Spring 2017
Resident Roundup

synapse: University of Nevada, Reno School of Medicine

New Primary Care Residency Program Arises

By Anne McMillin, APR

Steven Zell
Steven Zell, M.D., developed a new primary care-focused residency training tract to address the need for out-patient internal medicine physicians in northern Nevada. Photo by Anne McMillin, APR.

To help meet the need for more primary care physicians in Nevada, the Department of Internal Medicine developed a new northern Nevada-based residency training tract, focusing on primary care. Starting this July, five new trainees annually will be added with a full complement of 15 trainees by 2018.

Funding for this new program flows from the announcement last fall of $10 million for graduate medical education programs in Nevada (See p. 16).

Of that amount, $1.7 million was set aside for the new internal medicine primary care resident training program concentrated on the outpatient clinical setting.

Keen to the challenges in training that preclude residents from seeking a career in outpatient medicine, Steven Zell, M.D., program director, assisted by Sujatha Pitani, M.D., associate program director, created an innovative primary care curriculum focusing on providing trainees the requisite skills to feel comfortable in the primary care setting.

Historically, according to Zell, residents have not opted to practice primary care medicine because of three factors: lack of confidence and skill in ancillary areas of medicine, inadequate time with patients to address their levels of complex medical conditions and lack of opportunity to bond with their patients.

The new curriculum addresses each of these factors.

In order to enhance confidence and specific skills, primary care residents will engage two half-days per week in skill enhancement clinics to focus and supplement clinical experiences. Skill enhancement clinics will give trainees exposure over the three-year training period, with each clinic building on prior knowledge. On average, each trainee will experience 17 skill clinics in each of the nine enhancement areas spread over their training years.

The clinical areas of skill enhancement range from HIV infection and STD management to dermatology, geriatrics, rheumatology, women’s health, chronic opioid therapy and pain management to outpatient office orthopedics.

“The skill enhancement clinics allow trainees to be mentored by specialists in nine areas so they will know what to do when patients present with any of these conditions,” Zell said. That, in turn, leads to more appropriate referrals, less health care costs and better patient satisfaction.

“We will achieve these experiences for our residents by working with our community faculty, many of whom are alumni, and hospital partners,” he said.

The emphasis on primary care is being addressed by reducing the time requirements for in-patient hospital service to 40 percent, which allows for the remainder of residents’ time to be devoted to the out-patient setting.

“Trainees will still do enough inpatient rotations to qualify for board certification, but roughly 60 percent of their training will be devoted to the outpatient setting,” Zell said.

Notably, residents in the primary care training program will be assigned and care for a dedicated patient population.

“Over the course of their training, we want trainees to bond and fall in love with their patients,” Zell said. This dedicated patient base is being recruited from the ranks of Nevada’s Public Employees Benefits Program Consumer Driven Health Plan members, along with Medicare and Medicaid clients.

“Recognizing the need for primary care trainees to feel connected to a specific patient population, our faculty and trainees will share a unique patient population and care for them using an enhanced team approach,” Zell said, adding that the new model allows for stronger collaboration between physician and patient by focusing on preventative health measures and improved accessibility.