winterallsummer Posted February 13, 2014 Share Posted February 13, 2014 What are your thoughts on entering a specialty right off the bat? For those who did so, were you able to enter IM or FM later in life? Did you feel you "lost" your skill set? Any regrets? Anyone recommend it? As always, thanks for the input! Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted February 13, 2014 Share Posted February 13, 2014 Worked ok for me, yes I was, nope, nope, it just depends on what you prefer to do. I always like the specialty areas because I could focus on only one area, well, except for EM, but the trade-off there was when I left I was GONE. Link to comment Share on other sites More sharing options...
Moderator ventana Posted February 14, 2014 Moderator Share Posted February 14, 2014 generally a very bad idea PA school has to be 'burned in' and you need to learn medicine have to decide rather you want surgery or medicine beyond that first jobs are where you truly learn the field of medicine Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 14, 2014 Moderator Share Posted February 14, 2014 Agree with V above. also very hard to leave a specialty after a few years if you know nothing else. a few of my former students took urology and endocrinology jobs out of school a few yrs ago with plans to enter em when jobs were available. now when jobs are around no one will hire them because they don't know peds/gyn/procedures/etc. they are effectively stuck there for life unless they want to do a residency or start at VERY entry level positions along with new grads... Link to comment Share on other sites More sharing options...
wjm7 Posted February 14, 2014 Share Posted February 14, 2014 Out of curiosity, what about emergency medicine? It seems you would develop a lot of typical FM/IM skills in EM because of the amount of non-emergency patients you end up treating. Genuinely curious, and any input would be appreciated. Context: Current student thinking ahead and wondering whether I should go family practice or specialty out of the gate. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted February 14, 2014 Moderator Share Posted February 14, 2014 Out of curiosity, what about emergency medicine? It seems you would develop a lot of typical FM/IM skills in EM because of the amount of non-emergency patients you end up treating. Genuinely curious, and any input would be appreciated. Context: Current student thinking ahead and wondering whether I should go family practice or specialty out of the gate. ER would certainly keep you at least abreast of all areas of medicine, but the problem is that the thinking is different. The goal in the ED is to only do testing necessary to determine your pt doesn't have an emergency. Yes, we end up treating a lot of minor stuff in the ED, but there are many situations where we refer people back to their PCP, or put them in touch with a PCP and re-educate on the utilization of the ER for primary care. For example, whereas in family practice you need to know when each class of anti-hypertensives is used and when to adjust and when to discontinue, in the ED we don't follow them for their blood pressure- we screen them for any evidence of end-organ damage, and if there is none and they are asymptomatic, they are referred to their PCP for management. Same with diabetes and anti-lipid meds- a lot of the fine nuances of management you learn during PA school and it's part of the core of good primary care, but in the ED there are other concerns. I have never worked primary care, and if I ended up going into that down the road I know I'd have to do a bit of re-education. But it wouldn't be as much as someone coming from a place like urology or OB/GYN as EMED alluded to above Link to comment Share on other sites More sharing options...
wjm7 Posted February 14, 2014 Share Posted February 14, 2014 Thanks for your response. Kind of what I was thinking. I appreciate the clarification. Link to comment Share on other sites More sharing options...
Soulfari Posted February 14, 2014 Share Posted February 14, 2014 Does this same mentality apply to Dermatology? Specifically Mohs surgery. If my 'boss' (MD), from whom I got all of my HCE as a MedAsst/Tech, offered me a job as Mohs Surgical PA - would that pigeon hole me into the specialty and hinder any chances to move to say EM/Cardio Thoracic Sx/ or other specialties? At this point my passion doesn't seem to be in FP, and I would really like to go down the surgical route. But something tells me that taking a Mohs Derm job straight out of school would be closing a lot of potential doors in other surgical specialties and definitely Internal Medicine. He really likes to romanticize the Mohs/Derm PA job, but something tells me his primary motivation lays in the interest of his own practice, and not my life-long career as a PA. Link to comment Share on other sites More sharing options...
