The Family Medicine Building and the Family Medicine Center located therein contain over 50,000 square feet for outpatient care, teaching and administration. The first floor houses the Family Medicine Center. The second floor has offices for faculty and staff, a library and a conference wing. The outstanding features of the Family Medicine Center facility are summarized in Table 1.
What do our patients look like?
Patient visits to the FMC currently stand at approximately 54,000 per year. The racial mix of our patients is 58% Caucasian, 29% African American, and 13% other ethnicities. The age distribution of the patient population in the most recent report is listed in Table 2.
Approximately 26% of patients are covered by Medicare (including approximately 5% that are dually-eligible with Medicare and Medicaid). Approximately 13% are covered by Medicaid only, 45% by managed care plans, and 5% covered by other health insurance plans. The remaining 12% are self-pay.
In the most recent analysis of FMC encounter data, we found that the top 15 diagnoses in the practice accounted for over 40% of all diagnoses entered on encounter forms. Hypertension, uncomplicated adult onset diabetes, and hypercholesterolemia topped the list, followed by limb pain, routine child health visits, routine adult exams, depression, abdominal pain, low back pain, fatigue, chronic pain, chest pain, headache, obesity, and anxiety.
Continuity Care Clinic. Over the course of three years in the program residents' practices build from a continuity panel of 75-100 patients (from 2-7 patient visits per half day) in the first year, with a total of 200 or more visits in a year. By 2nd year, panels are between 150 and 200 (7-9 visits per half day) with the expectation they will have 500 patient visits. By third year, residents average 350 patients (10-12) visits per half day and can expect to have over 1,000 visits by the end of the year. When residents see patients in the Family Medicine Center, there is a minimum of one faculty preceptor for every four residents available for questions and teaching.
Special Clinics. During the course of residency our residents have the opportunity to work in special clinics that are part of the FMC practice. Some of these clinics focus on services in the form of procedures such as colposcopy, vasectomies, and exercise tolerance testing. Alternative medicine contributes to this array with an active acupuncture clinic within the confines of the FMC. A skin clinic provides a substantial part of the residency training in dermatology. This variety gives residents a broad exposure to a wide range of issues in outpatient clinical care and an opportunity to interact with a variety of different providers
Family Medicine Months. A concentrated Family Medicine month in the first year is devoted to orienting residents to the Family Medicine Department, and to developing fundamental skills as family physicians. Educational themes include interviewing and counseling skills, outpatient procedures, prevention and health promotion, and the management of common outpatient diseases. The month also provides an opportunity for new residents to meet faculty and to get to know the Family Medicine staff. In the second year, another month is devoted to a Family Medicine experience, which includes increased clinical time, a focus on developing clinical skills for facilitating behavioral change, prevention, and community medicine. The second year also includes 2-weeks of behavioral medicine and a month of procedures, which is largely spent in the FMC. The focus of the senior year is on developing and honing ambulatory patient care skills in final preparation for practice.
Conference Curriculum. Another major component of training in the Family Medicine Building is the conference curriculum. Every Wednesday morning is devoted to the conduct of structured learning using small group and seminar style techniques of teaching. Each month covers a specific topic or theme ranging from cardiovascular health to preventive care. The curriculum is based over an 18 month time period so that each resident has the opportunity to learn and apply the information twice. Embedded in the Wednesday Conference block are also opportunities for both Intern Support and Finding Meaning in Medicine. (To Index)
This 665 bed tertiary care teaching facility provides a unique opportunity for learning the management of diseases in a technically sophisticated environment. It also serves as the community hospital for Chapel Hill. UNC Hospitals support a comprehensive range of residencies of excellent quality and strong reputations across the country. Family practice residents work closely with, and learn with, residents in other specialties. There is a full range of diagnostic and therapeutic services available within the institution.
Family Practice Inpatient Service. The Family Practice Inpatient Service provides a strong presence for Family Medicine in the UNC Hospitals system and has evolved into its present form over the course of more than a decade of development. A major portion of inpatient medical training for FP residents occurs on this service. Residents rotate through it for 8 weeks in the first year, 3 months in the second year and 6 weeks in the third year of residency. It consists of a broad spectrum of inpatient family medicine with educational emphasis on the management of acutely ill patients, selection of therapeutic agents, appropriate consultation, and skills in interviewing, physical exam and critical appraisal of the literature. Multidisciplinary care is emphasized with case managers and pharmacists as key members of the team who actively participate in rounds.
Family Practice Maternal and Child Health Service. The Family Practice Maternal and Child Health service provides the labor and delivery services for all patients who deliver in the FMC practice. Second and third year residents cover this service to complete their last two years of obstetrical training. The focus is on delivery of continuity patients whom residents have followed for prenatal care in their continuity clinics and care of the newborn. The MCH service also handles the obstetrical care at the time of delivery for women who seek their health care at the Orange County Health Departments, Highgate Family Practice, and Chatham Primary Care practices. The service also provides physician backup to a freestanding birthing center operated locally by midwives. In the last year the volume has risen to about 450 deliveries per year.
