Specialize and do primary care?

[1cor1311]

I'm posting in the family medicine section because I know primary care physicians can help answer this.

Is it possible to specialize and still do primary care? How does that work more or less?
The reason I ask is because I want to do primary care, however maybe want to (like the physcian I shadowed) do primary care part time and still work in a hospital, and as I get older switch over to full time primary care.

If so which specialties are better for this? Obviously ortho surgery is not really a wise choice. I've seen it done with intern med docs. But what are se other practical choices?

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[DIce3]

I did a fellowship after internal medicine and practice both.

 

[VA Hopeful Dr]

I'm posting in the family medicine section because I know primary care physicians can help answer this.

Is it possible to specialize and still do primary care? How does that work more or less?
The reason I ask is because I want to do primary care, however maybe want to (like the physcian I shadowed) do primary care part time and still work in a hospital, and as I get older switch over to full time primary care.

If so which specialties are better for this? Obviously ortho surgery is not really a wise choice. I've seen it done with intern med docs. But what are se other practical choices?

A combined hospital/outpatient practice is nothing new for internal medicine physicians. The separation between the two with the advent of hospitalists is, in fact, fairly new. What you're wanting to do is perfectly reasonable, if a little hard on the home life.

The same is true with pediatrics and family medicine. Some OBGYNs will act as PCPs for their patients. Past that, I can't think of any other specialty that really has any business trying their hand at primary care.

 

[1cor1311]

I did a fellowship after internal medicine and practice both.

Which field was your fellowship in?

 

[1cor1311]

A combined hospital/outpatient practice is nothing new for internal medicine physicians. The separation between the two with the advent of hospitalists is, in fact, fairly new. What you're wanting to do is perfectly reasonable, if a little hard on the home life.

The same is true with pediatrics and family medicine. Some OBGYNs will act as PCPs for their patients. Past that, I can't think of any other specialty that really has any business trying their hand at primary care.

What about dermatologists ? Can / should they do primary care? Or is that unreasonable.

 

[Toohotinvegas33]

Typically when you specialize you do so because you really want to focus on a certain field. Some physicians play both for select patients. for example if a patient has difficult to manage asthma or copd, but is otherwise healthy their pulm doctor may also play PCP. For healthy woman, their OBGYN normally play PCP for them. Oncologist will be a primary doctor while people are on chemo etc...

on the flip side, some specialist don't like starting from scratch and like the problem narrowed down to their field.

 

[SuperSoccer19]

I am a psychiatrist and from the beginning I had a goal to not lose my general medicine background. Didn't work. Due to the system I practice in it is pretty easy for me to communicate and send most patients to their PCM when there is a medical concern, but there have been a few cases where I have done more then what probably should be the scope of a psychiatrist.

For instance, I have a few patients with high blood pressure or cholesterol who refuse to see their PCM and I feel the benefits of my treating this outweigh the risks and I counsel them on this. I also play in a few sports leagues and tend to be the most medically qualified person on the field when there is an injury. I mostly just stabilize and assist until EMTs arrive or transport to the hospital (since the EMTs out here for whatever reason do not like to take people to the hospital). Also, on the inpatient unit I tend to do the initial work up and often then run the case by internal medicine if needed instead of doing a formal consult sometimes.

If doing a combined psych/FP or psych/IM residency was an option for me I probably should have done this in retrospect, but for a lot of reasons it wasnt...which is why now I am looking at the FP forums to see about doing a second residency.

 

[JESSFALLING]

I am a psychiatrist and from the beginning I had a goal to not lose my general medicine background. Didn't work..

What would happen if a psychiatry resident moonlighted at a primary-care clinic throughout their residency....do you think that would be a way for them to keep their medical skills sharp? Or, does the problem mostly stem from not enough rotation time in primary care/medicine? I'm really curious about this topic because I hope to be a small town psychiatrist some day...which might require some general medicine, depending on how rural I decide to go.


Thanks!

 

[MJB]

What would happen if a psychiatry resident moonlighted at a primary-care clinic throughout their residency....do you think that would be a way for them to keep their medical skills sharp? Or, does the problem mostly stem from not enough rotation time in primary care/medicine? I'm really curious about this topic because I hope to be a small town psychiatrist some day...which might require some general medicine, depending on how rural I decide to go.


Thanks!

You would probably be better off doing an FM residency and then a behavioral health emphasis/fellowship if you want to do primary care.

If you wanna do psych, I'd stick to psych.

 

[SuperSoccer19]

What would happen if a psychiatry resident moonlighted at a primary-care clinic throughout their residency....do you think that would be a way for them to keep their medical skills sharp? Or, does the problem mostly stem from not enough rotation time in primary care/medicine? I'm really curious about this topic because I hope to be a small town psychiatrist some day...which might require some general medicine, depending on how rural I decide to go.


Thanks!

I did not have the option of moonlighting and not a lot of say over my job description because I practice in the military. There are psych/FP and psych/IM residencies out there that might offer more of this. The problem I find now is that I have a lot of admin and collateral responsibilities that make staying up to date in both areas very difficult. Perhaps without this added responsibility and if I was really motivated It could be done. I did do a rotation as a resident with a psychiatrist who worker in palliative care and his job was more similar to that of an internist. Also, CL and geriatric fellowships offer more general medicine. One model that is being looked at more and more is incorporating mental health into the primary care setting, but I've mostly seen psych nurse practitioners serve this role.

The job that you describe in a civilian setting could open the door to malpractice. If you are a psychiatrist pretending to be an internist (or vice versa), you are still upheld to the standard of an internist. I've been told that it would look bad if there was a negative outcome or a lawsuit and we all know that these can be complete BS and have nothing to do with poor practice or error.

I have seen providers working for undeserved communities do more general medicine due to access to care issues and very sick patients not being able to navigate the system but I don't know how common that is.

 

[JESSFALLING]

I did not have the option of moonlighting and not a lot of say over my job description because I practice in the military. There are psych/FP and psych/IM residencies out there that might offer more of this.

Thanks for the thoughtful reply SuperSoccer19 (& MJB)...The palliative medicine option sounds interesting, and that would likely be enough medicine to satisfy my interests without opening me up to excessive malpractice risk (good point, btw). I have a long journey ahead, but I appreciate knowing what my future options are.