EM private practice?

[mountaindew2006]

---

Members don't see this ad.

Out of curiosity. My wife is going into int medicine (hopefully cardiology). I'm interested in EM. Although this may sound a little 'stupid', can EM docs after theyve completed their EM residency practice as an internist? Or must one complete an EM/IM residency in order to do that?

thanks in advance!

 

[Apollyon]

You can practice whatever you want, if you get credentialed by a hospital. Unless the hospital is directly in the middle of nowhere, it is unlikely you would ever get credentialed in IM with only EM training. In the rural hinterlands, IM/FP/Surgery/whatever can get credentialed in these hospitals to work in the ED, but studies show that non-EM trained ED docs lose more frequently when sued, and lose more.

 

[docB]

No, docs trained in EM should not work as primary care docs. I say that because most of us (res trained EM docs) assert that you should be trained in EM to work in an ED we must also acknowledge that we shouldn't be working as PMDs in an office setting. And in reality we are not trained in long term mgmt of DM, HTN and other chronic problems. If you've done EM/IM then fine. I get really angry when I hear EM docs gripe about non-boarded docs in the ED and at the same time put down primary medicine as easy and beneath them. It makes us look like hypocrites.

 

[DrMom]

good point, docB. What are your feelings on EM docs working in the doc in a box type offices that aren't really about long-term care?

 

[mountaindew2006]

so let me clarify....

if you are an IM doc you may (i guess depending on what hosp) work as an EM doc. however, it cant work the other way around? That's the feeling I'm getting here... 😕

My concern is I want to go into practice or be real close to the wifey who is going to be in primary care essentially with her own practice. I know this is wishful thinking, but at this point I wouldnt want to not be working at least in the same vicinity/hosp as her.

 

[Apollyon]

if you are an IM doc you may (i guess depending on what hosp) work as an EM doc.

That is becoming rarer and rarer. You may not be able to find a job in the ED if you are IM, in a place where your wife would want to be cards.

 

[roja]

The two fields are not, and should not be the same. Why do you assume you wouldn't be able to practice EM where you wife was a cardiologist. This doesn't reallymake sense to me.


Dr. Mom- I come from a state where there are many 'doc-in-a-box' places that are owned and staffed by EM docs. They are essentially 'fast track' clinics. I have no problem with them as that is what they are functioning as... they don't do fp,im stuff. they take care of sore throats, sprains and suturing type stuff when people can't get into their PMD or don't have one. The few I knew wouldn't fill chronic meds, etc same as the ed.

 

[DrMom]

That's the kind of practice I was thinking of, roja. thx.

 

[roja]

Gives me nightmares to think about it... *shudder* but we also have one or two attendings here who onlywork our fast track clinic..........

 

[mountaindew2006]

ok this 'doc in a box' type things is essentially what i was getting as, excuse the ignorance i did not know they were called that. 😀 (or atleast referred to that).

so the thing is this. my wife who is thinking of cardiology but may just stop at the 'internist' level and not pursue the fellowship wants us to have our own practice. I think it would nice to have say an outpatient clinic or one of these 'doc in the box' things where essentially theyd be this fast track clinic scenarios. as you guys know i guess thats the new trend, these 15min doc visits in malls, etc (i read about them on cnn.com). I mean i'm just wondering is this EM fast track outpt deals lucrative? I figure i could take care of the acute probs, and i can refer the chronic probs to her or the others working in our practice aka outpt clinic? The other thing is that i have a cousin that will be a pharmacist as well and some cousins that are radiology techs and nurses. I figure if we can provide all these service at one spot and have the imaging read by radiologists at nearby hospitals, we could perhaps have our little 'hospital' of sorts.

what do you all think? sorry about the ignorance and or confusion. I'm kind of new at trying to figure these things out.

 

[docB]

good point, docB. What are your feelings on EM docs working in the doc in a box type offices that aren't really about long-term care?

I think that's OK. We're trained for that sort of stuff. I'd say the doc in the box environment is also OK for FPs, internists, PAs and others with some extra training and experience.

