Scripps Clinic and Scripps Green Hospital Internal Medicine Residency

Diversity in training sites 

Inpatient rotations take place at two San Diego hospitals — Scripps Green Hospital and Scripps Memorial Hospital La Jolla. Ambulatory experiences include Scripps primary care clinics with locations throughout the county. Each inpatient and outpatient site offers unique patient populations and disease expertise. By training at all these locations, residents are exposed to a wide variety of patients and disease processes. 

4+1 block structure

Our block system ensures breaks in work intensity with dedicated outpatient continuity between inpatient weeks. 

High board pass rates

Our categorical internal medicine residents have achieved a 100% ABIM pass rate over the past three years and a 97.6% pass rate over the past six years.

Resident wellness 

A resident wellness committee comprised of members from each class plans monthly bonding activities and meets with core faculty weekly to represent resident priorities in the program. Our Mindful Monday curriculum is designed to train residents to be compassionate and empathetic while also building strong relationships with professional colleagues. Residents are divided into small groups which meet every fifth Monday throughout residency. During sessions we study and discuss health humanities, narrative medicine and mindfulness. We also take part in Balint groups sharing experiences and insights from the practice of medicine. Additionally, we have launched a new initiative where residents in each Mindful Monday group participate in one community service outreach project of their choosing per year. 

Fellowship placement 

Ninety-five percent of our residents who apply to subspecialty fellowships get one of their top three choices. One-fourth of our residents match with Scripps Clinic fellowship programs.

Primary care pathway

We offer an optional primary care pathway for residents who wish to become primary care physicians in the outpatient setting. This program prepares residents with the robust, evidence-based knowledge and practical clinical skills required for immediate independent practice upon graduation. The pathway offers its own learning objectives and clinical guidelines and must be completed in addition to the internal medicine residency program’s core rotations.

Mentor system

Each resident is assigned a mentor at the beginning of the intern year to help them navigate residency and achieve career goals.

Quality improvement projects

All residents receive a certificate from the Institute for Healthcare Improvement and complete a quality improvement project in their third year. Additionally, all interns complete a one-week specialized quality improvement rotation during which they study the basics of QI and propose various projects. 

Research

All residents complete a scholarly project during residency under the guidance of a project mentor and the residency research director, with an option for up to eight weeks of dedicated research elective time.

Resident-as-teacher curriculum

Residents complete a formal, longitudinal curriculum to educate house staff and faculty on how to be exceptional teachers. They then apply this education when they lead their teams of interns and students during inpatient months. 

Medical student partnership with UCSD

All inpatient teams have third- and fourth-year medical students. The majority come through our UCSD student training partnership.

Learn more about the distinctions highlighting the quality of clinical care and research discovery at Scripps Clinic and its affiliated hospitals and research institute:

• The combined programs of Scripps Green Hospital and Scripps Memorial Hospital La Jolla are ranked among the best in the nation in six specialties, according to U.S. News & World Report’s annual Best Hospitals.  
• For the 17th consecutive year, Fortune magazine named Scripps Health among the top employers in the nation on their annual list of the 100 Best Companies to Work For
• Five times named among Truven Analytics top five large health care systems in the country
• 99th percentile in Southern California by Press Ganey for Quality of Physicians
• National referral center for percutaneous revascularization, allergic disorders, chronic leukemia, integrative medicine, joint reconstruction, liver disease, obesity management, radiation therapy and transplantation (marrow, liver, kidney and pancreas)
• One of 55 academic centers recognized nationally with an NIH Clinical & Translational Science Award, recognizing unique clinical-translational discovery driving health care change
• Nature Index 2019 ranked Scripps Research #1 among nonprofit scientific institutes in the U.S. for high quality research, based on discoveries published in leading scientific journals

Categorical track

Our categorical residency track includes all the training components required by the American Board of Internal Medicine (ABIM). It’s delivered within Scripps Health’s top-rated Scripps Green Hospital and Scripps Memorial Hospital La Jolla, along with many affiliated ambulatory clinics. Program highlights, attributes, rotations, curricula, faculty, training partners and additional opportunities are described in detail in their individual sections on this web page.  

