Family Practice Residency Program

From the Program Director

Welcome to the Shenandoah Valley Family Practice Residency Program! We are glad to have you learn more about us. Our residency is a rural-oriented program in the Shenandoah Valley of northwestern Virginia, about 70 miles west of Washington, D.C. We are affiliated with the Medical College of Virginia/Virginia Commonwealth University School of Medicine (www.familymedicine.vcu.edu). We are fully accredited for our 3-year residency by both the ACGME and the American Osteopathic Association, allowing full board certification eligibility for MD and DO physicians. We have 5 residents in each class.

The Best of Both Worlds: our residency is the “Best of Both Worlds” in many ways. We have a unique curriculum in a unique setting. Our goal is to be the best rural training in this part of the country, and to enjoy the journey.

Location: The Best of Both Worlds includes our location. Training occurs in two complementary sites. We have a small town practice in Front Royal, along with cutting edge subspecialists and technology and cultural amenities of the larger city of Winchester. Specialty rotations are in the award-winning Winchester Medical Center, a 411 bed, four-state referral medical center, Trauma Center, Heart Institute, Cancer Center, Neonatal ICU, and much more. The specialty faculty physicians are from the best residencies and fellowships in the country. And yet, on-call for our admissions and Family Practice Inpatient Service, we practice at the smaller, 76 bed, Warren Memorial Hospital in Front Royal. This is a Family Practice-dominated hospital, with an attached 120 bed nursing home, where you apply that high-tech med center training in managing the breadth of the patients in Family Medicine: office care, nursing home, ER, hospital floor, ICU, OB, Nursery, and Operating Room, without subspecialists’ immediate backup. Our residents learn to manage patients, not just to triage and refer to others. The Winchester Medical Center and Warren Memorial Hospital are connected by 23 miles of interstate highway, allowing quick access for rotations, yet enough distance that our patients come to us for the bulk of their care. It is a wonderful balance.

Graduates: This training works! Just look at what our graduates do and where they practice. The vast majority of our graduates practice the breadth of Family Medicine – office, hospital and ICU. They choose this, because they develop the comfort and confidence to do so. A few graduates have chosen office-only practice, but even some of those have expanded into hospital work within the first year. Because of the breadth of our training, some of our graduates have been aggressively recruited to full-time work in Emergency Medicine, where they are quite comfortable, because of our two excellent ER rotations, as well as certification in ATLS, PALS, ACLS, NRP, and ALSO. Some have been recruited to full-time Hospitalist work, where our graduates are routinely complimented for their comfort and skills with a broad array of hospital care needs, in contrast to many younger Internal Medicine graduates, who may insist on deep subspecialty backup that is impractical for most small hospitals. While some practice in suburban and major city locales, about half of our graduates practice in small town and rural areas, and this is a large percentage for rural training programs. Graduates’ practices range from large medical center or inner city practice to remote mountain office and hospital practice hours from a medical center, or to a distant island clinic, or to a rural Texas office-hospital-ICU-OB-C-section practice. Most of our graduates stay to practice here in Virginia. Many of the respected Family Physicians on staff at the Winchester Medical Center are graduates of our program. Once you get to know Virginia, it can be hard to leave.

Private Practice: The core Family Practice Faculty members are partners in a real private practice, with residents working as junior associates. You witness up close the details of real practice: the hiring and firing of staff, purchasing equipment, training needs, billing and working with insurances, finding needed resources, and so on. This day-to-day work in a real-life private practice, along with our excellent 3-year Practice Management Curriculum, is one reason that so many of our graduates have felt comfortable setting up their own solo practices. This is very unusual in our day. Our Electronic Medical Record is mature, started 10 years ago, and is fully integrated with the large regional health system hospitals, labs, and x-ray, for smooth patient care and coordination.

Behavioral Health: Our Behavioral Health and Psychiatry Curriculum is one of the few in the country to meet the Recommendations for Psychiatric Training in Family Medicine from the American Psychiatric Association. Our residents learn to handle whatever mental health problems are thrown their way in real practice. This really is the level of training in mental health problems that is needed in practice.

