Internal Medicine Residency Program
Frequently Asked Questions
For your convenience, we have prepared the following questions and answers frequently raised by applicants. Please click on a question to be presented with the answer.
- Are your house staff happy?
- Does CPMC's Internal Medicine Program have a University affiliation?
- Why would a prominent East Coast Ivy League Medical School pay to fly its medical students across the continent to do core clerkships and electives at CPMC?
- Are there other student clerkships at CPMC?
- Which schools did the current Intern class graduate from?
- What medical schools did your current Residents come from?
- How does the first year Categorical Medicine program differ from the first year Preliminary Medicine program?
- What are the 3 most frequently asked questions by the applicants for the Categorical program?
- How does one become a second year resident in Internal Medicine?
- How well do our residents perform on the Internal Medicine Boards?
- Where do graduates from CPMC's Categorical program go?
- Does CPMC offer Fellowships in Medicine?
- I might want to apply for a sub-specialty fellowship after residency - how have your residents been doing in terms of fellowship placement?
- What does CPMC do to help me get a job when I have finished the program?
- What are the 3 most frequently asked questions by applicants for the Preliminary year?
- What are the call schedules like?
- How often do medicine teams admit?
- How many patients does each intern follow?
- Where do hospital patients come from?
- Which patients are teaching patients?
- Will I have adequate responsibility for the care of my patients?
- Is there a night float system?
- How much ICU experience does the program offer?
- Who will be teaching me?
- Are Hospitalists used at CPMC?
- How much primary care is there?
- How will my education be affected by managed care?
- How much elective time is scheduled and what electives are available?
- Is there much scut work?
- What ancillary services are available to the house staff?
- How extensively are computers used at CPMC?
- Is there an opportunity to do research during the residency?
- How are residents evaluated?
- Do residents have a say in how the program runs?
- What is the work environment like?
- Is your program in compliance with the ACGME work hour regulations that were instituted in July 2003?
- How did your program perform in the most recent RRC-IM (Residency Review Committee for Internal Medicine) site visit?
- What is the PGY-1 salary?
- Are there any additional education funds?
- How much vacation time is permitted?
- How is CPMC doing financially?
- Will I get to work in the new hospital while I am a resident?
- What is there to do outside the hospital?
- Can I spend more time at the hospital while I'm here for my interview?
Are your house staff happy? Top of Page
Despite the fact that our house staff work hard, and that residency is usually not considered "the happiest time" of one’s life, our residents are a very happy bunch. Reasons cited by residents (in both formal and informal surveys) include working in a supportive environment, quality of relationships with peers, teachers and nurses, living in the San Francisco Bay Area and the strong emphasis on teaching and learning from a diverse patient population. Feel free to ask them this question directly if you come for an interview-it's a good question to ask on all of your interview days, no matter where you are. If you're going to work hard in residency, we believe you'll learn more and have a better experience if you are part of a supportive community where you feel good about what you are doing. The medical literature also supports the fact that patients tend to be most satisfied with physicians who are satisfied with the work they are doing.
Does CPMC's Internal Medicine Residency program have a University affiliation? Top of Page
In 2008 CPMC formed high level affiliation with Dartmouth Medical School (please see below). In 1996, the Internal Medicine Program at California Pacific also became an affiliate of the University of California at San Francisco (UCSF). CPMC continues to select all its residents. Residents who match at CPMC do the vast majority of their inpatient and outpatient training at California Pacific and its outpatient facility. California Pacific residents can choose a number of electives at UCSF and its affiliated hospitals and clinics.
Why would a prominent East Coast Ivy League Medical School pay to fly its medical students across the continent to do core clerkships and electives at CPMC? Top of Page
Despite already having an affiliation with UCSF School of Medicine, CPMC formed an affiliation in January 2008 with Dartmouth Medical School. Dartmouth Deans were looking for a great clinical setting with excellent residents, fellows, and faculty, vibrant conferences, a busy, efficient hospital, and extensive patient and case diversity. After a national search and several site visits to CPMC, they were convinced that they had found the right place for their students. Dartmouth flies students to San Francisco for 3rd and 4th year rotations where they are housed by Dartmouth in conjunction with CPMC.
CPMC benefits from this affiliation by having more student learners in its supportive environment. Working with Dartmouth students affords medicine residents and faculty additional opportunities to teach, collaborate on scholarly activities, and hone their team leadership and mentoring skills. To quote many of the residents and interns, “you never truly appreciate what you don’t know until a student asks you a question.”
These students come to CPMC from an excellent medical school, extremely well educated and well prepared for their clinical duties. All CPMC faculty and residents have been impressed with their clinical performance to date.
