• Inpatient Psychosomatic Medicine Service – The fellow will spend 50% of his/her time on this service, The psychosomatic medicine service is currently staffed by three faculty physicians and one clinical nurse specialist. Additionally, there is typically one PGY-4 and two PGY-1s, along with 3 to 4 medical students. The fellow will act as a junior faculty member on the service and be responsible for supervising the PGY-1s and medical students, discussing and staffing cases with them. Each attending psychiatrist will also directly work with the fellow evaluating the same patient, together or sequentially, discussing the findings, and arriving at a well-considered diagnosis and treatment plan. Cases are discussed in morning rounds and a review of relevant literature is strongly encouraged. Additional responsibilities of the Fellow include: liasoning with medical/surgical services (including teaching opportunities), decision to commit unstable patients, advice regarding psychiatric evaluation, management and disposition

The patient socio-demographic and payer mix is diverse. There are between 1,200 and 1,300 new cases annually. The average age is 50; 50% male/50% female. Diagnoses: 40% mood disorder, 30% cognitive disorder, 20% substance use disorder. The typical daily census is 15 cases. The average caseload for the PSM fellow is six or seven cases.

• Integrated Behavioral Health (IBHT) Clinic – This clinic is embedded in the Primary Care Center (PCC), which is a County clinic for the medically ill. The psychiatric clinic is primarily responsible for seeing patients who qualify for County Medically Indigent Services.  The goal is to provide psychiatric evaluation, brief treatment, and referral to the PCC primary care physician for ongoing treatment of the patient’s medical and psychiatric conditions. A dually accredited faculty in medicine and psychiatry is the supervisor for this clinic.

• Huntington’s Disease Clinic – This clinic is imbedded in the Department of Neurology clinics and occurs approximately twice monthly. One of the PSM faculty and the fellow are assigned to the clinic on alternating Friday mornings.  Huntington's Diesease patients are assessed for neuropsychiatric manifestations of their disease and an appropriate care plan is arrived at. The psychiatric care is then managed by the PSM team with assistance from the Neurology clinic. This can be a 6-month or full year clinic.

• Internal Medicine Consultation Liaison Clinic – A clinic that is embedded in the Internal Medicine Residency Clinic in which medical patients are referred for psychiatric evaluation. The fellow works with an adjunct PSM faculty who is dual certified in Internal Medicine and Psychiatry and together they come up with an assessment and plan for each patient that is then relayed to the primary treating physician. As this is a consult clinic, patients are generally not followed long term, but 1 or 2 follow-ups are common. Typical census is 4 patients per half day. This can be a 6-month or full year clinic.

• Transplant Clinic – Approximately one half day per week that can be done for 3, 6, or 12 months. The transplant service works primarily with kidney patients, as well as patients who received their liver transplants at UC Davis before June 2009 and still get follow-up care. All patients receive a psychosocial evaluation from a social worker prior to transplant. Transplant patients with psychiatric illness either pre- (once listed) or post-transplant are evaluated and treated by the transplant psychiatrist. The average caseload is two pre-transplant evaluations weekly and one to two follow-ups a week for treatment. The fellow functions as a primary consultant to the service with principal responsibility for his or her patients. He or she will also sit on the Kidney Transplant Committee, which meets one hour a week. The transplant psychiatrist provides one hour of supervision every week and also serves on the Kidney Transplant Committee with the fellow. There are no other mental health services rotating to the transplant patients, though there are two full-time social workers who provide all initial psychosocial assessments to the Transplant Service. There are transplant surgeons, surgical residents, nephrologists, dieticians, and occasional medical students on the transplant service. The psychiatrists work closely with transplant social workers and nurses to address psychiatric assessment and treatment issues with transplant patients.

• Bariatric Surgery/Gastric Bypass Clinic – Approximately one half day per week that can be done for 3, 6, or 12 months. The GI surgery service has a dedicated psychiatrist who is a faculty member on the psychosomatic medicine service. The patient population is predominantly female (70%) with a range of psychiatric diagnoses, including affective, substance abuse, anxiety, and eating disorders. The average caseload is two patient evaluations a week for gastric bypass surgery and one to two follow-ups per week for postoperative patients.  The fellow functions as a primary consultant to the service with principal responsibility for his or her patients. The attending psychiatrist provides supervision directly on-site. There are medical students and GI surgery residents and attending’s who see patients in the clinic at the same time as the psychiatrists. There is a full-time psychologist and dietician who consult to the service and work closely with the psychiatrist and fellow. There is also a weekly GI surgery support group for post-surgery patients led by the social worker with whom the fellow can electively co-facilitate. There are opportunities for collaborative research with the attending psychiatrist on gastric bypass patients. UC Davis is a participating site in the LABS (Longitudinal Assessment of Bariatric Surgery) program.

• Telemedicine Clinic – This is available approximately one half-day per week for 3, 6, or 12 months—currently Thursday PMs with services to the Indian Health Service of California. There is one faculty psychiatrist—Dr. Soulier. Educational activities involve patients/families, PCPs, medical students, and residents. The fellow will teach patients (and PCPs) about mental illness and treatments through psychoeducation, live demonstration of web sites, and other resources that may be of use to them. The fellow could also do grand rounds for the Center for Health and Technology (CHT), which houses the telemedicine consultations, by interactive video to multiple sites using a bridge such that all sites are interactive.  Faculty can moderate the discussion as applicable. The fellow will teach medical students and residents through individual cases about interviewing, diagnosis, treatment, consultation to primary care and rural health. Clinical population: adults,mostly, with some geriatric and child cases.  Patient diagnoses include: Mood disorders, 51%; Adjustment Disorder, 22%; Anxiety Disorders, 11%; Psychotic Disorder, 4%; Substance Disorder, 3%; other, 9%. Fellows complete 1-2 evaluations and 1-2 follow-up patients per 4-hour clinic. As this service is consultation, there is not an ongoing caseload but there may be patients referred for re-consultation. On-site, case-based supervision is provided with presence for each patient.

• HIV Clinic – This is an elective rotation that is available for 6 or 12 months, located at the Center For Aids Research, Education and Services Clinic. The fellow will have the opportunity to work with a dual certified physician in medicine and psychiatry and act a primary consultant to Infectious Disease physicians caring for HIV patient. The clinic will involve assessment and diagnosis of psychiatric ailments that are comorbid to, or directly related to the patient’s disease and/or treatment of the disease. This is a continuity clinic so that patients can be monitored on a long-term basis.