Primary Care?

[deborah212]

Anyone transition out of inpatient/emergency medicine into primary care? I've been asked to join a new primary care practice by one of my former attendings, and it sounds enticing for many reasons... A normal work-week, patient continuity, and perhaps most importantly, less personal stress from patients who are very sick.

 

My favorite rotation in PA school was inpatient medicine. Primary care was "ok." Now, though, that I've been doing hospitalist medicine for a while as an actual PA, I feel burned out. Of course, primary care has its own issues with dealing with chronic patients, not having immediate access to laboratory and imaging data, and more paperwork.

 

Just looking for some opinions as I try to make this decision.

[ventana]

sounds great - I have tried many different fields and primary care is the one for me - great for people that love to

Dx new things - never know what is coming in

also think you influence the patient the most as you have long term f/u and you decide where they go - you send to a surgeon then get surgery answer or send to physiatry you get a different answer - and if you are stumped you just refer...

 

would not want to do anything else

 

 

if it is a new practice then should also ask for productivity pay - typical is shoot for 45% of collections but settle for anything that gets you up over 100k per year with a 4 day work week

be VERY careful on call - it needs to be compensated

[deborah212]

Thanks, Ventana, for the advice.

 

I don't think I'll have much room for negotiation since it is a practice affiliated with the hospital I currently work for (ie. standard PA compensation), but I'll keep that in mind. The nice thing about this practice is that it's a "medical home model" where pharmacists, nutritionists, RN, LPNs, and care coordinators are integrated into the practice.

 

What concerns is me is changing fields, even though of anything, it should be easier to go from hospitalist medicine-->primary care than another specialty. In the hospital, my patients are always seen within 24 hrs by an MD. In this primary care model, my patient may never see the MD. Of course, I'm afraid of missing something; though there should be less urgency than what I'm currently doing.

[ventana]

I don't think I'll have much room for negotiation since it is a practice affiliated with the hospital I currently work for (ie. standard PA compensation), but I'll keep that in mind. The nice thing about this practice is that it's a "medical home model" where pharmacists, nutritionists, RN, LPNs, and care coordinators are integrated into the practice.

 

.

 

wrong - the ONLY time you have leverage is before you hire on - learn from everyone else's mistake - don't think you will change their minds after you are there. If they want you and are willing to pay you fairly then it might be a great long term fit - if they only want cheap labor you will outgrow it and move on....

 

don't worry on the transition. You have to know what looks bad and when to work them up but remember most you out patient patients are fairly healthy. Also DOCTORS that see 20-30 patients a day miss stuff all the time. Last week alone I stopped the premarin on a lady that had a stroke a month ago who saw her PCP two weeks earlier and told a lady on OBCP at age 37 that smoked that no matter what her BP was (the OB/GYN sent her back to PCP for HTN before refilling OBCP) she should not be on hormone therapy.

 

If you go fast you miss stuff - rather you are a nurse, MD, DO, PA, NP - if you slow down and think and talk to the patient you are more then educated to provide great care - there are whole clinics and towns with out a doc but instead a PA and the people are very well cared for.

 

If you don't know ask

 

Read and do CME

 

never lie to the patient or make something up - research it

 

I think you will love it - in the primary care world PA's function 100% of the time as an MD/DO - there is NOTHING my SP does that I do not do - however there are things I do that my SP does not (sutures, I&D and the like.....)

 

oh yeah and you will miss things too - it just a part of medicine but you should be missing the true zerba's, not the routine that you were just to lazy to ask about.....

[HopefulPA]

Ventana is right you have the most power to negiotiate at the time of hire. However if benefits (health/dental etc..) are provided by a large organization then the plans are what the plans are an dno room for negiotation. So if there is a CME policy that pays 1500 a year for everyone doubtful you can get something different. But you can negiotiate pay, hours, call time, work schedule, pt load caps, a rasie in salary to X if producitivity is Y by 6 months. Just be creative.

 

If this practice is part of the same system, any chance they will let you try it out for a week or two before making a final decision? You are already credentialed right? This way you get a flavor of what it will be like. You may hate it, may love it you don't really know. Good Luck