Are there other student clerkships at California Pacific? Top of Page
Yes. We offer a multitude of sub-internships to fourth year medical students. Students come from many U.S. medical schools. In addition, we offer core clerkships to third year Dartmouth students in Internal Medicine, Psychiatry, Pediatrics, Ob/Gyn and Family Medicine in addition to a fourth year Neurology core clerkship. To UCSF medical students we offer core clerkships in Surgery, Internal Medicine, Psychiatry, Ob/Gyn and Pediatrics.
Which schools did the current Intern class graduate from? Top of Page
Categorical Program:
Sola Ademola, M.D. - University of Ibadan
Joann Dominguez, M.D. - University of Nevada
Barbara Galligan, M.D. - University of California, Davis
Joseph Henry, M.D. - University of California, Davis
Lisa Hladik, M.D. - St. George's University
Tamsin Levy, M.D. - University of California, San Francisco
Alexander Luger, M.D. - University of Minnesota
Hanley Ma, M.D. - University of Minnesota
Hitasha Singh, M.D. - Virginia Commonwealth University
Von Ta, M.D. - Virginia Commonwealth University
Susanna Tan, M.D. - Northwestern University
Sheba Vohra, M.D. - Wayne State University
Albert Won, M.D. - Albany Medical College
Jia Yang, M.D. - University of Cincinnati
Preliminary Program:
Scott Bratman, M.D. - Columbia University
Daniel Kim, M.D. - University of California, San Francisco
Geoffrey Langham, M.D. - Case Western Reserve
Calvin Lew, M.D. - UMDNJ Robert Wood Johnson Medical School
Vincent Lew, M.D. - Oregon Health Sciences University
Albert Lu, M.D. - University of California, Davis
Lucas McCarthy, M.D. - Albert Einstein College of Medicine
Valli Muthappan, M.D. - Washington University
Joshua Ng, M.D. - Harvard Medical School
Chul-Kyun Park, M.D. - University of California, Davis
Premal Patel, M.D. - University of California, Davis
Daniel Rosenbaum, M.D. - Cornell University Medical College
Ricky Tong, M.D. - Stanford University School of Medicine
Aaron Yang, M.D. - State University of New York, Syracuse
What medical schools do your current R2s and R3s come from? Top of Page
Second Year Residents
Tina Au, M.D. - Case Western Reserve
Jamie Berger, M.D. - University of Texas, San Antonio
Louis Casso-Gomez, M.D. - Texas A&M
Lindsay Chong, M.D. - Northwestern University
Alissa Detz, M.D. - University of California, Irvine
Yile Ding, M.D. - University of California, San Francisco
Alireza Ghotb, M.D. - Tehran University
Amy Gin, M.D. - New York Medical College
Nicole Gonzales, M.D. - University of California, Davis
Yu-Chen Hu, M.D. - University of Michigan
Andrea Ling, M.D. - George Washington University
Jason Talavera, M.D. - University of California, Davis
Robert Wong, M.D. - University of California, San Francisco
Priscilla Yee, M.D. - University of Hawai'i
Third Year Residents
David Bowden, M.D. - Tulane University
Lori Cooper, M.D. - Albany Medical College
Sally Daganzo, M.D. - University of California, San Francisco
Aaron Falk, M.D. - University of Nevada
Nicole Hickey, M.D. - Temple University
Kristine Hsieh, M.D. - University of California, San Diego
Janet Hur, M.D. - Wayne State University
Karin Kerk, M.D. – Howard University
Helen Lau, M.D. - University of California, Davis
Jennifer Ling, M.D. - Ohio State University
Ernest Lo, M.D. - University of California, Davis
Eliza McCaw, M.D. - Rush Medical College
Kim Nguyen, M.D. - Mayo Medical School
Matthew Reimert, M.D. - Keck School of Medicine, USC
Ryan Wong, M.D. – Albert Einstein College of Medicine
Shaun Young, M.D. - Keck School of Medicine, USC
Chief Residents
Julie Gillespie Payne, M.D. - Medical University of South Caroliina
Sharon Kim, M.D. - George Washington University
Nicholas Moy, M.D. - New York Medical College
Maggie So, M.D. - New York Medical College
How does the first year Categorical Medicine program differ from the first year Preliminary Medicine program? Top of Page
Both programs include Internal Medicine experience sufficient to qualify as a first year for Board Certification in Internal Medicine. The categorical medicine curriculum incorporates outpatient as well as inpatient Internal Medicine rotations while the preliminary medicine curriculum has less experience in ambulatory care.
