EM to Primary care switch?

[JED617]

Hey everyone,

I've been in the ED for almost two years, and completing a fellowship in EM as well. While I did learn a TON, the hours are absolutely everywhere (we are staffed in 7 different hospitals all with different shifts). I work a ton of weekends/nights/holidays and often get little time to switch from days to nights. The pay is pretty good (for this area anyway, I have colleagues making a lot more in the same field), but lifestyle-wise it's all over the place. I want to be able to have a more structured schedule and spend time with my SO and enjoy nights/weekends. That being said, I have interviewed a few primary care facilities. The pay would be lower, but I can negotiate a 4 day work week. Has anyone made the switch from EM to FM? I feel like I'd miss the rush of the ED, but would also to follow my patients and get them better rather than slapping a bandaid on their acute on chronic issues. Any advice is welcome!

Thank you!

[GetMeOuttaThisMess]

I did years ago when one of my ED docs, boarded in FM, left to open an office.  It lasted three months before reality set in and he saw that it wasn't busy enough for the two of us.  I lasted 10 years in EM before the scheduling and patients took me out.  I couldn't do the 6p-3a shifts due to my brain combusting after 12pm.

This is the one argument that I see for putting the time and money into a residency.  While the knowledge, training, and experience are never taken from you, will it pay for itself in the years to come in PC?  Only time will tell.  FM is it's own disaster I have come to realize which is why I was led into employee health prior to retirement.

[PAinPenna]

I recommend looking into a specialty. You can still have cushy hours without all the extra BS that's forced onto PCP's these days

[MediMike]

I think FP has its own pitfalls, as many people can attest to here, with working late, taking work home with you, following up on labs on days off etc...Are there options for you at a different facility? Somewhere with a better schedule? Seems pretty unfortunate to spend that 12-18mos postgrad and then not be able to utilize the knowledge and skills. Certainly seems like the tide flows in the other direction FP>ED

Good luck though!

[MediMike]

5 minutes ago, PAinPenna said:

I recommend looking into a specialty. You can still have cushy hours without all the extra BS that's forced onto PCP's these days

Yeah I've been working in an ICU nocturnist role for a while now, 10 shifts/mo... scrambling to find something to get me out of the house before my spouse murders me

[Joelseff]

Primary care used to be great... Not since it became a business and with the govt imposing metrics my work Tripled. I got out of primary care last year and into an IM subspecialty. A lot less busywork. The one thing I need to get used to is the narrow scope. I mean I see pts day to day for about the same 5 medical conditions. Can be boring at times. But there are other sides to the specialty that keep me interested... I would not want to go back to bread and butter internal medicine. After 8 years I'm done with it.

 

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[dfw6er]

You'll be fine if you want to jump ship to Primary Care.  Your ER background will help you with what many primary care PAs don't have a good feel for:  knowing sick/not sick.

As for the hours.....I get it.  But I'd warn you....I did primary care for 12 years.  Frequent night and weekend call really sucks and makes it hard to go to the movies or any place with questionable phone reception.  I also found the ever-increasing paperwork....FMLA, prior authorizations, recertifications, health maintenance exam paperwork, etc to be mind-numbing.

Good luck to you in whatever you choose.

[thinkertdm]

Personally, two aspects to primary care that I hate:

1. As noted above, the commercialization of medicine.  No room for “clinical decision making” because everything is an algorithm, either from the corporate overlords or insurance companies.

2.  The patients themselves and unrealistic expectations.  Instant satisfaction.  Make Me young again.  I had a fellow telling me how he used to be able to run and play football but he’s soooo tired now...except he’s 78 now, and ain’t nuthin gonna bring back those days.  And constant requests for testosterone testing from 29 year olds.  ADHD.  And pain....and sleeping issues.  And constant arguing over statins.

 

[Joelseff]

Personally, two aspects to primary care that I hate:
1. As noted above, the commercialization of medicine.  No room for “clinical decision making” because everything is an algorithm, either from the corporate overlords or insurance companies.
2.  The patients themselves and unrealistic expectations.  Instant satisfaction.  Make Me young again.  I had a fellow telling me how he used to be able to run and play football but he’s soooo tired now...except he’s 78 now, and ain’t nuthin gonna bring back those days.  And constant requests for testosterone testing from 29 year olds.  ADHD.  And pain....and sleeping issues.  And constant arguing over statins.
 

Uggghhh... Gave me chills... Happy I got out [emoji23]

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[JED617]

1 hour ago, PAinPenna said:

I recommend looking into a specialty. You can still have cushy hours without all the extra BS that's forced onto PCP's these days

I have looked at specialties (i have a love for plastics), but this area is so terribly saturated and I can't move (SO has a very stable awesome job and we bought a house).  I am trying to dig around a little more, but I fear the ER will consume me if I don't find something else haha

[JED617]

14 minutes ago, thinkertdm said:

Personally, two aspects to primary care that I hate:

1. As noted above, the commercialization of medicine.  No room for “clinical decision making” because everything is an algorithm, either from the corporate overlords or insurance companies.

2.  The patients themselves and unrealistic expectations.  Instant satisfaction.  Make Me young again.  I had a fellow telling me how he used to be able to run and play football but he’s soooo tired now...except he’s 78 now, and ain’t nuthin gonna bring back those days.  And constant requests for testosterone testing from 29 year olds.  ADHD.  And pain....and sleeping issues.  And constant arguing over statins.

 

I am all about unrealistic expectations in the ED haha! But I understand what you're saying. I don't feel as though I'm using my brain enough in the ED either. As you mentioned, it can be very algorithmic at times and a lot of it is just ordering tons of tests instead of using clinical judgement because we have to somehow see tons of patients in a short amount of time, so it's easier. andddd there is a lot of CYA 

[thinkertdm]

Just now, JED617 said:

I am all about unrealistic expectations in the ED haha! But I understand what you're saying. I don't feel as though I'm using my brain enough in the ED either. As you mentioned, it can be very algorithmic at times and a lot of it is just ordering tons of tests instead of using clinical judgement because we have to somehow see tons of patients in a short amount of time, so it's easier. andddd there is a lot of CYA 

In the ED you get young faster.  I sent a guy there yesterday, in fact.  I was hoping they would focus on the ginormous 6 cm bcc growing out of this guys chest, but they instead called cardiology for the st elevations he was showing on his ekg.  True story!  Guy got two stents an hour after getting there.

a bit of excitement .  I still need to focus on calling derm to get him in.  And he just came in for a yearly physical and was having a “phlegm” sensation in his chest, did an ekg because his lungs sounded clear (and to fill time while I talked with my rn about the derm consult). 
im sure that perked him up a bit.