Department of Medicine

Primary Care: Introduction Innovation Training Schedule How is this Different? Internal Medicine Home Page

How is the Primary Care program different from Categorical Internal Medicine?

1. High proportion of outpatient/inpatient ratio (inpatients » 40%).

Surprisingly, the increase in outpatient training does not come at the expense of less inpatient ward months. Primary care residents have the same number of inpatient ward months and ICU as other categorical internal medicine residents. I believe that the general medicine ward is a very precious experience that should not be reduced; after all, we are training physicians to be internists.

The increase in outpatient training time is mainly due to shifting of medical subspecialty training to outpatient-based settings “subspecialty clinic rotation”, instead of traditional inpatient-based training. That is to say residents will be in different subspecialty clinics such as nephrology clinic, cardiology clinic, etc…

Why is that better for primary care medicine?

2. Training in non-internal medicine specialties (Primary care rotation):
Real life has shown us that patients uncommonly come with concerns that their Hemoglobin A1C is higher than the recommendation of a scientific organization, or that they are worried about their LDL level. Rather, while you are very worried about your patient hemoglobin A1C and LDL, s/he is worried about a pain in her/his shoulder, an unusual discoloration in the skin, or a lump in a part of the body. A primary care internist should know how to address the former, as well as the latter issues.
Primary care internists should also be trained to PERFORM, not only to order the most commonly needed procedures, such as stress test, joint aspiration and injections, skin biopsy, and others. So the purpose of this rotation is:
1. To train residents to perform the most common procedures.
2. To train resident to respond to simple problems that our patients suffer from, since these are real life problems that need an answer. Studies have shown that internal medicine residents can handle difficult problems but not simple ones.

What would such a rotation look like:

3. Training in community settings.
This is a PGY-3 rotation in which residents will be sent out of LSU to a private clinic setting for 2 months.

Why is that?

1. To learn the “business” side of medicine.
2. Allow residents to “experience” the fun of longitudinal patient/doctor relation as it is in real world.
3. Opening opportunities to know pattern of practice, and be familiar with potential employers.

4. Selective Rotations
This is a 2-month rotation in the PGY-3 year. In this unique rotation, residents select a specific area of interest in which they get more training time.
Why is that?
• This rotation is our way to individualize training according to each resident’s interest.
• To give each resident a chance to develop expertise in an area of interest that would keep him challenged and interested in his primary care career.
• To generate an income beyond routine visits.

Examples of the selective rotation:
- Cardiology: stress test.
- Cardiology: Echocardiography, Arrhythmia and pacemaker
- GI: Flex Sigmoidosopy , upper endoscopy.
- Acupuncture.
- Minor surgery clinic.
- Allergy clinic: allergy skin testing.
- Radiology: CT and MRI reading, carotid ultrasound, or vascular ultrasound.
- Neurology: performing and/or interpreting EMG, nerve conduction studies, and sleep studies.
- Occupational medicine.