Family Med vs Urgent Care clinics

[NYYk9005]

Hey all,

I was wondering if anyone here who has their own family med clinic can shed some light on how it compares to an urgent care clinic.

Is income comparable? Why don't more doctors open a walk in/ urgent care type place?

Thanks!

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[DPCsoon]

Because urgent care sucks?

 

[deleted87716]

 

[DIce3]

awesome

 

[DrMidlife]

Give a newbie some telling anecdotes? Is this patient load just one URI after another?

 

[deleted87716]

Give a newbie some telling anecdotes? Is this patient load just one URI after another?

Close to 50% of urgent care visits are for URI/HEENT complaints. Nearly 50% of all prescriptions written are for antibiotics. The number one antibiotic prescribed is Zithromax.

http://jucm.com/pdf/JUCM_Urgent_Care_Chart_Research.pdf

 

[KnuxNole]

Close to 50% of urgent care visits are for URI/HEENT complaints. Nearly 50% of all prescriptions written are for antibiotics. The number one antibiotic prescribed is Zithromax.

http://jucm.com/pdf/JUCM_Urgent_Care_Chart_Research.pdf

Oh really? I thought urgent care was similar to going to the ED, but less wait time, where people walking in with chest pain, dyspnea, intense abdominal pain...but instead of the emergency room they go to clinic. I remember thinking moonlighting would be a nightmare because they would leave me alone in the urgent care where the patients I see are coming in with DKA, sepsis, well women visits, intense vaginal bleeding, and AMS. :O

Then again, I guess I never knew what urgent care really was. I just thought it was care that was given urgently

 

[deleted87716]

I thought urgent care was similar to going to the ED, but less wait time

It is, but without the full cardiac workup and head CT, generally.

http://www.rand.org/pubs/external_publications/EP50172.html

 

[DrMidlife]

Links to studies are my favorite answers.

 

[cabinbuilder]

Oh really? I thought urgent care was similar to going to the ED, but less wait time, where people walking in with chest pain, dyspnea, intense abdominal pain...but instead of the emergency room they go to clinic. I remember thinking moonlighting would be a nightmare because they would leave me alone in the urgent care where the patients I see are coming in with DKA, sepsis, well women visits, intense vaginal bleeding, and AMS. :O

Then again, I guess I never knew what urgent care really was. I just thought it was care that was given urgently

Yes, urgent care CAN be like this where the sickest folks walk through the door and you ultimately have to ship them to ER anyway. I personally LOVE urgent care because it changes every day and it's enough variety not to keep me bored but not the crash and burn folks you have to manage in the ER. I hate clinic medicine where its every day of DM, HTN, HLD, preventative care, and chronic back pain. Ugh, I just hate it. True, many days in urgent care are sick kids with fever and ear infection, folks with bronchitis and the tons of flu cases. I have seen MI, DKA, sepsis, severe skin tears, acute abdomen, severely broken bones, deep lacs, etc.

Sometimes I have the full lab, xray, and CT available. Sometimes I just have xray. Many times I have been where I just have my hands and my brain to determine plan of care and decide how sick the person is on physical exam and vitals alone.

Now, if you have FP clinic and you run it correctly there should be slots for walk in/urgent same day patients so they can see their own doctor and not have to go to urgent care. Almost never works that way unfortunately.

 

[deleted87716]

Now, if you have FP clinic and you run it correctly there should be slots for walk in/urgent same day patients so they can see their own doctor and not have to go to urgent care. Almost never works that way unfortunately.

Well, it works that way for me.

 

[DrMidlife]

CB when you do an urgent care gig, are you supervising midlevels?

 

[cabinbuilder]

Well, it works that way for me.

Well, you are the EXCEPTION, Blue Dog, so glad you are the doctor we all should be.

 

[cabinbuilder]

CB when you do an urgent care gig, are you supervising midlevels?

Not usually, I have worked where there are midlevels in the same office but since I am contract I don't "supervise" them. I do, however let them know I am available for consult should they need help, especially with procedures, injections, OMT, and lesion removal they may not be trained to do.

 

[styphon]

Give a newbie some telling anecdotes? Is this patient load just one URI after another?

I think on a typical day there are lots of URI/ear pain/coughing/sprains.. Occasionally lacerations, fractures, dislocations.. And rarely CVA's, MI's, infant sepsis, unstable SVT, hand/finger amputation..

