January 15, 2024
Thirty years ago, Mayo Clinic in Florida introduced its first residency program — cementing the site's strength in all three shields and paving the way for today's more than 60 training programs that have served more than 2,100 residents and fellows.
Origins of Mayo Clinic's Florida campus
In 1990, residents from Mayo Clinic in Rochester began rotating to four-year-old Mayo Clinic in Florida for four-month stints. In 1991, Leo Black, M.D., CEO of Mayo Clinic in Florida, decided to pursue Florida-based residency programs. He believed that strength in all three shields was critical for Mayo Clinic in Florida to be successful, and residency programs were necessary to attract academic-minded physicians to the staff.
The thinking at the time was to develop Mayo Clinic Graduate School of Medicine programs on all three campuses, allowing for three-way movement of residents — moving throughout the system in whichever direction would provide them with the greatest strengths.
A transitional year residency commenced on the Florida campus in 1993, with an internal medicine residency starting the following year.
Transitional Year Residency in Florida
Gary Lee, M.D., now Mayo Clinic emeriti staff, trained at Mayo Clinic in Rochester but left after his residency to fulfill a public health scholarship obligation. By the time Dr. Lee was free to accept another position in 1986, Mayo Clinic had established a Florida campus, and he was asked to join the staff. Seven years later, he was asked to lead the transitional year residency program — a position he held for 20 years and which earned him a Mayo Clinic Distinguished Educator award.
Dr. Lee consulted with his counterpart at Mayo Clinic in Arizona, Paul Schnur, M.D., now Mayo Clinic emeriti staff, for guidance in interviewing and ranking students. Hundreds applied for the first class of the transitional residency program, 60 were interviewed and 40 ranked for the six spots.
"Word spread quickly, and our program was very popular with medical students who wanted to come to Florida," says Dr. Lee. "The Mayo Clinic name and reputation for patient care helped us attract the best and brightest."
Mayo Clinic didn't have its own hospital in Jacksonville and used St. Luke's Hospital, about 10 miles from the clinic. Because St. Luke's wasn't built for residency training, it lacked space for call rooms, conferences, and rounds. Morning report and noon conference took place in a trailer with a leaky roof located between the hospital and medical office building.
First class of the Transitional Year Residency: James "Jim" Johnson, M.D.
James "Jim" Johnson, M.D., was in the first transitional year residency class. He attended Vanderbilt University on an Air Force scholarship and needed to complete a one-year program before returning to the Air Force. A competitive swimmer and swim coach, he was excited to find a program in Florida.
"It was a dream to be among the first six residents — a huge advantage," he says. "We got to work directly with attendings who were among the best in their fields in the world. I wouldn't have had that kind of access anywhere else.
"Most transitional year and family medicine residencies take place in community-based hospitals. At Mayo, I saw unusual diseases, severe illnesses, and high-end surgical procedures early in my career, which led to my having a broader perspective for differential diagnoses," he says. "With no other residents or fellows between us and the attendings, we developed close relationships. The core group of physicians who were the first at Mayo Clinic in Florida gave their all to make sure the residency programs were rigorous and regarded as equal to those in Rochester."
Dr. Johnson recalls the close bonds among those initial residents. "We did everything together that year," he says. "We had regular Tuesday nights at my apartment, watching TV and eating dinner."
After returning to the Air Force for flight surgeon training, Dr. Johnson came back to Mayo Clinic in Florida as a second-year resident in the new family medicine program. He then went to Stanford University for a primary care sports medicine fellowship, and served as a team physician for swimming and other sports at the university and as an Olympic swim team physician. He moved to Nashville, where he has a private sports medicine practice with residents and fellows rotating with him.
"I'm among the Mayo Clinic alumni who continue to teach those values to other physicians, residents, and students we interact with," he says.
Second class of the Transitional Year Residency: Teresa Welsh, M.D.
Teresa Welsh, M.D., was in the second class of transitional year residents. She'd attended Loyola University Chicago Stritch School of Medicine. "I had no hesitancy about the newness of Mayo's program," she says. "On the contrary, there was excitement around the program, and I thought I'd have the opportunity to be more involved."
Dr. Welsh planned to be at Mayo Clinic for a year and return to Loyola to pursue an anesthesiology residency. She fell in love with internal medicine and Mayo's approach to education, stayed for that residency, and served as chief resident.
"From day one of residency, we were respected as physicians," she says. "The hospital was our entire life except for one day off a week. We sometimes were on call overnight, rounded the entire next day, and had to complete documentation before we went home after 36 hours. We literally resided at the hospital. I look back on it as a joyous time in my life."
After training, Dr. Welsh moved to Denver, where she worked as an internal medicine physician at Kaiser Permanente until retiring in April 2023.
Dr. Lee says the transitional year residency program proved that Mayo Clinic in Florida could attract top-notch residents, train them with excellent outcomes, and succeed in the education realm. It was a stepping stone to the internal medicine residency program and others to come.
Internal Medicine Residency in Florida
Joseph Kaplan, M.D., now Mayo Clinic emeriti staff, was asked in 1991 to develop the internal medicine residency at Mayo Clinic in Florida. Dr. Kaplan was an assistant professor at Johns Hopkins and taught internal medicine residents. He enjoyed teaching, knew how to conduct and publish research, had faculty experience, and was considered to be young enough to have the energy to run the program.
Dr. Kaplan visited the Rochester campus to study its internal medicine residency program and began building Florida's program in 1992 with help from associate program directors Kenneth Nix, M.D., now Mayo Clinic emeriti staff, Gerardo Colon-Otero, M.D., Division of Hematology and Medical Oncology, and Marc Cohen, M.D., now Mayo Clinic emeriti staff.
The program launched in 1994 for six first-year and four second-year residents. Two of the residents had been in the transitional year program.
Dr. Kaplan says the program was different from Rochester's — lower resident–faculty ratio, more outpatient time and graduated autonomy, and a larger metropolitan area to draw patients from. "We also recruited more diverse trainees than did Rochester," he says. Dr. Kaplan served as program director for nine years and, like Dr. Lee, was named a Mayo Clinic Distinguished Educator.
The early residents at Mayo Clinic in Florida were treated to individual attention — lots of attention. Dr. Kaplan picked up each resident at their hotel to begin the introduction to Mayo Clinic and Jacksonville.
First class of the Internal Medicine Residency: Anna Miller, M.D.
Anna Miller, M.D., was in the first internal medicine residency class. She'd attended the Uniformed Services University of the Health Sciences in Bethesda, Maryland, aiming to practice medicine with an underserved population.
"I thought I'd have closer interaction with attendings because there were fewer residents and no fellows in Mayo's program," she says. "I had face-to-face daily contact with some of the best and brightest physicians in the world, and we spent time talking about patients, diseases, underlying pathology, and treatment options. We had the best of both worlds, training in a community-based hospital and then seeing patients from all over the world with exotic diseases in the clinic."
After residency, Dr. Miller went to Oklahoma to work for the Indian Health Service as a medical officer. She retired from active duty in 2016 and now works for the Cherokee Nation in Tahlequah, Oklahoma. "My residency training at Mayo Clinic in Florida has been the foundation of this interesting and diverse career," she says.
The success of the internal medicine program spurred a flurry of other residencies at Mayo Clinic in Florida. Family medicine started in 1995 and general surgery in 1997.
Originally published in Mayo Clinic Alumni magazine.