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From Urgent Care to Primary Care

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Okay, guys. I've done it. I've accepted a new position in a very cool primary care group. I'll probably start a thread elsewhere, later, about why it's so great, but for now here's the thing: I have always worked in EM or Urgent Care. I have gone on and on at length about why the UC has way more in common with the ED than the office of your PCP, and I still believe it.

 

Obviously my skills, knowledge, and can-do attitude were sufficient to get me this new kick-ass position, and I have faith I can be really good at this. But right now, I'm a little intimidated at just how different life will be for me. Rather than saying "hm, yeah, I think it's fine for now but you should talk to your PCP about it," I will have to take responsibility.

 

And so: who here has made a similar transition? And if that's not you, then what would you want to say to someone new to your group, if they had an EM background? What are the big differences in thinking style, or priorities, or approach? Take me to school.

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I can give you some tips on FM, but can't give you advice on the transition.

 

I'm actually trying to make the reverse transition right now.

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Fix one thing per complaint per visit: new or changed rx, specialist or therapy referral, something OTC to try at home.

 

Give your patients homework.

 

Don't give them "yes/no" options, but let them prioritize what they want to work on first: smoking or diabetes control? :-) Some patients you will need to invest in to build community and help them help themselves.  There's a LOT of motivational interviewing.  Even if you don't need to build relationships, the few relationships that you DO make, make everything that much better.  I have one patient who is a medically retired pastor, and pretty much every visit, I pray for him and he for me--even though he has a serious illness, it's a ray of sunshine in my day.

 

Praise your patients as often as you can do it sincerely.

 

Take notes on the non-medical things: kids names, jobs, vacation... if you can look at the chart or EMR for 30 seconds before a visit and ask a relevant question that shows you care about them as a person, you're showing they're not an anonymous revenue source.

 

Don't lose the focus on "worst possibles", but switch towards thinking about "most commons".  Know what OTCs and home remedies you like or hate, because a lot of primary care is using those things judiciously.

 

When someone tells you their deepest, darkest, secret shame, look them in the eye and tell them "you would not believe how many other people are also dealing with that"

 

You will use PT, massage, and psych a lot... so get to know the ones who are good.  Whenever you send a patient to a specialist, ask them how they were treated.  Make sure the notes come back addressed to you if your name is on the referral. Don't refer to jerks or egotists unless you have no choice.  Talk up your specialists "I've got a mile wide and a foot deep set of medical knowledge, but an awesome Rolodex*, so I'd really rather you be seen by someone who's made this their life's work"

 

Every other human being has within them the essence of the Divine, however your particular religious perspective puts that.  Remember that.  They are sometimes bitter and hateful and lying and addicted and smelly and... and none of that changes our sacred calling to care and improve their life.

 

* Look it up, millennials.

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life threats get sent to ER or Urgent Care - don't do them in the office

 

one complaint per visit

 

remember the patient is the one with the disease

 

remember this is a job, not your entire life, you need to go home and live (primary care practices can suck the life right out of you)

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remember this is a job, not your entire life, you need to go home and live (primary care practices can suck the life right out of you)

 

The underlined - much worse if you're one of those that charts when time is spare or at home.

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This group I'm joining never schedules any visits for the last hour of the day. That's charting time, and they don't want anyone having to do it at home.

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This group I'm joining never schedules any visits for the last hour of the day. That's charting time, and they don't want anyone having to do it at home.

Do they pay you extra if it takes more than an hour?

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Do they pay you extra if it takes more than an hour?

 

No, but if it routinely takes longer I'm sure we could talk about why, and if the problem is simply "I need more time," my intuition is that I could stop seeing patients and start charting earlier. Plus they only schedule 20- and 40-minute visits in the first place, so in theory I shouldn't be significantly behind anyway. The hour at the end is for catching what falls through the cracks.

 

Another thing about the new gig is that it's salaried. No RVUs. My current job is straight hourly, which works out well for charting time, but even getting paid to do it (even if it's overtime) I find I'd rather go home at the end of a long day and finish stuff tomorrow. So I'm thinking it shouldn't be such a tough adjustment.

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I just made this switch myself - UC for 4 years, moderate volume and now I'm in internal medicine (same clinic) seeing 14 pts/day.  It's a huge frame-of-mind shift.  I love the medicine and I like that I'm getting the sickest of the sick right now (everyone still thinks of me as a UC provider so I get a lot of same-day fill in stuff and it's always the sickest people cause they're internal medicine patients who are decompensating). 

 

It sounds like your set up is pretty wonderful.  Take full advantage of the longer appts to learn as much as you can about your patients.  I always think of primary care as, "I should know the most about this person medically so that any time a specialist calls or anytime something truly changes I can recognize it."  We strive to be a true medical home for our patients and it can be pretty tough.  Hope you have a good nurse.  My philosophy about my nurse is that anything I don't absolutely have to do, she can do.  It helps a lot. 

 

Keep us posted.

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I am currently switching to UC from Family medicine where I admit and manage my own hospital patient and take 1 in 5 - 24 hour call.  I am switching primarily due to burnout/too much paperwork and to take a position in a region closer to my family.  My best bit of advice would to make sure you have good, efficient EMR.  Otherwise you will spend your life charting.  And I agree with realizing it is a job and not your life.  Definitely define the appointment in the beginning so you stay focused on one issue instead of delving into all areas.  

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life threats get sent to ER or Urgent Care - don't do them in the office

 

one complaint per visit

 

remember the patient is the one with the disease

 

remember this is a job, not your entire life, you need to go home and live (primary care practices can suck the life right out of you)

I am jealous of you if this works at your practice. Most patients look at us like we just sprouted horns when we try to streamline appointments. On the plus side, the RVUs are better when they have several issues.

 

I went from Urgent Care to family medicine about 20 months ago. It is a shock at first; I was used to treating them, and then passing them off to their PCP. Now I am the one getting the turfs. The schedule seemed nice at first--I make the same money, but work 32 hours a week. However, the amount of ancillary work (in-box, phone calls, call, etc.) seems to balance it all out.

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Congrats!

 

I made a similar transition last year and couldn't be happier!

 

I would recommend subscribing to primary care rap! I was a die hard emrap subscriber for the last 8 years. The same folks released primary care rap 2 years ago. It will keep you up to date and help to fill in any knowledge gaps.

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