Primary care pathway

The primary care pathway is a unique, optional program within the categorical track. It’s designed to provide a focused training experience for residents interested in a career in primary care. Residents may request to enter the pathway prior to the start of residency or during the first two years of training with earlier entry encouraged. 

The purpose of the pathway is to prepare residents with the necessary comprehensive evidence-based knowledge and practical clinical skills for immediate independent practice upon graduation. Close mentorship is provided with the primary care pathway director and other faculty members. 

Residents receive appropriate supervision with progressive autonomy in practice and are responsible for the care of a dedicated panel of patients that increases in size over the course of training. Continuity of care, communication, safe transitions of care, high-value care, humanistic practice and patient advocacy are high priorities. 

The pathway’s educational curriculum focuses on subjects relevant to the practice of outpatient medicine. Residents are provided high-yield learning objectives, educational resources and didactic conferences promoting robust clinical knowledge. Rotations in specialty clinics include women's health, dermatology, sports medicine, addiction medicine, a free health clinic through UCSD, outpatient neurology and all internal medicine subspecialties provide exposure to the diverse pathology encountered in outpatient practice. 

Residents also have rotational experiences in rural medicine and clinics serving indigent underserved populations, with the flexibility for additional tailored experiences based on the interests of the resident. Residents receive career placement resources and guidance to assist with securing an ideal position upon graduation.  

Additional program features include:

• Close mentorship with primary care preceptors and primary care pathway director
• Dedicated curriculum for outpatient medicine
• Career placement resources
• Additional opportunities to rotate at clinics treating underserved populations
• Dedicated weekly office hour for patient communication and follow-up

Review the primary care pathway learning objectives and clinical guidelines (PDF, 190 KB), which must be completed in addition to the residency program’s core rotations.

Primary care pathway patient panels

• Year one goal: 15 patients
• Year two goal: 30 patients
• Year three goal: 50 patients

Primary care pathway procedures and electives

Residents in the primary care pathway should plan to perform at least 10 each of the following procedures: 

• Arthrocentesis/joint injections (knee)
• Joint injections (shoulder)
• Greater trochanteric bursa injections
• Pelvic exams
• Pap smears
• Breast exams
• Shave biopsies
• Punch biopsies
• Cryotherapy
• Abscess incision and drainage (I&D) 
• Pre-operative evaluations

Residents are encouraged to complete a sports medicine elective and a rural medicine elective at Kayenta Navajo Reservation in Arizona or Crow Reservation in Montana. Residents should also consider increased rotation experiences in dermatology, gynecology, podiatry and ophthalmology. Finally, residents must complete a research/quality improvement (QI) project centered on outpatient medicine.

The Scripps Clinic and Scripps Green Hospital Internal Medicine Residency research track is an extended training program that follows the research pathway requirements of the American Board of Internal Medicine (ABIM), and is designed for new physicians envisioning an investigational career in either clinical or translational scientific research. Residents may apply for this track during their PGY-2 year. 

The program includes two years of standard internal medicine residency training, followed by three years in active research during which approximately two months annually are spent in clinical assignments. Trainees in this track may be afforded the opportunity to “fast-track” into subspecialty training fellowship programs, though this is not guaranteed. 

Scholars enrolled in this program become members of Scripps Research Translational Institute, a precision medicine research team within Scripps Research that has received the prestigious Clinical and Translational Science Award from the National Institutes of Health (NIH). Residents develop, conduct and present translational research projects designed to solve unmet health care needs within clinical areas of interest. They also participate in translational science coursework through the Skaggs Graduate School and may earn a master’s degree in clinical-translational investigation or continue for a PhD, depending on degree at entry and career goals.