For example, the Categorical curriculum includes scheduled emergency room and medical clinic assignments. The Preliminary (1-year) residents may do an ER rotation as an elective. "Prelim" interns do more months (2-3) of MICU, while "Cat" interns are only allowed to have one. The MICU is one of the most popular rotations in the program.
Both curricula include inpatient general medicine, cardiology, critical care units, and Hematology/Oncology.
Average Categorical and Preliminary interns have almost identical numbers of call nights, night float and work load. The biggest difference between the two programs is that Preliminary interns do 2-3 months of MICU while Categorical interns are only required to do 1 month of MICU due to RRC guidelines. Categorical interns do 1 required month of San Francisco General Hospital Emergency Room, an excellent but rigorous learning experience. Preliminary interns are not required but may elect to do ER if they desire or if they need to fulfill this requirement for Anesthesia training.
It is worth emphasizing again that there is little difference between treatment of "Prelims" and "Cats", to the point where most of the attending physicians in the hospital don’t even know who is Preliminary and who is Categorical at the end of the academic year. While some training programs use their Preliminary interns as "grist for the mill" of clinical work while sparing their Categorical interns, we do not. We are very proud of the training we provide our Preliminary interns and the excellent preparation it provides them for their future careers. Many years after our preliminary interns have graduated and moved on we continue to hear from them about how well prepared they were for their specialty training – whether Dermatology, Radiation Oncology, Anesthesiology or Neurology. A significant number have even "come home" to CPMC after their advanced training as neurologists, radiologists and anesthesiologists. We love to see them back here again!
What are the 3 most frequently asked questions by applicants for the Categorical Program? Top of Page
i. My advisors at my medical school don’t know much about “community” training programs and they told me I should go to a university-based training program even though I like the sound and feel of CPMC and the house staff seem quite happy there.
This is an excellent question. First of all, CPMC isn’t really a “community” training program. It boasts a large research institute with bench-top, clinical and outcomes projects. It is a major Northern California referral center for both renal and liver transplant and for challenging diagnostic or therapeutic cases. We are also affiliated with Dartmouth Medical School and UCSF which provides plenty of opportunity, if desired, to teach and to do rotations at a large University hospital.
We interview many categorical applicants who are clearly an excellent “fit” at CPMC but are scared by venturing into what they or their advisors perceive as the “unknown”. CPMC has the warmth and camaraderie of a small program, yet has the prestige, quality and education of many large university programs. Applicants who may be lost in the “cogs” of a larger university program and like being part of a “place” and a community tend to be happiest at CPMC.
ii. But I still don’t know what I want to do after residency and I’m worried that if I want to do a fellowship I won’t be able to secure a spot if I train at CPMC?
Naturally, the ability to secure anything in life is a function of how hard you work and how you apply your talents. There are record numbers of applicants to sub-specialty fellowships the last several years and most of our residents are still able to obtain fellowship spots at places as diverse and competitive as Stanford University, UCSF, Albert Einstein, University of Pittsburgh, University of Arizona, NIH, UCSD, OHSU, Boston University, UCLA, among others (please see complete list under Life After Residency - Fellowships).
iii. OK. I’m impressed with the place, but will I be happy at CPMC? And are your current residents and interns happy at CPMC?
This is an excellent question. As you visit other programs this is one of the best questions you can ask. If a program’s house staff are not happy, you probably won’t be happy there either. If a program’s house staff are happy, you’ll probably be happy.
The best way to get a handle on this at CPMC is for you to ask our residents and interns, directly, whether they’re happy and satisfied. Do they feel listened to? Do their Program Directors exhibit passion (as ours do) for education, patient care and housestaff wellbeing? Do they feel happy when they go to work each day? Do they look forward to getting to the hospital or clinic? In this year’s satisfaction survey our house staff rated themselves as happy with the program. When asked to rate how happy they were with becoming a doctor (the ultimate question, when you think about it) on average they are very happy with their career choice. On a Likert scale of 1-10 (with 10 being “extremely happy” to have chosen medicine as a career) 3rd year residents averaged 9.4!!
We were particularly struck by this last piece of data. Many applicants, understandably, tend to focus on internship forgetting that it’s the big picture (“will I be as happy or happier at the end of the ‘pipe line’ as I am throughout training?”).
For the past three years R1 "happiness with training at CPMC" (for both preliminary and categorical interns) has ranged from 8.1-9.2 on the 1-10 Lickert Scale (i.e. they're happy.) But come visit for a day (or 2) and see for yourself!
