Would an ER doc be classified as primary care?

[bellringer]

A question on a secondary asked if i was interested in primary care. i'm interested in ER, and i think, at least definition wise, it works.

"a physician/medical doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis."- wiki

maybe not the second part of that definition...thoughts?

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[RySerr21]

i think primary care is used to describe speciailties more like family practice, peds, IM, etc. Could be wrong tho.

 

[johncalvin]

Primary care doctors reduce the chances that a patient has to ever see an ER doctor...

 

[Rendar5]

People try to use us as a substitue for primary care, but we are not and will never be primary care providers.

Now we are front-line and we are generalists in that we have a wide-breadth of medical issues we deal with. But that's another issue.

 

[FutureInternist]

People try to use us as a substitue for primary care, but we are not and will never be primary care providers.

Now we are front-line and we are generalists in that we have a wide-breadth of medical issues we deal with. But that's another issue.

 

[scattun]

Emergency Medicine is definitely not considered a primary care specialty. Internal Medicine, Pediatrics, and Family Medicine are universally accepted as primary care, with most also considering OB/GYN to be in that group.

 

[MossPoh]

Technically, no. In practice many people do use them as such. The ED is not very concerned with managing your hypertension over a long span. They are concerned with stabilizing you after your heart attack.

Many schools kind of put Emergency Medicine in a fuzzy zone. It really doesn't matter much. Schools are realistic and know that most people change their minds.

 

[iduwanna]

It's not secondary or tertiary. You'll never get referred to an ER.

I'm not alone in thinking that it's primary care. In fact, I'm pretty sure that the government's tuition repayment programs for doctors going into primary care also consider EM to be primary.

 

[starfishprime]

It's not secondary or tertiary. You'll never get referred to an ER.

I'm not alone in thinking that it's primary care. In fact, I'm pretty sure that the government's tuition repayment programs for doctors going into primary care also consider EM to be primary.

In my hometown, FPs refer patients to the ER all the time.
"If Jimmy's fever doesn't go down by tomorrow morning, take him to the ER." - example of something a PCP might say via telephone on a Friday or Saturday evening. Of course I don't condone this behavior.

 

[scattun]

It's not secondary or tertiary. You'll never get referred to an ER.

I'm not alone in thinking that it's primary care. In fact, I'm pretty sure that the government's tuition repayment programs for doctors going into primary care also consider EM to be primary.

Yeah, no. From the National Health Service Corps

"
The approved primary care specialties for physicians are

• family medicine,
• obstetrics/gynecology,
• general internal medicine,
• gerontology,
• general pediatrics, or
• general psychiatry."

Gerontology threw me, since I thought it required a fellowship following family medicine or internal medicine and would therefore be a moot point since the doc would qualify anyway, but I digress.

Psychiatry is new to me, glad to see it though.

 

[WhizoMD]

It's not secondary or tertiary. You'll never get referred to an ER.

I'm not alone in thinking that it's primary care. In fact, I'm pretty sure that the government's tuition repayment programs for doctors going into primary care also consider EM to be primary.

It's not the typical point of first contact, since you only go there when your condition has reached a certain point. And, there's no continuity of care in the ER; once the emergency is over you go home or get admitted.

 

[TexasPhysician]

Technically EM is not considered primary care by medical schools.

If EM isn't primary care though, I don't know what is.

 

[FlowLimited]

A question on a secondary asked if i was interested in primary care. i'm interested in ER, and i think, at least definition wise, it works.

"a physician/medical doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis."- wiki

maybe not the second part of that definition...thoughts?

Nope. Your definition is missing one thing: continuity of care.

 

[45408]

Yeah, no. From the National Health Service Corps

"
The approved primary care specialties for physicians are

• family medicine,
• obstetrics/gynecology,
• general internal medicine,
• gerontology,
• general pediatrics, or
• general psychiatry."

Gerontology threw me, since I thought it required a fellowship following family medicine or internal medicine and would therefore be a moot point since the doc would qualify anyway, but I digress.

Psychiatry is new to me, glad to see it though.

You can do geriatrics without a fellowship, but if you want the extra training, you'll do the fellowship. I had a preceptor who was a board-certified IM doc who worked primarily with the elderly. After many years of practice, he decided to take the geriatrics boards. He figured he'd take them, fail them, and then have the motivation to study for them, but he passed on his first try. So now he's double-boarded, without having done a fellowship.

 

[theacks1]

It's not secondary or tertiary. You'll never get referred to an ER.

I'm not alone in thinking that it's primary care. In fact, I'm pretty sure that the government's tuition repayment programs for doctors going into primary care also consider EM to be primary.

You should see some of the dumps our ED gets. In all seriousness, probably about 1/3 of all patients the ED sees are directly referred by their PMD, 1/3 have no PMD and use the ED as such, and 1/3 come in directly, often calling their PMD to let them know they are coming in. It may surprise you, but the Emergency Department is only really concerned with emergent care. If there is no emergent situation, the ED will either release you to follow up with your PMD, or admit you, usually under your PMD's service. In any case, a patient's PMD is almost always involved, and is often the one directing care (except for standard proceedures/time sensitive action, the ER doc will call the PMD and say, we're thinking about doing x,y, and z, do you agree?).

 

[turkeyjerky]

A question on a secondary asked if i was interested in primary care. i'm interested in ER, and i think, at least definition wise, it works.

"a physician/medical doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis."- wiki

maybe not the second part of that definition...thoughts?

No, but you might as well say you're interested in primary care regardless. Nobody's going to hold you to it four years (or 4 weeks) from now. Plus, if you think you're interested in EM now then there's a good chance that you'll like primary care in a few years. Or not.

 

[rocketbooster]

I asked an ER doc while out to dinner if EM is considered primary care. he said absolutely not. he said primary care is family practice, peds, and OB. internists would also be considered primary care, though.