Our research track is distinguished by:

• Scripps Research Translational Institute’s founding theme of research in individualized, precision medicine, which includes groundbreaking studies in genomics, digital medicine and data science
• Support from the National Institutes of Health Clinical and Translational Science Award program since 2008, with each research track resident designated a K-12 Scholar
• Opportunities to combine the research track with subspecialty fellowship training
• An affiliation with the Skaggs Graduate School of Science and Technology at Scripps Research, one of the world’s premier biomedical research institutes for biology, chemistry and drug discovery
• Instruction in translational science methodologies including human genomics, digital health, data science, clinical study design, biostatistics, bioinformatics and molecular medicine
• Expansive research options in any of the Scripps Research departments and collaborative opportunities with several other San Diego academic and biotechnology research institutes
• Mentored scientific communication including authorship of manuscripts, community engagement and team science roles

Dear residency candidate,

Welcome to the Internal Medicine Residency Program at Scripps Clinic and Scripps Green Hospital. I am excited to introduce you to our wonderful training program! 

Our primary goal is to cultivate and maintain a culture of excellence in a clinical learning environment that promotes high expectations with a high level of support. We provide a comprehensive outpatient and inpatient clinical experience emphasizing humanism, professionalism, high-value care, quality improvement and evidence-based practice. We aim to create a community of empathetic, lifelong learners with the goal that all training activities center on the doctor-patient relationship.

We are proud to promote resident wellness with the introduction of our humanities curriculum. Our current Mindful Monday sessions are dedicated small-group sessions that incorporate health humanities, narrative medicine and mindfulness. 

Our internal medicine residency program offers outstanding training in the highest quality ambulatory and tertiary care settings, a diverse patient population and research opportunities in state-of-the art facilities. For example:

• At Scripps Green Hospital, where the Scripps Clinic Torrey Pines urgent care sees 45,000 patients per year, our trainees care for medically complex patients including those undergoing solid organ and bone marrow transplant, neurosurgery and orthopedic surgery.  
• At Scripps Memorial Hospital La Jolla, our trainees practice within a Level 1 trauma center, advanced Intensive Care Units, the Prebys Cardiovascular Institute, our maternal-fetal program and a busy emergency department that sees 44,000 patient visits per year. 
• We proudly staff St. Leo’s Clinic, a medical clinic that cares for the medically underserved population in our local community. 

Our curriculum also includes training in quality improvement, use of ultrasound and extensive experience in peer presentations and public speaking. We also feature a unique resident-as-teacher curriculum to foster future clinician educators. 

All our residents complete a scholarly project and are afforded dedicated time to conduct research during their training. They have access to Scripps Research, the nation’s highest ranked non-university biomedical research institute, and its clinical scholars program within the Scripps Research Translational Institute.

Finally, we love San Diego for its cultural diversity, year-round sunshine and proximity to beautiful beaches, hiking and other world-class attractions.

Thank you for your interest in our program, and I look forward to meeting you!

Biraj D. Shah, MD, FACP

Scripps Green Hospital

Scripps Green Hospital is a 173-bed acute care hospital with 24 ICU beds. A tertiary referral center, the hospital is based entirely on adult inpatient medicine and offers a wide range of clinical and surgical services, including pulmonary/critical care, oncology, advanced gastroenterology services, and general and subspecialty surgeries. Specialty services include bone marrow transplantation, solid organ transplantation and chemotherapy clinical trials. In addition, there is a 24-hour urgent care attached to Scripps Green that receives 45,000 patient visits annually and is the site of most patient admissions.

Residents complete half of their inpatient general medicine blocks, one-fourth of their ICU blocks and several subspecialty inpatient rotations at this site.