Global Medicine: Rural Family Medicine training is ideally suited for work in the Third World. Many residents are excited about our Global Medicine Elective in Honduras, under the direction of our own Dr. Thomas Ball. Each year, Dr. Ball takes residents and VCU medical students to an ongoing clinic site in the mountains of Honduras. Our VCU connection has expanded this opportunity to include the Dominican Republic and Ghana in West Africa.

Our Patients: Our patients represent our area – a broad range of people: from the poverty and mountain culture of Appalachia on our western side, to the well-off of the winery and horse country to our east. We have patients who are farmers and builders and teachers, and many others who work in the high tech defense and security consulting and computer industries of the Virginia suburbs of D.C., as well as professors from the area colleges. Rich or poor, working or unemployed, locals and immigrants, educated or needy disabled: Our region’s demographic closely resembles that of the U.S. as a whole. There is social and ethnic diversity, and Spanish language skills are helpful. We care for patients not just in the office, hospital, and nursing home, but also in patient homes, an adolescent medicine school clinic, university sports medicine clinic, three public health clinics, and a free clinic.

Academics: Our academic training is excellent. Board review begins in the first year and continues all three years. Our program’s unique level of management of complex patients without immediate specialist backup allows our residents to have a deeper than usual knowledge of complicated medical problems. For several years, each class of residents has scored above the national average for their training year on the In Training Exam of the American Board of Family Medicine. Our D.O. residents also score in the top percentiles on the yearly In-Service Exam of the American College of Osteopathic Family Physicians. Our program and faculty and residents have won numerous awards and honors (see Awards and Research page). This may surprise some, as we are a small program. Our residents and faculty regularly present at national and international conferences, and most residents get published. Most of our core Family Practice Faculty have completed teaching fellowships, gaining advanced teaching skills for this clinically-based, practical group. Our close academic affiliation with the MCV/VCU School of Medicine affords our residents many learning opportunities with our fellow VCU programs, and additional resources, support and academic training for our faculty.

Students: Our faculty and residents train medical students from numerous medical and osteopathic schools. Student rotations include Family Practice Office-based rotation, or our very popular hospital Acting Internship. The Student Curriculum is under the direction of Dr. Jon Winter. Housing is provided. For rotations, contact our Residency Program Coordinator, Tina Krajacic: tkrajaci@valleyhealthlink.com.

Living: The Best of Both Worlds is also seen in our locale. In our small towns, you may get to know the people at the coffee shop or diner, see your patients at the supermarket or bookstore, without the traffic congestion, headaches, and hustle-bustle of suburban metro living. But cultural amenities are not far. You can attend a concert after work at Wolf Trap (www.wolftrap.org) or see a play at the Kennedy Center (www.kennedy-center.org). You can take a day trip on the weekend to the museums of the Smithsonian Institution (www.si.edu) or visit the National Zoo (http://nationalzoo.si.edu).

Outdoors: Outdoor life is big here. Front Royal is the Canoe Capital of Virginia, and canoeing and kayaking are popular. The Shenandoah River runs through Front Royal, about 1,000 yards from our office. The Shenandoah National Park (www.nps.gov/Shen) borders the southeast side of town. The Appalachian Trail (www.appalachiantrail.org) goes through Front Royal. The mountains of the George Washington National Forest are our western border. Cycling is popular on our country roads. The area is known for fishing and hunting. Skiing is nearby at Massanutten Resort (www.massresort.com) or at Canaan Valley Resort (www.canaanresort.com/winter), as well as other ski areas.

History is everywhere in the Shenandoah Valley, from the Colonial Era and Revolutionary War, to numerous Civil War Battlefields and sites. George Washington’s first job (age 16) and first elected office (early 20's) were both in Winchester.


So, you can see the contrasts. We have the comforts and outdoors of friendly small town living, with not-too-far cultural and city life. We have the fun and full breadth and challenges of small hospital practice, with the recurrent exposure and training in a cutting-edge referral medical center. This is the Best of Both Worlds! Come and take a look.

Frank Dennehy, MD, FAAFP
Residency Program Director
                                                


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