Training

The training experiences of fellows are tailored to their individual interests, enriched by interprofessional team-based care, and supervised by nearly 20 interdisciplinary program faculty board-certified or eligible in addiction medicine.

Amersa
Fellows and friends at AMERSA 2018


The clinical learning environment continues to grow through academic and community partnerships with teaching sites that include:

  1. Public hospital-based ambulatory addiction, primary care, and inpatient services at San Francisco General Hospital and Highland General Hospital.
  2. A wide range of community-based primary care, case management, sobering, respite, chronic pain, harm reduction and addiction pharmacotherapy programs sponsored by the San Francisco Department of Public Health.
  3. Local, non-profit community organizations that provide integrated primary medical care and mental health services, withdrawal management, harm reduction, and residential and outpatient addiction treatment for substance use disorder for communities in the San Francisco Bay Area.
  4. Clinical programs that specialize in the prevention and treatment of unhealthy substance use in adolescents, young adults, and pregnant and post-partum people.

Core Clinical Experiences 

Opiate Treatment Outpatient Program (OTOP)

OTOP is a publicly funded, licensed opioid treatment program (OTP) that provides outpatient treatment with methadone and buprenorphine to persons with opioid use disorder. The program provides a wide range of services, including psychiatric, hepatitis C and HIV treatment services, to poor and indigent people with addiction to illicit and prescription opioids. OTOP is licensed to provide methadone to 750 persons daily and located on the San Francisco General Hospital (SFGH) campus.  OTOP also operates satellite sites to reach patients in underserved parts of San Francisco through deployment of a mobile methadone van and office-based opioid treatment programs in three primary care health centers.

Site Directors: Scott Steiger, MD and Brad Shapiro, MD

Street Medicine and Shelter Health 

The Street Medicine and Shelter Health program provides street-based medical, mental health, and substance use treatment services to people experiencing homelessness in San Francisco. Using an adapted patient-centered medical home model, the Street Medicine team’s mission is to provide effective care for high risk, high vulnerability individuals experiencing homelessness, who were not getting what they needed elsewhere in the system.  The team will assess patients and establish care for chronic conditions such as medical, mental health, substance use, and cognitive disorders. Care is offered at an open access clinic, homeless encampments, navigation centers, shelters, and syringe service programs.  Medical staff join outreach services to help transition people living on the streets into shelter and housing. 

Site Director: Barry Zevin, MD

Inpatient Addiction Care Team (ACT) 

The Inpatient Addiction Care Team (ACT) is an interprofessional service launched in January 2019 at San Francisco General Hospital (SFGH) to improve the quality of care for hospitalized persons with unhealthy substance use. In a 284-bed hospital facility opened in 2016, SFGH provides 24-hour, comprehensive emergent, urgent and non-urgent care to 98,000 adult and pediatric patients annually. It is the city’s public safety-net hospital for the most socially and medically vulnerable persons living in San Francisco. It is also the sole Level 1 Trauma Center and psychiatric emergency service for the City & County.  The ACT features two components: 1) expert inpatient addiction medicine consultation; and 2) timely linkage-to-care to appropriate community programs post hospital discharge. The ACT provides the full spectrum of inpatient addiction medicine consultation, including screening and assessment; SUD diagnosis; behavioral therapies; medically supervised withdrawal management; and addiction pharmacotherapy initiation and optimization. 

Site Directors: Marlene Martin, MD 

Family Health Center (FHC) Bridge Clinic

The Bridge Clinic is embedded in the Family Health Center (FHC), the largest primary care clinic in the San Francisco Health Network (SFHN) public safety net system. Located on the SFGH campus, the Bridge Clinic provides consultation to FHC primary care providers and SFGH obstetric and orthopedic providers on a wide range of substance use-related issues, including risky, non-dependent alcohol use, prescription medication misuse, as well as alcohol, tobacco, and other substance use disorders.  The clinic also serves as a hospital discharge clinic for patients, who were admitted or seen in the emergency department and diagnosed with a SUD.Services include comprehensive evaluations, counseling, pharmacotherapy, referrals to higher levels of care with close follow up, and integrated prenatal care for pregnant women with SUDs.  

Site Director: Hannah Snyder, MD

Outpatient Buprenorphine Induction Clinic (OBIC)

Founded in 2003, OBIC offers buprenorphine initiation and stabilization for persons seeking treatment for opioid use disorders, then transitions patients to ongoing buprenorphine care integrated within community-based primary care or mental health care clinics. Patients served are largely indigent and many are experiencing homelessness or marginally housed. As the first buprenorphine induction clinic in the country, OBIC has initiated treatment for well over 1,400 patients. All patients receive culturally, linguistically, and age-appropriate care based on best-practice principles. Emphasis is placed on eliminating the stigma associated with substance use and other behavioral health problems. OBIC is co-located with the CBHS pharmacy and Treatment Access Program at 1380 Howard Street and funded by the San Francisco Department of Public Health.  

Site Director: Christine Soran, MD, MPH 

 

Participating Continuity Clinics 

Primary Care Addiction Medicine Fellows engage in two types of yearlong clinical experiences.  As primary care physicians, they maintain the equivalent of one half-day per week in a primary care continuity clinic that matches his or her prior clinical training. Fellows deliver integrated, comprehensive care for their primary care patients, including diagnosis and treatment of substance use disorders and related problems.  As addiction medicine physicians, fellows spend about one half-day per week in a primary care setting, practicing office-based addiction medicine and consultation to colleagues on the management of unhealthy substance use and chronic pain.