How does one become a second year resident in the Medicine program? Top of Page
The selection for Medicine R-2 is on the basis of performance during the R-1 year. We do not have a pyramid system. Assuming that an R-1 performs satisfactorily, an R-2 slot is reserved for each R-1 in the three-year program. On occasion, R-1s in the Preliminary program may ask to stay and enter an R-2 year in Internal Medicine rather than in their previously selected subspecialty. We have usually been able to accommodate such requests, although this is based upon that intern's performance and is subject to space availability. If space is not available, the Program Directors have always been able to secure preliminary interns wishing to stay in Internal Medicine positions in other excellent training programs.
How well do your house staff perform on the Internal Medicine Boards? Top of Page
Our 3-year ABIM "rolling pass rate" (average over the previous 3 years) is usually around 95%. The Program Director teaches an evening "Accelerated Board Review" course in late spring where good food, excellent teaching and collegiality are provided. Other Board Review sessions occur at noon conference. The Program Directors also provide "coaching" on a one-on-one basis to any residents who have difficulty with standardized testing.
Where do graduates from CPMC's Categorical program go? Top of Page
(Please see "Life After Residency" on this website.)
Some go into primary care (many at our institution or elsewhere in the San Francisco Bay Area), and the rest choose subspecialty training or hospitalist work. Fifteen of our graduates are hospitalists on CPMC's staff.
We are proud of our record of obtaining excellent fellowships for our graduates. Many of our full time faculty and other members of the attending staff are very active in National Subspecialty Societies. Thus, direct contact can be made with colleagues at prestigious institutions that respect the recommendations of our faculty regarding fellowship applicants.
Does CPMC offer Fellowships in Medicine? Top of Page
Yes, in Cardiology, Pulmonary/Critical Care, Gastroenterology and Transplant Hepatology.
I might want to apply for a sub-specialty fellowship after residency-how have your residents been doing in terms of fellowship placement? Top of Page
Our residents have traditionally done very well with fellowship placement (please see "life After Residency-Fellowships" on this website). Despite this being a very competitive time to seek sub-specialty training, our residents have generally been very successful (NIH, Stanford, UCSF, UCLA, CPMC, OHSU, Boston University, UCSD, etc.)
What does California Pacific do to help me get a job when I have finished the program? Top of Page
The job market is pretty good in the Bay Area. We have an extensive program to help graduating house officers secure desirable practice opportunities and fellowships. The proof of our commitment is documented in the list of positions that our graduates occupy. Regarding practice opportunities, by working at California Pacific, residents will work with most of San Francisco's most respected internists. Some will be offered positions based on the quality of their patient care and interactions with private attendings. Because our residents work in a managed care environment, they are considered to be “desirable” hires by large HMO's. The Program Director, Associate Director and Chair of Medicine have close contacts with Kaiser and other physician groups and work diligently at placing graduates in positions and locations they want. In addition, California Pacific is a Sutter Health affiliate. Sutter owns 29 hospitals and operates approximately ten large medical groups in Northern California. Sutter-affiliated hospitals and groups favor California Pacific graduates because our training program is well known for producing primary care internists who have expertise in both ambulatory care and complex inpatient management and who practice evidence-based medicine.
We are proud of our record of obtaining excellent fellowships for our graduates. Many of our full time faculty and other members of the attending staff are very active in National Subspecialty Societies. Thus, direct contact can be made with colleagues at prestigious institutions that respect the recommendations of our faculty regarding fellowship applicants.
The Program Directors meet with Categorical R-1s, R-2s and R-3s twice each academic year to discuss fellowship possibilities. Each R-3 meets with the Program Directors early in their graduating year and as needed thereafter until the resident has a contract for a desired position.
What are the 3 most frequently asked questions by applicants for the Preliminary year? Top of Page
i. How hard is CPMC’s Preliminary year compared with other programs?
This is a tough question to answer with 100% accuracy since “hard” is a relative term. There is very little scut work at CPMC, the food is good, the people are nice, the administrative support is excellent, the Program Directors and Chief Residents are approachable and supportive and residents and interns are kind to each other. The number of call months, elective-at-risk (“jeopardy”) and night float (1 month total) are about average for a Preliminary medicine program. The patient census and turnover are probably average or slightly above average for a Preliminary Program.
Some interns have finished their Preliminary year stating that they thought the year was “cush” (as in cushy) while others have finished stating that they felt like they were “worked pretty hard” most of the year. Most, according to the annual survey and personal anecdote, feel that the year was about what they expected for an internship.