Other Rotations. Family Medicine residents also do rotations in other departments at UNC hospitals. The first year Emergency Room experience provides an opportunity to evaluate and care for emergent medical problems and learn how to make dispositions for their management. During Outpatient Surgery residents, spend time in the ER minor care area. In their second year, another month of pediatric training for the program comes in UNCH Pediatric Acute Care, where residents work shifts in the pediatric emergency room. Portions of the ENT, ophthalmology, dermatology, and sports medicine rotations also occur at UNC hospitals, satellite clinics of UNC and private practice clinics. (To Index).
WakeMed is an 870-bed, private, not-for-profit health care system based in Raleigh, NC and serving eastern North Carolina. It is located in Raleigh approximately 35 minutes from Chapel Hill. Below are some interesting facts about this community hospital:
- North Carolina's first freestanding Children's Emergency Department. It is a national model and serves more than 40,000 children each year.
- The WakeMed Heart Center ranks number one in volume among all North Carolina hospitals providing cardiac care and is also one of the highest volume heart centers in the United States.
- Mobile critical care services offering ground and air transport for adults and children.
- One of eight mother's milk banks in the world.
- Two nationally accredited Chest Pain Centers.
- Wake County's first Primary Stroke Center
Wake Med is Wake County's only:
- Level I Trauma Center as designated by the North Carolina Office of Emergency Medical Services.
- Neuro intensive care unit and dedicated neurosciences inpatient unit.
- Children's inpatient unit and intensive care unit - staffed around the clock by pediatric intensivists.
- Children's diabetes and asthma programs.
- Pediatrics specialists in surgery, neurology, endocrinology, orthopaedics, neonatology, child development and more.
- Women's Pavilion and Birthplace - Cary
- North Healthplex offers the state's first stand alone full-service emergency department.
- Emergency Services Institute focusing on research, emergency preparedness and response in the event of community emergencies and disaster either natural or man-made.
- Patient Simulation Center for training health professionals.
With over 35,000 admissions, 100,000 visits in the emergency department, and close to 5,000 deliveries a year, from a resident's perspective, it is an excellent site for community based training. Patients' medical problems are appropriate for training in primary care, the hospital has comprehensive ancillary services, and as an Area Health Education Center, it has many excellent faculty dedicated only to patient care and to teaching. Family Medicine residents spend all or part of six months at Wake in the first year.
Wake Pediatrics. Pediatrics (1 month each on inpatient ward and in outpatient clinic) at Wake Medical Center has always been very popular, and provides core experiences in acute and inpatient pediatric problems. Teaching on this service consistently receives high ratings from our residents. Residents adapt to the day shift and nightfloat system in place by the pediatrics service, as a member of the team covering the pediatrics floor during the inpatient month and as a cross-cover during the outpatient month.
Wake Obstetrics. The six-week obstetric rotation centers on a very busy labor and delivery deck. Residents average 30 or more deliveries a month, with a high proportion of normal deliveries and good backup available when complications arise. Time is also spent in the prenatal care and GYN clinics.
Wake Surgery. Residents do a month of general inpatient surgery at Wake where they have a wide range of learning opportunities available. Anyone who wants to spend time learning operating procedures gets good hands-on training on this service. Outpatient surgical procedures are done in the clinics and residents also see patients for pre-operative assessments and postoperative follow-up. (To Index)
The UNC Department of Family Medicine has had a long and fruitful partnership with Piedmont Health Services (PHS). PHS is a Federally Qualified system of community health centers and PACE (Program of All-inclusive Care for the Elderly) programs, operating six primary health care facilities in central North Carolina and a PACE program for the elderly, all within forty miles of the UNC School of Medicine. PHS started the first Community Health Center in North Carolina at Prospect Hill over 40 years ago. PHS also delivers multidisciplinary care to their patients with services that include Pharmacy, Case Management, Nutrition, Dental and Farm Worker outreach. PHS is one of the most important sites for prenatal care for underserved and minority patients with over 1,200 deliveries annually. Additionally as one of the key safety net providers in the area they play a central role in many of the regional community health programs. Its central facility is in Carrboro, adjacent to Chapel Hill in southeast Orange County, and five others are located in the surrounding counties of Chatham to the south, Caswell to the north and Alamance to the west. Like much of North Carolina, these counties are predominantly rural, 40% are below poverty level and 50% are black. There are also a significant and increasing number of Hispanic patients in the population and in some clinics more than half the patients are primarily Spanish-speaking.
Resident involvement with PHS patients and practitioners provides hands-on learning of the unique skills, knowledge and competencies needed to care for a diversity of populations such as rural, minority, immigrant and migrant populations in a resource constrained environment. During different rotations all residents have the opportunity to work at PHS sites, both the clinics and PACE program. PHS patients requiring hospitalization are admitted to the Family Practice Inpatient Service at UNC. The PHS site at Prospect Hill serves as the continuity site for our residents participating in the Underserved Track. (To Index)
Updated August 2012