IntroductionThere are six subspecialty firms at Yale New Haven Hospital's York Street Campus that housestaff will rotate through over the course of training. These firms include the Oncology Firm, the Duffy Firm (hematologic malignancies), the Donaldson (HIV) Firm, the Klatskin (liver disease) Firm, the Peters (renal disease) Firm and the Goodyer (non-CCU cardiology) Firm. The goal of training on the medical subspecialty inpatient Firms is to provide an intensive and focused interdisciplinary experience caring for patients with both common and less common conditions in these specialty areas of medicine. While these topics are also encountered during general medicine rotations, the subspecialty rotations provide a complimentary in-depth experience working directly with attending physicians from the respective specialty sections of the Department of Medicine. The specialty Firms are geographically localized and the Firm Chiefs oversee both the clinical and educational experiences of the Firm, integrating quality of care, systems-based improvement and inter-professional care into the daily experiences of the Firm.
Oncology and Hematology FirmsThese Firms consists of two parallel Firms, one focusing on the care of patients with solid tumors and the other focusing on patients with hematologic malignancies. Each is staffed by an Oncology and a Hematology attending, fellows, PGY-II and III residents, interns, students and integrated mid-level providers. The inpatient oncology service provides exposure to a wide variety of cancer patients including those with oncological emergencies, neutropenic fever and graft versus host disease. Pain management and end of life issues are also a focus on this service. Cancer care at Yale New Haven Hospital is centralized at Yale Cancer Center and Smilow Cancer Hospital.
Donaldson (HIV) Firm
The Donaldson Firm consists of two attendings with specialty training in Infectious Diseases/HIV disease, PGY-II and III residents, interns and students. This Firm is named after Dr. Robert M. Donaldson Jr.
Dr. Donaldson was not an infectious diseases specialist, but an eminent gastroenterologist who served the Department of Medicine at Yale in many capacities, as chief of Medicine at the VA Connecticut Healthcare System, vice chair and interim chair of Medicine and interim dean of Yale School of Medicine. In the latter phase of his professional career, the AIDS epidemic had peaked and resulted in devastation of the lives of those whom it affected and the lives of their loved ones. Dr. Donaldson could not remain on the sidelines, and well into his mid-sixties, he began to attend outpatient clinics that cared for patients with AIDS, learned about the disease from faculty colleagues who were experts in the disease and devoted the latter part of his life to the cause of patients with AIDS. The Donaldson Firm is also staffed by a dedicated nursing staff with added expertise in HIV care, a dedicated case manager and social worker and is linked with the outpatient HIV service at Yale.
Klatskin (Liver) FirmThe Klatskin Firm consists of an attending with expertise in Hepatology/Gastroenterology, a subspecialty fellow, PGY-II and III residents, interns and students as well as integrated mid-level providers who have added expertise in the care of patients with end-stage liver disease and technical expertise in paracentesis. This Firm is named after Dr. Gerald Klatskin, identified by many in the field as the father of hepatology in America and one of the pioneers of the subspecialty of liver disease in the world. Dr. Klatskin was the recipient of the American Gastroenterological Association’s highest award, the Julius Friedenwald Medal. A master clinician, he maintained detailed records on index cards of the thousands of patients that he saw over the years. His collection of many thousand Kodachromes of liver biopsies of every kind of liver disease known at the time, to the understanding of many of which he had made substantial contributions to, is legendary. With the largest liver transplant program in New England at Yale, the breath of liver disease encountered on the Klatskin Firm is broad. In addition to diagnostic assessment and management of liver disease, there is a focus on assessing and managing quality of life and end-of-life care issues.
Peters (Renal) Firm
The Peters Firm consists of a Nephrology attending and a general medicine attending, a nephrology fellow, PGY-II and III residents, interns and students as well as integrated mid-level providers who have added expertise in the care of patients with end-stage renal disease. In addition to the care of patients on the inpatient service, trainees have the opportunity to attend a variety outpatient nephrology clinics.
This Firm is named after a giant in american medicine, Dr. John Punnett Peters, who joined the Yale faculty in the 1920s, developed laboratory medicine and contributed greatly to metabolic diseases, from which in time emerged the subspecialties of nephrology and endocrinology. Dr. Peters was also a man with a deep sense of social commitment who ruffled many feathers in the political system of his time in the U.S. by being a champion for the poor and complaining bitterly about the quality of the health care they received, initially during the Great Depression, but also thereafter. His liberal views on this and similar issues such as universal healthcare while politically unpopular at the time, spoke to his commitment to the social contract of medicine, a core value of Medicine at Yale.
Goodyer (Cardiology) Firm
The Goodyer Firm consists of a Cardiology attending, a cardiology fellow, PGY II and III residents and integrated mid-level providers. The Firm cares for patients admitted to the telemetry unit with a wide range of cardiac conditions. In addition to the care of patients on the Firm, residents spend afternoons in the cardiac diagnostic labs (e.g., echocardiography, nuclear cardiology, the cardiac cath lab, the exercise stress test lab). The focus of these sessions is on the appropriate selection of patients for various cardiac diagnostic tests, the sensitivity and specificity of the tests and the role of the cardiologist consultant in the collaborative care of patients.
This Firm is named after Dr. Allan V.N. Goodyer, the first full time faculty member to serve as chief of cardiology. He joined the Department of Internal Medicine at Yale as an instructor in 1948 and was promoted to professor in 1966. His early research was in the field of fetal electrocardiography, which provided the background for this technique in modern obstetrics. His subsequent research was in the elucidation of the mechanisms relating electrolyte and water disturbances to cardiac failure. He then became involved with the evaluation of left ventricular function by computer analysis of the left ventricular pressure curve. Dr. Goodyer was recognized for his teaching skills and the Yale inpatient cardiology service proudly bears his name.
Medical Step-Down Unit (SDU)
The medical step-down unit (SDU) is located at Yale New Haven Hospital York Street Campus and provides an opportunity for senior residents to provide care to a diverse array of acutely ill patients in a true inter-professional model of care. The team consists of two attending physicians, three senior residents, mid-level providers and a dedicated nursing staff.
Patients are typically admitted from the emergency department and there is a focus on learning how to triage patients to the appropriate level of care, the initial care of patients who have a level of acuity of illness that is not high enough to warrant an ICU admission, but that is above that which can be safely and efficiently accomplished on a general medical ward, and the safe transition of patients from one level of care to the next.