Karen Garloch

Young doctors buck the trend and train for primary care at Novant

Ariel Talts says her father, a longtime anesthesiologist in Eden, N.C., warned that her dream of becoming a primary care doctor could leave her “overworked and underpaid.”

But she ignored his advice, and today she’s one of the first six medical school graduates training to become family physicians through a three-year Novant Health residency program that officially begins Friday.

It’s the first medical residency program sponsored by Novant Health, a Winston-Salem-based system with four hospitals in Charlotte. And it is North Carolina’s 15th family medicine residency program, joining others at Carolinas HealthCare System in Charlotte as well as those at the state’s five medical schools.

Talts interviewed at other established programs, but said she was impressed by the willingness of Novant’s residency to embrace the “holistic” therapies she studied during four years at Virginia College of Osteopathic Medicine. Doctors of osteopathic medicine (D.O. instead of M.D.) have the same privileges as medical doctors but put more emphasis on holistic care and the musculoskeletal system.

“I’m very into spiritual and mental wellness,” Talts said. “And they just really were so open-minded.”

Talts is the youngest of the Novant Health residents, four women and two men, who range in age from 25 to 35. She’s from Danville, Va., and the others come from across the continent – Arizona, Indiana, Florida, Pennsylvania and Canada. Two are married, and several worked in other jobs – as a bioengineer and a veterinary technician, to name two – before going to medical school. In addition to Talts, three others graduated from osteopathic schools.

After orientation, residents will begin rotations through various specialties. Under supervision from experienced doctors, they will care for patients at Huntersville Medical Center and Presbyterian Medical Center and in a new clinic specifically for residents, adjacent to Lakeside Family Physicians in Cornelius.

“These are going to be the six pioneers,” said Dr. C.J. Atkinson, assistant director of the residency program.

New director from military

The focus on family residency is intended to address an anticipated shortfall of primary care physicians, according to Dr. Mark Higdon, Novant Health’s residency program director.

Today there are 2,800 family physicians in North Carolina, with a projected need of 4,700 by 2020, according to the N.C. Academy of Family Physicians.

Higdon also cited a report that says North Carolina will require an additional 1,885 primary care physicians by 2030, a 31 percent increase.

Of doctors trained today, Higdon said 70 percent become specialists, 30 percent become primary care doctors. “That needs to be reversed,” he said.

By giving residents the opportunity to work in office-based clinics as well as hospitals, Higdon said they should be prepared for the real world when they finish. “You can really practice the way you’re going to practice on the outside,” he said.

Higdon came to the program as director after being recommended by Atkinson, a Lakeside physician who got his training in the U.S. Army residency program at Fort Benning, Ga., where Higdon was director.

“He was my (Army) colonel,” said Atkinson, who later worked alongside Higdon as a faculty member at Fort Benning.

They are among five full-time faculty who will supervise Novant Health residents. Others include Dr. Christopher Snyder, who in 1996 also helped launch the family medicine residency program at Cabarrus Memorial Hospital (now Carolinas HealthCare System NorthEast) in Concord.

“There’s a lot of excitement,” Snyder said. “In a new program, there’s no ruts in the road that you have to follow. So you have to create new pathways. We’ve got a chance to paint our own picture.”

Work hours limited

In years past, medical residency programs were known for “brutal hours and lack of sleep,” Higdon said. But thanks to revisions in national medical education guidelines, today’s hours are a bit more sane.

Residents are not allowed to work more than 80 hours per week. They get one day off in seven. And they get at least eight hours off between shifts. “First-year residents do not pull overnight call, and never work more than 16 (consecutive) hours,” Higdon said.

“This is a better way,” he said, noting that it will allow the program to “put a well-rested, well-trained resident in front of patients.”

Residents will always have faculty physicians nearby for consultation. In the clinic, for example, “I am basically two doors down the hall,” Higdon said.

When rotations begin Aug. 1, Talts will start with two of the toughest – internal medicine, from 7 a.m. to 7 p.m. six days a week, and obstetrics/gynecology, 7 a.m. to 9 p.m. five days a week. But she said the philosophy outlined by Novant Health leaders gives her comfort.

“Any intern in their first year is a little bit terrified,” Talts said. “But they just reassured us over and over, we will never be alone. We will be well-trained. We might work our butts off, but we’re going to end up doing extraordinarily well in terms of competency.”

Other residents agreed that Novant Health leaders were “progressive and open-minded” as well as “inspirational” during their interviews. Eugene Wang, 35, from Vancouver, British Columbia, said he liked the idea of being a pioneer in the new program.

“How many opportunities do we have in life,” he said, “to actually join something at the very beginning?”

Doctor training in Charlotte

Charlotte is the largest U.S. city without a four-year medical school, but medical students and residents get trained in local hospitals and doctors’ offices. In addition to the new family medicine residency program at Novant Health, here are other programs in the Charlotte area:

▪ Carolinas HealthCare has operated medical residency programs since the 1940s. Its largest hospital, Carolinas Medical Center, is home base for about 300 residents and fellows in more than 30 medical specialties, including family medicine.

▪ Carolinas HealthCare also operates a regional campus of UNC Chapel Hill medical school, the UNC School of Medicine Charlotte Campus. Created in 2010, it trains about 60 third- and fourth-year medical students annually. Other medical students rotate through various hospital settings, bringing the total number of students on campus to about 230 per year.

▪ Carolinas HealthCare System NorthEast, formerly NorthEast Medical Center, in Concord has run a family medicine residency program since 1996. Each year, the program accepts eight new residents, who train for three years.