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Comprehensive Primary Care Initiative

Message from the Medical Director

Tom Chau

Whether your ultimate career goal is primary care, hospital, or subspecialty medicine, a solid grounding in outpatient medicine will make you a great doctor to your patients. With increasing scrutiny of readmissions, successful hospitalists of the future will need to understand what it takes for patients to thrive in the community. Every medicine subspecialist from pulmonologists to nephrologists to cardiologists spends substantial time in clinic and the skills of a facile outpatient medicine doctor translate to every subspecialty.

The residency clinic at Providence St Vincent is a well-functioning clinic that serves the entire spectrum of our surrounding community: from Central American/Russian/Korean/Middle East immigrants, to the sub/urban poor, to nursing home/memory care residents, to people with jobs at Nike/Intel. The atmosphere of the clinic is one of collaboration and rapport between residents, attendings, and staff with residents and staff sharing their creations in nearly monthly potlucks prior to the pandemic. More importantly, the intentionally longitudinal structure of the clinic fosters deep, meaningful relationships between residents and their patients. Every May and June for the 13 years that I have taught at Providence St Vincent (and even during CoVID-19), I have seen patients make appointments with their graduating third-year...just to say good-bye.

In this spirit, it was natural that the Providence St Vincent Internal Medicine Residency Clinic was selected as one of the first medical homes in Medicare’s primary care innovation projects.

Tom Chau, MD
Director, Providence Medical Group – St. Vincent

Medical Home: An Innovative Outpatient Learning Environment

Internal medicine residents at Providence St. Vincent Medical Center have the unique opportunity to learn how to become someone’s primary care doctor within an inventive medical home clinic model.

The resident clinic has become one of only 500 primary care clinics in the nation–and the only internal medicine teaching clinic in the Providence system–to be chosen by the Centers for Medicare and Medicaid Services to receive a grant and participate in the Comprehensive Primary Care Initiative (CPCI). The grant's purpose is to inspire innovative thinking which will set the standard for the future of primary care. When CPCI sunsets at the end of this year, the residency clinic has already been selected to participate in Medicare’s next innovation program: Primary Care First.

We have used this funding to offer full-time assistance to residents and faculty providers in several support areas which highlight our focus on team-based care:

Full-time Professional Clinic Staff

  • Registered Nurse with emphasis on patient safety
  • Registered Nurse with emphasis on care management
  • Clinical pharmacist
  • Clinical psychologist/behaviorist
  • Access to case managers and social workers

Clinical Experience

Intern year

One half-day/week

Four dedicated weeks of outpatient medicine

Patient panel: 50-75 patients

Second year

Two half-days/week

Four dedicated weeks of outpatient medicine

Patient panel: 120-140 patients

Third year

Two half-days/week

Eight dedicated weeks to outpatient medicine

Patient panel: up to 175 patients

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Ownership

Over three years, a resident in our program builds valuable relationships with clinic patients who know the resident as their primary doctor. This powerful experience built on strong continuity, an excellent clinic support team, and ownership of patient care maximizes resident education and satisfaction.

Most medical graduates come to residency with relatively less outpatient than inpatient experience. To help our interns build confidence in outpatient workflows and knowledge, we have recently introduced 2+1 scheduling for all categorical interns, that is, two months of inpatient rotations will always be followed by a week of clinic. We aim to have all interns do their first clinic week within the first few months of residency, so they begin to gain the skills and tools to be their patients’ primary doctor.

Youker“Our innovative clinic model creates an enhanced environment for mentorship by giving me the opportunity to work with no more than two residents at a time and by allowing me to work with specific residents for three years as they manage a diverse and complex panel of patients.”
Jeff Youker, M.D., Program Director

patientpromo

"Working with the residents is great. My resident physician, Dr. Natalie Friedin, is not only caring for my health but also for my wellness. She firmly but nicely encourages me to eat healthier and get more exercise.”
Providence Medical Group-St. Vincent patient