Becoming a DOC in the North Country

Ask a family medicine physician what he or she has done in the last week and a likely answer might be, “I delivered a baby, saw some prenatal mothers, took care of a sick newborn, did a few well-child and well-adult visits, had a difficult chronic disease case, and referred a patient to a psychologist. And I also saw some patients in the hospital.“ This full spectrum of primary care is the norm.

For Dr. Andrew Kriger, a third-year resident in family medicine at CVPH, a primary care practice is where it’s at, “I like the strong relationships with patients. You get to see them over and over again and tackle problems together. You see people in the some of the best moments of their lives. You get to experience their big changes, like when they get pregnant and when their babies are born.”

To get to this level of family medicine — the front line of primary care — is a long, hard, intense journey. After four years of college and four years of medical school, newly minted doctors must complete three years of residency training under the supervision of other doctors to become family medicine physicians. Dr. Marianna Worczak, the Program Director for the Family Medicine Residency at the Champlain Valley Physicians Hospital (CVPH), an affiliate of the University of Vermont Health Network, explained what the residents undergo, “The training involves seeing patients in clinic as primary care providers under supervision but also being in the hospital and rotating through each specialty from inpatient medicine, surgery, obstetrics/ gynecology, pediatrics, psychiatry.”

CVPH created the Family Medicine Residency in 2016 to address the shortage of primary care providers in the North Country. Nationwide there is a shortage of physicians, but the shortage is especially felt in the area of rural primary care. According to Dr. Worczak, medical schools don’t do a good job of pushing people into primary care. “I graduated in a class of some 200 students and only six of us went into primary care. Part of it is that medical students are graduating with gigantic loans. Specialists make a lot more money. A lot of students are saying, ‘I want to get out of debt as fast as I can so what are the best options?’ The other thing is that primary care is really hard because you get a lot of calls, a lot of responsibility. If you’re in a small place, you do the house calls, see the nursing homes, you may go to the hospital. I believe students are actually discouraged from going into family medicine because you’re told you are not going to have a good work life balance.”

Another factor hurting the North Country is the majority of primary care providers in the area will be retiring in the next ten years. This will exacerbate the deficit that already exists. But CVPH’s residency program is chipping away at the expected shortage. First, the program has grown from accepting four residents a year to six so instead of twelve residents in training, the program will now have eighteen. Second, three residents in the first class found positions in the area after they graduated.

Kathleen Freeman, the program administrator of CVPH’s Family Medicine Residency since its founding, is ecstatic over the program’s success, “It’s a big deal because so far they are staying in the area and more have stayed than we anticipated. This class and next year, there are already people who we know want to stay.” Part of the attraction is CVPH’s generous loan repayment plan. If a graduating resident stays in the area, $120,000 of their loans will be repaid which Dr. Worczak noted distinguishes CVPH from other programs, “It’s kind of a shoo-in if they apply for a job in the area. They graduate and they get it. Not all programs are like that.”

To get into a residency program, whether at CVPH or some other hospital, is not easy. From September to mid-October, Freeman says she and the rest of the staff go through over 1500 applications, “We narrow that down to who we think will be a good fit for our program. Then we start doing interviews from the middle of October to the middle of December. We usually interview six candidates every Tuesday and Thursday.” The faculty, residents, everyone is involved in the one hundred plus interviews.

Meanwhile, the candidates are interviewing at about 25 programs. Then each side ranks their first choice down to their last choice. At that point, the Electronic Residency Application Program (an electronic algorithm nicknamed ERAS) takes over and matches candidates with family medicine residency programs throughout the United States and Canada. “It’s pretty amazing!” said Freeman who went on to describe Match Day, usually in mid-March, “Everybody finds out at the same time and it’s a surprise – for the candidates as well as for us.”

Once in the program, most candidates find residency training intense and challenging but also a rewarding experience as they learn to balance their professional and personal lives. According to resident Dr. Andrew Kriger, “This is a very attractive program. Every year I expect it is going to be more difficult to get into it because we’re nice. We don’t overwork them and they partner one-on-one with specialists. The hospital’s mission is to teach.”

Freeman continues to be amazed at the support the hospital has received from UVMHN-CVPH physicians, “We talk about them being teachers and mentors and advisors in the clinic and they have done it with open arms and are a huge part of our success.” But just as important said Freeman are the outside providers who have also become part of the program, “Our residents can rotate through Lake City Primary Care practice, Behavioral Health Services North, the Champlain Valley Family Center, Lake Placid Sports Medicine, the Vilas Nursing Home, etc. They even work at Whiteface Mountain. They are all over the North Country. It was a huge undertaking to get the program off the ground, to have the support of the community, the support of the whole hospital and the network took years. It’s quite a feather in the cap for this hospital to have started this program.”

UVM Health Network
Champlain Valley Physicians Hospital
75 Beekman Street
Plattsburgh, NY 12901