winterallsummer Posted February 14, 2014 Author Share Posted February 14, 2014 What about specialty fields such as hem/onc that may involve more medicine then say derm or urology? Or what about critical care? Link to comment Share on other sites More sharing options...
bradtPA Posted February 14, 2014 Share Posted February 14, 2014 Does this same mentality apply to Dermatology? Specifically Mohs surgery. If my 'boss' (MD), from whom I got all of my HCE as a MedAsst/Tech, offered me a job as Mohs Surgical PA - would that pigeon hole me into the specialty and hinder any chances to move to say EM/Cardio Thoracic Sx/ or other specialties? At this point my passion doesn't seem to be in FP, and I would really like to go down the surgical route. But something tells me that taking a Mohs Derm job straight out of school would be closing a lot of potential doors in other surgical specialties and definitely Internal Medicine. He really likes to romanticize the Mohs/Derm PA job, but something tells me his primary motivation lays in the interest of his own practice, and not my life-long career as a PA. In my opinion, yes. You will know one thing very well, and that's how to remove skin cancers , and have no exposure to reading x-rays, interpreting EKGs, and treating illnesses. It will be hard to convince a FP to hire you, especially when he/she can't pay you derm PA wages.... Link to comment Share on other sites More sharing options...
Bubo101 Posted February 14, 2014 Share Posted February 14, 2014 So is FP the best field you can start in to learn or would something like IM or critical care be better? What would be the absolute best setting to learn? On the flip side if you decide that you want to go into a specialty later would it be looked down upon to have been so long since those clinical rotations with no exposure in-between? Link to comment Share on other sites More sharing options...
bradtPA Posted February 14, 2014 Share Posted February 14, 2014 So is FP the best field you can start in to learn or would something like IM or critical care be better? What would be the absolute best setting to learn? IMHO it's an FP practice that admits and rounds on its own patients. You will get a bit of everything other than surgery that way.... Link to comment Share on other sites More sharing options...
winterallsummer Posted February 14, 2014 Author Share Posted February 14, 2014 What about hem/onc? There is a decent amount of exposure to XR, CT, ECG etc reading in this field and also treating some acute problems. Any insight would be appreciated as I near my graduation date! Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 14, 2014 Moderator Share Posted February 14, 2014 So is FP the best field you can start in to learn or would something like IM or critical care be better? What would be the absolute best setting to learn? depends what your long term goal is..... Link to comment Share on other sites More sharing options...
treejay Posted February 14, 2014 Share Posted February 14, 2014 how about first job: IM primary care vs urgent care ? Longer term goals: EM, hospitalist, primary care, urgent care . I'm thinking urgent care might be the better choice. It seems to sorta split the difference. IM outpatient might be better for hospitalist role? Link to comment Share on other sites More sharing options...
cbrsmurf Posted February 14, 2014 Share Posted February 14, 2014 What about hem/onc? There is a decent amount of exposure to XR, CT, ECG etc reading in this field and also treating some acute problems. Any insight would be appreciated as I near my graduation date! As someone who started in FP and currently works in outpt heme/onc, not really. You likely will not read ECGs or interpret imaging (although I haven't done much imaging interpretation in FP, either). Heme/onc is more about managing side effects of medications/chemo, monitoring/surveillance, and hematology stuff. You really miss out on ortho (you'll see a good amount in FP), preventative care, cardiovascular disease, respiratory disease, etc. Not a good place to start out, in my opinion, if you want to try other fields. Link to comment Share on other sites More sharing options...
cbrsmurf Posted February 14, 2014 Share Posted February 14, 2014 how about first job: IM primary care vs urgent care ? Longer term goals: EM, hospitalist, primary care, urgent care . I'm thinking urgent care might be the better choice. It seems to sorta split the difference. IM outpatient might be better for hospitalist role? internal medicine is broader. it will give you a better understanding of medicine than urgent care as a first job. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 14, 2014 Moderator Share Posted February 14, 2014 internal medicine is broader. it will give you a better understanding of medicine than urgent care as a first job. however with a long term goal of em UC might be a better choice. IM does not see kids or ob issues which are frequent issues in em. IM would certainly be better for critical care/hospitalist but is not as broad as UC for EM. fewer procedures, etc. Link to comment Share on other sites More sharing options...