Site placements are within the San Francisco Health Network (SFHN), the city’s public safety net health system that cares for some 110,000 patients annually in 13 primary care health centers throughout the city.  An additional practice site is the Downtown Clinic of the San Francisco Veteran’s Administration for homeless veterans. 

Richard H. Fine People’s Clinic (RFPC)

Richard H. Fine People’s Clinic (RFPC) is an academic primary care practice that cares for about 8,000 of the City’s most medically and socially complex patients, delivering well over 30,000 visits per year. RFPC also is a major teaching site for UCSF Internal Medicine residents (categorical and primary care). Addiction Medicine fellows trained in internal medicine deliver comprehensive primary care and integrated addiction medicine and chronic pain management in this hospital-based general internal medicine clinic.  Location: San Francisco General Hospital (SFGH), 1001 Potrero Ave (Main Building 5, 1st floor, 1M).

Family Health Center (FHC)

Family Health Center (FHC) is the largest primary care clinic in the SFHN, providing the full scope of primary care services to 11,500 children, adolescents, adults, elderly and home-bound patients, all of whom are uninsured or publicly insured.  Services include continuity and urgent care, prenatal care and perinatal case management, family planning, HIV family clinic, minor office procedures, mental health and social services, substance use counseling and treatment, nutrition consultation, nurse care management and more. FHC patients reflect the rich ethnic and socioeconomic diversity of San Francisco – they speak 29 different languages, 70% are ethnic minorities, 60% are uninsured, 25% receive Medi-Cal, and 2% are homeless. The FHC also is a major teaching site for UCSF Family & Community Medicine residents.  Addiction Medicine Fellows trained in family medicine provide comprehensive care with a focus on systems based family-oriented care that optimizes use of health care resources.  Location:  San Francisco General Hospital, 995 Potrero Ave. Building 80, 1st and 5th floors.

Castro-Mission Health Center (CMHC)

Castro-Mission Health Center (CMHC): Established in 1965, Castro-Mission Health Center is the first public health center in San Francisco. Formerly known as Health Center 1, today this primary care clinic serves about 4,100 adults and children annually. About half of patients are Latinx and many patients are LGBTQ identified. The clinic also offers active HIV treatment and prevention programs.  Primary Care Addiction Medicine fellows fluent in Spanish work on a multidisciplinary care team to provide care for their patients. The clinic’s home is in the Castro District of San Francisco.  While undergoing renovation in 2019-20, its temporary location is at San Francisco General Hospital, 995 Potrero Ave. Building 80, 1st floor.

Positive Health Program (PHP) Ward 86 HIV Clinic

Positive Health Program (PHP) Ward 86 HIV Clinic: Established in 1983 as one of the first dedicated HIV clinics in the United States, Ward 86 at SFGH provides comprehensive medical care for roughly 2,600 persons living with HIV in San Francisco.  Ward 86 also is a teaching site for UCSF Internal Medicine residents and HIV/ID fellows. Addiction Medicine Fellows with HIV training deliver primary care and integrated chronic pain and substance use treatment based on harm reduction principles and evidence-based care.  Location:  San Francisco General Hospital, 995 Potrero Ave. Building 80, 6th floor.

Tom Waddell Urban Health Center (TWUHC)

Tom Waddell Urban Health Center (TWUHC) cares for adults experiencing homelessness, residents of supportive housing, and other members of San Francisco’s Civic Center and Tenderloin neighborhood community. Of the 3,700 patients served annually, nearly half fit the Health Care for the Homeless eligibility criteria; 15% Latinx, 35% Black, and 7% Asian. Specialty services include comprehensive HIV prevention and care; hepatitis C treatment; office-based opioid treatment; transgender care; integrated behavioral health services; podiatry and dental services. Primary Care Addiction Medicine fellows work in a multidisciplinary care team to provide care for a panel of patients with or at risk of unhealthy substance use. Fellows will see a high prevalence of homeless or marginally housed patients with “dual diagnosis” of substance use disorders and severe mental illness and work collaboratively in a harm reduction model with an integrated behavioral health team to optimize care for their patients. Location: 230 Golden Gate Avenue (between Leavenworth & Golden Gate).

Downtown Clinic (DTC)

Downtown Clinic (DTC) is one of 43 Department of Veterans Affairs program sites for homeless veterans. This comprehensive homeless center offers a wide range of psychosocial and health care services, including programs for outreach, therapy, housing, and employment to some 2,000 patients. The mission of Health Care for Homeless Veterans (HCHV) is to identify and engage veterans who are homeless or marginally housed and who underutilize VA services. By linking veterans with appropriate treatment and social services, its goal is to increase stability in veterans’ lives and assist veterans in returning to independent, healthy and productive lifestyles.  The DTC also is a teaching site for UCSF Internal Medicine residents.  Addiction Medicine fellows trained in internal medicine join a multidisciplinary team to provide low-threshold addiction, primary, and consultative care. Location:  401 3rd Street on the corner of 3rd Street and Harrison.