States don’t regulate what kind of medicine you can practice. It’s a facility/ insurance issue. Any physician can open up a primary care office. Whether you are opening yourself up to huge liability if something goes wrong will be for the court to decide.
States though do not determine scope of practice based on residency training.
Exactly. Plus if you have a good relationship with your hospital system you may be able to work something out. Three + examples from my EM group:
1) One ER doctor started a concierge primary care practice. His niche is hospice and home visits for patients with limited mobility. Lots of retirees in the area and he is doing really well. Reasonable business person and a few years later with a ton of business he just hired 2 more docs to work with him and see more of the basic primary care stuff. He didn’t get a fellowship in palliative or go back to FM/IM residency. I’m sure he did some reading. I think he is really good and both of my parents signed up with him and I’ve been pleased with their care. His website states up front that he is a prior ER doctor and the patients that like that sign up. A kind, genuine MD with lots of medical experience who knows their limits and when to ask questions and refer out/ read more will do well especially when competing in a primary care desert against a few random PAs.
2) one person left our group to work at the local prison in a primary/urgent care function. Slow pace, salary of 300k+, amazing pension of 2.5% of more recent salary accrued per year vesting after 5 years, great health benefits. 5 days a week with all sorts of trainings and days off and half the patient volume of a regular FM practice. I interviewed for a director position at local county jail. Pay, job and benefits was atrocious and I couldn’t run out of there fast enough. Not even close to competitive to state prison system so subtleties matter.
3) Start an urgent care or work at an urgent care. Starting one will eat you up and cost a lot of money. Many areas are now saturated as other entrepreneurs and now hospital systems have jumped in the game. The time to do this was 10 years ago. But in the right location it works. A few people from our group (including PAs) have left and tried some shifts and they feel burnt out and don’t like the 4 patients per hour viral factory but for many the 8am-6pm hours or portion of that is worth it. Pay is lower as an employee. One couple I know who started a string of urgent cares in a big city worked a ton and after a huge amount of stress started to coast making over 1M per year and ended up selling to the big local academic medical center for 8 figures.
4) Local university health clinic. Mainly urgent care but hours are even better, young and not sick population. Good benefits and pension, much lower comp in low 200s. I have heard people interview for this but weren’t tempted enough to take a position.
5) One of the hospitals that I currently work at is looking for a same day clinic provider and they are desperate for somebody who can cover peds, internal medicine, etc.. If I wanted the position, I am sure I could get considered. This would basically be urgent care with clinic hours.
6) You are mainly only limited by hospital privileges and insurance. My big academic residency had a major issue where a derm resident was fired for misrepresentation and moonlighting in a rural ER saying he was an ER resident and had a bad outcome that brought it all to light. He never got to finish derm residency as a result. Ran into him a few years later and he was a “critical care dermatologist” working at a rural hospital in the middle of nowhere as a hospitalist/ICU combo role. Unclear if they did their due diligence with credentialing and were so desperate they didn’t care or he was about to get sued for something soon. I bet that with the desperate rural critical hospital role an actual board-certified and respected Emergency physician could get a job like this no problem.
7) several of the docs from my group work at a surf resort in Fiji during their vacations. Free vacation, great surfing, see a couple of patients here and there. No extra pay involved but you could live there for free, a great bridge to retirement.
8) Cruise ship doctor. Generally these roles are filled by international docs at low pay and the mega city cruise ships seem like hell on earth. But usually only have clinic 2-4 hours a day and on call with pager for when grandma falls down at the buffet. I would consider this for a small adventure focused expedition cruise like National Geographic etc. Not a good career change but more of a semi retirement alternative.
9) Peace corps doctor: work in a country or region and take care of some younger cool people. Lower pay but funded way to live abroad for a while. They love ER doctors.
10) US foreign service. Each US embassy location abroad has a doctor. Needs to be EM or FP I think. More like basic urgent care, a bit of travel medicine. Pay isn’t awesome but it comes with free housing, sometimes car/driver and taxes can be way lower if not free. I am seriously considering this as a second act as my wife and I really want to spend 1-2 years living abroad at some point. I lived for a year in east Africa as a kid and the embassy doctor was my stop for a few minor issues. The ambassador is highest up on the totem pole but some other roles (chief of mission, USAID deputy and usually doctor get housing and more resources).
