What is the Firm System?
"Firms" are smaller units within the AIM clinic. Housestaff
and attendings have been divided into five groups,
each consisting of roughly 4-5 attendings and 12-28
residents. Each firm has an assigned "Firm Chief," an attending with
supervisory, "troubleshooting", and administrative responsibilities
for the housestaff in that group. In addition,
residents are assigned one specific Firm attending who would be available to
the housestaff, on an on-going basis, to discuss
patients or questions. The AIM General Medicine clinic is extremely large--more
than 120 housestaff, 6 NPs, and 25 attendings. The goal of the firm system is for
smaller groups of residents, NPs, and attendings to
work closely together, fostering familiarity, better continuity of patient
care, on-going teaching, and closer supervision. On an administrative level,
unlicensed residents will use their attendings
license number/NPI/UPIN numbers for patient home care orders/medical
supplies/prescriptions. These numbers can be obtained by calling x 5-6262 (NPI
and license numbers can also be looked up at the DOH and NPI websites).
From a
resident's perspective, your firm assignments involve the following:
1) Your
firm is loosely geographically localized. Firm 1 is the Primary Care Team in module 240, Firm
2 is module 231, Firm 3 is module 224, Firm 4 is module 207,
and Firm 5 is module 214. Residents and attendings,
for the most part, are assigned based on the location of their clinic
office.
2) You have an assigned
attending/PIC. This
attending may or may not be present when you are in clinic (some attendings supervise only one session a week, some four
sessions a week), but if they are, you should try to present your cases to
them. This isn't mandatory, but the more you present to the same person, the
more familiar that attending will be with your practice style and your
patients. If a question or problem on one of your clinic patients comes up when
you're not in clinic (medical, logistic, bureaucratic, anything), and you'd
like to run it by an attending, contact your Firm Attending.
3) You have an assigned
firm chief. This is
one of the full-time clinician educators in the AIM clinic. They are
usually available on site, and are the person to speak to if you can not
immediately access your assigned attending.
4) Use your Firm Practice Partners to help provide clinic
follow-up/coverage. With the Firm system, we hope to replicate the "real
world" situation of small groups of physicians covering each other's
patients. If you have patients who need to be seen soon, but you don't have an
upcoming appointment slots to see them, schedule them with one of your Firm
partners, NPs or attendings (Soarian
is now built to be able to search for any open appts
within a module to see who has available clinic slots). Just make sure that you
write an informative clinic note to inform your practice partner what needs to
be followed and acted upon.
How does my Firm Coverage System Work?
If you have a clinic patient who needs to be seen at a time when you are
unavailable, you have several options:
- If it is urgent or an acute
problem (abdominal pain, URI, rash, refills....), the patient should go to
the Walk-In Clinic, which is open from
- If the issue is one of
follow-up (e.g., poorly controlled HTN, DM) or a situation in which
continuity is important or one which is more complex than is appropriate
for the walk-in clinic, you can make the patient an appointment to see one
of your practice partners (including the specific Firm attending and NP),
or any other practitioner’s in the practice, who have available
clinic slots. Make sure to write clear and understandable electronic
notes to convey clearly what you need them to do or focus on for the pt.