Once again, it's that time of year.
The new interns are starting to trickle onto campus, and they will start their clinical rotations next week.
The senior residents have for the most part wrapped up their last outpatient block rotations, and have said often emotional goodbyes to their long-term patients, many of whom they've cared for over the past 3 years.
They have helped them manage their medical conditions, addressed healthcare maintenance needs, made new diagnoses, saved lives, helped some die with dignity.
They have helped guide patients through these past few terrible pandemic years, a challenge none of them signed up for, but they took on wholeheartedly with unflinching courage.
At a certain point next week -- I believe it's at midnight on June 21 -- a switch will be flipped somewhere deep in the electronic medical record, and the primary care provider field for the patients of the senior residents will change over to their new intern providers.
This can often be a challenging time for patients, as well as for the new interns, and ensuring continuity can be critical to the success of the process and enhancing the care of our patients.
One of the wonderful things about our practice is how we have tried to ensure this continuity, that our patients will preferentially see their primary care provider as the default whenever possible.
In the first few months of the new academic year, when patients have not yet had an opportunity to meet their new providers, there are often more interim visits and increased discontinuity, which can be challenging and frustrating for all involved.
The remarkable thing about practicing at a site with interns and residents -- one of the many remarkable things -- is the quality of the bond that forms between these younger physicians and their patients.
In many ways, this is the heart and the soul of primary care.
We owe it to this process, to these doctors, and to these patients, to create a healthcare system in which they can all thrive and succeed and get healthy.
Often on social media and other places, I see people commenting about the lack of stature for primary care as a choice for graduating medical students.
Many see it as a place where care is chaotic, where it's all about paperwork and forms and endless note taking, and on the inpatient internal medicine side, rounds that last forever.
If we can enhance and improve the experience of training in an Internal Medicine resident clinic practice, we can demonstrate to more and more of these folks coming through that this is an amazing choice, an incredible place to practice medicine and to have a career, and to fill an absolutely necessary role in the healthcare of our society and the health of our patients.
There will always be chaos.
Patients will (always) arrive late due to transportation issues: because the subway was delayed, or they thought their appointment was at 10 am not 9 am, or traffic was a mess because the United Nations was in session making gridlock of our entire neighborhood.
The challenges our patients face in dealing with their social determinants of health reflect onto the ability of the providers to care for them, leading to more and more challenges we need to overcome.
The social needs and how they impact the health of our patients makes it doubly hard to get their medical conditions under control.
When patients are choosing food and rent over medications, it's hard to control their hypertension.
When patients are fearful about taking their medications, due to mistrust or misinformation or lack of the knowledge they need to make the best decisions, it's hard to get their diabetes under control.
When our patients are suffering from anxiety, depression, and other significant mental health issues, these can present unbreachable barriers to getting to the best health possible around all their other medical conditions.
When structural racism and other inequities stand in their way, healthcare often falls by the wayside.
In Internal Medicine there will always be forms to fill out, barriers from insurance companies, charts to complete, pandemonium in the day-to-day practice.
But if we can pump up the resources available to our new physicians, and align these with resources in the community to help our patients address these many underlying issues, we will more likely be more successful in enticing people to join the ranks of primary care.
Primary care in all its different iterations forms the foundation of our healthcare system, the foundation of the health of our communities and our individual patients, and we owe it to them all to build a better system.
Welcome, new interns, to the wonderful world of caring for patients.
Let's get started.