Downtown ST. Louis Ambulatory Internal Medicine & Urgent Care Residency Program
Downtown Urgent and Primary Care was founded in 2009 with Dr. Saggar's vision for and values of access, affordability, respect, integrity, inclusion, excellence, and diversity. These values have withstood the first ten years and still ring true today. We are proud to serve, train, and employ people that represent the real world in which we live. All life is precious and we take our duty to care for everyone very seriously, regardless of their ability to pay. These values continue to provide us with inspiration and direction. We remain committed to our founding values and stand together to support each other.
Program Overview
Our typical resident will be a Missouri-licensed Assistant Physician. The 24/7 Urgent Care and the associated residency known as Downtown STL Medicine (DSM) was created specifically and deliberately for Assistant Physicians, such that they have a means to directly care for patients, regardless of whether they are still applying to traditional residencies or not.
Because of the nature of this learning opportunity, a resident may join a program at any time during the calendar year, upon successful completion of Shadowing Shifts and an offer letter from the program director.
The residency program will accommodate any needs to get away for interview elsewhere and it is our goal to help all our residents get to where they really want to be. Similarly, if the resident commits to DSM until such a time that full licensure is awarded, we will be honored to have you on board for the duration, and we will do our best to train, teach and hone your clinical skills as much as possible. We pride ourselves on being credited for the skills and clinical acumen of the people who have received their training with us.
Because of the nature of this learning opportunity, a resident may join a program at any time during the calendar year, upon successful completion of Shadowing Shifts and an offer letter from the program director.
The residency program will accommodate any needs to get away for interview elsewhere and it is our goal to help all our residents get to where they really want to be. Similarly, if the resident commits to DSM until such a time that full licensure is awarded, we will be honored to have you on board for the duration, and we will do our best to train, teach and hone your clinical skills as much as possible. We pride ourselves on being credited for the skills and clinical acumen of the people who have received their training with us.
PGY-1
The rotations of the ambulatory care internship are designed to fill the needs of those planning for either an internal medicine career or an urgent care career or both, and emphasize acute care, chronic care, time management and the development of requisite clinical skills.
This first year of training is chiefly outpatient internal medicine and urgent care.
Educational competencies, goals, and objectives are achieved through required learning experiences. The required educational competencies are as follows:
Required Learning Experiences (all PGY years)
Teaching Requirement
Seminar attendance is mandatory and mostly occurs in the form of 1 to 1.5 hour seminars on Tuesday and Thursday mornings. A minimum of 40 seminars must be attended in each calendar year, this number including the seminars delivered by the PGY-1.
The PGY-1 resident will be expected to deliver a minimum of 12 presentations, each being a minimum of 15 minutes, in each calendar year. The presentations must be scored out of 10 by a minimum quorum of 3 recipients, achieving a minimum of 20 points (out a maximum of 30) for each presentation.
The PGY-1 resident will also provide lectures, presentations, and in-services to physicians, nurse practitioners, medical assistants and other healthcare staff.
Residency Projects (all PGY years)
The resident is expected to help design and complete two major projects during each academic year. One project will be Internal Medicine based. The other project will be Urgent Care based.
Projects are presented at a Project Presentation Meeting held in the spring. The resident will work with the residency program director to identify a potential project and for mentoring throughout the project period.
This first year of training is chiefly outpatient internal medicine and urgent care.
Educational competencies, goals, and objectives are achieved through required learning experiences. The required educational competencies are as follows:
- Patient care
- Leadership and management
- Advancement of community-based practice and improving patient care
- Teaching, education, and dissemination of knowledge
Required Learning Experiences (all PGY years)
- Orientation (typically a minimum of 120 hours, as set by the Missouri Board of Healing Arts)
- Diabetes, Hypertension, Hyperlipidemia Management for Primary Care patients
- Annual Physicals and Follow-Up Visits for Primary Care patients
- Other Primary Care Conditions
- Management of Common Conditions in the Urgent Care patient
- Management of Worker Injury Cases in Occupational Medicine
- Management of Telemedicine Cases
- Understanding the Business of Medicine, specifically how to run an outpatient practice in Internal Medicine and/or Urgent Care
- Teaching Requirement (see below)
Teaching Requirement
Seminar attendance is mandatory and mostly occurs in the form of 1 to 1.5 hour seminars on Tuesday and Thursday mornings. A minimum of 40 seminars must be attended in each calendar year, this number including the seminars delivered by the PGY-1.