I do urgent care as it allows my brain to change gears from doing clinic work in the week.

 

[NPI]

UCCs are popping up all over the country due to increased wait times at ERs. That, and many people going to ERs could've been treated at a UCC. Some studies even say upwards of 20% of ER visits could've been handled at a UCC. As styphon mentioned, a lot of medical professionals prefer it so they can mentally shift gears throughout the day.

 

[DocBlin]

Yes UC is growing at an astounding rate. I even predict it will become a sub specialty of FM or EM or a stand alone specialty within the next 10 years. I believe there are already a few fellowships in UC around the US.

 

[DPCsoon]

It's as though you would have to take extra training to learn how to ignore the unmet chronic health needs of the UC patient while attending to their complaint regarding an "urgent" condition whose natural history is self-resolving. "Um, let me ignore those sugar crystals in your pores to give you antibiotics for your cold..."

UC exists to catch ED and PCP clinic overflow. The ED will not evolve to accept any more primary care overflow than they currently are. EM is evolving the other direction, towards 24h obs, critical care stuff, etc. This leaves the PCP clinic to pick up the slack.

UC medicine is episodic at best, routinely is an utter waste of healthcare financial resources, and too-often practices bad and arguably unethical medicine. It feeds off patient ignorance, while reinforcing that ignorance (e.g. patients think they need antibiotics to get better, the UC doc gives them antibiotics). Decades of research shows how episodic care, as opposed to longitudinal care, is more expensive with worse outcomes. Anyone who thinks that payors will continue pay more to get less in return has another thing coming.

 

[deleted87716]

It's as though you would have to take extra training to learn how to ignore the unmet chronic health needs of the UC patient while attending to their complaint regarding an "urgent" condition whose natural history is self-resolving. "Um, let me ignore those sugar crystals in your pores to give you antibiotics for your cold..."

UC exists to catch ED and PCP clinic overflow. The ED will not evolve to accept any more primary care overflow than they currently are. EM is evolving the other direction, towards 24h obs, critical care stuff, etc. This leaves the PCP clinic to pick up the slack.

UC medicine is episodic at best, routinely is an utter waste of healthcare financial resources, and too-often practices bad and arguably unethical medicine. It feeds off patient ignorance, while reinforcing that ignorance (e.g. patients think they need antibiotics to get better, the UC doc gives them antibiotics). Decades of research shows how episodic care, as opposed to longitudinal care, is more expensive with worse outcomes. Anyone who thinks that payors will continue pay more to get less in return has another thing coming.

^ What he said.

 

[JustPlainBill]

I haven't read through all the posts ---

1) We had a heck of a time getting patient's to understand that same day clinic is for urgent care, rather than a way to get seen sooner because you don't want to wait for the next appointment in 2 weeks. No, discussing your toenails and athlete's foot is generally not a UC visit. But it was residency and we were ordered to take care of it.

2) Agree -- most of the ER at the county system where I did my training was Family Medicine at 0200 -- which is why I didn't do ER. During the ER rotation, the trauma went to the ER residents and Trauma residents and the off service types (IM, FM, etc) did more fast-track type of stuff;

3) The wait times in the ER are what I hear most patients gripe about -- plus, the acuity which is just "not quite" ER level....and thus, they head to a UC after hours and on weekends. If you've ever been a non-medical parent, most kiddos will get sick on Saturday at 13:30 --- which is about 1 hour after the pediatricians office closes for the weekend. Then your choice is: 1) gut it out over the weekend or 2) go sit in the ED for several hours with a sick kiddo.

Thus the advent, in our area, of pediatric urgent care staffed by BC pediatricians straight out of residency...seeing a whole lot of tummy aches, ear aches, coughs, colds, sprains, strains, cuts....but it was nice when my daughter complained that her ear hurt 2 hours before we were headed to a movie and dinner --- what could have been a complete change of plans for the weekend ended up being treated with Amoxil in about 30 minutes, thanks to this place.

So I see the value -- now payor view is a different story. I think if an FP clinic were willing to be open on the weekends and off hours, they would make a killing...but that's concierge medicine which generally doesn't deal with the riff-raff ;-> (it's a joke guys).....

I'm considering filling the barrel between jobs with an urgent care gig and locums until I can either start my own place or join a group....but who knows, I like being busy and variety so UC may be the way to go for me....or do a fellowship in EM and head that route.....

