Wish1pa Posted August 31, 2018 Share Posted August 31, 2018 I’m considering a job in an adult internal medicine office. I’m currently in UC. Some of the docs I work with used to be PCPs and are constantly bashing primary care and making me discouraged as I Always thought I would end up doing it one day. I might get a job offer at what seems like a decent practice with nice docs and supposedly nice, compliant patients. I just wanted to hear from people who do IM/primary and love it. I have also interviewed with a Peds practice which I’ve done before but I think adult IM would be more interesting too. Thoughts? Link to comment Share on other sites More sharing options...
Joelseff Posted August 31, 2018 Share Posted August 31, 2018 I work in Primary care... While "love" is a very strong word... I wouldn't say I "hate" Primary care. I don't always enjoy it. It can be tedious and you are the gatekeeper for EVERYTHING! I "love" the medicine part, hate (with a great passion) the admin part. And actually there seems to be more admin than medicine. Sometimes you get to see some interesting stuff but bread and butter PC is often boring and there is plenty of scut. Plenty! Not just for PAs but Docs do their share of scut as well but they get paid 2-3x more than us. Sent from my SAMSUNG-SM-G891A using Tapatalk Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted August 31, 2018 Moderator Share Posted August 31, 2018 Agreed. When I worked in primary care, I really liked the medicine part. I was every kind of specialist. It really teaches how much evidence out there is "expert opinion." Hated the admin part. Paper work for frigging days. Link to comment Share on other sites More sharing options...
mgriffiths Posted August 31, 2018 Share Posted August 31, 2018 I'll repeat what has been said, but a bit differently...I love the medicine, I dislike the admin/paperwork, I HATE with a passion the controlled substances (see my thread from yesterday). Honestly, after writing that post I am looking for something outside of family medicine - or at least something that doesn't require me to be a specialist in pain management. If I could just end my practice as it pertains to chronic narcotics and benzodiazepines my job satisfaction would increase exponentially. Link to comment Share on other sites More sharing options...
ravenspac Posted August 31, 2018 Share Posted August 31, 2018 Fiance hates it...likes the medicine, but the hospital system that came in to run it. big call centers just throw patients on, dont screen properly, paperwork is insane Link to comment Share on other sites More sharing options...
Joelseff Posted August 31, 2018 Share Posted August 31, 2018 Fiance hates it...likes the medicine, but the hospital system that came in to run it. big call centers just throw patients on, dont screen properly, paperwork is insaneI've had to send pts to the ER after they've been thrown on my schedule in this fashion. One pt with left sided weakness n&v, another elderly pt who fell with an orbital bruise and poor mentation and another one who called saying she had a HA dizziness and BP of 210/108. This just last week. Our call center sucks. We have a policy that any "flag words" (which we have a list of) is supposed to get triage by an RN but our Call Center folks are not medical assistants and usually have zero medical training. They know me as one who would, within reason, see almost anyone same day and some of my colleagues are quick to dismiss pts to ED so if it's a pt of a provider I am covering or a pt on my panel, they just put it on my schedule. I have had multiple conversations with admin (who is also non medical) about this and so have the other providers but it still happens. I suggested they reprimand the call center worker but nothing really happens to them and the beat goes on... SighSent from my SAMSUNG-SM-G891A using Tapatalk Link to comment Share on other sites More sharing options...
Joelseff Posted August 31, 2018 Share Posted August 31, 2018 I'll repeat what has been said, but a bit differently...I love the medicine, I dislike the admin/paperwork, I HATE with a passion the controlled substances (see my thread from yesterday). Honestly, after writing that post I am looking for something outside of family medicine - or at least something that doesn't require me to be a specialist in pain management. If I could just end my practice as it pertains to chronic narcotics and benzodiazepines my job satisfaction would increase exponentially.I've been looking for other specialties the past few months nothing seems to pan out. I always find something in that job/specialty that would still irk the hell out of me so I have stayed in PC. I'm always on the lookout though. Sent from my SAMSUNG-SM-G891A using Tapatalk Link to comment Share on other sites More sharing options...
BruceBanner Posted August 31, 2018 Share Posted August 31, 2018 Link to comment Share on other sites More sharing options...
mgriffiths Posted August 31, 2018 Share Posted August 31, 2018 41 minutes ago, Joelseff said: I've been looking for other specialties the past few months nothing seems to pan out. I always find something in that job/specialty that would still irk the hell out of me so I have stayed in PC. I'm always on the lookout though. Absolutely - the grass is not always greener... Link to comment Share on other sites More sharing options...
