Northern Navajo Medical Center 

US-491, Shiprock, NM 87420

How to Get to Shiprock: There are two airports airports in the area: Albuquerque, New Mexico (3.5 hours away, a larger, international airport) and Durango, Colorado (90 minutes away, a smaller, regional airport). Durango is more convenient but has smaller planes and higher prices.

Shiprock is approximately 3.5 hours Northwest of Albuquerque. You must rent or bring a car to get around. There is no public transportation system and no way to get around (including to the grocery store) if you don’t have a car.

Parking: Please park in the staff parking lot which wraps around the entire west side (back) of the hospital. There is also a dirt overflow lot on the northwest side of the hospital that is for staff. Please do not routinely park in the lot directly in front of the hospital as that is intended for patient parking. Please also do not park in the lot in of the Navajo Regional Behavioral Health Center building. The “Hospital Compound Map” attachment shows the parking areas with those you are permitted to park in circled in green.

Where to go on Day 1: On the first day of your rotation, please come to the ICU (just below the ED) for rounds at 8AM- you will meet the IM team there. If ICU rounds are cancelled, there will be a sign on the door saying so. You can then have someone direct you to the Physicians’ Offices where one of the secretaries in front will get you started on the orientation process.

The Gist: One of the unique things about our model at NNMC is that we practice full spectrum internal medicine care, from outpatient primary care to ICU, in any given day. Except in the case of critically ill ICU patients, PCP’s care for their own patients when admitted to the hospital. Your schedule here will reflect this model. Days are split into half day blocks and you will frequently do both inpatient/ICU care and clinic in the same day. You will carry up to 3 inpatients at a time, either patients you admit or ones that are assigned to you because they are good teaching cases. This means you will be able to follow the care of these patients longitudinally, and also means that you need to round on them daily before performing your other duties (such as going to clinic). All patients you carry will be staffed daily with an attending.

Daily Start Time: whatever time is necessary for you to be able to round on your inpatients and staff with the attending prior to clinic—see below

7:30AM: person assigned to Inpatient AM gets sign-out from night coverage

8:00AM: ICU rounds; you are expected to attend daily, regardless of your assignment for the day (unless going to DZ clinic)

8:30AM: AM Walk-in clinic starts

8:30 or 9:00AM: Continuity/specialty clinics start

11:30 AM: latest patient check-in time for AM Walk-in & last scheduled appointment of AM clinic session; sessions go until all patients are seen

1:00PM: PM Walk-in and continuity clinics start

3:30PM: latest check-in time for PM Walk-in & final clinic appointment of day; sessions go until all patients are seen

5:30PM: day generally ends around this time, unless you are on “late” or overnight call—see below.

Daytime Inpatient

Inpatient AM blocks go from sign-out at 7:30AM to ~12:30PM. Inpatient PM blocks go from ~12:30PM to 5:30 PM when you sign out to either the Late or overnight Call person. If you are on “Late” you will take sign-out from the day attendings/residents at around 5:00-5:30PM and sign out to the night coverage at 7:30PM. While on inpatient AM/PM blocks, in addition to caring for your own inpatients, your responsibilities will include doing admissions, consults, procedures and otherwise helping out as needed. This may also include rounding on/caring for other inpatients if their primary provider needs assistance, but as above you will only be asked to longitudinally follow up to 3 inpatients. In addition, while on Inpatient AM/PM shifts if you are not busy with inpatient work you are expected to assist in Walk-in clinic.

• IHS Facility

• Indigenous population

• Inpatient medicine (mostly adult)

• Outpatient medicine (pediatrics and adults if working with MP provider)

• ER (24 hour emergency room) and urgent care

• Home health visits

• Procedures: inpatient (paracentesis, thoracentesis, central lines, LP)

Some on-campus housing is provided free of charge for visiting residents, however since COVID-19 the housing availability has been very limited. Please also note that you may be required to share a room with a person of the same gender identify.

If there is no housing available or if you elect to stay off campus, you will be responsible for making lodging arrangements - there is at least one Airbnb in Shiprock as well as rentals/motels/hotels in Farmington, NM (~30 mins away) and Cortez, CO (~45 minutes away). Many of the staff members at NNMC commute from one or the other of these places and residents have stayed in both places recently. There is no public transportation in Shiprock or the surrounding area so you will need a vehicle (either a personal car or a rental car) for the duration of the rotation. 

