primary care?

lawj said:

I know that primary care docs (IM/FP) can practice in an ED, but are EM docs able to practice primary care?

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lawj said:

Ok, I mean actually have an office with a patient base.

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a) Why would you train in EM with the intention of working in primary care?
b) It would be a huge disservice to the patients. We don't learn much about chronic management of HTN, DM, etc.

lawj said:

I know that primary care docs (IM/FP) can practice in an ED, but are EM docs able to practice primary care?

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While some EDs still staff with non-EM boarded docs their numbers are dwindling. The remaining EDs that allow non boarded docs are rural, low volume or low acuity, very hard to staff for some reason or the have long time docs that they don't want to let go. Your statement that primary care docs can practice in EDs is not accurate unless you qualify it by saying that primary care docs (or any other doc with any level of training in any specialty) can practice in a few EDs with fewer and fewer annually.

As most of us on this forum are board certified, EM trained EPs we're a little touchy about the subject of non boarded docs working in EDs. That's why your post got some snarky replies.

Now, as for EPs opening primary care clinics, they can but they shouldn't. I know of several EPs who have opened clinics and now practice primary care. They usually start out as urgent cares then collect a patient base and, presto, they're primary care clinics. The problem is that, unless the doc has gotten training in IM or FM they're not really trained to do primary care. For an EP to assume that they can competently practice primary care shows a lot of hubris and at least a little disrespect to the training that actual PMDs go through.

I agree, and I wouldn't mean any disrespect to FPs or their training, but I could see myself wanting to "retire" into FP and not deal with regimented 12 hour shifts or connected to a hospital / urgent care when I'm old and 65. It'd be a nice option to have at that time.

Every primary care doctor I know that's still practicing over the age of 65 works much longer hours than I do. They're not doing night shifts, but they still take call at night and then are in clinic all day the next day. Primary care does not scale as easily as EM. If your patients cannot get in to see you, they switch doctors. And it can take years to build up a patient base. Now I guess with they way the future of healthcare is headed, you could be the doctor who signs the charts for a group of midlevels (likely NP's). Kind of like the anaesthesia/CRNA relationship. Or more accurately, the surgeon/CRNA relationship.

Arcan57 said:

Every primary care doctor I know that's still practicing over the age of 65 works much longer hours than I do.

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The other reason for this is that, by definition, they're from a MUCH different generation. Their expectations of what a life in medicine would entail are/were different than current grads.

It'll be interesting to see how things change with a new generation of PCPs out there who grew up not taking call or working past 5. I'm not trying to slam primary care but there is a huge difference in how the different generations approach work.

Take care,
Jeff

If I'm still working at 65... well, let's just say that I certainly don't plan to be.

And you couldn't pay me enough to run a clinic all day. Shudder.