What is full spectrum family medicine training?

Family physicians are uniquely qualified to provide comprehensive health care for people of all ages and can treat most conditions in addition to promoting health and wellness.  At MDFMR, we embrace the core values of family medicine: first contact, whole person, comprehensive care delivered in the context of family and community, through a continuous healing relationship. While we recognize that our graduates might choose a narrower scope of practice, we want them to leave our program prepared to do anything. To that end, training at MDFMR emphasizes the full spectrum of family medicine practice from birth to end of life, encompassing inpatient care, outpatient care, prenatal and reproductive health care, deliveries, and common procedures.

What is it like to live in Central Maine?

Life in Maine is truly unique – the pace is a bit slower and year round there are amazing outdoor opportunities. Augusta and Waterville are small towns nestled in a valley of peaceful lakes and rivers. Many of our residents and faculty live right on or near water – coming home from work in the summer is like being on vacation each night. Fishing, swimming, kayaking, and hiking as well as cross-country skiing and snow-shoeing can be daily activities depending on the season.

Waterville is home to Colby College and Augusta is the state capital. Though “small towns,” both are host to a diverse and often quirky collection of cultural opportunities. Railroad Square Cinema in Waterville is a classic art house theatre that also sponsors the Maine International Film Festival each summer. There are several eclectic and organic restaurants in the area as well as a great home-town brew-pub. We even have a family-owned sushi restaurant that can compete with any urban establishment! Our location in the center of the state also makes it easy to spend a weekend hiking in stunning Acadia National Park or visiting Portland or Boston for a fix of city life. Check out our Web site for information on local resources.

Finding work for partners and spouses has not proven to be a challenge for most people. Some residents live closer to Portland or Bangor to facilitate a partner’s commute, and our well-connected community of staff and faculty work hard to assist with transitions – everything from finding a used car to making day-care recommendations.

Though some of our residents are Maine natives who already know the secret of life here, we often find that those “from away” become hooked after three years and find it hard to leave!

Are there other residency programs there?

Our program is based at a community hospital (MaineGeneral Medical Center’s Alfond Center for Health) rather than a tertiary care center – this provides a learning experience that more closely represents the type of practice many of our residents plan to work in after residency. Because ours are the only residents here, they never have to “compete” with other specialties and can be the primary physician involved with patients in all departments, from the ICU to labor and delivery. It also allows our residents to tailor their learning to individual interests – the rare “slow” night on medicine call can be livened up by calling the ED and getting involved in procedures like central lines and lumbar punctures. Residents work directly with our family medicine attendings as well as with our local specialists, and all are enthusiastic teachers. Though we do not have sub-specialists such as neonatology or interventional cardiology in our hospital, residents interact directly with these attendings by phone and learn first-hand the skills of stabilization and transport needed to practice in a rural setting. Also, the nurses and other support staff of our hospital get to know residents on a first name basis and are another source of invaluable learning. 

What is call like?

Traditional call has changed quite a bit over the years, largely due to changes in work hour rules. Maine-Dartmouth has its own hospital service which is covered 24/7 by residents and faculty working in shifts, and residents no longer have at-home call responsibilities.

First year residents work approximately 12 hour shifts an average of 6 days/week while on inpatient medicine and OB rotations. On OB rotations, first years work 2 weeks of nights for a total of 4 weeks of OB nights in the first year. On inpatient medicine rotations, we employ a night float system to cover the medical service overnight, with first and third year residents each assigned a total of 4 to 6 weeks of night float in two-week increments, supported by a faculty attending on a weekly rotating basis. Some nights are busier than others. It is rare that residents get no sleep, and usually there is time for a nap at some point. On the inpatient service, a typical night includes 4-6 admissions as well as 1 or 2 ER evaluations. Residents also cover outpatient phone calls while covering the inpatient service. Maine-Dartmouth is committed to compliance with accreditation-mandated work hour rules, and faculty are quick to remind residents to go home and get sleep when their shift is completed.

Daytime coverage of the inpatient service is provided by a team of two faculty attendings, two first year residents, two second year residents, and one third year resident. We work hard to ensure continuity over the weekends. Weekends are covered by members of the medical team during the day and night float plus a senior on a 24 hour shift during the overnight.

Where do residents sleep and eat?

