I briefly worked in a health clinic on a college campus that did academic and pre-employment physicals for the students. We also functioned as a minor illness clinic. We also did some health screenings like BP, cholesterol, skin, etc.
I am pretty sure I can learn on the job and can research anything I don't know.
I am EM trained and have done primary care or subacute care. Do it. You can learn alot by doing some reading on BP,CAD etc.
This is one time I feel SDN misleads.
I am boarded in EM and used to believe the quotes above. I have family and friends in primary care and they told me the same thing. My wife even told me, "They have NPs doing this and YOU feel nervous?" She added, "Just refer whenever you're not sure. It's not like the ER where people die if you get it wrong." However, after having worked at a college campus student health clinic, I have to disagree. I wasn't even working in a bonafide primary care clinic and I felt I was outside my comfort zone. Sure, no one will go home and die within 48 hrs. And after letting a condition or symptom go for longer than it should before referring or taking other measures, for most cases, I would probably eventually "get it right." But the truth is it just didn't feel ideal or fair to the patient.
In the ED, I don't consult for every condition nor do I admit every vague presentation. In that setting, I am quite confident clinically. But in the outpatient setting, I felt woefully unprepared and making up for it by just reading uptodate, doing a literature search or glancing over a review article seemed pathetic and dangerous. I saw young, healthy college kids for the most part and talking to them about pap smear recommendations, birth control options, cholesterol and HgbA1C numbers, weird moles, migraine HAs, unexplained wt gain/loss, etc. couldn't be any further outside the medical world I was trained for. Sure, you can look things up and continue to "practice" until you gain experience but it felt wrong, even if nobody died immediately or suffered significantly as a result of my care.
There is something to be said for having seen experienced physicians before me do things a certain way, give you specific reminders, point out certain red flags, tell you about their experiences. You need to see normal outcomes, expected complications and treatment side effects, see common mistakes and their consequences. You need to do journal club and see if what is written actually applies in real practice settings. A lot of emergency medicine writing talks about orthostatic BP for GI bleeds, auscultating bruits in AAAs, vagal maneuvers for SVT, neck stiffness for meningitis, ultrasounding every body part, etc. In reality, most ER doctors don't practice that way. You need to have the perspectives of many different attendings with different philosophies, tolerances for risk, practice styles. You need to do things over and over again. You need to see the routine stuff thousands of times so you recognize when something is wrong. You get this in residency, NOT when "practicing" in isolation while reading review articles.
The final straw for me was when I thought about the notes I was writing in the pt charts. Could I be proud of my care for these pts? If I stayed at this clinic for 10 years, could I look back on my body of work and feel good? Would the next physician look back and say, "Man, this guy was good!" My own answer to that question was that I wasn't sure because I didn't really know how other PCPs practice. Other than what I've read, I couldn't be sure what was actually standard of care. Because of that, I resigned.
Primary care is not easy. It sounds easy but believe me, it is not. I am not saying don't try it. I do believe that my experience in the outpt setting has made me a more well rounded physician. However, you need to remember that you are not a PCP. You really need to watch yourself closely to be sure you don't cross any major scope of practice lines. As much as I enjoyed my break from the chaos and dysfunction of the ER, I quit the clinic because watching that line day in and day out was not what I wanted to do.
