TWR Posted January 17, 2015 Share Posted January 17, 2015 What do you think is the most difficult specialty to work in and why do you think so? Link to comment Share on other sites More sharing options...
winterallsummer Posted January 17, 2015 Share Posted January 17, 2015 Surgery (trauma, neuro, CV) or ICU in a position w/ a lot of autonomy, as far as having to make a lot of quick life or death decisions. Or solo ED coverage. Link to comment Share on other sites More sharing options...
KMD16 Posted January 17, 2015 Share Posted January 17, 2015 Most difficult in terms of what? Be more specific? Primary care I would say is the most difficult specialty to work in IMHO. And this is coming from s/one who had done IM/FM/hospital med/Orthospine & neurological surgery. Trauma/ICU I would say is challenging not difficult. But w/ better training & mentor ship; it's not that bad. Specialists ID a problem, fix it and move on to the next pt. When the pt crash, medicine folk stabilize and complain about specialist. Link to comment Share on other sites More sharing options...
TWR Posted January 17, 2015 Author Share Posted January 17, 2015 KMD16, You asked a question and then answered it. Primary Care (I agree) Link to comment Share on other sites More sharing options...
KMD16 Posted January 17, 2015 Share Posted January 17, 2015 KMD16, You asked a question and then answered it. Primary Care (I agree) You were too slow for me. Couldn't wait. So, I went ahead and answer the question. Makes sense? Just kidding...lol. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 17, 2015 Moderator Share Posted January 17, 2015 the specialty you hate....for me, occ med would be the hardest as I would want to quit every day.... Link to comment Share on other sites More sharing options...
cbrsmurf Posted January 17, 2015 Share Posted January 17, 2015 mine. whatever specialty I'm working in at the moment. it really helps my ego. Link to comment Share on other sites More sharing options...
cc56 Posted January 18, 2015 Share Posted January 18, 2015 I say an over zealous ortho surgeon. Some surgeons have nothing but the job to keep them warm at night. They like to drag their PA along and operate like 14 hours a day. Some PA's make GREAT money doing it, others get screwed and hate ortho. Link to comment Share on other sites More sharing options...
Joelseff Posted January 18, 2015 Share Posted January 18, 2015 I say internal med. Nothing like working your butt off for pennies. Link to comment Share on other sites More sharing options...
KMD16 Posted January 18, 2015 Share Posted January 18, 2015 ^ Does primary care counts. Working in the inner city serving the less privileged n the medically population. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 18, 2015 Moderator Share Posted January 18, 2015 ^ Does primary care counts. Working in the inner city serving the less privileged n the medically population. you must mean emergency medicine. in the inner city the poor can't get an appt to see a pcp because no one takes medicaid....my full time job is an inner city dept. we see mostly medicaid pts. Some have a pcp but appts are months out to see them so they de facto don't have access... Link to comment Share on other sites More sharing options...
TWR Posted January 18, 2015 Author Share Posted January 18, 2015 I say primary care/family medicine. The amount of knowledge you have to know is staggering particularly if you work in a family practice that takes medicaid and ACA. This is not to say I am smarter than anyone but to recognize, treat and refer take lots of work. I have done this for 29 years and a day doesn't go by that I don't have to refer to a book or an article (my favorite magazine is American Family Physician) great articles and 3-5 cat. 1 CME every 2 weeks. I don't know all the answers, just where to find them! Link to comment Share on other sites More sharing options...
WeBuyAndSellJunk Posted January 18, 2015 Share Posted January 18, 2015 American Family Physician is incredible and is only $100 a year for the online subscription. I really enjoy Family Practice Notebook also. I haven't been doing FP for 29 years, but even in the 1.5 years I have, what I have come to understand is that a good family practice provider doesn't need to know all the information, but just needs to know where to access it. Link to comment Share on other sites More sharing options...
KMD16 Posted January 18, 2015 Share Posted January 18, 2015 you must mean emergency medicine. in the inner city the poor can't get an appt to see a pcp because no one takes medicaid....my full time job is an inner city dept. we see mostly medicaid pts. Some have a pcp but appts are months out to see them so they de facto don't have access... Primary care I meant. PCP still takes Medicaid. Mostly those in the inner city. Some do though are selective and take certain # of Medicaid pt per mo or yr. Those PCP in the suburbs don't accept Medicaid & if you can't afford to pay door will shot at your face. I agreed with you that Medicaid pt seek care in the ED due of lack of access. This folks are send back to PCP after they're discharge knowing that they have no PCP. The quality of care isn't the same. Is like, Medicaid or unsure pt who presents to the ED for sore throat. After 3 hrs wait in the ED. The pt is eyeball and given zpack and discharge home w/ instruction to f/u w/ PCP literally. When they final see PCP guess what the actual dx was? HIV. What? Yes. It was HIV. True story. Link to comment Share on other sites More sharing options...
winterallsummer Posted January 18, 2015 Share Posted January 18, 2015 To above poster - how could you fault the ED for missing that? If it truly presented as sore throat and was first and only visit and no clues in hx eg high risk pt, and new sore throat, I doubt the pt would have received any different type of care at their first FM appt. likewise many PTs are seen by pcp, given a tx then present in ED in awful shape where CT or whatnot makes the proper dx. Longitudinal hx and perhaps some degree of continuity make these dx, that is why. On that note I totally agree FM is more challenging in these cases. FM cannot r/o life threatening condition and turf to someone else to make the dx. FM must make the dx (granted some immediately turf to specialist) or at least get initial work up before referral. But on the other hand if a sick pt presents to pcp (and sometimes not so sick) they easily turf to ED. And also sometimes pcp will turf to ED what they could have handled in their office - eg pt is sent to Ed for "work up" but one is neither needed or done and problem is solved without need of "Ed resources". Anyways not to argue or anything. Just pointing out there are two sides of this coin. Link to comment Share on other sites More sharing options...
jmj11 Posted January 18, 2015 Share Posted January 18, 2015 Working in any environment where the employer doesn't respect our profession is the worst of the worst. I could work in horrible conditions with support and respect from an employer. Link to comment Share on other sites More sharing options...
