Can an ER doc switch to GP?

[strongboy2005]

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I was thinking about possible career paths as a doctor and I wondered if it was possible to switch from a specialty to general practice. Could an ER physician, OB/GYN, or psychiatrist just "change their mind" and become a GP? Would anything be required to make the change?

 

[DrYoda]

I was thinking about possible career paths as a doctor and I wondered if it was possible to switch from a specialty to general practice. Could an ER physician, OB/GYN, or psychiatrist just "change their mind" and become a GP? Would anything be required to make the change?

They would need to go back and do a residency in family med/ internal med(assuming that's what you mean by general practice).

 

[cbrons]

I was thinking about possible career paths as a doctor and I wondered if it was possible to switch from a specialty to general practice. Could an ER physician, OB/GYN, or psychiatrist just "change their mind" and become a GP? Would anything be required to make the change?

I always wanted to know this too... I was unclear about how certain specialties go about doing things like volunteering in free walk-in clinics and whatnot.

 

[strongboy2005]

They would need to go back and do a residency in family med/ internal med(assuming that's what you mean by general practice).

Interesting. Well, in that sense, then there really is no "specialist" because everyone has to specialize. My thought of a specialist was that the ability to do anything a family practice doctor could do, and then some, was what it meant that they were specialized. So an emergency medicine doctor, ophthalmologist, or OB/GYN couldn't work in a free clinic? An ER physician will ONLY deal with emergencies their whole life and could not, even if they wanted to, give a prescription for common strep throat or open up a practice? This just doesn't sound right.

EDIT: I guess my real question is: what can a family practice doctor do that an ER doctor, OB/GYN, or ophthalmologist COULDN'T do?

 

[Bike on a Trek]

There is nothing that prohibits an EM physician from making a career switch into outpatient adult primary care (general internal medicine), they just can't be board certified without doing the residency and passing the board examination. The issue in switching is their degree of competence and finding a place that will credential and privilege them to practice. Some EM physicians might be able to work as hospitalists. I suspect that you would not find many EM physicians with competency to switch to pediatrics or psychiatry, and I doubt that many hospitals would credential or privilege them in those specialties. The opposite also holds, and there are many family medicine practitioners and general internists who wind up doing EM medicine--the issue here is whether the hospital has a policy that requires them to hire EM trained physician with boards or whether they are allowed to hire physicians with comparable training.

 

[Handyman73]

The above poster hit the nail on the head. In most states, your medical license is an unrestricted license to practice medicine and surgery. As long as you can find a patient willing to let you do your thing, you are free to do it.

 

[Bike on a Trek]

mistakenly reposted

 

[strongboy2005]

There is nothing that prohibits an EM physician from making a career switch into outpatient adult primary care (general internal medicine), they just can't be board certified without doing the residency and passing the board examination. The issue in switching is their degree of competence and finding a place that will credential and privilege them to practice. Some EM physicians might be able to work as hospitalists. I suspect that you would not find many EM physicians with competency to switch to pediatrics or psychiatry, and I doubt that many hospitals would credential or privilege them in those specialties. The opposite also holds, and there are many family medicine practitioners and general internists who wind up doing EM medicine--the issue here is whether the hospital has a policy that requires them to hire EM trained physician with boards or whether they are allowed to hire physicians with comparable training.

Thank you, that clarifies a lot.

So, could an ER physician open a PRIVATE outpatient adult primary care practice? Could they open their own private psychiatry clinic? Why couldn't a family practice doctor just simply open a dermatology office if that's what they wanted to do? What actually limits a physician to doing one thing?

So, if a family practice doctor said to himself, "Man, I'd rather just open up a psychiatry practice," what actually could keep him from doing so?

 

[DrYoda]

Interesting. Well, in that sense, then there really is no "specialist" because everyone has to specialize. My thought of a specialist was that the ability to do anything a family practice doctor could do, and then some, was what it meant that they were specialized.

Internal medicine subspecialities are certified in internal med and then do a fellowship in their subspeciality (cardiology, infectious disease, oncology and many more). So in some cases this is true.