 

[DPCsoon]

If you use antibiotics to reduce pain from OM pressure then you probably have a future in UC.

 

[Makati2008]

Question JustPlainBill- I read your post advising using comquest for level 3( since I am thinking about doing it now) and you stated if you used comquest on level one you would be doing EM instead of FM? But here you said you picked FM over EM I'm confused?

 

[VA Hopeful Dr]

If you use antibiotics to reduce pain from OM pressure then you probably have a future in UC.

If you make douchey comments without the full story...

What if he had already tried 2 doses of APAP/NSAIDs, still no relief. Gets to urgent care, bulging, erythematous TM with pus-filled middle ear? You wouldn't treat that?

 

[DPCsoon]

If you make douchey comments without the full story...

What if he had already tried 2 doses of APAP/NSAIDs, still no relief. Gets to urgent care, bulging, erythematous TM with pus-filled middle ear? You wouldn't treat that?

Stand down. You can make "what ifs" but you are almost describing an urgent care zebra. Have you worked in urgent care? You routinely see parents who have tried two doses of two meds before bringing the kid in? Please. For every hot purulent TM I see in urgent care I easily see 2+ cases of dry ETD on abx x2 days wanting to know why their ear isn't better, maybe 3-5 serous effusions, and maybe 5-10 dry ETD not on abx. I'm shooting from the hip with these numbers but hot purulent certainly is <10% of otalgia presentations. Most of these didn't need to see the doctor in the first place (i.e. absolute waste of resources) while almost every one of these could and should have waited until the next clinic day.

Those of us who work hard to practice EBM and maintain good doctor-patient relationships absolutely detest the erosive effect that weak clinicians and weak clinical practices have on those relationships. If you don't appreciate this, then you're simply part of the problem. My current position uses UC instead of phone call for my patients to use after hours. The weak among the herd go to UC and in the clinic they require much re-education on why we don't need abx for every sniffle and imaging for every booboo. FYI I am required to work a couple UC shifts per month, but, DPCsoon.

 

[VA Hopeful Dr]

Stand down. You can make "what ifs" but you are almost describing an urgent care zebra. Have you worked in urgent care? You routinely see parents who have tried two doses of two meds before bringing the kid in? Please. For every hot purulent TM I see in urgent care I easily see 2+ cases of dry ETD on abx x2 days wanting to know why their ear isn't better, maybe 3-5 serous effusions, and maybe 5-10 dry ETD not on abx. I'm shooting from the hip with these numbers but hot purulent certainly is <10% of otalgia presentations. Most of these didn't need to see the doctor in the first place (i.e. absolute waste of resources) while almost every one of these could and should have waited until the next clinic day.

Those of us who work hard to practice EBM and maintain good doctor-patient relationships absolutely detest the erosive effect that weak clinicians and weak clinical practices have on those relationships. If you don't appreciate this, then you're simply part of the problem. My current position uses UC instead of phone call for my patients to use after hours. The weak among the herd go to UC and in the clinic they require much re-education on why we don't need abx for every sniffle and imaging for every booboo. FYI I am required to work a couple UC shifts per month, but, DPCsoon.

I currently moonlight at an urgent care, and just took a job to do it full time while the hospital system readies a regular FM job for me.

I don't disagree with your assessment of UC, but patients want same day care and I sure as hell am not going to work 7 days a week. I think the better ploy would be to try and educate our UC colleagues. I know that I, personally, am stingy as all hell with antibiotics for URIs - I lost a solid dozen patients this year over it. But, I do tend to err on the side of prescribing for OM while in UC if for no other reason than I can't see them back the next day if conservative care doesn't work. Plus, OM kids are usually completely miserable and if treating it has a halfway decent chance of getting that kid better than I will.

Of note, sorry for the tone in my previous post - the job I'm leaving is being a pain in the ass about my quit date.

