Family/Urgent Care

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docman85

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So I have been die hard about EM since the beginning of med school, and now that I am a 3rd year I am starting to consider doing FM and then getting a job with urgent care.

My question is while I know I love EM now, will this be the same 10-20 years down the road once I have kids? or will urgent care/sports med/ FM provide me with a better option for diversity in practice? More so are there any current EM docs that wish they would have gone into a different specialty?

I am not sure if this is me just second guessing myself or if I am just starting to like other things, but I am trying to be as objective as possible before I start setting up 4th year audition rotations.

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Its IS very hard to decide, since it is basically a life-time decision.

From EM, I think you could easily transition to Urgent Care if you wanted to (decreased $, but daylight hours). From FP you could also easily transition to Urgent Care if you wanted to.

Most of the jobs I see listed for urgent care will gladly take IM trained, EM trained or FP trained physicians (some places will take a broader spectrum too).

So if that is your backup plan, I think either career leaves it open.

However, the day to day life of FP clinic and ED are very different, so to me the real choice is which primary field do you want to go into...
 
I have not run into many Eps who wish they had gone into another field. Most people in EM are happy with it long term. Even me. For all my griping I continue to think EM is the best specialty in medicine for me. Now medicine in general, that's a different story.
 
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Most of the jobs I see listed for urgent care will gladly take IM trained, EM trained or FP trained physicians (some places will take a broader spectrum too).
em and fp folks work well in urgent care, internal med not so much. a large portion of urgent care is babies, kids, and ob complications, things in which internists have very little training. I have worked at several urgent cares over the years. those that hired internists wish they hadn't and didn't make the same mistake twice.
ps a lot of urgent cares are open long hrs or 24 hrs so you may have a lot of nights/weekends/holidays in uc just like in em.
em is more fun. uc is more predictable.
 
em is more fun. uc is more predictable.

uc is not for everybody (tends to get real boring) but an em desiring more of the fm experience without being a ft fm the uc might be an option because many of the uc are becoming pcp for a significant segment of the population

(not in the EM sense of pcp for crackheads et al)

simply because of better access (business hours), insurance acceptance or because the patient has few if any real medical issues and doesn't require a true pcp (who are often booked up with chronic patients).


As I said, uc tends to get real boring. But it can be rewarding to see the same patient from time to time ..... as long as said patient isn't seeking their 4th Vitamin D 'script of the week.
 
I wanted to do Family Medicine for nearly all of med school. Then I tried it and immediately switched to EM because it is fun and time flies. No offense to anyone out there, but I found primary care to be like watching paint dry. Most people seemed to get better or worse despite rather than because of what you do. Monitoring weight, BP, and glucose - this was not exciting. Monitoring them on the critically ill patient - yes!

During residency I moonlit in urgent care. I hated nearly every shift, but the money was good. It was mostly pushy, entitled people demanding antibiotics for URI's and insured drug-seekers with chronic pain. An occasional small laceration where sutures were mostly optional. A splint or two per shift for sprains or minor fractures. The shifts were 8a-8p so even the lifestyle was not that good.

My last shift in the ED before the holiday: anticoagulated head bleed, STEMI, spinal cord injury, traumatic amputation, DKA, urosepsis, etc

You should try FM and EM. Fortunately they are really quite different so choosing shouldn't be that difficult. Your family would probably rather you be happy and sometimes working nights and weekends, than around but resenting your job.
 
Downside? A lot more years of training.
and you still don't get training in ob. or good training in ortho.
in my experience with urgent care FP>med/peds>IM.
we had a med/peds doc at an urgent care that I worked at who was very bright and should have been a hospitalist. the problem was they couldn't recognize when people weren't that sick. every single bronchitis got a PE workup, etc. they averaged around 1 pt/hr even on busy days. the obs unit at our affiliated hospital was often filled just with their pts.
they no longer work there.
 
Just as a side note, part of the reason for thinking about family would be to end up in a small town in Colorado. I feel like if I lived in a larger city then EM is a no brainer but FM seems to be more popular in an area like CO. correct me ifim wrong here
 
Just as a side note, part of the reason for thinking about family would be to end up in a small town in Colorado. I feel like if I lived in a larger city then EM is a no brainer but FM seems to be more popular in an area like CO. correct me ifim wrong here

A residency trained EP is like gold for a small town.
You could write your own ticket.
 
I have not run into many Eps who wish they had gone into another field. Most people in EM are happy with it long term. Even me. For all my griping I continue to think EM is the best specialty in medicine for me. Now medicine in general, that's a different story.

May I ask what you think is the best specialty in medicine in general?
 
May I ask what you think is the best specialty in medicine in general?

I think you may be having a hard time understanding his comments.

My read is EM is the best field in medicine but medicine (across all specialties) as a career is getting much much harder.
 
May I ask what you think is the best specialty in medicine in general?

EM

I think you may be having a hard time understanding his comments.

My read is EM is the best field in medicine but medicine (across all specialties) as a career is getting much much harder.

:thumbup: That's way better than the way I phrased it.
 
I know med students analyze these things to death, and I did also... but I'd say that you can overanalyze to the point where you lose sense of your basic gut instinct. Go with your gut. If you love EM, you know it. It shouldn't be something you're unsure about. You either feel the vibe or you don't. We can all ask ourselves "What if?" questions about the future. Hell, 10 years ago I was in a corp office, in front of a computer, in a management position, thinking...gee where do I want to be 10 yrs from now? I was addicted to a local Deli turkey and brussel sprout sandwich with ranch dressing and watched sit coms.

Now? I hate brussel sprouts and I rarely order ranch dressing on anything anymore. I'm addicted to Subway veggie or chicken breast sandwiches and I rarely watch sit coms or have any desire to. I'm also in a completely different career and happy with my decision. 10 years from now? Who knows. None of us are clairvoyant. You have to live in the present, hope for the best, and make life decisions as you go along that hopefully improve your overall happiness.

So, in short. Go with your gut. If you are nervous about EM, then it's prob not for you. Personally, I think it's the best specialty out there along with the most flexible. But hey, we're all biased in here. If you want nothing more than urgent care, then go another route.

I don't recommend combined residency programs. I consider them "residencies for people who can't make up their mind."
 
I know med students analyze these things to death, and I did also... but I'd say that you can overanalyze to the point where you lose sense of your basic gut instinct. Go with your gut. If you love EM, you know it. It shouldn't be something you're unsure about. You either feel the vibe or you don't. We can all ask ourselves "What if?" questions about the future. Hell, 10 years ago I was in a corp office, in front of a computer, in a management position, thinking...gee where do I want to be 10 yrs from now? I was addicted to a local Deli turkey and brussel sprout sandwich with ranch dressing and watched sit coms.

Now? I hate brussel sprouts and I rarely order ranch dressing on anything anymore. I'm addicted to Subway veggie or chicken breast sandwiches and I rarely watch sit coms or have any desire to. I'm also in a completely different career and happy with my decision. 10 years from now? Who knows. None of us are clairvoyant. You have to live in the present, hope for the best, and make life decisions as you go along that hopefully improve your overall happiness.

So, in short. Go with your gut. If you are nervous about EM, then it's prob not for you. Personally, I think it's the best specialty out there along with the most flexible. But hey, we're all biased in here. If you want nothing more than urgent care, then go another route.

I don't recommend combined residency programs. I consider them "residencies for people who can't make up their mind."

Thank you for this. Helped me a lot.
 
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