Transcript Dr. Kurt Angstman, Medical Director at Mayo

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