Family Practice Service
Our family practice service is a full-spectrum service that cares for OB, pediatrics, and adult inpatient medicine. We care for the entire panel of Blue Ridge Health patients, coming from several clinics across Western North Carolina. Residents spend three months during their intern years on the FPS, and two months each year during years 2 and 3. Our longitudinal call structure ensures that residents continue to be confident and comfortable with inpatient medicine throughout their residency. Several of our graduates have gone on to practice hospitalist medicine as a result.
Our family practice service is the primary team for our intensive care patients. We do more than make social visits or watch as others care for our patients. Our residents are the first call when our patients require intubation, procedures, or resuscitation. In addition to gaining this experience during your family practice rotation, all of our residents have a dedicated intensive care month at Mission Hospital and an elective month of pulmonary and critical care here in Hendersonville. A hallmark of our hospital is that it is large enough to have a busy ICU, but small enough that our residents retain primary responsibility to care for our patients there.
Pardee Hospital in Hendersonville is the only hospital in Western North Carolina where family doctors are practicing operative obstetrics. We have committed to training family doctors to be competent in OB. Our residents graduate with between 60-120 deliveries, depending on their interest, and have gone on to become faculty and full-spectrum physicians across the country because of their comfort with obstetrics. Due to an underserved patient population without easy access to specialists, and our High Risk OB clinic staffed by a fellowship-trained faculty, you will become comfortable with managing higher risk prenatal patients who would usually be managed by specialists in an urban environment or larger program.
During the first year, residents spend three months in inpatient pediatrics at Mission Hospital in Asheville and are taught by pediatric hospitalists, intensivists and sub-specialists. They admit pediatric patients from all over Western North Carolina and are the only inpatient pediatricians to admit, which allows for a wide range of cases. Residents become comfortable caring for newborns and coordinating care with specialists, as well as managing common and complex illnesses.
Residents acquire ongoing inpatient pediatrics experience on the inpatient service in Hendersonville. Because of the thriving OB practice, many children are recruited by residents into clinic after participating in deliveries. Residents enjoy additional outpatient experiences at the local Health Department and a month-long rotation at our affiliate Pediatrics clinic.
Mental health is an area of great need in our community, and our residents see behavioral health as a vital component to family medicine. We have a dedicated LCSW faculty member who is responsible for the behavioral health education of the residents, which comes as both didactic education and co-managing patients in the clinic. Residents also lead group visits for behavioral health issues. Rotations during second year on community medicine and behavioral health provides experiences in counseling patients and teaches residents about available community resources. Additionally, resident wellness is a key part of our behavioral health curriculum and a major focus of our program in general.
For one month during intern year and another during second year, residents train in the second busiest emergency room in Western North Carolina, where they focus on actively managing critically ill patients, as well as gain procedural experience. Residents often perform additional procedures in the ER while on call for the inpatient service. Family doctors in rural areas are expected to care for acutely ill patients in an emergency setting, and our residents are comfortable caring for our patients in this environment. Our residents also spend one month in pediatric emergency medicine at Mission Hospital.
Our residents spend one month during intern year on a surgery rotation rotating with the surgical group from Pardee Hospital. During this month, their emphasis is on evaluation for surgical intervention, basic surgical skills, endoscopy, and post-surgical care. Residents also use this opportunity to become adept at intubations and procedural techniques that are useful during their longitudinal call. During second year, our residents have a dedicated Procedural Skills rotation where they will have an entire month dedicated to both outpatient and inpatient procedural skill training.
One month during intern year and one during second year are spent with two local orthopedic practices. Residents learn outpatient management of orthopedic problems and participate in surgery. During the second year, residents rotate through sports medicine clinics and physical therapy. Residents are encouraged to learn perform sports medicine procedures and techniques to use with their continuity patients. Also residents will have the opportunity to be involved with local sports teams and events.
Residents learn about and have the time to visit several different practice models. They become adept at coding, billing, personnel management, patient flow and satisfaction. A one-month rotation during the third year focuses on skills necessary to run a practice. During this time residents will also complete a practice improvement project and community project.
We are one of the only programs in the country where residents will have the opportunity to practice overseas during each year of their residency. Residents can travel to rural Honduras through Shoulder to Shoulder as early as intern year, and have one month of dedicated time during each of their subsequent years to travel and practice away from Hendersonville. Additionally we have dedicated time during didactics to address international and wilderness medicine topics. Western North Carolina is home to a diverse population of native Spanish speakers, and we provide our residents with interpreters or the time and support needed to learn medical Spanish.
Several of our residents have taken advantage of elective time to gain experience and credentialing in wilderness medicine. Residents participate in didactics as well as periodic workshops and outings. They are given the opportunity to teach lectures for a wilderness EMT course. The residency is within close proximity to Dupont State Forest, Pisgah National Forest and multiple wilderness areas. As part of orientation, new interns go with the Hendersonville residency on a rafting trip on the Nantahala river and practice rescue techniques.
Ultrasound/Simulation Center Trainings
The scarcity of rural providers makes procedural skill training a focus of our program. Ultrasound is a major priority of our procedural training curriculum. Our program has developed a longitudinal and rotational curriculum to train our residents to utilize this tool during and after residency. Our didactic curriculum includes simulation center trainings on difficult airways and intubations, central line placement, and point of care ultrasound. Each resident’s curriculum can be tailored to match his or her anticipated needs, but every resident will graduate feeling comfortable with a broad range of procedural skills.
Residents have the opportunity for afternoon didactics weekly and during several lunch and morning events throughout the week. These conferences cover a broad range of primary care topics including: patient management, behavioral medicine, OB/GYN, community medicine and practice management. All learning sessions are interactive. Regular monthly conferences within the residency include lunch discussions of hospital cases, obstetrics cases, difficult outpatient cases, a wellness group and resident meetings. We are currently working toward digitizing and disseminating our didactic training so that residents will have these lessons at their fingertips while actively caring for patients in the clinic.
Our call schedule is one of the most important aspects of our program, according to recent graduates. During intern year, our residents spend a total of four weeks on night float while rotating at Mission Hospital. The primary goal of intern year is to prepare the resident for longitudinal call at Pardee Hospital, where the resident will be actively caring for critically ill patients. Our residents will be on call once per week, on average, and one weekend per two months. Residents have the day off after their call. Whereas most programs have changed to a night float system, our graduates insist that they felt prepared to continue practicing obstetrics and inpatient medicine because they had continuous full-scope training throughout their residencies.