Wonderful to see this idea resurface every few years in various residency cultures. This always identifies a talented young physician who goes on to be a contributor wherever they go. The problem reflects an ambulatory training system where chronic care has come to dominate the family medicine office visit schedule.
Medicos performs most surgical cases(even elective ones) on the same day or the next day. Involving the resident/student who offered significant continuity and mandatory postop follow-up at 1 and 3-5 days, has created a reasonable distribution IF the residents are in the office almost every day. Some are called to come in for their patient. On the other hand, each day there is a selected urgent care MD who inherits all urgent issues including these add on surgeries.
In our system, senior residents are in the office almost every day. Faculty are trained if they lack these skills. Faculty without simple surgical skills are not retained. We have never met a family physician who lacked the cognitive and psychomotor aptitude for these procedures. Therefore Medicos does not have to create a separate staffing schedule.
Additionally, Medicos opened the office Saturdays and Sunday after church. All of our uninsured surgery is done on these days. This is when these patients are not working. Improved access quadrupled our weekly surgical volume and fracture care service.
WMR
I have run such a procedures clinic for several years in our residency. I wish I could say it has been a great success.... We have not attracted patients from outside the residency practice, so we have relied upon our practice to generate 'referrals'. That being said, we do capture most of the ATTENDING patient procedures, and make sure that no procedure goes 'unresidented'. The residents really like the concentrated afternoon. They also get to try some somewhat more advanced procedures than they might otherwise see in our office (since I will do them). Our residents also do some time in derm and with a plastic surgeon so they do get other exposures. I worried for a time that they would learn how I do things, and not get a broader exposure to the other family physicians who work in our office... but I think that has not turned out to be a problem.
Relying as we do on in-clinic referrals, we do have some months when we just don't have enough procedures scheduled really to justify having an attending and a resident booked out.... but other months are fine.
Jeremy
(UMass Worcester)
I am a third year resident working on a process improvement project to increase exposure of core skin procedures within our family medicine residency clinic. As residents, we do receive good dermatology training at our local VA hospital clinic and scattered visits during our personal continuity clinic, but I feel we could increase exposure to various dermatologic issues along with increasing our procedural exposure with a dedicated skin clinic.
The goal would be to set up a skin clinic 1-2 days a month, manned by a senior resident (already completed derm rotation) for skin checks, biopsies, cryo, etc. Rather than cannibalize procedures from fellow resident continuity patients, the goal would be to increase awareness of such a clinic and inform patients of services available (many think they have to go to a dermatologist for any skin issues, and patients often ignore or are embarrassed by concerning skin lesions). Use of lesion/skin checks, dermoscopy, and biopsies would be performed for diagnosis. Any longer procedures (excisional biopsies) would be referred back to their PCP.
My hope is to increase resident exposure with various skin lesions and become even more comfortable with diagnosing common skin lesions, performing dermatologic procedures, and providing proper follow-up management of such lesions.
I have heard of other residency programs and offices with similar procedure clinics and would appreciate any recommendations and advice for success. Those of you with a dedicated procedure clinic, what have you found to increase its use by your patients? What obstacles have you run in to? How do your residents feel about being a part of a procedure clinic? Do you think this would enhance resident education?
Any information and advice from those who have been a part of or are currently running a dedicated skin clinic (1-2 times/month) as part of your residency's family medicine clinic would be greatly appreciated.
SHC Resident
Index--Surgery in the office-Derm
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