General Practioner?

[futuredo32]

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I am a psychiatrist, I like psychiatry but miss the rest of medicine. I applied for FP and IM and due to funding reasons (along with I just passed board scores), I never matched into FP or IM. I ran across this and wondered if anyone had any knowledge or experience? American Academy of General Physicians – Official AAGP Website (aagp-academy.org)

 

[DrMetal]

I am a psychiatrist, I like psychiatry but miss the rest of medicine. I applied for FP and IM and due to funding reasons (along with I just passed board scores), I never matched into FP or IM. I ran across this and wondered if anyone had any knowledge or experience? American Academy of General Physicians – Official AAGP Website (aagp-academy.org)

Seems a little gimmicky.... I suppose it's a way of granting 'board certification' to those who haven't completed a residency.

But then again, calling one board certifying body gimmicky over others is like arguing that my religion is better than yours (when in fact, it's all foolishness).

 

[VA Hopeful Dr]

I am a psychiatrist, I like psychiatry but miss the rest of medicine. I applied for FP and IM and due to funding reasons (along with I just passed board scores), I never matched into FP or IM. I ran across this and wondered if anyone had any knowledge or experience? American Academy of General Physicians – Official AAGP Website (aagp-academy.org)

That board certification isn't going to open any new doors for you that your psych BC won't.

 

[shaggybill]

It's interesting that they state in their Member Options that members are encouraged to advertise that they are BE/BC. I wonder how state medical boards would feel about that. Aren't there requirements in some states that in order to claim board certification it must be ABMS.

 

[DrMetal]

That board certification isn't going to open any new doors for you that your psych BC won't.

and isn't this the 'golden era' of psych, money to be made all over the place, especially in telepsych?

I don't disagree with the concept of the AAGP. I think a MD+PGY1 should be allowed to work, in some context (not doing brain surgery obviously). Hell if a 'naturpath' can prescribed eucalyptus leaves and macrobid, why not let a physician like this work in some capacity?

 

[VA Hopeful Dr]

and isn't this the 'golden era' of psych, money to be made all over the place, especially in telepsych?

I don't disagree with the concept of the AAGP. I think a MD+PGY1 should be allowed to work, in some context (not doing brain surgery obviously). Hell if a 'naturpath' can prescribed eucalyptus leaves and macrobid, why not let a physician like this work in some capacity?

They can, just hard to get credentialed with hospitals/insurance.

Could do DPC to their heart's content.

 

[hamstergang]

Hell if a 'naturpath' can prescribed eucalyptus leaves and macrobid, why not let a physician like this work in some capacity?

Because we have standards?

 

[Sushirolls]

If one is going to be a GP, odds are most insurance will discriminate. Thus, cash only is the practice venue. At that point, is this certification worth its value as a marketing tool?

OP, just go open your own GP practice and let it grow. As your patient panel grows, keep hammering down on your CME self education.

 

[shaggybill]

It's also interesting that due to the fact that the OP has completely a residency, even if it's psych, most doctors/peers wouldn't bat an eye at him getting a little CME and going out and practicing primary care, but if he had completed - say only 1-2 years - of primary care residency and quit for whatever reason and tried to do the same thing as a GP, most would look down on him as inexperienced and substandard. I wonder what the difference in rate of lawsuits for negligence/incompetence is between non BC GPs and those who are board certified PCPs. I'm sure there are a lot more complexities to it than meets the eye.

 

[Sushirolls]

Probably not even an issue.

Look around, 500hr online trained ARNPs are opening their own practices, with no oversite. Any physician who has an indepenent medical license is superior to these ARNP mill grads. Even if they wash out of their residency program or re-tool themselves from their original specialty (like psychiatry for the OP).

The things I'm seeing from ARNPs/DNPs or NDs coming through my office, the floor hasn't just dropped in the standard of care in medicine it is completely gone, the building is starting to lean, and art students are lining up outside to take pictures at the cool old 'Ghost house.' Just wait for the flood of EM docs to start hanging their shingles and opening up GP practices. It just doesn't matter anymore.

 

[DrMetal]

Because we have standards?

Do we really? We as physicians do, but the rest of society does not, as evidenced by the proliferation of 'prescribers', see @Sushirolls post above, it hits the nail on the head.

The things I'm seeing from ARNPs/DNPs or NDs coming through my office, the floor hasn't just dropped in the standard of care in medicine it is completely gone

Unfortunately true. It's really becoming a free for all. We'll have Amazon bots/drones soon delivering high quality health care.

