans often evolve over the course of training so we provide flexibility to our residents as they determine the training that supports their career goals. Residents who match into our Categorical Program will be able to apply for a Primary Care Program position during their first 2 years of residency, and residents who match into the Primary Care Program will be able to switch into the Categorical Program, should they wish to during the course of their training. We feel that residents will be well prepared to provide both outpatient and inpatient care at the completion of either of the residency programs and the choice of a program allows a resident to tailor their education to fit their career plans.
Each resident who matches into our categorical program will serve as the primary care physician for his or her own panel of patients in our patient-centered medical home residency clinic practice at either Strong Memorial Hospital or Highland Hospital, working closely with their faculty preceptor. All interns will also spend two half-days per week during ambulatory blocks in a community-based primary care practice working with a single outstanding primary care physician teacher and mentor throughout their intern year.
In addition, all residents will have substantial elective flexibility to pursue additional primary care medicine and ambulatory elective experiences that are tailored to their learning needs. Residents interested in primary care may choose to spend 1, 2, or even 3 half days per week during ambulatory blocks in a community-based primary care office practice (in addition to their usual continuity resident-clinic half days) working with a single outstanding primary care physician during their R2 and R3 years. All of our residents also have the opportunity to pursue 2 or 4-week long electives in very highly-rated rural primary care practices in upstate New York and elsewhere.
Primary Care Program
Beyond the usual flexibility of our block model, we also offer 4 Primary Care Program positions per year for residents who intend to pursue a career in primary care internal medicine (note that this program has a separate match number). The Primary Care Program is similar to our usual “6+2” categorical residency curriculum, but has a somewhat reduced commitment to inpatient rotations in the second and third years to allow additional ambulatory and primary care-based experiences to better prepare residents for primary care practice. Primary care residents have the additional option of having their continuity panel of patients within a community-based primary care office rather than in the hospital-based teaching practices located at Strong Memorial Hospital or Highland Hospital.
Our primary care residents also have a specialized primary care curriculum in addition to the ambulatory educational sessions in which all residents participate. Topics include joint and bursa injections, cognitive behavioral therapy, etonogestrel implant (Nexplanon) training, buprenorphine training, cryotherapy in dermatology, lifestyle management, and motivational interviewing among others.
Primary care residents also have the option of choosing a “4+4” schedule during the R2 and/or the R3 year. This allows a resident to have additional time in the outpatient practice and participate in more ambulatory electives. Residents can also elect to participate in a primary care long block rotation, rural primary care in locations in the Adirondacks, Finger Lakes region, or in rural Maine.
Specific changes relative to our standard categorical internal medicine residency can be customized, but an example of the schedule changes for a Primary Care Program resident are listed below and summarized in the Primary Care Program detailed description:
- R1 year: opportunity to customize community-based primary care site and elective time for different types of primary care experiences.
- R2 and R3 years: 3-4 fewer inpatient blocks (from a mixture of rotations, including floors, CCU, and heme-onc floors) to allow either 1) a primary care long block experience and an elective in a rural primary care office, or 2) a 4+4 schedule.
- Note that primary care residents in their second and third years have the option of pursuing a "4+4" schedule for both years or either year, allowing additional primary care and ambulatory electives.
Rural Primary Care
The University of Rochester is committed to helping expand the workforce of primary care physicians in under-served rural locations. Despite being based in an urban setting and a world-class academic medical center, Rochester is uniquely situated in close proximity to a large rural catchment area. Interested residents can easily access multiple different rural clinical opportunities, ranging from 30 to 60+ minutes away. Our flexible scheduling allows residents to have rural experiences in primary care and/or subspecialty settings within their ambulatory blocks and/or built into 2- or 4-week elective experiences, allowing residents to either commute from Rochester or stay near the rural healthcare site. We also have affiliations with more remote sites in upstate New York and Maine that residents may choose for electives, and we allow residents to pursue electives through the Indian Health Service. We have dedicated funds to help support travel and housing costs associated with resident experiences in rural settings.
The URMC internal medicine residents, staff, and faculty are incredibly supportive of each other, while promoting education and wellness. Additionally, the program takes resident feedback seriously. Furthermore, there are always mentors who are ready to work with us on research or QI projects.
Kriti Thapa, MD, MPH
Primary Care Resident
Class of 2021