winterallsummer Posted June 11, 2014 Share Posted June 11, 2014 What are your thoughts on these two specialties compared to each other? Which is more enjoyable in your opinion? Which is more challenging or a better learning experience? Do you believe UC PAs practice bad medicine? Link to comment Share on other sites More sharing options...
Guest Paula Posted June 14, 2014 Share Posted June 14, 2014 Family Medicine vs Urgent Care? UC PAs do not practice bad medicine. Why do you ask? I practiced UC as a main job for 3 years (and still practice UC in a FM position) and believe me one must have a good handle of medicine to do a good job. It is not about the snotty noses and earaches that come in to the UC...it is all about the impending disasters. There are plenty of them. I found UC challenging but learned alot from starting in UC at an EM department and had fairly good MD mentors. FM is my other specialty. At times it can be rather routine, except when it's not, then it is very challenging. FM is a good training ground for UC and to learn what is normal and not normal. Both have been enjoyable for me in my 10 year career. I may be fortunate in my position as I work up complicated conditions and these patients are not automatically turned over to the MD. I do a full complete workup and then let the MD know what I'm thinking and doing and why. He usually 98% of the time agrees with me and will occasionally ask if I've thought of x, y, or z. I think he likes it I do the work-up and follow through. Less for him to do! Plus I learn and have expanded differential thinking by working in this manner. I would get bored if all I did was H&Ps all day or routine medication refills and tweaking of medications. That is not my cup of tea. Link to comment Share on other sites More sharing options...
winterallsummer Posted June 14, 2014 Author Share Posted June 14, 2014 The reason I ask is because I had a job offer for both and wanted to know which is a better experience and learning opportunity. Link to comment Share on other sites More sharing options...
winterallsummer Posted June 15, 2014 Author Share Posted June 15, 2014 Your last comment is that how you feel about fm ? Link to comment Share on other sites More sharing options...
Guest Paula Posted June 15, 2014 Share Posted June 15, 2014 I like FM. I have autonomy and a good practice that is challenging, possibly because of the FQHC status and the population. It is a good mix of patient ages and conditions and I am developing my own patient panel. If I was not able to have such a wide practice and saw only follow ups from the MD I would be bored to death. I need a challenge and I do not know how other FM clinics utilize their PAs. Link to comment Share on other sites More sharing options...
winterallsummer Posted June 15, 2014 Author Share Posted June 15, 2014 This one is in a pretty underserved area and is privately owned (so called doc in a box) with XR, labs and US at the office. They do walk ins (5-8/d) and scheduled appts. They said they also do a "decent" (open to interpretation) amount of procedures including suturing and I&D. I would see the same type pts as the doc and practice autonomoly once I'm able to (new grad) and would also develop my own pt panel. Thoughts? Would this or UC be a better learning experience in your opinion? Thanks a bunch for your replies, very helpful! Link to comment Share on other sites More sharing options...
Guest Paula Posted June 15, 2014 Share Posted June 15, 2014 A FM job with a mixture of both same day and scheduled patients sounds like a good learning op. And maybe not so fast paced that it gives you time to learn and discuss with the doc. How many patients a day will you be expected to see? Ultimately you will have to make the best decision that works for you. Link to comment Share on other sites More sharing options...
winterallsummer Posted June 15, 2014 Author Share Posted June 15, 2014 20-30 and the doc loves to teach and it includes a training period of 3 mos. thoughts? Link to comment Share on other sites More sharing options...
Guest Paula Posted June 15, 2014 Share Posted June 15, 2014 20 to 30 is a lot for a new grad even with 3 month training period. In my opinion training and learning never end. I see about 13 to 15 max and am beat by the end of the day. It's more than just seeing patients. It's call backs, addressing labs, consulting with others, that takes time. Is there an effective Ehr system? We go live tomorrow with our second try so hope it goes well. Link to comment Share on other sites More sharing options...
winterallsummer Posted June 15, 2014 Author Share Posted June 15, 2014 Yeah I would work my way up to that volume. I would love to know out of those 13-15 how many are med refills or well visits ?how often do you see a "good dx" like a malignancy or autoimmune do etc? They are switching to a new EMR before my arrival. Link to comment Share on other sites More sharing options...
Guest Paula Posted June 16, 2014 Share Posted June 16, 2014 My schedule is no more than 2 well visits (well child, sports physical, well adult exam) a day as they take 45 minutes. A "good dx" comes more often than I expect but the population delays their care for so long I seem to see one or two "train wrecks" a week. I have had several new onset diabetics, RA, "real Community acquired pneumonia" (not "bronchitis" where many of our patients expect abx for their colds), influenza, failure to thrive babies, several cancer cases, DVT, broken bones, A fib cases, undiagnosed severe hypothyroidism, hyperthyroidism, domestic violence cases, skin biopsies and I&D's, elder abuse cases, COPD exacerbations, suicide ideation, and diabetic nephropathy in a noncompliant patient who rapidly declined within a 6 month period. Medication refills are done now through our nurse triage to prevent a patient from coming in for a med refill when all they really had to do was read the bottle and see they still had 3 left and call the pharmacist. I have been at this current job for 2 1/2 years full time. Our clinic director has changed how we manage the provider schedules so I have a certain number of appointment slots open each day where a patient can call for same day appointment, plus 2 well visits a day, plus walk-in overflow. The MD has 1-2 well visits a day and the rest of his schedule in doing same-day or walk-in visits. He is no longer taking new patients so all new patients are put on my schedule. The clinic director is wanting me to expand my practice and I'm all for it. The NP retired end of May and that position is not going to be replaced for a while. I am happy to be busy as with both of us we were not busy enough. And the doc only did scheduled appointments then and wasn't extremely busy either. So far it is working out. Let me know which job you decide to accept. The first 3 years after PA graduation is a steep learning curve. Link to comment Share on other sites More sharing options...
winterallsummer Posted June 16, 2014 Author Share Posted June 16, 2014 That sounds great. Would you say that is representative of your typical underserved fm practice? I am leaning heavily towards fm but have to make sure they qualify for the loan forgiveness program (supposed to find that out this coming week). Link to comment Share on other sites More sharing options...
Guest Paula Posted June 16, 2014 Share Posted June 16, 2014 I've worked on two reservations in FP and one UC in a rural underserved area plus have done locums EM.....all in Critical Access Hospitals. I would say it is typical and representative in my area (MI and WI) but can't really speak for any other states. Link to comment Share on other sites More sharing options...
Febrifuge Posted June 17, 2014 Share Posted June 17, 2014 Wait, are you a new grad? Go where the mentoring is. Don't try to solo an Urgent Care, because you will very quickly learn why it's dangerous to look down on it. Link to comment Share on other sites More sharing options...
winterallsummer Posted June 20, 2014 Author Share Posted June 20, 2014 Both promised teaching. Neither is solo. Both said there will be a little solo coverage once I am comfortable, that is same for UC or FM, and both said that won't occur until I feel I am ready. The mentoring appears to be stronger at FM. UC would see and tx more pts. The salary difference is quite significant (UC better) and UC qualifies for loan repayment through public service but is in a less desirable town to live in for me. Shifts are also better at UC as are benefits. Link to comment Share on other sites More sharing options...
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