 

[cabinbuilder]

I work urgent care mostly because I love it. I don't give abx for URI's and certainly don't for an every day sore throat without exudate that is strep negative. I do a lot of teaching and referring to the Wal-Mart aisle for many things. Just did an MSE on a girl with a sore throat and HA who came to the ER and didn't even try any tylenol or OTC cold medicine. Sometimes it's very scary how ignorant people are and they think coming to the ER or Urgent care will get them something better to make them well faster. I do a lot of "you need to drink some white vinegar to cure that sore throat/hoarseness" It really works, I take it myself when I get that tickle and never get sick. I also like Chinese hot mustard for chronic sinus complaints, really cleans those out too. Just because I work urgent care doesn't mean I'm a bad doctor and I certainly don't see myself as "weak". I try really hard not to give antibiotics but I definitely give for high fever and a baby with red ears. What misery to have to deal with overnight as the parents and child. True that the Z-pak is overused but the patient better tell me they have a yellow or green sputum before I consider it.

 

[deleted87716]

True that the Z-pak is overused but the patient better tell me they have a yellow or green sputum before I consider it.

I still wouldn't consider it.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410464/

 

[VA Hopeful Dr]

I still wouldn't consider it.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410464/

Yeah, I go by the IDSA rules for giving antibiotics for URI (sinusitis essentially, since bronchitis and laryngitis are like 99% viral). It does say purulent sputum is one of the 4 criteria, but I also need fevers, sinus tenderness to percussion, and either at least 10 days or a few days, slightly improvement, then worsening.

If you don't have that, or COPD, then no antibiotics for you.

 

[cabinbuilder]

One of the things that makes me crazy is people who come in for the "allergy shot" because they want a quick fix of steroid and aren't on any allergy meds. Is the rare person who gets a steroid for allergy. Seen too many bad reactions. Urgent care just like anything else has a lot to do with the "art of medicine" and being able to balance the good ratings sought by admin, the tantrums of old people, the ignorance of the general public, and treating correctly the case in front of you.

 

[KnuxNole]

UC seems so much different from what I initially imagined :O

 

[primadonna22274]

One of the things that makes me crazy is people who come in for the "allergy shot" because they want a quick fix of steroid and aren't on any allergy meds. Is the rare person who gets a steroid for allergy. Seen too many bad reactions. Urgent care just like anything else has a lot to do with the "art of medicine" and being able to balance the good ratings sought by admin, the tantrums of old people, the ignorance of the general public, and treating correctly the case in front of you.

WORD. That drives me nuts!
I might like urgent care better as a physician than I do as a PA. Something about having your SP who never sees the patient tell you it's "good business" to give the patients what they want, not what they need--good medicine.

 

[JustPlainBill]

Question JustPlainBill- I read your post advising using comquest for level 3( since I am thinking about doing it now) and you stated if you used comquest on level one you would be doing EM instead of FM? But here you said you picked FM over EM I'm confused?

Understand how the two posts from two different threads from two different forums could be confusing ---- so lemme 'splain

If I had used Comquest, my scores would have been higher...and I likely would have been able to audition at a local EM program where I didn't have to move my family and where the EM residents actually got a lot of trauma experience....as it was, with my COMLEX scores, I wound up rotating at a tier 2 or 3 program for my required rotation. Even though they weren't as concerned about board scores, the locale was more of a combat zone including the areas where residents could afford housing...with schools for the kiddos to match.

That program was not as emphatic about their residents getting good trauma experience (low patient volume) and the trauma cases were used to train the trauma teams....in effect, there was very little initial trauma stabilization in that ER vs a plethora of it where I did my FM training....in fact, the FM residents were used for the fast track cases and the trauma went to the EM residents preferentially and when the surgery trauma team decided to grace the ED with their presence, that's when they took over....same with the ICU residents at that place.

So, where I did my ED rotation as student, the cases we had were more like Family Medicine at 0300....my thinking was if that was EM, I'd rather do that on an 8-5 schedule in FM and be at home with my wife and family at 0300. If I had higher comlex scores via comquest, I could have done an audition rotation at a local program and given my work ethic, likely matched. When I rotated through there as a resident in FM, it was a really good experience, got good grades but there were no openings and then funding became an issue.

Now that I'm out, I've got kids to put through high school/college and am a little long in the tooth for another residency, so a fellowship might work..but that's another thread....

Bottom line --- When you're young and single or young and married with no kiddos, it's all about you. When you have kiddos, the world changes and it (at least in my paradigm) became about them and what's good for the family....I moved a lot as a military brat and vowed I would never do that to my kids...and I haven't, Thank God.

 

[JustPlainBill]

Yeah, I go by the IDSA rules for giving antibiotics for URI (sinusitis essentially, since bronchitis and laryngitis are like 99% viral). It does say purulent sputum is one of the 4 criteria, but I also need fevers, sinus tenderness to percussion, and either at least 10 days or a few days, slightly improvement, then worsening.

