Prison Medicine: FM or IM "better" at it?

[QueenJames]

Hey all,

For those of us interested in pursuing correctional medicine, I see many jobs that say they need either FM or IM.

My question to those of y'all who have worked in correctional settings or who plan to, is choosing one field better than the other persay? Given than FM also has experience with peds and OB... I don't see how that may help rather than just doing IM in a jail that only deals with adult males.

I could and hope that I am wrong and would love to be educated by my superiors on this site in regards to their experiences with correctional medicine.

Thanks.

The Queen

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[W19]

Where I worked before as a nurse, there was an ID doc which was the director, 1 IM doc , and a couple of them were GP (not FM).

 

[sunshinefl]

Yay!!! Did I convince you correctional healthcare was great? Lol. I actually kind of agree with the person above about the advantages of family medicine for prison.

Our prison doctors do way more procedures than a normal OP PCP. Like we had an inmates tongue cut in half that he had to suture a TONGUE back together. A lot of skin biopsies and skin procedures— I’ve seen genital wart removal for example. Dislocations to be reset. I could go on all day.

Jails aren’t separated by age or sex.

Prisons are. BUT even if you work at an adult male prison, (in Florida anyway) you would still (probably) share call and leave coverage with neighboring prisons, which could be Juvenile or female. Even if you didn’t, we have males as young as 15 in adult male prison.

 

[teacherman84]

I did some moonlighting at a prison. The call shifts (overnight and weekend) were mostly ortho and PMR residents (sweet gig they liked to keep secret). The medical director was OB (womens prison at least) and the day time docs were IM/FM. I dont think it matters but id argue FM is more well rounded for clinic (ages/procedures/msk/womens health)

 

[septoplasty]

Our prison doctors do way more procedures than a normal OP PCP. Like we had an inmates tongue cut in half that he had to suture a TONGUE back together. A lot of skin biopsies and skin procedures— I’ve seen genital wart removal for example. Dislocations to be reset. I could go on all day.

Alright, this is a bad example. Thats plain cowboy medicine.. NOT something GP's should do.

 

[sunshinefl]

Alright, this is a bad example. Thats plain cowboy medicine.. NOT something GP's should do.

Okay so my experience so far in prison is from being an RN, I’m a current M2. I’m not at a place in my training as a physician yet to know where the lines are. BUT, that’s part of the point, that with prison you’re going to be doing more than the average outpatient PCP. It’s like you’re the sole provider in a very rural location. Even as a nurse on duty without a physician/PA/NP there on nights and weekends, I had to manage patients that I wanted to go to an ER but it wasn’t authorized. So you make do. Some people can’t handle that and that’s why a lot of nurses and doctors who dip their toes into correctional medicine go running out.

PS the inmate’s tongue healed very well in the end and he was not upset at all with the treatment plan or results.

 

[septoplasty]

Okay so my experience so far in prison is from being an RN, I’m a current M2. I’m not at a place in my training as a physician yet to know where the lines are. BUT, that’s part of the point, that with prison you’re going to be doing more than the average outpatient PCP. It’s like you’re the sole provider in a very rural location. Even as a nurse on duty without a physician/PA/NP there on nights and weekends, I had to manage patients that I wanted to go to an ER but it wasn’t authorized. So you make do. Some people can’t handle that and that’s why a lot of nurses and doctors who dip their toes into correctional medicine go running out.

PS the inmate’s tongue healed very well in the end and he was not upset at all with the treatment plan or results.

Sure, N=1.

Just because you can doesn't always mean you should, what happens if it went bad?

A huge part of medicine as a physician is recognizing your limitations, if you fail to do so, that's when you cause harm. I fail to understand that just because the patient is in confinement, that they are unable to get to a needed higher level of care.

#mootpoints

 

[sunshinefl]

Sure, N=1.

Just because you can doesn't always mean you should, what happens if it went bad?

A huge part of medicine as a physician is recognizing your limitations, if you fail to do so, that's when you cause harm. I fail to understand that just because the patient is in confinement, that they are unable to get to a needed higher level of care.

#mootpoints

Because you can’t just send anyone out without authorization. It’s not me judging them as inmates and withholding care. I do the best I can every time and then some. The point is you doing your best is better than recommending the optimal absolute best option which requires the inmate to leave the prison and being told No, and just shrugging and putting your hands up in defeat. This is exactly the point I’m making and try to explain to people who don’t work in correctional healthcare.

To use arbitrary ratings, If the absolute best/most cutting edge/optimal/platinum option is a 10, but requires the inmate leaving the prison, and you are told NO. What then? You are saying to do nothing, which is a zero. I am saying you have to do something with the resources on hand. Maybe that is a 7. People who aren’t comfortable with being creative/doing the most/best they can within the reality of a correctional environment shouldn’t do correctional medicine.

I used the analogy of rural medicine because you might be 2 hours from a tertiary medical center which can provide the absolute best/most cutting edge/optimal/platinum option and need to provide something from what’s available. That’s not withholding care to be punitive, that’s just reality. Just like in prison. You can’t just unilaterally just run up to the gate telling the prison officials you’re letting an inmate out to go to the ER. It doesn’t work like that. Go work in a prison if you really can’t picture what I’m saying. You are trapped in your options by the situation.

 

[septoplasty]

Respectfully,
1) Perhaps the doctor in question had enough experience to feel comfortable with this situation. Maybe they sought out additional training in residency, maybe they did a fellowship, etc.


2) I'm still a student but have done a lot of work with patients who have a history of incarceration...it's truly awful how difficult it is for them to get the care they need while in jail/prison. I've had patients with chronic issues due to untreated traumatic injuries, patients who didn't get HIV meds and psych meds they sorely needed, etc. The doctor isn't the boss of whether the patient gets specialist/ED care, the people in charge of the facility are - and they care much more about money than they do about the well-being of the inmates.

1. The thread at hand identifies two types of primary care groups: IM and FM, thus practicing within their scope of training.
2. I'm not doubting how awful the care must be, just doubting whether cowboy medicine which can be harmful is really indicated in all instances.

 

[septoplasty]

To use arbitrary ratings, If the absolute best/most cutting edge/optimal/platinum option is a 10, but requires the inmate leaving the prison, and you are told NO. What then? You are saying to do nothing, which is a zero. I am saying you have to do something with the resources on hand. Maybe that is a 7. People who aren’t comfortable with being creative/doing the most/best they can within the reality of a correctional environment shouldn’t do correctional medicine.

I used the analogy of rural medicine because you might be 2 hours from a tertiary medical center which can provide the absolute best/most cutting edge/optimal/platinum option and need to provide something from what’s available. That’s not withholding care to be punitive, that’s just reality. Just like in prison. You can’t just unilaterally just run up to the gate telling the prison officials you’re letting an inmate out to go to the ER. It doesn’t work like that. Go work in a prison if you really can’t picture what I’m saying. You are trapped in your options by the situation.

So this is very broad, but in the example that was identified, the evidence and peer census doesn't agree with it. That's all. Regardless, if harm is to occur, and you get busted, good luck defending the situation.

 

[DO2015CA]

Just a curiosity questions, but what do correctional medicine docs make salary wise? Ones that are fully board certified.