ZSFG Primary Care
About the Richard Fine People's Clinic
RFPC provides more than 30,000 patient visits to more than 8,000 individual patients, the majority of whom were low-income people with complex medical conditions. RFPC is staffed by UCSF faculty from the ZSFG Division of General Internal Medicine and UCSF Internal Medicine residents from the Primary Care and Categorical Residency Programs. Nurse practitioner, nursing, behavioral health, nutrition, medical evaluation assistants, and clerical staff are provided by ZSFG. Faculty, residents, and students from the UCSF School of Pharmacy provide a range of pharmacist services.
RFPC uses an electronic health record that is integrated with hospital data, and includes notes, medications, allergies, laboratory and diagnostic studies, as well as an electronic referral and consultation system.
Richard Fine People’s Clinic patients select or are assigned to a Primary Care Provider to ensure both continuity of care and the opportunity for residents to develop longitudinal relationships with patients. At the same time, in order to support our residents in caring for their patients, we use a team model of care that includes a practice partner, a primary attending preceptor, a resident continuity nurse practitioner, team medical evaluation assistants, team behavioral assistants, and team clerks.
RFPC provides a wide range of services for patients, including primary care, urgent care, telephone advice, nurse triage, nutritional counseling, pharmacist consultation, and behavioral health services. Because nearly 30% of RFPC patients have diabetes, the clinic has focused much of its efforts on developing an array of chronic disease management programs including registry support, nurse care management, insulin intensification visits, group visits, and referrals to the Wellness Center as San Francisco General Hospital.
As one of the core clinics for Healthy San Francisco, San Francisco's universal access to care program, RFPC is working with our sister clinic, the Family Health Center, and multiple specialty services to develop co-management programs to improve the care of diabetes, asthma/COPD, chronic low back pain, and congestive heart failure.
Hours of Operation
The clinic is open from 8:30 a.m. to 5:00 p.m., Monday through Friday. In addition, there are evening clinics on Monday, Tuesday, Wednesday, and Thursday from 5:00 p.m. to 9:00 p.m.
The patients served by RFPC are highly diverse and medically and socially complex, with many patients from vulnerable and underserved populations. RFPC disproportionately cares for complex patients without established primary care providers who are discharged from ZSFG inpatient wards. By race/ethnicity, 39% of RFPC patients are Latino, 24% are Asian, 18% are White, 14% are African American, 2% are American Indian/Alaska Native and 1% are Native Hawaiian/Pacific Islander. The vast majority of RFPC patients are low income, and have three or more chronic illnesses (e.g. diabetes, heart disease, arthritis, depression, cancer, etc.) and psychosocial comorbidities. Many grapple with homelessness (10% of our patient population), psychiatric disease, poor social support, low English proficiency (nearly 40% speak a primary language other than English), limited health literacy (less than 50% have adequate functional health literacy), history of substance use (25%), and a history of domestic violence (45% of female patients).
The breakdown of patient primary insurance type is as follows for RFPC: Medi-Cal, 49%; Medicare, 22%; Healthy Worker (a health insurance program administered by San Francisco Health Plan to providers of In-Home Support Services, Public Authority, Homebridge or temporary exempt employees San Francisco), 12%; Healthy San Francisco (available to uninsured San Francisco adults without access to affordable health insurance), 9%; Uninsured, 6%; Commercial Insurance, 1%. About 1 in 5 RFPC patients are hospitalized at ZSFG one or more times a year, a rate comparable to that of older Medicare patients. Twenty three percent of RFPC’s patients are over age 65.
Excellent Teaching Environment
The Richard Fine People’s Clinic has over many years been consistently rated one of the best sites for resident continuity clinics among UCSF residents. While the complexity and pace of patient care can be challenging, attending physicians are available on-site and after-hours to provide consultation and advice as needed. Clinical experience is supplemented by daily pre-clinic conferences that cover a breadth of outpatient medicine topics. RFPC is also fortunate in having experienced, dedicated nursing and clinic support staff who facilitate the learning experience for residents.
The Richard Fine People’s Clinic has a strong commitment to quality improvement, and welcomes resident and fellow involvement in improving our processes of care. Resident projects have focused on colorectal cancer screening, women’s health/cervical cancer screening, weight management, Hepatitis C, advanced directives, and other important clinical areas. RFPC provides individualized quality metrics to each primary care provider on a quarterly basis.
The Richard Fine People’s Clinic provides access to clinical and non-clinical data for a diverse patient population. Residents, fellows, and attendings interested in performing research projects involving RFPC patients must obtain approval from the RFPC Medical Director or Nurse Manager and other appropriate members of the Division of General Internal Medicine at ZSFG. Download the detailed Process for Applying to RFPC for Research Studies here.
San Francisco Health Network
RFPC is a clinic situated within the broader San Francisco Health Network (SFHN). SFHN is a network of clinics and hospitals dedicated to bringing quality health care to all San Franciscans, regardless of immigration status or lack of insurance. Learn more about the San Francisco Health Network here.