EPs doing primary care addition to their urgent care?

[TrumpetDoc]

Is this something any of you guys are seeing in your community urgent cares? Particularly, primary care services offered with urgent cares on by emergency physicians?

Is a lot of urgent care stuff in the primary care realm? Sure. However, wouldn't pose a bit of a problem marketing yourself as a PCP and/or offering PCP services as an EP?

I have no idea. I realized recently that a former partner in our group who had left emergency medicine from a hospital standpoint went to open his own urgent care has his urgent care as a "urgent care/primary care". I even had a patient in the ED that states he was "her doctor"... blew my mind for a second.


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[Birdstrike]

Absolutely. Why wouldn't you?

A paid visit, is a paid visit.

Anyone who does urgent care is going to develop a subset of regulars, who use the urgent care as a PCP. And why wouldn't you do the BP med refills, URIs, pap smears, and just refer out as indicated? Some of that is what you do in the ED anyways.

I know one guy who just left full time EM to do UC and he loves it (despite the pay-cut). He hasn't built up a tons of regulars yet, but has some. Those that have been there longer have many more. We had this exact conversation a couple of weeks ago, actually. You do it to the extent you're comfortable. If anyone gets too chronically complex, you just tell them they need an internist, or sub-specialist as indicated, and refer. Anyone that's an acute train wreck,

"Call 911" baby!

 

[TrumpetDoc]

Absolutely. Why wouldn't you?

A paid visit, is a paid visit.

Anyone who does urgent care is going to develop a subset of regulars, who use the urgent care as a PCP. And why wouldn't you do the BP med refills, URIs, pap smears, and just refer out as indicated? Some of that is what you do in the ED anyways.

I know one guy who just left full time EM to do UC and he loves it (despite the pay-cut). He hasn't built up a tons of regulars yet, but has some. Those that have been there longer have many more. We had this exact conversation a couple of weeks ago, actually. You do it to the extent you're comfortable. If anyone gets too chronically complex, you just tell them they need an internist, or sub-specialist as indicated, and refer. Anyone that's an acute train wreck,

"Call 911" baby!

I hear yeah. And from a practical standpoint I would agree I don't think I would have any problem doing simple to moderate primary medical stuff at all. I'm very comfortable in my medical knowledge and I consider myself pretty well up to date.

I've never given issue much thought in the past, but I wonder if there's any issues from a state board perspective and/or insurance perspective regarding practicing outside your specialty? I suppose, as with most state issues, it would be very state specific And by outside one's specialty that would mean "technically" as per the specialty monikers. However as you mentioned above, simple, noncomplex, things, I feel practically speaking would be a nonissue.


More power to him.


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[Birdstrike]

You're right. For low risk things, "scope of specialty" is a non-issue. For even more complicated issues, gray areas are the rule.

Is an SSRI out of the scope of primary care? Must such come from psych?

Can primary care not treat any chronic pain? Must all opiates, even low dose, only be prescribed by pain?

Can primary care not treat an Emergency? Must an Emergency physician be the only one to treat emergencies?

Can Emergency Medicine not treat a uri, since it's primary care and not an Emergency? What about a BP med refill for 3 days? What about 7 days? What about 30 days with a refill?

When you start asking the questions you start to realize specialty overlap is the rule, and how difficult defining such borders are and why Medical Boards tend to stay hands off on this issue.

An EP doing some basic primary care overlap in an Urgent Care, I think, generally would be unquestioned.

A psychiatrist dabbling in brain surgery would be a whole different matter.

 

[Hercules]

No there are no medical board issues with it. I guess you also have to define what primary care is. For me and our urgent care we define it as long term management of chronic medical problems and we have a list of PCPs we refer to if the patients needs that (diabetes, htn, etc). Do you see a lot of low acuity problems that could have gone to a PCP? Absolutely. I can tell you that for young healthy patients with no chronic medical problems we wind up being the only doctor they see a lot of the time whether it's for sick visits, pre-op physical, work physicals, DOTs, travel vaccinations, etc.