What are the most common outpatient procedures family docs perform?

[KeikoTanaka]

Title says it all. Obviously, if someone went on and did a sports medicine or sleep medicine fellowship, that would bring this up considerably, but assume you're just a generalist FM doc, what procedures are most common? What are things you see that aren't surgical but you choose to refer out to just due to lack of comfort doing it? Conversely, do you not feel comfortable doing it just because you're rusty, or because it truly is outside your scope of practice? I ask this second question because, if you chose to do CMEs or what not and had some way of practicing those procedures, would you obviously then perform more of them?

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[LeroyJenkinsMD]

All the minor skin stuff, gynecology procedures like colposcopy, LEEP. Injections. Vasectomies if you got the training. Circumcisions.

 

[KeikoTanaka]

All the minor skin stuff, gynecology procedures like colposcopy, LEEP. Injections. Vasectomies if you got the training. Circumcisions.

What are the most common injections you do?
And other than cryo, what other minor skin stuff is there?

 

[VA Hopeful Dr]

What are the most common injections you do?
And other than cryo, what other minor skin stuff is there?

Vast majority of FPs don't do colpos, LEEP, circs, or vasectomies.

For most of us, joint injections, skin cryo, skin biopsies/excisions are 99% of our procedures.

 

[DrMeowMeow]

Cryotherapy, cutting skin tags off with scissors, steroid injections in knees/shoulders, shave/punch skin biopsies, a million pap smears. Less common are IUDs, nexplanon, colposcopies. I probably will not end up doing the latter 3 as an attending

 

[AMEHigh]

It really depends on your interest and where you end up practicing. I think that’s the beauty of FM.
Without going in to too much identifying info, clinic I was visiting recently during procedure clinic had a wide variety on the schedule. Colpo, skin biopsies, bartholin cyst removal, I&D, IUD placement & removal, nexplanon placement & removal, warts, joint injections.

It all depends what you’re comfortable with. I love gyn procedures and have done extra training in that, so that’s going to carry over to my career, whereas I’m not as interested in msk. So I’ll do the basics, but will likely refer out more msk than gyn.

 

[LeroyJenkinsMD]

What are the most common injections you do?
And other than cryo, what other minor skin stuff is there?

Knees, bursa, shoulders. Shaves, punches, cyst removal, laceration repair.

 

[PlutoBoy]

Title says it all. Obviously, if someone went on and did a sports medicine or sleep medicine fellowship, that would bring this up considerably, but assume you're just a generalist FM doc, what procedures are most common? What are things you see that aren't surgical but you choose to refer out to just due to lack of comfort doing it? Conversely, do you not feel comfortable doing it just because you're rusty, or because it truly is outside your scope of practice? I ask this second question because, if you chose to do CMEs or what not and had some way of practicing those procedures, would you obviously then perform more of them?

I’m an internal medicine doctor but I focus on outpatient care:

1) Joint injections and arthrocentesis
2) Skin biopsies, removal of benign and malignant skin lesions, cryotherapy
3) Incision and debridement of abscesses
4) Removal of epidermoid cysts
5) Partial and complete removal of nail plates (ingrown toenails)

That’s probably 95%. That’s what I could think about within one minute.

 

[deleted87716]

1) Joint injections and arthrocentesis
2) Skin biopsies, removal of benign and malignant skin lesions, cryotherapy
3) Incision and debridement of abscesses
4) Removal of epidermoid cysts
5) Partial and complete removal of nail plates (ingrown toenails)

Same here. Plus, the occasional laceration repair.

 

[Freezeout]

I’ve been in the real world for 4 months now and so far what I’m doing is:

1) Joint injections (small-large but did a fellowship in PCSM)
2) Tendon sheath injections (trigger fingers and DeQuervain’s)
3) Excisional biopsy
4) Skin tag removal
5) Cryo
6) OMT
7) I and Ds

I’m hoping to do more of 1 and 2 in the future but am working on building an MSK practice up.

 

[deleted87716]

Less common are IUDs, nexplanon, colposcopies. I probably will not end up doing the latter 3 as an attending

My two partners (both female) do IUDs (Mirena). None of us do colposcopy. Not enough volume to justify the hardware investment.