There are individual call rooms exclusively for the residents, all equipped with cable TV, a telephone, a computer with internet access, a few medical texts, and beds with clean sheets. The hospital cafeteria is open daily until 7 pm and features a deli bar, healthy salads, and brick oven pizza among other choices, while a small cafe within the hospital offers grab and go items, specialty coffees, and healthy juices weekdays until 9 pm.

Residents receive a meal stipend in the form of a credited account to pay for food purchased at the cafeterias located in MaineGeneral Medical Center’s Alfond Center for Health in Augusta and Thayer Center for Health in Waterville while on duty. Residents order lunch from a nearby café when they are seeing patients at FMI and don’t have access to the hospital cafeterias.

How well do residents develop procedural skills?

Procedures on the inpatient medicine service (thoracentesis, intubation, central lines, etc.) are done by residents, and precepted by specialists, ER attendings, or our own family medicine faculty. Additional experience in any procedure of choice is attainable by setting up extra time with one of these attendings.

During inpatient pediatric rotations, residents have the opportunity to do lumbar punctures, endotracheal suctioning, and other common pediatric procedures.

During their surgery rotation, residents usually second-assist on major cases and first-assist on minor cases. Residents have a lot of leeway in determining what experiences would be helpful during their surgery rotation. There is ample opportunity for starting I.V.’s, placing central lines, and intubating patients preoperatively under the guidance of the anesthesia staff.

Residents perform office procedures on their own clinic patients under faculty supervision. These procedures include excision of lumps, bumps, and skin lesions, joint aspiration and injection, casting and splinting, vasectomies, and cryotherapy of warts and other lesions.  In addition, residents gain experience performing IUD and hormonal implant insertion, endometrial biopsy, and colposcopy by working directly with our faculty. Colonoscopy and exercise stress testing are not part of our routine procedural training, but interested residents are able to pursue additional training in these areas. The opportunity to learn termination of pregnancy is also readily available through our local family planning office but is not mandatory. A number of years ago we developed a unique collaboration with local dentists to train residents in basic dental extraction;  this aspect of our program is currently paused but it is our hope to offer it again.

During inpatient family medicine and emergency rotations, residents gain more experience suturing and casting, as well as caring for trauma patients and running codes. We provide Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Neonatal Resuscitation (NRP) certification courses for residents each year, and offer a stipend for all residents who wish to take an Advanced Trauma Life Support (ATLS) course during their training. Advanced Life Support in Obstetrics (ALSO) is scheduled for residents to take in their first year.

How important is obstetrics in your curriculum?

We believe that the practice of obstetrics is an integral part of caring for families. It is also among the most joyful facets of a physician’s work; most of our faculty provide obstetrical care in their practice. At Maine-Dartmouth, all residents complete OB training, with an average of about 70 vaginal deliveries by graduation (more than 80 total deliveries). Residents first-assist on STAT C-sections and also work with midwives, allowing for education in a variety of labor management styles.

Because of our rural location, residents are able to stay involved and co-manage a variety of higher-risk prenatal patients with our local obstetricians, including twins and gestational diabetics. We have also added an OB/GYN and two certified nurse midwives to our faculty to further improve training in this area and to serve more complex patients at our own family medicine practices. To gain more concentrated exposure to high risk patients, residents complete one month on labor and delivery in Nashua, New Hampshire. Our goal is to prepare all residents to incorporate comprehensive pregnancy-related care into independent practice, regardless of what type of future practice they choose.

How is your educational curriculum structured?

Everyone learns in different ways, and much of traditional residency work supports learning in an independent, experiential way. Attendings and senior residents teach “on the fly,”  and teaching rounds happen on inpatient rotations, led by a rotating combination of senior residents, faculty, and specialist attendings. Grand rounds sponsored by the hospital occur weekly, hosting regional specialists from Portland and Boston as well as highlighting topics of interest led by local physicians.

Tuesday afternoons are dedicated to teaching conferences that require a longer period of time, including procedural training, behavioral health, osteopathy, ethics and diversity, patient safety and quality improvement, and core clinical topics. First and second year residents also have protected time weekly between clinic sessions for education with their class.

