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Rural Arizona Family Medicine Rotations

Rural Site: Hopi Health Center

Location: Polacca, Hopi Indian Reservation
Distance from Tucson: 334 miles (6 hours driving time)
Physician Site Director: John Stucki, MD

Hopi Health Center is located on the Hopi Reservation, approximately two hours to the northeast of Flagstaff in Polacca, Arizona.  There are eight family physicians involved in patient care and teaching at this Indian Health Service medical center, as well as three mid-level providers.

Residents who choose to complete their rural family medicine rotation here have the opportunity to evaluate and manage the full-spectrum of typical family medicine patients, including pediatric, prenatal, adult and geriatric patients with a variety of acute and chronic medical problems. 

The resident experience occurs primarily in the outpatient setting, though residents also work in the emergency room, treating patients with a variety of urgent and emergent conditions.  There are four inpatient beds, described as "short stay" beds for those with conditions such as cellulitis, bronchioloitis, or other illnesses that warrant short-term admission for monitoring and medication administration. 

Residents are expected to complete at least 40 duty hours per week.  Most of these are daytime hours, through some evening shifts will be scheduled to allow for exposure to the management of after-hours medical issues in the rural clinical setting.  There are no "on-call" requirements, though residents may request to be called for additional exposure to certain procedures or conditions of interest.  There are no weekend responsibilities, and residents are encouraged to explore some of the natural attractions not far from Polacca, including Zion National Park, Canyon de Chelly and the Grand Canyon.

There is housing provided in a three bedroom trailer provided by the University of Arizona, located within one of the IHS housing areas approximately 13 miles from Polacca at Keams Canyon.  Up to three residents or students may be housed in the trailer at any given time.

Physicians at the Hopi Health Center are enthusiastic about teaching, and enjoy hosting residents and students from a variety of training institutions.  They limit the number of learners in their facility at any one time so as to not dilute the learning experience, and previous residents and students who have completed rotations at Hopi Health Center have expressed many positive comments about their experience.  

Rural Site: St. Johns Family Medicine Clinic

Location: St. Johns, Arizona
Distance from Tucson: 233 miles (4.5 hours)
Physician Site Director: Jim Sielski, MD

The St. Johns Family Medicine clinic is affiliated with North Country Healthcare in Flagstaff.  Dr. Jim Sielski and Michelle Page, FNP, are the primary providers of healthcare at this clinic.  They see adult, pediatric, geriatric and prenatal patients.  They provide chronic and acute care, including the full spectrum of commonly encountered problems for the family physician.  Procedures such as casting, splinting, incision and drainage, laceration repair, osteopathic manipulation, trigger point injections, acupuncture, skin biopsies and colposcopy are performed at the St. Johns Clinic.  Although prenatal patients are cared for in the clinic, deliveries are performed by an obstetrician group at the Springerville Hospital.

The nearest hospital is in Springerville, approximately 33 miles from St. Johns.  Dr. Sielski provides inpatient rounding in this approximately 20 bed facility on average, about one full week per month.  Although this is primarily an outpatient rotation, residents participating in this rotation are expected to round on patients with Dr. Sielski.  Residents who choose to live in Springerville and commute to St. Johns would also have the opportunity to spend some time in the Springerville Hospital Emergency Department. 

St. Johns is located near the Sunrise Park Ski Resort, Petrified Forest, the Apache Sitgraves National Forest and the Mogollon Rim.

Rural Site:  Fort Defiance Indian Hospital (FDIH)

Location: Fort Defiance, Arizona
Distance from Tucson:  340 miles (6 hours 10 minutes)
Physician Site Director:  Julianna Reece, MD

Fort Defiance is a 56 bed inpatient hospital and outpatient clinic providing medical care for approximately 35,000 Navajo.  Fort Defiance and its satellite primary care clinics provide the only medical services in the area, and play a large role in public health programs for the Navajo Nation.   The Fort Defiance staff is trained in the following fields: internal medicine, family practice, pediatrics, OB/GYN, general surgery, ENT, orthopedics, emergency medicine, anesthesiology, pharmacy, PT/OT, optometry, psychiatry, dentistry, and radiology. 

Serving a rural area, many of the patients who come to FDIH travel more than 50 miles round trip to see a doctor.  Many of the elderly patients speak only Navajo, and live according to traditional Navajo cultural practices.  A large number of the hospital’s patients do not have electricity or running water in their homes.

