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Considering switch from specialty to Family Med


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I went to PA school with an interest in family medicine, prehospital prior experience. When I graduate in 2017 the offer I got was for Uro locally and a few primary care gigs at a nearby city. 

I took the Uro gig due to location and decent offer for pay/benefits. The group is great as a whole but I’m not exactly passionate about the specialty and have constantly looked into primary care jobs since I took. That fact alone makes me think I should switch.

Any recommendations regarding the transition to a primary care field from specialty practice? 

Thanks

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Everyone in family med has some specialty, some little bit of extra knowledge in a few areas--we aren't all cookie cutters.  Your Uro knowledge will be very valuable.

At the same time, we all need to know not just the big, board things, but the bread-and-butter stuff.  Yes, DM, HTN, HLP management... but rashes, well exams, UTIs/BV, URIs/Strep/Flu/whatever, and all the little stuff they don't really spend much time on in didactic year.  You'll want to know what OTCs you like and why.  Oh, learn to manage constipation, too.

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I agree to seriously think very hard about this  before you make the switch.  Primary care in the US is a holy mess, particularly if you are employed by a hospital and/ or corporation. Call centers managing your schedule - not you. Pressure to schedule more and more patients per day- and then overbook on top of that.  15 or 20 minute slots to deal with acute exacerbation of increasingly complex medical issues . Endless documentation , lab and imaging follow ups.  The EHR work never ends 

Not trying to scare you away, just want you to go into this with your eyes wide open. 

Now- if you are lucky enough to have hooked up with an independent doc who runs his own show, maybe that'd be ok, but those jobs are few and far between. 

 

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  • 4 weeks later...

Don't let them. Much of what they say it true but a lot of it depends on the practice. I have been in primary care in one form or another for 30 years. Some days its a suck fest. Some days are really good.

There aren't enough of us in primary care. We have, like the physicians, followed the money into specialty care. If you want to do primary care....go do it. If it were possible I'd work for a private practice again but they have gone the way of the do-do.

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I would love primary care, except for two facets, one of which is derived from the other: first, medicine becoming a retail, "customer service" field.  It's not.

And second, the general decline? Or lack- of self responsibility- and I'm not talking about weight loss or even following my advice.  I'm talking about this: don't come to me when a basic understanding of science or biology would have answered your question.  Don't come to me with the expectation that it is my job to keep you healthy.  It's not.  It's my job to give you the tools so you can keep yourself healthy.  If you can buy cigarettes, you can understand lung cancer and it's treatment.  

I'm not talking about knowing individual receptors, but knowing the difference between viruses and bacteria ...

 

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easy to tell rather you will sink or swim in PC

 

length of visits is everything (just about)

 

new patients - one hour in the book (45min for young simple)

follow up - mostly 30min

 

only the most basic simple nothing type complaint gets a 20min visit

 

NEVER NEVER NEVER over booked or double booked or dove tailed or any other polite way to tell you they are going have you see more patients in a day

 

Total daily patients 12-16 MAX  that is is and less if highly comorbid or new provider

 

 

 

As well YOU control your schedule, no some remote bean counter

as well YOU have an MA dedicated to you at all times

You get a lunch that NEVER gets taken - or you are paid right on through you lunch (most will work right through lunch so this idea of getting 30min unpaid for lunch is just a way to take money away from you)

CME $2500 min

Time off CME one week

Salary - at least 90k - if you look at the amount you make *not billed but collected* most new grads will be in the 180-200k range so you are covering you own overhead

 

Oh yeah and mostly a 4 day work week is considered full time - it is just the way it is.....

 

I love PCP  but I hate insurance companies - I now work for the state in a highly respected small jail and love the medicine - and I get to pretty much always mostly control my practice.....

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