Additionally, residents participate in two four-week-long non-clinical rotations. One is focused on practice management and physician leadership, and the other is a combination of community medicine, integrative medicine, and critical thinking in medicine; both rotations are structured as a combination of classroom and experiential learning. Residents are assigned to the rotation as a class rather than individually. Further education in these topic areas happens longitudinally, but the rotation format allows depth and breadth of exploration and enables residents to connect as a class.

Are residents involved in teaching medical students?

Maine-Dartmouth is a host site for third year medical students from the University of New England College of Osteopathic Medicine, Tufts School of Medicine, and Geisel School of Medicine at Dartmouth, as well as for fourth year students from all over the country doing electives. Residents are involved as teachers and preceptors of students in both the inpatient and outpatient settings. We find that teaching students is one of the best ways for residents to really solidify their own learning.

What is osteopathy? What does it mean to have MD and DO residents train together?

MDs have studied allopathic medicine whereas DOs have studied osteopathic medicine. Osteopathic medical school is a four-year training program that is structured much like allopathic training with an additional emphasis on primary care and osteopathic manipulative therapy. Proportionally, osteopaths actually provide more primary care than allopaths, especially in rural areas.

Our program opened to osteopaths in 1994 and became dually accredited by the ACGME and the AOA in 2004. We transitioned to the single accreditation system and are now an ACGME-accredited family medicine residency with Osteopathic Recognition.

Allopathically trained residents have the opportunity to work daily alongside osteopathic residents, who are a great resource in diagnosing and treating musculoskeletal conditions. All osteopathic residents take part in an organized three year osteopathic manipulative medicine (OMM) curriculum and work directly with our osteopathic faculty; allopathic residents participate in an OMM curriculum tailored to help them develop basic manipulation skills. As a residency we are proud of our commitment to integrating osteopathy with full-spectrum family practice, both in the curriculum as well as in day to day office and hospital practice.

Are there opportunities and support for international rotations during residency?

Maine-Dartmouth provides opportunities for residents to experience medical work abroad through a partnership with a non-government organization registered in Honduras that provides medical care to rural Hondurans. The annual group service trips last about 10 days and faculty participate alongside residents.

Residents interested in international work sometimes use their “no call pool” elective in their third year to plan their own international experience. Members of the residency community have contacts and past experience around the world and are happy to mentor residents and facilitate international experiences. Over the years, residents and faculty have traveled individually to Africa, Australia, Belize, Guatemala, Haiti, Honduras, India, New Zealand, and Vietnam, to name a few places.

Are there opportunities for research?

Many of our faculty and all of our residents are involved in scholarly activity, primarily related to clinical topics. Each resident is required to have an academic project, and support for this work comes from a faculty member with experience in research and publication. Some recent research projects include: exploring unintended pregnancy among women in medication assisted treatment for opiate use disorder; investigating the association between eye movement disorders and buprenorphine exposure in young children; evaluating an intervention to increase the use of advanced directives among family medicine patients; and assessing the feasibility of researching OMT for newborns struggling to breastfeed. Faculty also regularly collaborate with residents to present and publish interesting clinical cases.

Is there a difference between the Augusta and Waterville clinic sites?

The Family Medicine Institute (FMI) serves patients from Augusta and surrounding rural areas. Located nearby is the state-managed Riverview Psychiatric Center, which provides involuntary inpatient care to individuals in psychiatric distress. This geographic proximity and the enhanced level of community supports for persons living with mental illness has contributed to more notable exposure to patients with chronic mental health issues for providers at the FMI. Maine Dartmouth Family Practice is located at the Thayer Center for Health in Waterville, a comprehensive outpatient care center approximately 20 miles from our regional hospital. It has a more rural setting and a slightly smaller patient volume; thus it has fewer providers and staff. Each site has its own “personality” — both have excellent faculty and staff, deliver team-based care with behavioral health, nurse care manager, and social worker support, and provide good exposure to a wide variety of medical conditions.

How are residents assigned to a clinic site?

After the Match is completed, we contact each incoming resident to ask about their preference for one site or the other (Waterville or Augusta). The sites do not have separate Match numbers. Resident preference is paramount in the assignment process, but an attempt is also made to balance osteopathic/allopathic training between the sites. For the next three years, residents see their family medicine office patients at their assigned center but are together for didactics and other aspects of training.

How well do people get along? Are residents involved in decision making?

