Family medicine not a lifestyle specialty?

Discussion in 'Family Medicine' started by antispatula, 05.15.14.

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  1. antispatula

    antispatula 5+ Year Member

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    I've heard so many conflicting stories about this, I don't know what to believe. However, a quick search for job offers for family medicine makes it seem clear that if you'd would like, it is certainly a lifestyle specialty in terms of hours.

    For example, this job offer says 40 hours/week and a 150k salary. I found many others with the same basic offer:

    http://www.indeed.com/viewjob?cmp=D...8C-TL-U3cA6TINDYnkEszhOMXX1kYMVA3sNxzuyEdW2LR

    Are these job offers for FM common? If so, why are people always saying FM is such a grueling profession?
     
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  3. VA Hopeful Dr

    VA Hopeful Dr Senior Member 10+ Year Member

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    Couple reasons....

    First, compared to most other physicians, 150k is on the lower end. Second, 150k is decent money assuming you have no student loans which most people DO have. Third, the grueling part comes from the huge amount of unpaid work we're now doing - mostly in the form of paperwork.

    That said, I completely think that FM is a lifestyle specialty. At my current job I work 8:30-5, with a 90 minute lunch 4 days a week and 8:30-noon the 5th day. No weekends. Call, phone only, every 4th week. Now the downside to that is that I'm paid less than everyone except pediatricians but I would rather get my current salary and have plenty of time off as opposed to making more money but having less time to spend with family.
     
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  4. styphon

    styphon Senior Member 10+ Year Member

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    I don't know about "grueling" but it is not a highly ranked speciality among medical students applying to the match...

    Reasons
    -150 may seem a lot to you, but I have friends who are starting 250-300 in EM, I had an ortho friend sign a 500k$/yr contract (he just finished his hand speciality). So in comparsion, Family medicine is the lowest paid speciality along with general pediatrics.
    -Taxes-> When you see 150k or whatever, you don't actually bring that home. I live in NY state, one of the higher taxed states - and when you consider Federal/state/medicare/Social security - I only take home 55-60% of what I make.
    -I think the Medscape Survery,which comes out each year, shows FM working an average of 50-60 hrs a week. Some of the other specialities work 35-40 *AND* are paid more per hour - specifically Derm (work average of 40 hr/wk) and Emergency medicine (36-40hrs a week but they do shift work)
    -there is very little respect for family medicine during residency/medical school. Odd, considering we are the backbone of the American healthsystem and we fill in when things become unpopular/disliked (Ex: Pain control, opiate abuse, abortions, psych patients) and will continue to do so in the future.

    Me personally:
    I work 55-60 hours a week by choice. I have a regular clinic job 8-4:30 M-F, but I normally work thru lunch doing charts. I also have a 2nd job at an urgent care where I do 1-2 (12-24hrs) shifts a week. *BUT* if I wanted to I could lose that, and take my lunches - which would be about 40-45 hours a week.
     
  5. antispatula

    antispatula 5+ Year Member

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    This is another thing I dont understand. Lets say you make 150k after residency. Studies have shown 75k is enough to live off of comfortably while supporting a family in most places in thr US. If I use half of my income to pay off my debt for two years, havent I just quickly paid off my debt while still living decently? Even if it takes 3 or 4 years, it still doesnt sound outrageous to me.

    So let me see if I understand what has been said so far: an FM can work 40 hrs a week pretty much anywhere in the country and make 150kish, or make closer to 200k by working more hours, but FM is not sought after, because RELATIVELY speaking, they don't make as much as other doctors?

    If thats the case I am in luck, because if I end up making more than 150k, I wont know what to do with my money, since i have absolutely no expensive hobbies, no desire to own fancy cars or boats, and have no interest in traveling
     
    Last edited: 05.15.14
  6. emedpa

    emedpa GlobalDoc 10+ Year Member

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    Correct me if I'm wrong here FM attendings, but wouldn't 150k be in the lowest 20% of FM salaries?
    I know many PAs making 150k+.....(em, derm, ortho, surgery). granted, these folks are working > 40 hrs/week...more often 50-60.
    most of the FM docs I know and work with make 180-225 k/yr.
     
    Last edited: 05.15.14
  7. antispatula

    antispatula 5+ Year Member

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    I place 150k in a reasonable salary if the FM only works 40 hrs a week. Is this perhaps unreasonable?
     
  8. msbbc833

    msbbc833 7+ Year Member

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    I've heard of FMs working 60 hr weeks with heavy hours in urgent care making 350k/yr. Is that common/realistic?
     
