How many of you FM docs would want/need an outpatient infectious disease doc to refer to? As a private inpatient ID doc I feel like a lot of you would like to offload UTI's, HIV, travel medicine and STI/STD hepatitis etc. etc. or would you rather just DIY? Curious because I'm in a pretty saturated area and see little to no outpatient ID offices.. seems like the ones that do exist are more for follow up after being discharged from inpatient (what I do now). I'm wondering how busy I'd get if I advertised to my local PCP's that I have no wait times for all things outpatient ID
Outpatient Infectious Disease Demand
- Thread starter vit8bsm
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The only things that I refer to ID for are HIV management, and some PCPs don't even do that. Hep C has become very easy to treat. Hep B can require more follow up, but chronic Hep B is pretty rare. I can't imagine any board-certified PCPs who would refer out UTIs and STDs. Travel medicine is generally referred to the health department if the patient needs any unusual vaccines; otherwise, if the patient needs malaria prophylaxis, most PCPs do that themselves, too. So, no, I don't think you'd be very busy even if you advertised.
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I’m a rheumatologist and I refer to outpatient ID quite frequently for latent TB, cases of hep C that I discover on working up rheumatologic referrals, chronic infections in rheumatologic patients, etc. ID is very helpful for me, and I couldn’t imagine working in an area where outpatient ID doesn’t exist.
And as for PCPs - in my area, they refer HIV, hepatitis cases, etc etc to ID. I don’t see any local PCPs trying to manage HIV or hep C themselves. Chronic UTIs end up going to either ID or urology.
There is an ID doc in my multispecialty practice who does OP clinic several days a week - she has no trouble whatsoever filling her clinic slots.
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i have a garden variety adult practice. Rarely do I call on ID. My patients who do see ID out pt are almost always a hospital f/u. I’ll curbside consult one of our guys a couple times a year but that’s really about it.
HCV goes to GI as I like that group and feed em my referrals.
HCV goes to GI as I like that group and feed em my referrals.
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9 years in West Texas, I think I have done 2 ID consults and I see 40-60 in urgent care on average. ID here is mostly for inpatient service. They have HIV clinic here. Hepatitis goes to GI. I had a guy with Tertiary syphilis and HIV - he went to ID. That's about it. Few with FUO that no one can figure out since there is Zika and all sorts of other weird viruses here.
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My big issue with GI practices and hep C is 1) GI is always booking way out wherever I’ve worked and 2) they usually don’t seem to relish seeing hepatitis consults. I’m not thrilled to have a hepatitis patient wait months and months to see a GI nurse practitioner…or for them to see a GI doc who acts like dealing with hepatitis is a waste of his/her time (seen it happen).
My experiences with sending hep patients to ID has been much better. They get seen and treated faster, and seem to be taken more seriously. ID is also much more likely to see a Medicaid patient - I’ve definitely worked in places where I had Medicaid patients with hep C and could not find a GI clinic that would see them.
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No one else is treating Hep C on their own? 
Guess I really did spend too much time at the community health center....
Guess I really did spend too much time at the community health center....
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Easy to do, hard to get drugs coveredNo one else is treating Hep C on their own?
Guess I really did spend too much time at the community health center....
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I learned the hoops to jump through in residency, so so long as I have all the labs, a FIB score or fibroscan, and a whiff of promise to abstain from IVDU I pull the trigger.No one else is treating Hep C on their own?
Guess I really did spend too much time at the community health center....
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Yikes. I never realized how spoiled I’ve been. For 15 years I’ve fed the same independent GI group. They take all insurance, patients never take more than 3 weeks, tops, to get in. Up until about a year ago they did not employ a mid level. I get all their office notes and endoscopy reports back quickly. They are more than happy for any income I can help them generate.
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Not many independent GI groups left sadly.
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Hep C is comically easy to treat these days, you don't even need fibroscan/sure, you can treat based off the FIB4 (CBC + CMP) score. I rarely even need to have my staff do a PA anymore. But if you don't work in an area with a high volume of HCV I can see referring.
HIV I treat myself but again likely very regional--big cities with lots of HIV have lots of HIV clinics and PCPs who trained in academic hospitals with those clinics. Rural areas will have less doctors comfortable treating HIV themself but also less patients.
I can't imagine referring UTIs or STIs--UTIs are too acute to wait for a specialist (also rarely complex) and most STI treatment is bread and butter.
I've referred a few times to ID for FUO or travel vaccines that we don't have and of course people with recurrent drug resistant UTIs where I've tried a few things like initial imaging, vaginal estrogen, etc but often they end up at urology as well.
It's unfortunate because I like dealing with ID but I rarely find myself with a need to do so as an outpatient.
HIV I treat myself but again likely very regional--big cities with lots of HIV have lots of HIV clinics and PCPs who trained in academic hospitals with those clinics. Rural areas will have less doctors comfortable treating HIV themself but also less patients.
I can't imagine referring UTIs or STIs--UTIs are too acute to wait for a specialist (also rarely complex) and most STI treatment is bread and butter.
I've referred a few times to ID for FUO or travel vaccines that we don't have and of course people with recurrent drug resistant UTIs where I've tried a few things like initial imaging, vaginal estrogen, etc but often they end up at urology as well.
It's unfortunate because I like dealing with ID but I rarely find myself with a need to do so as an outpatient.
