Can an ER doctor start a private primary care practice?

[TXMD33]

Had a question, when I'm tired of EM, am I able to open a primary care type practic? Yes I know I won't be board certified in Family practice, but is there a legal reason that couldn't have a private practice managing BP, DM, annual checks/health maintenance, weight loss, etc for a slower pace?

After all you have Fam med/Int med in EM, and god knows we see enough primary care stuff in ER. Yes I would have to bone up on stuff to fill in any gaps in knowledge but assuming I'm appropriately managing patients, anyvway I could get in trouble legally by opening up a practice?

Or could I hire a family medicine trained NP to work in my practice under my license?

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[RustedFox]

My head hurts.

 

[VA Hopeful Dr]

Anyone worked for a primary care clinic? Experiences?

Hi all, I am considering picking up a moonlighting gig for a primary care clinic. The clinic is run by an IM doc and sees typical primary care stuff (annual physicals, diabetes and HTN management, referrals to specialists, maybe some urgent care stuff, etc) I have no primary care experience and...

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[BoardingDoc]

Had a question, when I'm tired of EM, am I able to open a primary care type practic? Yes I know I won't be board certified in Family practice, but is there a legal reason that couldn't have a private practice managing BP, DM, annual checks/health maintenance, weight loss, etc for a slower pace?

After all you have Fam med/Int med in EM, and god knows we see enough primary care stuff in ER. Yes I would have to bone up on stuff to fill in any gaps in knowledge but assuming I'm appropriately managing patients, anyvway I could get in trouble legally by opening up a practice?

Or could I hire a family medicine trained NP to work in my practice under my license?

Is it possible for you to do this somewhere in the country? Probably. Is it a good idea? No. You don't know what you don't know. Odds are you will be a crappy PCP. This is literally the same argument in reverse about how some FPs feel like they are just as qualified to work in an ED as EM boarded docs. They aren't, just like you aren't qualified to do their job. It literally boggles my mind that because there is some overlap between specialties that people feel that they are qualified to work as an entirely different specialty.

 

[Lexdiamondz]

Nothing stopping you from hanging a shingle and being a PCP - you can literally do whatever you want. That doesn't mean you'll be good at it though. Primary care isn't the same thing as urgent care and EM training doesn't prepare you to properly function as a PCP.

 

[BigPikachu]

If Emergency Physicians can run a Primary Care Practice, then can Family Physicians run an Emergency Department? Probably not. There's overlap between the specialties, but they're still very different scopes-of-practice. Medicolegally I would be board certified in Family Medicine (or one of the other primary care based specialties) if you want to practice in that field, or at least, work with a senior colleague in that practice who has the qualification.

 

[The wise one]

Guys, you missed this. That's his question; the rest is just fluff, for lack of a better word.

Or could I hire a family medicine trained NP to work in my practice under my license?

 

[Brigade4Radiant]

Nothing stopping you the legal risk is minimal. ER just has higher acuity so more people can be hurt.

If you like to learn constantly after a few years of being an ER physician you can do primary care.

However being a good primary care doctor is harder often than being a specialist which is why many NPs and PAs work in specialty fields.

 

[gutonc]

Helluva first post.

 

[docB]

You shouldn't. You also shouldn't be supervising an MLP in a specialty you aren't trained in. If you really want to slow down look at urgent care or a low volume ED.

 

[Splenda88]

I see a lot of GPs doing primary care in south FL. Not sure how good they are...

 

[docB]

I see a lot of GPs doing primary care in south FL. Not sure how good they are...

When you say "GP" what do you mean? Almost everyone now is trained and boarded in something. For primary care that's usually IM or FM with some Peds,OB/Gyn, cards and so on depending on the patient. Back in the day a "GP" was someone who did 1 year of internship, no residency and met the minimum requirements to be licensed in some states. There aren't many of them around any more. The primaries in your area may not be good but they're probably not "GPs."

 

[Splenda88]

When you say "GP" what do you mean? Almost everyone now is trained and boarded in something. For primary care that's usually IM or FM with some Peds,OB/Gyn, cards and so on depending on the patient. Back in the day a "GP" was someone who did 1 year of internship, no residency and met the minimum requirements to be licensed in some states. There aren't many of them around any more. The primaries in your area may not be good but they're probably not "GPs."