We believe that our program is probably in the 75th percentile for difficulty but there’s really no way to accurately quantitate this. Suffice to say, if you’re looking for a “kick back” year with minimal call and patient care responsibility, this is not the place for you. If you’re looking for a place with a fantastically diverse patient population and case mix where you’ll work hard, learn a lot and establish an excellent foundation for your future career, this is the place for you. The Preliminary interns that have most enjoyed themselves here (and there have been a lot of these), have been those that wanted to see lots of different things—from bread and butter to the truly bizarre—and to work hard and work well with other house staff. If you are interested in a “cush” program where you can simply get the required preliminary year “out of the way,” PLEASE don’t waste your time applying here. Our teachers and program directors take the education of our preliminary interns very seriously and, in turn, these interns take their own educations and hard work seriously. You can certainly find an easier program elsewhere but you will not find a program that prepares you better than ours does.
ii. But do current medical house staff at CPMC feel like their internships and residency are what they expected relative to hard or easy?
Yes. For the past six years in the annual house staff satisfaction survey, house staff were asked to score how close to their expectations internship/residency came. On a Likert scale from 1 through 10, 1 was “much harder than I expected” and 10 was “much easier than I expected”. 5 was “about what I expected”. The average score was consistently between 5.6 and 5.9. In other words, on average, house staff felt that their training was about what they had expected. When analyzed by sub-groups (Preliminary R1s, Categorical R2s, Categorical R3s) there was no difference between groups in their perceptions of difficulty/ease of training.
The Program Directors would be happy to review results from these surveys with you during their closing afternoon session if you visit for an interview.
iii. But will I be happy at CPMC?
For the past 3 years R1 “happiness with training at CPMC” (for both preliminary and categorical interns) has ranged from 8.1-9.2 (9.2 in 2008-2009) on the 1-10 Likert Scale (i.e. they’re happy!)
What are the call schedules like? Top of Page
Call varies depending upon the type of rotation and how one defines "call". We would encourage you to ask residents about this when you visit as it is too complicated to explain in this small space! Suffice to say that residents have about six months of rotations/year where there are 2 or more nights spent in the hospital. Interns have about 8-10 month/year where two or more nights are overnight. Private call rooms are provided in a recently renovated resident sleep facility. Residents on electives usually do not have scheduled night call responsibilities. They may be included on a “jeopardy” schedule to cover other residents in the event of an illness or emergency. Because of the night float systems, resident call on the medicine service generally does not require overnight stay in the hospital on weeknights (Sunday through Thursday). Cardiology rotations are traditional Q4 call. All other rotations include some use of night floats.
How often do medicine teams admit? Top of Page
Medicine teams accept admissions on their long call, short call, and medium call days. The short call team takes admissions until 1pm and the medium team until 6:00pm. The long call team admits until 8pm. Essentially this means that medicine teams admit 3 out of 5 days with no H&Ps done on pre and post-call days. Pre-call teams may receive already admitted "holdovers" from the overnight resident night float to "decompress" the short, medium and long call teams. This system allows us to keep admissions evenly distributed, thereby avoiding exceeding patient "caps". Specialty teams admit patients on a daily basis, but no one admits when post-call.
How many patients does each intern follow? Top of Page
On most inpatient services, each intern will admit 2-5 patients per admitting day and will carry an average census of 8-10 patients.
However, census varies from service to service with the higher intensity services, such as Hematology/Oncology, having slightly fewer patients. Intern services are strictly "capped" at 10 patients and interns may admit no more than 5 new patients and accept 2 transfers in a 24-hour period.
Where do hospital patients come from? Top of Page
California Pacific's core mission is to serve the local community. San Francisco has an exceptionally diverse population and, as a result, we have a broad range of patients covering the entire spectrum of disease and socioeconomic status.
Approximately 30% of patients come from outside San Francisco. These include travelers and referral patients for programs in Transplantation, Infectious Diseases, Strokes, Complex Neurosurgery, GI Dysmotility, complex GI Diseases, Cardiology, Hematology/Oncology, Neuromuscular Diseases and complex immunologic disease.
Which patients are teaching patients? Top of Page
Most patients (>80%) are on the teaching service. "Non-teaching" status is reserved for patients whose stay is brief, routine, and of limited teaching value (e.g., patients admitted for same-day cardiac catheterization or same-day chemotherapy). The program directors continually evaluate the nature of admissions in an effort to balance education with patient care.
When services are "capped" some patients may be assigned to a "non-teaching" service.
