Nobody likes these ER frequent flyers less than the people who work there, but they can't turn people away.
Who said to turn them away? I sure didn't. I said not to encourage them to use the ER in place of PCP
And a lot of the people who use it for this purpose are people who are extremely sick.
Not likely to get much better visiting the ER twice a week or once a month. Would be much better off just checking in the hospital and being seen by and IM....or better yet, establish care with a PCP who can adequately track the Patient through multiple settings and over a sigifigat duration of time. (gee, there's a thought - a doctor who establishes baselines and then treats the WHOLE patient, not just the acute problem at hand).
Lots of homeless people with AIDS, ESRD, psych problems, or combinations of the above. At Grady, we dialyze patients in the ED all the time. It isn't ideal, but there isn't a better option.
Right. This is why Family Medicine needs a significant boost.
So do we just start turning them away? Aside from the obvious moral implications, do you see a problem with sending a bunch of AIDS patients with things like TB out into the general population, un-treated, to infect everyone? Or turn loose some psych patients without their meds?
Again, I didn't say not to treat them. However, I believe unless a Patient meets specific criteria, they shouldn't be treated in the ER. They should be refereed to a PCP, just a like a PCP would refer a Patient to a specialist if thats what was truly needed. You wouldn't admit a person who did not meet criteria to be admitted, so don't treat people that can legitimately be seen by a PCP.
It is a ****ty situation. I don't have the answer.
Me either. But its worth fighting for.
They need our help, and bad. FPPs went through the crappy undergrad classes, survived the MCAT and the application cycle, went to med school and passed the boards. They are real doctors too, just like you or any other doctor. Family Medicine
is a specialty and it needs to be recognized for what its worth. Doctors in other specialties have an obligation, in my opinion, to try and hep alleviate this mess by supporting PCPs and their fight for equality.
Also, the problem isn't that specialists make too much.
Disagreed. And I really don't care what you (they) *think* your worth. Let the neurosurgeon try to manage a patient with several different morbidities, that is on 20 different meds and is generally non complaint with things like exercise, nutrition, etc, then tell me that the PCP, who handles these types of Patients day in and day out is not as worthy as the neurosurgeon. Forget operating on the brain, the Patient has to survive otherwise, beyond just that one procedure and the neruosurgeon sure as hell aint gonna sit down and do a full workup of the Patients other problems. You cant live without specialists and you cant live without PCPs. They are a TEAM. And they should be treated and supported as such.
Its that FP docs make too little
They do. Funding needs to be significantly increased. Some PCPs are seeing some 30+ Pts a day. Now imagine doing a FULL workup and FULL follow up on these people (not just a work up on the acute problem, and not just a follow up of the acute problem). They are working their ass's off just to be told things like:
they don't have a very interesting job anymore. They used to deliver babies, set broken bones, etc..
and
Today, they are mostly a prescription-writing referral factory.
Gee, way to support your colleagues
. And just for the record, they still do some of the things you mentioned, especially in rural areas. And if they refer you a Patient for maternity/delivery or something else that they have trained to handle, you should be thankful cause THEY just made YOU money.
Who the hell wants to go to med school and then residency to do a job that
People that are really in it to help people and do a little mix of everything, not people who are in it for the money. And yes, those people actually exist...and they should be fostered vs. the money/glory seekers.
realistically, a good RN could do most of the time? If there was more money in it, to pay back the ******ed loans that we're all going to owe, then it might be a little better.
. No seriously.
Im an RN. And I consider myself damn good. There is NO way in HELL that I could even come close to proving primary care. Just FYI, some nurses only have TWO year degrees from local CC's. I suppose I should be happy that you think so highly of nurses, but um, I'm more saddened that you give such little credit to Family Medicine Physicians. What was I saying about specialist not comprehending the complexity of family medicine again....? Oh yeah, take a FULL panel of Patient's for a few months or so then get back to me.
I really, really don't want to get into a debate or flame war about this because I know a bunch of ER/Specialist are gonna blow me up for *only* being a pre-med and giving away the money that I haven't even earned yet and and blah, blah, blah. Basically I just wanted to reply to the OP, however my response was a little unrelated (sorry, it was late, and I was bored at work, it just sorta spewed out, kinda like this post
). And just for the record, not that it matters any, but I plan to specialize (yay research pathology!), so I'm not fighting for myself here, I'm fighting for what I believe is right and fighting against what I see happening in my ER day in and day out.