Scripps Memorial Hospital La Jolla

Scripps Memorial Hospital La Jolla has 432 licensed beds and offers a wide range of clinical, surgical and specialty services, including a Level I Trauma Center and a 51-bed, 24-hour emergency department that receives 44,000 patient visits annually. The hospital has a 59-bed ICU, a mechanical circulatory support program, interventional cardiology, interventional neuroradiology, women’s health services (including OB-GYN and labor and delivery services) and general, trauma, vascular, bariatric, orthopedic and other subspecialty surgical services.

Scripps La Jolla is consistently recognized for quality patient care and was the first hospital in San Diego to be designated a Magnet Hospital by the American Nursing Association.

Residents will complete half of their inpatient ward blocks, three-fourths of their ICU blocks, inpatient cardiology, ER, and other inpatient subspecialty rotations at this hospital.

Scripps Clinic

Scripps Clinic is the ambulatory center of medical care and teaching for the program, with multiple sites throughout San Diego County. The physicians who provide care at Scripps Clinic constitute the ambulatory teaching faculty of the program.

Ambulatory clinics in general medicine and a wide range of subspecialties are located at Scripps Clinic Torrey Pines, an outpatient pavilion attached to Scripps Green Hospital, as well as at the John R. Anderson V Medical Pavilion, an outpatient building next to Scripps Memorial Hospital La Jolla. Continuity clinics and subspecialty assignments take place at both sites. Residents also train at a variety of large outpatient satellite clinics throughout San Diego County, which provide care for patients who present with a variety of health conditions.

Scripps Research Institute

Residents have access to unique research training opportunities through our collaboration with Scripps Research and Scripps Research Translational Institute — the home of our residency research track.

Ranked as the most influential scientific institution in the world by the journal Nature, Scripps Research offers qualified residents the opportunity to participate in bioscience research that leads to innovative diagnostics and therapies. 

Focusing on science and medicine, the Scripps Research Translational Institute aims to individualize health care through human genomics, wireless digital technologies and advanced data science. 

Scripps Cancer Center

Scripps Cancer Center provides adult cancer patients greater access to the most advanced oncology care available. During their training, residents see firsthand how Scripps implements translational research through clinical trials and new treatment protocols that continuously improve standards of cancer care.

During each year of training, internal medicine residents have approximately 10 blocks of four-week rotations at different inpatient and outpatient settings with each block followed by one week in continuity clinic (4+1). This exposes residents to a variety of medical specialties, patients and health issues.

Inpatient services and call structure

During inpatient rotations, residents practice in a team structure that allows for leadership opportunities overseeing medical students, as well as one-on-one practice with an experienced hospitalist. Residents can expect a capped number of admits, depending on their team structure.

View the inpatient call structure (PDF, 61 KB).

Ambulatory training (4+1) 

The ambulatory curriculum is arranged into the 4+1 model over 52 individual weeks in any given year. The 4+1 schedule involves four-week blocks composed of various inpatient rotations, specialty services and electives. Every fifth week is known as a “+1” week of ambulatory training, of which there are 10-11 total each year. 

All continuity clinics are located at a Scripps Clinic site and are supervised by attending physicians. Residents are also able to supplement primary care education online through the Johns Hopkins Physician Education & Assessment Center (PEAC) and the Yale Office-Based Medicine Curriculum. These modules allow residents to work through question-based didactic cases pertinent to outpatient medicine.

View the ambulatory training schedule (PDF, 190 KB).

Wellness curriculum

The residency program at Scripps Clinic and Scripps Green Hospital has a vested interest in promoting the health and wellness of our trainees. With this goal in mind, every Monday during a resident’s +1 week begins with protected free time until 11 am that can be used as desired for self-care activities. All residents who are on “Mindful Monday” and then attend regular didactic sessions at Scripps Green Hospital before participating in a structured curriculum. These afternoon sessions are designed for discussion on topics ranging from humanism to narrative medicine to mindfulness. They take place in various beautiful locations around San Diego, including parks, beaches and museums.

In addition to the structured wellness curriculum, a resident- and fellow-run Wellness Committee organizes regular extracurricular activities with the aim of promoting camaraderie and a family environment that extends beyond the hospital or clinic.

