Primary Care Job Opportunities!

There are many organizations currently hiring primary care doctors in the Southern California region and UCSD graduates are highly desirable candidates! If you are considering a job in primary care, please reach out to Stacy Charat, Primary Care Pathway Director for more information (scharat@health.ucsd.edu)

Examples of opportunities include:

  • TrueCare Federally Qualified Health Centers in North County, San Diego
  • St. Jude Heritage Medical Group in Orange County
  • Private Practice multi-specialty group in San Diego

Pathway Applications – 2020

Hi everyone,

We are excited to announce that the applications for all our pathways are open!

This includes the following pathways:

– Global Medicine Pathway

– Hospital Medicine Pathway

– Integrative Medicine Pathway.

– Primary Care Pathway

– RACE (Residents As Clinician Educators) Track

The deadline is November 20th at 11:59pm PST. You may apply to as many of them as you would like, and we will work with you to match into one of them based on competitiveness, interest, and fit. Please note that you may do the Integrative Medicine Pathway concurrently with another pathway.

Please read the application requirements carefully (listed at the bottom of each google form) to ensure that you submit the required documents before the application deadline!

Global Medicine Pathway:

https://docs.google.com/forms/d/e/1FAIpQLScTh3Bb6CkBTGWTkvNyxx-EmeBi-IqDPRTSy1xNCtVOV9aRqw/viewform?usp=sf_link

Hospital Medicine Pathway:

https://docs.google.com/forms/d/e/1FAIpQLSec4P4abWlv3cGYMLCQuIgqeCHGNOg0eARC6SAgs45VAXFLLg/viewform?usp=sf_link

Integrative Medicine Pathway:

https://docs.google.com/forms/d/e/1FAIpQLSc2SCFqNVAe4pMxxG18L9GF61KKFJfkKaajhY-O83ibx4Nh3g/viewform?usp=sf_link

Primary Care Pathway:

https://docs.google.com/forms/d/e/1FAIpQLSeTKML9e9HKzEv77TxgJjmBkXxnO1gC1F-zxNAREp0sVaQJRA/viewform?usp=sf_link

Residents As Clinician Educators (RACE) Track

https://docs.google.com/forms/d/e/1FAIpQLSevIszRLhqoOh0s-Bewaj9jpXT863pXzNySuWxoaI9KtsnsNg/viewform?usp=sf_link

If you missed the pathway interest meeting, you can hear a bit about each pathway https://ucsdim.com/pathway-interest-session/ or review more on our blog under the ‘prospective residents’ heading, then ‘residency pathways’ here: https://ucsdim.com/residency-pathways/.

Feel free to reach out with any questions. Thank you!

Luke Webster, CMR

Pathway Interest Meeting–10/21/20

Thank you to everyone who joined us last night for the Pathway Interest Meeting! I have attached a link to the 30 minute introduction video as well as documents that were presented during the meeting for those of you who were not able to attend. 

Applications are being finalized as we speak! We will send a consolidated email in the next 1-2 weeks containing all pathway application forms and final application details. 

If you have any questions regarding specific pathways, please reach out to the chief in charge of your pathway!

Hospital Medicine: DJ

Global Health: Alex

Integrative Medicine: Samantha

Primary Care: Luke

RACE track: Nick

Pathway Session Video: 

Pathway Information on the Blog:

Please reach out with any questions!

Sincerely, 

Luke Webster

Buprenorphine DEA X-Waiver Training: September 17th!

Who:  Residents can take this course prior to obtaining their own DEA – your completion will be recorded for use later.

What:  AAAP Buprenorphine Half and Half Course (½ online independently and ½ “in person” via Zoom)

Where:  YOUR OWN HOME via Zoom! You MUST RSVP in advance, attendance will be taken

When:  September 17th, 2020; 8 am -12:30 pm (you must attend the entire time for the waiver)

Why:  To be qualified to get a DEA waiver to prescribe buprenorphine products (one common brand name is Suboxone) AND to feel confident managing this growing patient population

This course is designed to equip prescribers with the information necessary to understand and prescribe buprenorphine in a safe and effective manner.  It also meets the 8-hour requirement (½ in person; ½ on line) for MD’s and DO’s to apply for the DEA waiver to prescribe buprenorphine.

Details:
This training is for ½ of the 8-hour requirement.  The remaining 4 hours must be done online, and you must pass a self-study exam to apply for the waiver. Contact Carla  Marienfeld (cmarienfeld@health.ucsd.edu) if you are interested in attending.

Opportunity in Addiction Medicine

The California Society of Addiction Medicine’s annual conference will be held in San Diego from August 26-29th, 2020. Scholarships are offered to cover the entire cost of registration. Please contact Stacy Charat (scharat@health.ucsd.edu) if you are interested in attending with local faculty members.  The scholarship application requires very little preparation but the deadline is April 24th so please express interest ASAP!

