Do I have to go into FP/Psych to work at a Community Health Center?

[Tungsten5]

I am currently looking into going into FP, but I'm curious if there are specialists that can work at community health centers full time as well.

The reason I ask is that I have a scholarship that demands I spend a few years full time at a community health center, but I'm wondering if it's simply a roundabout way of forcing me into FP or Psych. At the moment I don't mind, but I'd hate to change my mind someday and feel trapped.

If specialists can work full time at a community health center, which ones do?

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[DrMidlife]

Generally you can do IM, do your community work, then do a fellowship to specialize.

 

[Tungsten5]

Let's say I did a more medicine oriented residency - would a community health center turn me away because I didn't go to a FP oriented residency?

I don't imagine they are competitive positions but I don't know.

 

[primadonna22274]

CHCs use FM, IM, peds, Med-Peds, psych and OB docs frequently. No worries. Plenty of patients needing excellent care in those places.

 

[Tungsten5]

CHCs use FM, IM, peds, Med-Peds, psych and OB docs frequently. No worries. Plenty of patients needing excellent care in those places.

Thank you. Also, have you heard of any EMs working at CHCs? If I don't go into FP/IM that's what I would prefer. I figured there would perhaps be a demand for emergent care at these locations.

 

[primadonna22274]

I highly doubt EM. They need folks trained in chronic care management as well as acute care, which you will learn in FM, IM and peds.

 

[DrMidlife]

Community health centers have websites and you can see what kinds of docs work there. You can also look at the HRSA jobs site to see what kinds of docs are being hired. http://nhscjobs.hrsa.gov/external/search/index.seam If you haven't visited a CHC, then visiting one would be a really good idea. Tons of chronic illness and behavioral health. They don't make TV shows about it.

But as we're trying to tell you, you aren't going to find anything other than FM, IM, Psych, Ob/Gyn, Geriatrics, Peds.

If you don't want to do primary care, then don't take a primary care scholarship. EM is not primary care.

Best of luck to you.

 

[smq123]

Community health centers have websites and you can see what kinds of docs work there. You can also look at the HRSA jobs site to see what kinds of docs are being hired. http://nhscjobs.hrsa.gov/external/search/index.seam If you haven't visited a CHC, then visiting one would be a really good idea. Tons of chronic illness and behavioral health. They don't make TV shows about it.

But as we're trying to tell you, you aren't going to find anything other than FM, IM, Psych, Ob/Gyn, Geriatrics, Peds.

If you don't want to do primary care, then don't take a primary care scholarship. EM is not primary care.

Best of luck to you.

Yes. THIS.

I work in a community health center. We have FM, PEDs, IM, OB, and psych. But EM doctors work in the emergency department or urgent care...not at a CHC.

 

[BestDoctorEver]

Yes. THIS.

I work in a community health center. We have FM, PEDs, IM, OB, and psych. But EM doctors work in the emergency department or urgent care...not at a CHC.

Is the salary for these CHC competitive? How much loan repayment amount they usually give? If these salaries are in line with physician average salary in primary care, that seems to be a good deal to me...

Edit: I was looking at 2 job listings (Peds and FM) for a CHC in FL and I see it is an 8am-5pm job M-F... Am I missing something here?

 

[VA Hopeful Dr]

Is the salary for these CHC competitive? How much loan repayment amount they usually give? If these salaries are in line with physician average salary in primary care, that seems to be a good deal to me...

Edit: I was looking at 2 job listings (Peds and FM) for a CHC in FL and I see it is an 8am-5pm job M-F... Am I missing something here?

They traditionally are a fair bit lower the average when it comes to salary. Plus, your population is going to be very frustrating to deal with. That said, you can at the moment get some decent loan repayment since its an underserved type situation.

 

[smq123]

Is the salary for these CHC competitive? How much loan repayment amount they usually give? If these salaries are in line with physician average salary in primary care, that seems to be a good deal to me...

Edit: I was looking at 2 job listings (Peds and FM) for a CHC in FL and I see it is an 8am-5pm job M-F... Am I missing something here?

The salary is quite a bit lower - I would estimate about $20K to $40K lower than you'd see at a nearby private practice. That said, you can expect about $20K - $30K in loan repayment per year.

I'm not sure why you're surprised at 8-5, Monday through Friday. That's fairly standard, and is actually somewhat more than expected (outpatient primary care clinics frequently give half a day or so off for "flex time" each week). Some CHCs do not have the funding to open on weekends and so don't expect their physicians/NPs to work on Saturdays.

 

[BestDoctorEver]

@VA Hopeful Dr and @smq123 ... I see online a couple of CHC job listings offering 145k-175k/year. If these jobs give 30k in loan repayment, I think that is a heck of a good deal...

 

[VA Hopeful Dr]

@VA Hopeful Dr and @smq123 ... I see online a couple of CHC job listings offering 145k-175k/year. If these jobs give 30k in loan repayment, I think that is a heck of a good deal...

Possibly. Few quick questions present themselves. 1. Location? 2. Patients you're expected to see per day. This one is surprisingly important as many CHC patients are pretty sick and need a good bit of time, which means if they expect you to see 30 patients per day.... 3. Is that 30k repayment per year or total and if total, how many years to earn the whole thing?