I mean physicians with ONLY one 1-yr post grad training, and there are still a few in south FL.

 

[BigPikachu]

I mean physicians with ONLY one 1-yr post grad training, and there are still a few in south FL.

Almost everyone ends-up specialising nowadays and attaining specialty board certification.

The breed of 'non- board certified' GPs and Hospitalists are a historical generation of medicos that are dying off.

With the competitive job market nowadays, and simply so you are better trained and educated about your craft, I think it's definitely worthwhile to complete specialty training, rather than just simply relying on your knowledge after medical school and internship.

 

[Splenda88]

Almost everyone ends-up specialising nowadays and attaining specialty board certification.

The breed of 'non- board certified' GPs and Hospitalists are a historical generation of medicos that are dying off.

With the competitive job market nowadays, and simply so you are better trained and educated about your craft, I think it's definitely worthwhile to complete specialty training, rather than just simply relying on your knowledge after medical school and internship.

I agree with your overall point

However, I don't agree about people saying an ED should not practice primary care... Of course, it will be difficult at the beginning and that ED doc has to rely on a colleague who is a good PCP for help at time. I think after a year, the ED doc should be fine. There is a great deal of overlap b/t EM/FM/IM, though I believe it's easier for an EM doc to do primary care (meaning it might take them around a year to be comfortable) than for IM/FM to do EM whereas it might take over 1-year to be comfortable... Again, I might be wrong here since I am just a PGY2 IM.

 

[VA Hopeful Dr]

I agree with your overall point

However, I don't agree about people saying an ED should not practice primary care... Of course, it will be difficult at the beginning and that ED doc has to rely on a colleague who is a good PCP for help at time. I think after a year, the ED doc should be fine. There is a great deal of overlap b/t EM/FM/IM, though I believe it's easier for an EM doc to do primary care (meaning it might take them around a year to be comfortable) than for IM/FM to do EM whereas it might take over 1-year to be comfortable... Again, I might be wrong here since I am just a PGY2 IM.

Yes, you are wrong

 

[Birdstrike]

Had a question, when I'm tired of EM, am I able to open a primary care type practic?

It's possible. Many, many EM docs have done this. Some might see all walk ins. Or they may take only appointments. Or they may schedule some appointments and leave some time open for walk ins. Generally, you're going to get mostly negative feedback on this subject from people on this forum, but many EM physicians have done this and the spectrum varies from 100% urgent care, to 100% primary care, and mixtures of every proportion in between.

Yes I know I won't be board certified in Family practice, but is there a legal reason that couldn't have a private practice managing BP, DM, annual checks/health maintenance, weight loss, etc for a slower pace?

It's 100% legal.

Yes I would have to bone up on stuff to fill in any gaps in knowledge but assuming I'm appropriately managing patients, anyvway I could get in trouble legally by opening up a practice?

No. It's totally legal. You would be a more open to malpractice claims if you had a bad outcome, since plaintiff's lawyers would quickly seize on your lack of board certification and exploit it as a weak point in your defense, but it's 100% legal.

Or could I hire a family medicine trained NP to work in my practice under my license?

Also, 100% legal.

There is no debate as to whether you can do this or if it's legal to do this. You can, and it is. The debate is as to whether or not you should do this.

 

[DeadCactus]

Yes, legally you can. A physician is a physician in the view of the law; formal training and certification comes into play for malpractice coverage, reimbursement, and hospital credentialing but the law generally really only recognizes medical licensure. I have a negative take on this and find it to generally disrespect the formal training and board certification of primary care which mirrors back into disrespect for formal training and board certification in emergency medicine.

Beyond that, the reality is that for the vast majority of physicians, this is a ridiculous notion. You're burnt out of emergency medicine and the pace so, instead of working a slow rural shift or two a week capitalizing on the efficiency granted by a career of experience, you're going to go work 40+ hours a week, possibly starting a business from the ground up, in a speciality you have no real experience in while maintaining a patient volume that keeps the doors open? I would argue there is a very small percentage of people that this makes sense for especially as a second career rather than a progressively growing side enterprise.