  9. DrMidlife

    DrMidlife has an opinion 10+ Year Member

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    Two problems.
    1. $150k salary is in the 30% federal tax bracket, give or take. So it's more like $100k.
    2. Unless you live in Texas and/or are wealthy, plan on $250k student debt after med school. You might get lucky and have less, but that's normal debt.

    Point being it'll take quite a bit more than 3-4 years to pay off med school. But I agree with you that paying off student debt gets blown out of proportion.
     
  10. cabinbuilder

    cabinbuilder Urgent Care Physician 10+ Year Member

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    Seriously, I would never ever consider a job that paid that low. A perm position should be minimum 180K before taxes. Still, 180K is low to me and I would never go back to that. Comes down to how much debt you have, how old you are, and if you have kids you want to do things with. My student loan debt is the least of my worries and I'm still paid 6 months ahead.
     
  11. VA Hopeful Dr

    VA Hopeful Dr Senior Member 10+ Year Member

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    The trouble is, that 75k is ignoring student loan payments (which you might get lucky enough to avoid) AND saving for retirement which you almost certainly won't be lucky enough to avoid.
     
  12. VA Hopeful Dr

    VA Hopeful Dr Senior Member 10+ Year Member

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    150k has been the average for fresh residency graduates in decent sized cities. I did have classmates earn more but that meant either a) more rural locations or b) more scope. For example, one of our chiefs is in a practice that still does inpatient. He is making more than the rest of us, but he's definitely working for it.
     
  13. VA Hopeful Dr

    VA Hopeful Dr Senior Member 10+ Year Member

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    Its not unheard of, but I wouldn't say its that common. If we assume 2 weeks of vacation/CME, that comes out to around 115/hr. I could see that if you're being paid as an independent contractor, but most employed jobs I've seen are closer to 100/hr. I did find one that was closer to 120/hr but it's a busy enough location that working 60hrs/wk would be just awful.
     
  14. Blue Dog

    Blue Dog Avec caféine. SDN Advisor 10+ Year Member

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    $150K might be a starting salary for a new graduate, but the upside potential for somebody working full time (4-5 days/week) with a full practice should be double that. There are lots of variables involved, however.
     
  15. VA Hopeful Dr

    VA Hopeful Dr Senior Member 10+ Year Member

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    Most of the new contracts I've seen have a provision that, based on an wRVU value, if you earn more than your salary then you earn more money. For example, if you're seeing 20 patients/day (assuming all level 3 visits) at $39/wRVU with 4 weeks of vacation that's 168k, so the doctor in my hypothetical would earn an extra 18k that year. Up that to 25 patients and we're talking an extra 60k.

    One of the reasons I'm jealous of my classmates who are replacing retiring MDs instead of being added on (like me).
     
  16. Smokemont

    Smokemont 2+ Year Member

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    Because they will be taking over the retiring docs patients?
     
  17. Blue Dog

    Blue Dog Avec caféine. SDN Advisor 10+ Year Member

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    If you're seeing all level 3 visits, you're coding wrong.
     
  18. VA Hopeful Dr

    VA Hopeful Dr Senior Member 10+ Year Member

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    No argument, but it makes the math easier (1 wRVU v. 1.5 wRVU) for internet debate.
     
  19. VA Hopeful Dr

    VA Hopeful Dr Senior Member 10+ Year Member

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    Exactly. A busy day for me is 16 patients (since I started with zero patients on August 1st of last year) while many of my classmates are doing 22-27 depending (since they had an established patient base on day 1)
     
  20. In Absentia

    In Absentia 2+ Year Member

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    Does this really occur though? I am a few years away from this stage regardless but the medscape data seems to suggest that only 7% of FPs make 300,000.

    As a Canadian, survey numbers seem to always be low though, and I was wondering if the same is true for the American numbers; for example, as a Canadian you see quoted averages like 140-200k or whatever but guys I know a couple years ahead who are finishing residency are signing contracts for about 400k. We live in a frozen wasteland though (Edmonton, AB) so that's part of it.
     
  21. Blue Dog

    Blue Dog Avec caféine. SDN Advisor 10+ Year Member

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    Then it occurs 7% of the time, I suppose.
     
  22. cabinbuilder

    cabinbuilder Urgent Care Physician 10+ Year Member

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    I guess I'm in that 7%, I will make that this year.
     
  23. CrileDO

    CrileDO 2+ Year Member

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    Is it possible to make this in a decently rural area (population >3000, but near towns with population >50,000) without doing locums?
     