The PGY-1 resident will be expected to deliver a minimum of 12 presentations, each being a minimum of 15 minutes, in each calendar year. The presentations must be scored out of 10 by a minimum quorum of 3 recipients, achieving a minimum of 20 points (out a maximum of 30) for each presentation.
The PGY-1 resident will also provide lectures, presentations, and in-services to physicians, nurse practitioners, medical assistants and other healthcare staff.
Residency Projects (all PGY years)
The resident is expected to help design and complete two major projects during each academic year. One project will be Internal Medicine based. The other project will be Urgent Care based.
Projects are presented at a Project Presentation Meeting held in the spring. The resident will work with the residency program director to identify a potential project and for mentoring throughout the project period.
PGY-2 and PGY-3
The next two years of residency (PGY-2 and PGY-3) are spent enhancing the skills learned in the PGY-1 year.
In addition, there will be concurrent 1-month-long rotations in the following 8 areas (in addition to the usually scheduled shifts), and an approved essay is required in each except #8 to summarize understanding of the rotation:
These 8 rotations will be done once as a PGY-2 and once as a PGY-3. The PGY-3 essay in each case will be a continuation of the PGY-2 essay to demonstrate increased knowledge and understanding of the rotation in question.
The goal of the PGY-2 resident is to function independently as an internal medicine or urgent care physician by conceptualizing and integrating accumulated experience and knowledge and incorporating both into the provision of patient care or other advanced practice settings.
Teaching Requirement
Seminar attendance is mandatory and mostly occurs in the form of 1 to 1.5 hour seminars on Tuesday and Thursday mornings. A minimum of 50 seminars must be attended in each calendar year, this number including the seminars delivered by the PGY-2.
The PGY-2 and PGY-3 resident will be expected to deliver a minimum of 20 presentations, each being a minimum of 15 minutes, in each calendar year. The presentations must be scored out of 10 by a minimum quorum of 3 recipients, achieving a minimum of 20 points (out a maximum of 30) for each presentation.
The PGY-2 and PGY-3 resident will also provide lectures, presentations, and in-services to physicians, nurse practitioners, medical assistants and other healthcare staff.
Residency Projects
The resident is expected to help design and complete two major projects during each academic year. One project will be Internal Medicine based. The other project will be Urgent Care based.
Projects are presented at a Project Presentation Meeting held in the spring. The resident will work with the residency program director to identify a potential project and for mentoring throughout the project period.
As part of the teaching requirement, the PGY-2 and the PGY-3 resident will design and deliver a 1-hour didactic lecture to all other residents (of all PGY years), at least once in any 12-month period.
In addition, there will be concurrent 1-month-long rotations in the following 8 areas (in addition to the usually scheduled shifts), and an approved essay is required in each except #8 to summarize understanding of the rotation:
- Supplies Management
- Coding & Billing
- Marketing
- Staffing
- Training support staff
- Policy development and application
- Budgeting: drafting and presentation for new/existing projects
- Leading the Tuesday/Thursday Morning Meetings
These 8 rotations will be done once as a PGY-2 and once as a PGY-3. The PGY-3 essay in each case will be a continuation of the PGY-2 essay to demonstrate increased knowledge and understanding of the rotation in question.
The goal of the PGY-2 resident is to function independently as an internal medicine or urgent care physician by conceptualizing and integrating accumulated experience and knowledge and incorporating both into the provision of patient care or other advanced practice settings.
Teaching Requirement
Seminar attendance is mandatory and mostly occurs in the form of 1 to 1.5 hour seminars on Tuesday and Thursday mornings. A minimum of 50 seminars must be attended in each calendar year, this number including the seminars delivered by the PGY-2.
The PGY-2 and PGY-3 resident will be expected to deliver a minimum of 20 presentations, each being a minimum of 15 minutes, in each calendar year. The presentations must be scored out of 10 by a minimum quorum of 3 recipients, achieving a minimum of 20 points (out a maximum of 30) for each presentation.
The PGY-2 and PGY-3 resident will also provide lectures, presentations, and in-services to physicians, nurse practitioners, medical assistants and other healthcare staff.
Residency Projects
The resident is expected to help design and complete two major projects during each academic year. One project will be Internal Medicine based. The other project will be Urgent Care based.
Projects are presented at a Project Presentation Meeting held in the spring. The resident will work with the residency program director to identify a potential project and for mentoring throughout the project period.
As part of the teaching requirement, the PGY-2 and the PGY-3 resident will design and deliver a 1-hour didactic lecture to all other residents (of all PGY years), at least once in any 12-month period.
