Substance use disorders are a common cause of morbidity and mortality. Alcohol and tobacco continue to be the most commonly abused drugs in primary care clinics; and illicit substance use disorders continue to grow. To address these issues, our residency incorporates substance use in the longitudinal Human Behavior and Mental Health curriculum and during the Psychiatry rotation. Some of our core faculty have Buprenorphine licenses and are supportive of resident Suboxone training. We also have core faculty in the Motivational Interviewing Network of Trainers. There is an Addiction Medicine elective to assist residents gain additional competence in substance use disorder screening, intervention, and treatment in primary care and community health settings. In addition, there are opportunities to moonlight at a community center providing treatment for Opioid Use Disorders.
Assisting patients with mental health issues, substance misuse, and behavior change are key elements in any family medicine clinic. To address these components, we integrate the biopsychosocial model throughout training, particularly during our outpatient continuity clinic and inpatient rounds. We are expanding evidence-based practices for integrative care within our continuity clinics utilizing our established interdisciplinary team. We offer electives in Addiction Medicine, Psychotherapy, Chronic Pain, Corrections Medicine, and Lifestyle & Self-Management strategies.
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, one of our own family medicine faculty who performs 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. They also have participated for several years in the Rocking Chair project.
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 local experts, complete online courses, and/or attend an away elective such as the University of Arizona Integrative Medicine Rotation.
Located in the heart of California , we have strategic proximity to our legislators and media hubs. Residents can spend an elective rotation accompanying CAFP lobbyists and there are always a variety of advocacy efforts going on around the Capitol.
Former residents Alisha McCon-Dyer and Irene Lee–Klass served as Resident Presidents of the CAFP during their respective years. Other residents have been involved with CAFP during their training or during medical school. Faculty member Nathan Hitzeman is the physician editor of CAFP’s quarterly magazine California Family Physician. Participation in advocacy with the CAFP is a nice way to network with other Family Medicine programs both local and statewide. To learn more about getting involved with CAFP, visit http://www.familydocs.org/advocacy/.
Our residents have also engaged in various community volunteering activities. 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!
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.
Our residency program has traditionally been most involved with Clinica Tepati, a free clinic for the local uninsured Latino population. However, some of our residents have volunteered at the other SRCs. 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.
Former resident Dr. Robert Martinez went on to fulfill his National Health Service commitment in the underserved mountain populations north of Los Angeles. Former resident Dr. Matthew Rosenberg cares for an indigent population in Winters California and prior to that worked with County Health. Former resident Dr. Heather Lucas-Ross returned to her home town of Grass Valley in the Sierras to care for the large local Medicaid population. Former resident Dr. Betsy Meux is a champion for the indigent Latino population in Davis through Communicare. Former resident Dr. Ninad Athale joined Clinic Ole in Napa Valley to serve a mostly Latino population insured by Medicaid. 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.
With faculty member and women’s health expert Dr. Sharon Blosk, residents provide advanced GYN care to indigent patients referred by County health and other community clinics in the form of colposcopy, cervical and endometrial biopsies, cryotherapy, and LEEPs.
Residents are exposed to a more rural population through an elective rotation in the Sierra foothills at Sutter Amador. There, Sutter internist Dr. Bob Hartmann serves as the public health officer, and he teaches students and residents the value of public health policy. He’s also passionate about rattlesnake bites!
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). This program identifies frequent visitors to the ED and provides them outpatient continuity. Instead of “haunting” the ED and getting short term fixes, these patients learn to pick up the pieces of their lives through counseling and social services.
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).
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. Residency is the ideal time to facilitate development of these practices to have career long impact. We integrate wellness throughout the residency experience. We regularly offer support groups, Balint, cohort retreats, program retreat, wellness activities (such as yoga, qi gong), team building. 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.