Boone Family Medicine Residency
At our primary resident clinic, AppFamily Medicine, we provide access to buprenorphine and other treatments for Substance Use Disorder. We feel this is an integral part of caring for our community and central to our goal of providing full-spectrum primary care to rural areas in Western North Carolina. Our clinics treat patients from a wide variety of socioeconomic backgrounds, and we work not only on providing care for Opioid Use Disorder (OUD), but also manage Benzodiazepine Dependence, Alcohol Use Disorder (AUD), and methamphetamine use.
Our MAT program is resident-founded and resident-led. From the beginning, our trainees have been integral in developing clinic policy and education related to buprenorphine use, and they regularly manage home and in-office inductions. We treat all-comers in our clinic and provide buprenorphine to anyone who needs care, including prenatal patients. Additionally, our residents are currently working in local Emergency Departments to create a strong referral system for patients with OUD, ensuring that patients who need MAT will have consistent access
We are extremely lucky to provide full-spectrum primary care to all members of our community, and prenatal care is a central part of our mission at MAHEC Boone. Our primary hospital, Watauga Medical Center, is the only hospital offering deliveries in four counties in Western North Carolina, and as a result, we have a broad catchment area and treat patients from a variety of backgrounds. Each of our residents has a panel of prenatal patients who they deliver in the hospital setting in order to maintain continuity and improve patient experience. They also regularly assist on C-sections and manage labor on their month-long L&D rotation each year. Patients have the option to pursue couplet care (care of postpartum mother and infant) with MAHEC Boone, the only clinic in Boone to offer this special service.
The majority of prenatal and OB care in our area is provided by midwives, and our residents work closely with local midwives on their Labor and Delivery months, as well as on GYN rotations. Prenatal care at the Baker Center, our rural site in Newland, NC, is also managed by midwives. Midwives have a strong historic and cultural presence in Western North Carolina, and many of them have been in the community for multiple decades, delivering generations of patients and caring for families from all walks of life. We are extremely proud to partner with them for our outpatient and inpatient OB care.
Our outpatient prenatal care fills a vital need in our patient population. We are the only primary care office in Boone that manages and delivers pregnant patients, and only one of two offices that sees pregnant women at all. Additionally, we provide annual well-woman exams,LARCS ( IUD and Nexplanon insertions and removals), Ob/Gyn ultrasound and most office based gynecologic procedures. . We have an excellent in-house Ob/Gyn, Dr.Beverly Womack, who is a pillar of the healthcare system in Boone and a very well respected member of the community. She also runs a weekly GYN clinic in Ashe County, just outside of West Jefferson, NC, where our residents assist with managing pathologies in a rural setting.
While Boone is by no means a dense urban area, it is often considered by locals to be “the city” in comparison to much of the surrounding region. Even from the heart of downtown, it only takes a short drive to get out of the city and deep into the valleys and hollows of Western North Carolina. Surrounding counties have poor access to healthcare, particularly primary care, pediatrics, and women’s health, and providing that care is a central tenet to our residency program. Many of our clinics serve populations from all across Western North Carolina, and even a strong contingency from Tennessee, who need to cross state lines to access healthcare.
Named for our faculty member and local legend Dr.Charlie Baker, the Baker Center for Primary Care is located within Cannon Memorial Hospital, a critical access hospital in Newland, NC. The Baker Center serves patients of all ages, as well as providing prenatal care via family physicians and midwives. Our residents rotate at the Baker Center frequently, and work with faculty members there while on their Family Medicine Outpatient rotation. We hope to expand our resident presence in the Baker Center as the residency grows in size.
Cannon Hospital is an acute care hospital built in 1999 to provide healthcare access to Avery County. It is located in Linville, NC, at the center of the county. In 2008, this hospital began to offer inpatient psychiatric services in an effort to close the extremely wide gaps in mental health coverage for rural people. It currently offers a 27-bed inpatient facility as well as a robust outpatient center for therapy and non-urgent psychiatric management. Have a look at the facilities on this video tour. At present, our residents rotate through both the inpatient and outpatient psychiatric facilities, the Baker Center, and the Cannon ED.
In the course of exploring the rugged beauty of Appalachia, sometimes things don’t go as planned. Our area is filled with opportunities to adventure in nature, and unfortunately this can translate to higher incidences of injuries and illnesses sustained in the wilderness. Our Wilderness Medicine curriculum is headed by Dr.Dave Brendle, our Assistant Program Director, who has a passion for exploring the outdoors, and caring for those who travel alongside him. The Wilderness Medicine curriculum is an opportunity that is open to all residents.
Our Wilderness Medicine Curriculum includes regular didactic sessions, AWLS (Advanced Wilderness Life Support) training, the opportunity to join National Ski Patrol, local and away electives, and becoming a Fellow in the Academy of Wilderness Medicine.
Our residency partners with AppOrtho to provide Sports Medicine training to our residents. Working with Drs. Matthew Giordanengo, Benjamin Parker, and Chris Bullers, our residents receive extensive exposure to many facets of Sports Medicine, including working with Appalachian State University’s various athletic teams to provide on-field treatment for injuries at football, soccer, and basketball games. Our residents will also occasionally travel with the App Football Team to provide sideline care at bowl games and other various tournaments across the country!
Additionally, AppOrtho hosts a Primary Care Sports Fellowship through MAHEC which accepted its first fellow in 2022. At present, we have a recurrent Ultrasound Lecture Series from our Sports Medicine colleagues, and plan to continue growing and integrating our residents into other Sports Medicine curriculum and events. Dr.Giordanengo also works with our residents at AppFamily and the Baker Center.
Part of providing well-rounded care for our patients involves translating our information and skill sets from the inpatient to outpatient settings. Ultrasound is one such skill that spans the spectrum of rural family medicine, and our residents receive a wide range of exposure to US techniques and hands-on practice in both settings. There are regularly scheduled POCUS didactics from our local US guru and faculty member Dr.Daniel Goble, and residents are encouraged to diagnose and treat conditions in the inpatient setting with the assistance of basic US techniques (pneumothorax, heart failure, ascites, DVT, central line placement, etc). In the outpatient clinic, residents use US to assist with management of abscesses, breast masses, muscular complaints, and ocular pathologies. We have plans to expand our outpatient US teaching by providing the clinic with new machines and faculty training in the next calendar year. Additionally, residents are exposed to and can perform pelvic US in both the family medicine and local Ob/Gyn clinics. Sports Medicine is also a focus of our ultrasound program, and we have regular didactic sessions with Sports Medicine faculty and fellows. At present, there is a 2-week US elective for PGY3 residents.
Scenic photo used with permission from Meta Gatschenberger.