 

[BestDoctorEver]

Possibly. Few quick questions present themselves. 1. Location? 2. Patients you're expected to see per day. This one is surprisingly important as many CHC patients are pretty sick and need a good bit of time, which means if they expect you to see 30 patients per day.... 3. Is that 30k repayment per year or total and if total, how many years to earn the whole thing?

South FL , which is mostly immigrants as far as patients one will see. They are online listings so they don't give much more info besides salary...

 

[VA Hopeful Dr]

South FL , which is mostly immigrants as far as patients one will see. They are online listings so they don't give much more info besides salary...

So mostly patients that I suspect don't speak English. Are you fluent in Spanish?

 

[smq123]

So mostly patients that I suspect don't speak English. Are you fluent in Spanish?

Or Creole. Extremely large Haitian population in south Florida.

 

[BestDoctorEver]

So mostly patients that I suspect don't speak English. Are you fluent in Spanish?

Yeah...

 

[BestDoctorEver]

Or Creole. Extremely large Haitian population in south Florida.

Nope... I used to work at County Department of Health in FL and many of the workers were Haitians and Spanish. Therefore, one will have people who can translate for you (I think)...

 

[deleted432032]

I've always noticed that they know more English than you would think, they just refuse to speak it in certain situations.

 

[BestDoctorEver]

I've always noticed that they know more English than you would think, they just refuse to speak it in certain situations.

You are SO right about that...

 

[smq123]

@VA Hopeful Dr and @smq123 ... I see online a couple of CHC job listings offering 145k-175k/year. If these jobs give 30k in loan repayment, I think that is a heck of a good deal...

Yes, they seem like a good deal.

But, for a community health center that cares mostly for Medicaid or uninsured patients, $175K a year is a lot to pay for a doctor. So you have to ask yourself how they can swing this.

1) They are really looking only for someone with experience - someone who has been out of residency for 2-5 years. That way, they can throw you in there pretty quickly, with the expectation that you will be able to generate a good amount of revenue with minimal hand-holding.

Or, conversely, that is the salary that they are paying seasoned physicians who have been with them for a few years. For someone new to the organization, especially someone fresh out of residency, they would pay you less.

2) They cut corners elsewhere. The facilities are run down, you have no supplies, and your staff is poorly paid and therefore they can only attract mediocre nurses or medical assistants.

3) Their payor mix is better than average. Which is fine, but that probably means that they won't qualify for federal loan repayment, because their need score is not high enough.

4) They expect you to generate a lot of revenue, either by upcoding (=padding your billing sheet, a common but somewhat unethical practice) or by seeing a f***-ton of patients a day.

5) They are doing things that are either somewhat fraudulent or flat out unethical.

6) They expect you to do things that you are either going to be uncomfortable with, or woefully undertrained for. One CHC that I interviewed at required that all physicians (except pediatricians) treat suboxone patients. If you're not familiar with suboxone, it is a medication used to treat addiction in patients with a history of heroin/opiate addiction. Heroin addicts are, frequently, highly unpleasant and difficult patients to treat. Now, imagine that you're taking care of two dozen heroin addicts ON TOP of your usual hypertension/diabetes/COPD/obese patients with their own medical problems.

So it looks great, and it MAY be great. But it could also be horrible. Don't fall for just the possible salary numbers.

 

[styphon]

I interviewed at multiple federal CHC's - some urban, some very rural.

-The salary was always 130-150$k + benefits + basically no ability to be sued(They must sue the federal government to get at you - so far, 0 cases have been successful) - this salary is the lowest in this area.
-The populations were challanging. The urban CHC are in the poorest spots of one of the poorest cities in the US. You are also not in a safe area for parking/leaving/coming to work. The urban CHC's mostly focused on migrant farmers - they offered me spanish training..
-You have pt # expectations and have a reviewal process if you do not meet it.
-The ones I interviewed at did not require suboxone training - although I did enjoy my suboxone patients when I was in residency - my "street knowledge" greatly increased by asking them questions no one else could/would answer for me.

 

[styphon]

Something relevant:

Up to 32% hike in rural CHC doctors salaries: 130$/yr would be 171$/yr, 150$/yr would be 198$/yr

Source: http://www.aafp.org/news/government-medicine/20140514fqhcpayhike.html?cmpid=em_17495077_L1

 

[BestDoctorEver]

I interviewed at multiple federal CHC's - some urban, some very rural.

-The salary was always 130-150$k + benefits + basically no ability to be sued(They must sue the federal government to get at you - so far, 0 cases have been successful) - this salary is the lowest in this area.
-The populations were challanging. The urban CHC are in the poorest spots of one of the poorest cities in the US. You are also not in a safe area for parking/leaving/coming to work. The urban CHC's mostly focused on migrant farmers - they offered me spanish training..
-You have pt # expectations and have a reviewal process if you do not meet it.
-The ones I interviewed at did not require suboxone training - although I did enjoy my suboxone patients when I was in residency - my "street knowledge" greatly increased by asking them questions no one else could/would answer for me.

Any loan repayment?

 

[styphon]

Any loan repayment?

The ones I interviewed at had repayment thru the NHSC, which you can get from any underserved area and is actually the the government, and not the employer.

Very few employers offered me a loan repayment thru them - BUT lots of them qualified as Health Shortage Areas (which they advertised as "loan repayment")