The fact that we have a half dozen board certifying bodies---ABIM (the entire Third Reich of the ABMS), AOBIM (all of the osteopathic organizations), NBPAS, ABPS, AAGP--makes it nice and confusing. Maybe we can play a game, "Who's Board Is It Anyway!?"

 

[DrMetal]

I wonder what the difference in rate of lawsuits for negligence/incompetence

I think most lawsuits have nothing to do with your level of training, nor even with your scope of practice. Sure if you're deficient in these regards, that doesn't help your case.

But most lawyers ask: what there a mistake made? Is there evidence to back it up? Yes, Yes? Pay up. And your home institution will likely settle quickly, allowing your to be named in the suit, to resolve the matter quickly and (most importantly) quietly.

You could be a quadrupely-BC'd physician who's > PGY10+, if you miss a PE, you're efff'd.

Now of course, if you practice outside of your scope of practice, you're only playing with fire, I certainly wouldn't go there.

 

[VA Hopeful Dr]

It's also interesting that due to the fact that the OP has completely a residency, even if it's psych, most doctors/peers wouldn't bat an eye at him getting a little CME and going out and practicing primary care, but if he had completed - say only 1-2 years - of primary care residency and quit for whatever reason and tried to do the same thing as a GP, most would look down on him as inexperienced and substandard. I wonder what the difference in rate of lawsuits for negligence/incompetence is between non BC GPs and those who are board certified PCPs. I'm sure there are a lot more complexities to it than meets the eye.

Its not so much that as that part of this has been addressed many times before, a thread talking about how being a GP means you're likely doing a bad job at whatever you're doing that you aren't trained for isn't helpful.

 

[futuredo32]

Telepsychiatry may be going away in some states. I was taught that prescribing anything that wasn't a psychiatric medicine or diagnosing anything not related to psychiatry was practicing outside the scope of my field of expertise. My PCP went to med school and internship when you could just do a one year internship. He is a GP and seriously genius smart. I have a few patients who won't see a PCP.

 

[hamstergang]

Do we really? We as physicians do

Seems odd that you answered the question right after asking it, but yeah that's the answer.

 

[DrMetal]

Seems odd that you answered the question right after asking it, but yeah that's the answer.

It's a rhetorical (or comedic) technique, to make one look smarter.

It matters not that we have standards; of course we do, they've been built into us. What matters is that the rest of society has standards, and clearly they don't.


Here's a great post in the Internal Medicine forum. So much for our 'standards':

Physician assistant as chief of hospital medicine

https://www.une.edu/news/2021/une-alum-new-chief-hospitalist-service-maine-va-medical-center The new chief of the Hospitalist Service at the Maine Veterans Affairs (VA) Medical Center at Togus is a graduate of the University of New England’s Master of Science in Physician Assistant (M.S.P.A.)...

forums.studentdoctor.net

 

[hamstergang]

It's a rhetorical (or comedic) technique, to make one look smarter.

It matters not that we have standards; of course we do, they've been built into us. What matters is that the rest of society has standards, and clearly they don't.

I don't know if you're just playing along, but to be clear I wasn't very serious in either of my last posts.

That being said, I think it's fine for physicians to want our degrees to continue to meet the standards we've set even if society is ok letting other professions do other things. We don't have to turn ourselves into PAs (which cutting down on physician education and training would essentially do).

 

[IonClaws]

I don't know if you're just playing along, but to be clear I wasn't very serious in either of my last posts.

That being said, I think it's fine for physicians to want our degrees to continue to meet the standards we've set even if society is ok letting other professions do other things. We don't have to turn ourselves into PAs (which cutting down on physician education and training would essentially do).

I am 99% sure that an MD or DO with 1-2 years of GME has more experience, knowledge and drive than a newly minted PA not only because of nature of their training but also selection bias from the very difficult medical school selection process

 

[Sushirolls]

A new MD/DO graduate already has more training than a PA.

 

[Splenda88]

Seems a little gimmicky.... I suppose it's a way of granting 'board certification' to those who haven't completed a residency.

But then again, calling one board certifying body gimmicky over others is like arguing that my religion is better than yours (when in fact, it's all foolishness).

Nice way of putting it.

 

[Splenda88]

A new MD/DO graduate already has more training than a PA.

Let's keep thumping our chest while saying 'we are the best; we are the best' when no one else cares. Let's be honest here: Primary care outpatient is not that complicated.

Pediatrics hospital medicine fellowship. What a joke! These same academic centers hire NP pediatrics hospitalists.

