can specialists ( ophto, derm, etc) treat primary care ailments (colds, flu, etc..)

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i have a qusetion about what specialists can do. If you train as a dermatologist, anesthesiology, ophtolmologist, ent, etc (the specialities w/ good hours/pay/lifestyle) which have their own residency programs and aren't a subset of internal medicine, can you still treatment patients for primary-care-based conditions like the common cold, diabetes management, annual physicals, etc? Right now I'm leading toward internal med but i'm also considering one of the other specialties. Are there combined programs for primary care (general pratice, fam pratice, im) + derm/anesthesiology/ophto/ent or would you have to do both independently if you wanted to pratice both? what about board certification? some docs have it while others don't. what's the length of the shortest primary care program?

Moving to the general residency forum.

Once you complete 1-2 years of residency and pass Step 3, you get an unrestricted medical license. Theoretically, this lets you do anything. You can do neurosurgery or psychiatry even though you are not trained as such. The restrictions come in when dealing with hospitals and insurance companies. A hospital is not going to let you use the OR unless you are trained appropriately. Similarly, insurance companies will not reemburse you unless you are approriately credentialed.

Now all this puts the brakes on PCPs from doing specialty stuff. Your question really concerns going the other way. I see two problems. First, you would likely have difficulty with your malpractice insurance. Since you have never been trained in primary care you may have trouble getting insurance. Second, you simply wouldn't be competant. Primary care is not just the absence of being a specialist, you need to know lots of stuff. When you get sued for malpractice (which happens to almost every physician irrespective of fault), you will also be an easy target for the plaintiff's due to your lack of primary care specialty training.

Ed

what's a transitional year? does that what gives you the prescription writing ability? For things like ophto and ent surgical procedures, I think you might have to retire earlier (like many dentists do) once you get old and your hands aren't as steady. on the other hand, pcp usually can work for a pretty long time. it'd be nice to be able to do both.

anyone know exactly what board certification is? I've know of some doc's who aren't board certified in their area but still pratice it. I've also heard of one researcher (md/phd) who's bragged that's he's board certified in some area even though he said he never officially trained in it.

There are 24 medical specialty boards. Being 'board-certified' means that you have met the criteria for a particular specialty board. If you look at physician job-websites or advertisements in journals you will see that most jobs requre you you to be BC/BE which means board-certified or board eligible. Each board has different certification requirements that usually include completing an accredited residency +/- fellowship and taking some oral and written exams.

I don't know if this information is what you are looking for, but it may be of interest to a few people....

Regardless of the specialty you have trained in, a few states are moving to absolve physicians from ANY liability for providing FREE care. For example, if you could be a psychiatrist with an interest in proving free primary medical care to the indigent and do so without worry of malpractice charges (depends on individual state law). Generally, you are not protected from GROSS malpractice issues. In my state, the statute is very clear on what constitutes "gross malpractice" such that you'd have to cut off the wrong leg or be high on crack during a procedure to be subject to a civil suit.

The intent of the legislation is to address the issue of the uninsured not receiving care, as well as to address the concerns of practitioners who would like to provide care, but are scared away from what is at least perceived to be a highly litigious demographic.

Reference: http://www.aaos.org/wordhtml/bulletin/jun01/fline6.htm

If anyone has an interest in this legislation, check your own state. If it doesn't have such legislation, see if there is a proposal on board and submit one if not .

You need a medical license in order to prescribe medications. Most states require that you do at least one year of residency (any field) and a lot of states require two years. Every state also requires that you pass Steps 1-3 or either USMLE or COMLEX. Every specialty (pathology and radiology included) can prescribe any drug and if you have a DEA license any narcotic that's available at the pharmacy (excluded some oncology drugs). I'm a radiology resident and have full prescription priveldges which I've had to use several times.

That's what you need to get your license and you usually have to attend so many hours of CME (continuing medical education) classes in order to keep your medical license. Every state is a tad different in this.

With this license you can practice medicine but as other replies have stated if you want hospital priveledges or even to get paid by most insurance companies you need to be board certified in an area. If you find enough patients to pay you out of pocket and don't need priveledges at a hospital you could practice medicine and probably do ok.

Once you're board certified in say..Ophthalmology, you will have no problems billing for primary care procedures, visits, etc if you wish but most specialists don't care to practice that kind of medicine and you really should leave it up to the people who have trained in that area, but there are no restrictions.

For board certification, it pretty much requires that you complete a residency in that field plus written and/or oral exams. Now, most specialties require that you recertify every 10 years or so as well. Back in the day...you could become board certified by just taking the test and now doing any residencies and without having to renew every 10 years as well...so lifetime certification. I know a guy who is BC in FP, Psychiatry, and PM&R and only did a FP residency. This doesn't happen anymore though, but that's why you may see people board certified in fields they didn't do a residency in.

If you were to enter one of the specialties you have named you will have no need or desire to perform annual physicals,treat colds,or follow diabetics.Firstly, its not what you are trained for so you will not feel comfortable doing it even if legally you are permitted to.It would be financially pointless as time spent doing specialty procedures generally pays far more than these activities.There have been combined Derm-IM programs in the past,primarily to train dermatologists with expertise in treating individuals with associated systemic diseases.So there may be few such types of programs still around but they are not set up to train primary care practitioners but to fill a unique niche.In general ENT,Anesth,opthal are happy to leave primary care to others.

If you didn't complete an IM or FP residency you should not be a pcp. If you complete a 3/4 year EM residency you are not qualified to be a fp physician. And even though FP's and IM's practice medicine in the ED, most of them work in ED which don't see trauma.
During a FP or IM residency you follow a particular curriculum which will prepare you to be a competent pcp. Being a doctor does not mean you knwo everything there is to know about every disease and every procedure available. You don't see gynecologist treating a patient who has heart disease.

Off topic...

On er, doesn't carter and luka who are trained as EM go to africa to do primary care?
-if you've watch the wb's show called 'everwood'...that one neurosurgeon doc left ny to become a family pratice doc.

ahh....it only happens in the movies....