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Pediatrician vs PNP

Pediatrician or PNP


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    26

PedsInTraining

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Hi!

I am very new here (this account was just verified a few minutes ago) so I apologize if there’s anything wrong with this post. I’m about to start college and need to make a decision, and these decisions have been narrowed down to Pediatric Nurse Practitioner or Pediatrician. I don’t hope to start fights, I just want to get expert opinions.
Anyway, I was convinced I wanted to be a Pediatrician, but when I told my parents, they told me not to and said I should be a nurse, and then the Pediatric NP (mom is a nurse). Their points did make sense in that the education is quicker and I like direct patient care, however I know that the shorter education is what causes the educational gap between NPs and MDs. Again, I highly respect both professions, just explaining my thoughts. Anyway, I do like the idea of not having to go through all the schooling, but I know it’s necessary and I don’t want to be more of a dependent provider. Plus my main concern is doing something wrong while treating patients due to the educational gap. Then again, I know that NPs are mostly for primary care, so I’m not sure what to go with. What would you guys recommend, Pediatrician or PNP? Would you say their roles are similar in primary care, or different? Please let me know! Thank you! I’m sorry it’s long!
 

GoSpursGo

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Welcome!

If you’re just about to start college, there is absolutely no rush to make this decision. Focus on doing well in your first semester, do well in your science classes, have fun, and if you have some time consider starting to shadow both NPs and physicians. The day to day time interacting with patients may be similar, but the training and resultant depth of knowledge are vastly different, and as you progress in your career some of the leadership opportunities available to physicians just aren’t available to NPs. Whether that is important to you is probably hard to say without shadowing both, so I highly encourage that.

NPs actually can work within a subspecialty as well—for example, there are a bunch of NPs who see our routine chemo patients in our onc clinic, and I know the PICU and NICU have tons of NPs who routinely round on a day to day basis. I’ve met some really good NPs who take care of patients very well. I’ve also encountered some who vastly overestimate his/her abilities and make a mess out of a complicated patient by trying to practice independently, and conversely I’ve encountered some who consult for every little thing that could probably be managed without a specialist. At the end of the day I don’t think being an NP makes anyone good or bad, it’s whether that NP has a firm grasp of his/her scope of practice and asks for oversight when they’re out of their depth. And they definitely get out of their depth a little sooner than a fully trained pediatrician, so you’ll have to decide whether that would bother you in the long run or if you’re willing to make that trade off for the shorter training.
 
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PedsInTraining

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Thank you for your reply! That certainly makes sense. I guess a big reason that I am considering the MD route is because I went to a PNP with a problem I had been having for a while, she said after just looking at me that I was fine and there was nothing to worry about. Nine months go by and the problem is still there. I finally went to a Pediatrician and he instantly said there was something wrong, ordered tests, and then prescribed medication. Knowing it went untreated that long makes me scared that I’ll do something similar if I were a PNP. It’s not her fault, it’s just that they’re educated differently. And yes, leadership is something that’s important to me.
 
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deleted407021

Congrats on graduating and thanks for your interest in helping young folks! I'm not terribly far out from the beginning of college and I remember trying to get my ducks in a row for med school way back in freshman year. I was an early bloomer in that I'd decided on med school back in HS and kept on that track throughout college. That said, many of my classmates, now colleagues, decided on Medicine later in college and many did so after. I even have a classmate in emergency medicine who was an RN for a few years before applying. This is to say you have time and people get to Medicine at different times and via different routes.

All that said, I'd really just reiterate what the doctor above posted. Pick a major you enjoy and can work prerequisites into. Don't be afraid to look into different majors in your first semester. You'll be doing it for 4 years, pick something you can really sink your teeth into. Shadow some physicians when you can, not just pediatricians. You learn to be a doctor in med school before a specialist, so you ought to have a good impression of what the profession is like. If you hang with some private practice docs, chances are you'll bump into some NPs and you can see how they work too.

I'm a brand new physician but, anecdotally, I've met some absolutely stellar NPs in pediatrics. It selects for people who actually want to be around and help kids. At the same time, they were not practicing at the same level as physicians in subspecialties. Their patients were less complex.
 
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PedsInTraining

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Congrats on graduating and thanks for your interest in helping young folks! I'm not terribly far out from the beginning of college and I remember trying to get my ducks in a row for med school way back in freshman year. I was an early bloomer in that I'd decided on med school back in HS and kept on that track throughout college. That said, many of my classmates, now colleagues, decided on Medicine later in college and many did so after. I even have a classmate in emergency medicine who was an RN for a few years before applying. This is to say you have time and people get to Medicine at different times and via different routes.

