progressive FP scope of practice

[sqeeks]

No, I'm just trying to figure out what exactly you're advocating for. You keep saying ACGME, but you probably should be saying ABMS. @petegriffin did a much better job of explaining it above.

The ACGME is the power behind every credentialed fellowship and residency. You knew what I was advocating for, for some reason you chose to argue semantics. Its fine.

Good luck with that. It's been talked about for years by frustrated docs who want to work in the ER, but I haven't seen any signs of institutional change. The emphasis these days is on primary care and keeping people out of the ER. Training more ER docs simply isn't part of our mission.

Thank you for finally answering the question.

So for post-residency physicians who want to do more procedures, this place exists:

Your second point is good, I'm 100% on board with that.

The issue comes with hospital systems misunderstanding those types of educational processes. A standardized curriculum with extended exposure to certain areas of medicine to not just help FP be more proficient (which you are saying already exists and I agree) but to give them an accredited program and board certification on par with a specialist. CME education is fine and all and can be very well done to help an FP learn procedures, but at the end of the day when a physician applies for hospital rights all of that education is unregulated and easy to dismiss. A program that offers board certification is more concrete.
I'm not saying turn an FP into a specialist, I'm saying give some kind of identifiable credential so healthcare systems can equate the experience with proficiency/competency.

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[VA Hopeful Dr]

The ACGME is the power behind every credentialed fellowship and residency. You knew what I was advocating for, for some reason you chose to argue semantics. Its fine.



Thank you for finally answering the question.



The issue comes with hospital systems misunderstanding those types of educational processes. A standardized curriculum with extended exposure to certain areas of medicine to not just help FP be more proficient (which you are saying already exists and I agree) but to give them an accredited program and board certification on par with a specialist. CME education is fine and all and can be very well done to help an FP learn procedures, but at the end of the day when a physician applies for hospital rights all of that education is unregulated and easy to dismiss. A program that offers board certification is more concrete.
I'm not saying turn an FP into a specialist, I'm saying give some kind of identifiable credential so healthcare systems can equate the experience with proficiency/competency.

We have that, its called residency. You're also never likely to see a new type of certification that would make us equal to specialists. What you might eventually see, and I would have no problem with, is opening up IM fellowships to FPs. I've long felt that Allergy should be open to us anyway. We're best qualified (after med-peds, of course) for this since we already see adults and children.

 

[sqeeks]

We have that, its called residency. You're also never likely to see a new type of certification that would make us equal to specialists. What you might eventually see, and I would have no problem with, is opening up IM fellowships to FPs. I've long felt that Allergy should be open to us anyway. We're best qualified (after med-peds, of course) for this since we already see adults and children.

I never meant to say we were equal to specialists, thats why I said "I'm not saying turn an FP into a specialist" just before that highlighted portion. And you just said exactly what I was saying just in different words. Allow an accredited fellowship for FPs in different portions of medicine for advanced exposure and training. So we're on the same page.

 

[VA Hopeful Dr]

I never meant to say we were equal to specialists, thats why I said "I'm not saying turn an FP into a specialist" just before that highlighted portion. And you just said exactly what I was saying just in different words. Allow an accredited fellowship for FPs in different portions of medicine for advanced exposure and training. So we're on the same page.

I actually think this part is a bad idea on the whole as there is a shortage of FPs as it is, but its nothing something I'll actively fight against.

 

[sqeeks]

I actually think this part is a bad idea on the whole as there is a shortage of FPs as it is, but its nothing something I'll actively fight against.

It all depends on how FPs are using it. Yes, if all we are doing is making FP IM 2.0 and people go on to practice like a gastroenterologist after completing a gastro fellowship. Thats why I personally think it should be a different subgroup of fellowships. Keeping with the gastro example, instead of having an FP complete a 3 yr fellowship make it 1-2 where you focus on proficiency in the more routine procedures. Programs that are focused on making the training more of an adjunct to FP than creating a specialist. I'm saying let a small town doc perform a colonoscopy or simple endoscopy. Not full scope gastro. Some of the more routine and preventative procedure could be invaluable in more rural locations. But obviously if you need to see a GI specialist go to a GI doc etc.

 

[VA Hopeful Dr]

It all depends on how FPs are using it. Yes, if all we are doing is making FP IM 2.0 and people go on to practice like a gastroenterologist after completing a gastro fellowship. Thats why I personally think it should be a different subgroup of fellowships. Ones that are focused on making the training more of an adjunct to FP than creating a specialist. I'm saying let a small town doc perform a colonoscopy or simple endoscopy. Not full scope gastro. Some of the more routine and preventative procedure could be invaluable in more rural locations. But obviously if you need to see a GI specialist go to a GI doc etc.

And what I keep saying is that such a tract already exists - its called residency. FPs all over the country come out of residency being able to do endoscopy. We don't need a post-residency tract when residency itself can accomplish what you're seeking.

 

[sqeeks]

And what I keep saying is that such a tract already exists - its called residency. FPs all over the country come out of residency being able to do endoscopy. We don't need a post-residency tract when residency itself can accomplish what you're seeking.

