Practicing Emergency Med as an FP...

[deleted87716]

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But they are hearing it from the AAFP in the position paper you posted!

The position paper is primarily geared towards rural FPs, where EM opportunities still exist.

 

[deleted109597]

The position paper is primarily geared towards rural FPs, where EM opportunities still exist.

And, from my personal opinion, are the worst places for an unexperienced person to work. Sure, if there is a tertiary center 10 miles down the road, it is ok. But if you are the only person within 3 hours, and haven't put in more than 1 chest tube during residency, you aren't who I want cutting a hole in my rib cage. That's all I'm saying.

 

[iatrosB]

And, from my personal opinion, are the worst places for an unexperienced person to work. Sure, if there is a tertiary center 10 miles down the road, it is ok. But if you are the only person within 3 hours, and haven't put in more than 1 chest tube during residency, you aren't who I want cutting a hole in my rib cage. That's all I'm saying.

Agreed. What is a good solution to the rural shortage then? More money? I don't think that has worked as places have tried that. Ideas?

 

[deleted87716]

And, from my personal opinion, are the worst places for an unexperienced person to work.

It would be a mistake to assume that all rural physicians are inexperienced.

 

[deleted109597]

It would be a mistake to assume that all rural physicians are inexperienced.

I don't assume. If they haven't been trained on those things, then the only way they learned them was at work, which is close to the worst way to learn something (only worse thing is learning a physical act by reading it). Now, there are a ton of FMs that have been practicing for a long time, and probably have some good experiences. But there are also a ton of young FM docs out there working uncovered at some little podunk ED, and that is a recipe for people dying. Young EM docs working uncovered are better at the critical care stuff simply because they are exposed to it during residency.

Iatros, I don't really know a solution. Maybe really fast helicopters or something. But seriously, there will always be a problem recruiting any kind of physician to rural areas, and that is why those populations are generally less healthy than urban people of the same socioeconomic status.

 

[FoughtFyr]

The position paper is primarily geared towards rural FPs, where EM opportunities still exist.

Really?!? I read it pretty close. Other than the section on the Rural FM fellowships, it didn't mention rural at all. In fact, the rural areas really wouldn't be addressed by that paper as it seems to discuss the interaction between FPs and other specialities where there are other specialties. The small rural hospital where FPs fill almost every role are not the institutions where there are fights. That paper speaks to EPs (BC/BE) "freezing out" FM from the ED. That happens in the larger areas where there are EPs to practice...

You aren't going to win this one Face it, while you are reasonable in your views of the role of FM and EM, your professional organization isn't. And based on the collective anecdotal expiences in this forum, neither are some your colleagues.

- H

 

[FoughtFyr]

It's in the Overview and Justification section.

No, they mention that as an example. The paper is not defined as limited in it's scope and spends far more time addressing the integration of FM into departments where EPs work (not the rural model).

- H

 

[deleted87716]

No, they mention that as an example. The paper is not defined as limited in it's scope and spends far more time addressing the integration of FM into departments where EPs work (not the rural model).

Sorry, I deleted my post (the one you just quoted), as I didn't really see the point in continuing what is clearly a one-sided argument. I'm not defending the AAFP's position on this issue.

 

[deleted109597]

I'm not defending the AAFP's position on this issue.

Alright. 1 down, lots more to go.

 

[deleted87716]

Alright. 1 down, lots more to go.

I didn't say that I didn't agree with it, just that I wasn't defending it. 😛

 

[Jeff698]

But they are hearing it from the AAFP in the position paper you posted!

- H

Yep, I can't count the number of times I was told this exact thing. Just do FM and you'll still be able to practice in the ER.

Sorry, Kent. You're dead on with most of your posts, but you're taking on a lost cause when trying to defend the AAFP's position on this topic.

It is very difficult for them to argue for the value of board certification in Family Medicine (done elsewhere outside of that position paper) while at the same time denigrating the value of board certification in Emergency Medicine.


Take care,
Jeff

 

[deleted87716]

Sorry, Kent. You're dead on with most of your posts, but you're taking on a lost cause when trying to defend the AAFP's position on this topic.

