P&S Journal: Fall 1996, Vol.16, No.3
Family Physicians for Urban Communities
By Kristen Watson
| Concerned with the shortage of primary care physicians in a medical system moving deeper into managed care, Columbia-Presbyterian Medical Center has started a family medicine residency program committed to training physicians to treat families, particularly in urban communities.|
CPMC is the second academic medical center in the New York metropolitan area-after Montefiore-to offer a family practice residency. On June 24, the program's first six residents began their three-year course of study. The inpatient rotations for the residents will take place primarily at the Allen Pavilion, a 300-bed division of Presbyterian Hospital, located in the Fort Tryon Park section of Washington Heights.
The family medicine program has blocks covering different areas of training. Residents will spend two months in the general surgery service at Allen, admitting patients from the emergency room, following them into the operating room, and managing their postoperative care. During an obstetrics rotation, residents will experience the busy labor floor, working with attending obstetricians, midwives, and other residents. Cardiology and intensive care rotations will be coordinated by Allen's highly regarded cardiology group. In the program's inpatient psychiatry training, residents will be part of a team that evaluates and cares for both mentally ill chemical abusers and general psychiatry patients at Allen. The remainder of inpatient training will take place at CPMC's main campus. Throughout their training, each resident will be the primary care provider for a panel of families at the Family Health Center on Nagel Avenue. The office experience at the Family Health Center will expand from one session a week in the first year to four a week by the third year.
Interested in assimilating themselves to the Fort Tryon Park community-home to a large Dominican population-the residents learned the basics of medical Spanish during their first few weeks of training. Two of the program's residents are Albert Einstein graduates; the other four are graduates of NYU, Mount Sinai, Albany Medical, and Thomas Jefferson.
The faculty is led by program director Dr. Christopher Wang, assistant professor of clinical medicine in the Center for Family Medicine. Other faculty in the center are Dr. James Spears, assistant clinical professor of medicine; Dr. Laura Thompson, assistant clinical professor of medicine; and Dr. Rajal Patel, assistant clinical professor of medicine. All are members of the collaborative group practice at the Family Health Center.
The family medicine program uses a team approach; each team is made up of attending physicians, nurse practitioners, patient representatives, medical assistants, nurses, and residents.
Associated with an academic medical center as prestigious as CPMC, the program will provide "optimal training," through the tremendous array of human resources available, says Dr. Wang. "In working with the clinical departments, the School of Public Health, School of Nursing, and several other groups to develop services, research, and training, the program has taken what up to now has just been an idea and leveraged it into something much larger in range and scope of practice."
The program gives residents skills in adult medicine, pediatrics, obstetrics and gynecology, minor surgery, behavioral science, and psychology, while also teaching them to practice community medicine, which requires knowledge of community agencies and referral opportunities. Besides being responsible for the hands-on care of their patients, urban family medicine physicians must also be coordinators of care with a clear understanding of a city's comprehensive web of specialty services-serving not only as doctors, but also as patient advocates.
In choosing residents for the program, Dr. Wang looked for individuals who demonstrated strong clinical skills, an interest in the care of families and communities, and a commitment to providing health care to urban underserved populations, such as that found in Washington Heights.
Six first-year residents will be added to the program each year, filling all three levels of training by 1998.
CPMC's first class of family medicine residents and residency director Dr. Christopher Wang during orientation at the Family Health Center. From left are Marion Richman, Suzanne Walker, Kim Seeger, Markus Kraebber, Janet Tseng, Dr. Wang, and George Lin.