If you don't have that, or COPD, then no antibiotics for you.

You sound like one of my attendings who is now the PD at my old program. He actually posted the IDSA rules for bacterial sinusitis in the charting area and was very EBM. Nothing wrong with that, we used to get our chops busted regularly about it, including by another attending who would actually read the PGY3's notes on inpatient at 23:00 and call you regarding things in the subjective section that didn't mesh with objective findings and a/p.....

They were like that until one day, they read an article regarding an oncologist who had cancer themselves. Part of their diary that was read after they had died stated," The doctors treating me keep quoting that there's no evidence to support any treatments when I ask them about certain things that I've heard about/read about -- I wish they would just please try something, anything rather than throw EBM in my face. I'm a person, not a machine"....or words to that effect. My attending then commented that a lot of times, there is no EBM to support what we do and community physicians have years of clinical experience to draw on and may do things that have no evidence for them, but work.....she had come to the revelation tha EBM is for the GUIDANCE of the physician and did not come down from Mt. Sindai engraved on stone tablets......

I do agree everyone wants an antibiotic for everything -- they don't know any better -- hell, I was that way prior to my medical career when my kids got sick....and yes, I've had to deal with people coming to me in allergy season wanting the allergy shot -- usually dexamethasone/triamcinolone -- which I don't do...lost a few patients and had a few get angry when I refused....usually if I explain the evidence, we can work towards a reasonable conclusion...some just want to feel better and evidence be damned....I get that.....

I know the evidence but am not married to it...and yes, in the back of my head, there's that warning light, right behind the chow detector and lateral to the payday meter, that says,"You're deviating from the norm and going off label -- be watchful!".....

And we now return you back to your regularly scheduled thread....

 

[JustPlainBill]

Question JustPlainBill- I read your post advising using comquest for level 3( since I am thinking about doing it now) and you stated if you used comquest on level one you would be doing EM instead of FM? But here you said you picked FM over EM I'm confused?

BTW -- forgot to ask -- I assume Makati2008 as in the Makati located near/in metro Manila, RP? If so, Kumusta ka, Pareko....remember that balut and San Miguel is the breakfast of champions....

 

[VA Hopeful Dr]

You sound like one of my attendings who is now the PD at my old program. He actually posted the IDSA rules for bacterial sinusitis in the charting area and was very EBM. Nothing wrong with that, we used to get our chops busted regularly about it, including by another attending who would actually read the PGY3's notes on inpatient at 23:00 and call you regarding things in the subjective section that didn't mesh with objective findings and a/p.....

They were like that until one day, they read an article regarding an oncologist who had cancer themselves. Part of their diary that was read after they had died stated," The doctors treating me keep quoting that there's no evidence to support any treatments when I ask them about certain things that I've heard about/read about -- I wish they would just please try something, anything rather than throw EBM in my face. I'm a person, not a machine"....or words to that effect. My attending then commented that a lot of times, there is no EBM to support what we do and community physicians have years of clinical experience to draw on and may do things that have no evidence for them, but work.....she had come to the revelation tha EBM is for the GUIDANCE of the physician and did not come down from Mt. Sindai engraved on stone tablets......

I do agree everyone wants an antibiotic for everything -- they don't know any better -- hell, I was that way prior to my medical career when my kids got sick....and yes, I've had to deal with people coming to me in allergy season wanting the allergy shot -- usually dexamethasone/triamcinolone -- which I don't do...lost a few patients and had a few get angry when I refused....usually if I explain the evidence, we can work towards a reasonable conclusion...some just want to feel better and evidence be damned....I get that.....

I know the evidence but am not married to it...and yes, in the back of my head, there's that warning light, right behind the chow detector and lateral to the payday meter, that says,"You're deviating from the norm and going off label -- be watchful!".....

And we now return you back to your regularly scheduled thread....

Balancing EMB and clinical gestalt takes time, I still find myself second guessing decisions that go just like that "Evidence says this, but I wonder if maybe X would help them feel better". The best I've been able to come up with is a mix of EBM and "what would I want if this was me". For URIs, that usually means no antibiotics but will give good cough syrup and talk about the things I do when I get sick - for some reason, if I say "I take honey a couple times a day and it really seems to help when I'm sick", people seem to really get behind the idea.

 

[Makati2008]

Understand how the two posts from two different threads from two different forums could be confusing ---- so lemme 'splain

If I had used Comquest, my scores would have been higher...and I likely would have been able to audition at a local EM program where I didn't have to move my family and where the EM residents actually got a lot of trauma experience....as it was, with my COMLEX scores, I wound up rotating at a tier 2 or 3 program for my required rotation. Even though they weren't as concerned about board scores, the locale was more of a combat zone including the areas where residents could afford housing...with schools for the kiddos to match.

That program was not as emphatic about their residents getting good trauma experience (low patient volume) and the trauma cases were used to train the trauma teams....in effect, there was very little initial trauma stabilization in that ER vs a plethora of it where I did my FM training....in fact, the FM residents were used for the fast track cases and the trauma went to the EM residents preferentially and when the surgery trauma team decided to grace the ED with their presence, that's when they took over....same with the ICU residents at that place.

So, where I did my ED rotation as student, the cases we had were more like Family Medicine at 0300....my thinking was if that was EM, I'd rather do that on an 8-5 schedule in FM and be at home with my wife and family at 0300. If I had higher comlex scores via comquest, I could have done an audition rotation at a local program and given my work ethic, likely matched. When I rotated through there as a resident in FM, it was a really good experience, got good grades but there were no openings and then funding became an issue.

Now that I'm out, I've got kids to put through high school/college and am a little long in the tooth for another residency, so a fellowship might work..but that's another thread....

Bottom line --- When you're young and single or young and married with no kiddos, it's all about you. When you have kiddos, the world changes and it (at least in my paradigm) became about them and what's good for the family....I moved a lot as a military brat and vowed I would never do that to my kids...and I haven't,
Thank God.

Cool and that is understandable

 

[Makati2008]

BTW -- forgot to ask -- I assume Makati2008 as in the Makati located near/in metro Manila, RP? If so, Kumusta ka, Pareko....remember that balut and San Miguel is the breakfast of champions....

You would be correct and my Tagalog is veryyyy basic. I couldn't stomach balut lol. San Miguel is good and cheap. I miss jolliebee, goldilocks the usual....

Were you stationed there?

 

[JustPlainBill]

You would be correct and my Tagalog is veryyyy basic. I couldn't stomach balut lol. San Miguel is good and cheap. I miss jolliebee, goldilocks the usual....

Were you stationed there?

With the family from 69-79---it's where I "grew up"....let's just say I know my way around Angeles City, Subic, Olangapo, and Tarlac.....either on the roads or through the jungle....and yes, I've eaten raw sugar cane swiped from the trucks as they passed by, marvelous mystery meat on a skewer outside the gate, and put down enough San Miguel to realize that quality control wasn't their forte....went from Clark to Olangapo hanging out the back of a Jeepney, bet on cock fights, had grilled lizard for lunch at a local church planting and watched the self-flagellation and crucifixion during Easter....I can sing the national anthem and start a barfight in Tagalog and remember the Filipino people as some of the kindest, most family oriented people once you got away from the bases with the hustlers, pimps and hookers....all in all, it was a great time in my life and I plan on doing some medical misisons in the future......

 

[MedicineMan99]

Keep in mind that medicine is now a "consumerist" society. If a patient really wants an antibiotic, they will UC-shop or Minute Clinic-shop until they get someone to give them a Z-pak. And, eventually someone will.

 

[Makati2008]

With the family from 69-79---it's where I "grew up"....let's just say I know my way around Angeles City, Subic, Olangapo, and Tarlac.....either on the roads or through the jungle....and yes, I've eaten raw sugar cane swiped from the trucks as they passed by, marvelous mystery meat on a skewer outside the gate, and put down enough San Miguel to realize that quality control wasn't their forte....went from Clark to Olangapo hanging out the back of a Jeepney, bet on cock fights, had grilled lizard for lunch at a local church planting and watched the self-flagellation and crucifixion during Easter....I can sing the national anthem and start a barfight in Tagalog and remember the Filipino people as some of the kindest, most family oriented people once you got away from the bases with the hustlers, pimps and hookers....all in all, it was a great time in my life and I plan on doing some medical misisons in the future......