PGY-3
The PGY-3s increase their autonomy throughout this year. Their time is spent crafting their patient management, time management, medical decision making and procedural skills to the point that proficiency, efficiency and confidence are achieved in a superior capacity, with regard to internal medicine and urgent care medicine.
Certification
A diploma will be awarded to any resident that has completed and demonstrated the following:
The diploma qualifies residents to apply for full licensure after 3 years with Downtown STL Medicine, having satisfied all the above requirements. Note: When we achieve a partnership with an umbrella residency, the certification would come from the overseeing program, just as any other resident therein.
- 6,000 hours of scheduled shifts (this does not include overtime or traded shift acceptances), typically over a 3-year period.
- Seminar attendance (as above): 40 as PGY-1, 50 as PGY-2, 50 as PGY-3.
- Presentation deliveries (as above): 12 as PGY-1, 20 as PGY-2, 20 as PGY-3.
- Completion of the 8 rotations as PGY-2 and PGY-3, as well as all 16 essays, that are deemed acceptable to the Program Director.
- Strong work ethic, including fairness to coworkers, including fellow providers and all support staff.
- Sharing the workload, with regard to housekeeping during shifts, including Lab Review, Chart Review, picking up shifts for others and being perceived as an all-round helpful person who is appreciated by one's fellows.
- Has worked hard to augment the patient experience and to promote the facility as a desirable place to visit, be it for internal medicine or urgent care matters.
- Professionalism in all matters, with regard to fellows, support staff and patient care.
- Has always endeavored to do the best for each and every patient, and has treated them "like a loved one".
The diploma qualifies residents to apply for full licensure after 3 years with Downtown STL Medicine, having satisfied all the above requirements. Note: When we achieve a partnership with an umbrella residency, the certification would come from the overseeing program, just as any other resident therein.
Current Pay Rates (as of 10/4/18)
Because this is a "safety-net as-yet-unaccredited residency program" and chiefly designed for unplaced medical school graduates, namely Assistant Physicians licensed in Missouri, the pay is not salaried, rather but based on actual clinical hours worked. This may change as when we partner with an overseeing umbrella residency program.
*hours or duration must be completed, whichever comes later.
**worked in primary care and/or urgent care shifts on the official schedule.
Note: The average residency salary in 2018 was $51,000 in year 1 to $60,000 by year 5. Working 60 to 80 duty hours during residency, the average hourly residency pay for 48 weeks (assuming 4 weeks vacation) = $17,70/hour to $20.83/hour.
All pay as as per a paid apprenticeship for independent contractor, meaning that no taxes or other deductions are withheld. Those are the responsibility of the resident to submit when filing annual taxes with the IRS.
Downtown STL Medicine is working hard with various legislators at the State level to streamline and provide a clear pathway for full unrestricted licensure as a physician in the State of Missouri, upon completion of the above criteria and having been awarded certification accrediting the Assistant Physician. Please refer to HB710 (subsection 334.033)
- PGY-1: $16/hour for first 1,000 hours/6 months*; $18/hour for 2nd 1,000 hours/6 months* (working from 36-60 hours typically)
- PGY-2: $21/hour for 3rd 1,000 hours/6 months*; $24/hour for 4th 1,000 hours/6 months*
- PGY-3: $27/hour for 5th 1,000 hours/6 months*; $30/hour for 6th 1,000 hours/6 months*
*hours or duration must be completed, whichever comes later.
**worked in primary care and/or urgent care shifts on the official schedule.
Note: The average residency salary in 2018 was $51,000 in year 1 to $60,000 by year 5. Working 60 to 80 duty hours during residency, the average hourly residency pay for 48 weeks (assuming 4 weeks vacation) = $17,70/hour to $20.83/hour.
All pay as as per a paid apprenticeship for independent contractor, meaning that no taxes or other deductions are withheld. Those are the responsibility of the resident to submit when filing annual taxes with the IRS.
Downtown STL Medicine is working hard with various legislators at the State level to streamline and provide a clear pathway for full unrestricted licensure as a physician in the State of Missouri, upon completion of the above criteria and having been awarded certification accrediting the Assistant Physician. Please refer to HB710 (subsection 334.033)
please Contact Us If You want to learn more.
We are always accepting applications. To start, please send us your C.V. and cover letter or reach our with questions via the form below!
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If you are a licensed Assistant Physician in the State of Missouri and you have the ability, willingness to learn new skills, and desire to serve your community, we would like to hear from you. Please see the residency milestones below for what you can expect:
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