EM to family med?

[Birdstrike]

Who? When?

Anonymous trolls

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[Apollyon]

Anonymous trolls

I mean, in public? Like, posts to which you can point!

 

[Splenda88]

When I was a PGY1 IM resident, there was an FM resident rotating with us in the ICU who made all us look bad as he was doing things we could not do. Later on, I found out the guy was an EM doc who left EM to do an FM residency.

 

[Groove]

Would an EM doc breaking in to outpatient medicine have any issues getting malpractice insurance because they weren't trained for OM?

 

[Entadus]

1 year palliative fellowship -> palliative clinic. Better than primary care, for the right person.

 

[cyanide12345678]

Would an EM doc breaking in to outpatient medicine have any issues getting malpractice insurance because they weren't trained for OM?

You’ll probably just pay more.

I got quotes for weight loss practice and it was two prices for board certification and without certification. Some companies also just didn’t insure you if you weren’t board certified. So your options decrease too

 

[emergentmd]

As an EM doc with and EM mentality, I don't understand why anyone would want to go into FM.

You will have to join a group b/c its impossible to make any $$ as a single operator. You have to deal with insurance, poor work staff, EMR, Gov regulations, insurance regulations, etc. Imagine opening up a single doc practice, making 300K with all of the above headache. Suddenly, the flaky nurse and ancillary staff doesn't show up on a regular basis b/c they called in sick or some dumb stuff. Then the insurance company starts to deny or delay payment. Then suddenly you are making 150K/yr with all of the added headaches.

If you are truly burnt out, go to telemed and throw in some UC shifts. make your 200+K and not have to deal with all the headache with opening up a practice. If you are joining a large practice, the headache are not any better.

 

[Brigade4Radiant]

Yeah Family med isn’t it better a specialty clinic like palliative or do a fellowship like occupational med

Family med is also too broad.

You can do urgent care and make the same

 

[Splenda88]

As an EM doc with and EM mentality, I don't understand why anyone would want to go into FM.

You will have to join a group b/c its impossible to make any $$ as a single operator. You have to deal with insurance, poor work staff, EMR, Gov regulations, insurance regulations, etc. Imagine opening up a single doc practice, making 300K with all of the above headache. Suddenly, the flaky nurse and ancillary staff doesn't show up on a regular basis b/c they called in sick or some dumb stuff. Then the insurance company starts to deny or delay payment. Then suddenly you are making 150K/yr with all of the added headaches.

If you are truly burnt out, go to telemed and throw in some UC shifts. make your 200+K and not have to deal with all the headache with opening up a practice. If you are joining a large practice, the headache are not any better.

Well, FM can work as hospitalists too.

The FM docs I work with make 350k/yr just like me to be on site 65-70hrs every other week.

I actually think EM docs should be allowed to do HM.

 

[RustedFox]

I remember I wanted to "go do FM so badly", but it was because I genuinely wanted to do the medicine; the true, chronic management.

 

[GonnaBeADoc2222]

As an EM doc with and EM mentality, I don't understand why anyone would want to go into FM.

You will have to join a group b/c its impossible to make any $$ as a single operator. You have to deal with insurance, poor work staff, EMR, Gov regulations, insurance regulations, etc. Imagine opening up a single doc practice, making 300K with all of the above headache. Suddenly, the flaky nurse and ancillary staff doesn't show up on a regular basis b/c they called in sick or some dumb stuff. Then the insurance company starts to deny or delay payment. Then suddenly you are making 150K/yr with all of the added headaches.

If you are truly burnt out, go to telemed and throw in some UC shifts. make your 200+K and not have to deal with all the headache with opening up a practice. If you are joining a large practice, the headache are not any better.

Lots of people underestimate the logistics and costs of "hanging your own shingle."

I'm happy to pay a small premium to show up, see a few patients, go home, and not deal with any of the above rigamarole.

The grass isnt greener folks.

 

[CoolDoc1729]

Its everywhere. I had a guy just yesterday who told me it was his right to demand and receive any testing he wanted and it was not my decision to not order what he wanted.

When people are truly egregious I have been known to say

This isn’t Burger King. It isn’t your way right away. It’s my way, when I get to it. You’re not the only patient here and the nurses do not follow orders from patients.

Usually that either causes them to calm down or walk out. Either is fine.

 

[emergentmd]

Opening up a single medical practice is close to impossible for the majority of specialties from scratch. Unless you are sub specialized that can leverage high NOI, the meat on the bone is just not worth it.

The hurdles put up by CMS/Gov/Carriers have made it near impossible to make enough to justify all the headaches. Try running labs in the office and you are talking about 10-30K+ machines and they Break down often.

 

[emergentmd]

When people are truly egregious I have been known to say

This isn’t Burger King. It isn’t your way right away. It’s my way, when I get to it. You’re not the only patient here and the nurses do not follow orders from patients.

Usually that either causes them to calm down or walk out. Either is fine.

The beauty of EM medicine is you never see the person again. So I order what I want within certain limits of patient satisfaction BUT I would never do it their way. I always can fall back on, "You are in the ER, my job is to rule out emergencies and in no way can I give everyone a diagnosis. If you want a diagnosis, then go to your PCP where they can run tests that are not available in the ER">

I would shoot myself seeing chronic complaining pts

 

[Splenda88]

The beauty of EM medicine is you never see the person again. So I order what I want within certain limits of patient satisfaction BUT I would never do it their way. I always can fall back on, "You are in the ER, my job is to rule out emergencies and in no way can I give everyone a diagnosis. If you want a diagnosis, then go to your PCP where they can run tests that are not available in the ER">

I would shoot myself seeing chronic complaining pts

Don't they go to the ED too?

 

[emergentmd]

Don't they go to the ED too?