Years ago, I did flex sigs, but stopped doing them for the same reason.

 

[SLC]

I’ve been at it for 5 months, so far my procedure list includes:

IUD, Nexplanon, Excisional Biopsy, Shave Biopsy, lac repair, joint injection, tendon sheath Injection, circumcision, anoscopy, wound debridement, cryotherapy. There are probably a few others too that I’m forgetting.

I’ve also done umbilical lines, intubation, vent management, chest tubes in the hospital setting.

 

[KeikoTanaka]

I’ve been at it for 5 months, so far my procedure list includes:

IUD, Nexplanon, Excisional Biopsy, Shave Biopsy, lac repair, joint injection, tendon sheath Injection, circumcision, anoscopy, wound debridement, cryotherapy. There are probably a few others too that I’m forgetting.

I’ve also done umbilical lines, intubation, vent management, chest tubes in the hospital setting.

This looks like a pretty cool list of procedures. How often do you go to the hospital setting to do these things? Are you taking shifts there or just covering patients of yours who are admitted?

 

[KeikoTanaka]

Also, just random question for all you doing the excisional biopsies, isn't that like the bread and butter of derm? So realistically do you get paid the same amount as a Derm who would do these as well? Or are the reimbursements lower

 

[SLC]

Reimbursement (for me) is tied to wRVU’s mainly. So no, I don’t get paid the same as Derm. But only because Derm is generally paid more per wRVU than I am.

The procedure generates the same wRVU, but a dermatologist might get $5-10 more per RVU than me.

Doesn’t mean I’m not going to do it though.

 

[SLC]

This looks like a pretty cool list of procedures. How often do you go to the hospital setting to do these things? Are you taking shifts there or just covering patients of yours who are admitted?

I voluntarily take hospitalist call 2-3 weekends per month on average. I cover all adults and Peds (except for newborns born to the FM attendings).

 

[KeikoTanaka]

I voluntarily take hospitalist call 2-3 weekends per month on average. I cover all adults and Peds (except for newborns born to the FM attendings).

Thank you for your responses. I really like how you have this variety in your practice. Obviously as you get older and may want to start a family, will you drop the hospitalist call on the weekends? Or is it not tolling enough that you feel the need to drop it / do you have a partner who is stay-at-home?

 

[teacherman84]

I agree with the common ones above. Joint injections, minor derm and contraception are prob most common, but get trained with as much as possible, some is lucrative and some is just fun.
I teach at a residency so I have a bit more variety than a strict outpatient practice...plus I did a sports fellowship.
I do contraception/womens health stuff like IUD, Nexplanon, vasectomy, vaginal deliveries and repair and first assist on c-section...plus circumcisions, Umbikical lines and NRP.
Derm stuff:Excisional Biopsy, Shave Biopsy, lac repair, cryo.
Lots of MSK/sports stuff: joint and tendon sheath Injections (landmark and US guided), diagnostic MSK US, casting/splinting, compartment pressure testing, treadmill stress testing.
I do acupuncture and OMT.
Were a small hospital but will do the occasional intubation, vent management, A-line, central line, paracentesis, thoracentesis. I'm starting Point of care
US and learning DVT, AAA, RUQ, lung scans and hoping to start limited ECHO stuff soon too.

 

[SLC]

Thank you for your responses. I really like how you have this variety in your practice. Obviously as you get older and may want to start a family, will you drop the hospitalist call on the weekends? Or is it not tolling enough that you feel the need to drop it / do you have a partner who is stay-at-home?

I already have a family, did before I started Med school. I don’t find the hospital work too taxing, it’s still far better than residency was. My partner stays home with the kids too, which certainly helps.

 

[Marcus Brody]

I think the answer to this is so dependent on multiple things that it becomes almost meaningless. Doesn't make any difference what is most common, it is relatively easy in FM to choose what types of things you want to do and not do. You are not obligated or restricted based on the numbers. If "Procedure X and Y" are most common it means very little to you as an individual.