EDITOR’S NOTE: This article was recently published in the Dothan Eagle’s Wiregrass Pride 2019 edition. It’s now being shared on a variety of our digital and social media platforms.
When doctors graduate from medical school, their education is far from over.
They do what is known as a residency, where they spend several years in post-graduate training – it may be three years for those who plan to go into primary care and longer for those who plan to specialize in an area of medicine such as surgery.
With more new doctors graduating than slots available for residents, it’s a competitive process to even get accepted into a residency program.
When Southeast Health created an Internal Medicine Residency Program three years ago, the hospital received 1,000 applications from medical school graduates. Four hundred applicants were interviewed. From there, 200 were ranked. Thirteen were chosen.
In its second year, the Southeast Health residency saw the number of applications double. And with the start of a third year approaching, the program’s leaders will face choosing another 13 residents from the 150 medical school graduates they plan to interview.
“It is far more competitive than medical school,” said Dr. Tom Tosto, an MD and the program’s director. “This is the ultimate educational process.”
Following the opening of the Alabama College of Osteopathic Medicine (ACOM) in 2013, the Dothan hospital looked at creating a residency program for osteopathic medical school graduates – which is designated as a DO after a doctor’s name compared to an allopathic degree, or an MD. ACOM is a private, nonprofit school that falls under the Houston County Healthcare Authority, which also oversees Southeast Health. An osteopathic residency program made sense. ACOM’s most recent class, which started in July, is the medical school’s largest so far with 192 students.
But starting in 2020, the Accreditation Council for Graduate Medical Education (ACGME) will have one accreditation for both osteopathic and allopathic residency programs. So, Southeast Health opted to create a program for both osteopathic and allopathic residencies.
There were challenges, Tosto said. There was a 450-page application for accreditation; an entire curriculum had to be written; and they had to recruit both faculty and medical school graduates.
“The real challenge, I think, is going from year one to two to three – growing the program,” Tosto said.
After the third year of residency, some of the residents may be extended an offer to stay on a fourth year as a chief resident, Tosto said.
The Internal Medicine Residency Program at Southeast Health is accredited for 13 residents each year up to 39 residents in the three-year program. But, Tosto said, the program moves into the next stage of its accreditation this fall and it’s hoped that the program will get more slots.
The residency has a mix of both MD and DO graduates.
Dr. Arielle Dahlin, an MD from Orlando, Florida, was among the first group of medical school graduates to be interviewed for the Southeast Health residency program.
“I probably applied to a couple hundred different programs and I got several interviews, so that was exciting” she said. “… We have to apply to a lot of programs and we only get so many interviews based on if we are meeting whatever it is they’re looking for.”
Dahlin liked what she saw at Southeast Health, impressed by Tosto and the vision for the residency program. She is now a second-year resident.
“I really felt that it aligned with what I was looking for in a program – a place that was going to help me grow as a physician, be a great physician and a community in which I had a lot to offer and a lot of people we could serve and make it better,” Dahlin said.
Being a new program didn’t worry her.
“I love the road less traveled – I’m all for it,” she said.
Dr. Bill Bancroft graduated from ACOM with his DO degree and is in his first year of residency at Southeast Health.
“This is my home rotation site, so I rotated through all the specialties here at the hospital,” Bancroft said. “I also did away rotations at different hospitals. So, I knew ahead of time how good they were. I knew what I was going to get into and from talking with Dr. Tosto, the direction. That’s kind of what sold me. … I knew it could only go up and had very good potential.”
Plus, for Bancroft, the Wiregrass is home. While raised in San Antonio, Texas, his parents are from Alabama – his mother from Hartford in nearby Geneva County.
“I want to do primary care and stay here,” he said. “That was my goal before medical school and it hasn’t changed.”
A resident’s day starts early, Dahlin said. They arrive at the hospital around 5:30 to 6 a.m. They do their rounds and see patients. At noon, they meet for an hour-long conference where they may discuss interesting cases, the thought process and diagnosis. There are also daily lectures by medical specialists. The rest of their day they continue to see patients, including clinic patients they see at Southeast Health’s Eastside Clinic on Columbia Highway.
“They’re usually patients we admit ourselves from the ER,” Dahlin said. “We take care of them while they’re here and then we get to see them and develop relationships with them outside in our clinic setting as well.”
The day typically ends by 7 p.m. This is six days a week.
While a lot of work, Tosto said the residency program is a healthier environment than when he was a resident. It’s important, he said, to protect the time intended for education and to make sure residents are healthy and do not become so exhausted they could make mistakes. After all, a well-trained and rested doctor is better for patients.
Tosto said his goal is to make sure Southeast Health’s residency is nothing like how residency programs were in his day when new doctors worked 37 straight hours and pretty much lived at the hospital. Nobody cared about the wellbeing of residents.
“In fact, they were quite toxic,” he said. “That is not the residency of today; that’s not this program – it never will be.”