Becoming a Resident

About the Program

Our mission is “to educate residents in the principles and practice of family medicine and prepare them to provide continuous, comprehensive, and culturally-sensitive, contextual care to underserved and rural populations.”

Our Program Highlights

  • Single-residency community hospital-based program where residents have primary clinical responsibility for all of their patients
  • Commitment
  • Dedicated family physician and sub-specialist faculty; skilled teachers who believe in comprehensive primary care training for underserved communities
  • Program is large enough to provide rigorous experience across all key clinical areas; small enough to have a real “family” feeling where everybody knows everybody
  • Academic affiliation with UCSF Department of Family and Community Medicine
  • Opportunities to teach medical students on all major rotations

Our Rotations

  • Strong maternity care training (high volume, high complexity and high level of responsibility) to prepare graduates to work in underserved communities
  • Outstanding Community Medicine curriculum with opportunities to partner with community service organizations
  • Longstanding night float system that promotes high-level training in addition to resident wellbeing
  • Strong inpatient training including Family Medicine Inpatient Service which partners with our local community/migrant health organization, CSVS (Clinica de Salud del Valle de Salinas), and our local Health Department clinics, sharing faculty, patients and resources
  • Opportunity for two Away Electives

Our Patients

  • Predominantly Latino (about 80%); majority Spanish-speaking only
  • Predominantly public-insured (about 80%, mostly Medicaid)
  • Many recent immigrants who may have had little access to medical care previously

Our Continuity Clinic

  • FQHC look-alike, located on the hospital campus, serving mainly Medicaid recipients
  • Excellent support staff, including 1:1 medical assistants
  • Electronic health record (Epic) with good reporting functions for population health and quality improvement activities
  • Opportunities for outpatient procedures and POCUS
  • Breadth of patients including many prenatal, pediatric and geriatric visits
  • Implementation of “Clinic First” principles in collaboration with UCSF Center of Excellence in Primary Care

Our Hospital

  • 172-bed county medical center built in 1998, with state-of-the-art equipment and seismically-safe environment
  • Institution-wide mission to care for the people of Salinas and Monterey County regardless of ability to pay
  • Full-service safety net hospital including Level III NICU, regional trauma service, acute rehab unit, inpatient mental health unit, and the only heliport in the region
  • Leadership committed to primary care training – our CEO is a family physician!

Our Community

  • Located on California’s scenic Central Coast, adjacent to the Monterey Peninsula, 100 miles south of San Francisco
  • Major agricultural center with a rural community feeling
  • Many opportunities for outdoor activities, on both land and water; Monterey Bay Aquarium; National Steinbeck Center; Monterey Jazz Festival; Big Sur; wineries and restaurants; and more!

Curriculum

Rotations

Rotation Year 1 Year 2 Year 3
Pediatrics Inpatient 5 weeks 5 weeks
Night Float (inpatient med, ICU, peds, surgery, OB, newborn) 5 weeks (split in 2 blocks) 5 weeks (split in 2 blocks) 5 weeks (split in 2 blocks)
Family Medicine Inpatient 5 weeks 5 weeks 5 weeks
Internal Medicine / ICU 10 weeks 10 weeks (5 Med, 5 ICU)
Obstetrics 5 weeks (5 weeks during night float)
Musculoskeletal and Sports Medicine 5 weeks 5 weeks
Surgery 5 weeks (inpatient) 5 weeks (outpatient)
Emergency Medicine 5 weeks 3 weeks
Community Medicine 5 weeks
Outpatient Med Specialties 5 weeks
Gynecology 5 weeks
Pediatrics Outpatient 5 weeks 1 week
Cardiology 5 weeks
Elective 5 weeks 12 weeks
Geriatrics 5 weeks
Neurology / Psychiatry 5 weeks
Practice Management 5 weeks

“The skills you learn in such a rigorous program prepare you to deal logically with the unknown. The complex cases you handle make routine care seem easy. You will be extremely marketable when you are looking for a job. Finally, you will feel a profound sense of accomplishment after leaving ‘the Nat’.”
– Dr. W. Mark Peluso, MD
Director, Student Health Team Physician at Middlebury College
Natividad Family Medicine Residency Graduate