Maybe the COVID stuff has me looking for something to go on a rant about but let me offer you another take on this issue. I would argue that the whole notion of "what will I do when I get tired of emergency medicine" is an awful approach. You're going into a career with a plan to hate it in a decade or two. This is a broken and fragment approach to career planning and falsely treats emergency medicine a some sort of monochromatic field. Your approach to career planning should not be to trudge along for 20 years until you can't stand it and then mash the eject button and plop into a new career hoping the grass is greener. Emergency medicine is a skillset that leads to employment in a related by vastly divergent positions. Rural community EM is different from academic tertiary EM is different from government positions is different from urgent care. Then there is research, administration, teaching, subspecialties (formal or otherwise), non-clinical work, etc. The variety of work as emergency physician is endless. I'm not saying there aren't cases when people just need to completely change specialties but I would argue most problems can be addressed more efficiently.

Trainees and early career physicians should be asking themselves what they broadly want out of their career and identifying what they hate and what they love about their career as well as how that will change over the next 5, 10, and 20 years. Now you've identified goals and problems and can develop a coherent framework for building your career in a way that progressively leverages your skills and experience while adjusting course through formal or informal training to reach the next career goal. You should constantly be re-evaluating opportunities to adjust your career to meet your current and future desires. So many people seem to just blindly stumble into a job, aimlessly climb the ladder or treadmill until they retire or decide they hate it, and then blindly jump into another position.

There's nothing wrong with planning ahead and realizing you'll want different things out of your career at different points in your life or even making backup plans in case things don't work-out. I'm just advocating for identifying the specific problems you're anticipating and looking for solutions that efficiently solve that problem. Maybe the original poster has done that and just wanted a specific answer regarding one specific part of their plan and I've gone into a needless monologue but oh well no one is forced to read this...

 

[betamale]

I don't see why you can't. My partners and I volunteer at free primary care clinics and treat DM, HTN, HLD, depression, order vaccines.

I would probably attend primary care CMEs. Most primary care docs do not do OB and peds volume in non-peds practice is very low.

Good luck on opening your practice!

 

[Mushdoc]

I think it would be frustrating to learn how to do outpatient workups - pre-authorization and insurance forms, which places to send people, following up on results and consults in your inbox etc. Would much rather attach myself to a group as their urgent care walk in person

 

[TXMD33]

It's possible. Many, many EM docs have done this. Some might see all walk ins. Or they may take only appointments. Or they may schedule some appointments and leave some time open for walk ins. Generally, you're going to get mostly negative feedback on this subject from people on this forum, but many EM physicians have done this and the spectrum varies from 100% urgent care, to 100% primary care, and mixtures of every proportion in between.


It's 100% legal.

No. It's totally legal. You would be a more open to malpractice claims if you had a bad outcome, since plaintiff's lawyers would quickly seize on your lack of board certification and exploit it as a weak point in your defense, but it's 100% legal.

Also, 100% legal.

There is no debate as to whether you can do this or if it's legal to do this. You can, and it is. The debate is as to whether or not you should do this.

Really appreciate everyone's input, both positive and negative. And thanks Birdstrike for taking the time to post a helpful reply! Definitely more food for thought. I do also have experience in other fields (marketing, business) so just wanted to see what my options were. Though I love EM at it's core, I see myself getting burnt out from the way it is delivered and the suffocating bureaucracy. Will always do it in some capacity but plotting for a way to have more work life balance while satisfying my entrepreneurial itch!

 

[TheTruckGuy]

I'm EM internship trained, and have been practicing primary care for a little while now as a military "general medical officer." I used to do the whole volunteer at free clinics throughout med school, even functioning almost independently as a 4th year med student our school's clinic. And I thought being a PCP would be pretty easy. But something I've learned since truly becoming an independent practitioner with only an EM PGY1 year behind me is that true primary care is hard.

The stuff you usually take care of at free clinics, titrating HTN/DM meds, biopsying moles, cutting out ingrown nails, etc., That's easy. Someone comes in to the ED with something in pain, rule out the bad stuff, try to fix it if you can, otherwise tell them to follow up with their PCP. That's not terribly difficult. Knowing how to do the complicated workups, that's hard.

What's the workup for chronic testicular pain? For asymptomatic hematuria? For an abnormal pap smear? For "dizziness," hearing loss, a weird rash that hasn't gotten better with steroids/moisturizing/drying etc., the young healthy person who has "lightning in my chest and I just know something is wrong," the chronic abnormal uterine bleeder, etc. You could be that PCP that doesn't do any actual medicine and just refers everything to the specialist, like more and more of them are becoming.

