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Primary Care Potpourri AED November 1, 2006 Kurt B. Angstman, MS, MD Medical Director, Mayo Family Clinics Department of Family Medicine Mayo Graduate School of Medicine Mayo Clinic Discussion topics • Primary Care • Rural vs.. Urban practice • Minnesota Lifeline October 2005Katrina/Rita PRIMARY CARE • Definition (mine): • Providers who assume the responsibility (with the patient and family members) to care for the patient and their family members; through a variety of medical conditions- over the course of their patient’s life. • Limited by training and scope of practice • Implies a relationship between the patient and the provider PRIMARY CARE • Who are Primary Care Providers• • • • • • Pediatrics Internal Medicine- general/ geriatric Family Medicine Pediatric/Internal Medicine combination Nurse Practitioners • Pediatric (PNP), Family (FNP) or General (NP) Obstetrics/GYN (?) Pediatrics • Generally care for children from birth to 15-18 • Will care for siblings; longitudinal care • Training is a 3 year residency program following medical school • Consists of outpatient clinical expertise, along with hospitalized care of sicker children Pediatrics • Some pediatricians will specialize and do further residency training in: ID; Cards; GI; Neph, etc.Currently 66% nationally go into Primary Care Internal Medicine • Generally care for Adults- some will see patients > 15 or 16 of age • Will care for members of the same family • Longitudinal care, stressing preventative services, hospitalized care. Internal Medicine • Three year residency training program after medical school • 1-2 year fellowships available for geriatrics, research, etc • Many residents will specialize in: • Cards/ GI/ Endo etc. • 48 % stay in Primary Care Pediatric/Internal Medicine Combined training • Training is 4 years of residency after medical school • Board certified in both Peds and IM • Care of all except obstetrical care • Emphasis on hospitalized care, sicker adults and children • Popular on coasts, where OB care is routinely done by OB/GYN Family Medicine • Three years of residency training after medical school • Training in broad range of medicine: • Peds; OB/GYN; Surg; ER; Ortho; Geriatric; IM; Neuro; etc. • Practice type depends on trainingflexible and variable. • Approx. 50% are choosing not to provide OB care Family Medicine • Specializing in outpatient management of a wide variety of medical illnesses • Coordinator of care with multiple specialists Rural vs.. Urban Primary Care • Rural • Expectation for wider range of practice- OB/Peds to geriatric/NH • Care for “practice” rather than “patients” • ER/ Hospital/ On-call a given • Close relationship with patients • Involvement in practice management Rural vs.. Urban Primary Care • Urban • More control over practice style • ER Coverage is assumed • After-hours care- usually arranged • More “shift” work • Less day to day management involvement • But… Patients are still Patients Rural vs.. Urban Primary Care • Similarities • Can still maintain part-time practices (? Definition of parttime) • Provide educational experience to medical students; NP students etc • Both types of practices can be isolating/ overwhelming Concern with Rural Practice • You know every one • BMP • Reality • How to survive Rural vs.. Urban Primary Care • Best of times • Worst of times Compensation • ALL PRIMARY CARE SPECIALTIES are in demand! • Recent data shows 25-50 offers to each resident • Starting salaries range: $120,000 to $220,000 • Signing bonuses range up to $30,000 Interested in Primary Care? • MAFP (www.mafp.org) • RPAP • MNAAP (www.mnaap.org) • www.sgim.org Wave Three Operation Minnesota Lifeline OCTOBER 2005 Operation Minnesota Lifeline: Wave Three provided • Providers from the University of Minnesota, Mayo Clinic and Mayo Health System • Support staff for pharmacy, supplies, logistics and registering patients • RNs for assessing and triaging patients FOUR WAVES • Wave One: Evaluation, start PHU’s, mass immunizations, “inpatient”, and RITA • Wave Two: Evaluation, staff PHU’s, mass immunizations, and wind down inpatient • Wave Three: Staff PHU’s, medical outreach, and immunizations • Wave Four: Staff PHU’s and coordinate departure Public Health Units • Designed as a “core public health” facility • Not a primary medical clinic. Minimal physician involvement Public Health Units • Have exam rooms for WIC, STD clinics • Minimal if any laboratory and xray equipment Operation Minnesota Lifeline: Wave Three provided • Immunizations (given by RN’s, medical students, NP’s and yes –even MD’s)- 4965 Operation Minnesota Lifeline: Wave Three provided • Physician/NP visits - 1934 patients seen in ~15 days; • 4034 prescriptions or medications given out. • 251 mental health consultationsdoesn’t count the untold “chats” Outreach (aka: Road Trips) • Initially, sites in and around the Lafayette area where there were pockets of refugees • Most of the shelters were being “cleaned out” • Mission in evolution. FEMA lines Hotels Churches Parking lots- most of the time working out of back of the van Even drive–by shootings! Outreach to smaller communities Gulf Coast Pecan Island New Orleans • A two hour trip from Lafayette • Clinic was from 9am – 5pm • At the site of the FEMA line in New Orleans • In four days- saw 434 patients and gave 683 people immunization with 59 mental health consultations. Lessons learned in Louisiana • Disaster medicine vs.. triage medicine vs. primary care medicine • Physicians without logistic support and equipment are almost worthless • “Mayo Clinic gator survival course” • A good “hard freeze” keeps the bugs small • Blizzards melt- Hurricanes destroy How to say “boudin” and then how to eat it