Fort Defiance is located in one of the most scenic areas of the country, and is within half a day’s drive of more than a dozen national parks and monuments, including Canyon de Chelly, Grand Canyon, Arches, Bryce, and Zion National Parks.  Durango, Telluride, Santa Fe and Flagstaff are also very close.

Residents who participate in a rotation at Fort Defiance will spend time caring for patients on the adult and pediatric inpatient wards, in the outpatient clinics, and in the emergency department.  Some of the outpatient clinics occur at remote satellite clinics outside of Fort Defiance.  Residents may spend time with specialty providers including cardiology, high-risk OB, podiatry, dental and physical therapy.  There is occasionally the opportunity to spend time with Native American healers, as well as with public health nursing staff who make home visits out into the local community.

Rural Site: Sells Hospital and Clinics

Location: Sells, Arizona (Tohono O'odham Reservation)
Distance from Tucson: 59 miles (approximately one hour)
Physician Site Director: Susan Hausser, MD
Months Available: Per limited basis due to service unit commitments with other academic centers.

The Sells Hospital and Clinics is the central component of the Sells Service Unit, an Indian Health Service Facility on the Tohono O'odham Reservation.  The majority of the Native Americans served in the facility are Tohono O'odham.  Physicians here provide outpatient services to pediatric, adult, geriatric and prenatal patients with a wide variety of acute and chronic medical conditions.  There is a small inpatient service, as well, limited to the care of adult patients.

Residents who choose to complete a family medicine rotation in Sells would have primarily an ambulatory care experience with some opportunity to participate in inpatient rounding and call.

Three satellite facilities are now operational in the Tucson Service Unit: the San Xavier Health Center, a large outpatient facility on the outskirts of Tucson, the Santa Rosa Clinic, a small outpatient facility located in the very rural setting of the north-central sector of the Tohono O'odham Reservation and the San Simone Health Center along the western end of the reservation. 

As a group, the Tohono O'odham have one of the highest occurences of Type II Diabetes in the world.  The study, treatment and prevention of diabetes is of major concern, though many other medical problems are seen and addressed by physicians in the clinic and hospital.  There are several projects going on in Sells related to disease prevention, health promotion and other public health related issues, important to the Native peoples they serve. 

Rural Site: Safford-Gila Valley Clinic and Mount Graham Community Hospital

Location: Safford, Arizona
Distance from Tucson: 127 miles (2 hours)
Physician Site Director: Gail Guerrero, MD

There are four physicians who specialize in family medicine at the Gila Valley Clinic in Safford, as well as two physician assistants.  The physicians practice full spectrum family medicine, caring for obstetrical patients, pediatrics, geriatrics and adults with both acute and chronic healthcare needs.  They see patients both in the ambulatory and inpatient setting, admitting patients to the Mount Graham Regional Medical Center.  The population of Safford is just over 9,000 people.  Traditionally, Safford has been one of the most popular sites for University of Arizona medical students, due to the quality of the teaching physicians.  Comments shared about the physicians and experiences there include "great teachers", "excellent rotation" and "I really enjoyed my experience."  Dr. Guerrero and her colleagues are excited about this new opportunity with the UofA/UPHK GME Consortium Family Medicine Residency.

                     

Rural Site: Whiteriver Indian Health Service

Location: Whiteriver, Arizona
Distance from Tucson: 200 miles (4 hours)
Physician Site Director: Dianna Mahoney, MD

                      

(PGY-2 Rural Family Medicine)

The Whiteriver United States Public Health Service Indian Health Service Hospital is a 40 bed inpatient and outpatient facility serving the 14,000 members of the White Mountain Apache Tribe. Whiteriver Hospital is accredited by the Joint Commission on Healthcare Organizations, and its satellite clinic, Cibecue Health Center (50 miles South-West), is also JCAHO accredited.

The primary care teaching staff at Whiteriver consists of eighteen physicians in the specialties of family practice, internal medicine, pediatrics, and medicine/pediatrics. The medical staff also includes five mid-level providers, a podiatrist, a part-time orthopedist, and part-time general surgeon. Whiteriver physicians provide inpatient and outpatient adult and pediatric care, obstetrical services, and emergency care. Whiteriver has an average inpatient census of 17 adults and children, an average daily clinic load of 100-200 patients, and approximately 12 vaginal deliveries per month. The Whiteriver Emergency Department sees 17,000 patients annually, and the facility transports over 400 patients by air to instate metropolitan areas each year.