I think if you really wanted to do some primary care, but not to the full scope of a FM trained PCP, you could probably actually fill that role of a mid-level practitioner at a PCP clinic. Handle most of the primary care level stuff that we see in the ED. This would be similar to an FM doc working at an urgent care or in the fast track of an ER.

 

[Oligodinero]

Or could I hire a family medicine trained NP to work in my practice under my license?

I personally think hiring a MLP to work in a specialty outside your specialty area is a bad idea and would leave you both more open to unfavorable malpractice outcomes........more importantly, it may not be legal in some states. I know for a fact that in most (if not all) states, PAs must limit their scope of practice to that of their supervising physician's. I suspect in many states, the same is true for NPs, although I have no proof. It's something you'd definitely want to verify with both the SBME and the SBN before attempting or you and/or the NP may wind up in hot water.

 

[Shmoclo]

the guy who treated me at urgent care was a general surgeon.. i honestly still dont understand how a lot of this stuff works.

 

[RustedFox]

the guy who treated me at urgent care was a general surgeon.. i honestly still dont understand how a lot of this stuff works.

Urgent Care is where Medicine Goes to Die.

 

[Birdstrike]

Urgent Care is where Medicine Goes to Die.

Urgent Care: Where Medicine goes to die and ER doctors go to live.

 

[NewYorkDoctors]

To answer the OP question , a family medicine NP can operate under his her own license . You could pay for the practice and just hireNPs .

Now it is hard to be a good responsible PCP who does things academically and creates a true “patient centered medical home “ and also looks into the patients social spiritual holistic approach beyond the physiology and pathophysiology . Example - the good pcp would say more than eat less and see a dietitian . He she would delve into the patients bellied system and realize within that Patients culture it is frowned upon to waste food or turn down a meal . Etc things like that which most of us roll our eyes at but are important for the pcp to get to the root of


Now pcp are just order and referral monkeys who run a 99213 mill . Make money easy and have the specialists make some softball money too ! You could totally do this . Just open your own practice and call it urgent care . You see the urgent acutes and do some pocus and arthricentesis and knee injections while youre at I it . Have the NPs do the screening (officially ) and longitudinal care .

To answer the OP question - yes it is a doable business model .

 

[BoardingDoc]

To answer the OP question , a family medicine NP can operate under his her own license . You could pay for the practice and just hireNPs .

Now it is hard to be a good responsible PCP who does things academically and creates a true “patient centered medical home “ and also looks into the patients social spiritual holistic approach beyond the physiology and pathophysiology . Example - the good pcp would say more than eat less and see a dietitian . He she would delve into the patients bellied system and realize within that Patients culture it is frowned upon to waste food or turn down a meal . Etc things like that which most of us roll our eyes at but are important for the pcp to get to the root of


Now pcp are just order and referral monkeys who run a 99213 mill . Make money easy and have the specialists make some softball money too ! You could totally do this . Just open your own practice and call it urgent care . You see the urgent acutes and do some pocus and arthricentesis and knee injections while youre at I it . Have the NPs do the screening (officially ) and longitudinal care .

To answer the OP question - yes it is a doable business model .

What a bizarre necrobump.

 

[cyanide12345678]

Had a question, when I'm tired of EM, am I able to open a primary care type practic? Yes I know I won't be board certified in Family practice, but is there a legal reason that couldn't have a private practice managing BP, DM, annual checks/health maintenance, weight loss, etc for a slower pace?

After all you have Fam med/Int med in EM, and god knows we see enough primary care stuff in ER. Yes I would have to bone up on stuff to fill in any gaps in knowledge but assuming I'm appropriately managing patients, anyvway I could get in trouble legally by opening up a practice?

Or could I hire a family medicine trained NP to work in my practice under my license?

Legally you won’t have a problem, but if there’s a bad outcome, you will get chewed out at a lawsuit as someone practicing outside of their scope of practice i feel.

Legally you’re a doctor. Heck anyone can set up shop if they have had 1 post graduate year of training and finished step 3 and have a state medical license.

 

[rokshana]

What a bizarre necrobump.

What? Bad advice 2 years too late?

 

[NewYorkDoctors]

What? Bad advice 2 years too late?

