Possible to practice FM at a free clinic though trained in a different field?

smiley737 said:

I was wondering if it is possible to do residency training in a different field, but still practice some basic family medicine in volunteering at a free clinic. Are there any restrictions in the US to doing basic preventative screening and medication prescribing if you are board-certified in a totally different field of medicine? Do you still need attending-level oversight?

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Free clinics love to have specialists. Whatever your field is, a free clinic can find work for you.

With a medical license, technically you can do pretty much whatever you want. Insurance often limits practice (not an issue here) as do hospitals (if you're EM you won't be able to find a place to take out gallbladders). The issue is, as always, what you're comfortable/competent doing.

VA Hopeful Dr said:

The issue is, as always, what you're comfortable/competent doing.

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Free clinics usually have sicker, more non-compliant, limited resource patients. No matter what specialty you come from, if you practice FM you will be held to the same standard as a board-certified FP in the same/similar setting. Good luck.

as others have said:
1. practice within your level of competence
2. practice within your level of comfort
3. confirm local standards and/or credentialing and/or coverage.

I have seen numerous general surgeons work in rural areas doing a great deal of primary care and even regular c-section delveries. It will depend on the dynamics of the area and your training. One thing I will say, do NOT use a local need/underserved situation to justify providing substandard care or coming in and shooting from the hip. It may make you feel good (i.e. ego). However, it's not the right thing to do.

So, my colleagues in general surgery that have gone rural did some things. They teamed up with local PCPs and OB/Gyns and they worked with them and learned from them over some years to increase their competence and skill set. The community was short on specialists and the limited PCP and OB/Gyn resources made them a welcome addition. On top of their 5 years of general surgery training that does involve plenty of cardiology/diabetes/hypertension/etc.... they then learned additional knowledge about these diseases by those that provide the primary care of them.

smq123 said:

But why would you want to do this? Spend your free time seeing more patients, exposing yourself to more lawsuits, etc?

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Wow...now, I'm not the biggest altruist out there, but this statement is, frankly, shocking. Why do people volunteer in free clinics? Umm...maybe because there are poor, poor people that are not riding the MedicAid train, and that will put up with signing in at 10am, and waiting until 3pm to be seen (as that's how it went when I was in SC - it wasn't that pts were being seen at 10am - that's when the list opened - clinic started at 3pm), who will jump through all of the onerous hoops (and there are many) that are presented to see a doctor. This is exactly how it rolled - there were several free clinics, including some dental, that would get people what they needed. It would take longer, but, what people needed, they would get.

A lot of people that do free clinic work do it out of a sense of noblesse oblige or religious duty. Even though you are a resident, that you could be so callous as to not see the perspective of why people volunteer (even if you disagree) is galling. Not everything needs a paycheck.

You would probably do better to establish a relationship with a free clinic and agree to see some of their patients in consult in your specialty. That would probably serve everyone better than trying to practice primary care when you're not trained for it.

smiley737 said:

I was wondering if it is possible to do residency training in a different field, but still practice some basic family medicine in volunteering at a free clinic. Are there any restrictions in the US to doing basic preventative screening and medication prescribing if you are board-certified in a totally different field of medicine? Do you still need attending-level oversight?

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Since you are not residency-trained or board-certified in FM, it would probably be more accurate to call what you are planning on doing "general practice" rather than "family medicine".

michaelrack said:

...it would probably be more accurate to call what you are planning on doing "general practice" ...

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Or primary care provider.

Blue Dog said:

I'm not a "provider." I'm a physician.

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Ok, primary care physician......

michaelrack said:

Since you are not residency-trained or board-certified in FM, it would probably be more accurate to call what you are planning on doing "general practice" rather than "family medicine".

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Is it possible to do anything anymore as a 'general practitioner?' And by this, I mean someone who just did an internship or whatever the state requirement was for a license? Locum tenens type work? Etc??

JaggerPlate said:

Is it possible to do anything anymore as a 'general practitioner?' And by this, I mean someone who just did an internship or whatever the state requirement was for a license? Locum tenens type work? Etc??