Farmington is a much bigger city (they have two WalMarts!). The main reason to stay there is it's a bit closer, more like a 30 minute commute rather than 45 minutes to Cortez. NNMC has multiple staff members who commute from there and you might be able to arrange carpools. Dr. Emery is otherwise biased against Farmington because she lives in Cortez and thinks it's a much more intriguing little community, but folks who spend a lot of time in Farmington mention the parks, San Juan College which has a gym and nice running trails, and the occasional decent restaurant/one decent brewery as highlights.

Cortez is a town of 8,000 across the border in Colorado. It's a 45 minute drive but it's a beautiful drive with essentially zero turns and zero traffic, so it's not like a big city 45 minute commute. It has amazing access to a bunch of Four Corners highlights- the desert/Bears Ears National Monument, Mesa Verde, the mountains of the San Juans, essentially any outdoor activity you could desire depending on the season. There is better food in town than expected from a small, rural community like this, an awesome brewery, a yoga studio, etc.

Activities

• Farmington Day Trips

• The Scenic Route to Shiprock

Dining

• Restaurants

Local News Sources:

• Navajo Times

Ellie Emery, an IM physician at NNMC, coordinates the rotation, eleanor.emery@ihs.gov 

Casey can reach out to her to see if your requested dates are available. NNMC prefers 4 week rotations, 3 weeks is the minimum. The credentialing process starts about 3 months before your rotation. 

*** in process

Becoming an Indian Health Services (IHS) employee and credentialing

1. Credentialing packet:

- Notify Dr. Emery, and she will help coordinate the credentialing process. 

- Get a copy of your immunization records (including recent PPD if you have it)

- Documentation of N-95 mask fitting certificate if available

2. Fingerprinting

- Two blank cards will be mailed to your address

- Go to the local police department. Occasionally, a FedEx/UPS place can usually do it for you. Keep your receipt.

If you are unable to fulfill this requirement, you can get your fingerprints done in Shiprock. Be sure to arrive before 5 pm and inform them that you will need fingerprinting done, so they can arrange it with Human Resources prior to your arrival.

4. DEA license

- Your DEA will be under the same as the Locum Tenens providers and there is nothing you need to do for it.

5. Work email

• Will set-up at check-in.

• Access it at https://www.ihs.gov

•  under “Employee Resources” link then “Email Web Access” link.

6. Pre-Orientation/Check-in work:

• You will have a day to go through the check-in process at Shiprock. You will receive a hand-out requiring you to go to different departments around the hospital to “check in” (ie Housing, Human Resources, Infection Control, etc), as well as some online computer training.

7. Elective Request Form

• 1. PGY1

  2. PGY 2,3,4

See our Indigenous and Native American Health Care Curriculum for an introduction to Indigenous Culture before you travel for this rotation. 

Geography

Shiprock is a town of about 8,000 people on Navajo Nation. It is the second largest community on Navajo Nation after Tuba City. The elevation is about 5,000 feet. Shiprock, the volcanic remnant that sits in the town of Shiprock, has religious and historical meaning to the Navajo people. The nearest large(r) city is Farmington, NM, which has a population of about 50,000 and is 30-45 min away (depending on which part of town you are going to). Cortez, Colorado is about 45 min away and has a population of about 8,500 people. Durango, CO is about 1.5 hrs away and has 17,000 people and a small airport. The nearest major city/airport is Albuquerque which is a 3.5 hr drive.

Work Hours: Residents will work on average five days per week with two days off per week. Inpatient hours are 7:30AM to 5:30PM on normal days or 7:30PM on “late” days, outpatient hours are approximately 7:30AM-5:30PM. Residents will take call on average once per week from 7:30AM until they finish rounds the following morning (goal to be out by 10AM post-call at the latest). On your last day your clinical duties will end at ~12:30PM but you will then need to complete any outstanding patient care tasks and follow checkout procedures, so you should not plan to leave campus until ~5PM. We generally recommend that you do not book your travel home until the following day. For more details on the schedule, please see the “Schedule Basics for IM Residents” document.

Since this is a short rotation, we try to make the most of your time here. If you have requests for specific days off for travel or other personal obligations, you must speak with the rotation coordinator about these as soon as you are aware of them and ideally before your schedule for the rotation is made (~2-4 weeks before your arrival).

What to Bring: Bring the usual medical stuff you would use in clinic and during a wards month. You will have access to Internet at the hospital, including UptoDate. We generally wear scrubs while on the inpatient service/when on call and hospital-appropriate clothing in clinic. Scrubs are available in the hospital but we do not always have all sizes available so some people prefer to bring a few pairs from home just in case. Scrubs should not be worn outside of the hospital compound. We do not wear white coats but you can if this is your preference. Many of our patients are elderly and are quite conservative in terms of dress so please consider this when making decisions about what to wear to work.

