Leading an Academic Medical Practice

343 Pages·2018·3.89 MB·English

by  Lee Bach Lu

Leading an
Academic
Medical Practice
Lee Bach Lu
Ernie-Paul Barrette
Craig Noronha
Halle G. Sobel
Daniel G. Tobin
Editors
123
Leading an Academic Medical Practice
Lee Bach Lu • Ernie-Paul Barrette
Craig Noronha • Halle G. Sobel • Daniel G. Tobin
Editors
Leading an Academic
Medical Practice
Editors
Lee Bach Lu Ernie-Paul Barrette
Baylor College of Medicine Washington University School of Medicine
Houston, Texas, USA St. Louis, Missouri, USA
Craig Noronha Halle G. Sobel
Boston University School of Medicine University of Vermont
Boston, Massachusetts, USA Robert Larner M.D. College of Medicine
Burlington, Vermont, USA
Daniel G. Tobin
Yale University School of Medicine
New Haven, Connecticut, USA
ISBN 978-3-319-68266-2 ISBN 978-3-319-68267-9 (eBook)
https://doi.org/10.1007/978-3-319-68267-9
Library of Congress Control Number: 2017964132
© Springer International Publishing AG 2018
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Foreword
The Society of General Internal Medicine (SGIM) is pleased to offer our endorsement
and support for this outstanding book. Leading an Academic Medical Practice had
humble beginnings; in 2002, members of the SGIM Medical Resident Clinic
Directors Interest Group presented a workshop about how to be an effective clinic
director at our Annual Meeting. This consensus-based effort evolved into a more
formal “orientation manual” for clinic directors that was shared internally with
SGIM members in 2003. The orientation manual was extremely well-received, and
our members asked that it be expanded and updated. This enthusiasm in part
reflected the increasing complexity of the academic, regulatory, clinical, and admin-
istrative aspects of care delivery in outpatient academic medicine. There was also a
strong belief that this new resource should maintain a pragmatic focus but also be
more robust and evidence-based. Beginning in 2015, SGIM members Lee Lu,
Ernie-Paul Barrette, Craig Noronha, Halle G. Sobel, and Daniel Tobin led the effort
to realize this vision as a team of co-editors.
This book is not an “official” statement of practice standards from SGIM. However,
the writing and editorial process involved extensive peer review and represents the
culmination of years of work from the authors and editors in collaboration with
Springer and members of SGIM. We are pleased to see this grassroots effort culmi-
nates in this outstanding product, one that will provide considerable benefit to those
who lead outpatient general internal medicine clinics along with their learners and
patients.
About Us: SGIM is a national medical society of over 3,000 physicians who
represent the general internal medicine faculty of every medical school and major
teaching hospital in the United States. SGIM members teach medical students, resi-
dents, and fellows how to care for adult patients. They also conduct research
intended to foster comprehensive coordinated care of adult patients across ambula-
tory and hospital settings, including preventive measures and treatment services.
You can learn more about our organization, our mission, and our members by
visiting us online at http://www.sgim.org/.
v
Preface
“Dream the impossible because dreams do come true.”
Elijah Wood
As I prepare writing the preface for this book, I find myself still in disbelief that
I am doing it. As one of the “boat people,” escaping from an oppressive government
regime and arriving to the United States, a teenager with one set of clothes and no
knowledge of the language of this new country, I never dreamt of becoming a physi-
cian, a teaching professor, and a medical director and certainly not an editor of a
book. The United States is truly a land of opportunities. I am proud to be an American!
After working for a few years as clinic faculty at Michael E. DeBakey Veterans
Affairs (MED VA) Medical Center in Houston affiliated with Baylor College of
Medicine, an opportunity came unexpectedly in the year 2003. I was offered the job
of being the resident clinic director for the MED VA Internal Medicine Resident
Continuity Clinic. I was hesitant at first, but after a lengthy consideration, I accepted
the job. Having never been in this type of position before, I was clueless on what to do.