KMD16 Posted January 18, 2015 Share Posted January 18, 2015 To above poster - how could you fault the ED for missing that? If it truly presented as sore throat and was first and only visit and no clues in hx eg high risk pt, and new sore throat, I doubt the pt would have received any different type of care at their first FM appt. likewise many PTs are seen by pcp, given a tx then present in ED in awful shape where CT or whatnot makes the proper dx. Longitudinal hx and perhaps some degree of continuity make these dx, that is why. On that note I totally agree FM is more challenging in these cases. FM cannot r/o life threatening condition and turf to someone else to make the dx. FM must make the dx (granted some immediately turf to specialist) or at least get initial work up before referral. But on the other hand if a sick pt presents to pcp (and sometimes not so sick) they easily turf to ED. And also sometimes pcp will turf to ED what they could have handled in their office - eg pt is sent to Ed for "work up" but one is neither needed or done and problem is solved without need of "Ed resources". Anyways not to argue or anything. Just pointing out there are two sides of this coin. Very quickly here. Not faulting the ED for missing the dx. I pointed this out to make a case for the complexity of working in IM/FM. I work on both side. Yes. ED r/o life threatening condition. However, if it's not life threatening, pt are sent back to PCP or back to the street. In FM outpt clinic. You get 15min per pt which makes it a difficult specialty IMHO. EM specialty was originally meant for life threatening condition. This has changed. In the ED, you see stuff that are non life threatening. The ED is not meant for URI or sore throat. However, because of lack of access to care, the increasingly lack of PC physician & medicaid low reimbursement rate, folks w/ URI seek care in the ED. Most say that bc going to the ER is convenient, those w/ private insurance also seek care because they can't get in to see their regular doctor. That's why around the country, urgent care had becomes ER alternative and very lucrative. Link to comment Share on other sites More sharing options...
winterallsummer Posted January 18, 2015 Share Posted January 18, 2015 Ah yes. Thanks for the reply. Could not agree with you more. Urgent care clinics would be a practical solution but unfortunately they don't even have to see Medicaid or follow emtala. What we need are "urgent FM" that follows up on these types. Unfortunately not very practical. "Free clinic" wait list in my area is about a month. Link to comment Share on other sites More sharing options...
Joelseff Posted January 19, 2015 Share Posted January 19, 2015 I say internal med. Nothing like working your butt off for pennies.I meant primary care... Must've had one too many Cuba Libre's that day :P Link to comment Share on other sites More sharing options...
jen0508 Posted January 19, 2015 Share Posted January 19, 2015 Nephrology, endocrinology. I hate hormones and electrolytes. I would die of boredom. Primary care is runner up. I can't imagine dealing with diabeetus, HTN, and screening ___ all day. Link to comment Share on other sites More sharing options...
TWR Posted January 19, 2015 Author Share Posted January 19, 2015 jen0508, You are way off the mark as to what family medicine does or is!!!!!!!!!!!! It is anything but boring. I have done FP for 29 years and find it interesting everyday particularly in my setting in Houston. We take all insurances and see the gamut of medical conditions from A-Z. Definitely not boring. IMHO. Link to comment Share on other sites More sharing options...
BruceBanner Posted January 19, 2015 Share Posted January 19, 2015 the specialty you hate....for me, occ med would be the hardest as I would want to quit every day.... ^Cant argue with that. I say an over zealous ortho surgeon. Some surgeons have nothing but the job to keep them warm at night. They like to drag their PA along and operate like 14 hours a day. Some PA's make GREAT money doing it, others get screwed and hate ortho. I would think clinically, ICU or solo ED would be the most challenging for a PA since the volume of knowledge needed is immense and you'd have to make a lot of quick, sometimes critical decisions. Lifestyle-wise, it doesn't get any worse than a hardcore surgery practice. Endless responsibilities, long and unpredictable hours, and a stressful work environment. Link to comment Share on other sites More sharing options...
SocialMedicine Posted January 19, 2015 Share Posted January 19, 2015 Primary care also has low pay and a lot of administrative work. Maybe all specialties have this admin component I am not sure. But PCP get a ton of paperwork, prior auth, nursing forms, patient phone calls. None of this is reimbursed either. Link to comment Share on other sites More sharing options...
Ridiculopathy Posted January 20, 2015 Share Posted January 20, 2015 General IM: 15 mins to address new complaints, preops, physicals, hospital follow ups,all while managing multiple comorbidities and keeping medication/problem/diagnoses lists up to date. Massive adminstrative work without given time to do it. Link to comment Share on other sites More sharing options...
David the Nome Posted January 20, 2015 Share Posted January 20, 2015 General IM: 15 mins to address new complaints, preops, physicals, hospital follow ups,all while managing multiple comorbidities and keeping medication/problem/diagnoses lists up to date. Massive adminstrative work without given time to do it. How can anyone enjoy practicing medicine like this? (honest question, as I've only ever done inpatient). But with those time constraints and multi- system problems of IM it seems impossible to the point I can't believe providers (especially PA/NP) are willing to work this way as opposed to selling out to sub specialty medicine Link to comment Share on other sites More sharing options...
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