Sigh. Thats all good and nice, but for the healthcare system we practice in, or the hospitals we need to perform the procedures at there is sometimes a disconnect on practice rights. Thats where a fellowship could be helpful. Plus, I doubt anyone would say extra training is a bad thing for some providers. Just like an IM doc can often do all these procedures getting the credentials to actually perform them wont happen 9/10 times unless they complete a fellowship. Those numbers might be different for FPs, especially in rural locations but it can still be a significant barrier. I personally would like the option to become more proficient before routinely performing them.

 

[VA Hopeful Dr]

Sigh. Thats all good and nice, but for the healthcare system we practice in, or the hospitals we need to perform the procedures at there is sometimes a disconnect on practice rights. Thats where a fellowship could be helpful. Plus, I doubt anyone would say extra training is a bad thing for some providers. Just like an IM doc can often do all these procedures getting the credentials to actually perform them wont happen 9/10 times unless they complete a fellowship. Those numbers might be different for FPs, especially in rural locations but it can still be a significant barrier. I personally would like the option to become more proficient before routinely performing them.

Most IM programs are actually less procedure oriented (outside of hospitalist-type procedures) than FP programs. I personally know FPs doing c-sections, endoscopy, vasectomies, circumcisions, and uterine biopsies. I don't know a single internist doing any of those sans fellowship.

If you got good numbers of any of these procedures in residency, its not all that hard to get credentialed at a hospital assuming they have a need for you to do them. If the hospital has several GI doctors already, you'll have a hard time getting endoscopy privileges. If they have none, and you've done a fair number in residency, its quite doable.

If you think you'll want to do anything like that, go to a program that is known for providing that training (Ventura being the most well known).

 

[sqeeks]

I agree. I just would like to see more options and structure for expanded practice. I want to practice full scope FM when I graduate. Instead of worrying about finding the right program and then hoping I get matched by them to train in said location I would like to know I can choose to expand my procedure competency through a 1-2yr program that would be focused on improving my exposure to a particular field while also maintaining my general FP competence.

 

[betamale]

We have that, its called residency. You're also never likely to see a new type of certification that would make us equal to specialists. What you might eventually see, and I would have no problem with, is opening up IM fellowships to FPs. I've long felt that Allergy should be open to us anyway. We're best qualified (after med-peds, of course) for this since we already see adults and children.

Ugh. Seriously? Residency spots are limited and highly regulated, tied to Medicare funding which is capped. Requiring FPs to do another 3 yr residency is inefficient and unfair since this puts significant economic burden on family physicians who already invested 3 years on a family residency where many rotations are similar to EM. Making a board certified family physician work as an emergency intern is punitive and absolutely embarrassing. I really wish you had thought about this because you even brought that up.

A 1 year fellowship to allow a family physician to focus his or her practice is more fitting don't you think? We learn a lot of medicine, and more importantly, how to develop good clinical skills/judgement during FP residency that is not exclusive to practice of family medicine...they're skills that are applicable to practice of medicine as a whole, in the clinic, in the hospital, and in the ER. The fellowship will allow the FP to learn nuances of emergency practice...not to teach us how to became a doctor like we know nothing.

 

[VA Hopeful Dr]

Ugh. Seriously? Residency spots are limited and highly regulated, tied to Medicare funding which is capped. Requiring FPs to do another 3 yr residency is inefficient and unfair since this puts significant economic burden on family physicians who already invested 3 years on a family residency where many rotations are similar to EM. Making a board certified family physician work as an emergency intern is punitive and absolutely embarrassing. I really wish you had thought about this because you even brought that up.

A 1 year fellowship to allow a family physician to focus his or her practice is more fitting don't you think? We learn a lot of medicine, and more importantly, how to develop good clinical skills/judgement during FP residency that is not exclusive to practice of family medicine...they're skills that are applicable to practice of medicine as a whole, in the clinic, in the hospital, and in the ER. The fellowship will allow the FP to learn nuisances of emergency practice...not to teach us how to became a doctor like we know nothing.

Jesus Christ.

There are, right now, plenty of FPs working in ERs all around the country. They are doing fine with just residency training. We don't need a pathway to accomplish something that residency does just fine already.

Even if we had a one year fellowship (like we do for, say, OB) that will not train an FP up to the level of a residency-trained EP. For hospitals that only hire EM-trained docs, that's the standard they will use and another year won't get an FP there. For hospitals that don't require EM-trained docs, FP is sufficient already so why add more training?

 

[betamale]

Jesus Christ.

There are, right now, plenty of FPs working in ERs all around the country. They are doing fine with just residency training. We don't need a pathway to accomplish something that residency does just fine already.

Even if we had a one year fellowship (like we do for, say, OB) that will not train an FP up to the level of a residency-trained EP. For hospitals that only hire EM-trained docs, that's the standard they will use and another year won't get an FP there. For hospitals that don't require EM-trained docs, FP is sufficient already so why add more training?

I'm realistic not crazy.