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short answer is, YES.
Longer answer is IT DEPENDS....
If you are in a rural area and meet the state licensing requirements, you can open your own private practice. However:
1. More and more common for hospitals to not privilege physicians lacking board certification
2. Insurance companies are restricting the reimbursements based on training/qualifications/board certification.
3. A reputable clinic/hospital often likes to make known their "experienced and highly trained" or excellent qualifications of staff.... i.e. "all our physicians are board certified".... So, clinics as such will likely avoid allowing a non-certified/incompletely trained physician to come in as locums and cover their patients. It has potential for very, very poor marketing. Further, if there are competitors, it may be a nice point for them to say, "...clinic over there has good surgeons Mon-Fri, but after hours/hollidays your going to get .... less"

There is need out there for physicians. You could probably make a living as a GP with just minimal residency. But, one needs to understand the less complete your training, etc... the less freedom you will have in choosing how you work, where you work and where you live. All things being equal, a fully trained specialist can generally travel to any state and work in any state. A GP with limited residency may not be free to relocate practice to and/or work in states, x, y, z....

At the free clinic I volunteer in, it is my understanding that the good Samaritan law protects them from lawsuits. Our county's EM group rotates a doc in every week and they seem to enjoy having a chance to practice outpatient medicine for once.

However, a nearby FM residency program rotates an attending and resident through at the same time... so its not uncommon to see the volunteer EM physician running things by the attending during clinical hours... I think things management of some of the chronic disease patients caused this to happen most of the time because they've "pooped those parts of their med school classes out" as one EM doc put it.

The OPs question is a LEGAL question. If it was me, I would not depend on advice from an internet site regarding laws governing the provision of health care. Laws and regulations differ from state to state. Being sued for malprctice is a serious thing. BEFORE I do anything at the free clinic, I would make sure to:

1) Seek the advice of a health care lawyer.
2) Ask your insurance if you are covered under your current policy if you work at the free clinic as a generalist (in a field that you are not formaly trained in).

Good Luck, and god bless you for willing to work in a free clinic....BUT ALWAYS make sure your butt is covered first.

I suppose legally it would vary by state -I would probably call the Board of Medicine, ask to speak to an attorney serving on the board, and talk to your free clinic director.

The free clinics I have worked in all had umbrella policies protecting their volunteers, and physicians receive tax breaks for donating their time and expertise. Several of the clinic physicians were specialists seeing pts for general concerns, and several were retired physicians, so they were not keeping up a separate malpractice policy.

The clinic patients were vetted (had to meet income requirements, etc) and any physician at any time could ask to discontinue to see a particular patient if the patient was abusive, etc. My experience in general was that if you were a specialist, pts would be assigned to you who had problems in that area (so our orthopedist volunteer would end up with lots of back pain pts).

We also had several specialists who saw patients in their offices, and a local radiology practice that read images for us. The hospital and local labs took care of a lot of specialist services/ancillary costs (OR, path, ED, etc) -this makes a lot of sense, because the idea is to cut back on ED visits and really expensive problems by getting these patients into regular preventative services, thus preventing DKA, MIs, etc and saving the hospital $$ and ED overcrowding with sinus infections, etc.

You certainly could volunteer for a free clinic w/o a license, board cert, but your services would likely be limited accordingly.

One of the things that helps w/ the whole malpractice thing is that free clinics in general do not allow prescriptions for controlled substances.

When I was in my third year of medical school I was assigned to a family practice clinic for rotations. There were 2 physicians there.

1) A Family Practice board certified doc who was there forever.

2) A retired Neurosurgeon who got out of the rat race of 100 hour weeks doing risky surgeries but who didn't want to quit medicine but who wanted to have a nicer lifestyle and still make some money while retired. He did very well and was happy. Any questions he had he looked up or asked his partner.

I also did a rotation in a free clinic where we had multiple specialists there doing mostly general family medicine. We had cardiology, ob/gyn, neurology, internal medicine all working together for the super poor. It was a lot of fun and the patients appriciated the service.