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Transition from primary care to specialty care


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I am interested in the experiences of others who may have transitioned from primary care to specialty. I have been in FP/UC/rural health for 27 years. I'm thinking about making a change and most of the available positions are in some sort of specialty. This morning I spoke to someone about a pulmonology position but, interestingly, they couldn't match what I already make because I have no pulmonology experience. They were really interested in me personally but didn't think they could make me a viable offer.

I tried this once before when I went to work part time for a neurologist I knew and, after a few weeks, left. I couldn't figure out what I was doing there because these were all people I would have seen and referred. There I sat on the receiving end of the referral. It just felt strange to me.

So... anyone who has made a similar transition I'm interested in your experience. Thanks in advance.

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I transitioned from primary care to OB/GYN a few years ago. I was hired because they were trying to grow the practice and they were fine with training me while building up my schedule. If I had been replacing someone and needed to hit the ground running it would have been a lot harder. I guess the key is to find a practice where they are willing to invest in you and allow the time you need to train up.

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At one point I went from outpatient HIV care to inpatient oncology.  It was a learning curve exactly like PA school, maybe even harder.   But after six months or so, with the assistance of two incredible oncology nurses (but with some very sketchy attendings) I could at least pull my weight.  I do recall that the first week was like landing in a foreign country with a completely unfamiliar language.  But you have to read and study at least as much as you did in school to stay afloat.  

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I went from ER to outpatient psychiatry.  Was basically shown an office, provided with a psychopharmacology book, and a DSM.  For me it was an easy transition just getting a handle on the medications.  I would though have the exact same experience you did going to neuro and think the learning curve would be tougher for me. 

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In 5 years, I've moved from family med into 80% sleep, 15% occ med, and 5% family.  Nothing in my rotations made me anticipate ending up in either specialty, but both specialties 'cohabit' extensively with Family Med, and so I got enough experience there to start with, and now I've learned to appreciate the disciplines as I've learned them.  It's a bit of a change, but not much, really, in that I'm just now on the other side of writing the consult notes.

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3 hours ago, rev ronin said:

In 5 years, I've moved from family med into 80% sleep, 15% occ med, and 5% family.  Nothing in my rotations made me anticipate ending up in either specialty, but both specialties 'cohabit' extensively with Family Med, and so I got enough experience there to start with, and now I've learned to appreciate the disciplines as I've learned them.  It's a bit of a change, but not much, really, in that I'm just now on the other side of writing the consult notes.

Is sleep medicine hard and/or stressful?  I'm used to reading PSG's and CPAP titrations from working in ENT, but never prescribed PAP therapy.

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I went from family medicine to GI about 3 years ago.  I was so lost in the beginning and really did feel the same way.  I once could just refer out and now patients are looking at me for the answer because I am the specialist.  I have a fantastic SP who helped with through the transition and was willing to train me.  He actually preferred it that way.  So I guess the main thing is make sure there is an SP who is patient and will help you through the transition. 

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21 hours ago, cbrsmurf said:

Is sleep medicine hard and/or stressful?  I'm used to reading PSG's and CPAP titrations from working in ENT, but never prescribed PAP therapy.

I find it very emotionally positive: I see people get better every single day.  Not always, but CPAP is a clearly beneficial therapy.  It takes some art to tease out what's really going on with the patients sometimes, but by and large it's safe, effective, beneficial medicine.  I sleep well each night--not just because I got a CPAP myself, but because it's everything I want in medicine: helping people live better, reasonable work/life balance, autonomy...

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On 10/27/2017 at 0:27 AM, rev ronin said:

I find it very emotionally positive: I see people get better every single day.  Not always, but CPAP is a clearly beneficial therapy.  It takes some art to tease out what's really going on with the patients sometimes, but by and large it's safe, effective, beneficial medicine.  I sleep well each night--not just because I got a CPAP myself, but because it's everything I want in medicine: helping people live better, reasonable work/life balance, autonomy...

Are you reading studies or is it primarily follow ups, titration orders and cpap compliance?

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On 10/25/2017 at 11:33 AM, sas5814 said:

I am interested in the experiences of others who may have transitioned from primary care to specialty. I have been in FP/UC/rural health for 27 years. I'm thinking about making a change and most of the available positions are in some sort of specialty. This morning I spoke to someone about a pulmonology position but, interestingly, they couldn't match what I already make because I have no pulmonology experience. They were really interested in me personally but didn't think they could make me a viable offer.

I tried this once before when I went to work part time for a neurologist I knew and, after a few weeks, left. I couldn't figure out what I was doing there because these were all people I would have seen and referred. There I sat on the receiving end of the referral. It just felt strange to me.

So... anyone who has made a similar transition I'm interested in your experience. Thanks in advance.

Well, when you have been around as long as I have, you have done about everything. I went from Headache Medicine, to Public Health (overseas) to FP/ER to Rheumatology to Urgent Care and back to Headache Medicine. I think the closest parallel to what you are talking about was when I went to  Rheumatology. I studied hard. My SP gave me books. I created index cards with meds and learned them as fast as I can as well as labs which I was not familiar with. So, I was making progress learning the new field. Then three months after I started, my SP attempted suicide (not my fault I promise) and ended up in ICU. She was the only rheumatologist in our practice and only the second one in our small city. The practice asked me to take over her full practice while she was out (for about 2 + months). That was very scary, but I survived. You are a smart guy and I think you can pull it off without any problem if it is something you want.

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10 hours ago, anewconvert said:

Are you reading studies or is it primarily follow ups, titration orders and cpap compliance?

The RPSGTs read and score the studies but neither they nor I can get paid for doing so--just the board certified sleep doc, who does his reads remotely.

 

So yes--all of that, plus new patient intake, education, iron studies for RLS/PLMD, and a few other things.  We've gone from a HST mill to a full-service sleep center in less than a year, and hope to be adding pediatric polysomnography next year...

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On 10/29/2017 at 11:08 PM, rev ronin said:

The RPSGTs read and score the studies but neither they nor I can get paid for doing so--just the board certified sleep doc, who does his reads remotely.

 

So yes--all of that, plus new patient intake, education, iron studies for RLS/PLMD, and a few other things.  We've gone from a HST mill to a full-service sleep center in less than a year, and hope to be adding pediatric polysomnography next year...

That’s great to hear. The sleep lab I used to tech at is doing well but is very concerned that census is about to drop because BCBS is going to pre-auth every in lab study starting in December. 

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2 minutes ago, anewconvert said:

That’s great to hear. The sleep lab I used to tech at is doing well but is very concerned that census is about to drop because BCBS is going to pre-auth every in lab study starting in December. 

We've been getting push back on PSG's rather than HST's for patients with high probability of obstructive sleep apnea, with a history consistent with restless legs and/or periodic limb movements.  From my standpoint, that's not a big deal, because we're still filling our lab capacity, and we can treat people MUCH quicker with an HST.

I haven't actually run the numbers (I try to stay out of it, but after a career at Intel, I can't NOT know these things) but I'm pretty certain that HST's are more profitable than PSG's as well.

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