  24. cabinbuilder

    cabinbuilder Urgent Care Physician 10+ Year Member

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    I don't know. I have never had good luck with a permanent contract.
     
  25. galactus

    galactus Devourer of WORLDS 10+ Year Member

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    Yes. Source: Previous graduates from my residency program who signed 3-6 year contracts in a rural area.
     
  26. EMDO2018

    EMDO2018 Banned Banned

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    No doctor should make 150k, some nurses make more than that.
     
  27. MJB

    MJB Senior Member Moderator Emeritus 10+ Year Member

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    I would love to meet all these nurses making over 100K. Hell...even 80K. I'm married to one, and the most she's ever made is in the 60K range.
    Sure, if you work two jobs plus overtime, I could see it, but I see this referenced often (often by pre-meds) on here, but have no personal knowledge of any nurse making that kind of money. Sure, the CRNA's do, but that's a whole other bit of ridiculousness with our healthcare system.
     
  28. cabinbuilder

    cabinbuilder Urgent Care Physician 10+ Year Member

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    Travelling nurses make that kind of money. I have a friend who is an ER nurse who makes over 100K/yr. I have another nurse friend who makes 120K/yr as the manager of a transplant team.
     
  29. BestDoctorEver

    BestDoctorEver Banned Banned Account on Hold 5+ Year Member

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    These salaries are not common... But salary over 100k is being thrown around all the time by many SDN members. 90%+ of nurses fall between 50k-80k salary range. Not considering the ones that have 2+ employments.
     
  30. Kahreek

    Kahreek 2+ Year Member

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    it is not a lifestyle specialty because you have more responsability, work more and you are paid way less than lets say a dermatologist.
     
  31. VA Hopeful Dr

    VA Hopeful Dr Senior Member 10+ Year Member

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    True, but we also have less call then pretty much any other specialty other than derm, are one of the few remaining that actually have "banker's hours", and the money isn't terrible so long as you avoid the big coastal cities.
     
  32. cabinbuilder

    cabinbuilder Urgent Care Physician 10+ Year Member

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    Urgent care and ER are shift work. When you walk out the door, the day is done.
     
  33. Dharma

    Dharma 5+ Year Member

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    So… why should any student go FM these days, besides a desire to be a rural MD/DO or relegation due to lack of competitiveness? I don't say that to be inflammatory. It's just that the more I learn about the downsides of FM, the more I want to avoid it. This is a sentiment all too common amongst med students right now. More than a few of classmates have stated something along the lines of "FM or PC sounds cool, but ________."
     
  34. VA Hopeful Dr

    VA Hopeful Dr Senior Member 10+ Year Member

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    The short answer: if you want to see both kids and adults in the outpatient world.
     
  35. Blue Dog

    Blue Dog Avec caféine. SDN Advisor 10+ Year Member

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    It is.
     
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  36. jl lin

    jl lin 7+ Year Member

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    OK, well, it depends on experience, geography, area of specialty, if advanced practice or if admin/mgt or not. There can be quite a number of variables with this. 60K is low range if experience, depending on where, depending on off-shift calc. inclusions, and depending upon specialty, and if mgt or admin in included--or if you are a part of research, specialized case mgt--or heck, if you work for a VA hospital. Their leveling of salaries is a world of its own, so yes, there are a number of nurses in certain VA centers that make > $100,000 depending upon how they are, as the government calls it, "boarded." Travel nursing and per diem work can add. RN First Assistants in the OR can make that much--there are indeed areas where six figures happens--sales included. It all depends on your experience, geography, and some of the other factors I've noted.
    In my area, an experienced specialized RN, BSN should make around $80,ooo. This is clearly what expect to make in various units in high level hospitals, as an hourly rate. As a Case Mger for peds, different story, b/c its salary, and the hours can be exceeded quite easily--not including on-call, which in this particular area of nursing is very low rate on-call reimbursement. So, in certain areas, that may be salary, so you might be working 70 or 80 hours for that--not necessarily a great deal if you are used to getting paid by the hour--as nurses are. All depends on what you want--or if you are making the trade-off for experience, 70% day work, 50% travel, and to get leadership and CM experience. Some case mgers mostly work from home, so they accept that salary and those hours. Travel nursing has tons of variables too, so you can't always count on that to be higher end.

    CRNAs, full-time, around where I live, definitely make well over $140+, especially with experience.

    Various advanced practice RNNPs can make %90,000 to ~$100,000 depending on if they are working in the hospital, say ED or ICU-NICU NPs, etc, and covering on off hours versus whether or not they are functioning as NPs in Peds or FP.

