What is the greatest strength of TFM?
People are the greatest strength of Tacoma Family Medicine. The relationships you build with co-residents, mentors, and staff often last far beyond residency. Check us out on Facebook.
Who makes up the TFM Faculty?
Our core family medicine faculty boasts a wide variety of post-residency experience and years of teaching experience. All core faculty provide full scope outpatient, inpatient adult and pediatric care, and obstetrics. We encourage interviewees to dialogue with the faculty and contact them by email.
We are unique, in having nine Obstetrician-Gynecologists as faculty (located in the same outpatient building), providing one of the most collegial family medicine/obstetric relationships available. Our OB/GYN teaching, labor management experience, and high-risk prenatal clinic takes our OB experience way beyond “baby-catching”.
Our full-time Behavioral Scientist shares her expertise in cultural competence; our part time Pediatrician boasts years of inpatient and outpatient care; our full-time Pharmacist is based in our clinic; and we have two Nurse Practitioners and a full time Social Worker—all to augment resident training/patient care.
In our building, we also have a psychiatrist who does consultations three days a week, and behavioral health counselors for our patients.
What is the residents' culture like?
Residents enjoy each other’s company and routinely spend time together outside of work. Often each class gets together weekly after Thursday afternoon didactics. In addition to an all-residency retreat, residents cover for each other to optionally allow each class to have their own retreat each year.
Where do TFM graduates practice?
Our graduates practice throughout the US and internationally. Since 1978 we have trained 223 residency graduates. 34% of those graduates practice in health care shortage areas with 25% practicing in rural communities. An updated map from the Graham center covers 145 graduates up to 2009 and is available at healthlandscape.org.
What is TFM’s relationship with the community?
Tacoma has a sophisticated medical community that is supportive of resident education. Residents find willing local teachers in virtually all medical specialties who provide rich educational opportunities. Community voluntary faculty see you as “our resident.”
Who is the sponsor for TFM?
MultiCare Health System sponsors Tacoma Family Medicine. MultiCare is a not-for-profit, locally based healthcare organization that encompasses eight hospitals and an extensive clinic network, with roots that go back to the founding of Tacoma’s first hospital in 1882. We are governed by a volunteer board of local community leaders.
What training opportunities are available at TFM?
- University of Washington Affiliation: Tacoma Family Medicine is part of a collaborative network of ACGME accredited Family Medicine Residencies in the Northwest with more than 30 Family Medicine Residencies and encompassing five northwestern states: Washington, Wyoming, Alaska, Montana and Idaho. Each of our core faculty holds an appointment in the University of Washington Department of Family Medicine.
- Unopposed: Family Medicine residencies are the only type of sponsored residencies at MultiCare, leading to an unopposed learning environment. TFM is the longest established Tacoma area family medicine residency program.
- Pediatrics: Mary Bridge Children’s Hospital is a true children’s hospital with its own ED, Pediatric ICU, and Pediatric subspecialty services. Our residents on Pediatrics are supervised by the Pediatric Hospitalists, who provide excellent training for a core of “bread and butter” pediatric admissions, and our Pediatric ED rotations utilize fellowship-trained teachers.
- Obstetrics: Our Inpatient Obstetrics service occurs in a regional maternal referral center with about 3,000 deliveries per year with a Level IV NICU. Our combined clinics in the 521 building provide prenatal care for 900 of these deliveries. Family Medicine residents and Family Medicine Rural fellows are the only postgraduates on labor and delivery.
- Longitudinal ICU Training: Our Inpatient Medicine service is supervised by MultiCare internal medicine and pulmonary-critical care hospitalists who enjoy teaching and provide expert, practical medicine education. Under their supervision, residents routinely admit to the ICU and provide care for critically ill patients. Each week there are scheduled ICU teaching rounds.
- Rural/Urban Curriculum: We have a scheduled opportunity for a one-month rotation away from our facility in each of the first two years to train for future rural or urban-underserved practice. A specific curriculum helps you review an underserved practice and perform a community assessment in order to prepare to choose wisely among future practice options.
- Other training opportunities include MAT, POCUS, gender affirming care, care for the developmentally disabled and OMT
How does TFM train residents for outpatient practice?
Residents rotate through four main modalities of care:
- TFM Specialty Clinics: procedural clinic assignments in Orthopedics/Sports Medicine, Colposcopy, Outpatient Procedures, and cognitive specialty clinics in Outpatient Pediatrics and Psychiatry.
- One-to-One Clinic Precepting: One-to-one precepting is a rich time of coaching in patient-centered interviewing and outpatient clinical practice with our behavioral scientist and our physician faculty.
- Practice Management and Outpatient Modules: A family medicine graduate will spend 90% of a typical week in the office. TFM devotes two weeks a year focused on common outpatient problems and processes, practice management, patient-centered medical home (PCMH) and health systems. Residents lead diabetic group visits, join our patient advisory council, and participate in our PCMH committee.
- TFM Outpatient Clinic: A supportive continuity clinic environment that will meet and succeed ACGME visit requirements. Residents are responsible for their own panel of patients. Clinic time increases during each year of training. R1s have 1-2 half day clinics per week, R2s have 2-3 half day clinics per week, and R3s have 4-5 half day clinics per week. During each half-day of clinic, interns see 4-6 patients, R2s see 7-8 patients, and R3s see 9-10 patients so that at the end of their training they are seeing 19 patients per day.
How does TFM train residents for inpatient services?
Interns on the family medicine and inpatient adult medicine services are expected to be primarily responsible for 6 patients. Interns on the inpatient pediatric service are expected to be primarily responsible for 7 patients. Senior residents are expected to know the entire panel and provide supervision, support, and teaching for interns. In addition, both interns and senior residents routinely work with medical students on all three services.
