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FP Surgeries, Procedures

Discussion in 'Family Medicine' started by tridoc13, Nov 22, 2005.

  1. tridoc13

    tridoc13 SDN Donor
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    Hi! I am going into FP after a brief and passionate affair with surgery. I read the sticky on FP FAQs (great, BTW!) and saw the below list for things that FPs can do, depending on what insurance will cover, what politics exist in the area, etc. I was just wondering what other procedures/surgeries we might be able to do that are not on the list. Appendectomies? Colonscopies? I am thrilled that I've chosen FP, but I still love to cut and sew, so I'm looking for additional surgery-type things that I should be asking the PDs about once I hit the interview trail. Thanks in advance for any info you might share!

    -Joint injections (knee, shoulder, etc)
    -Suturing of lacerations
    -Biopsies (punch, excisional, shave, etc.)
    -Cryotherapy
    -Central line and peripheral line placement
    -Closed reduction of simple fractures
    -Drain simple abscesses
    -Simple vaginal deliveries
    -C-sections
    -Tubal Ligation
    -Newborn Circumcision
    -Chest tube placement
    -Endotracheal intubation
    -Conscious Sedation
     
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  3. Mike59

    Mike59 Sweatshop FP in Ontario
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    I'm a graduating Medstudent also so take my $.02 with a grain of salt..

    In residency at most places (especially unopposed), the world is your oyster in terms of getting hands on experience to do those things in your list while in training, you just have to be keen.

    However, getting comfortable enough to do them on your own without backup when in practice is a whole other ordeal. Your malpractice insurance would be insane with that gyne/obs stuff and I've never seen any FPs who do tubals or chest tube insertions, that's quite specialized. There are those few top programs with quotas for appys/choly's but I would be surprised to see if any of the residents are actually doing them after residency, you'd have to be way way out in the boonies for sure.

    Best of luck on the residency trail.
     
  4. gungho

    gungho gungho
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    other office-based stuff, too, e.g. vasectomies, lumps and bumps, colposcopy, endometrial bippsies, etc.
    came from an area where fp's were doing app'ys, t and a, there are programs that train you for those, but you are going to have to go to a fairly rural area which means back-up and relief for time off may be a problem, you will be VERY busy with office, post-op, deliveries, plus malpractice. actually, good practice for the right person, you just have to be the right person.
     
  5. tridoc13

    tridoc13 SDN Donor
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    My main interest in appys, etc. is for international work. I plan to do a lot of traveling and want to make sure that if I am in some tiny village in South Africa or somewhere and a hot appendix comes in, I can handle it. I just had my first interview today and this was one of the topics that I raised. Their philosophy was that if you want to learn it, they can find someone who will teach it to you. It was a very flexible program, and they are fine with their residents doing several months of international work throughout the 3 years. I think I'll just continue to raise it at each interview and see what their response is. Thanks for all of the good info!

    tridoc13
     
  6. mustangsally65

    mustangsally65 Sally 2.0
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    My family doc has removed my big toenails a couple of times. I don't think that's really relevant to international work, but I thought I'd offer that up in case you were really interested in taking off toenails. ;)
     
  7. tridoc13

    tridoc13 SDN Donor
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    We actually had to do that in Belize in 2004! It sure did look painful. Those procedure skills definitely come in handy overseas, I must say. :)

    tridoc13
     
  8. mustangsally65

    mustangsally65 Sally 2.0
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    :laugh: I'm not sure why you had to remove toenails, but I can tell you it's not nearly as painful (with lidocaine, at least) as walking around with ingrown toenails for weeks or months. It's funny, because even though you don't really have any pain, after they are removed it's like instant relief because the pressure is gone.
     
  9. tridoc13

    tridoc13 SDN Donor
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    I'm glad to know you get immediate relief. We did it for a badly infected ingrown toenail. The kid was only about 12 and was making a huge scene, so we had to cover it up so he couldn't see what we were doing. He immediately calmed down and started cracking jokes after we did. I took photos of the whole thing. If anyone wants to see a step-by-step toenail removal, PM me back-list. :)

    tridoc13
     
  10. ramonaquimby

    ramonaquimby I'm a PGY3?! WHAT?!
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    whoa - this thread took a turn, lol...


    some of the things on your list sounds very 'hospitalist'-esque, in which case, you could/should choose to do more hopstial-based elective months, i would guess. similarly, the more rural you go once you finsih residency, the more of those procedures you'll be allowed/able to do ;)
     
  11. tridoc13

    tridoc13 SDN Donor
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    Just an update...I've completed all but one of my interviews and while some programs I've seen are more procedure-heavy than others, every one has said that I can do as much surgery/procedures as I want as long as I express interest in doing them. An overwhelming theme among the programs I've seen has been their flexibility. They all seem to want you to get the experiences you need in order to have the practice that you envision having in the future. I hope everyone else's interviews have gone/are going well. One more and I'm done! Thank goodness.
     
  12. skypilot

    skypilot 2K Member
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    Some FPs in my area do Flex Sigs and Vasectomies. And I am in Boston which is probably not a rural underserved area! :)
     
  13. Echinoidea

    Echinoidea Senior Member
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    To add to the theme of this thread, I'd like to hear some opinions on whether there is any future to the family practice doc doing simple vaginal deliveries and gyn work. I'm starting to seriously look at rural family practice (as I watch EM get insanely competitive) and I'd really like to incorporate obstetrics, procedures, and some ER coverage into my practice. I know the malpractice is a huge negative, but I'm wondering if, by the time I graduate (2008) there will be ANY FP docs doing deliveries.
     
  14. lateness

    lateness Senior Member
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    I know a family doc, who does C section, circs, I and D of abscessess, and did colonoscopy, flexible, and did central lines, he didnt train in a rural program, but he did train in an unopposed program well actually it had one other residency, and he said it was all about the desire to learn and motivation back then, dont know if he is still doing OB/GYN and c sect, but he used to do it alot.
    ithink it comes down to the desire and motivation as some one else said, you can do it, u just hav eto show interest and be in the right Area for sure to do it, b/c of malpractice and state and regional requirements. he was in MIchigan by the way.
     
  15. Blue Dog

    Blue Dog Fides et ratio.
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    There are certainly FPs out there who perform appendectomies - but there aren't a lot of 'em. Mostly, this comes in handy in rural practices with no general surgeons nearby. Ditto c-sections, if you're doing OB. Training opportunities for these tend to be mostly in the Western U.S. and Canada, as I understand it.

    Any FP can learn to do colonoscopies, but you'll need to do a lot of them to make it worth your time. You'll also need to be credentialed at a facility (hospital or ambulatory surgery center) where you can do them, which is an additional hurdle, often with local political factors to complicate things.

    I learned how to do flex sigs in residency, and did quite a few of them the first couple of years I was out. As more and more insurance plans started paying for screening colonoscopies, however, the demand for flex sigs dropped off to the point where I decided to quit doing them. I wasn't doing enough to keep my skills up.

    I also learned how to do vasectomies in residency, but haven't done one since. One of my partners did hundreds of them during his tenure in the Air Force. However, when he joined us, he found that he couldn't cost-justify the added malpractice costs (the insurance company charged him the same rate as a urologist, simply because of that one procedure), and reluctantly had to quit doing them. Apparently, that's not the case everywhere, because I know of other FPs outside academia who continue to do them.

    Most of the minor procedures you listed (joint injection, lesion removal, cryosurgery, incision and drainage of abscesses, simple laceration repair, partial toenail avulsions, etc.) are things that I do regularly.

    Hope this helps!
    Kent
     

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