Will I have adequate responsibility for the care of my patients? Top of Page
Yes. California Pacific is not your stereotypical private hospital. Most faculty choose to admit to California Pacific over other hospitals because of the excellence of our house staff. Program leadership and faculty are strongly committed to the concept that house staff learn best by "doing". House staff feel responsible for patient care because they are responsible for patient care. Attending physicians work closely with the house staff to supervise and teach.
The house staff are expected to handle the day-to-day management and are expected to write all orders. We believe our house staff have the same degree of responsibility as in university hospitals and a much greater degree of responsibility than in the majority of private hospitals.
Is there a night float system? Top of Page
Yes, there are currently five night float systems in place. One intern night float does only medicine and Heme-Onc admissions on a team with an R-2 Medicine night float.
A second intern night float does only medicine cross-cover 7 nights/week. This float does all medicine service cross-coverage between 5pm and 7am. This system has permitted admitting interns to focus on their new admissions without the distraction of cross-coverage. The medicine day interns go home all nights except one Friday and one Saturday night/month when they stay in house with their entire team to admit. They leave the hospital no later than 1:00 p.m. the following day.
A 2nd year medical resident night float covers admissions from 8pm to 8am. This allows the second and third year residents on the medicine service to go home between 8 and 10pm on weekday (Sunday-Thursday) nights.
The fourth night float system is the CCU night float, which allows CCU residents to maintain a Q4 call schedule. Residents have a maximum of one month of night float each year, about average for Internal Medicine programs in the United States.
During MICU rotations each intern-resident team does 5-6 nights of night float where they admit to and cover the ICU from 5:00 p.m. until 7:00 a.m
How much ICU experience does the program offer? Top of Page
Over the three years of training, residents will get 5-6 months of ICU and CCU experience.Our faculty and residents believe that a well-trained internist should have sufficient experience with “sick” patients to allow them to ultimately practice inpatient and/or outpatient medicine. In addition, CPMC has excellent teachers and a broad patient base in Critical Care Medicine. The residents are exposed to critically ill patients with “routine” disease as well as to “referral” patients who are hospitalized with complicated multi-system disease. The MICU is consistently ranked as one of the top most valuable educational experiences on the annual house staff survey.
Who will be teaching me? Top of Page
CPMC residents admit patients with and interact daily with a diverse group of medical attending physicians, all of whom are dedicated to the clinical practice of medicine. These clinicians serve both as teachers and role models to the residents. Selected attendings chosen for their excellence as teachers and clinicians serve as teaching physicians and round in small groups with general medicine and specialty teams three or four times each week. The focus of attending rounds is soley on teaching. Furthermore, besides teaching of procedures by residents, fellows or attendings is an important aspect of training at California Pacific. Our superb hospitalist group, the majority of whom are former California Pacific or UCSF Residents, are key members of the teaching team.
Are hospitalists used at CPMC? Top of Page
Yes. CPMCwas one of the first hospitals in the U.S. to employ full-time hospital-based physicians. There are currently 48 inpatient "specialists" on the acute wards and in the Skilled Nursing Facility. These "hospitalists" have special expertise in efficient inpatient management. They are important members of the teaching program, and are in the hospital 24 hours-a-day, seven days-a-week. Surveys of residents and interns have consistently shown that they are among the most visible, valued and committed teachers at CPMC.
How much primary care is there? Top of Page
We have a very strong continuity clinic located at the California Campus which is a 7-minute shuttle ride from the main inpatient campus. The clinic offers exposure to a broad range of patients in a well-supervised setting. We believe that our outpatient clinic is one of the best available to train residents in outpatient primary care medicine. The patient base includes 50% HMO patients. Most of these patients work in the local community. Approximately 25% of our ambulatory patients are Medicare seniors (age > 65), and twenty five percent are indigent (Medicaid).
All residents in the three year program spend one half-day every week in the outpatient continuity clinic beginning in the R-1 year. In addition, house staff in the three-year program have four mandatory rotations in the outpatient setting over the course of the three years (including one ER month, two ambulatory care months and one month of geriatrics). The two ambulatory care rotations include exposure to the following activities: urgent care, care of the uninsured ("Free Clinic"), office orthopedics, ENT, dermatology, geriatrics, travel medicine, podiatry, rheumatology, among others.
Elective months can be devoted to further enhancing primary care exposure. Residents can choose to work for one month in the office of a group of primary care internists and/or care for indigent ambulatory patients.
Although we do not have a primary care track, residents can select to spend up to 35-40% of their time during their second and third years in ambulatory training sites. We encourage house staff who are interested in a primary care career to use assigned rotations and electives to design a comprehensive ambulatory care training experience.
