Continuity Clinics
Overview
At UCSD we offer our residents a wide variety of continuity clinic experiences. From the underserved and uninsured populations to community-type practices, our residents have the opportunity to treat patients throughout our diverse San Diego community. Residents establish care at one clinic over their entire residency to build continuity with their patients. Each clinic incorporates a broad, well-received and nationally utilized case- based curriculum on a weekly basis. This multidisciplinary approach to outpatient medicine prepares our residents well for Internal Medicine boards. Each clinic is supervised by Internal Medicine attending physicians.
VA FIRM Clinics
The VA FIRM clinics, located in La Jolla and Mission Valley, deliver excellent primary care to a diverse veteran patient population. A well-established Women's Continuity Clinic provides the opportunity to care for patients of both genders under the direction of excellent general medicine and women's health faculty. The strengths of this clinic include outstanding continuity, excellent nursing and support staff, easy access to diagnostic testing and consultation, and an outstanding computerized medical record that facilitates delivery of outstanding preventive care. Telephone follow up of patients is shared between residents, using a small group practice model that includes a multi-disciplinary call center with clerical and nursing staff.
UCSD Hillcrest Clinic
Hillcrest Internal Medicine, also known as "Lewis Internal Medicine," is located a few blocks away from Hillcrest UCSD Hospital. Patients are culturally and ethnically diverse, and are both from the local area and from locations as far as several hours away. Many languages are represented, including a large Spanish-only speaking population. The clinic serves a total of approximately 4,200 patients, averaging 38,000 patient visits per year. Average patient age is 50 years. Male: female ratio is 2:3. Many of the residents' patients are insured by Medicare or MediCal (California Medicaid). Approximately twenty-five residents have their continuity practice at this location.
UCSD La Jolla Internal Medicine Group
This UCSD La Jolla Internal Medicine Group has a group of well-established attendings with large individual practices. The patient population is predominately from the La Jolla and north San Diego county area. Residents will see routine medical issues, and become comfortable with pain management and women's health. Records are computerized. Consultations are readily available. Continuity is outstanding, and patient follow up is shared between attending physicians, interns and residents.
Logan Heights Family Medical Center
The Logan Heights Family Health Center is the flagship medical clinic for Family Health Centers of San Diego, a 10 plus site community health center system, which is one of the oldest, most sophisticated and successful in San Diego County. Located in the historic San Diego Latino neighborhood, Barrio Logan, this multi disciplinary continuity site affords a richness of cultural/ethnic diversity and experience in a care setting devoted to providing quality, comprehensive medical care to those who may otherwise not have access.
Consistent with the community health center model, Logan Heights serves a patient population greater than 90% of whom live at a level below 200% of the federal poverty index. The majority of our IM patients are members of working families many of whom qualify for no health insurance or only limited funding through Medi Cal or County Medical Services, San Diego County's "safety net." No patient is ever turned away from primary care for inability to pay and multiple additional funding programs/specialty service agreements have been developed to help defray patient costs for medical care, pharmaceutical and diagnostic/laboratory work-up available onsite. Despite access potential that surpasses that available in most community health centers nationwide, it needs be remembered that this is not a free clinic and a significant number of uninsured patients will still not be able to access all services you may deem appropriate, especially expensive off site exams such as colonoscopies.
At Logan Heights Clinic, interns and residents follow their own continuity panels of medically challenging patients under the supervision of a core group of 4 UCSD IM faculty members with an interest in underserved medicine. One of this faculty group completed his resident continuity clinic also at Logan. Care for pts when the primary care resident is off-site is provided by on-site staff/residents with case management assistance. Many of our patients are Hispanic and although supportive translation is available, this is the ideal spot for someone who is interested in honing their Spanish language skills. Serving the un and under funded is always medically challenging but more importantly especially rewarding and hones excellent clinical skills. Logan has been consistently considered a valuable educational experience by our housestaff and was the continuity site for one of our current CMRs.
St. Vincent de Paul Society Clinic
St Vincent de Paul Village in San Diego is a world-renown facility and model of comprehensive continuum of services provision for the homeless and disenfranchised community. This includes housing, clothing, food services, laundry, schools, vocational training, employment services, psychological counseling and of course medical care. Founded by the Catholic Diocese of San Diego, St Vincent de Paul Village is now a non-denominational, federally recognized non-profit corporation. The Village Medical Clinic is well established and has been site for IM continuity training for well over a decade and was the continuity training site for one of this year's and last's IM CMRs and for several of our current Department of Medicine faculty, including a hospitalist, 2 HIV specialists and the Director of our 4th and Lewis IM Group Practice. The St Vincent de Paul Village Medical Clinic is also residency home to the UCSD Combined Family Medicine & Psychiatry Program which ranks consistently by all measures as one of the top programs of its kind in the country.
Our interns and residents follow continuity panels and are staffed by a Core Group of four IM faculty members with special interest in the underserved community. The priority mission of the Medical Clinic has been to care for residents of the Village who number in the hundreds on short term stays and individuals and families in housing for up to two years. Once established in the Village Clinic, pt care can continue on an ongoing basis even once an individual leaves the Village. Unfunded patients from the community are also welcomed and can continue in continuity care even if health funding is established. Housestaff referral of un- and underfunded patients from the inpatient arena is also encouraged. Many of our patients from the community, especially, are Hispanic and this is an excellent site to hone Spanish skills but there is a good multicultural/ethnic mix.
The St Vincent de Paul Medical Clinic is an excellent venue to hone clinical/diagnostic skills in a limited resource environment. Our current faculty who are SVdP alumni report that their training in this challenging site made them better, more astute clinicians. One of last year's training program graduates, now a UCSD fellow, described his continuity clinic at SVdP as the best experience of his residency. However the SVdP site is not the right fit for every resident depending on their own learning style, goals and perspective. Among the residents who have had complaints re: the value of the educational experience there, it has focused on the reality that many of the patients do not have the potential funding to obtain all the outside speciality referrals or health maintenance screening which would be optimal. Those residents who have thrived at SVdP in the past and will in the future have not considered this a barrier to their experience but part of their educational opportunity. We seek those residents for this unique site.
Scripps Green Clinic
Located in La Jolla at Scripps Clinic and Green Hospital, this is a well established clinic in a "nested practice" model. This clinic has a unique model whereby each resident is paired with one attending for the entire year and sees a subset of the attending's patients as his/her continuity patient panel. The patient population is typical of a community practice with excellent patient follow-up and opportunity for continuity of care. Records are computerized, and consultations, tests and procedures are readily available on site. The experience provides excellent continuity with follow up shared between the resident and attending in a true partnership model. Residents will see between 4 and 8 patients per half-day session, depending upon the resident's level of experience. Residents will perform all bedside diagnostic and therapeutic procedures indicated for their patients.
Kaiser Permanente
Located in La Mesa at Kaiser Permanente Medical Offices, this is a well established clinic in a "nested practice" model. This clinic has a unique model whereby each resident is paired with one attending for the entire year and sees a subset of the attendings' patients as his/her continuity patient panel. The patient population is typical of a community practice with working and middle class patients with excellent patient follow-up and opportunity for continuity of care. An electronic medical record is in place and consultations, tests and procedures are readily available.