doing procedures as a nonfellowship trained IM

[j_sde]

hey...
i've been hearing from classmates who have father/relatives who are doctors.... and they said that a nonfellowship trained IM doctor can take accrediation classes to learn how to do things like Stress tests, Bone scans, and many other procedures which generate more cash. Is this true? Can a noncardiologist conduct a stress test for their patients? What are the insurance/malpratice implications? Any other thoughts?

I've heard the argument from General Medicine attendings that eventually primary care docs are gonna be doing stuff like colonoscopies for screening (versus lettin the GI guys do the scopes for high risk/pretest pts)..... since, there is just gonna be the need for it.

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[Kalel]

Internists can already do many of the procedures that you mentioned. I'm not 100% certain how it works, but it seems to me that who can do what procedure is based on a complex relationship between The Joint Commission on Accreditation of Healthcare Organizations, state licensing boards, the American board of internal medicine and it's subspecialty boards, and who insurance companies are willing to reimburse. There are definitely a lot of turf wars with everyone trying to say that they can do something just as good and others trying to protect their turf. One time, I wanted to fiddle with a bronchoscope in a patient, but the attending said that even residents couldn't fiddle with them, fellows were the only one who were even able to practice or try them. He was going to hand me off the scope when he had to get a phone call because the fellow wasn't there, but unfortunately, I was on the phone too. Your training in doing procedures is often an issue during malpractice suits. Malpractice insurance companies even get a say in saying what procedures you can or can't do by saying what they will cover you for. Then health insurance companies sometimes won't reimburse for anybody doing certain procedures too, if it has been shown that costs are lower and outcomes are better with the specialist doing the procedure. Anyways, even FP's are doing colonoscopies these days:
http://www.aafp.org/afp/20000901/aafp.html

 

[Docxter]

I think by "bone scan", you meant "bone density scan" or DEXA scan, because they are very very different. As an IM doc, you cannot do bone scans since it requires handling and administration of radioactive material to the patient.