All that said, I'd really just reiterate what the doctor above posted. Pick a major you enjoy and can work prerequisites into. Don't be afraid to look into different majors in your first semester. You'll be doing it for 4 years, pick something you can really sink your teeth into. Shadow some physicians when you can, not just pediatricians. You learn to be a doctor in med school before a specialist, so you ought to have a good impression of what the profession is like. If you hang with some private practice docs, chances are you'll bump into some NPs and you can see how they work too.

I'm a brand new physician but, anecdotally, I've met some absolutely stellar NPs in pediatrics. It selects for people who actually want to be around and help kids. At the same time, they were not practicing at the same level as physicians in subspecialties. Their patients were less complex.

Thank you for that advice as well, The_Bird! If I went the med school route, I'd probably major in Psychology and minor in something like Biology, Biomedical Science, or Biotechnology. I LOVE psych and it would be helpful for child development. I have a bit over 200 volunteer hours at a hospital too, and if I chose medicine I'd probably try to be a medical scribe or something like that before applying.

I currently work in child care; do you think having that on my application would help with pediatrics, or would you say being something like a medical scribe would be more helpful?
 
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deleted407021

Thank you for that advice as well, The_Bird! If I went the med school route, I'd probably major in Psychology and minor in something like Biology, Biomedical Science, or Biotechnology. I LOVE psych and it would be helpful for child development. I have a bit over 200 volunteer hours at a hospital too, and if I chose medicine I'd probably try to be a medical scribe or something like that before applying.

I currently work in child care; do you think having that on my application would help with pediatrics, or would you say being something like a medical scribe would be more helpful?
I majored in psych, myself. Didn't minor though, seemed like too much work :eek:

Some of your questions are better served over at the pre-med sub-forum. Conventional wisdom has it that quality > quantity in terms of service work. This means that putting in the hours somewhere where you're passionate about your volunteering (and subsequently can talk and write more compellingly about it as your apply) is better than having 15 things on your CV. Keep up your volunteering going into college. And certainly your experiences in child care can help ... they round you out! Keep in mind that volunteering and such is as much to make you more of a whole person as it is to give you a good application to medical school, probably more so even.

Go check out the premed forum, too. Take what you read there with a grain of salt, of course.

EDIT: To your main question, again. Consider how well-rounded you might hope to be. Everyone goes into med school with a bachelor degree, theoretically in any subject. Many get masters or even PhDs before they even start medical training. Then you do residency and/or fellowship. This is just far and above the educational exposure you'd get before you start practicing as an NP. If you feel like being in school for ages produces valuable experiences (which it certainly can), that's something to consider.
 
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PedsInTraining

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I majored in psych, myself. Didn't minor though, seemed like too much work :eek:

Some of your questions are better served over at the pre-med sub-forum. Conventional wisdom has it that quality > quantity in terms of service work. This means that putting in the hours somewhere where you're passionate about your volunteering (and subsequently can talk and write more compellingly about it as your apply) is better than having 15 things on your CV. Keep up your volunteering going into college. And certainly your experiences in child care can help ... they round you out! Keep in mind that volunteering and such is as much to make you more of a whole person as it is to give you a good application to medical school, probably more so even.

Go check out the premed forum, too. Take what you read there with a grain of salt, of course.

EDIT: To your main question, again. Consider how well-rounded you might hope to be. Everyone goes into med school with a bachelor degree, theoretically in any subject. Many get masters or even PhDs before they even start medical training. Then you do residency and/or fellowship. This is just far and above the educational exposure you'd get before you start practicing as an NP. If you feel like being in school for ages produces valuable experiences (which it certainly can), that's something to consider.

It's not a guarantee but I'm definitely leaning towards the Pediatrician route... just hope I can get my parents to agree too! Psych really is an amazing major. Thank you again for your help!
 

mvenus929

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Thank you for that advice as well, The_Bird! If I went the med school route, I'd probably major in Psychology and minor in something like Biology, Biomedical Science, or Biotechnology. I LOVE psych and it would be helpful for child development. I have a bit over 200 volunteer hours at a hospital too, and if I chose medicine I'd probably try to be a medical scribe or something like that before applying.

I currently work in child care; do you think having that on my application would help with pediatrics, or would you say being something like a medical scribe would be more helpful?

