Some background on Medicos' curriculum for interview visits:
Medicos was designed to train physicians for medical missions in developing countries where there is no medical insurance.
There is no geriatric medicine unless the family accompanies the grandmother or grandfather at the time of the visit. A family member usually witnesses all office surgeries up to and including hernia repair.
Medicos discharges patients who are repeatedly concompliant or who insist on fragmented care (ER abuse-doctor shopping). Prescriptions are not refilled by phone with rare exceptions. Medicos will not prescribe chronic lortabs or benzos. Medicos will not ever prescribe ADHD meds for adults.
Medicos generally discourages HPV subtyping, herpes cultures, and other costly interventions which add little to the management of the patient. Medicos avoids almost all nongeneric medications. Doctors are required to tabulate the cost of each visit prior to discharge of the patient.
Most medical management approaches are identical, but in some areas Medicos is different. Xrays, ECG's, and ultrasounds are rarely overread except by targeted consultation. Integration of psychiatric issues is a daily occurrence. Addressing the emotional needs of mothers and families is always a factor in the Medicos visit.
Even though Medicos has attracted many English speaking patients, Spanish is spoken every day most of the time.
Medicos does not employ any full time OB faculty, because Medicos believes that family medicine needs to govern its own house while collaborating with OB specialists for consultation as needed. OB specialists do participate in the program.
This fellowship focus is slightly different than the current American FM residency training system. These idiosyncrasies merit investigation during the interview.
We share a common interest in maintaining delivery services within the medical specialty of Family Medicine. With regard to Medicos'FAMILY MEDICINE-OBSTETRICS fellowship, the central goal is the ability to perform a Cesarean section. Most applicants are residency trained and "soon to sit for their boards" family physicians. To enter the fellowship they are required to obtain a Tennessee Medical license and hospital privileges including normal deliveries. Medical malpractice insurance is provided. Over 60% of graduates practice rurally, but some have gone on to positions of leadership in training programs and hospitals.
For 20 years fellows have come with the expectation that the benchmark of success will be the ability to respond to an obstetrical emergency by performing a Cesarean section. The range for the past 80 fellows has been 70-240 Cesarean sections with some of them being assists. For the past four years all fellows have performed over 120 sections and most did over 200. Our goal is 50. Medicos teaches a surgery lab twice a year, and there is a weekly high risk OB clinic. Over ninety percent of graduating fellows 1992-2010 have obtained Cesarean privileges. [Rodney WM, et al. Fam Med Nov 2010; 42: 712-716]
With best wishes for your professional success
Wm. MacMillan Rodney MD
Clinical Professor and Chair
Medicos para la Familia
Memphis, Nashville, and International
Index--fellowship brief disclaimer
efds
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