How will my education be affected by managed care? Top of Page
Managed care organizations provide payment for approximately 30% of inpatients at California Pacific. One of the features of our training program is the ability to learn medicine in a managed care environment, which stresses evidence-based medicine(EBM), disease prevention, and outcome analysis. Residents will learn about appropriate utilization of resources, clinical pathways, and other aspects of cost efficient medical care. Residents work closely both with attending physician hospitalists practicing in managed care model and with attendings practicing in either managed care or traditional models.
How much elective time is scheduled and what electives are available? Top of Page
Each first year resident (R-1) has one or two months of elective time. Electives can be chosen in any subspecialty area. Commonly selected electives include: anesthesiology, cardiology, dermatology, gastroenterology, infectious diseases, nephrology, research, quality improvement (GI) and rheumatology. It should be noted that during one of those elective months the intern is “at risk", otherwise known as "On jeopardy call". At risk means that the intern may be called in from elective in the event that a colleague becomes ill or for other extenuating circumstances.
R-2 and R-3 schedules include two months of elective time per year and several "selective" months. All second and third year residents also have "selective" rotations which include gastroenterology, nephrology and geriatrics/palliative care during their 3 years at CPMC.
Residents take most of their electives at California Pacific. Electives can also be taken at other Bay Area hospitals including: UCSF hospitals (Moffitt-Long, the VA and SF General), Stanford, and Alameda County ("Highland") Medical Center.
Elective opportunities are available in all traditional subspecialties of internal medicine and in many related fields, including HIV medicine, complementary medicine, rehabilitation medicine, and end of life care/hospice medicine. Research electives are encouraged as part of the scholarly activity of our house officers. One month of research is allowed each year. Quality Improvement and Residency Program improvement electives are readily available and have been popular, productive and successful.
Is there much scut work? Top of Page
There is remarkably little if any scut work. Residents and interns consistently comment on how a lack of scut work frees them up to think about and take care of their patients.
What ancillary services are available to the house staff? Top of Page
All routine lab tests as well as special multiple timed lab draws are drawn by phlebotomy personnel 24 hours a day. Similarly, the nursing staff will place nasogastric tubes, foley catheters and IV's, including PICC lines. Respiratory therapy is available 24 hours a day. EKG technicians or nurses perform EKGs. There is very little if any "scut work" done by our house staff.
How extensively are computers used at CPMC? Top of Page
CPMC uses computers extensively throughout the hospital. All orders are entered by house staff via computer terminals located at all nursing stations, in the physicians' lounge and next to the call rooms.
Computerized literature searches are accessed via Ovid, PubMed, MD Consult and Up-To-Date. A full text search capacity is available at many computer terminals and, with the exception of Up-to-Date, can be used by our residents at home. There are over one hundred and fifty medical textbooks available through our intranet library website. House staff have ready access to the full range of library services, including all major journals and copying services. There is an excellent href="/professionals/hslibrary/">library and several smaller collections of important books and journals available in or adjacent to call rooms. Please see Unique Aspects of Our Curriculum and Work Environment for information about our residency “Shared Drive,” Core Articles Curriculum and internet-based sign-out system.
Is there an opportunity to do research during the house staff training program? Top of Page
Yes. We encourage house staff to participate in research projects which may be done during elective rotations (up to 1 per year) or as an ongoing project during the course of training. There is funding available for worthy projects, including costs of travel and lodging at national meetings. Our interns and residents have had abstracts accepted for presentation at both regional and national meetings. Numerous resident-authored articles and letters have been accepted by peer-reviewed journals. Please see our listing of recent "Scholarly Activity" to get a feel for some of our house staff abstracts, recent research projects and publications.
How are the residents evaluated? Top of Page
CPMC's program is "feedback intensive." Residents are expected to review curriculum materials and to clarify their expectations at the onset of each rotation. Real time verbal feedback is encouraged as residents and faculty members work together on the wards or in the clinics.
Web-based evaluation forms are completed by both residents and faculty at the end of each rotation and are reviewed with the residents by one of the program directors at least twice yearly. Residents may, and often do, request more frequent evaluation and feedback sessions with the program directors. There are also "360 degree" evaluations completed by patients and nurses in the outpatient setting.
All continuing residents are observed by a faculty member during one or more patient examinations in the outpatient center and immediate feedback is provided to the residents.
Beginning in 2008 residents on the medicine service are also observed by Program Directors or faculty and a "T-REX" (Teaching Resident Exercise) evaluation is completed and given to them regarding their teaching and team leadership. This is part of the "Residents as Teachers" curriculum.