    Those at the top are the nurses with Masters or doctoral degrees and are directors of busy hospital cardiac centers or those that are hospital CNOs--and of course experienced CRNAs.
    If you are tenured as a nursing professor w/ a doctoral degree in many universities around here, you will make over $100,000 full time. If you get into medical writing, depending on experience, you can make six figures. If you do specialized medical equipment or pharm sales for large companies, you have the potential to make well over $100,000--but you don't necessarily have to have a BSN for that--healthcare experience of some time with a BA or
    BS and the ability to network and sell can get your there.
     
    Last edited: 06.17.14
  37. jl lin

    jl lin 7+ Year Member

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    Here's one major reason one, from my perspective. I have a lot of critical care nursing experience--adult and peds, including surgical recovery-OHS, etc. I share this so you might consider that I'm not a total idiot with some remote opinion.

    OK, so many of the kids I care for are so FREAKING MEDICALLY COMPLEX--and so are so MANY ADULTS. The primary care providers caring for these types of individuals absolutely must be well-educated and trained (post-graduate training) and have such strong experience in medicine that includes these kinds of complex patients. Hell, w/ the patients that need help today, guess what? I'd beg PD and residency programs to actually include more ICU/SICU, ED, and Peds ICU in family-practice residency programs. Some might say that's overkill, but I'm not so sure it is given the level of complexity I'm as seeing by the full-range of patients needing outpt care.

    Now, Do the primaries defer out for specialization for the medically complex for various things? Sure they do. But it is very important to have a primary care physician that is insightful and on top of what these kinds of specific details are overall--the care should be much more comprehensive and shared in nature. Unfortunately, b/c of specialization, so MUCH of the care becomes quite fragmented.

    I could give you 100's of examples--people that will see their specialists q 3 to 6 mo.s or so, and are basically stable as far as those specialists are concerned on things. Fine, right? But then the complex pt's RAD kicks in or they get bronchial pneumonia,, or they get a serious bladder infection that could easily kill them. Their specialist is NOT going to see them in many cases for another X amount of months; so they are forced to either go and risk exposure to God knows what in an ED somewhere, go to an urgent care center, or go to a local "store" clinic, for example.

    Now, the NP or PA is scared to give them (these medically complex patients) effective treatments due to their other complications--care becomes fragmented--and the very opposite of pro-active.--even some primary care physicians can get like this and are not pro-active--which is why I have changed these providers, when they just were not proactive enough for these kinds of patients.

    MANY of these people with complex issues want and need to stay out of the EDs and hospitals as much as is safely possible--but things gets brushed off that an experienced, pro-active, medical physician would and could handle and effectively treat--w/o adding further stress, strain, turmoil, and potential complications by delay of effective action to the adult, or pediatric client and their families.

    Many patients today can be very complex anymore--for numerous reasons. So having primary care PHYSICIAN PROVIDERS from great programs, etc, with the right attitudes, is not just about the need for strong MEDICAL family/primary are in rural areas.

    I am an experienced RN, BSN, and I am telling you, throwing NPs and PAs at the gap issue for a lot of these kinds of patients IS NOT THE ANSWER.
     
    Last edited: 06.17.14
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  38. GalenVesalius

    GalenVesalius Longtime observer

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    Go to your search engine and type: "family medicine spa". Read the posts on SDN about direct practice primary care/concierge med followed by the ones about urgent care medicine. Then, fill in your blank.

    As for "relegation due to lack of competitiveness," it would be worthwhile to bear in mind that popularity of specialties among students and compensation for specialties (which oddly enough tends to dictate popularity among students) is not static and can be difficult to predict. SDN has been a round for almost 15 years or so, and if you go back to some earlier posts in certain fields, you can see the inflection point from when that field was barely given a second thought by med students and was the domain of "less competitive applicants" to when that field became one of the most competitive $pecialties in the space of 3-5 years! Do you think those who were "relegated" to that field in the early 2000s are unhappy with their choice today? Nor could they have predicted the course that field would have taken. Bottom line, choose carefully. It's easier to choose based on what you like and what you'll enjoy doing for the next 40 years (or longer if you are truly passionate), than based on what you think will bring in the $ based on what you see today. Sounds corny and trite, but maybe worth considering. Good luck with your match.
     
