Possible to mix inpatient and outpatient?

[genessis42]

I know this is a far-fetched question since I’m still a student studying boards. But do any primary doctors still do the traditional model?

I grew up around docs who would see both kinds of patients, where the pcp would be the doc treating you if you were hospitalized. But now most IM/FM docs I speak to just stick to one or the other

Do you think that kind of mixed practice model was better back then?

---

Members don't see this ad.

 

[chessknt]

It is rare but does exist still. It is a bad model to practice on the inpatient side because it is hard to answer a page in a timely manner and run on time in your outpatient office, you wont be able to respond to emergencies in person, and your grip on up-to-date practice on the inpatient side will probably slip over time.

 

[IMGASMD]

There was a thread recently talking about this. Tl;dr: it still exists, harder to find.

 

[CatFactorial]

Do transplant and cellular therapy. Inpatient and outpatient, guaranteed!

 

[InternistDO]

There’s another thread on this somewhere but basically yes you can. The traditional model where you round every morning is a lot of extra work for very little increased pay, but being in a large group with shared hospital responsibilities (rounding every 4th week or something) can make it more reasonable. The other option is more of a part time hospitalist model, where you’d do clinic for say 3-6 weeks and then a week of only inpatient, which to me seems like a better way of doing it since you only have to worry about one at a time.

 

[IMGASMD]

There’s another thread on this somewhere but basically yes you can. The traditional model where you round every morning is a lot of extra work for very little increased pay, but being in a large group with shared hospital responsibilities (rounding every 4th week or something) can make it more reasonable. The other option is more of a part time hospitalist model, where you’d do clinic for say 3-6 weeks and then a week of only inpatient, which to me seems like a better way of doing it since you only have to worry about one at a time.

There’s something to be said about having “your” patients. At times, it’s just not fair to the patients, family and doctors when the care is so fragmented. I’ve come to “accept” it as a fact, but it shouldn’t be. People believe that the EMR suppose to fix it, but I personally think it created more problems. It also created an opportunity for the big health care systems and insurance companies an excuse to consolidate their power/footprint. “I cannot schedule you for that doctors office, because we can’t see their record...”. Or something....

 

[InternistDO]

There’s something to be said about having “your” patients. At times, it’s just not fair to the patients, family and doctors when the care is so fragmented. I’ve come to “accept” it as a fact, but it shouldn’t be. People believe that the EMR suppose to fix it, but I personally think it created more problems. It also created an opportunity for the big health care systems and insurance companies an excuse to consolidate their power/footprint. “I cannot schedule you for that doctors office, because we can’t see their record...”. Or something....

Oh I agree 100%. I’ve just personally never seen a traditional practice setup that wasn’t either concierge (which I have no interest in) or with doctors pulling consistent 60 hour weeks, which makes me a bit nervous about the concept.

 

[Osteoth]

One of my attendings rounds on his patients in the hospital 5-7A then goes to clinic 8-12P, back to the hospital for whatever 12-1P, then afternoon clinic until 5.

Can walk from clinic to hospital

 

[genessis42]

I feel like primary care was much more appealing when you could do the Traditional practice. There also wasn’t an overlap of NPs/PAs coming into primary care. I do think that is overblown, but people in my class are worried about other providers taking over

 

[NicMouse64]

I feel like primary care was much more appealing when you could do the Traditional practice. There also wasn’t an overlap of NPs/PAs coming into primary care. I do think that is overblown, but people in my class are worried about other providers taking over

Care to elaborate as everyone else I talk to is saying the opposite?

 

[MLNS]

I feel like primary care was much more appealing when you could do the Traditional practice. There also wasn’t an overlap of NPs/PAs coming into primary care. I do think that is overblown, but people in my class are worried about other providers taking over

Stop referring to yourself as a “provider” you look like a dingus and, yes, it actually is a MUCH bigger issue than the word in and of itself.

You aren’t in “provider school” and you aren’t interchangeable with other “providers” (which is 100% why the word was created in the healthcare setting).

And, it actually isn’t overblown. We are at a real major crossroads in our country’s healthcare and the options aren’t looking too pretty.

 

[VA Hopeful Dr]

Care to elaborate as everyone else I talk to is saying the opposite?

No one I know is all that worried about it from an employment perspective.

My group has 6 openings for physician primary care right now. Zero for mid-level primary care.

This may not be universal, but where I am physicians are more productive (I see 50% more patients than our most productive NPs and I'm not even top 10% of physicians). Our quality numbers are better. We refer less. Only thing they beat us on is patient satisfaction, which we know correlates with worse outcomes.

 

[Keep2r]

Idk what the traditional model is but I’ve seen a bunch of institutions where primary care physicians rotate between outpatient and inpatient months, caring for patients who all go to one practice. Seems to be pretty prevalent in family medicine programs affiliated with smaller community hospitals. Prolly makes the ED’s job harder since they have to differentiate the patients who have family med PCPs from the ones who don’t in order to figure out whether to admit to family med vs internal med.