This may come across as somewhat harsh, but I'm not intending it that way. Before you apply for pediatrics, you have to apply for medical school. Sure, you can apply for medical school with a specialty in mind, but most med students change their mind during school. So while the work experience in child care will be helpful in general, you do need medical experience to apply to medical school--that's where the shadowing/scribing/healthcare volunteering comes in. So you have an idea of what medicine is about.

When you're applying for residency, sure, experience in child care may help. You know generally how to handle kids. But it doesn't necessarily translate to taking care of them in a medical setting super well.

I agree with The_Bird--you should probably head to the pre-med forum for more specific answers, because, again, you'd be applying for medical school, not a pediatric residency, right out of college.
 
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PedsInTraining

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w

This may come across as somewhat harsh, but I'm not intending it that way. Before you apply for pediatrics, you have to apply for medical school. Sure, you can apply for medical school with a specialty in mind, but most med students change their mind during school. So while the work experience in child care will be helpful in general, you do need medical experience to apply to medical school--that's where the shadowing/scribing/healthcare volunteering comes in. So you have an idea of what medicine is about.

When you're applying for residency, sure, experience in child care may help. You know generally how to handle kids. But it doesn't necessarily translate to taking care of them in a medical setting super well.

I agree with The_Bird--you should probably head to the pre-med forum for more specific answers, because, again, you'd be applying for medical school, not a pediatric residency, right out of college.

You weren’t harsh at all, you were answering a question and I appreciate it! I knew that you have to get the bachelors, then medical school then residency— just know that medical schools want more diversity so that’s why I asked. The childcare thing was my high school job anyway. I definitely think that the scribe would be more helpful as well, and I’m glad you guys agree. I also have about 200 volunteer hours at a hospital near me, so that will hopefully help. Thank you again, and no offense taken!
 

FrkyBgStok

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I think you answered your own question, you just need to reflect on what it means to you. There is an educational gap. Is that something you are OK with? The answer actually depends.

Nurses and physicians are different career paths, not a further progression on the same path. The foundational training of nursing is different than a physician. And then when you move to advanced training, you build on that foundation. If you are wanting well child checks and want to operate under the supervision (using that word very broadly) of someone, than NP may be for you. As a physician, the buck stops with me. Because of that, I am unwilling to deal with that gap in education.

Yes it often looks like PNPs and pediatricians do the exact same thing. And often they are. But often, that pediatrician is not operating at the top of their training level whereas the PNP is. I am in PEM and many hospitals have PEM fellowship trained physicians as well as general pediatricians who work in the ED. Day to day, their job looks exactly the same. But in those situations where it really matters, the training difference is significant and noticeable. I didn't go to fellowship for the low acuity patients, which is actually the significant bulk of what I see. I went to fellowship to handle everything that comes in the ED including those very high acuity patients. And we have NPs in the ED operating at a similar level and it can appear similar. But it definitely isn't.

So what can you deal with? But as others have said, focus on college first. A statistic that I read once (don't remember where, don't have a source, but anecdotally it fits) is that about 7% of people who start college with intention of going to medical school will actually attend medical school. And while you may love pediatrics, you don't get to specialize until you graduate medical school which is a lot of adults. That's ok, we all did it, but it is there. So focus on finding a degree that you can do well in and determine if medical school is for you.
 
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PedsInTraining

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I think you answered your own question, you just need to reflect on what it means to you. There is an educational gap. Is that something you are OK with? The answer actually depends.

Nurses and physicians are different career paths, not a further progression on the same path. The foundational training of nursing is different than a physician. And then when you move to advanced training, you build on that foundation. If you are wanting well child checks and want to operate under the supervision (using that word very broadly) of someone, than NP may be for you. As a physician, the buck stops with me. Because of that, I am unwilling to deal with that gap in education.

Yes it often looks like PNPs and pediatricians do the exact same thing. And often they are. But often, that pediatrician is not operating at the top of their training level whereas the PNP is. I am in PEM and many hospitals have PEM fellowship trained physicians as well as general pediatricians who work in the ED. Day to day, their job looks exactly the same. But in those situations where it really matters, the training difference is significant and noticeable. I didn't go to fellowship for the low acuity patients, which is actually the significant bulk of what I see. I went to fellowship to handle everything that comes in the ED including those very high acuity patients. And we have NPs in the ED operating at a similar level and it can appear similar. But it definitely isn't.