Of course they do but I either give them alittle juice or deny it; 5 min of my time that I likely will never see again. If I see them often, then I just cut them off. Can't do that easily as their PCP.

 

[smq123]

When people are truly egregious I have been known to say

This isn’t Burger King. It isn’t your way right away. It’s my way, when I get to it. You’re not the only patient here and the nurses do not follow orders from patients.

Usually that either causes them to calm down or walk out. Either is fine.

 

[betamale]

do it. i volunteered with ED docs in free primary care clinics and they like it. you can read the washington manual for primary care. do adults first then some straight forward peds stuff like preparticipation physicals, vaccines, acne treatments, sports med, occ med, weight loss

 

[DrDrummer]

I think if I was going to do something like this, and I have considered it but would never start doing it now -- I like emergency medicine and think that it's unlikely I'd be able to exceed my current income / free time / etc, but that may change as I get into the second decade of the career -- I would focus on specific patient populations. Doing generic DPC seems to have a lot of downsides as illustrated by others, including the neediness of your patient panel and their expectations if they're paying a lot of money. Dealing with insurers / prior auths / etc. sounds terrible.

I would focus instead on something like non-operative sports medicine (I think you could probably do this without a fellowship if you had interest in it), become an self-taught expert on "preventative" medicine focusing on things like Peter Attia's currently-trendy approach to lipid management and hyperaggressive screening for patients who can pay for their own lab tests and imaging and colonoscopies / etc, or do something like geriatric home visits, again after a very intensive focused period of self-study and reflection on whether / how I could do that well. Again, you might not be as well-trained as a fellowship trained geriatrician, but I think if you picked your patients well you could probably offer valuable service.

Many people would have a hard time functioning without quick access to labs and imaging, but if you felt like you could get by without those tools using a good H&P and your gestalt, I think the average ER doctor could do well by those patients at least compared to what most of them are currently getting in the community (at least where I am).

 

[smq123]

I would focus instead on something like non-operative sports medicine (I think you could probably do this without a fellowship if you had interest in it)

Nowadays, that's probably not feasible either. There are so many fellowship trained Sports Med doctors that you'd be at a serious disadvantage. And most sports med doctors who do only sports med are part of larger groups - usually owned by ortho. I can't imagine that they'd have much interest in hiring a self-taught sports med doctor.

 

[DrDrummer]

Nowadays, that's probably not feasible either. There are so many fellowship trained Sports Med doctors that you'd be at a serious disadvantage. And most sports med doctors who do only sports med are part of larger groups - usually owned by ortho. I can't imagine that they'd have much interest in hiring a self-taught sports med doctor.

I think you're probably largely right. That said, there are plenty of people out there hanging up shingles independently and offering steroid injections, "stem cell" injections, PRP therapy and the like including some former ER doctors in my area. I personally wouldn't do those things unless the science came a long way and the therapies were evidence-based and effective, but it is interesting to think about focusing on trying to get people moving without surgery and I think if you focused on a few evidence-based interventions you could probably do a lot with training that you could obtain on your own or via conferences / CME / device manufacturer trainings.

 

[EthylMethylMan]

I dunno if it’s been mentioned yet, but when I first got out of residency, I got multiple interview offers from FM practices trying to hire FM, IM, and EM docs in Alaska. Mid 300s salary, and they would pay for a car and help with getting a house. Alaska’s also a really beautiful place. If being really far from the mainland US isn’t a deal breaker, might be worth it to call a few places. Obviously I’d echo the sentiments from others here about needing to study up a lot on preventive medicine first.

 

[EvoDevo]

I worked with a EM doc who was extremely good and very smart. After 20 years, he got out of busy EDs and did a couple of years in urgent care. In urgent care, he did a little bit of low acuity EM with some primary care, mixed in. During those 2 years, he read everything he could get his hands on regarding preventative family medicine and outpatient primary care. He then got hired by a multi specialty group of mostly primary care docs, to do outpatient medicine (a practice I also happen to work at, and part own).

He didn't advertise as a Family Medicine physician. He didn't claim to be board certified in it. He was board certified EM and that was his certification. But he built a very busy practice seeing outpatients and did that for about 5 years, until he retired. He was widely accepted by colleagues as very good at what he did and was well liked by patients. I don't know of any competency issues during the 5 years I worked side by side with him in the outpatient setting (or in the years I worked with him in the ED, for that matter).

Anyone who is against this type of practice transition has to ask their self, if CRNAs can do the work of an anesthesiologist, nurse practitioners can have an outpatient practice and PAs can de facto work as Emergency Physicians in busy EDs, why can't a board certified EP have an outpatient practice? Answer: they can.

Tldr: You absolutely can do it, OP.

This is very similar to my current situation

 

[EvoDevo]

Do direct primary care.

An experienced EM doc would be more than competent after a few months. It’s not that hard at all.

The key is to only take the cases that you feel comfortable managing. Read a TON. I mean, ALWAYS. Do lots of CME. Then Read some more. You’ll gradually become more comfortable managing complex cases.

 

[Old_Mil]

We let them do damned near everything. That doesn't make it a good idea nor should that be your standard if you want to practice primary care.

As for your second sentence, My third paragraph directly addresses that. But I'll state it again: as an emergency physician, if you're willing to put in the leg work to really study up on primary care for a decent bit of time before making the jump into primary care, you will probably be pretty good at it. Go to conferences, do primary care CME, a very high yield thing would be to do a family medicine board review course.

True. The one advantage the EM doc trying to practice FM has is that you know what to fear. You are not going to be the FM attending that sends a patient home on antacids only to have him die of a massive MI that evening (true story, happened to an attending when I was rotating in an FM clinic as an MS3).