 

[Helen Wheels]

Nope, EM is not a primary care specialty. They might be the first docs to diagnose a new problem but they do not provide continuing care. EM docs treat and stabilize and either admit the patient or send the patient back to a primary care physician.

 

[Bryson17]

It's not secondary or tertiary. You'll never get referred to an ER.

I'm not alone in thinking that it's primary care. In fact, I'm pretty sure that the government's tuition repayment programs for doctors going into primary care also consider EM to be primary.

If something goes wrong during surgery patients go to the ER. Also applies for things like rehab, and recovering from surgery.

You should see some of the dumps our ED gets. In all seriousness, probably about 1/3 of all patients the ED sees are directly referred by their PMD, 1/3 have no PMD and use the ED as such, and 1/3 come in directly, often calling their PMD to let them know they are coming in. It may surprise you, but the Emergency Department is only really concerned with emergent care. If there is no emergent situation, the ED will either release you to follow up with your PMD, or admit you, usually under your PMD's service. In any case, a patient's PMD is almost always involved, and is often the one directing care (except for standard proceedures/time sensitive action, the ER doc will call the PMD and say, we're thinking about doing x,y, and z, do you agree?).

I'd have to second this. I've spent a bunch of time working in the ED this year, and the majority of the patients aren't experiencing an emergency that needs to be dealt with immediately. That being said, I think ER docs have a lot of the skills of a PCP. They just never tell patients "come back here to let us check you again in a month" or anything like that.

 

[iduwanna]

If something goes wrong during surgery patients go to the ER. Also applies for things like rehab, and recovering from surgery.

I've never seen a patient go from surgery to the ER, only the other way around.

 

[Bryson17]

I've never seen a patient go from surgery to the ER, only the other way around.

I was talking to an ER murse today about it. Maybe he was full of ****. But I do know that people get transferred to the ER from other places.

 

[McPoyle]

I was talking to an ER murse today about it. Maybe he was full of ****. But I do know that people get transferred to the ER from other places.

Yes, this definitely happens, albeit not often. I personally have transported such patients, generally going from one level of care to a facility with more specialized capabilites. I must be honest, I never have understood the stopin the ED, I believe this is strictly a hospital policy as the pt. is invariably moved from the ED to ICU/OR very quickly (within minutes, enough time to do a basic assessment).

 

[Captain Fantastic]

I must be honest, I never have understood the stopin the ED, I believe this is strictly a hospital policy as the pt. is invariably moved from the ED to ICU/OR very quickly (within minutes, enough time to do a basic assessment).

Triage. You don't want to send a patient to the floor that needs to go to the unit. Things can change since the outlying doc arranged the admission and when the patient arrives at the hospital. I've seen it happen more than once.

The ED is the place to take a look and make sure the patient is headed to the right place. The ED is stocked with the equipment and an appropriate doc-nurse-patient ratio. The ambulance bay is at the ED so the patient is coming through those doors anyway. It is a smart hospital policy and is good patient-centered care.

 

[45408]

I was talking to an ER murse today about it. Maybe he was full of ****. But I do know that people get transferred to the ER from other places.

If you're at a rinky-dink community hospital, and surgery goes horribly awry, and you want to transfer to a higher-level facility, you *might* stop in the ER at the higher-level facility, but I think hell would freeze over before our surgery teams transferred a patient to the ER.

 

[melanoleuca]

You should see some of the dumps our ED gets. In all seriousness, probably about 1/3 of all patients the ED sees are directly referred by their PMD, 1/3 have no PMD and use the ED as such, and 1/3 come in directly, often calling their PMD to let them know they are coming in. It may surprise you, but the Emergency Department is only really concerned with emergent care. If there is no emergent situation, the ED will either release you to follow up with your PMD, or admit you, usually under your PMD's service. In any case, a patient's PMD is almost always involved, and is often the one directing care (except for standard proceedures/time sensitive action, the ER doc will call the PMD and say, we're thinking about doing x,y, and z, do you agree?).

The other day I had a primary care doctor send a patient in for "abnormal labs;" the abnormalities of consisting of an elevated white count and a slightly low hemaglobin and other findings consistent with iron deficiency anemia in an otherwise stable, alert, and definitely not acutely sick patient.

The patient wanted to be admitted. Her doctor, who I called, told her she would be admitted (but not by him because he deferred his admissions to the hospitalist). I eventually had to call security to get her to leave after we rechecked the lab values and found them unchanged.

This shows you how insane American medicine has become and what a dumping ground the Emergency Department is for everyone and everybody who has any medical problem whatsoever that their regular doctor doesn't have the skill, the time, or the gonads to address...which is why the most common answer when I ask a patient with an extremely minor complaint why they braved the icy night-time winter roads and waited for six hours with the hookers and crack addicts to be seen is, "Because I called my doctor and he told me to go to the Emergency Room."

Emergency Medicine isn't primary care but it does involve a lot of general medicine. I'd say about ten percent of my patients really need to be seen in the Emergency Department for life-threatening and time-critical complaints. Another twenty percent have urgent medical problems that, if not life-threatening, are at least legitimate emergencies and need quick intervention. The rest are bogus or so close to bogus that I weep to think of the money we spend and the money we are going to spend when health care becomes free for everybody.

 

[TexasPhysician]

Nope, EM is not a primary care specialty. They might be the first docs to diagnose a new problem but they do not provide continuing care. EM docs treat and stabilize and either admit the patient or send the patient back to a primary care physician.

If you think there is no continuity of care in EM, you are kidding yourself. Even during my rotation in EM, I've seen the same patients multiple times. Those without insurance have no where to go. While not officially primary care, many EM docs have a primary care role with some of their patients.