cbrsmurf Posted February 14, 2014 Share Posted February 14, 2014 however with a long term goal of em UC might be a better choice. IM does not see kids or ob issues which are frequent issues in em. IM would certainly be better for critical care/hospitalist but is not as broad as UC for EM. fewer procedures, etc. I agree Link to comment Share on other sites More sharing options...
jmj11 Posted February 15, 2014 Share Posted February 15, 2014 Out of school - 4 years in headache, followed by 3 years in Third World "healthcare", after seven years out of the mainstream, jumped back into primary care. Had 3 rough months, studied each night like I had a final the next day, was back in the saddle by the forth month. Not ideal but not a crisis either. It doesn't ruin your career. Link to comment Share on other sites More sharing options...
bradtPA Posted February 15, 2014 Share Posted February 15, 2014 Out of school - 4 years in headache, followed by 3 years in Third World "healthcare", after seven years out of the mainstream, jumped back into primary care. Had 3 rough months, studied each night like I had a final the next day, was back in the saddle by the forth month. Not ideal but not a crisis either. It doesn't ruin your career. I have lots of friends that never did primary care and are doing fine. They do seem to have a tougher time with PANRE, however...... Link to comment Share on other sites More sharing options...
UGoLong Posted February 15, 2014 Share Posted February 15, 2014 I think I might have another angle on this. I practice mostly on the IM side of cardiology and have taken the PANRE (not a huge deal after a review class). Our practice is a mix of inpatients and outpatients, the latter including some people who don't have a PCP so we have to handle some noncardiac issues. I also casually take care of medical concerns for about half of our 20 staff. So it's a varied life. For most of the time, I'm not at the same site as my SP. So, I'm in a specialty, but in a setting that has forced me to be flexible and respond to a variety of situations. At one point, I was looking around to do something new and found no problem being offered hospitalist jobs. I think that some specialties may be more portable than others and that making sure that you have a varied experience in your first job (either varied disease states or varied clinical situations) is a good thing. I suspect that, having chosen medicine over surgery, I'd have a hard time revisiting that decision. Also, if I did something completely different, I might have to take a step back in pay. That's true for lots of nonmedical career decisions as well, including mine to leave my old career to become a PA. I'm happy where I am at this point, but I accept the fact that sometimes you have to go backwards to go forwards. My Dad was a well-paid aircraft mechanic who took a cut in pay to go into an administrative job that he felt had more long term promise. In the end, it was a financial plus and, decades later, he worked in Launch Control for the Apollo 11 mission to the moon. The point is that we all make decisions about what to do next and we can't always anticipate where things will take us. If we always expect things to move forward for us in a straight line, then we may be artificially restricting our choices. Do what you want to do, try to keep learning, and look for breadth of experience along the way. Link to comment Share on other sites More sharing options...
wjm7 Posted February 15, 2014 Share Posted February 15, 2014 I always enjoy hearing you chime in, UGoLong. And that's really cool about your dad working in launch control for Apollo 11! Link to comment Share on other sites More sharing options...
kang1208 Posted February 19, 2014 Share Posted February 19, 2014 Interesting thread. I am a new grad myself and 3 weeks into my first job as a hospitalist PA, I must say the vast amount of information I am not at all familiar with was real. At times, I wonder if I made the right decision thinking that hospitalist PA will give me the strong medicine foundation I needed if I ever want to specialize (I am still pondering). One thing I am concerned though; my diagnosis ability may suffer just because a lot of these folks are already admitted with a diagnosis and there'll be less of an opportunity to form differential dx and perform work-up, not to mention no exposure to peds/obgyn issues. Any recommendations if I want to ultimately transition into EM? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 19, 2014 Moderator Share Posted February 19, 2014 Any recommendations if I want to ultimately transition into EM? consider an em residency.... Link to comment Share on other sites More sharing options...
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