Residents, faculty, and staff of Maine-Dartmouth share a commitment to providing comprehensive and compassionate primary care for our patients. At times, this work can be challenging in the face of patients’ poverty, lack of transportation, mental health concerns, language barriers, or our own struggles for personal balance. Our community of care providers have diverse experiences and a wide variety of personal beliefs, customs, and medical training. This diversity leads to many different approaches to care and sometimes to spirited debate. We emphasize respect and celebration of our differences and support each other when our work becomes challenging. Because we are working together toward common goals, we find we get along well as a community.

Residents meet biweekly to discuss issues affecting the program or learners. From these meetings, the chief residents communicate concerns to the residency leadership team, with whom they meet weekly, and to faculty at monthly faculty meetings. Additionally, committees and work groups have resident members assigned, which ensures residents have a voice in decision-making.

Every year, changes are made to the curriculum or other residency logistics which demonstrate not only the active role of the residents in helping to shape the program, but also faculty and leadership receptivity to residents’ suggestions. For example, based on feedback that residents have given, we moved to a “clinic first” model with residents scheduled to be in the outpatient clinic on consistent days each week and on full days during inpatient medicine rotations.

Away from work, residents form friendships in and outside the residency community. Residents get together on a regular basis for support, decompression, and for having fun. Faculty members consistently expect that residents interact with them on a first-name basis, and they feel like friends as well as mentors. These relationships are fostered by dinners together, and occasional parties which involve family and friends of everyone in the program. The faculty is also exceptionally dedicated to this residency, and a number of faculty completed their family medicine training here.

What about time off?

Each resident gets twenty-one paid days off (combined vacation and sick days) per year. There are also five CME days granted per year, and a conference stipend of $2,000 is provided for residents to use during their training. There are a few rotations during which residents cannot take planned time off, but most rotations allow between 1-5 days of time away. Holidays are divided evenly among the residents. Usually residents work 2 holidays per year, only one of which is a major holiday (Thanksgiving, Christmas, or New Year’s). Per rotation, each resident usually has at least one full weekend off.

Can I have a family while learning family medicine?

Many of our residents have children and all successfully maintain a variety of relationships with family and friends while at Maine-Dartmouth. Every year we have several new children born to residents and faculty – our community is always growing! The Residency works hard to be as flexible as possible to support residents and faculty in balancing personal and professional priorities, recognizing the value of committed physicians who are fully engaged members of their families and their communities. Please feel free to contact us if you have questions.

What does your compensation package for residents look like?

For the 2023-24 academic year, resident salaries are as follows:

PGY1 residents – $63,672
PGY2 residents – $66,856
PGY3 residents – $70,039

Benefits include the following:

  • Ability to purchase group health, dental, & vision  insurance for self and family
  • Long-term disability insurance
  • Life/ accidental death and dismemberment insurance and the ability to purchase additional coverage for self, spouse/domestic partner, and dependents
  • Ability to contribute to retirement account and medical & daycare reimbursement accounts
  • Twenty-one days of paid personal time off for non-educational purposes per resident’s academic year
  • Paid time off for bereavement and extended sickness
  • Up to twelve weeks of leave under the Family Medical Leave Act  (includes up to six weeks of paid leave) with no waiting period
  • Continuing education funds of up to $2,000 total over the three-year training program and up to five days away for CME per year with prior approval (spending limit of no more than one-third the total amount during PGY-1)
  • Time away of up to 3 days and financial support of up to $1,000 for Advanced Trauma Life Support (ATLS) certification one time during family medicine training
  • One-time moving expense allowance for incoming residents — up to $1,000
  • Employee Assistance Program – five sessions of individual and confidential counseling at no cost, referrals to longer-term services
  • Professional malpractice insurance with limit values of at least two million/eight million for the policy period, and with tail coverage after the resident leaves
  • Cost of obtaining medical licensure for required experiences at the level needed for training
  • Full reimbursement of the cost of taking USMLE or COMLEX Step 3 once, and time away to do so
  • Full reimbursement of the cost of taking either ABFM or AOBFP family medicine certification exam in PGY3 and time away to do so
  • Suitable housing and reasonable travel reimbursement for required away rotations
  • PC laptop provided for use during term of residency
  • Membership in the AAFP for all residents
  • Membership in the AOA and ACOFP for all residents in an osteopathic-designated position
  • Reimbursement of J-1 visa application fees for exchange visitor resident physicians (up to $600 for PGY1 residents, up to $400 for PGY2 and PGY3 residents)
Does Maine-Dartmouth support international medical graduates?

