Can an ER doctor start a private primary care practice?

[VA Hopeful Dr]

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

Acutely critical, sure. Not sure that's relevant to the discussion though.

Of course not. But most of the time the difference isn't significant.

I have no objection to y'all doing primary care, and in the past have even suggested what I think would be the appropriate CME to allow a trained emergency physician to practice primary care reasonably safely. I just find it interesting how people's opinions have changed about all of this in the last handful of years.

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[Fox800]

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".

It’s not many people. But yes, you could do it. If I had 30-60 minutes per appointment and some hard prep (review courses), I could probably handle a lot of primary care encounters. I would have to be picky about who I saw. 12 minutes per encounter with patients with 25 chronic problems? No way. A well-educated, engaged patient that takes care of their health over a 30-60 minute appointment? Yeah probably.

I’m a hundred times better trained and more capable than the thousands of midlevel noctors that try to deliver primary care all over the US every day.

 

[Fox800]

Acutely critical, sure. Not sure that's relevant to the discussion though.

Of course not. But most of the time the difference isn't significant.

I have no objection to y'all doing primary care, and in the past have even suggested what I think would be the appropriate CME to allow a trained emergency physician to practice primary care reasonably safely. I just find it interesting how people's opinions have changed about all of this in the last handful of years.

Well hospitals and CMGs have a stranglehold on things and we make physicians do slave labor for an additional 3+ years after residency and take an 80+% pay cut to go back for another residency when midlevels can take a weekend course or two and change from dermatology (with a pa$$ion for aesthetics) to ortho to GI to primary care at their leisure and no one bats an eye, then they bill at 85% of the physician rate (or 100% if you’re in a state that’s pushing for pay parity, the ultimate fraud). 3% of the clinical hours to bill at 85-100% of the physical rate…

They aren’t dumb, but they are dangerous, greedy frauds.

 

[Lexdiamondz]

"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.

Disagree on both fronts

Most of us on here have worked with IM/FM docs with >10 years of EM exposure who are still mediocre ER docs because they never got the necessary foundational training.

Along those same lines, there are likely subtleties to outpatient medicine that an EM-trained physician will never learn just hanging a shingle and winging it for a few years. Never mind the logistics of running a practice and making it profitable.

If you're alright with rolling the dice by being "just good enough" then sure, go ahead.

 

[Fox800]

Disagree on both fronts

Most of us on here have worked with IM/FM docs with >10 years of EM exposure who are still mediocre ER docs because they never got the necessary foundational training.

Along those same lines, there are likely subtleties to outpatient medicine that an EM-trained physician will never learn just hanging a shingle and winging it for a few years. Never mind the logistics of running a practice and making it profitable.

If you're alright with rolling the dice by being "just good enough" then sure, go ahead.

A “good enough” physician is still leaps and bounds better trained and more capable than the unsupervised noctors graduating from online DNP programs. Yet state legislatures and insurance companies seem to think that they are good enough, and deserve decent insurance payments.

Tell me I’m wrong.

 

[RustedFox]

A “good enough” physician is still leaps and bounds better trained and more capable than the unsupervised noctors graduating from online DNP programs. Yet state legislatures and insurance companies seem to think that they are good enough, and deserve decent insurance payments.

Tell me I’m wrong.

Yep. Most of the PLPs in my community are five-star dangerous.
Like, I know for sure I could do a better job.

 

[Splenda88]

Disagree on both fronts

Most of us on here have worked with IM/FM docs with >10 years of EM exposure who are still mediocre ER docs because they never got the necessary foundational training.

Along those same lines, there are likely subtleties to outpatient medicine that an EM-trained physician will never learn just hanging a shingle and winging it for a few years. Never mind the logistics of running a practice and making it profitable.

If you're alright with rolling the dice by being "just good enough" then sure, go ahead.

They must be mediocre physicians or do not care to learn. In all honesty, people in other specialties think many EM docs don't know what the heck they are doing anyway. EM is arguably the most criticized specialty in the hospital setting.

~80% of what you guys do can be done by an IM/FM doc (and some IM/FM docs don't think you even do it well). I find it difficult to believe that the 20% can't be learned in 1 year. Again, I might be wrong cause I only spent 8 wks in the ED as a IM resident.