Resident schedules usually include a week each on the inpatient service (including OB), the clinic, the emergency room, and in Cibecue. This schedule is flexible depending on resident interest and on the number of rotating students/residents in each block.

According to CDC: “Of all racial/ethnic populations, American Indians/Alaska Natives have the highest poverty rates (26%)—a rate that is twice the national rate. Coincident with these socioeconomic burdens are persistent, and often increasing, health disparities.” (Reference-Center for Disease Control and Prevention. Health Disparities Experienced by American Indians and Alaska Natives. MMWR 2003;52:697-713)

For example, “ the rates of injuries, diabetes, and bronchiolitis were two to three times as high among American Indians/Alaska Natives…” as compared with the US general population. Residents help care for people with these health conditions, in addition to other pediatric infectious disease and alcohol-related disease. Resident participate in the full spectrum of pediatric, adult, and obstetrical care, gaining the opportunity to perform many procedures, as well. Primary care clinics form the core of the outpatient services and are supplemented by visiting consultants in multiple specialties.

Residents also learn about the local culture of the Apache people with opportunities to observe traditional activities such as the Apache Sunrise dance, which celebrates the coming of age of young Apache women, and takes place most weekends from April to September.  The tribe also hosts a large rodeo over Labor Day weekend. Residents are asked to visit the tribe’s Cultural Center and Museum near historic Fort Apache. Additionally, there is in the student/resident house, a collection of cultural readings, which includes work by and about Native American peoples in general, and the Apache people in particular.

The White Mountain Apache Reservation is a 1.6 million acre area covered by forested mountain terrain.  Whiteriver is at 5,290 feet in elevation. High summer temperatures approach the 90s, and freezing temperatures are routine at night from November to April. Expect rain in July and August (monsoons!), and snow from October to April.

Whiteriver and the White Mountains are phenomenal places to visit. Those who visit enjoy great hiking, fishing, boating, mountain-biking, and other activities almost year-round. In the winter, excellent skiing is 30 minutes from the hospital at Arizona’s largest ski resort, Sunrise, run by the White Mountain Apache Tribe. Numerous brochures and books about local outdoor adventure as well as hiking trail maps and such are located in the student/resident house.

Rural Site: Show Low

Location: Show Low, Arizona
Distance from Tucson: 190 miles (3 hours 50 minutes)
Physician Site Director:  Becky Thompson, MD

Residents who choose to complete a rural family medicine rotation in Show Low, Arizona, will work with Dr. Becky Thompson.  Dr. Thompson is a University of Arizona College of Medicine graduate, and works in private practice in the community of Show Low.  She does not practice obstetrics, but cares for both adult and pediatric patients in her clinic, and does take care of her patients who require hospitalization at Summit Healthcare Regional Medical Center.  Summit Healthcare Regional Medical Center is a regional hospital with 89 licensed beds, taking care of more than 90,000 permanent and seasonal residents living in a 3,000 square mile area.  Call is taken by the resident with Dr. Thompson on a limited basis.  Procedures performed in her office include joint injection, skin biopsies and lesion removal, cryotherapy and newborn circumcision. 

Show Low is located in the beautiful White Mountains, a destination for those who enjoy skiing, hiking, fishing and other outdoor activities, and a cool spot to get away especially in the summer.

                                                                                           

                 

                                                                                              

Rural Site: Nogales

Location: Nogales, Arizona
Distance from Tucson: 65 miles (approximately one hour)
Physician Site Director: Jeff Maudlin, MD

PGY-1 residents who choose to participate in the family medicine rotation in Nogales will work with Dr. Jeff Maudlin.  Dr. Maudlin has been in Nogales for approximately 20 years, and is passionate about providing compassionate, comprehensive care to the patients of Nogales.  Prior to working in Nogales, he served as a residency director in Ecuador, and enjoys teaching medical students and residents very much.  Dr. Maudlin cares for both pediatric and adult patients in the outpatient and inpatient settings.  He does not currently do obstetrics.  Hospital inpatient work also includes neonatal nursery, med-surg, and geriatrics rounds.  His in-office procedures include: skin biopsies, arthrocentesis, casting/splinting, endometrial biopsies, and toenail removal.  We strongly encourage this rotation for those of you interested in a border health experience.  Fluency in Spanish is not required, though appreciated, as many of his patients speak Spanish only.

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