Conferences & Lectures
Residency didactic education takes place every Thursday afternoon during protected time from 1:00 pm to 5:00 pm. During the first hour, residents meet with their own Year Group (R1, R2, R3) to learn about behavioral medicine, practice management, outpatient medicine and a variety of other topics. During the next two hours, the residents meet together for education on a wide variety of topics covering the entire spectrum of family medicine as well as procedural skills, with speakers from our own family medicine faculty, community specialists, and specialists from Stanford and UCSF. First-year residents conduct monthly group prenatal visits during this time. The last hour of the afternoon is spent on various activities, from Journal Club and resident-faculty meetings to physician wellbeing activities. Residents attend inpatient morning report every weekday morning, as well as CME lectures such as Pediatric and Medicine Grand Rounds in the hospital.

Behavioral Health
The Behavioral Health curriculum is longitudinal and integrated into all three years of training. The R1s participate in their own Balint group and general Behavioral Health didactics. The R2s have additional didactics during year-group sessions. The R2s and R3s participate in a combined Balint group. The R3 year continues with didactic year-group sessions, but also includes video review and clinical experiences in psychiatry. The R3s also have about 10 clinic sessions per year dedicated to seeing their continuity FMC patients for extended counseling sessions with Behavioral Health faculty.

Pediatrics
Pediatrics is an integral component of our training here at Natividad. A total of three months are spent during the R1 and R2 years in a variety of settings including the general and specialty pediatric clinic, in-patient pediatric ward, nursery, and Level III NICU. This provides residents with a full spectrum of childhood presentations from the well child to an acute trauma in the ED. Residents are trained in procedures such as neonatal resuscitation, lumbar puncture and circumcision. Educational sessions are provided during the rotation by ward attendings, as well as by visiting UCSF faculty, including pediatric specialists in neurology, endocrinology and gastroenterology. The R3 rotation is exclusively ambulatory, with experience in the general and specialty clinics.

Night Float
During this rotation, residents “run the hospital” from 6:00 pm to the following morning, Sunday through Thursday nights. The first-year resident covers medicine, pediatric and surgery admissions. The second year resident runs the  labor deck. The third year resident supervises the junior residents, including on the labor deck and ICU, and assigns and supervises all admissions. Night float residents have a high level of autonomy, with in-house attendings available for support, including family medicine, pediatric hospitalist, internal medicine hospitalist, and OB/GYN, with other specialties available by phone or to come in when needed. Night Float is an intense rotation, but is rewarding and helpful in developing decision-making, teaching and leadership skills.

Family Medicine
The Family Medicine Inpatient Service is comprised of an R1, R2, and FM Attending who work together to care for adult and pediatric patients from the Family Medicine Clinic, two county Health Department Clinics, and the Clínica de Salud del Valle network of community/migrant health clinics. In addition to caring for and learning about a broad spectrum of medical conditions, residents develop skill in working with multiple consultants, communicating with patients’ families and primary care physicians, and coordinating discharge needs.

Internal Medicine/ ICU
Our inpatient internal medicine and ICU rotations take place in the R1 and R2 years. Working with a cadre of internal medicine hospitalists and critical care specialists, residents admit and assume primary medical management for adult patients with a wide array of medical problems. A group of dedicated subspecialists are available for consultation and teaching. During rotations in general internal medicine and ICU, residents acquire procedural skills including lumbar puncture; central line placement; point of care ultrasound; ventilator management; cardiopulmonary resuscitation; intubation; paracentesis and thoracentesis.

Obstetrics
Our inpatient maternity care rotations take place during the R1 year and night float, and an outpatient GYN rotation occurs in the R3 year. On labor and delivery, residents assume responsibility for all patients on our unit which averages 200 deliveries per month.  Residents manage patients with high risk conditions in labor, including preterm labor, hypertensive disorders, trial of labor after cesarean, and gestational and preexisting diabetes. They also see patients in the high-risk OB clinic, where they manage many medically complex pregnancies with perinatology and obstetric back up.