Do residents have a say in how the program runs? Top of Page
Absolutely! Residents are members of key committees such as: the Curriculum Committee and the Graduate Medical Education Committee. Off site retreats are held annually for each resident class and program review is a regular agenda item at the retreats.
The Program Directors consider the residents to be colleagues with invaluable ideas arising from their experiences in the "trenches" of patient care. Residents and interns also complete anonymous, annual surveys to evaluate program innovations, curriculum and Program Director and Chief Resident performance. The Program Director may review some of the key results of the 2008-09 survey with you during the afternoon "wrap up" session at the time of your visit to CPMC.
What is the work environment like? Top of Page
Residents say the environment at CPMC is professional, yet relaxed and friendly. Attending Physicians are approachable and down-to-earth and there is a positive and dynamic interaction between residents. The number one thing that residents say they like most about the program (consistently noted on the annual house staff survey) is the friendly, supportive work environment provided by administrators, co-residents and interns, nurses, ancillary support and custodians. They also feel that their concerns and suggestions are taken very seriously by the Program Directors and members of the hospital leadership.
Is your program in compliance with the ACGME work hour regulations that were instituted in July 2003? Top of Page
Yes. Our Internal Medicine house staff have, at minimum, an average of 1 day off/week. House staff that take calls in the hospital over night are required to leave the hospital no later than 1pm post-call (the "24 + 6" rule). No one admits patients for more than 24 hours. Based upon subjective house staff "self reporting" and objective monitoring of work hours by Program Directors and Chief Residents, we have achieved greater than 95% compliance with the average 80-hour work week rule.
How has your program performed in recent RRC-IM (Residency Review Committee for Internal Medicine) site visits?
Our most recent site visit was in June 2006; we were given a 5-year cycle length, the maximum a program can receive. The RRC recently awarded us an additional year, due to our excellent "track record", which means we won't have another visit until at least 2012.
What is the PGY-1 salary? Top of Page
The intern salary as of January 1, 2010 will be $50,280.32.
Benefits include standard health, dental and vision insurance. These are at no cost to the house staff.
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Are there any additional education funds?
Additional funds currently include one-time reimbursement for a PDA or other electronic device (e.g., iTouch) that can be used for medical care/education in the PGY-1 year. The "Noble Family Education Fund" provides $250/year. These funds can be used for books, meetings, journal subscriptions or professional society membership (e.g., ACP, SGIM, ACC). If a resident or intern is first author on an abstract accepted for oral or poster presentation at a regional or national meeting (see scholarly activity page for more information on our excellent track record in this area), travel, food and lodging and meeting registration will be reimbursed by our department of Graduate Medical Education. Many of our interns and residents take advantage of these funds. Some residents present different posters or talks at more than one meeting each year. The maximum funding per year is $2,000 – extremely generous for any program in the United States.
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How much vacation time is permitted?
Three weeks per year. In addition, there is a one week period of unpaid leave between the R-1 and R-2 years.
How is CPMC doing financially? Top of Page
Despite challenging economic times, CPMC continues to do well financially- it is one of the most financially stable hospitals in the entire San Francisco Bay Area. The hospital and its medical group (Brown & Toland Medical Group) have the largest number of HMO patients in San Francisco. California Pacific is also one of the most successful hospitals in the state of California. National organizations seek our advice about how to succeed in the era of Managed Care. The medical center is currently planning to build a new hospital (completion date approximately 2014) at an estimated cost of $2 billion.
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Will I get to work in the new hospital while I'm a resident?
No. Architectural plans are currently approaching completion. "Groundbreaking" for the new facility will probably occur some time around 2013 with completion occurring 1-2 years after groundbreaking.
>What is there to do outside the hospital? Top of Page
San Francisco's climate, surrounding natural landscape and its diverse and tolerant inhabitants helps define it as one of the world's most livable cities. You will never experience a lack of fun and interesting things to do here. There are many outdoor activities such as: surfing, mountain biking, trail running, hiking and sea kayaking and eating (people love to eat in San Francisco!!). Local events include: street fairs, concerts, theater and parades. Of course, one can simply take a deep breath and relax in one of the many parks or cafés. You can also go wine tasting (but please bring a designated driver). The closest ski area, of the many in the Sierras, is only 3 hours from San Francisco
Can I spend more time at the hospital while I'm here for my interview? Top of Page
Yes! Wear your name tag and you are invited to go on rounds, talk with house officers, and attend any conference you find of interest. If you wish to spend more than one day in order to get an in-depth picture of our program, that can also be arranged. Please try and give us at least 48 hours notice if you wish to visit a second or even third time.