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what all procedures and extra stuff do those FP get to do working in small towns that do not have any specialist.
It's not about what you "get" to do, it's about what you are "trained" to do and are safely comfortable doing.
What I have seen rural FP's do in various states. Not everyone does all of these.
C-Sections
Colonoscopy
EGD
Appendectomy (Montana)
T&A (Montana)
Paracentesis
Cardiac Stress Test
Thoracentesis
Setting bones under conscious sedation
Central lines
ICU
Vent management
Bronchoscopy
Then all the usual stuff that I do
casting, joint injections, nail removal, skin biopsy, suturing wounds, taking off lesions, OMT, I&D, etc.
Wholy smokes.
Would they even encounter legal implications (even if done properly) because its something outside of "their" specialty?
It's not about what you "get" to do, it's about what you are "trained" to do and are safely comfortable doing.
What I have seen rural FP's do in various states. Not everyone does all of these.
C-Sections
Colonoscopy
EGD
Appendectomy (Montana)
T&A (Montana)
Paracentesis
Cardiac Stress Test
Thoracentesis
Setting bones under conscious sedation
Central lines
ICU
Vent management
Bronchoscopy
Then all the usual stuff that I do
casting, joint injections, nail removal, skin biopsy, suturing wounds, taking off lesions, OMT, I&D, etc.
It's not about what you "get" to do, it's about what you are "trained" to do and are safely comfortable doing.
What I have seen rural FP's do in various states. Not everyone does all of these.
C-Sections
Colonoscopy
EGD
Appendectomy (Montana)
T&A (Montana)
Paracentesis
Cardiac Stress Test
Thoracentesis
Setting bones under conscious sedation
Central lines
ICU
Vent management
Bronchoscopy
Then all the usual stuff that I do
casting, joint injections, nail removal, skin biopsy, suturing wounds, taking off lesions, OMT, I&D, etc.
During my rural FM rotation I regularly went to the OR with the FP doc to do appy's EGD, colonoscopy, laproscopic procedures, ulnar nerve transposition, median nerve release, etc.
Sometimes in certain rural locations you are the end of the line for peoples healthcare, either by choice or some other restricting reason.
where were you? and was he the primary surgeon?
What laparoscopic procedures ?!
I trained med/peds for 2 years, spent a year in Iraq with the Army, returned home and finished 2 more years in FP. I practice in rural Oklahoma and do all common FP procedures + EGD, colonoscopy, hemorrhoidectomy, thoracentesis, paracentesis, vent management, LP, central lines, art lines conscious sedation, casting. Dont do OB now only because hospital dropped that service due to overhead costs. As long as you are trained to do the procedure and your hospital credentials you to do it, you are fine. Medical Boards are glad to have rural docs who provide such care. I've never once had insurance question my credentials before paying me. Most docs in rural OK who have similar practices stand to make as much as some specialists in the bigger towns. I have a buddy from med school who is also FP and does appy's, gallbladders, and C sections. He is single and works 12 hour days, but makes on average around $800K a year.
I've always been curious...how does one get trained to do lap appy's/ choleys in an FP residency? Is it that these people feel like they've gotten the 'base' of FP down and seek out these skills during training, or are some residencies advertised as being able to teach its residents basic surgeries? Pardon my ignorance...if it's not clear, I'm MS-0 (applying right now, but working in hospital right now and super duper loving rural FPs' inpt/outpt/ER combo punches). I really hope FP's continue to be able to do surgeries by the time I am an attending!
I've always been curious...how does one get trained to do lap appy's/ choleys in an FP residency?
Very much depends on the residency. Best chances are in unopposed residencies (at hospitals where the only residency program is an FP program so there is no competition with residents from other specialties). My training program had 24 residents (8/year) in a relatively large community hospital that served as a regional referral center. We had 6 general surgeons on staff at the hospital who also acted as adjunct faculty for the residency program. 3 of the 6 were known to be much more likely to let residents take a greater hands-on approach in the OR rather than just letting us close up the incisions at the end. So, if you were a resident who had greater interest in learning surgical skills, you made certain to spend your rotations with them and let them know you were eager to learn. That said, the residents who wanted to do some of the basic general surgery procedures in practice would pretty much have to use all their elective months as general surgery months to add enough experience. The vast majority of residents didn't plan to do choles and appys in practice and there was probably only one resident every 2-3 years who really got aggressive enough to get comfortable doing them on their own. In the example of my friend, he also spent his f irst two years in practice doing them alongside an aging general surgeon in his home town and got more proficient with them. It was a good thing, because the surgeon died relatively suddenly and was the only surgeon in that town. Now this FP is the only doc there who does appys and choles.
No, he mostly makes that because he works crazy long hours. He is single and works at least 12 hours a day on weekdays. It just all adds up... lots of office visits, hospital visits, nursing home rounds, lots of procedures, delivers babies, etc. He's a machine. He owns and runs his own clinic, so he gets to keep all profit past overhead. When he's in clinic, he has 4 exam rooms going with a nurse (LPN) for each room who also acts as a scribe for his EHR system. Nurses put in all data as he "dictates" to them and then he just signs the note and orders/Rx's at the end. He can move right on to the next room/nurse without pause. He also lives in a bed and breakfast (which he also owns), so doesn't have to worry about keeping up a house at all.