So what can you deal with? But as others have said, focus on college first. A statistic that I read once (don't remember where, don't have a source, but anecdotally it fits) is that about 7% of people who start college with intention of going to medical school will actually attend medical school. And while you may love pediatrics, you don't get to specialize until you graduate medical school which is a lot of adults. That's ok, we all did it, but it is there. So focus on finding a degree that you can do well in and determine if medical school is for you.

This all makes a lot of sense, thank you so much for your response!
 

PedsInTraining

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As a physician and parent, I won't let my kids be seen by an ARNP.

I would trust a 3rd/4th year medical student first.

Honestly, thank you for your honest response. I’m not a parent yet (too young right now) but that makes sense and makes the decision of what to pursue easier when I hear/see it that way. Thank you, it really honestly cleared a lot of things up.
 
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As a physician and parent, I won't let my kids be seen by an ARNP.

I would trust a 3rd/4th year medical student first.

Wow, that's too bad. I've worked with a lot of good NPs. The neonatal ones I worked with in residency were especially good in code situations. I would trust them in a heart beat.

As for Pediatric NPs, I trust them for general matters. My kids have been seen by them for general physicals. The good ones that I work with will refer to us when things get more serious. With that said, NPs can run a wide range when it comes to abilities. You will find both good and bad NPs. The same can be said for pediatricians - but because of the training, a bad pediatrician is more rare. [this is all based on my opinion]
 
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ifailedmcat

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I am a general pediatrician and have worked with many PNPs through training and in private practice. We have several PNPs in our practice. Yes there is a gap. Yes we do similar things. Where a doctor's experience shines is with zebras and complex cases. We also do better with higher acuity patients. As another poster said, many PNPs are operating at their full capability. I work in an outpatient clinic however I trained (we all did) to be a hospitalist.

Advantages to going a PNP route would be faster training and still generally doing all the things a general pediatrician would do. I would take an experienced PNP over a fourth year med student and probably over most interns.
 
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PedsInTraining

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I am a general pediatrician and have worked with many PNPs through training and in private practice. We have several PNPs in our practice. Yes there is a gap. Yes we do similar things. Where a doctor's experience shines is with zebras and complex cases. We also do better with higher acuity patients. As another poster said, many PNPs are operating at their full capability. I work in an outpatient clinic however I trained (we all did) to be a hospitalist.

Advantages to going a PNP route would be faster training and still generally doing all the things a general pediatrician would do. I would take an experienced PNP over a fourth year med student and probably over most interns.

That makes sense, thank you for letting me know! I know this is a dumb question, but what exactly is a hospitalist? I don't have training yet so I haven't been exposed to stuff like that. To my knowledge they work only in hospitals. I guess Pediatric Hospitalists work as General Pediatricians in hospitals? That they do inpatient work instead of outpatient? Or is that way off? Sorry if it's a dumb question, I've just always wondered that and never understood it.
 

tantacles

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That makes sense, thank you for letting me know! I know this is a dumb question, but what exactly is a hospitalist? I don't have training yet so I haven't been exposed to stuff like that. To my knowledge they work only in hospitals. I guess Pediatric Hospitalists work as General Pediatricians in hospitals? That they do inpatient work instead of outpatient? Or is that way off? Sorry if it's a dumb question, I've just always wondered that and never understood it.

A pediatric hospitalist is a general pediatrician (in other words, someone who finished pediatric residency after medical school) who specializes in treating patients in the hospital. They are also qualified to do primary care, and like the original poster, some do ultimately switch to primary care for various reasons, but most have chosen to do hospital medicine because it is more rewarding to them than outpatient primary care.
 

PedsInTraining

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A pediatric hospitalist is a general pediatrician (in other words, someone who finished pediatric residency after medical school) who specializes in treating patients in the hospital. They are also qualified to do primary care, and like the original poster, some do ultimately switch to primary care for various reasons, but most have chosen to do hospital medicine because it is more rewarding to them than outpatient primary care.

That makes sense, thank you for the clarification! I love the idea of also being able to work in the hospital. Is there a specific unit they stick with?
 

hlancaster

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Usually pediatric Hospitalist doctors work in the general medicine ward for children and/or see children in the ED or newborn nursery. However, another type of hospitalist is emerging too. There is a trend where the pediatric and neonatal ICUs are now staffing general pediatricians who work under an attending ICU specialist. These general pediatricians take care of most of the routine things and then touch base with the ICU attending when needed. It’s kind of like being a super-resident except you work a normal number of hours and get paid a normal salary. Most often I’ve seen it done by people who are taking time off between residency and fellowship. I think it helps alleviate some of the staffing/call burden for the ICUs.
 