In addition to their OB-GYN rotations, residents provide prenatal care in their continuity clinic and are expected to attend to the mother and baby on labor and delivery and the maternal-infant unit. During the OB-GYN rotations, residents gain experience in:

  • Obstetrical triage
  • Labor management and vaginal birth
  • Laceration repair
  • Vacuum assisted vaginal delivery
  • Limited obstetric ultrasound
  • Colposcopy
  • IUD insertion
  • First trimester abortion care
  • Ambulatory gyn evaluations

Musculoskeletal/Sports Medicine
This curriculum includes diverse experiences integrated into all three years of residency. There are two dedicated rotations in the first and third year which include working with Sports Medicine, Orthopedic Surgery, Podiatry, Physical Therapy, Collegiate Athletic Training and an Ortho tech. Additionally, there are longitudinal musculoskeletal didactic experiences and resident musculoskeletal team presentations. Second and third year residents perform group physicals for local athletes and attend a sporting event. The Sports Medicine/Orthopedics experience provides an opportunity for residents to learn how to provide team based care for patients with musculoskeletal concerns.

Surgery
Our Surgery curriculum has two distinct components: an R1 general surgery inpatient rotation, in which residents assist our general surgeons in all areas of pre-op, OR, and post-op patient care;  and R3 outpatient surgery rotations, in which residents spend time with both our general surgeons and local surgical sub-specialists, acquiring skills including excision of “lumps and bumps”, punch biopsies, suturing techniques, vasectomies, circumcisions, and slit lamp eye exams. The emphasis is on developing solid surgical skills that are useful for FMs in the care of their patients.

Emergency Medicine
Residents learn to evaluate and manage a variety of problems in the Emergency Department for a total of two months. This includes trauma and emergencies such as injuries, poisoning, shock, respiratory and cardiac arrest, as well as the acute care of a spectrum of medical, psychiatric, and surgical conditions. The ED is also an important milieu to learn about the interaction of physicians and patients with law enforcement, public health agencies, and the inpatient services. The emergency medicine attending physicians instruct and supervise the resident in diagnostic and therapeutic procedures. Throughout the residency, residents with a special interest in learning procedures or interventions are invited to participate in cases in the ED.

Community Medicine
This rotation combines independent work and scheduled modules to help residents learn how to advocate for the health of the greater community in their role as a family physician. The first module involves multiple health promotion activities in community and agricultural settings. Residents work with community health leaders doing hands on work in free clinics at the homeless shelter, health presentations in the lettuce fields, and visits to migrant labor camps. Residents also provide health education to “Promotores,” community leaders in health promotion in Monterey County.

The second module leads residents through a Community Oriented Primary Care (COPC) process in a public health issue of the resident’s choice. Here residents conduct patient health surveys, meet with local leaders, explore partnerships and coalitions and develop promotion and control strategies that impact our community health.  Recent projects include residents collaborating together to develop a woman’s free clinic, diabetes prevention outreach and education, and building wheelchair access ramps in low income apartments. Frequent one on one meetings with the Community Medicine attendings provide support and guidance.

UCSF-Natividad Family Medicine Residency has won a national grant from Center for Substance Abuse Treatment (CSAT) and has become a model in training Residents in Substance Abuse: Screening, Brief Intervention, and Referral for Treatment (SBIRT). Residents receive intensive training in recognizing substance abuse and in counseling techniques as well as participation in the recovery process at multiple addiction centers for men, women and teens.

Outpatient Medical Specialties
During this rotation, second-year residents work with specialist preceptors at Natividad and the surrounding community including Allergy and Immunology, Nephrology, and Endocrinology, Oncology/Hematology, Pulmonology, Gastroenterology and Rheumatology. Residents also work with family physicians and internists caring for patients with HIV in the Natividad Immunology Division Outpatient (NIDO) clinic.

