Family Medicine Clinic

The family medicine clinic schedule for residents depends on their year in the residency and whether they are on an inpatient or outpatient rotation.

 On inpatient rotations, residents have one full day of clinic each week. During that day in clinic, attending physicians cover for their patients in the hospital (including handling all pages), so the residents can focus fully on the patients they are seeing in clinic. The diagram below shows which days of the week the R1s, R2s and R3s have clinic on inpatient rotations:

 On outpatient rotations, residents have clinic those same full days but add additional half days of clinic, as diagrammed below (for instance, the R1s add a clinic on Wednesday afternoons).

On night rotations, residents do not have clinic.

All three clinic sites are located in portions of our county (Contra Costa county) where 30% of the population has an income below two times the Federal Poverty Level (FPL): 

About 80% of our patients have a form of Medi-Cal insurance (California's name for the Medicaid program). About 10% have Medicare.

Our patients speak many languages. The top 10 languages spoken by patients in these clinics (after English) are Spanish, Punjabi, Vietnamese, Portuguese, Dari, Arabic, Mandarin, Tagalog, Farsi and Cantonese. About 20% of the patients that residents see in clinic speak (as their preferred language) Spanish.

25% of the patients are age 17 or less. 18% are age 60 or older.

Applicants often ask about the racial and ethnic makeup of our patient population. That is a difficult question to answer, for multiple reasons, including how our system asks patients their self-identification. We have a very diverse patient population.

The number of patients that residents see per 4-hour clinic increases every 6 months (except that interns start with only two patients but then increase to 4 patients per clinic after their first few weeks of clinic:

We recognize that having too many residents with too few preceptors in clinic can harm the educational value of that clinic experience.

 ACGME permits family medicine residencies to have a ratio of residents to preceptors as high as 4:1.

We achieve better. At all three training sites, we maintain an average ratio in clinic better than 3:1.

Our healthcare system (hospital, health centers, detention) has been using the Epic Systems electronic health care system since 2012.

Besides primary care, the Martinez, Pittsburg and West County Health Centers have clinics for most specialties (for instance, at Martinez, the available specialties are listed at the description of the Martinez Health Center). Some specialties require referrals to outside providers or systems.

Behavioral Health practitioners are integrated into primary care at all of our clinic sites.  They are available for warm hand-offs in urgent or emergent cases, or for short-term therapy if appropriate.  For patients requiring long-term management, we have a referral system to therapists and psychiatrists.

 We have superb access to qualified healthcare interpreters. Contra Costa Health Services is a member of the Health Care Interpreter Network (HCIN), a national network of hospital and health systems that shares its interpreter staff . All exam rooms in clinic have video/audio devices that provide quick access to HCIN.

 Other resources available at all three clinic sites include:

• Dental clinics
• Laboratory
• Diagnostic Imaging (ultrasound and X-ray. CTs, MRIs, echocardiography, or other studies are done at Contra Costa Regional Medical Center or referred to outside diagnostic imaging facilities)
• Physical therapy/Occupational Therapy
• WIC (Special Supplemental Nutrition Program for Women, Infants, and Children)
• Social workers
• Healthy Start (a comprehensive program for coordination of prenatal and postnatal care)
• Health Navigation Coordinators (African-American Health Conductors, Promotoras, Re-Entry Conductors)
• Care coordinators
• Resource nurses (who help providers handle lab and imaging results and can also provide education to patients)
• Systematic "Social Determinants of Health Screening" (SDIH) of patients

The clinics are part of a large, integrated health care system, and other system-wide resources are available to assist patients (such as public health nurses and transportation resources to help patients get to and from their clinic appointments).

A few days after the match, members of the new class of residents are sent an email about choosing their clinic site and block schedule.

The incoming interns reply with their clinic and schedule preferences along with an explanation of those preferences.

The chief residents then make the assignments taking into account the preferences and reasons stated by the interns.

 Once residents have been assigned their clinic site, they must stay at the same site for the duration of their residency