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PedsInTraining

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Usually pediatric Hospitalist doctors work in the general medicine ward for children and/or see children in the ED or newborn nursery. However, another type of hospitalist is emerging too. There is a trend where the pediatric and neonatal ICUs are now staffing general pediatricians who work under an attending ICU specialist. These general pediatricians take care of most of the routine things and then touch base with the ICU attending when needed. It’s kind of like being a super-resident except you work a normal number of hours and get paid a normal salary. Most often I’ve seen it done by people who are taking time off between residency and fellowship. I think it helps alleviate some of the staffing/call burden for the ICUs.

Interesting, I’ve never heard of that actually. I’ll look into it, thank you!
 
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deleted407021

Usually pediatric Hospitalist doctors work in the general medicine ward for children and/or see children in the ED or newborn nursery. However, another type of hospitalist is emerging too. There is a trend where the pediatric and neonatal ICUs are now staffing general pediatricians who work under an attending ICU specialist. These general pediatricians take care of most of the routine things and then touch base with the ICU attending when needed. It’s kind of like being a super-resident except you work a normal number of hours and get paid a normal salary. Most often I’ve seen it done by people who are taking time off between residency and fellowship. I think it helps alleviate some of the staffing/call burden for the ICUs.
This sounds like a nice option to have, especially if you’re a big fan of babies but not ready for fellowship yet (and want to get paid).
 
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hlancaster

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Interesting, I’ve never heard of that actually. I’ll look into it, thank you!

I don’t think the different practice settings matter much for your decision to go NP or MD. At my institution we have NPs fill a similar role in the ICU honestly.

Disclaimer: As a resident, I’ve born all of the costs of MD training with none of the benefits yet so my advice is biased. I don’t think it’s worth it to go the MD route to do pediatrics if you just want to do patient care. Research is a big part of my career which I couldn’t have done in the NP route, but if you’re interested mostly in clinical care and no other extra curriculars, then my vote is save yourself the hassle. Residency is really hard and the debt is crushing. The clinical role is not different enough that I think it’s worth it.
 
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hlancaster

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This sounds like a nice option to have, especially if you’re a big fan of babies but not ready for fellowship yet (and want to get paid).

Definitely, I’ve had colleagues who chose to do NICU hospitalist while they decide whether they wanted to take the plunge into nicu fellowship. Some did fellowship after and some have just stayed in the hospitalist role for now.
 
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PedsInTraining

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Usually pediatric Hospitalist doctors work in the general medicine ward for children and/or see children in the ED or newborn nursery. However, another type of hospitalist is emerging too. There is a trend where the pediatric and neonatal ICUs are now staffing general pediatricians who work under an attending ICU specialist. These general pediatricians take care of most of the routine things and then touch base with the ICU attending when needed. It’s kind of like being a super-resident except you work a normal number of hours and get paid a normal salary. Most often I’ve seen it done by people who are taking time off between residency and fellowship. I think it helps alleviate some of the staffing/call burden for the ICUs.

I swear I’ve been responding, guess it hasn’t been going through lol. Thank you guys for clearing up the hospitalist’s role in pediatrics, definitely makes more sense now. I love the idea of outpatient pediatrics, but fear it may get boring (is it really all well child visits and immunizations, or is that just an exaggeration) and I do want to spend some time in hospitals as well. Decisions, decisions...
 

mvenus929

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I swear I’ve been responding, guess it hasn’t been going through lol. Thank you guys for clearing up the hospitalist’s role in pediatrics, definitely makes more sense now. I love the idea of outpatient pediatrics, but fear it may get boring (is it really all well child visits and immunizations, or is that just an exaggeration) and I do want to spend some time in hospitals as well. Decisions, decisions...

A lot of it is well visits and vaccines. But there's also rashes, asthma, ADHD, URIs, UTIs, STIs, occasionally a pregnancy, and all the things that the subspecialists see, just in lower numbers. I get my diabetes patients from somewhere, and they all still have a primary care doc that they go see for everything other than their diabetes.
 
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PedsInTraining

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A lot of it is well visits and vaccines. But there's also rashes, asthma, ADHD, URIs, UTIs, STIs, occasionally a pregnancy, and all the things that the subspecialists see, just in lower numbers. I get my diabetes patients from somewhere, and they all still have a primary care doc that they go see for everything other than their diabetes.

Makes sense. Thank you!
 
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