Lol no . Stick to your day job. You might tickle more funny bones treating hypoparathyroidism.

 

[NewYorkDoctors]

What a bizarre necrobump.

Nah . This thread showed up in the suggested threads when I was contemplating making a related thread. One of my colleagues (EM) is considering doing such a thing and I asked him just to use my office space as an urgent care doctor . After going through the business framework , we found there was nothing with what the OP wanted to do that can’t be done . As mentioned above , it would be an easy lawsuit of (you are not board certified in FM or IM) if you were named . In general there are few things you can get sued for successfully in primary care . The ones that are successful are for not paying attention to screening intervals and not referring for a nebulous gray area case that one keeps dismissing as don’t worry about it . (Example cough and hoarseness in a smoker can be chalked up to “gerd “ once . But have to follow up and if not better consider imaging or endoscopy . Missing throat or esophageal cancer would be a lawsuit . This sounds like common sense to most primaries , but you’d be surprised what lack of attention ion of detail could lead to )

Since opening up private practice 99213 mills are lucrative , I can see the appeal that an EM physician would want to have an out besides urgent care . I wold suggest if you went that path , pair up with an IM or FM physician and you serve as the “covering attending” or “proceduralist” in the office .

Of corneas this whole thing would be easier for an EM/IM.

Hey I never said it is good advice . But advice it is . Good luck OP. For reference I do a primary care in addition to my specialty care as I inherited a large pcp panel a few years back

 

[VA Hopeful Dr]

Nah . This thread showed up in the suggested threads when I was contemplating making a related thread. One of my colleagues (EM) is considering doing such a thing and I asked him just to use my office space as an urgent care doctor . After going through the business framework , we found there was nothing with what the OP wanted to do that can’t be done . As mentioned above , it would be an easy lawsuit of (you are not board certified in FM or IM) if you were named . In general there are few things you can get sued for successfully in primary care . The ones that are successful are for not paying attention to screening intervals and not referring for a nebulous gray area case that one keeps dismissing as don’t worry about it . (Example cough and hoarseness in a smoker can be chalked up to “gerd “ once . But have to follow up and if not better consider imaging or endoscopy . Missing throat or esophageal cancer would be a lawsuit . This sounds like common sense to most primaries , but you’d be surprised what lack of attention ion of detail could lead to )

Since opening up private practice 99213 mills are lucrative , I can see the appeal that an EM physician would want to have an out besides urgent care . I wold suggest if you went that path , pair up with an IM or FM physician and you serve as the “covering attending” or “proceduralist” in the office .

Of corneas this whole thing would be easier for an EM/IM.

Hey I never said it is good advice . But advice it is . Good luck OP. For reference I do a primary care in addition to my specialty care as I inherited a large pcp panel a few years back

So you admit its bad advice?

 

[betamale]

Had a question, when I'm tired of EM, am I able to open a primary care type practic? Yes I know I won't be board certified in Family practice, but is there a legal reason that couldn't have a private practice managing BP, DM, annual checks/health maintenance, weight loss, etc for a slower pace?

After all you have Fam med/Int med in EM, and god knows we see enough primary care stuff in ER. Yes I would have to bone up on stuff to fill in any gaps in knowledge but assuming I'm appropriately managing patients, anyvway I could get in trouble legally by opening up a practice?

Or could I hire a family medicine trained NP to work in my practice under my license?

Yes you can primary care. Read a primary care textbook and do CMEs. Refer what you can't handle.

 

[NewYorkDoctors]

So you admit its bad advice?

Yes it is bad advice. I thought my exposition was rather clear. Only EM IM should contemplate that model . But it is doable . Thank you intrepid reporter .

 

[VA Hopeful Dr]

Yes it is bad advice. I thought my exposition was rather clear. Only EM IM should contemplate that model . But it is doable . Thank you intrepid reporter .

Interesting response given this exchange:

What? Bad advice 2 years too late?

Lol no . Stick to your day job. You might tickle more funny bones treating hypoparathyroidism.

 

[NewYorkDoctors]

Yes you can primary care. Read a primary care textbook and do CMEs. Refer what you can't handle.

Yep this pretty much what most private pcp do Anyway .

The academic internist GIM will go all out and be holistic and talk to the patient for one hour at a time and construct a

Interesting response given this exchange:

You know what they about people who make assumptions . Anyways I will allow you stop save face and stop replying to this thread and we can let this thread die and I won’t bump it anymore .

