How important is your 1st job?

[winterallsummer]

Hello.  Quick question.  If someone wants to work in patient or ED but starts of in FM, will this hinder them?  Or vice versa for that matter?  Is it better to have a good job in a specialty you don't particularly enjoy vs a job with less learning potential in the field you ultimately want?

[EMEDPA]

your first job is very important. primary care is fine , as it is the basis for everything. think of your first 2-3 years in practice as a residency. after a few years in primary care you can easily transition to urgent care, and from there into EM or a hospitalist position.

[ventana]

^^^^^

 

2nd that

[rcdavis]

How important? Very.

 

Think of your first job as the time you take to solidify the mush and muck of data you have been swimming it.. You need to use the data and watch its application in real patient scenarios so that you actually come to trust it, and yourself, as it gels into a solid wall of experience.

 

This becomes your fundamental base core, onto which everything else is built.

 

This job is so important, I would recommend a 30,000 dollar a year pay cut sacrifice to get an opportunity to work anywhere where they will teach you and give you extra training.

 

The lost bucks will easily be replaced later.

 

Cannot express this jobs importance.

[EMEDPA]

How important? Very.

 

This becomes your fundamental base core, onto which everything else is built.

 

This job is so important, I would recommend a 30,000 dollar a year pay cut sacrifice to get an opportunity to work anywhere where they will teach you and give you extra training.

 

The lost bucks will easily be replaced later.

 

Cannot express this jobs importance.

the underlined can mean a formal residency (which I HIGHLY recommend) or a great job with a good teacher(S) and reasonable expectations for productivity, given new grad status.

I totally lucked out at my first job. My SP was director of the residency at the same facility and he told me day 1 he would assume I was an intern and treat me as such. my 2nd yr there I was teaching the new md interns. my third year there I was teaching the 2nd yr md residents.

[rcdavis]

Ha! E- that is exactly what I was thinking of!

[winterallsummer]

Thanks for all the replies. More directly if you were to take a first job in FM would you "lose out" if you wanted ultimately to work in patient? Would you forget the skills you learned dealing with sick pts through clinical years? This may be a dumb question but I really appreciate all replies.

[EMEDPA]

Thanks for all the replies. More directly if you were to take a first job in FM would you "lose out" if you wanted ultimately to work in patient? Would you forget the skills you learned dealing with sick pts through clinical years? This may be a dumb question but I really appreciate all replies.

nope, primary care is the foundation of reverything. you need to understand what folks do outside the hospital before you can understand what goes on in the hospital.

[rcdavis]

Nope. In patient medicine is like riding a bike. Once you have learned the fine art of chart combing and data collection, and once you have brought yourself up to speed on national, regional and institutional regimens for the various infections you will see, pneumonia, bacteremia, sepsis, etc, and once you've learned what resources your institution has to help you ( discharge planning, social work, placement assistance, etc), it is all gravely, one week on the job and it will all comeback to you.

 

What family medicine or internal medicine will give you, that inpatient medicine will not, is perspective.

 

And a more thorough understanding of pathophysiology

 

If you apply yourself diligently to those clinics for 3 years, study, study and study some more, the subsequent 10 years will be easier and infinitely more enjoyable.

 

You will know enough to begin a career in the ED, needing only to expand your clinical interventional skills and to understand the peculiar ED priority and disposition mindset... .

[GetMeOuttaThisMess]

If you paid attention during your training, and can check information sites from Medscape to the journals for review articles or latest/greatest recommendations, you should be fine.  I specialized out of school in a surgical setting, went to cardiology, tried two health related business ventures for a year without direct care exposure, played in emergency medicine, and then spent eight plus of the last nine years in public health.  I've been in a self-induced hiatus since last March ('13).  I would argue that none of those settings would be consistent with "primary care" as we tend to think of it yet I have no reservations in picking back up my stethoscope in a month or so when I join the VA in a primary care, in-hospital setting.  It's like anything else, if you pay attention to the basics and understand normal, then you can appreciate abnormal.  Once you're able to recognize abnormal then you should have enough core knowledge to know where to look to get an answer, if you don't know it already.  Now, does this mean that one doesn't forget things?  Nah, but the basic signs/symptoms of any illness should be enough that with our degree of training we should have a pretty good idea with regard to what direction to at least look.  Frankly, you guys are one of the reasons why I hang out here during the days so as to keep my mind somewhat focused on medicine as opposed to how many baby daddies an individual has on any number of daytime talk shows.

 

What scares the crap out of me is having had the opportunity over the past year to observe others deliver care and to wonder where the heck their mind is at, and I'm not talking rocket science here.

[winterallsummer]

Can anyone please share their opinion on UC vs FM for 1st job?  I also have had some UC places very interested and they pay quite a bit more but I'm wondering which is a better learning opportunity.

[Febrifuge]

I am exclusively an Urgent Care provider, and have been for almost 4 years now. My first job was.... not great, and a little traumatic, but I'm glad I didn't start with the UC.

 

I consider the old saw about "you don't know what you don't know" to be a personal bugbear, and it grinds my gears when it's applied uncritically, but in the case of a shiny brand-new PA, fresh out of school, even I might be tempted to drag it out.

 

Even with my solid 3 years of ER Tech experience before school, and my trial by fire as a hospitalist, I was incredibly nervous with the UC for my first six months, because I was (and am) the only clinician on site. I probably sent more people to the ER for additional evaluation in that first six months than I did in all of the last year. And for good reason; they had seen an Urgent Care provider who wasn't sufficiently sure they didn't have something serious.

 

If you have an experienced PA or an MD there at your elbow, and conditions are such you can ask any question at almost any time, it might be fine. The variety is a little better than most people think, as is the opportunity for quality diagnostic thinking. It's rare you'll need to whip out some obscure "House, MD" type diagnosis, and frankly no one cares if you're brilliant, but people who think Urgent Care is nothing but sinusitis and UTIs must have way more compliant patients than I tend to see. That person who hasn't had a checkup in 7 years who decides today is the day to stroll in and become your problem is part of the gig, too.

 

So, my opinion would be that FM is a better first job, but UC is a surprisingly cool second job. At least it was for me.

[EMEDPA]

 

"That person who hasn't had a checkup in 7 years who decides today is the day to stroll in and become your problem is part of the gig, too."

 

 

This is especially true since the implementation of ACA with many folks getting coverage for the first time in a long time and no PCPs taking that coverage.