Do IM docs in primary care do procedures?

[Captain DO]

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For non-fellowship IM trained docs, Do they learn to do minor surgical procedures like removing lesions? Suturing? Abscess drainage?

Or is it strictly medicine?

Depend on the residency you go to?


Thanks 🙂

 

[deleted392989]

Yes. Number of procedures you get to do in residency depends on the residency itself too. And your initiative to seek out such procedures on your own.

 

[PlutoBoy]

Every doctor learns suturing, bro. But no one goes to the office when they need suturing!

Abscess drainage? It's not rocket science but I'd rather not deal with it. This is just me. It's easy to do (I assume you mean small skin abscesses).

 

[Captain DO]

I ask cause I think I'm heading for primary care, and deciding between FM or IM.

I don't wanna do FM because I'm not a fan of OB, general surgery, or dealing with kids under 3yrs. BUT, I definitely would like to learn how to do minor procedures like I&D, removing skin lesions, ingrown toenails, etc... Basically in-office procedures only!

If IM can give me those skills without having to do rotations in OB or general surgery....BAM! I'm sold!!

If IM generally does less of those things than FM...then I still have deciding to do lol.

Abscess drainage? It's not rocket science but I'd rather not deal with it. This is just me. It's easy to do (I assume you mean small skin abscesses).

Yeah, small skin abcess. I would love to do that! Maybe I'm weird but I would love releasing that painful wad of pus! lol

Yes. Number of procedures you get to do in residency depends on the residency itself too. And your initiative to seek out such procedures on your own.

Ok...I'll keep this in mind when researching residencies. I'll be sure to ask how procedure heavy it is. and put myself out there and try to get the experience I want! 🙂

 

[babdoc]

I'm heading for IM primary care. Office procedures are nice to complement your practice. Common procedures you can do in the clinic are joint injections, arthrocentesis, skin/etc biopsies, paps, I&Ds, cryo, cutting off skin tags and such. I've seen a lot of internists also taking a half day a week to run stress tests. That's the common stuff. You'll also hear legends of internists, particularly in rural areas, doing crazy stuff like colonoscopies.

Look for a residency that makes the office procedures available. There are primary care tracts in some programs that offer some more time in the clinic. Ask about what procedures are commonly available, do they actively teach and supervise procedures in their clinic, etc. You don't want clinic training where they turf all of that stuff to derm, gyn, and surgery. If you get the "you just have to seek out those procedures" answer, know that it's code for "it's not that common in our program." If the other residents and the attendings aren't teaching those procedures, then you won't be skilled enough by the end of your three years to do them in your practice.

So, yeah. Office procedures are available and definitely good to incorporate into an office-based internal medicine practice.

For non-fellowship IM trained docs, Do they learn to do minor surgical procedures like removing lesions? Suturing? Abscess drainage?

Or is it strictly medicine?

Depend on the residency you go to?


Thanks 🙂

 

[PlutoBoy]

You will learn those procedures. They are easy and straight forward. Don't sweat it 🙂

Well, some joint injections actually require some training.

Most people don't do these procedures out of time constraints not because they don't know how to.

You may want to add to that list learning how to unclog ears!

 

[babdoc]

You may want to add to that list learning how to unclog ears!

I stopped doing that the first time the plug was a roach. #ENTconsult

 

[IMreshopeful]

I have worked with community PCPs who do occasional procedures but it's not the bulk of their practice due to the amount of time it can eat up. Usually involves arthrocentesis or joint injections but some places do offer sclero therapy etc for veins. It's a lot of out of pocket boutique stuff.

 

[Pemulis]

I do lots of procedures, with cerumen dis-impactions, abscess I&Ds, pap smears, and shave and punch biopsies being my most common ones. They're a good way to boost income, are fun to do, and let me provide a valuable service to my patients since I can handle a lot of the more straightforward cases without having to send people to a specialist. On the other hand, there are 3 other docs in my office and they don't do any procedures at all - they either refer stuff out, or sometimes send it to me. So primary care is really open, and you can make of it what you want.

As for training, there's no way you'll get as much procedural training in an IM residency as in a good FM one. The culture of IM just isn't as geared toward minor office procedures.