So an emergency medicine doctor, ophthalmologist, or OB/GYN couldn't work in a free clinic? An ER physician will ONLY deal with emergencies their whole life and could not, even if they wanted to, give a prescription for common strep throat or open up a practice? This just doesn't sound right.

I was addressing you question of employement and not talking about volunteer activities.

Technically once you complete your intern year you are license to practice medicine in the broadest sense (everything). However, it isn't feasble to get hired (or pay what I imagine would be sky high malpractice insurance) without doing further training. That's the nature of the beast, you make career decisions and some door close.


and people come into the ER with non-emergencies like strep throat all the time.

 

[DrYoda]

What actually limits a physician to doing one thing?

At the core it's what the customers demand.
Would you want a pathologist putting in a stent?
A cardiac surgeon doing your eye surgery?
*insert other combos as needed*

 

[strongboy2005]

Technically once you complete your intern year you are license to practice medicine in the broadest sense (everything).

Wow that's pretty sweet... I guess I just like the IDEA that if the world were coming to an end and there were a huge need for doctors, all MDs could be expected (and would be able) to perform a whole range of services.

I talked to a DO family practice physician who was the only doctor in a rural area for literally hundreds of miles. He said he performed basically all types of medicine, and even took ambulances from a nearby freeway. I just think it's so cool that this profession allows you to be versatile and actually be a real asset to society.

 

[Bike on a Trek]

Thank you, that clarifies a lot.

So, could an ER physician open a PRIVATE outpatient adult primary care practice? Could they open their own private psychiatry clinic? Why couldn't a family practice doctor just simply open a dermatology office if that's what they wanted to do? What actually limits a physician to doing one thing?

So, if a family practice doctor said to himself, "Man, I'd rather just open up a psychiatry practice," what actually could keep him from doing so?

Well, yes they could open up a private practice. Most would certainly want malpractice insurance, so you would need to convince your carrier that you were competent. But, that can be done for primary care for many EM physicians. You almost certainly would need admitting privileges at a hospital, unless you never planned on taking care of sick people or you had an arrangement to have someone else admit and take care of your patients. The scenario is much more likely (and does happen), if an EM physician can find a primary care group practice that is willing to hire them (almost no one opens solo practices); this can happen easily when the EM physician works well with local practices in the community and develops familiarity with them.

Psychiatry would be tougher to get malpractice coverage out of other specialties. And, I think it would be much harder to demonstrate beforehand that you had competence without some specific experience. Even then, it's tough for me to imagine that many EM physicians could do that. Maybe some family medicine practitioners could try, but I bet they'd have trouble.

Some posted the question about "just going into dermatology". That would be very difficult to do without specific training. You likely wouldn't be able to get malpractice coverage.

 

[DrYoda]

I talked to a DO family practice physician who was the only doctor in a rural area for literally hundreds of miles. He said he performed basically all types of medicine, and even took ambulances from a nearby freeway. I just think it's so cool that this profession allows you to be versatile and actually be a real asset to society.

That is one cool thing about rural family med/internal med, that they do get to do a wider range of things than their peers in the more populated areas.

 

[smq123]

My thought of a specialist was that the ability to do anything a family practice doctor could do, and then some, was what it meant that they were specialized.

No, that's definitely not the case.

Every physician has a certain baseline knowledge of how to treat really basic diseases. But there is no way that a specialist = family doctor + specialty skills.

For instance, there is no way that an orthopedic surgeon is capable of managing hypothyroidism as well as a family doctor is. There's also no way that an adult cardiologist can treat children as well as a family doctor can. And there's no way that a pediatric endocrinologist is capable of treating adults.

So an emergency medicine doctor, ophthalmologist, or OB/GYN couldn't work in a free clinic?

Sure they can. But they would have to work in specialty free clinics.

For instance, an ophthalmologist isn't going to hold free neighborhood cholesterol screenings, or free neighborhood prostate cancer screenings. But an ophthalmologist could participate in free glaucoma screenings, etc.

EDIT: I guess my real question is: what can a family practice doctor do that an ER doctor, OB/GYN, or ophthalmologist COULDN'T do?