Didactic conferences for the program occur midday every Monday through Friday. Led by the chief resident, senior residents, program director and faculty, the conferences offer insights on a range of internal medicine topics, including:

• Internal medicine core and specialty topics
• Emergency medicine
• Electrocardiogram (EKG) interpretation
• ICU topics
• Simulation rounds
• Point-of-care ultrasound
• Evidence-based practice
• Journal club

View the didactic conference schedule (PDF, 95 KB).

The faculty of the Internal Medicine Residency Program at Scripps Clinic and Scripps Green Hospital are dedicated to sharing their knowledge and experiences to provide residents with a challenging, rewarding training experience. At Scripps, we offer a broad range of clinical services to patients and work collaboratively across specialties within our award-winning health care system.

• Biraj D. Shah, MD FACP - Program Director 
• Karima Ali, MD - Assistant Program Director, Feedback and Evaluations
• Robert Tickes, MD - Associate Program Director, Recruitment and Evidence-Based Medicine
• Heather Doherty, MD, FACP - Assistant Program Director, Ambulatory Care, Health Humanities and Curriculum
• Vedka Begovic, MD, FACP - Core Faculty: Primary Care Director, Faculty Lead for Community Outreach
• Edsel Abud, MD, PhD - Core Faculty: Research
• Jacklyn Lee, MD - Core Faculty: Faculty Development, Women in Medicine, Clinical Instructor Program Lead
• Jason Lee, MD - Core Faculty: ICU Director, POCUS Lead, Recruitment
• Steven Zhao, MD - Core Faculty: Simulation Director, Pulmonary Lead, Chief Resident Development

The Internal Medicine Residency Program at Scripps Clinic and Scripps Green Hospital offers 15 first-year resident (PGY-1) positions each year. Our residents typically get to know one another very well during their three years of training. Additionally, residents have an opportunity to develop close mentor-mentee relationships with faculty within the program and throughout Scripps Health.

View a list of current residents (PDF, 2.2 MB).

After completion of the three-year program, 95% of our residents who apply to subspecialty fellowships get into one of their top three choices. Many alumni have gone on to make notable contributions in the field of internal medicine and its specialties, and in the day-to-day lives of patients.

View a list of recent alumni (PDF, 220 KB).

Resident research projects have recently included:

• Opioid prescribing patterns: our patients’ perspective (Scripps quality improvement project)
• Prospective randomized controlled trial (RCT), subgroup analysis: ramelteon (melatonin agonist) effect on opioid utilization among post-op ICU patients
• Impact of an audit and feedback antimicrobial stewardship program on acceptance of procalcitonin-directed antibiotic discontinuation in critically ill patients with sepsis (Scripps quality improvement project)
• Evaluating cancer predictors and outcomes of outpatient colonoscopy in patients 85 years and older
• Utilization of palliative care services at Scripps – Are we doing too little, too late? (Scripps quality improvement project)
• Longitudinal outcomes of cryoablation for Barrett’s Esophagus
• Left ventricular outflow tract velocity time integral predicts outcome in heart failure
• Epic improvements for house staff rounds
• Promoting Epic sleep (Scripps quality improvement project)
• The challenges of missed diagnoses – Ramsay Hunt Syndrome
• Intermittent Fasting – Eating less to live more
• A strain on the system: Is opioid induced constipation associated with longer lengths of stay? (Scripps quality improvement project)
• Symptomatic and colonoscopic remission rates in patients with inflammatory bowel disease (IBD) on the autoimmune diet
• Risk factors and clinical presentations of colon cancer before age 50
• Randomized trial of oral powdered diclofenac versus ketorolac injection for migraine headache patients presenting to urgent care
• Mammogram screening ordered by primary care providers (internal medicine, family medicine, OB-GYN) compared with screening recommendations (Scripps quality improvement project)
• Hepatitis C virus screening rates before and after a randomized intervention: clinic poster versus Epic popup versus patient notification (Scripps quality improvement project)
• Post-Watchman bleeding rates on novel oral anticoagulants (NOAC) versus warfarin
• Bedside smart-device ultrasound to reduce time to diagnosis and studies ordered in radiology on medicine inpatients
• Bleeding complications by glomerular filtration rate (GFR) classification in Scripps patients started on direct-acting oral anticoagulants (DOAC) since 2015
• Characteristics of patients diagnosed with sarcomatoid carcinoma of lung in past 40 years — a SEER database project
• Congestive hepatopathy compared to right heart catheterization as a prognostic indicator in LVAD patients

