We view Substance Use Disorder intervention as a core competency of any family physician. Our residency incorporates substance misuse (eg. alcohol, tobacco, opiates, stimulants) in the longitudinal Human Behavior and Mental Health curriculum, as well as during the PGY1 Psychiatry rotation and PGY2 Addiction Medicine rotation. During continuity clinic and inpatient rounds; residents gain experience in substance use disorder screening, intervention, and treatment. Our core physician faculty have x-waiver licenses and residents gain Suboxone training during continuum. We also have core faculty in the Motivational Interviewing (MI) Network of Trainers, who helps residents gain competency in this brief intervention.
Assisting patients with mental health issues, substance misuse, and behavior change are key elements in our family medicine clinics. To fully integrate the biopsychosocial model, our full-time behavioral scientist regularly precepts with physician faculty during continuity clinic and inpatient rounds. This enables ongoing, real time feedback about doctor-patient communication, contextual factors, psychosocial issues, and mental health disorders. We strive to apply evidence-based practices for integrative care within our continuity clinics utilizing an interdisciplinary team and community referrals. Residents can also opt to use elective time for additional experiences in areas such as Addiction Medicine, Psychotherapy, Chronic Pain, Corrections Medicine, Lifestyle & Self-Management strategies, Spirituality in Medicine, and Well-being.
Our residents enjoy a high quality and comprehensive women's and reproductive health education. Why refer patients out for services we can provide in a familiar and comfortable medical home? Under the guidance of core faculty who specialize in reproductive health, our residents integrate wide-ranging women's health procedures into their own continuity clinics and participate in dedicated procedural clinics.
During residency, interested trainees can gain competency in medical and surgical TABs, miscarriage management, gynecological ultrasound, colposcopies and cervical biopsies, endometrial biopsies, and IUD and Nexplanon insertions. We not only diagnose cervical dysplasia and cancer, but also provide treatment with LEEPs and cryotherapy.
Here at the Sutter Family Medicine Residency program, we offer a wide variety of educational experiences in obstetrical and maternity care. Our goal is to provide residents with a positive OB experience and graduate family medicine doctors who are competent and confident to take care of a broad array of OB patients. Our residents care for their own continuity patients in the clinic and deliver alongside our family medicine faculty as well as community OB/GYNs.
In their second year, residents will learn high-risk obstetrics from our perinatologist group and family medicine faculty. Additionally, residents interested in more advanced OB education have the opportunity to manage high-risk and diabetic patients in our clinic and manage patients undergoing a trial of labor after cesarean section. Residents may also take part in cesarean sections with our OB/GYN colleagues as well as Dr. Ryan Spielvogel and Dr. Megan Ash, family medicine faculty who perform cesarean sections.
After delivery, we continue to provide comprehensive care to both mother and baby. We promote postpartum contraception and family planning. We strongly encourage breastfeeding among our new mothers and are proud to boast that both Sutter Medical Center Sacramento and Sutter Davis Hospital have been designated a baby-friendly hospitals. Our residents do home visits for new mothers with social challenges.
Best of all, we often become the doctors of the babies we deliver!
The Future Faces of Family Medicine project is a mentoring program set up by Sutter Health and UC Davis Family Medicine residents to inspire local high school students to become primary care physicians. The program has received statewide and nationwide attention. This video was produced with the help of the California Academy of Family Physicians (CAFP).
Our program encourages residents to enhance appreciation and understanding of Integrative Medicine through mind, body, and spirit. Residents have the option to work with Sutter clinicians focusing in this approach (in both Sacramento and San Francisco), complete online courses, and/or attend a longitudinal or away elective such as the University of Arizona Integrative Medicine Rotation.
Located in the capitol of California , we have strategic proximity to our legislators, media hubs, and community initiatives. Our faculty are active in the community and there are opportunities to get involved in local, state, and national efforts. Dr. Hitzeman is active in CAFP and encourages the entire FMRP community to participate in their annual advocacy day. Dr. Spielvogel provided testimony at the State Capitol in 2019 regarding the End of Life Options Act (ELOA), and is a founding member of this issue’s national medical society. Drs. Brothers & Kettle work to ensure our Health Equity & Community Medicine curricula give a range of both high-level and hands-on experiences. Residents can spend additional elective time in an advocacy rotation which could include accompanying lobbyists to the capitol, attending County Board of Supervisor meetings, participating in Health Action networks, networking with community organizations, and/or writing letters to the editor - there are always a variety of advocacy efforts going on around the Capitol. We also offer a leadership elective to help residents hone skills as physician team leader, as well as for a range of other leadership roles. For example, Dr. Julia Logan (FMRP class of 2008) holds a number of state-wide leadership roles including as an Associate Medical Director at the California Department of Healthcare Services (DHCS).
We are proud of our residents’ consistent engagement in community volunteering activities. Although residency is busy; we ensure there is spare time to volunteer at underserved medical clinics, attend community meetings, and engage in meaningful activities as part of the larger community. We have regular protected afternoons for teambuilding activities, which often are chosen as group activities volunteering throughout local communities. We also partner with many community organizations to collaborate on improving the health of our neighborhoods and addressing social determinants of health and inequities on a more systemic level. Please see other sections and slideshows on our website for more information.