But keep in mind that training doesn't end once residency does. I learned some procedures in residency (often by doing an elective with a specialist), but some of the other ones I do I picked up afterwards. It's not hard. For example, I really got comfortable doing shave biopsies by watching a bunch of youtube videos, and then spending a few hours with a local dermatologist. He was happy to teach me, given that I send many referrals his way. I would venture that I could call any other specialist I refer folks to regularly and get a similar quick lesson in a topic of their expertise. Never forget: one of the truly under appreciated benefits of being a PMD is that you become a walking dollar sign to your sub specialists, who will therefore go out of their way to keep you happy. There are also CME workshops for learning office procedures.

If you're heart is mainly in IM, I wouldn't switch to FM just for the procedural training.

 

[Siggy]

I stopped doing that the first time the plug was a roach. #ENTconsult

 

[smq123]

If IM can give me those skills without having to do rotations in OB or general surgery....BAM! I'm sold!!

FM residents don't learn those procedures in OB or general surgery, either. We learned them through our rotations in sports med/rheum/ortho, dermatology, outpatient GYN, etc. Then we do more of them in our continuity clinic.

If your residency program has a lot of elective time, that might be an option as well - that way, you could rotate in those fields and get some practice.

 

[IMreshopeful]

FM residents don't learn those procedures in OB or general surgery, either. We learned them through our rotations in sports med/rheum/ortho, dermatology, outpatient GYN, etc. Then we do more of them in our continuity clinic.

If your residency program has a lot of elective time, that might be an option as well - that way, you could rotate in those fields and get some practice.

Yeah also doing things like cryo for warts or skin tags is pretty easy. It's not like there's much of a learning curve. (Waiting for a derm resident to come into this thread angrily and say otherwise)

 

[GOLDMARK]

Yeah also doing things like cryo for warts or skin tags is pretty easy. It's not like there's much of a learning curve. (Waiting for a derm resident to come into this thread angrily and say otherwise)

Seconding this. Worked with an FM doc who did one day of derm procedures like cryo, tags, skin biopsies, cyst removals, etc. and she seemed to be doing well financially.

 

[Captain DO]

Seconding this. Worked with an FM doc who did one day of derm procedures like cryo, tags, skin biopsies, cyst removals, etc. and she seemed to be doing well financially.

It bills the same regardless of what specialty does it, right?
All cases bill the same, but some specialties make more because they have a higher percentage of the higher billing cases? Is that how this worsks?

 

[Pemulis]

It bills the same regardless of what specialty does it, right?
All cases bill the same, but some specialties make more because they have a higher percentage of the higher billing cases? Is that how this worsks?

Correct

 

[psychMDhopefully]

I'm heading for IM primary care. Office procedures are nice to complement your practice. Common procedures you can do in the clinic are joint injections, arthrocentesis, skin/etc biopsies, paps, I&Ds, cryo, cutting off skin tags and such. I've seen a lot of internists also taking a half day a week to run stress tests. That's the common stuff. You'll also hear legends of internists, particularly in rural areas, doing crazy stuff like colonoscopies.

Look for a residency that makes the office procedures available. There are primary care tracts in some programs that offer some more time in the clinic. Ask about what procedures are commonly available, do they actively teach and supervise procedures in their clinic, etc. You don't want clinic training where they turf all of that stuff to derm, gyn, and surgery. If you get the "you just have to seek out those procedures" answer, know that it's code for "it's not that common in our program." If the other residents and the attendings aren't teaching those procedures, then you won't be skilled enough by the end of your three years to do them in your practice.

So, yeah. Office procedures are available and definitely good to incorporate into an office-based internal medicine practice.

Cool, I thought all of the procedural stuff was for FM, and IM mainly just focused on inpatient medicine.

 

[babdoc]

It depends. The majority of general medicine rotations are in the inpatient setting. In IM primary care tracts, it seems that you get maybe 2-3 half days of clinic per week rather than 1-2. So as far as the time in a primary care clinic goes, it is still not as much as one might think if you're going to be a PCP. That's just how it goes.

For perspective, FM programs can only have you in your primary care/continuity clinic a few half days a week. But you'd have to look through some FM programs curriculum to see how frequently you'd be where.

Also remember that you will get a fair number of procedures in the inpatient setting that can translate to the clinic. Probably half of the arthrocenteses I have done have been in the hospital.

Lastly, that all being said, a lot of general internists I've known don't want to do procedures. It's probably somewhat program and doctor specific. Look for a program that fits what you think your goals are and go from there.

Cool, I thought all of the procedural stuff was for FM, and IM mainly just focused on inpatient medicine.