By Rajasree Pai, M.D.
This young doctor reflects on the primary care residency that allowed her to build the types of relationships with patients that attract students to primary care in the first place. Residencies that accurately represent primary care are the "need of the hour" for training and maintaining primary care docs, she says.
During my second year of residency, I made house visits with the veteran’s clinic staff as part of my geriatric rotation. I met many veterans and their families. Examining a patient in his own environment was a novel experience for me, through which I built relationships that I might not have in a more traditional internal medicine residency program. I never would have met Mr. M nor would I have gotten this real life experience with a private doctor in outpatient primary care. But as a resident in the University of Connecticut’s Primary Care Internal Medicine program, I spent a part of my second and third years working with private physicians in the outpatient setting.
The Primary Care Internal Medicine program at UConn aims to address the current trend of medical students and residents opting to sub-specialize rather than practice primary care. Health care workers and policymakers who have looked into the reasons for the trend have proposed, among other strategies, improving physician-patient relationships developed in primary care residencies. Uconn’s program strives to do exactly that.
UConn’s is one of only 16 programs in the United States that focuses on primary care internal medicine. However, very few students and policy makers are aware of the existence of these programs and their potential role in building the new generation of primary care physicians.
Unlike most internal medicine programs, this three-year program divides residents’ time equally over inpatient and outpatient settings with emphasis on office practice, continuity of care, and health promotion – cornerstones of primary care and likely what attracts medical students to the field in the first place.
Total call blocks in the first year are limited to six. This makes a striking contrast to most traditional Internal Medicine programs that include nine to eleven blocks the first year of predominantly or only inpatient rotations.
During the mandatory four-week geriatrics blocks in my first and third years, I rotated through the veteran’s hospital, community hospitals and health centers. In these blocks, I learned to manage elderly patients taking multiple medications, which will be key in caring for an aging population in the primary care setting. But perhaps more notable was the opportunity the geriatrics block provided to care for patients in their own communities by conducting house visits. This provided a unique opportunity to see first-hand many of the socioeconomic concerns that may impact my patients’ illnesses and thereby strengthened our relationships.
In the month spent in outpatient specialty clinics, I had the opportunity to work with specialists and apply the knowledge I gained with them to my primary care practice. It was due to this rotation that I was able to identify sezary syndrome – a type of cutaneous T-cell lymphoma – in a patient later on.
Residents spend time with the diabetes control team at the Joslin Diabetic Center to prepare us as primary care physicians to manage diabetic patients who will likely comprise a great part of our patient population. There, training is provided on diabetes education, insulin pumps, continuous glucose monitors, and podiatry for diabetic patients. The diabetes and specialty clinic rotations are unique to primary care residency programs and not found in traditional internal medicine residencies.
During the month of musculoskeletal medicine rotation, residents spend part of their time in the occupational medicine clinic, where they get an understanding of disability applications when they are asked to decide whether to approve or deny the disability applications of patients who have incurred work-related injuries.
Now at the end of my residency, I feel that this program has equipped me with comprehensive exposure to the kinds of patients I will care for in my practice, helping to reiterate and sustain my passion for primary care. It has trained me to better understand my patients and build stronger relationships with them. Primary care residencies that teach primary care are the need of the hour to encourage and guide young physicians to practice and stay in primary care.
Rajasree Pai, M.D., attended medical school in Trivandrum, India. She completed University of Connecticut’s primary care residency this spring.