 

[Brigade4Radiant]

Nah . This thread showed up in the suggested threads when I was contemplating making a related thread. One of my colleagues (EM) is considering doing such a thing and I asked him just to use my office space as an urgent care doctor . After going through the business framework , we found there was nothing with what the OP wanted to do that can’t be done . As mentioned above , it would be an easy lawsuit of (you are not board certified in FM or IM) if you were named . In general there are few things you can get sued for successfully in primary care . The ones that are successful are for not paying attention to screening intervals and not referring for a nebulous gray area case that one keeps dismissing as don’t worry about it . (Example cough and hoarseness in a smoker can be chalked up to “gerd “ once . But have to follow up and if not better consider imaging or endoscopy . Missing throat or esophageal cancer would be a lawsuit . This sounds like common sense to most primaries , but you’d be surprised what lack of attention ion of detail could lead to )

Since opening up private practice 99213 mills are lucrative , I can see the appeal that an EM physician would want to have an out besides urgent care . I wold suggest if you went that path , pair up with an IM or FM physician and you serve as the “covering attending” or “proceduralist” in the office .

Of corneas this whole thing would be easier for an EM/IM.

Hey I never said it is good advice . But advice it is . Good luck OP. For reference I do a primary care in addition to my specialty care as I inherited a large pcp panel a few years back

Lawsuits depend on the state. Also a lot of PCPs are NP and PA with no supervision. Since you are EM trained you have a bigger trigger for badness than most docs. Insurance companies for payment and malpractice care if you are board certified. You do continuing medical education. Also your lawsuit risk is far lower as a PCP than working in the ED regardless of state.

Saying IM or FM is more trained for clinical PCP assumes that there program trained them to do PCP work. Most IM docs don't do clinic or haven't done it in a decade since doing hospitalist work. I have a FM friend who has done hospitalist work for 10+ years and hasn't seen kids. As a PCP you don't have to see what you don't feel comfortable with several peds won't see pregnant several IM wont see kids or do procedures or manage wounds.

 

[Leonthemedico]

Technically speaking, I don't think you will do a good job. Practicing Family medicine involves a lot more than annual chekups. You need to be not only correct but also efficient and rational. You need to choose the most rational approach to your patient's symptoms. Hence the amount of uncertainty is 10x higher than in em or in any other medical specialty. Do you think you can manage a chest pain without doing an ECG? Because if you ask a family doctor they will tell you that chest pain requires an ECG maybe sometimes. This is just one example of the little details of family medicine.

 

[Rekt]

This topic always cracks me up.

Any EM docs can do a significantly better job than the low level providers you PCPs let run around and kill patients. I wouldn't be as nearly as good as a board certified FM/IM but I'm without a doubt more capable than any NP/PA.

 

[sylvanthus]

Ya my thoughts exactly, if we let NPs practice independently…..Pretty sure most EM docs would do a better job. At least the docs would know what they dont know.

 

[VA Hopeful Dr]

This topic always cracks me up.

Any EM docs can do a significantly better job than the low level providers you PCPs let run around and kill patients. I wouldn't be as nearly as good as a board certified FM/IM but I'm without a doubt more capable than any NP/PA.

Hey, if you want to come work in my office for 70k a year having to run 15% of your patient encounters by me you are more than welcome to do so. Although I don't actually supervise mid levels anymore, so you'd have to report to somebody else.

Interestingly, my hospital system is requiring all new mid-levels in primary care to only take care of acute visits. Y'all would definitely be better at that than they are.

 

[Brigade4Radiant]

Technically speaking, I don't think you will do a good job. Practicing Family medicine involves a lot more than annual chekups. You need to be not only correct but also efficient and rational. You need to choose the most rational approach to your patient's symptoms. Hence the amount of uncertainty is 10x higher than in em or in any other medical specialty. Do you think you can manage a chest pain without doing an ECG? Because if you ask a family doctor they will tell you that chest pain requires an ECG maybe sometimes. This is just one example of the little details of family medicine.

Practices vary but EDs get sent things all the time positive DVT or D dimer. Abnormal ekg or abnormal tests

We do this all the time but under emergent conditions while dealing with several distractors.