Our selection committee individually reviews and considers applications that meet our criteria. We are open to training any medical graduate from any country who is genuinely interested in family medicine. Over the years we have welcomed international medical graduates to Maine-Dartmouth as residents, chief residents, fellows, and faculty, and our community has only been the richer for it. Residents, faculty and staff gain not only a different clinical perspective from our international colleagues but are also challenged and strengthened by a continually growing diversity of beliefs, cultures, and perspectives on health and illness. Please feel free to be in touch with any of our residents to learn more about their individual experiences.

What do graduates end up doing?

Most graduates practice comprehensive family medicine with several each year doing OB. Though our goal is to provide excellent training to prepare for practice in a rural setting, our residents feel able to practice anywhere – including international and urban locations. We have had many graduates over the years with National Health Service Corps commitments. Some alums work in emergency medicine, some are hospitalists, and others have pursued advanced subspecialty training. Many of our graduates have an interest in teaching and have taken full-time academic clinical positions, and others serve as part-time preceptors in our program.

Does Maine-Dartmouth receive drug company support?

Maine-Dartmouth has a longstanding policy of not accepting solicitations/gifts from drug company representatives. We feel very strongly that medical education should be free from conflicts of interest, financial or otherwise, to the fullest extent possible. While the issue of drug reps may seem a minor one, it is characteristic of what attracted many residents to this program: a willingness to question assumptions about a physician’s responsibilities, and a refusal to do things a certain way simply because of tradition.

How is wellbeing promoted at Maine-Dartmouth?

The wellbeing of the entire health care team is a priority at Maine-Dartmouth. We support resident wellbeing in a number of ways. Residents are strongly encouraged to create an individual wellness plan with their faculty advisor, and regular check-ins occur throughout the year to help residents assess their work-life balance and to ascertain how the program can best support them. Residents have a half day of administrative time built into their rotation schedules during many of their four-week blocks, and they are able to take time off when needed for health-related appointments. All Maine-Dartmouth residents, faculty, and staff have 24/7 access to an employee assistance program.

Residents and faculty enjoy spending non-work time together and frequently host social events and open their homes to those who are away from family and friends on holidays. They share meals, go on adventures exploring the wonders of Maine, and develop long-standing friendships which help them navigate the emotional, physical, mental, and spiritual fatigue sometimes experienced in residency, in medicine, and in life.

What are Maine-Dartmouth's practices related to COVID-19?

Safeguarding the wellbeing of our patients, trainees, faculty, and staff has been paramount throughout the COVID-19 pandemic. Even though we are in an endemic phase of the virus now, we continue to be on alert for new trends and are prepared to respond to changing conditions as they arise. If you have specific questions regarding COVID-19 and our program, please don’t hesitate to reach out to us.

Why should I consider coming to Maine-Dartmouth?

Most of our residents were drawn to this program by the exceptional mix of faculty and residents who are bound together by a commitment to medicine that is scientifically rigorous and always compassionate. A fly on the wall of the hospital wards or in our clinic preceptor rooms will find a lively give-and-take among faculty and residents, characterized by respect for experience as well as desire for fresh perspectives. During these discussions the guiding philosophy of our program is most apparent: we are all students, and we are all teachers. The respect that residents and faculty hold for each other carries over into the respect they give to the people who are their patients. When the day is long and residents and faculty are tired, interactions with colleagues help to not dehumanize patients but to preserve their dignity.

Many residents choose to come here because of the Residency’s commitment to the medically underserved and to improving primary and preventative care in rural communities. We believe that the best way to prepare to practice in a community with limited resources is to train in a similar setting, with mentors who continue to practice full-spectrum care and hands-on learning as the rule.

Finally, there is life in Maine: one of the few areas in New England where community doctors practice the full range of family medicine in an incredibly beautiful setting. Residency can be a physically and emotionally challenging time, and there are few places as stunning as this in which to relax and seek personal balance. Listening to loons sing on a warm summer night or cross-country skiing on a pristine backwoods trail is an added bonus to fulfilling medical training. While there is no expectation that graduates will stay in Maine, it’s not hard for us to understand why many do.