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: