progressive FP scope of practice

[betamale]

I was browsing through Canadian CFPC website and came across various FM programs in Canada that offer advanced training to FPs including FP Anesthesia, Emergency, Oncology. How awesome are they!

We need to start developing leaders in our field that would advocate for FPs to unlock our potential to provide more services to our patients.

Training Programs | Family Practice Residency Program

Love to hear how you guys feel about expanding FP scope of practice. We already have CAQs in Sleep Medicine and Pain, I don't see why we shouldn't be allowed the opportunity to train in Critical Care medicine as well since many of us take care of emergent and hospitalized patients on vents, pressors, antiarrhythmics...

And to be fair, I know of psychiatrist s, ER docs, and surgeons who are interested in primary care and I believe that they should also be allowed to receive training should they have interest in expanding their scope of practice.

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[deleted87716]

I'm busy enough, thanks.

 

[septoplasty]

I was browsing through Canadian CFPC website and came across various FM programs in Canada that offer advanced training to FPs including FP Anesthesia, Emergency, Oncology. How awesome are they!

We need to start developing leaders in our field that would advocate for FPs to unlock our potential to provide more services to our patients.

Training Programs | Family Practice Residency Program

Love to hear how you guys feel about expanding FP scope of practice. We already have CAQs in Sleep Medicine and Pain, I don't see why we shouldn't be allowed the opportunity to train in Critical Care medicine as well since many of us take care of emergent and hospitalized patients on vents, pressors, antiarrhythmics...

And to be fair, I know of psychiatrist s, ER docs, and surgeons who are interested in primary care and I believe that they should also be allowed to receive training should they have interest in expanding their scope of practice.

Interesting you brought this up.. guess how many grads pursue those and other fab specialties compared to primary care? I'll give you a hint, the gate keeper actually means something there.

- Canadian

(Not to put down the point, but we need more primary care docs, not primary care docs who get burned out who end up pursuing other specialties).

 

[betamale]

many of the new

Interesting you brought this up.. guess how many grads pursue those and other fab specialties compared to primary care? I'll give you a hint, the gate keeper actually means something there.

- Canadian

(Not to put down the point, but we need more primary care docs, not primary care docs who get burned out who end up pursuing other specialties).

For an FM/Sports docs who works as a hospitalist, I would have guessed that you would be supportive of FPs to be able to train in additional areas of their interest and get licensed in it... I don't think that family docs should be limited to work in primary care clinics as other specialties want to limit us to.

 

[Atlas Shrugged]

A medical degree means you can do anything you like. If you want to be a cowboy, be a cowboy. Sure, a hospital won't credential you, but you can do anything you like in PP or DPC.

 

[VA Hopeful Dr]

Unless that post-residency training is equivalent to an anesthesia residency or a full oncology fellowship, this seems a truly bad idea. We already have under-trained providers doing anesthesia and oncology - we call them CRNAs and naturopaths, respectively.

 

[betamale]

Unless that post-residency training is equivalent to an anesthesia residency or a full oncology fellowship, this seems a truly bad idea. We already have under-trained providers doing anesthesia and oncology - we call them CRNAs and naturopaths, respectively.

Ugh, seriously? Zero value to the conversation. Let's just take all those well trained CRNAs who deliver amazing routine anesthesia in many rural communities out there because you think they're not qualified. And by that argument, you're assuming this FP Oncologists in Canada are prescribing naturopathic treatments or unproven meds... Newsflash, vast majority of cases we treatment are straight forward and uncomplicated...same goes in other specialties.

 

[VA Hopeful Dr]

Ugh, seriously? Zero value to the conversation. Let's just take all those well trained CRNAs who deliver amazing routine anesthesia in many rural communities out there because you think they're not qualified. And by that argument, you're assuming this FP Oncologists in Canada are prescribing naturopathic treatments or unproven meds... Newsflash, vast majority of cases we treatment are straight forward and uncomplicated...same goes in other specialties.

 

[BigRedBeta]

I was browsing through Canadian CFPC website and came across various FM programs in Canada that offer advanced training to FPs including FP Anesthesia, Emergency, Oncology. How awesome are they!

We need to start developing leaders in our field that would advocate for FPs to unlock our potential to provide more services to our patients.

Training Programs | Family Practice Residency Program

Love to hear how you guys feel about expanding FP scope of practice. We already have CAQs in Sleep Medicine and Pain, I don't see why we shouldn't be allowed the opportunity to train in Critical Care medicine as well since many of us take care of emergent and hospitalized patients on vents, pressors, antiarrhythmics...

And to be fair, I know of psychiatrist s, ER docs, and surgeons who are interested in primary care and I believe that they should also be allowed to receive training should they have interest in expanding their scope of practice.

Not an FP, but what is the end game here for providers that pursue this? Like the category 1 progams are 12+ months in length, but what are people doing with this...additional care outside the office? Is the extra EM trainee going to cover the ED more often? Add ICU care to their list of practice venues?

Considering that this is based out of Canada, the prospect of a rural provider needing a bit of training to stabilize and treat prior to transfer, that's probably useful. But given the number of studies throughout all fields of medicine that demonstrate that higher volumes equal better outcomes for patients, this sort of training shouldn't confuse providers into doing something they're not actually ready for on a consistent basis. As a peds intensivist, yes, 80% of my ventilated patients go on autopilot after we get them settled, but that remaining 20% need a lot of attention and tips/tricks/pearls/experience/advanced tools that aren't available to the lightly trained provider.

I'd also argue that the biggest hurdle for FM providers is the shear amount of information out there for them to stay on top of. While some training programs really try to swing this idea that it's this monolithic specialty of FAMILY MEDICINE, it's not. It's three fields, three sets journals, three sets of best practices, three sets of board exams for which most FM providers would be unable to pass without taking dedicated time to study for individually. And you want to add a 4th specialty on top of that? I don't think that's wise.

The Category 2 programs seem more like merit badges. I question what their real effects on clinical care would be. The oncology program is 8 weeks...what can you realistically learn in 8 weeks that's going to make a consistent, significant, improvement in your patient outcomes in that time?

 

[septoplasty]

many of the new



For an FM/Sports docs who works as a hospitalist, I would have guessed that you would be supportive of FPs to be able to train in additional areas of their interest and get licensed in it... I don't think that family docs should be limited to work in primary care clinics as other specialties want to limit us to.

Being supportive of what I was trained for and traditionally is a FM role i.e. hospitalist is not necessarily equating to pursuing lets say an Oncology fellowship. The key difference is, the hospitalist training is in itself a core part of FM training, while the other fellowships fields are not.

You raise a good point, for being a sports doc, with my training in primary care puts me in a key role. I'm an FM doc before i'm a sports doc. This means I manage all primary care for my athletes, some non-operative orthopedics. There is truly a niche there. Any other specialty who can do Sports Med can't do primary care for athletes equally as well, because their training is in a different specialty, despite in the end them also being a primary care sports med doc.

As for the fellowships as above, nothing against it. But you need to look at the situation that is truly different here state side compared to canada. The Family Physician (dislike term PCP) to Patient ratio... which would just get worse if lets say a burnt out FM doc could pursue a derm fellowship in America. Not to mention, the amount of lobbying/anti-other physician we've become, encroaching on another specialty tends to divide us, which is bad because we face other threats (i.e. midlevels).

- End ramble.

 

[ThoracicGuy]

Ugh, seriously? Zero value to the conversation. Let's just take all those well trained CRNAs who deliver amazing routine anesthesia in many rural communities out there because you think they're not qualified. And by that argument, you're assuming this FP Oncologists in Canada are prescribing naturopathic treatments or unproven meds... Newsflash, vast majority of cases we treatment are straight forward and uncomplicated...same goes in other specialties.

And as a fp oncologist, you'll be held to the same standard as fellowship trained im oncologists. Given the fp pathway is likely shorter than the im pathway, are you ready to be at that standard? How about for anesthesia? EM?

 

[betamale]

And as a fp oncologist, you'll be held to the same standard as fellowship trained im oncologists. Given the fp pathway is likely shorter than the im pathway, are you ready to be at that standard? How about for anesthesia? EM?

I already do every shift in the ED, every time I give propofol for a deep sedation, and every time I initiate a work up for suspicion of cancer in clinic...because I have been trained to deliver that care. I regularly consult and refer for cases I am not trained to care for and I know how to recognize what I cannot handle because I was taught what cases should be handle by subspecialists. Most of us know what we can and cannot do...we're not all a bunch of idiots running around doing things we're not supposed to...to be blunt.

 

[ThoracicGuy]

I already do every shift in the ED, every time I give propofol for a deep sedation, and every time I initiate a work up for suspicion of cancer in clinic...because I have been trained to deliver that care. I regularly consult and refer for cases I am not trained to care for and I know how to recognize what I cannot handle because I was taught what cases should be handle by subspecialists. Most of us know what we can and cannot do...we're not all a bunch of idiots running around doing things we're not supposed to...to be blunt.

But if you were getting this specialized training that Canadian fp docs can get, are you ready and able to be held to the same standard as someone who had done a full training pathway in that field?

I just don't thing this fp training pathway would be near as rigorous as the traditional one.

 

[betamale]

But if you were getting this specialized training that Canadian fp docs can get, are you ready and able to be held to the same standard as someone who had done a full training pathway in that field?

I just don't thing this fp training pathway would be near as rigorous as the traditional one.

Research is underway. Rigor is subjective don't you think? Intuitively, you'd think that a really long training program will produce superior docs but I've actually had the pleasure of training in academic, Ivy-league, and community hospitals where I worked with Ivy league-trained docs with fellowship training and family medicine physicians in the same field (ER, hospital medicine, primary care clinic)...and I can honestly say that many of the family medicine were better clinically.

Also, I've had the pleasure of working as a student at an awesome family medicine residency in Texas where faculty and residents did their own colonoscopies, moderate-deep sedation, C sections and they have published papers that show family med docs with focused-training in endoscopy achieved outcomes similar to gastroenterologists. It's not unreasonable to think that those outcomes can be extrapolated to other procedures as well.

As far as CCFP-EM vs FRCPC-EM safety outcomes, I've scanned PubMed and cannot find any data to say that CCFP-EM docs provided inferior care. And the fact that FRCPC and CCFP-EM training programs co-exist at many educational institutions in Canada (including McGill) and that CCFP-EM docs continue to practice through Canada, I'm willing to venture and say that CCFP-EM docs (family medicine-trained with additional 1 year training in emergency medicine) are not inferior to 5-year residency trained FRCPC doc.

And I get that there is significant heterogeneity in residency experiences among family docs and that many did not receive adequate training in procedures, acute care...but I feel that you can overcome those deficiencies in a focused 1 year training program.

Anyway...end of my vent.

Expanding Access to Colorectal Cancer Screening: Benchmarking Quality Indicators in a Primary Care Colonoscopy Program
The Next Generation of Cancer Research and Prevention
Rural Project Summary: Texas C-STEP Project: Cancer Screening, Training, Education and Prevention Program - Rural Health Information Hub

 

[deleted87716]

I have no problem with FPs broadening their skill set with additional training, but I don't see the point in trying to make family medicine a path to specialization. It would be a colossal waste of time, IMO.

 

[betamale]

I have no problem with FPs broadening their skill set with additional training, but I don't see the point in trying to make family medicine a path to specialization. It would be a colossal waste of time, IMO.

that's your personal opinion which I do not agree with.

 

[betamale]

which is bad because we face other threats (i.e. midlevels).

- End ramble.

advance practice providers will fill the artificial void caused by restrictive sanctions imposed by physicians on other physicians...

 

[betamale]

Not an FP, but what is the end game here for providers that pursue this? Like the category 1 progams are 12+ months in length, but what are people doing with this...additional care outside the office? Is the extra EM trainee going to cover the ED more often? Add ICU care to their list of practice venues?

The Category 2 programs seem more like merit badges. I question what their real effects on clinical care would be. The oncology program is 8 weeks...what can you realistically learn in 8 weeks that's going to make a consistent, significant, improvement in your patient outcomes in that time?

The FP oncology program is 1 year (included the U of Toronto); the 8 week preceptorship is just like it says, a preceptorship to increase familiarity with the field. IM oncology fellowships can be 2-3 years (18 mos clinical + 18 research) because they have the benign hematology component; I rotated through MD Anderson as a medical student and IM intern. The goal is the wholistic management of the cancer patient by a primary care physician who has additional knowledge of the patient's history and cancer-needs. I attached links above that show physicians with additional training pertaining to cancer (colonoscopy, biopsy...) expand availability to patients particularly in rural areas (America is more vast geographically and demographically than Canada, suffice to say, rural providers are an even greater need). Realistically, the FP oncologist will be initiating work up, presenting patient to a tumor-board that include oncology subspecialists, radiologists, radiation oncologists, surgeons, palliative who will all contribute ideas to the patient's care...the FP oncologist will not be a solo-driver on the patient's care, just like medical oncologists are not.

Many rural FP docs are already covering ED. The new trend in healthcare is the concept of the "micro-hospital" which is being marketed largely to ER docs and to lesser extent FP docs as a single coverage facility where the ED physician covers the ER and limited inpatient bed. I personally feel that are an FP doc with additional training in ER is equally suited for the micro-hospital concept. Or for the more traditional rural practice, the additional ER training would enhance their ability to provide acute care.

Many suburban community and rural hospitals do not have intensivisits but are staffed with FP hospitalists who run the ICU, sadly, not always by choice but requirement of the work. Many FPs are now asking to have training in intensive care and I really believe that we should so that we can provide better care...like you say.

Fellowship Program > Medical Oncology | Internal Medicine | Yale School of Medicine
Enhanced Skills Program: Medical Oncology
Hospitalists trained in family medicine seek critical care training pathway

 

[deleted87716]

advance practice providers will fill the artificial void caused by restrictive sanctions imposed by physicians on other physicians...

Can you provide any examples of this?

 

[BJJVP]

I think there are really 3 different questions being debated here:
1) Should FPs or any other physicians be allowed to obtain additional training in other fields?
2) Is there enough demand for this to drive the development of many training fellowships?
3) Is this good for medicine as a whole?

My opinion:
1) Yes
2) My guess is probably not.
3) I would think yes, assuming the additional training is equivalent (for example, FPs with dermatology fellowships get same the training as dermatologists). I realize that the assumption of equivalency in training is controversial and probably the source of most of the conflicting opinions on this matter.

 

[betamale]

Can you provide any examples of this?

Single coverage rural ER staffed by NPs and PAs because hospital by laws only allow ER residency trained docs; the hospital would rather staff the free standing ER with a PA or a 2nd year ER resident rather than me because I am ABFM boarded... There are other examples. This particular ER is rural but part of a large multistate health system; they are chronically understaffed because the pay is low.

 

[septoplasty]

(America is more vast geographically and demographically than Canada, suffice to say, rural providers are an even greater need).

Lol, what?

You do know that Canada is bigger geographically right? Their population density is 9x less than America., a significant portion of Canadians are immigrants, creeping up to 20%.. compared to 13% in the USA.

Anyways, I think it might work for the Canadian system, but probably not so good for America. This is coming from a guy who's family doc is in Canada.

 

[betamale]

Lol, what?

You do know that Canada is bigger geographically right? Their population density is 9x less than America., a significant portion of Canadians are immigrants, creeping up to 20%.. compared to 13% in the USA.

Anyways, I think it might work for the Canadian system, but probably not so good for America. This is coming from a guy who's family doc is in Canada.

Technically America has greater land mass and definitely greater habitable land where patients actually live...that probably does not include American territories..

 

[deleted87716]

Single coverage rural ER staffed by NPs and PAs because hospital by laws only allow ER residency trained docs; the hospital would rather staff the free standing ER with a PA or a 2nd year ER resident rather than me because I am ABFM boarded... There are other examples. This particular ER is rural but part of a large multistate health system; they are chronically understaffed because the pay is low.

Aside from the fact that an ER fellowship won't have any bearing on a facility's credentialing decisions, why would you even want to work there if the pay sucks...?

 

[sqeeks]

Aside from the fact that an ER fellowship won't have any bearing on a facility's credentialing decisions, why would you even want to work there if the pay sucks...?

I think the idea is its too low for a EM to move themselves out to the boondocks and actually staff the ER fulltime. A FP who is an EM fellow could have a practice/other work on the side while picking up shifts now and again at the local ER.
But why dont you think an EM fellowship would have an effect on a hospital allowing an FP to staff their ER?
Sure the credentials dont exist now, but I think we are talking in terms of a fellowship in the future that is accredited by the ACGME. Dont you think that would hold the same/similar clout as an

 

[deleted87716]

But why dont you think an EM fellowship would have an effect on a hospital allowing an FP to staff their ER?

The OP himself said it: the hospital will only hire EM residency-trained docs.

 

[sqeeks]

The OP himself said it: the hospital will only hire EM residency-trained docs.

Bro... I addressed this in my question to you. You just needed to keep reading: I think we are talking in terms of a fellowship in the future that is accredited by the ACGME. Thats the whole point of OPs thread. That ACGME should be extending board certification.

 

[sqeeks]

I edited my first response with this additional statement but I'll put it down here because I think it might be over looked.

The biggest issue in rural healthcare is that organizations (Healthcare systems, insurance companies etc) dont understand that policies that are cost effective in an urban environment often dont hold water and are sometimes downright harmful in rural settings. This is a good example of one. More education for FPs (who are really the only specialty in medicine properly equipped to handle rural medicine) designed to fill these gaps is the best way to address these discrepencies without relying on midlevel providers being granted more rights to do a physician's work. It kills me to see turf wars going on amongst physicians while midlevels are moving further and further infield. I'm not bashing midlevels, they are invaluable, but we need to have more discussions like these where we are physicians discuss how WE are going to address these disparities. Otherwise our profession is going to slowly become encrouched upon by those willing to step up.

 

[deleted87716]

I think we are talking in terms of a fellowship in the future that is accredited by the ACGME. Thats the whole point of OPs thread. That ACGME should be extending board certification.

It still wouldn't be an EM residency, so any hospital that only hired EM residency-trained docs still wouldn't hire you.

 

[sqeeks]

It still wouldn't be an EM residency, so any hospital that only hired EM residency-trained docs still wouldn't hire you.

I think you have established that if hospital says X then it means X. That's as clear as water to everyone.
At what point does the dialog change? That is the question. At what point does a chronically understaffed ER see a physician and say they are credentialed to fill their need for a physician instead of a midlevel provider? OP is suggesting that maybe that would change with the same certifying board giving credentials of fellowship to FPs. That is a reasonable argument IMHO. So if you dont think that will be sufficient can you explain why not Blue Dog?

 

[deleted87716]

When you say “same certifying board,” are you referring to the ABEM?

 

[sqeeks]

When you say “same certifying board,” are you referring to the ABEM?

Perhaps you are getting caught up on "certifying board"? Not sure if that is what you misunderstood but if you need clarification you can go to the ACGME website and look at the link for "What we do".

This is an exact quote from the website:
"ACGME accreditation provides assurance that a Sponsoring Institution or program meets the quality standards (Institutional and Program Requirements) of the specialty or subspecialty practice(s) for which it prepares its graduates. ACGME accreditation is overseen by a Review Committee made up of volunteer specialty experts from the field that set accreditation standards and provide peer evaluation of Sponsoring Institutions and specialty and subspecialty residency and fellowship programs."

I mentioned it in the post above the last where I quoted it from my first reply to you. So I guess third time's the charm? I am talking about the ACGME.
Yes the ABEM is EM specific as would be implied in their acronym, but all fellowships receive their accreditation through the ACGME.

 

[betamale]

Aside from the fact that an ER fellowship won't have any bearing on a facility's credentialing decisions, why would you even want to work there if the pay sucks...?

For now, many credentialing committees will credential docs who have ABMS or BOS certification in their pertinent division. For example, a hospital will ccredential a critical care doc for ICU work if they have ABMS/BOS certification in critical care (excluding neurocritical care, peds, and trauma ICU) which is offered by four different boards: Anesthesia, Internal Medicine, Surgery, Emergency. And so, in order for a doc to get credentialed to work in the ER, these same committees require ABMS/BOS certification in emergency medicine which is monopolized by ABEM and AOBEM. This is not the case in other countries like Canada and Australia where other boards offer ER certification not just the board of emergency medicine (ACEM, ARRM in Australia; RCPSC and CFPC in Canada). This is why the ABPS certification in Emergency Medicine is not accepted by many hospitals because they only recognize ABMS and BOS. Interestingly, the European Society of Emergency Medicine offers ER board certification to physicians who have worked at least three years full-time in the ER and pass a written and oral board irregardless of what their primary specialty was in; Canada (CFPC) offers this as well except they require 4 years of full-time work.

Unfortunately, ABMS will not allow a board to offer a CAQ if a specialty board already offers that certification, ie, ABFM cannot offer CAQ in Emergency because ABEM offers ER certification. Different boards can offer critical care certification/accredited training pathway because there is no ABMS critical care board. So the problem is the ABMS/BOS have allowed ABEM/AOBEM to have a monopoly on ER certification and prevent other boards from offering a similar certification or training pathway, thereby preventing us, family physicians (ABFM), from having our own ER training program and certification. There are EM/FM training programs but are very few and too long especially since there are many rotations that satisfy both EM and FM residecies.

What I hope for in the future is that the ABFM advocate for certification pathway for FPs who work in the ER so that we receive an ABMS certification in emergency medicine that is acceptable to hospital credentialing committees like in Canada where many consider FRCPC and CCFP-EM interchangeable.

 

[betamale]

Aside from the fact that an ER fellowship won't have any bearing on a facility's credentialing decisions, why would you even want to work there if the pay sucks...?

Location matters not just the pay. I'm more than happy to work in a gorgeous oceanside or mountainside rural hospital with a beautiful sunrise/sunset views even if the pay is crap rather than be miserable in a well paying inner city hospital. What I get all butt-hurt about is the red tape put up by such hospitals that bar me from working there even though I have the experience working in emergency medicine.

 

[deleted87716]

Perhaps you are getting caught up on "certifying board"?

No, I'm just trying to figure out what exactly you're advocating for. You keep saying ACGME, but you probably should be saying ABMS. @petegriffin did a much better job of explaining it above.

 

[deleted87716]

Unfortunately, ABMS will not allow a board to offer a CAQ if a specialty board already offers that certification, ie, ABFM cannot offer CAQ in Emergency because ABEM offers ER certification.

And there you have it.

What I hope for in the future is that the ABFM advocate for certification pathway for FPs who work in the ER so that we receive an ABMS certification in emergency medicine that is acceptable to hospital credentialing committees

Good luck with that. It's been talked about for years by frustrated docs who want to work in the ER, but I haven't seen any signs of institutional change. The emphasis these days is on primary care and keeping people out of the ER. Training more ER docs simply isn't part of our mission.

 

[ThoracicGuy]

I think you have established that if hospital says X then it means X. That's as clear as water to everyone.
At what point does the dialog change? That is the question. At what point does a chronically understaffed ER see a physician and say they are credentialed to fill their need for a physician instead of a midlevel provider? OP is suggesting that maybe that would change with the same certifying board giving credentials of fellowship to FPs. That is a reasonable argument IMHO. So if you dont think that will be sufficient can you explain why not Blue Dog?

FM offers an OB fellowship. Even with that, many hospitals will prefer OB trained docs rather than FM docs. It's not entirely equivalent.

 

[VA Hopeful Dr]

FM offers an OB fellowship. Even with that, many hospitals will prefer OB trained docs rather than FM docs. It's not entirely equivalent.

No kidding. I'm an FP and I would chose an actual OB 99% of the time versus an FM with the OB fellowship.

 

[PlutoBoy]

Interesting discussion. I believe that we should make focused training more available to primary care doctors, both IM and FM trained. Johns Hopkins and other leading institutions are training midlevels to do routine colonoscopies. The length of training? Six months. Now, if a midlevel can be trained to do that then certainly IM and FM doctors can receive the training as well.

The current state of affairs makes no sense. We either need four years of college, four years of medical school, and six years of residency/fellowship to do a colonoscopy/EGD or we don't.

Midlevels can go from a primary care clinic to a subspecialty clinic with minimal to no problems and no additional training (a terrible idea). Would my hospital allow me to staff the endocrinology clinic? Probably not. And for good reason.

Ultimately, what I am saying is 1) that our system makes no sense and 2) primary care doctors can be trained to perform certain routine procedures, if we accept that midlevels can receive that training.

 

[VA Hopeful Dr]

Interesting discussion. I believe that we should make focused training more available to primary care doctors, both IM and FM trained. Johns Hopkins and other leading institutions are training midlevels to do routine colonoscopies. The length of training? Six months. Now, if a midlevel can be trained to do that then certainly IM and FM doctors can receive the training as well.

The current state of affairs makes no sense. We either need four years of college, four years of medical school, and six years of residency/fellowship to do a colonoscopy/EGD or we don't.

Midlevels can go from a primary care clinic to a subspecialty clinic with minimal to no problems and no additional training (a terrible idea). Would my hospital allow me to staff the endocrinology clinic? Probably not. And for good reason.

Ultimately, what I am saying is 1) that our system makes no sense and 2) primary care doctors can be trained to perform certain routine procedures, if we accept that midlevels can receive that training.

Except that already exists. I know a fair number of FPs who do colonoscopy or deliver babies - but only in areas that don't have adequate OB/GI coverage. Same with vasectomies and urology, nasolaryngoscopy and ENT, and uterine biopsies and GYN. If you're an FP and want expanded scope, go to one of the programs that is well known for doing it and then go work rural afterwards.

 

[PlutoBoy]

Except that already exists. I know a fair number of FPs who do colonoscopy or deliver babies - but only in areas that don't have adequate OB/GI coverage. Same with vasectomies and urology, nasolaryngoscopy and ENT, and uterine biopsies and GYN. If you're an FP and want expanded scope, go to one of the programs that is well known for doing it and then go work rural afterwards.

I understand but that's not the point of this thread. We are talking about additional training after a physician has completed their residency. I think it is safe to assume that the FM doctors you mentioned above did less colonoscopies than they would have done in a focused GI procedural fellowship. If we accept that a midlevel can be trained to do these procedures, then a FM doctor can definitely learn to do them as well. I would wager that the demand for such training would be high.

The obvious counterargument here is that these FM docs should have trained in IM and then pursue a GI fellowship if that's what they wanted to do but this argument misses the point. For one, often we don't know with 100% clarity of detail what we want to do five or ten years down the line or the challenges we will face after we begin work (so we don't know that we could have used more time in the OR, for example). Number two, I'm not arguing that the training would be enough to replace GI physicians, but we could train more physicians to do some basic procedures.

 

[VA Hopeful Dr]

I understand but that's not the point of this thread. We are talking about additional training after a physician has completed their residency. I think it is safe to assume that the FM doctors you mentioned above did less colonoscopies than they would have done in a focused GI procedural fellowship. If we accept that a midlevel can be trained to do these procedures, then a FM doctor can definitely learn to do them as well. I would wager that the demand for such training would be high.

The obvious counterargument here is that these FM docs should have trained in IM and then pursue a GI fellowship if that's what they wanted to do but this argument misses the point. For one, often we don't know with 100% clarity of detail what we want to do five or ten years down the line or the challenges we will face after we begin work (so we don't know that we could have used more time in the OR, for example). Number two, I'm not arguing that the training would be enough to replace GI physicians, but we could train more physicians to do some basic procedures.

And I'm saying we already do that. FPs can get credentialed in a surprising number of procedures if they either a) go to a procedure-heavy residency or b) make certain procedures a priority in residency. My residency, which is not known for being procedure heavy, has trained docs who do most anything if they show an interest. For example, the GI group in town will gladly train residents if the residents want to do them and if the resident agrees to not stay in town after residency. The OB group is happy to train in c-sections if someone is interested.

We don't need additional training in most things because a) it won't make FPs equal to the other specialists and b) you can get enough experience to be adequate in a rural location in residency already.

I guess I'm just seeing these proposed fellowships as a solution looking for a problem.

 

[PlutoBoy]

And I'm saying we already do that. FPs can get credentialed in a surprising number of procedures if they either a) go to a procedure-heavy residency or b) make certain procedures a priority in residency. My residency, which is not known for being procedure heavy, has trained docs who do most anything if they show an interest. For example, the GI group in town will gladly train residents if the residents want to do them and if the resident agrees to not stay in town after residency. The OB group is happy to train in c-sections if someone is interested.

We don't need additional training in most things because a) it won't make FPs equal to the other specialists and b) you can get enough experience to be adequate in a rural location in residency already.

I guess I'm just seeing these proposed fellowships as a solution looking for a problem.

You and I are not talking about the same thing. The OP and I are talking about post residency training.

 

[VA Hopeful Dr]

You and I are not talking about the same thing. The OP and I are talking about post residency training.

Obviously, and I'm saying its not necessary.

 

[PlutoBoy]

Obviously, and I'm saying its not necessary.

We can disagree.

 

[VA Hopeful Dr]

We can disagree.

We can, but in America you'd be wrong.

Tell me: what do you think FPs should be allowed to do that we can't already?

 

[PlutoBoy]

We can, but in America you'd be wrong.

Tell me: what do you think FPs should be allowed to do that we can't already?

Why do you feel a need to push every topic to the limit? Your question is not even relevant to what I am discussing. Two reasonable people can disagree.

 

[VA Hopeful Dr]

Why do you feel a need to push every topic to the limit? Your question is not even relevant to what I am discussing. Two reasonable people can disagree.

Perhaps I've misunderstood then. My understanding from your first post in this thread:

Ultimately, what I am saying is 1) that our system makes no sense and 2) primary care doctors can be trained to perform certain routine procedures, if we accept that midlevels can receive that training.

was that FPs need more training to do routine procedures (your first point is much larger and outside the scope of this thread).

Am I mistaken?

 

[PlutoBoy]

Perhaps I've misunderstood then. My understanding from your first post in this thread:


was that FPs need more training to do routine procedures (your first point is much larger and outside the scope of this thread).

Am I mistaken?

I think it is a misunderstanding. If you receive the training during your residency, then obviously you are trained enough. The point I am raising is that primary care physicians should be able to get training after residency to develop some punctual skills that do not require a traditional fellowship.

Whether this is advisable is debatable. If training board certified primary care physicians (after they have completed their residency) to perform a certain procedure is not reasonable/safe, then allowing midlevels to get that training is not rational.

 

[VA Hopeful Dr]

I think it is a misunderstanding. If you receive the training during your residency, then obviously you are trained enough. The point I am raising is that primary care physicians should be able to get training after residency to develop some punctual skills that do not require a traditional fellowship.

Whether this is advisable is debatable. If training board certified primary care physicians (after they have completed their residency) to perform a certain procedure is not reasonable/safe, then allowing midlevels to get that training is not rational.

So for post-residency physicians who want to do more procedures, this place exists: CME Courses | Medical CME Courses | CME Course Listing

Your second point is good, I'm 100% on board with that.