Joelseff Posted August 31, 2018 Share Posted August 31, 2018 Absolutely - the grass is not always greener...It may or may not be. just gotta keep looking for the right lawn Sent from my SAMSUNG-SM-G891A using Tapatalk Link to comment Share on other sites More sharing options...
PAMEDIC Posted August 31, 2018 Share Posted August 31, 2018 I love my current PC job. I honestly don't think I will ever find a better job. I work in a rural clinic where I see nothing but patients on our state's medicaid program. So we only accept one specific type of insurance. This makes things a lot easier because as long as I know the rules for what is covered and how to get a PA, it is all pretty quick and smooth. I know which specialists take our patients and just funnel them through the system. Frankly, many of these patients are extremely complex with all sorts of medical and social complications. It can sometimes be a bit overwhelming, but as my SP says, "How do you eat an elephant? One bite at a time." Just prioritize their problems and address them in a triaged manner. Since the patients are on medicaid and there is no out of pocket expense, it is pretty easy to get them to come back in frequently for follow ups. I get 1 hour for new patients and 30 minutes for routines and follow up. I try to schedule 12 patients a day, but honestly... there are lots of no shows and last minute rescheduling. On a normal day, I see around 8. Link to comment Share on other sites More sharing options...
sas5814 Posted August 31, 2018 Share Posted August 31, 2018 I was in PC for many years and, like others, I wouldn't say I loved it but I like it for the most part. I was always in a small private owned practice. The thing I dislike about "medicine" these days is the corporatization. Bean counters and administrators who don't have much understanding of what actually happens at the point of service. Absurd rules and regulations. Patient satisfaction surveys and Press-Ganey scores. I'm currently in UC mostly because I'm slowing down in prep for semi-retirement in 6 years or so and mostly because it isn't hard for the most part. Boring? Yea some days but things happen from time to time that make me feel like I'm still in the game. Our UC centers are co-located with the FP and IM clinics. They close at 5. We close at 8. It is a rare day I leave when one of them aren't still at their desk doing paperwork or answering messages. Pass...... Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted August 31, 2018 Share Posted August 31, 2018 As one gets older I think our thought process changes from which specialty do I like best to which patient population and specialty can I tolerate the best? Link to comment Share on other sites More sharing options...
sas5814 Posted August 31, 2018 Share Posted August 31, 2018 LOL! When my wife and I say goodbye in the morning (she is a RN at a psych hospital) instead of "have a good day" we say "I hope your day doesn't suck!". Link to comment Share on other sites More sharing options...
IMGtoPA Posted August 31, 2018 Share Posted August 31, 2018 The administration part of the job is the worst, by far. It contributes to the burnout. There's so much shit that they don't even educate you about in school that is the annoying part of primary care. It's almost like you have to be a social worker. Gotta learn how to refer to a Social Worker if the patient has financial difficulties getting meds, setting up referrals for Durable Medical Equipment if they need a specialized wheelchair or motorized wheelchair, filling out the forms properly to get these things approved by insurance, filling out forms for handicap permits. Then there's the annoying part such as if your practice cranks out controlled substances. Towards the end of my tenure in primary care, my practice was starting to crack down on controlled substances and would require Urine Testing, but doing the pee test on top of seeing the patient would often run past the allotted 15 min time slot, so you are constantly running behind and patients are getting pissed off about waiting. I loved learning general medicine while I practiced, but primary care is the dumping ground for all kinds of sketchy characters; this is unavoidable and I don't know many PA's that stay in primary care for long, especially since we can move to different specialties. Link to comment Share on other sites More sharing options...
Joelseff Posted September 1, 2018 Share Posted September 1, 2018 Ok need to share a "Win" today! My very last pt after a typically hellish Primary Care Friday Before a long weekend (last minute need for narco refill, "emergency" paperwork, or emergency [name your condition here] before I fly out of vacation tomorrow crap) was an old pt of mine who I have been treating for a few years for metabolic syndrome issues morbid obesity DM etc. When I first met him he was over 480lbs and DM was uncontrolled etc. Today he lost over 120 lbs, A1c is now 6.5 and his Lipids are well controlled! No weight loss meds no bariatric sx! I remember telling him to start logging his food, gave him guidelines for hypocaloric intake and carb maintenance and he's been doing that ever since!an what a way to start my 3 day weekend!These are the things I Love about PC. Not as exciting I'm sure form our EM colleagues but boy does it make you feel like you helped make a difference..Ok now back to my scutwork so I can leave here at a decent hour and avoid labor day traffic.Later palzSent from my SAMSUNG-SM-G891A using Tapatalk Link to comment Share on other sites More sharing options...
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