PGY-1 resident salary: $86,923

PGY-2 resident salary: $88,670

PGY-3 resident salary: $92,206

Medical

All members of the resident staff are offered health insurance benefits for themselves and eligible dependents at a minimal cost. Medical coverage includes vision, prescription drug and chiropractic/acupuncture plans.

Dental coverage

Dental plan offers network and out-of-network coverage options. Eligible dependents can also be covered at a minimal cost.

Life insurance/Accidental death and dismemberment (AD&D)

Multiple levels of employee life insurance are available, including accidental death AD&D coverage. You may purchase supplemental, spousal or dependent life insurance at various levels. Long-term disability insurance is available at an additional cost. State disability insurance is paid by the resident. The state of California requires this contribution, which provides income insurance for disability due to non-job-related injury or illness.

Employee Assistance Program (EAP)

Confidential, free, short-term professional counseling is available for employees and family members for issues impacting work or personal life.

Vacation

Internal medicine residents receive four weeks of paid vacation per academic year.

Travel expenses

Travel expenses are covered for an annual educational meeting when the resident is presenting, with some financial support available for additional meetings. Travel for a third-year humanitarian mission is covered by the residency.

Educational resources

Residents have free access to the American College of Physicians' (ACP) Medical Knowledge Self-Assessment Program (MKSAP) and UpToDate. PGY-2 and PGY-3 residents also receive an educational stipend of $2,000.

Additional benefits

• License and Drug Enforcement Administration (DEA) fees covered 
• Step exam fee paid
• On-site daycare
• On-site fitness centers
• 401(a) matching retirement program

ERAS application

All appointments are facilitated through the NRMP’s Electronic Residency Application Service.

Scripps/Green Categorical Internal Medicine (3-year residency)

• Number of positions: 13
• NRMP Match Number: 1340140C0

Scripps/Green Internal Medicine Physician/Scientist Track

• Number of positions: 2
• NRMP match number: 1340140C1

Application requirements

Applicants must submit the following materials through ERAS:

• ERAS Common Application Form (CAF)
• Personal statement
• Dean’s letter/Medical Student Performance Evaluation (MSPE)
• Medical school transcripts
• United States Medical Licensing Examination (USMLE) Step 1 and Step 2 transcripts as they become available (COMLEX not a substitute)
• Minimum of three letters of recommendation, with at least two from a department of medicine faculty, including one from the chairperson or designee

Interview schedule

Candidates will be notified of interview invitation status via the ERAS system. Virtual interviews for residency positions will be scheduled on Mondays - Wednesdays, starting at the end of October.  

Candidates who are graduates from medical schools accredited by the Liaison Council on Medical Education (LCME) or the American Osteopathic Association are invited to apply.

Candidates who graduate from medical schools outside of the US must have a valid certificate from the Educational Commission for Foreign Medical Graduates (ECFMG) prior to the scheduled date for interview. Scripps Green Hospital does not offer visa support or observerships.

Learn more about our other GME programs, including medical student rotations or fellowship programs at Scripps Clinic.

To learn more about the Scripps Clinic and Scripps Green Hospital Internal Medicine Residency Program, contact Deanna Bretzing at bretzing.deanna@scrippshealth.org or call 858-554-3236.