For example we get many people sent because they have no pcp and some pcps do not do psych meds or they only see a certain patient population.

Also ED docs talk to so many pcps and specialists while working. An EM physician 5 years out is different from one straight from residency.

As ED work declines I’m telling you guys have options without doing another residency

 

[Vandalia]

FWIW the health system I worked for

Practices vary but EDs get sent things all the time positive DVT or D dimer. Abnormal ekg or abnormal tests

We do this all the time but under emergent conditions while dealing with several distractors.

For example we get many people sent because they have no pcp and some pcps do not do psych meds or they only see a certain patient population.

Also ED docs talk to so many pcps and specialists while working. An EM physician 5 years out is different from one straight from residency.

As ED work declines I’m telling you guys have options without doing another residency

The problem is that is the most trivial part of primary care.

How are you going to handle the 80 year old widow with newly diagnosed Alzheimer's and a dozen other commodities who wants to stay at home but shouldn't, where half the kids want her to be in a nursing home and the other half who live out of state want the half that live near her to take care of her? And they are all in your office or on the phone arguing with each other?

Or dealing with insurance pre-certification requirements? Do you want to know how many insurance companies I dealt with in EM? Zero. Particularly when they deny the medically necessary MRI because you are an EM physician? (I have heard of the peer-to-peer denying coverage for far more petty reasons.)

Or spend 60 minutes convincing the woman with very concerning symptoms that she needs imaging, which she refuses because "until the tests say I have cancer I don't have cancer."

The universal refrain from primary care is that dealing with the actual hard-core medicine is the easiest part of the job.

I also tell other specialities that the fundamental problem with them working in the ED is that the ED requires a totally different mindset and thought process. It also works the other way around; if you have done EM, it is incredibly difficult to change the medical thought process from "what is most likely to kill you in an hour" to "what is the most likely pathology and we have six months to figure it out."

EDIT: One more point but this may just be hyper-local:

It used to be that specialists had to take consults to get the lucrative procedures; e.g., the GI had to take that Crohn's case to get the screening colonoscopy. Now, with hospitals owning specialists, they don't need that to get the procedures, and they want the specialists generating procedure revenue. Which means that the consults handled by the physicians years ago are now handled by PA/NP. Bottom line, the cases that twenty years ago would have been turfed off to GI and cards, now have to be handled by primary care. This is one reason the system I worked for mandated that NP/PA could only handle acute visits for primary care in the system.

So how are you at managing Crohn's?

 

[rokshana]

This topic always cracks me up.

Any EM docs can do a significantly better job than the low level providers you PCPs let run around and kill patients. I wouldn't be as nearly as good as a board certified FM/IM but I'm without a doubt more capable than any NP/PA.

What like the plethora of NPs that are manning the ED now? And you wonder why 219 EM spots went unfilled this year?

 

[Brigade4Radiant]

FWIW the health system I worked for

The problem is that is the most trivial part of primary care.

How are you going to handle the 80 year old widow with newly diagnosed Alzheimer's and a dozen other commodities who wants to stay at home but shouldn't, where half the kids want her to be in a nursing home and the other half who live out of state want the half that live near her to take care of her? And they are all in your office or on the phone arguing with each other?

Or dealing with insurance pre-certification requirements? Do you want to know how many insurance companies I dealt with in EM? Zero. Particularly when they deny the medically necessary MRI because you are an EM physician? (I have heard of the peer-to-peer denying coverage for far more petty reasons.)

Or spend 60 minutes convincing the woman with very concerning symptoms that she needs imaging, which she refuses because "until the tests say I have cancer I don't have cancer."

The universal refrain from primary care is that dealing with the actual hard-core medicine is the easiest part of the job.

I also tell other specialities that the fundamental problem with them working in the ED is that the ED requires a totally different mindset and thought process. It also works the other way around; if you have done EM, it is incredibly difficult to change the medical thought process from "what is most likely to kill you in an hour" to "what is the most likely pathology and we have six months to figure it out."

EDIT: One more point but this may just be hyper-local:

It used to be that specialists had to take consults to get the lucrative procedures; e.g., the GI had to take that Crohn's case to get the screening colonoscopy. Now, with hospitals owning specialists, they don't need that to get the procedures, and they want the specialists generating procedure revenue. Which means that the consults handled by the physicians years ago are now handled by PA/NP. Bottom line, the cases that twenty years ago would have been turfed off to GI and cards, now have to be handled by primary care. This is one reason the system I worked for mandated that NP/PA could only handle acute visits for primary care in the system.