 

[DrMetal]

Let's keep thumping our chest while saying 'we are the best; we are the best' when no one else cares. Let's be honest here: Primary care outpatient is not that complicated.

Pediatrics hospital medicine fellowship. What a joke! These same academic centers hire NP pediatrics hospitalists.


View attachment 337360

She looks kinda hot, so I'm ok with this.

 

[Raryn]

She looks kinda hot, so I'm ok with this.

Looks pretty crazy, so it correlates

 

[Redpancreas]

She looks kinda hot, so I'm ok with this.

Looks pretty crazy, so it correlates

You're making that conclusion based off a lower facial shot? Clearly neither of you have had experience with online dating apps...which is maybe a good thing.

Note: The above comment applies to both genders.

 

[Raryn]

You're making that conclusion based off a lower facial shot? Clearly neither of you have had experience with online dating apps...which is maybe a good thing.

Note: The above comment applies to both genders.

Im making the conclusion that she’s crazy based on the lower half of her face... and the text she tweeted out.

 

[Mass Effect]

Telepsychiatry may be going away in some states. I was taught that prescribing anything that wasn't a psychiatric medicine or diagnosing anything not related to psychiatry was practicing outside the scope of my field of expertise. My PCP went to med school and internship when you could just do a one year internship. He is a GP and seriously genius smart. I have a few patients who won't see a PCP.

Telepsychiatry will never go away. It's been here since before COVID and will be here long after. It's the pay rate that won't stay the same, but I would bet it'll be comparable and there will not be a shortage of telepsych companies. Plus, you can always start your own private practice, cash only even.

As for what you were taught, that isn't necessarily true. No, you shouldn't be managing someone's HIV meds, but prescribing metformin or even a statin in someone without a PCP, especially if the DM, weight gain, and/or cholesterol spike is due to a med you put them on, is acceptable. You just follow prescribing guidelines. We do this on the inpatient unit all the time and I occasionally do it outpatient as well (metformin mainly) if there's no PCP.

 

[rokshana]

Telepsychiatry will never go away. It's been here since before COVID and will be here long after. It's the pay rate that won't stay the same, but I would bet it'll be comparable and there will not be a shortage of telepsych companies. Plus, you can always start your own private practice, cash only even.

As for what you were taught, that isn't necessarily true. No, you shouldn't be managing someone's HIV meds, but prescribing metformin or even a statin in someone without a PCP, especially if the DM, weight gain, and/or cholesterol spike is due to a med you put them on, is acceptable. You just follow prescribing guidelines. We do this on the inpatient unit all the time and I occasionally do it outpatient as well (metformin mainly) if there's no PCP.

What! You are certainly not the norm!!
I’ve gotten calls from inpt psych because a pt has dm! I’ve been ok with it since I figured they didn’t know anything about diabetes meds!

 

[Mass Effect]

What! You are certainly not the norm!!
I’ve gotten calls from inpt psych because a pt has dm! I’ve been ok with it since I figured they didn’t know anything about diabetes meds!

That's a shame. Seems psychiatrists sometimes forget we went to med school too.

 

[futuredo32]

Telepsychiatry will never go away. It's been here since before COVID and will be here long after. It's the pay rate that won't stay the same, but I would bet it'll be comparable and there will not be a shortage of telepsych companies. Plus, you can always start your own private practice, cash only even.

As for what you were taught, that isn't necessarily true. No, you shouldn't be managing someone's HIV meds, but prescribing metformin or even a statin in someone without a PCP, especially if the DM, weight gain, and/or cholesterol spike is due to a med you put them on, is acceptable. You just follow prescribing guidelines. We do this on the inpatient unit all the time and I occasionally do it outpatient as well (metformin mainly) if there's no PCP.

There is definitely talk in Michigan about telepsych ending...................... And no, I shouldn't be managing HIV

 

[Mass Effect]

There is definitely talk in Michigan about telepsych ending...................... And no, I shouldn't be managing HIV

I don't understand. Telepsych existed in Michigan long before COVID. Why would it go away? Has something happened that's changed the state laws?

ETA: This is what I remember. It was huge news in the state when it happened. It would be a shame if something has changed.

Telemedicine Regulations in Michigan | Chiron Health

Learn how to get reimbursed for telemedicine and the details around telemedicine regulations in Michigan. View: guidelines, FAQs, and key terms.

chironhealth.com

 

[futuredo32]

I don't understand. Telepsych existed in Michigan long before COVID. Why would it go away? Has something happened that's changed the state laws?

ETA: This is what I remember. It was huge news in the state when it happened. It would be a shame if something has changed.