Unless we speak up in our community, our voices will not be heard and the needs of our patients will not be met. Have you found your voice yet? Maybe we can help!
We dedicate time and resources to promote research and scholarly activity among both Resident and Faculty Physicians. During didactics, residents present journal club articles, as well as teaching a core family medicine topic. Sutter Medical Center library personnel are available to assist with research and scholarly activities, as well as the staff at SIMR, the Sutter Institute for Medical Research. Specific didactics are provided each year to introduce these resources to residents. In addition, residents may choose to participate in research studies and scholarly articles that residency faculty are undertaking.
Some recent projects include:
- Preconception CoIIN project – Investigate and innovate new approaches to pregnancy intention screening and follow up delivery in primary care setting
- The PATHFINDER study – A prospective study of 6,200 participants using the Grail multi-cancer blood test for screening and identification of multiple cancer types
- ROSES – A 3-year implementation study of ROSES, an evidence-based intervention to prevent postpartum depression in low-income women.
- Case study – One of our Family Medicine residents, in collaboration with Infectious Disease and Hematology/Oncology doctors, is authoring a case series on Intravascular B-Cell Lymphoma.
- Interpersonal Violence (IPV) – Qualitative research exploring the impact of California’s physician IPV mandated reporting law
The Sacramento area is unique in that there are 8 Student Run Clinics (SRCs) where local students and Family Medicine residents can volunteer. All 3 Family Medicine residency programs in the area have been very involved in the student run clinics. As a resident, one finds that, after a short time, he or she can quickly pass on what they have learned to budding medical students. The teaching is valuable to the student and the resident. The patients are so appreciative.
For more information on the local SRCs, please see the UC Davis School of Medicine.
To compare Sacramento’s abundance of SRCs with that of other cities around the country, please see the website for the Society of Student-Run Free Clinics.
We value service to the underserved and disenfranchised populations. Taking care of our local population’s health is not only compassionate, it is a moral imperative.
Many residents have entered our program to continue their quest in helping the underserved. Some residents trained in the rural and urban University of California PRIME programs before residency and have plans to return to their underserved communities.
Residents are introduced to marginalized populations from the start on their inpatient Internal Medicine rotation where many uninsured “no-doc” patients are admitted. A variety of pathologies are learned on this rotation including infectious disease, chronic liver and kidney disease, advanced cancer manifestations, substance abuse, and malnutrition.
Through community rotations, residents work with underserved populations through County health services,the Chest (TB) Clinic, and The Davis Community Clinic). Many residents opt to volunteer at the local UC Davis student run free clinics.
Continuity clinic is the ultimate medical home for many of our underserved patients. Although Sutter Health contracts with many private insurance plans, a significant proportion of our patient population is comprised of Medicaid or indigent Medicare folks. Residents learn early on the importance of addressing multiple problems in a visit, as well as the psychosocial context of the patient, and cost-effective medication management.
Sutter Health has a relationship with WellSpace Health, a local FQHC (federally qualified health center). They specialize in mental health and substance abuse disorders. WellSpace Health has joined forces with our Emergency Department (ED) through the T3 Program (Triage, Transport, and Treat).
Our residents have also mentored local low-income high school students to pursue a career in the health sciences (see our Future Faces of Family Medicine section). Many of us have also volunteered in the local student run clinics (see Student Run Clinics section). Some residents and faculty have also served abroad, but as we all know, you don’t have to go that far to find underserved populations! With so many opportunities and so much community need, one physician makes a difference and many physicians together make an even greater impact.
What will be your calling?
Office-based and point-of-care ultrasound is starting to overshadowed traditional diagnostic tools like the stethoscope and tongue depressor. We are on the cutting edge of this technology with two high-end ultrasound machines in our clinics and a handheld V-Scan device.
Residents are trained in using ultrasound for not just prenatal purposes, but for IUD placement, abnormal vaginal bleeding, biliary disease, aortic aneurysm, hydronephrosis, vascular imaging, differentiation of cysts/masses/abscesses, and for musculoskeletal imaging including joint aspiration/injection. Images can be uploaded into patient records and archived for teaching purposes. Our residents and their spouses’ own pregnancies never lack for ultrasound pictures!
Multiple online training resources are available as well, including Sonosite’s website and through the University of South Carolina. We also have extensive teaching aids through the American Institute of Ultrasound in Medicine (AIUM).
Residency is hard. Our program knows Physicians are likely to develop many of their wellness patterns during residency just as they develop other behaviors that are part of medicine. These 3 years are the ideal time to facilitate development of well-being practices to have career long impact. Therefore, we integrate wellness throughout the residency experience.
Residents enjoy having 2-week rotation blocks, jeopardy call, representation at faculty meetings; as well as easy parking and food at the physician lounge. We regularly offer support groups, Balint, cohort retreats, program retreat, wellness activities (such as yoga, qi gong), team building (eg. Volunteer at foodbank, float down the American River), and administrative support (eg. ‘Friend with EPIC’/EHR, quality improvement of clinic operations). Our behavioral scientist is available at all times; as are senior residents, faculty advisors, and employee assistance program (EAP). There is also a Well-being elective to provide protected time for the resident to focus on creating a sustainable wellness plan for themselves and to model for patients.