Cardiology
Cardiology training includes a five-week rotation during the R2 year. The resident works with Natividad’s in-house cardiologists. The average day begins with inpatient cardiology consultation for conditions that include heart failure, atrial fibrillation, acute coronary syndrome, and many other conditions. In the afternoon, residents participate in scheduled cardioversions, pacemaker/defibrillator surgical placement, and stress tests. The resident also sees patients in outpatient cardiology clinic in the afternoons. Intermittently, the resident will accompany the cardiologists to Salinas Valley Memorial Hospital for cardiac catheterization procedures. Cardiology at Natividad is a very well received rotation with a group of cardiologists who love to teach.

Geriatrics
This five-week R3 rotation includes ambulatory geriatric clinics, home visits and work with the VNA and Community Social Services for the Elderly for exposure to local geriatric resources. The rotation is augmented by a geriatric lecture series and monthly visits to provide longitudinal care to a panel of patients in the skilled nursing facility.

Neurology/Psychiatry
The Neurology/Psychiatry rotation occurs in the R3 year as a one month rotation. Residents spend three half days per week working with local neurologists. In addition, they spend two half days a week with a psychiatrist in the Monterey County Mental Health Unit or other ambulatory behavioral health settings. Residents may be asked to do intake evaluations of newly admitted mental health patients, participate in group activities, or do ongoing treatment evaluations with the inpatient psychiatrist. They also spend one half day a week with our clinical psychologist reviewing video recorded encounters with clinic patients and providing one on one counseling.

Surgery Outpatient
The Surgery curriculum has two distinct components: an R1 general surgery inpatient rotation, in which residents assist our general surgeons in all areas of pre-op, OR, and post-op patient care; and R3 outpatient surgery rotations, in which residents spend time with both our general surgeons and local surgical sub-specialists, acquiring skills including excisional biopsies, punch and shave biopsies, suturing techniques, vasectomies, circumcisions, and slit lamp eye exams. The emphasis is on developing outpatient surgical skills to provide comprehensive primary care.

Salary and Benefits

Our residents have a Memorandum of Understanding between the County of Monterey and the SEIU – Service Employees International Union Local 521. This contract is re-negotiated every three years, with resident participation. Click here to go to the personnel website for Monterey County to view the contract (MOU, Unit R) for Resident Physicians.

Annual Salaries

Resident Physician I: $54,927
Resident Physician II: $59,979
Resident Physician III: $64,518

Medical Coverage

Out-of-pocket cost:
Employee only: none
Employee +1 dependent: $61/mo
Employee +2 or more: $100/mo

Additional Benefit Information

Moving expenses: up to $2,000 with receipts
Educational Reimbursement: $2,000 per year
Bilingual Pay: $45 per pay period
Professional Stipend: $50 per month
Medical Records Completion Incentive: $150 per month
Paid Time Off (PTO): 20 days per year (plus 10 holidays)
Educational leave with pay: R1s – 3 days; R2s and R3s – 5 days
Life Insurance: $20,000
All meals during working hours provided free of charge

Admission

How to Apply
Our Residency Program accepts applications through ERAS, the Electronic Residency Application Service.

We accept applications through November 30. Interviews take place from mid-October through early January. If you are selected to interview, you will be contacted either by phone or email.

We will begin reviewing applications and arranging interviews after all of the following are received:

  • ERAS Application
  • Personal Statement, addressing:
    • Desire to work with a rural underserved population
    • Desire for OB experience
    • Level of Spanish proficiency
    • Where you wish to practice after graduation
    • A list of your senior rotations
  • Letters of Recommendation (2 or more)
  • Medical School Transcript
  • USMLE Scores Step 1 and 2

The Dean’s Letter must be received by the time of your interview.

NOTE: International Graduates must obtain a Postgraduate Training Authorization Letter (as required by the California Medical Board) in order to be considered on match day.

For more information, or if you have further questions, please call our office at (831) 755-4201, or e-mail us at nmcfpres@natividad.com