What is TFM's patient population? Do you work with the underserved?
Pierce County is the most ethnically diverse county in Washington State. We are an urban-under resourced clinic with a large contingent of Medicaid/Medicare patients that incorporates diversity in race, language, social economics, ethnicity, physical and psychiatric disabilities, and patterns of pathology. In our clinics, interpretation services are used in approximately 25 different languages in a year, with top five languages used being Spanish, Vietnamese, Cambodian, Arabic, and American Sign Language.
Is TFM a Patient-Centered Medical Home (PCMH)?
Yes, we have been recognized by the NCQA as a Level 3 Patient Centered Medical Home on January 22, 2015 and maintain a current certification. Residents are active members of our Patient-Centered Medical Home Meetings.
How is the call system structured?
Residents take call during inpatient medicine and pediatrics rotations. They also take individual call for their OB continuity patients. Please look at the Call Schedule tab for more information. Our duty-hour policies comply with the July 2019 ACGME rules. Residents take 24 hour call during NICU rotation, a four week block, during their R3 year.
What OB volumes can residents expect?
Most residents leave TFM with more than 80 total deliveries over three years. Residents more interested in OB routinely leave with 100 or more deliveries. Our goal is that all graduates provide competent prenatal care, manage labor well, properly conduct a vaginal delivery and repair, and be a good first assistant at C-section. Proficiency in C-sections by graduation is a goal but we don't guarantee it.
Are there opportunities for international rotations?
Several of our faculty members have experience working in international settings. Third-year residents may request a one-month international rotation to be approved by the faculty. The purpose for international rotations should be congruent with career plans of the resident. The rotation must have an educational plan and goals; and needs an approved preceptor at the proposed site. Recent places our residents have worked include Honduras, Peru, & Niger.
How are residents supported?
Tacoma Family Medicine has integrated structural support for the resident well-being including a longitudinal Wellness Curriculum. R1s receive a two-week initial orientation, followed by a four-week fundamentals rotation, and then weekly facilitated support group. Other supports include our night float call system, teaching panels with caps to maintain the education/service balance, Balint Groups, collegial teams and our advisor system (advisor meetings take place at a quarterly minimum). We are sincere about having a climate of excellent education coupled with support.
How are residents evaluated?
Most of your education and growth will come from daily and weekly feedback. A clinical competence committee evaluates your progress semiannually, based on 360 feedback from preceptors/attendings, faculty, office staff/nurses, and patients. Your advisor acts as a guide and meets with you individually to help you plan your growth as a physician.
Does TFM have structured didactics?
Didactics occur on Thursday afternoons with an 18-month repeating topic cycle covering all areas of family medicine. All residents are expected to attend with the exception of the on-call team, or on mandated post call off time. When a fifth Thursday occurs in a month, we present afternoon procedure workshops with lectures, procedural workstations, and basic competency training.
We have many other structured opportunities for learning to include: ICU teaching rounds, sim lab, and monthly psychiatry case conferences, radiology rounds, pediatric grand rounds, and teaching medical students.
Does TFM require a scholarly project?
Our third-year residents complete an academic project in evidence-based scholarship, researching an evidence-based answer to a clinical question, which is mentored and organized by trained faculty. The results are presented in a local CME presentation and with expectations they will be submitted for publication.
Which electronic health system does TFM use?
MultiCare Health System uses the EPIC electronic health records system, making us one of the top four integrated health care delivery systems in the nation. Our office, ED, and inpatient services all use the same electronic record and it is accessible from both home and mobile devices. Several of our faculty are Epic “super-users” and regular time with Epic trainers is part of your longitudinal curricula.
How does fellowship affect the residents?
Our five Family Medicine Rural Fellows spend seven months on OB directly supervising R1s on OB, and two weeks supervising R2s on OB. Senior residents are full members of a four-person team with the Fellows in providing high risk prenatal care in OB Access Clinic (OBAC), providing NST/AFI clinic and running the OB labor deck. Supervision is provided by the OB Faculty.
Will emerging residencies negatively affect training opportunities?
No. The three emerging family medicine residencies in Tacoma (The Puyallup Tribal Health Authority, East Pierce Family Medicine, Community Health Care Residency), along with TFM, are collaborating to access our entire county for teaching resources. We are coordinating our efforts through the Pierce County Medical Society with the goal of having a nationally recognized consortium of high-quality residencies in Pierce County.
Do residents enjoy the Tacoma area?
Tacoma is a little big town, with family-oriented people, a reasonable cost of living, recently re-built public schools, and ready access to outdoor activities. Resident’s partners have easily been able to find jobs. There are waterfront biking and walking paths, kayaking trips, fantastic parks, and museums for you and your family to flourish in. We encourage you to balance your life with fun and family, as well as medicine.
Residents' Top Reasons Why They Love Living in Tacoma:
- Small city feel and affordability with big city amenities.
- Very little traffic with free parking on campus and easy bike commutes to work.
- 2.5 mile waterfront promenade makes a great place for a run or walk your dog with panoramic mountain views of Mount Rainier and Olympics.
- Immense city park (Point Defiance) has a beach, gardens, zoo, aquarium, trails and a five-mile “scenic drive” that makes a great bike ride.
- Great local restaurants and unique neighborhood pubs.
- Easy outdoor access: 1.5 hours to Mount Rainer, two hours to Eastern Olympics, one hour to Snoqualmie Pass, two hours to the Pacific Ocean. We are closer to Mount Rainier and the Olympic Peninsula than Seattle.
- Kayak rentals available on the waterfront.
- The Art Museum, Glass Museum and Washington State History museums are free on the 3rd Thursday. Children’s Museum is always free.
- More diversity than Seattle/King county, Short 45 minute drive/bus ride to Seattle for an easy night on the town.