Telemedicine Regulations in Michigan | Chiron Health

Learn how to get reimbursed for telemedicine and the details around telemedicine regulations in Michigan. View: guidelines, FAQs, and key terms.

chironhealth.com

In Michigan, Bluecross has stated it will continue to cover telepsych visits through December 2021, kinda sounds like it won't be forever. Soon, it will require "providers" to work at the physical location of the office, not from home. I'm interviewing for an outpatient psychiatry position currently and some clinics are doing telepsychiatry but keep saying they will "have to go back to seeing patients in person when insurances stop covering it."

 

[Mass Effect]

In Michigan, Bluecross has stated it will continue to cover telepsych visits through December 2021, kinda sounds like it won't be forever. Soon, it will require "providers" to work at the physical location of the office, not from home. I'm interviewing for an outpatient psychiatry position currently and some clinics are doing telepsychiatry but keep saying they will "have to go back to seeing patients in person when insurances stop covering it."

I don't live in MI anymore so you know the landscape better than I do, but I don't see how that's possible when the law was passed back in 2012 that telepsych visits will be covered. It could be that they just won't pay the same, which is a problem nationwide and why a lot of clinics will go back to seeing patients in person. But telepsych companies aren't going anywhere imo, especially nationally. Even if you live in MI, there's nothing stopping you from working with a telepsych company in another state and getting licensed in that state.

We can revisit this in a year and see where everything lands, but I'll eat my hat if telepsych goes away.

 

[Chads2]

What! You are certainly not the norm!!
I’ve gotten calls from inpt psych because a pt has dm! I’ve been ok with it since I figured they didn’t know anything about diabetes meds!

I have a good friend, a psychiatrist, with whom I sometimes share inpatients. We have a good working relationship, as I told him “Well, I only know 3 antidepressants just like you probably only know 3 antibiotics.”

He responded with “I don’t even think I know that many.”

 

[Raryn]

I have a good friend, a psychiatrist, with whom I sometimes share inpatients. We have a good working relationship, as I told him “Well, I only know 3 antidepressants just like you probably only know 3 antibiotics.”

He responded with “I don’t even think I know that many.”

What does an Orthopod consider antibiotic double coverage?

*Two* grams of Ancef.

 

[EthylMethylMan]

Seems a little gimmicky.... I suppose it's a way of granting 'board certification' to those who haven't completed a residency.

But then again, calling one board certifying body gimmicky over others is like arguing that my religion is better than yours (when in fact, it's all foolishness).

 

[Sushirolls]

I don't live in MI anymore so you know the landscape better than I do, but I don't see how that's possible when the law was passed back in 2012 that telepsych visits will be covered. It could be that they just won't pay the same, which is a problem nationwide and why a lot of clinics will go back to seeing patients in person. But telepsych companies aren't going anywhere imo, especially nationally. Even if you live in MI, there's nothing stopping you from working with a telepsych company in another state and getting licensed in that state.

We can revisit this in a year and see where everything lands, but I'll eat my hat if telepsych goes away.

I'm seeing letters hinting from some of my insurance companies at covering telemedicine only until date X.

Granted my state says all telemedicine services must be covered by law.

Here's what I predict, one insurance company was sending out letters about enrolling as their special designated telmedicine providers. So I'm assuming that if you are on their special list - which few will bother with - or few will accepted into - then they will systematically deny all other telemedicine claims. They won't be afoul of the law because they are still technically covering it, but only in their sneaking limited fashion that sticks it to your every day clinic...

 

[Mass Effect]

I'm seeing letters hinting from some of my insurance companies at covering telemedicine only until date X.

Granted my state says all telemedicine services must be covered by law.

Here's what I predict, one insurance company was sending out letters about enrolling as their special designated telmedicine providers. So I'm assuming that if you are on their special list - which few will bother with - or few will accepted into - then they will systematically deny all other telemedicine claims. They won't be afoul of the law because they are still technically covering it, but only in their sneaking limited fashion that sticks it to your every day clinic...

This could be, but a lot of these insurance companies were covering telehealth before the pandemic (at lower rate), so for them to switch things up after in this fashion is likely not to hold up. I still predict telepsych is going nowhere.

 

[Sushirolls]

This could be, but a lot of these insurance companies were covering telehealth before the pandemic (at lower rate), so for them to switch things up after in this fashion is likely not to hold up. I still predict telepsych is going nowhere.

Hope you're right.

