Creating a Niche: Four Hours of “Choose Your Own Adventure”

The aspirations and values of new physicians, fresh out of residency or fellowship, shape the future of academic primary care in profound ways. We are witnessing a paradigm shift, where flexibility and the pursuit of niche clinical interests, often acquired through additional training, are increasingly prized by new graduates. At UCLA’s Department of Medicine (DOM), we attempt to provide faculty positions in Primary Care that align with these emerging trends, offering physicians a unique blend of flexibility and specialized care within the framework of academic primary care medicine.

This approach is structured around 3 key frameworks: referral structures, specialized visit blocks, and carve-out/protected time. These strategies not only cater to the diverse interests of physicians but also enhance patient care through specialized expertise.

Referral Structure

In addressing the specific clinical interests of physicians, the EMR referral structure plays a pivotal role. For instance, primary care physicians with extensive training in Women’s Health can join a specialized medicine referral pool. This allows them to focus on areas of care, such as IUD placements, Nexplanon insertions, or treating menopausal symptoms. High-volume referrals in these areas result in dedicated blocks in their schedule, enabling them to concentrate on these specialized services apart from their regular primary care responsibilities.

Similarly, physicians with a background in Sports Medicine are afforded a comparable referral infrastructure. This arrangement ensures they have dedicated time blocks for their sports medicine practice, integrating their specialty into the broader fabric of their primary care clinic.

Specialized Visit Blocks

Once a physician chooses a niche, we establish specialized visit types in the appointment template to cater to physicians’ interest in caring for specific patient populations. Physicians designated as LGBTQ champions, having undergone additional training, are provided with gender health blocks featuring expanded visit durations. This initiative ensures comprehensive and specialized care for the LGBTQ community.

Physicians with an interest in Obesity Medicine can participate in the Program for Reducing Obesity (PRO). This multidisciplinary, supervised medical weight loss program features group visits led by physicians, offering a novel approach to tackling obesity. Physicians have time set aside to conduct group visits with visit blocks placed into their schedules.

A similar initiative caters to patients with sickle cell disease. Physicians interested in this condition are grouped in certain offices, providing concentrated care for this patient population using specialized visit blocks.

Adding to these initiatives is the RAIN program—Reducing Alcoholism in Neighborhoods. This innovative program positions primary care physicians (PCPs) at the helm of a multidisciplinary team, including behavioral health specialists, to address alcoholism. In this medically supervised program, the team works collaboratively to provide comprehensive treatment and support for patients struggling with alcoholism, blending medical expertise with behavioral health strategies to offer holistic care.

Carve-out/Protected Time

We recognize the importance of nurturing new areas of specialization as well. Physicians interested in becoming LGBTQ champions, who did not complete additional training prior to joining on as faculty, are offered 10% protected time for a two-year training program. Post-training, these physicians integrate gender health visits into their clinical practice.

Opportunities also exist for protected time for faculty who join the Quality team, those who are interested in Health Equity, or Global Health.

Offering structured pathways for specialized primary care, the department caters to the evolving desires of our physicians and hopefully helps new faculty members to find value and fulfillment in academic primary care at the start of their careers.