Man your post makes me miss the Philippines. And I agree they are truly the kindest people I ever met. Even the poor there are so kind and happy. Very hospitable. I even thought about going to medical school there(Fatima) but couldn't risk not passing the USMLE since they don't teach for the exams like they do here.

I was just thinking earlier I would give anything to go back before my residency starts but due to multiple issues here I can't go My family even offered to buy my ticket to go back there.

I was looking into practice rights over there and I think DOs are only allowed to do manipulation unless we are working off the grid?Do you know if that is correct?

 

[JustPlainBill]

Man your post makes me miss the Philippines. And I agree they are truly the kindest people I ever met. Even the poor there are so kind and happy. Very hospitable. I even thought about going to medical school there(Fatima) but couldn't risk not passing the USMLE since they don't teach for the exams like they do here.

I was just thinking earlier I would give anything to go back before my residency starts but due to multiple issues here I can't go My family even offered to buy my ticket to go back there.

I was looking into practice rights over there and I think DOs are only allowed to do manipulation unless we are working off the grid?Do you know if that is correct?

No idea on practice rights -- but there is an office in the AOA that can tell you...

yes, they do not teach to the exams -- they teach you to be a doc -- and by doing that, you know what you need to know and it's all immediate recall, not buzz word memorization. Some of the best physician's I've met were schooled in the PI. Heck, 2 of my anatomy professors were from there and they really knew their stuff.....

 

[NWDoc]

My friend is retiring and selling his FPractice, It's a private practice, in a small Oregon coastal community. He's been turning away new patients like crazy too.

 

[primadonna22274]

My friend is retiring and selling his FPractice, It's a private practice, in a small Oregon coastal community. He's been turning away new patients like crazy too.

OMG I would totally take it if I had money. And was finished with residency. I miss the Oregon coast more than I miss my family...almost

 

[cabinbuilder]

My friend is retiring and selling his FPractice, It's a private practice, in a small Oregon coastal community. He's been turning away new patients like crazy too.

Yes, HUGE need for FP on the Oregon coast. Not enough doctors for the patient load. Lots of chronic pain folks too who travel a very long way to get their narcs since no one wants to deal with them. Just an FYI. I have worked in Tillamook, Lincoln City, Manzanita, and Brookings on the coast and it's crazy how many folks come through urgent care trying to get drugs.

 

[VA Hopeful Dr]

Yes, HUGE need for FP on the Oregon coast. Not enough doctors for the patient load. Lots of chronic pain folks too who travel a very long way to get their narcs since no one wants to deal with them. Just an FYI. I have worked in Tillamook, Lincoln City, Manzanita, and Brookings on the coast and it's crazy how many folks come through urgent care trying to get drugs.

That sounds like the best reason in the world to NOT work there...

 

[cabinbuilder]

That sounds like the best reason in the world to NOT work there...

True, similar in many other places. I have learned to say NO very well.

 

[deleted87716]

That sounds like the best reason in the world to NOT work there...

Ditto x 10.

 

[cabinbuilder]

I personally think Colorado is a worse place to work. I was there before the marijuana stores opening up and it was TERRIBLE to deal with all the druggies and drug seekers there too.

 

[VA Hopeful Dr]

I personally think Colorado is a worse place to work. I was there before the marijuana stores opening up and it was TERRIBLE to deal with all the druggies and drug seekers there too.

I would bet that its gotten better now that the stuff is legal for everyone not just the special card holders

 

[d2305]

With the family from 69-79---it's where I "grew up"....let's just say I know my way around Angeles City, Subic, Olangapo, and Tarlac.....either on the roads or through the jungle....and yes, I've eaten raw sugar cane swiped from the trucks as they passed by, marvelous mystery meat on a skewer outside the gate, and put down enough San Miguel to realize that quality control wasn't their forte....went from Clark to Olangapo hanging out the back of a Jeepney, bet on cock fights, had grilled lizard for lunch at a local church planting and watched the self-flagellation and crucifixion during Easter....I can sing the national anthem and start a barfight in Tagalog and remember the Filipino people as some of the kindest, most family oriented people once you got away from the bases with the hustlers, pimps and hookers....all in all, it was a great time in my life and I plan on doing some medical misisons in the future......

Sam's hotel with guaranteed hot water in the morning, but turned off at 10:00am. Victory Liner to Manila with San Miguel stops alone the way. We had to be off the streets at midnight at risk of being shot during martial law, same in Korea. I'd like to do a mission there too.