 

[dpmd]

Telepsychiatry will never go away. It's been here since before COVID and will be here long after. It's the pay rate that won't stay the same, but I would bet it'll be comparable and there will not be a shortage of telepsych companies. Plus, you can always start your own private practice, cash only even.

As for what you were taught, that isn't necessarily true. No, you shouldn't be managing someone's HIV meds, but prescribing metformin or even a statin in someone without a PCP, especially if the DM, weight gain, and/or cholesterol spike is due to a med you put them on, is acceptable. You just follow prescribing guidelines. We do this on the inpatient unit all the time and I occasionally do it outpatient as well (metformin mainly) if there's no PCP.

What! You are certainly not the norm!!
I’ve gotten calls from inpt psych because a pt has dm! I’ve been ok with it since I figured they didn’t know anything about diabetes meds!

I have gotten calls from inpatient psych to remove a bandage on a wound the ER already closed and gave a plan for but they "didn't feel comfortable" with looking at (not even they looked at it and thought something looked off, they didn't feel they could remove the dressing and look at it even.

 

[Mass Effect]

I have gotten calls from inpatient psych to remove a bandage on a wound the ER already closed and gave a plan for but they "didn't feel comfortable" with looking at (not even they looked at it and thought something looked off, they didn't feel they could remove the dressing and look at it even.

Hate that. That kind of crap makes us all look like clowns.

 

[Lost in Translation]

She looks kinda hot, so I'm ok with this.

She's THICC but her face is average. Not great, not horrible.

 

[clausewitz2]

What! You are certainly not the norm!!
I’ve gotten calls from inpt psych because a pt has dm! I’ve been ok with it since I figured they didn’t know anything about diabetes meds!

I mostly subscribe to the "break it you bought it" principle. I prescribe metformin often enough to have a dot phrase. If I have someone on antipsychotics whose cholesterol goes to h*ll, I will start a statin. If I have someone on lithium and their previously perfectly normal TSH starts spiking I too am capable of reading guidelines and starting them on synthroid and rechecking at an appropriate interval. Once or twice I have had cause to use midodrine when someone has been super orthostatic but reaaaaaally need to stay on what they were on. I sometimes manage lithium-associated edema. I treat beaucoup sexual side effects of SRIs. I have had occasion to treat hyponatremia stemming from carbamazepine. I also adjust lamictal based on regular levels during pregnancy. I not infrequently prescribe medications for weight loss.

If anything out of the ordinary or strange happens in these situations, for sure I will refer out to a specialist. But if there are really crystal-clear guidelines for the first step in addressing common problems that I caused for one of my patients, you'd best believe I will follow them.

 

[VA Hopeful Dr]

I mostly subscribe to the "break it you bought it" principle. I prescribe metformin often enough to have a dot phrase. If I have someone on antipsychotics whose cholesterol goes to h*ll, I will start a statin. If I have someone on lithium and their previously perfectly normal TSH starts spiking I too am capable of reading guidelines and starting them on synthroid and rechecking at an appropriate interval. Once or twice I have had cause to use midodrine when someone has been super orthostatic but reaaaaaally need to stay on what they were on. I sometimes manage lithium-associated edema. I treat beaucoup sexual side effects of SRIs. I have had occasion to treat hyponatremia stemming from carbamazepine. I also adjust lamictal based on regular levels during pregnancy. I not infrequently prescribe medications for weight loss.

If anything out of the ordinary or strange happens in these situations, for sure I will refer out to a specialist. But if there are really crystal-clear guidelines for the first step in addressing common problems that I caused for one of my patients, you'd best believe I will follow them.

I can only speak for myself, but in the outpatient world I'd rather handle blood sugar, cholesterol, and thyroid medications myself if its a mutual patient (or would be happy to help with a new patient). You've got enough on your plate with these patients already, and all of this stuff is my all day every day.

But, if you want to do it you'll get no complaint from me so long as you actually do follow current guidelines.

 

[clausewitz2]

I can only speak for myself, but in the outpatient world I'd rather handle blood sugar, cholesterol, and thyroid medications myself if its a mutual patient (or would be happy to help with a new patient). You've got enough on your plate with these patients already, and all of this stuff is my all day every day.

But, if you want to do it you'll get no complaint from me so long as you actually do follow current guidelines.

I see a lot of people whose PCP is "ha" or "my cousin who's a doctor." Based on psychiatric literature on metformin use for neuroleptic-associated weight gain I am probably not in every case using it based on same guidelines you are mostly following with it (in the sense that the recommendations in this regard make no reference to A1C or frank evidence of glucose dysregulation) but yes, I do realize it is incumbent on me to stay as current as possible.