Max Rosenfeld '26: Primary Physician Partners

In 2022, Eli Lilly and Company conducted the SURMOUNT-1 trial, a double-blind, placebo-controlled study, to evaluate the efficiency and safety of a weight-loss medication, tirzepatide, marketed as Zepbound; the study involved over 2,500 participants across multiple countries, spanning 72 weeks. On average, participants on the highest dose of Zepbound, 15mg, reported a loss of 20.9% of their total body weight over the 72 weeks, while participants in the placebo group lost only 3.1%. Like most weight-loss medications, tirzepatide activates receptors in the brain that help with appetite regulation, resulting in a decrease in hunger. It can also slow down the rate at which food leaves the stomach, allowing users to feel fuller for longer and reducing overeating.

This summer, I had the opportunity to shadow Dr. Todd Malvey with the Primary Physician Partners at St. Vincent Hospital, where I learned much more than just the benefits of Zepbound and other weight loss medications. Primary Physician Partners is a private practice that works closely with a few other practices within the hospital; in recent years, Dr. Malvey has taken on the role of “Practice Owner”. The added responsibilities that arise with running a practice on top of being a physician were unbeknownst to me before this summer. However, I was fully able to experience them during my internship.

Generally, most days were similar. After handing my parking ticket to be validated by Katie at the front desk, I would take a left and walk down the hall to Dr. Malvey’s office. Once there, he and I would sit down and discuss the day’s schedule. Currently, Dr. Malvey only sees established patients, meaning he isn’t taking on anyone new. The benefits of an established patient to a physician are evident, since doctors have dealt with them in the past and have an idea of what to expect. For example, if a certain patient has experienced recent trauma or is more difficult to deal with, Dr. Malvey can let me know so I am prepared beforehand. However, what is paramount about an established patient is their medical records. When a new patient visits the office, they inform the doctor of any previous injuries, procedures, medications, etc., to be put on file. Upon their next appointment, the doctor can access the information already given by the patient to aid their exam. According to Dr. Malvey, when dealing with an acute problem, there are certain steps to figuring out what might be happening. Step 1 is to review the patient’s chief complaint and medical history, to see if any previous encounters match the current issue, before even seeing the patient. This step allows him to come up with a mental list of a variety of conditions that could be occurring. Step 2 is to discuss the patient’s issue in the exam room to narrow down options. Dr. Malvey will ask questions such as “When did the pain start?” or “Have you begun taking any new medications?” to gain any additional information that will aid his diagnosis. Step 3 is the actual exam. 

A typical exam room

Here, Dr. Malvey utilizes his background as a DO (Doctor of Osteopathic Medicine) to examine the entire body and identify the root of the problem. Oftentimes, he will be left with two to three possible conditions, and can recommend a plethora of options for the patient to consider in their healing process, including medication, therapy, or referrals to specialty doctors in other fields.

While the majority of patients came in for physical exams or minor complaints, ever so often, appointments would increase in complexity. During my two weeks at the hospital, I had the opportunity to witness and even perform several procedures: some with Dr. Malvey and others with the MAs (Medical Assistants). Jackie, the main MA I worked with, would often perform procedures such as standard vaccinations. 

Vaccine Fridge in the MA

However, when a patient came in for a pre-op (pre-operation appointment) or related reason, an electrocardiogram (EKG) was needed. An EKG is a short, non-invasive test that measures electrical activity in the heart. This is important, as it helps a doctor assess the patient’s heart health and identify any potential risks associated with the surgery or anesthesia. The machine works by attaching 10 sticky electrodes to the skin —two for the arms, two for the legs, and six around the pectoral muscles—and connecting them with wires. Once in place, the machine begins measuring and prints out a reading for the physician to look over and determine.

Examples of EKG results

With Dr. Malvey, however, procedures typically varied. I was able to assist with numerous cases, including freezing a plantar wart with liquid nitrogen, administering a “cortisone” shot, applying finger splints, and flushing out earwax.

Loading the cryogun   Dr. Malvey demonstrating how to prepare a cortisone shot

Because he runs his own practice, Dr. Malvey must take administrative, or “admin”, days. Essentially, this means that once weekly, instead of seeing patients, he will use the day to run through employees’ insurance, putting in orders for medications, sending in labs (bloodwork), and reviewing patient billing. Witnessing many appointments showed me their variation in complexity; not every visit was straightforward or routine, forcing Dr. Malvey to constantly be ready for any given issue. However, I was unaware that these complexity levels factored heavily into how a patient is billed. Dr. Malvey showed me how certain factors affect the cost of an appointment, including time, complexity - how difficult or how many problems a patient has - and procedures. For example, a patient with a minor headache will be charged far less than a patient who spends thirty minutes getting a mole removed. Since most of this work was done on the computer and non-interactive, I would stay home on admin days doing explorations of my own. After seeing a patient, Dr. Malvey and I would discuss the diagnosis for me to research. I was able to come in the next day to match my findings with the histories and symptoms of the patients earlier in the week, gaining a further understanding of the medical conditions themselves and how to spot them in real time.

An example of my research

With an interesting and exciting job also came average tasks. As an intern, part of my work was to help make sure the office was fully stocked and prepared for whatever a physician or patient may need. I learned that doctors’ offices keep informational packets on specific conditions or issues to hand out to the patients, and physicians need to regularly make copies of them to keep up with demand. 

   Photocopying patient handouts                          Stocking informational packets

Another important job was to check the supply closets for expired medications. After a medication has passed its expiration date, its effects begin to wear off slowly. While they might technically still work, it is unprofessional to provide a patient with an expired aspirin, for example. Once a month, a physician will go through the medications that are either expired or about to expire; this was one of my duties. 

Checking for expired medications

Tasks like these helped develop standard office and life skills, and further showed me that preparation is one of the most important parts of being a doctor.

Aside from being in the office with Dr. Malvey, another part of my internship that came about on its own was my work with Dr. Dimitrios Angelis in Cardiology. Dr. Angelis runs his practice out of the same office space as Dr. Malvey, so he quickly became a familiar face. From the start, his inviting spirit was evident, as he came to me on the first day with an opportunity to observe a live cardioversion, a scheduled procedure. When someone of older age adopts unhealthy habits, their heart can fall out of sinus rhythm - a normal heartbeat - and fall into what is known as atrial fibrillation, or AFIB. In AFIB, the heart beats in an unusual, shaky pattern and is at a strong risk of failure or stroke. There are several paths to get out of AFIB; however, one of the most common ways is to shock the heart back into a sinus rhythm, which cardioversion does. Once the patient was fully anesthetized and hooked up, Dr. Angelis demonstrated how to use the defibrillator that supplied the energy. On one side was a screen that displayed the patient's heartbeat and rate for the doctors and nurses to see, while the other had a panel of buttons capable of increasing voltage, charging, and delivering the shock. 

A defibrillator used for cardioversions

After my first cardioversion, Dr. Angelis was kind enough to allow me to return for two more cardioversions during my internship, even pressing the button to shock the patient.

My time with the Primary Physician Partners served not only as an incredible experience, but also as an insight into what a career in medicine looks like. There is much more to being a doctor than simply checking in on patients. Seizing every chance to learn about and witness something new benefited my internship and provided me with further knowledge into how different professions within a hospital go about their work. I’m fortunate and grateful to have had this opportunity; thank you, Dr. Malvey, for making it happen.

Dr. Malvey and I in his office