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  39. Blue Dog

    Blue Dog Avec caféine. SDN Advisor 10+ Year Member

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    I concur. :)
     
  40. Blue Dog

    Blue Dog Avec caféine. SDN Advisor 10+ Year Member

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    Seconded. :)
     
  41. styphon

    styphon Senior Member 10+ Year Member

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    I also agree. Making your decision today is based on todays medical and financial climate - which no matter what the "experts" say - cannot be predicted. If you go into, for example, "ROAD" speciality - there is no guarantee that they still have the great "lifestyle" AKA ca$h as they do currently.
     
  42. jl lin

    jl lin 7+ Year Member

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    Thanks Blue Dog. It's just a reality I see literally multiple times a day or week. It's actually a very frustrating situation for the patients, families, and other caregivers.
     
  43. apoptoaster

    apoptoaster 5+ Year Member

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    This probably says more about your classmates and the institution where you're studying than it does about FM. I've only had a few people I've worked with respond negatively when I've told them I was interested in FP (mostly nurses and one or two attendings), and when I try to find out their reasons for discouraging it, it usually relates to money or prestige (or the stupid argument that NPs and PAs will take over primary care, which just tells me that they don't know what they're talking about).

    @jl lin , thanks for sharing this. Your thoughts help me understand something that I love about primary care that I haven't been able to put words to. I love the idea of being able to coordinate care and keep a patient out of the hospital.
     
  44. Dharma

    Dharma 5+ Year Member

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    Thanks for the responses. My plan from the get-go has been to go with what I see myself enjoying the most. That said, while being the most important factor it certainly isn't the only one. Regardless of ones opinion of the matter, mid level encroachment is happening, whether it's good for patients or not. Yeah it's happening in all areas of medicine, but PC is taking the worst hit as NPs "storm the beach." I think it's only logical to take this into consideration and unwise to ignore or deny. Current market trends and conceptions of prestige don't play much in this one's view of things though.
     
  45. Leo Aquarius

    Leo Aquarius Anxiety.org Schizophrenia.com DepressionHealth.net 2+ Year Member

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    This thread is interesting. Funny how all the family medicine docs I've worked with in med school and my own private doctor talk about how hard they work and leave late doing paperwork and phone calls while fighting with insurance companies to get paid. Seems like pretty average physician lifestyle if you ask me.

    But you all knew that going into this specialty back when you chose it right?
     
    Last edited: 06.19.14
  46. VA Hopeful Dr

    VA Hopeful Dr Senior Member 10+ Year Member

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    I have yet to leave more than 30 minutes after the office closed because of paperwork. I have staff to handle the insurance companies. I do work hard, but I'd rather that than be bored.
     
  47. Blue Dog

    Blue Dog Avec caféine. SDN Advisor 10+ Year Member

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    Ditto.
     
  48. styphon

    styphon Senior Member 10+ Year Member

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    The clinic I work at has staff that handles insurances - we have 2 referral clerks who handle referrals/MRI/CT problems, in house pharmacists deal with med prior-auths, and 2 coders who deal with billing for visits. I also have not left more than 30 minutes after my scheduled "leaving time".

    At urgent care - it is a different story. I often leave on time, but I have had a laceration, or a chest pain come in 2 minutes before close - causing us to be 90 minutes late in leaving.
     
  49. jl lin

    jl lin 7+ Year Member

    Joined:
    10.09.09
    Messages:
    5,051

    Hey you are welcome; but in terms of both specialized experiences as a long-term RN, and working the insanity that is case mgt, I am only reporting the reality of what I witness on a regular basis. Coordination of care is absolutely essential. It saves not only patients from unnecessary complications and frustrations that tend to make them want to be less compliant and proactive over their own conditions and care--it saves money, which, if their complex disorders are serious enough, will already bleed their pocketbooks and society's as well.

    This is why the whole notion of NP and PAs to replace FP physicians is absolutely insane. Family practice is a broad specialty that requires intellectually deep insight, knowledge, and strong experience IMHO.
     
    InGen likes this.
  50. InGen

    InGen 2+ Year Member

    Joined:
    11.04.13
    Messages:
    89
    Status:
    Medical Student (Accepted)
    I wish all RN's/healthcare admins shared your well-educated opinions on this :=|:-):
     
  51. jl lin

    jl lin 7+ Year Member

    Joined:
    10.09.09
    Messages:
    5,051

    I understand your concerns. The increase need for sound coordination of care for complex cases is growing not shrinking. In light of the statistical realities, such as the burgeoning population of elderly, and the general noncompliance of even basic wellness practices among the youth and middle-agers, not to mention the growing ability to genetically pinpoint a number of serious health issues, it is overstating to think NPs and PAs will fill the care needs to the degree that you feel is imminent.
     
    Last edited: 06.20.14

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