 

[Apollyon]

ok this 'doc in a box' type things is essentially what i was getting as, excuse the ignorance i did not know they were called that. 😀 (or atleast referred to that).

so the thing is this. my wife who is thinking of cardiology but may just stop at the 'internist' level and not pursue the fellowship wants us to have our own practice. I think it would nice to have say an outpatient clinic or one of these 'doc in the box' things where essentially theyd be this fast track clinic scenarios. as you guys know i guess thats the new trend, these 15min doc visits in malls, etc (i read about them on cnn.com). I mean i'm just wondering is this EM fast track outpt deals lucrative? I figure i could take care of the acute probs, and i can refer the chronic probs to her or the others working in our practice aka outpt clinic? The other thing is that i have a cousin that will be a pharmacist as well and some cousins that are radiology techs and nurses. I figure if we can provide all these service at one spot and have the imaging read by radiologists at nearby hospitals, we could perhaps have our little 'hospital' of sorts.

what do you all think? sorry about the ignorance and or confusion. I'm kind of new at trying to figure these things out.

Everybody referring patients to everyone else in the family might be illegal.

 

[roja]

Its fine to have a doc in the box but it is a conflict of interest to refer them to your wife's practice. Or your families 'radiology' clinic. I believe some docs lost thier liscence in texas for doing exactly this (refering patients to a radiology clinic that they owned).

Sounds to me that you aren't really wanting to be an EMP. Perhaps you should consider an IM community program that way you can set up your own clinic.

 

[DrQuinn]

Look up the "Stark Law."

"Referrals and claims that violate the Stark statute are each punishable by a $15,000 civil money penalty, any claim paid as the result of an improper referral is an overpayment, and circumvention schemes are punishable by a $100,000 civil money penalty."

http://www.aafp.org/fpm/20031100/27thes.html

 

[stoic]

Everybody referring patients to everyone else in the family might be illegal.

A local doc just lost her license for that....

 

[mountaindew2006]

never knew about that one....i wasnt planning on illegally doing anything. i just thought if i wanted to r/o somethign and needed a cxr or something it would convenient and fast if there was one right in the same office/clinic. so even if its in the same clinic, it's still illegal?

 

[roja]

Look up the stark law that quinn posted.


Basically, it sounds like you want to be a clinician, someone who wants to do primary care in a clinic setting. If that is the case, why would you waste time being an EMP?

 

[mountaindew2006]

Look up the stark law that quinn posted.


Basically, it sounds like you want to be a clinician, someone who wants to do primary care in a clinic setting. If that is the case, why would you waste time being an EMP?

thanks quinn for that link. i just looked it up and read it real fast. it appears that what i was describing was referred to as in-office ancillary services exception.

correct me if i am wrong, but it appears that as long as the services (xrays, pharmacy) are w/i in the same office building and part of my group, then it's legal. however, if i were to refer to another center which provided these services and which i had financial interest in then it's illegal.

why EM? well i like the lifestyle. I like the quick pace. I like the flexibility. but seeing as the above is my plan i'm wondering if i would be better suited as an internist? I really do want to own my own clinic/center. I just thought that given these doc in the box situations, EMP would be the best suited for the job 😳

🙁 🙁 🙁

 

[roja]

The lifestyle you are describing is not EM. Sounds more like FP/IM to me. I would say if you want to own your own center, adn maximize your clientele, fp might better suit you (you will get some peds training, which you won't get in IM)

EM is about the management of emergencies, airways, breathing circulation. Its not about 'clinic' medicine.

 

[lawmd]

mountaindew-I think it is a great idea-I would lean toward FP, seems like so much of IM residency is hospital based. try to do a few elective months in the ER. I would aslo recommend looking into getting an MBA. Physicians are financial idiots at times and if you have two physicians salaries at stake it would be helpful for one of you to have a clue as to what is happening with your money.

 

[Sessamoid]

I'm going to concur with most of the opinions here in saying you probably would be best served by family practice training, unless you absolutely detest treating children. Owning and running a small clinic isn't really an emergency medicine thing.

My EM group is also responsible for staffing some urgent care centers. Guess what kind of doctors we staff them with? Family practitioners.

 

[ERMudPhud]

I have to ask. How sure are you that your wife wants to be in solo private practice or a small practice with just you? That isn't very common these days even for internists much less for cardiologists. Even if she shares a practice with you you won't be able to share call responsibilities if she is a cardiologist and you are FP or EM. More than likely she will end up practicing with a larger group just for the convenience of call and coverage for vacations. Furthermore do you really want to spend 24 hours a day together. My wife is also an EM doc and its bad enough that we fall back to talking about medicine when we are together but the few times we actually worked at the same time in the same ER was unbelievably painful. My wife's original plan was to go work in her fathers "doc-in-a-box" after residency before she realized she could make more working in the ER and have more time off, more autonomy, and still see her parents as much as she wanted. Do what ever type of medicine interests you and you should at least be able to practice in the same city. Otherwise, you may change your mind about your business plan and then be stuck in a field that doesn't interest you.