 

[RustedFox]

@Lexdiamondz is right. I worked with a few of these journeymen FM/IM docs in the ER and they absolutely could not learn the "IDGAF, WHY ARE YOU HERE NOW" approach that is the core tenet of EM.

 

[Lexdiamondz]

A “good enough” physician is still leaps and bounds better trained and more capable than the unsupervised noctors graduating from online DNP programs. Yet state legislatures and insurance companies seem to think that they are good enough, and deserve decent insurance payments.

Tell me I’m wrong.

Yeah but the bar shouldn't be someone who has ⅛ our education from diplomamill.com college of nursing

They must be mediocre physicians or do not care to learn. In all honesty, people in other specialties think many EM docs don't know what the heck they are doing anyway. EM is arguably the most criticized specialty in the hospital setting.

~80% of what you guys do can be done by an IM/FM doc (and some IM/FM docs don't think you even do it well). I find it difficult to believe that the 20% can't be learned in 1 year. Again, I might be wrong cause I only spent 8 wks in the ED as a IM resident.

Dunning meet Kruger

The problem with the last 20% is that you have to 1) recognize something is important 2) recognize that you're fxcking up that important thing 3) find someone to teach you or some way to teach yourself not to fxck it up again.

EM is one of the most criticized specialty in the hospital setting because other specialties don't understand the reasons why we do what we do. This fundamental misunderstanding, coupled with a lack of training and mentorship, is precisely why many physicians who didn't train in Emergency Medicine often fail to become good EM doctors despite practicing in ERs for years, sometimes decades.

 

[Splenda88]

Yeah but the bar shouldn't be someone who has ⅛ our education from diplomamill.com college of nursing

Dunning meet Kruger

The problem with the last 20% is that you have to 1) recognize something is important 2) recognize that you're fxcking up that important thing 3) find someone to teach you or some way to teach yourself not to fxck it up again.

EM is one of the most criticized specialty in the hospital setting because other specialties don't understand the reasons why we do what we do. This fundamental misunderstanding, coupled with a lack of training and mentorship, is precisely why many physicians who didn't train in Emergency Medicine often fail to become good EM doctors despite practicing in ERs for years, sometimes decades.

Yeah...yeah..yeah... EM is special.

You guys have even said in your forum that even a 2-yr fellowship would not make an FM doc good enough to practice EM. Give me a f... break.

Everyone thinks there is something special about their specialties.

Would you mind giving specific examples about the highlighted part?

 

[Fox800]

Yeah...yeah..yeah... EM is special.

You guys have even said in your forum that even a 2-yr fellowship would not make an FM doc good enough to practice EM. Give me a f... break.

Everyone thinks there is something special about their specialties.

Would you mind giving specific examples about the highlighted part?

Manage hundreds of major traumas, perform hundreds of emergent intubations, ortho reductions, ultrasound-guided procedures, working across the SICU and the MICU, yada yadda.

You know what you know until you don't, and you don't have time to go to WikEM or UpToDate to act fast. You don't have time to have anesthesiology come bail you out or a surgeon come do your procedures for you. Or the intensivist isn't there and you're having to initially resuscitate a patient and admit them to a "hospitalist NP" or "critical care NP". Then someone gets hurt or killed.

Seconds and minutes matter, that's why the ABEM logo is an hourglass.

A well-trained FM graduating resident might be able to shave off 6 months of EM PGY-1, but there are still areas where an EM intern is going to lap them from a procedure and speed standpoint after a few months in the ED. A practicing FM doc might be another story, but they'd still likely be rusty from an EM-standpoint if they've been out of residency for a few years.

 

[Lexdiamondz]

Yeah...yeah..yeah... EM is special.

You guys have even said in your forum that even a 2-yr fellowship would not make an FM doc good enough to practice EM. Give me a f... break.

Everyone thinks there is something special about their specialties.

Would you mind giving specific examples about the highlighted part?

I actually think a 2 yr fellowhship is reasonable - the EM-FM combined programs are all 5 yrs which makes complete sense. Most "fellowships" in the US though are only 1 year, and are less rigorous than the average EM intern year. So miss me with that.