So how are you at managing Crohn's?

Yes they are trivial problems because those problems are sent to the ED.

We deal with the first issue all the time. Also there are insurance companies that credential EM docs they deny coverage for whatever reason.

The image issue we deal with as well

We deal with Chron’s flares all the time they go to the EDHow are you going to to give a TNF alpha? Also FM docs won’t get the authorization for MRI or humira.

Specialty clinic still manages those issues they see a NP or PA in specialty clinc
Also manage Chrohn’s?

How are you going to diagnose it in the first place?

 

[Fox800]

If FM docs think they can staff rural EDs (which has been going on for decades despite EM being a board certification since 1976, so 46 years now...), then we can take AAFP review courses/materials and do some variation of direct primary care, with longer appointments and a lower patient panel.

FM docs keep saying they are "filling the gap" despite an over-supply of EM docs. This continually allows hospitals to gaslight and steal reasonable wages from EM-trained physicians and post jobs that attract unqualified physicians. This is a scam. You don't see hospitals accepting other specialties to be fill a general surgery or OB/GYN role, but for some reason it's perfectly fine for EM. It's simple - pay a reasonable wage. $150/hr to see 4-5 patients in 24 hours and sleep? Sure. But don't gaslight us and say you "can't attract qualified candidates". You could, you're just pinching pennies.

 

[VA Hopeful Dr]

If FM docs think they can staff rural EDs (which has been going on for decades despite EM being a board certification since 1976, so 46 years now...), then we can take AAFP review courses/materials and do some variation of direct primary care, with longer appointments and a lower patient panel.

FM docs keep saying they are "filling the gap" despite an over-supply of EM docs. This continually allows hospitals to gaslight and steal reasonable wages from EM-trained physicians and post jobs that attract unqualified physicians. This is a scam. You don't see hospitals accepting other specialties to be fill a general surgery or OB/GYN role, but for some reason it's perfectly fine for EM. It's simple - pay a reasonable wage. $150/hr to see 4-5 patients in 24 hours and sleep? Sure. But don't gaslight us and say you "can't attract qualified candidates". You could, you're just pinching pennies.

Legally you absolutely can do exactly what you're suggesting. We're all licensed physicians, not licensed FPs or EPs.

That said, I do find it interesting that up until the last year or so most of this forum was vehemently against FPs working in the ED due to lack of sufficient ED experience (a view I happen to share if that matters) but now it's "take some CME courses and go practice primary care".

 

[Brigade4Radiant]

Legally you absolutely can do exactly what you're suggesting. We're all licensed physicians, not licensed FPs or EPs.

That said, I do find it interesting that up until the last year or so most of this forum was vehemently against FPs working in the ED due to lack of sufficient ED experience (a view I happen to share if that matters) but now it's "take some CME courses and go practice primary care".

ED is more critical and you can’t say no.

Primary care is a large clinical specialty where many people have various skills you telling me FM is better than peds or better than OB GYN?

FM has been working in the ED and will continue to do so. I don’t see why EM must limit themselves

 

[Splenda88]

If FM docs think they can staff rural EDs (which has been going on for decades despite EM being a board certification since 1976, so 46 years now...), then we can take AAFP review courses/materials and do some variation of direct primary care, with longer appointments and a lower patient panel.

FM docs keep saying they are "filling the gap" despite an over-supply of EM docs. This continually allows hospitals to gaslight and steal reasonable wages from EM-trained physicians and post jobs that attract unqualified physicians. This is a scam. You don't see hospitals accepting other specialties to be fill a general surgery or OB/GYN role, but for some reason it's perfectly fine for EM. It's simple - pay a reasonable wage. $150/hr to see 4-5 patients in 24 hours and sleep? Sure. But don't gaslight us and say you "can't attract qualified candidates". You could, you're just pinching pennies.

"Filling the gap" blah..blah..blah is BS. Everyone wants to make money. The fact of the matter is that there is significant overlap between these specialties. FM/IM docs can learn to do as well as an BC ED doc if they want to learn it. Of course, it might take them at least 1 yr of exposure. The reverse is true as well. There is no secret sauce to these things.