Which is why I have stated emphatically that I am not defending them (at least three times, in fact.)

 

[NKMU]

I could not resist sharing this case I saw with a family physician who moonlights in the 30K/year community ED I'm rotating in:

31 y.o. white male

CC: "I want my cholesterol checked. My family doctor checked it last week, and it was 350, and I'm worried."

HPI/ROS: No CP, SOB, F/C/S, N/V/D, wt -/+. No urinary sx, no change in bowel habits. No complaints at all.

PMH: HTN, DM, GERD

Fam: didn't know

Soc: no cigs, no etOH, no street drugs

Meds: Lipitor, verapamil, metformin

All: NKDA

Vitals: afebrile, HR normal, BP 116/60 Pain 0/10 5'9" 284 lbs

PE: obese white male in NAD. Exam is completely normal.



What do you think the FP attending did? Curtly inform the patient he has no emergency, and to GOMER? Politely reassure the patient and refer him back to primary care (who saw the patient one week ago)? No way. Here's what the patient got:

-CBC/diff
-BMP
-EKG ("You should always do EKG on a guy who is hypertensive like this." Umm, he's not hypertensive now...)
-Lipid profile ("I know it was 350 last week, but I'll check it again.")
-A1C ("You know what this test is, right?" Me--umm, yes. Pt stated glucose was running consistently in mid-upper 90s, no problems)
-IV Access (This was ordered when the very confused nurse reminded the doctor that some of the lab tests would take up to three days to get back, and thinking maybe something serious was going on, figured the patient would be needing something through that IV. The attending said, "Yes, get IV access, in case his sugar is low." 😕 😕 😕

It was unbelievable. The whole night went that way, except usually in the opposite way-- the more critical patients did not get indicated testing unless someone else suggested it. I'm just a fourth year med student, and I have so much to learn, but this guy was downright scary. Everyone in the ED recognizes it, but this place can't attract many BC EM physicians, so they have to hire FP/IM, etc. The EM-trained docs at the place are so far ahead of him, it's unbelievable. The unfortunate thing is that the other FP docs who work there are as frightening as him.

 

[deleted87716]

I could not resist sharing this case I saw with a family physician who moonlights in the 30K/year community ED I'm rotating in

Yeah, well...for every one of those, I can tell you a "scary ER doc" story that's just as bad. Board certification doesn't ensure competence, although it certainly helps.

 

[NKMU]

Yeah, well...for every one of those, I can tell you a "scary ER doc" story that's just as bad. Board certification doesn't ensure competence, although it certainly helps.

That may be true. But I find it hard to believe you'd find an EM physician who would order that many tests for THAT chief complaint! I swear that we sat and talked to that patient much longer (about DM mgt, cholesterol reduction strategies, etc.) than we did evaluating the 26 yo female with CP, + enz, and a sister who had an MI at the same age... 🙄

 

[deleted87716]

I find it hard to believe you'd find an EM physician who would order that many tests for THAT chief complaint!

I've met lousy doctors in all specialties. One of the worst was a semi-retired general surgeon who thought he could do primary care. Oh, the humanity...

 

[Apollyon]

I've met lousy doctors in all specialties. One of the worst was a semi-retired general surgeon who thought he could do primary care. Oh, the humanity...

I have never met a pediatrician (even the pedi specialists that trained in adult specialties and did a fellowship for peds, like rads, cards, CT-surg, neuro, neurosurg, ortho, or uro) that didn't love kids - except one. It was a peds cards guy who went into peds hospitalist, thinking he could cruise to retirement - and was a tragedy to talk to every time I had to call him - everyone was dumping on him, faking, or "not sick enough - why are you calling me?". I was really, truly disheartened, as peds people (no matter the job) are a different breed, and were (and are) always, always a breath of fresh air in the stuffy world of adults.

 

[Jeff698]

Which is why I have stated emphatically that I am not defending them (at least three times, in fact.)

And so you have. It's what I get for responding prior to reading the rest of the thread. Sorry.

Take care,
Jeff