A family practice doctor can treat children and men (which an OB/gyn can't - OB/gyns receive very little training in how to treat male diseases, like prostate cancer or erectile dysfunction).

A family practice doctor can take care of people for long periods of time, and manage chronic diseases (which an ER doctor usually doesn't do).

A family practice doctor can take care of people below the neck (which ophthalmologists rarely do).

As you said, pretty much everyone specializes....even the "general" practitioners.

 

[MossPoh]

Above is true for the most part. There are limited circumstances where a specialist might go in and help, but it certainly isn't a great career path nor is it something they'd want to do. My dad is a radiologist with a fellowship in cardiovascular radiology but he did do occasional stand-ins for a basic physical for athletes in the local middle school and high school. He would never go so far as to prescribe medicine or any of that, but he kept on track of the basics and he knows when something was wrong and would push that student over to the family practice guy that was doing the bulk of the physicals. Technically, if you are a "GP" then you all you did was complete a residency. GP in the UK is generally seen as the family medicine here I believe. Once in a while you'll hear about some doc that screwed up really bad and the only way they can get some income is by doing basic scut hell at some clinic somewhere. (I know of an anesthesiologist and an obgyn off the top of my head that this happened to)

The overall answer is that it is a pain in the arse to just up and switch and you'll never really see it except for some very rare circumstances.

 

[JaggerPlate]

Above is true for the most part. There are limited circumstances where a specialist might go in and help, but it certainly isn't a great career path nor is it something they'd want to do. My dad is a radiologist with a fellowship in cardiovascular radiology but he did do occasional stand-ins for a basic physical for athletes in the local middle school and high school. He would never go so far as to prescribe medicine or any of that, but he kept on track of the basics and he knows when something was wrong and would push that student over to the family practice guy that was doing the bulk of the physicals. Technically, if you are a "GP" then you all you did was complete a residency. GP in the UK is generally seen as the family medicine here I believe. Once in a while you'll hear about some doc that screwed up really bad and the only way they can get some income is by doing basic scut hell at some clinic somewhere. (I know of an anesthesiologist and an obgyn off the top of my head that this happened to)

The overall answer is that it is a pain in the arse to just up and switch and you'll never really see it except for some very rare circumstances.

Is that a Boston in your avatar?? My buddy used to have one that sat the exact same way. She literally couldn't sit like a normal dog. We'd seriously just laugh for hours when we would be sitting around watching TV and she'd hop up on the couch and sit there like a little fat person.

 

[RySerr21]

I was thinking about possible career paths as a doctor and I wondered if it was possible to switch from a specialty to general practice. Could an ER physician, OB/GYN, or psychiatrist just "change their mind" and become a GP? Would anything be required to make the change?

I once called a family practice doc to shadow and she said she was no longer in FP and had switched to EM, so I'm sure its possibel the other way around.

I also worked with a current preventive medicine resident who had been a practicing OB/GYN for 20 years or something like that.

 

[Bacchus]

If you're interested in EM and IM you can do a dual residency. EM/IM and FP/EM are some of the more popular combined residencies, I believe.

 

[umean2tellme]

I know a doctor who practiced EM for 10 years. He was/is board certified. Now he is in private practice. He seems very competent and others where I work have nothing but good things to say about him, including his patients. He changed b/c he got older and wanted better hours/less stress once he became a father. A lot of the stuff that goes on in the ED is primary care stuff anyways (from what I've heard).

 

[link2swim06]

If you're interested in EM and IM you can do a dual residency. EM/IM and FP/EM are some of the more popular combined residencies, I believe.

I work for a ER doctor who does 10 months down in the ED and 2 months a years as an IM doctor up on the floors. After talking to alot of residents they seem to have alot of respect for his word because he can see beyond just the focus of emergency medicine. I got to shadow him a few times, he know his **** and is far better than my personal FP.

 

[Bacchus]

I work for a ER doctor who does 10 months down in the ED and 2 months a years as an IM doctor up on the floors. After talking to alot of residents they seem to have alot of respect for his word because he can see beyond just the focus of emergency medicine. I got to shadow him a few times, he know his **** and is far better than my personal FP.

Like every profession there are people that do it better than others.