What is the Firm System?
"Firms" are administrative 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 administrative and "troubleshooting"
responsibilities for the housestaff in that group. In addition, residents are
assigned one specific attending (their "physician-in-charge" or PIC)
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 and 25 attendings. The goal of the firm system is for
smaller groups of residents 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.
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 practice
partners or attendings (You can look in CADENCE to see who has available clinic
slots; schedule your patient in as a follow-up/coverage slot). Just make sure
that you write an informative WebCIS 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) 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 attending) who may have available clinic
slots (look in CADENCE). Make sure to write electronic notes, and
email or notify your partner about the patient in advance.