My main focus was to make sure the internal medicine residents assigned to my clinic
received a great education. Advised by one of my colleagues, I attended the Society of
General Internal Medicine (SGIM) Medical Resident Clinic Director Interest Group
(MRCDIG) at the national meeting. At that meeting, I met Dr. Mohan Nadkarni, the
lead of this interest group. He and his colead Dr. David C. Dugdale put together the
Medical Resident Clinic Director’s “Orientation Manual” in September 2003. Despite
having this interest group to provide me with some guidance, I was yearning for more.
I wanted a comprehensive manual on how to effectively lead my clinic.
As our healthcare system evolved, more administrative responsibilities were
being added to my job (e.g., having to deal with quality indicators, the patient vol-
ume, the no-show rate, patient satisfaction, etc.). In 2006, I joined a community
system for the underserved, now known as the Harris Health System (HHS) which
is affiliated with Baylor College of Medicine (BCM), and in 2010, I became the
medical director of a Harris Health primary care/specialty clinic working with
physicians from both Baylor College of Medicine and the University of Texas
Health Science Center at Houston.
vii
viii Preface
As a physician, I always try my best to follow the teaching of Sir William Osler
who once said, “The practice of medicine is an art, not a trade; a calling, not a busi-
ness….” With all the changes in our healthcare system, many academic physicians
are drifting away from Sir Osler’s teaching and are inevitably forced to deal with the
business aspect of medicine such as work relative value units (wRVUs) and patient
volume. In May 2011, Dr. Mohan Nadkarni passed his baton and appointed me the
cochair of MRCDIG. The evolution of our healthcare system continues to impose
more mandates and regulations, and having a manual to provide guidance to clinic/
medical directors is essential. With this in mind, SGIM MRCDIG has updated and
produced a guide on how to lead a successful academic medical practice. This book
will cover many topics spanning from the clinic director’s roles, faculty recruitment,
resident clinic requirements, academic clinic workflow, and education to quality
improvement, Veterans Affairs clinic, and model of care delivery. We hope the con-
tent of this book will benefit leaders in an academic medical practice/institution and
serve as a comprehensive guide with key clinical and administrative components on
how to manage and lead a practice. The manuscript will describe an overview of the
administrative challenges encountered when leading an academic medical practice;
detail core clinic director roles and responsibilities; offer guidance to support,
supervise, and improve faculty and trainee performance; provide strategies to effec-
tively overcome common clinical and academic workflow challenges; and deliver a
flexible resource that can be used across a variety of clinical and academic settings
and models of care delivery.
I am fortunate to have found 35 national leaders and contributors with years of
experience and expertise, and one of the authors, Dr. Mohan Nadkarni, is the origi-
nal editor of the “clinic orientation manual.” I appreciate their enthusiasm and
devoted effort in this project. In this journey, I have recruited four co-editors, Drs.
Ernie-Paul Barrette, Craig F. Noronha, Halle G. Sobel, and Daniel Tobin, to assist
me, and I am grateful for their partnership and contributions. Lastly, I want to thank
SGIM for their support!
For leaders, some obstacles may seem impossible to overcome; however, as one
of the samurai of the Saga Domain Yamamoto Tsunetomo quoted, “Nothing is
impossible in this world. Firm determination, it is said, can move Heaven and
Earth….”
Houston, TX, USA Lee Bach Lu
Contents
Part I Clinic Director and Faculty
1 Clinic Director Roles and Expectations . . . . . . . . . . . . . . . . . . . . . . . . 3
Halle G. Sobel and Mark E. Pasanen
2 Supervising and Supporting Faculty . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Alaka Ray, Priya Radhakrishnan, and Halle G. Sobel
3 Faculty Recruitment and Retention . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Mohan Nadkarni and Ira Helenius
4 Outpatient Billing and Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Lee B. Lu and Scott V. Joy
Part II Resident Clinic Requirements
5 ACGME Requirements/Accreditation Issues . . . . . . . . . . . . . . . . . . . . 63
Craig Noronha and Mark E. Pasanen
6 Resident Clinic Orientation and Expectations . . . . . . . . . . . . . . . . . . . 71
Emily Fondahn and Daniel S. Kim
7 Evaluation and Milestones in Continuity Clinic . . . . . . . . . . . . . . . . . 83
Jillian S. Catalanotti and Parvinder Sheena Khurana
8 N urturing a Culture of Diversity and Inclusion in Resident Clinic . . . 93
Inginia Genao and Laura Whitman
Part III Academic and Clinical Workflows
9 Traditional and Block Scheduling Challenges
and Solutions for Internal Medicine Residents . . . . . . . . . . . . . . . . . . 105
William Weppner, Craig Noronha, and Mamta (Mimi) K. Singh
10 Maximizing Continuity in Continuity Clinic . . . . . . . . . . . . . . . . . . . . 121
William Weppner, Reena Gupta, and Robert J. Fortuna
ix
x Contents
11 Population Health Management for Residents. . . . . . . . . . . . . . . . . . . 129
Robert J. Fortuna and Halle G. Sobel
12 Results, Refills, and Critical Communication . . . . . . . . . . . . . . . . . . . 139
Parvinder Sheena Khurana, Chad Henson, and M. Danielle King
13 Clinic Handoffs and Sign-Outs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Parvinder Sheena Khurana and Lee B. Lu
14 Safe Opioid Prescribing and Controlled Substance Policies . . . . . . . . 157
Daniel G. Tobin and Ernie-Paul Barrette
Part IV Education
15 A mbulatory Curriculum Design and Delivery
for Internal Medicine Residents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Margaret C. Lo, Alia Chisty, and Emily Mullen
16 Electronic Medical Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Gail Berkenblit, Elizabeth Koehler, and Jeremy Epstein
17 Medical Students in Clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Achilia Morrow and Kelly White
Part V Quality Improvement
18 Quality Improvement Projects and Indicators . . . . . . . . . . . . . . . . . . . 245
Emily Fondahn
19 Practice Improvement Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Craig Noronha
20 Patient Safety in an Academic Medical Practice . . . . . . . . . . . . . . . . . 269
Emily Fondahn and Claire Horton
21 Scholarship in Clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Jillian S. Catalanotti and Parvinder Sheena Khurana
Part VI Models of Care Delivery
22 Patient-Centered Medical Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Priya Radhakrishnan
23 Veterans Affairs Continuity Clinics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Rebekah A. Kaplowitz
24 Nontraditional Methods of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
William Weppner and Bradley H. Crotty
25 Federally Qualified Health Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Magni Hamso and Shwetha Iyer
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Contributors
Gail Berkenblit, M.D., Ph.D. Assistant Professor of Medicine, Associate Program
Director, Olser Residency Program, Johns Hopkins University School of Medicine,
Baltimore, MD, USA
Jillian S. Catalanotti, M.D., M.P.H., F.A.C.P. Associate Professor of Medicine,
Associate Professor of Health Policy Management, The George Washington
University, Washington, DC, USA
Alia Chisty, M.D., F.A.C.P. Assistant Professor of Medicine, Associate Program
Director, Temple Internal Medicine Residency Program; Medical Director, Medicine
Group Practice; Lewis Katz School of Medicine at Temple University, Philadelphia,
PA, USA
Bradley H. Crotty, M.D., M.P.H., F.A.C.P. Assistant Professor of Medicine,
Section of General Internal Medicine, Medical College of Wisconsin, Milwaukee,
WI, USA
Jeremy Epstein, M.D. Instructor of Medicine, Assistant Program Director of
Ambulatory Education, Osler Residency Program, John Hopkins University School
of Medicine, Baltimore, MD, USA
Emily Fondahn, M.D., F.A.C.P. Assistant Professor of Medicine, Washington
University School of Medicine, St. Louis, MO, USA
Robert  J.  Fortuna, M.D., M.P.H. Associate Professor, Internal Medicine,
Pediatrics Community; Health Associate Medical Director, UR Primary Care
Network; University of Rochester, Rochester, NY, USA
Inginia Genao, M.D. Associate Professor of Medicine; Medical Director, Adult
Primary Care Center; Associate Chair for Diversity and Inclusion, Yale University
School of Medicine, New Haven, CT, USA
Reena Gupta, M.D. Associate Professor of Medicine; Medical Director, Care
Transformation, San Francisco Health Network; University of California, San
Francisco, CA, USA
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