Consider also bringing gear, guide books, backpacks, hiking shoes, skis, water bottles, camera, etc. for your weekend adventures. Some nearby towns have outdoor gear stores. Everyone here also has gear that you can borrow if you don’t have your own tent, etc.

If you are staying on campus, please see separate attachment entitled “Shiprock Housing Logistics” for a list of what to bring or purchase here for your dorm room.

Groceries: Bashas’ is a grocery store in Shiprock. It is the most convenient place to buy groceries. 

Safeway in Farmington (there are two Safeways, the larger/better one is further down Main street next to PetSmart and Home Depot) has a large grocery selection, including many fresh fruits and vegetables.

Natural Grocers in Farmington (on 20th St) has a selection of natural, organic, and healthier foods.

Cortez has a City Market with more selection than Bashas’ in Shiprock, and a large Safeway similar to the Safeway in Farmington.

Other Shopping

Walmart x 2, Target, Kmart, Home Depot, Lowes in Farmington

Mall in Farmington with Dillards, JCPenny, etc.

Walmart in Cortez

Navajo Arts & Crafts next to Shiprock City Market

Trading Posts

Restaurants: Shiprock mainly has fast-food chains including McDonalds, Burger King, KFC, Taco Bell, and Sonic. There is also a Subway, a diner next door to Subway, and an excellent Chinese restaurant - Bamboo House. There is also a Navajo restaurant – Natani Nez – next to Subway serving traditional, American and Chinese food.

Farmington has a few more options for dining, including many authentic Mexican and New Mexican restaurants, barbecue restaurants, a Thai restaurant (Boon’s Family Thai BBQ on Main), a couple breweries (Three Rivers Brewery on Main- also has pizza- and Lauter House), another and a Wine Bistro/Bar (St. Clair Winery and Bistro on Main).

Cortez is also an option for dining out with more non-fast food options than Farmington. Some favorites include WildEdge Brewing Collective, Stonefish (sushi), Loungin’ Lizard, Thai Cortez, The Farm Bistro (farm-to-table), Silver Bean Coffee Shop and Esmeraldas (tamales). We also love Sutcliffe Vineyards, a winery up McElmo Canyon in Cortez- go to Sand Canyon for a hike/run first then bring a picnic to the winery!

Durango, about 1.5 hrs away, has the most varied selection of restaurants in the Four Corners Area. Some favorites include Bread (breakfast), 11th St Station (outdoor food court, try Manny’s Fresh Co), Eolus, Cyprus Café, Jen & Sue’s, Carver Brewing Company, Bookshelf and the Barber (barbershop + speakeasy) and Animas Chocolate Company (hot chocolate). There’s also an amazing book store with a great native authors section- Maria’s Bookshop.

Dolores: The Dolores Brew Pub (really good pizza), Three Chicks Bakery, EsoTerra Cider

Banking

Wells Fargo in Shiprock, Farmington

Bank of America in Farmington

Movie Theaters

Farmington: Allen 8 Cinemas, Cameo Theater, Centennial Twin Cinema

Cortez: 2 screens at theater on Highway 160

Exercise

Gym in NNMC: Located in the first floor of the West Wing, free to any hospital employee or patient. Limited hours – open from 6:30 AM to 9 AM, 11 AM to 1 pm, and 4:30 PM to 7 PM from Monday to Thursday only. There is a schedule of fitness classes posted outside.

Shiprock Running Trails: Nearby trails include a dirt trail along the irrigation ditch behind the hospital/housing and extensive seemingly endless trails across the street from hospital, which start at the end of the road down the street from Mesa Elementary School. There are countless unmarked dirt roads and trails extending off main roads. The dirt road that leads out to the Shiprock formation itself is also an excellent running spot. Be aware of stray dogs and wild horses when running.

Farmington: Defined Fitness on 20th St is large, w/ a large selection of weights and machines, classes, and a pool ($10 for a day pass). San Juan College Human Performance Center offers passes to their athletic facilities including climbing gym ($30 for 10 day passes).

Cortez: City of Cortez Rec Center – Pool, free weights, machines, climbing wall – $5/day

Because case volume is lower in rural areas, it's important to be proactive and take opportunities as they come. Introduce yourself to people here and when things come up (procedures, important cases, etc.) then you can find out. We want this rotation to be high-yield. 

Contact program for Rotation Guide.