Grand Rounds 2/26: Glucose Monitoring for the Internist!

Today our very own APD and endocrinologist extraordinaire Dr. Trish Santos presented an amazing talk on “Glucose Monitoring for the Internist: A Growth Mindset.”

We started with a discussion of the history of glucose monitoring since the 1950s into the current state of continuous glucose monitors (CGMs). This lead to a review of the use of hemoglobin A1c as a screening and monitoring tool for diabetes mellitus. Dr. Santos highlighted that the A1c is especially helpful from a population level and for predicting microvascular damage, but has some issues for individual patients. Current assays have a margin of error of 0.5%, and with data provided by CGM, it has been shown that the previous assumed fasting blood glucose (BG) levels may not actually reflect the true range of daily glucose variability in an individual. We reviewed some of this variability by looking at two patient examples and also discussed some of the reasons for variability in hemoglobin A1c.

We then started discussing the role of self-monitored blood glucose (SMBG) checks, which really only seems to have a role in patients on insulin therapy. Dr. Santos highlighted many of the challenges that patients face when using SMBG, which can be extensive! In addition to the challenges, we also discussed that the SMBG can give people false assurance about the true value of BG levels – it is not the gold standard for BG levels (plasma BG is the gold standard)!

Dr. Santos then completed her talk with a discussion of the CGM specifically. The CGM has 3 components: a subcutaneous glucose sensor, a transmitter, and a receiver (usually via a smart phone/device). Between devices, the mean absolute relative difference (MARD) is used, which assesses the accuracy between devices for BG monitoring. Dr. Santos then reviewed the most common devices available for our patients, with some important distinctions and caveats between devices (check out the summary table below). We discussed that the likely future of CGM will be an implantable sensing device that lasts for up to 90 days (newly available at UCSD)! Finally, we reviewed how CGMs can be used for data acquisition and for therapeutic intervention for type 2 diabetics. The use of CGM has been shown to improve both average BG levels and has lead to improved patient satisfaction as well! We are also slowly working on how to utilize the data provided by these devices, which is an ongoing, but exciting prospect!

HC MTC 2/19: Hypertension in Pregnancy

Today we went through a outpatient case of a pregnant woman who comes to her primary care clinic for follow-up to acid reflux. She was thankfully doing fine but when we examined her we noticed that on her vitals she had an elevated BP, tachycardia, tachypnea, a systolic murmur and pedal edema. Should we be alarmed? Should we send her to the hospital?


We next revisited normal physiological changes to expect during pregnancy and ultimately concluded that we should be concerned about her elevated blood pressure but the rest of the physical exam findings are were normal for pregnancy. We then spend the next part of session going over the diagnostic criteria and findings for chronic hypertension, pre-eclampsia/eclampsia and gestational hypertension and the treatment option a. Our teams did a great job filling out the information and teaching each other. We were also fortunate to have our outstanding Family Medicine attending, Dr. Julie Celebi join us today to give us some expert insight regarding what she does in her practice.

Thank you for your clinical pearls, Dr. Celebi!

Janet also shared a fascinating, and very relevant, recent study that indicates that there is increased risk of developing AS and MR later in life if women experience a hypertensive disorder during pregnancy: https://www.acc.org/latest-in-cardiology/articles/2019/11/09/08/42/nov11-5am-hypertensive-disorders-of-pregnancy-aha-2019.

Take-aways:

  1. Blood pressure should decrease as SVR decreases normally in pregnancy during the first trimester and then returning to prior baseline during the 2nd trimester. Elevated BP is therefore abnormal and should be concerning.
  2. If BP is elevated prior to 20 weeks, it is likely chronic hypertension. if is elevated after 20 weeks without any lab abnormalities, it is gestational hypertension. With proteinuria, after 20 weeks, we are concerned for pre-eclampsia.
  3. The current guidelines recommend treatment for SBPs >160, DBP >110, but for mild to moderate cases (between 140-150s/90-100s), treatment depends on patients’ co-morbidities and symptoms. First line treatment options are: PO nifedipine, IV labetalol or alpha-methyldopa. Attempt to deliver if this is a safe option for women experiencing pre-eclampsia/eclampsia.

Fellowship Opportunity in General Internal Medicine!

For those of you interested in primary care, please consider this unique fellowship opportunity:

Harvard Medical School (HMS) Fellowship Program in General Medicine and Primary Care

The fellowship program is a collaboration of major clinical institutions of HMS (Massachusetts General Hospital, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, Cambridge Health Alliance, and the Department of Population Medicine) and the Harvard T.H. Chan School of Public Health. The aim of the program is to prepare general internists for successful and rewarding careers as academic leaders. The research focus of the program includes priority topics identified in Healthy People 2020 such as reducing racial/ ethnic and socioeconomic disparities in care, improving access to care and the treatment of patients with common medical problems.

Please click the link below for further information:

https://www.hmsgenmedfellowship.org/