Urgent Care Owner An IM trained/BC

[KMD16]

An internist is one who has completed either a three years of adult (18y and above) medicine residency training and should have no business treating pediatric pt or supervising PA in an Urgentcare if the PA will be treating pediatric patients. Correct me if I'm wrong? The legal implications are too many to tract. Particularly, treating peds, if the SP is IM trained. A good friend in NY is in this circumstance!

[Acebecker]

In theory, yes. The PA may be in hot water for that. But the IM doc basically gets to do whatever. That said, IM docs do train in general medicine during clinicals. They have as much FP time in as we do as students. So theoretically they are capable. But not board certified.

[EMEDPA]

internists also have no ob training so have no business working er or urgent care at all.

no ob

no peds

no trauma.

first thing I did when I was involved in the leadership of the er at my last job was to fire all the moonlighting IM residents and replace them with em pa's at half the price who saw twice as many pts/hr with better quality of work.

they were paying IM residents 65/hr ten years ago to see avg 1 pt/hr who they discussed with an em pa or em md.

[ToppDog]

So, if mandatory residencies become the norm, what would you recommend for someone who's goal is to do primary & urgent care, including OB/Gyn, Peds, & minor trauma? I'm assuming Family Practice covers all but the trauma.

[EMEDPA]

So, if mandatory residencies become the norm, what would you recommend for someone who's goal is to do primary & urgent care, including OB/Gyn, Peds, & minor trauma? I'm assuming Family Practice covers all but the trauma.

honestly I think only specialties will be required to do postgrad training initially. primary care is doable right out of school and will likely remain so for a long time.

[rcdavis]

honestly I think only specialties will be required to do postgrad training initially. primary care is doable right out of school and will likely remain so for a long time.

 

I have come around to your side on this e, but we cannot have it both ways.. Exempting "primary care" from residency is difficult...

 

The slippery slope starts with asking what the OP. is in fact asking... A general medical education and internship used to but no longer qualifies a generalist to provide OB, pediatric, surgical, evaluation or care... And requires more in depth residency training. ( she also was pointing out several states' admonitions that the PA not perform or due any medical acts which his preceptor has no training to oversee).

 

This is exactly how the family practice specialty was born in the 70s.... And general medical practice was wrestled from the old GP...

 

The GP ( who did deliveries, herniorraphys, appendectomies, fracture setting, managed MIs, etc) with his one year PGY1 internship was declared not well enough trained to continue performing at that level.

 

The GP who saw 50-70 folks/day plus rounds went away, and the FP was born.. Who saw half as any and with much less range.

 

Create specialty pathways and requirements for PAs, and we will eventually follow the path of the GP.

[ventana]

how about a 1 yr post grad fellowship offered after 5 years of primary care (IM) for independent practice......

 

;-)

[EMEDPA]

I have come around to your side on this e, but we cannot have it both ways.. .

don't get me wrong, eventually I think all PAs will have to do a postgrad yr but right now the big push for "more education for PAs" is coming from the md specialty societies like acep so that is why I think it will happen there first.

[KMD16]

It's scary to have an internist supervise PA in an urgent care setting. A friend is in this situation and I'm trying to talk him out of accepting the position. As PAs, our scope of practice mirror that of our respective SP.

[EMEDPA]

. As PAs, our scope of practice mirror that of our respective SP.

or in this situation exceed that of our sp's...

[Guest Paula]

It's scary to have an internist supervise PA in an urgent care setting. A friend is in this situation and I'm trying to talk him out of accepting the position. As PAs, our scope of practice mirror that of our respective SP.

 

This is the exact reason I had to leave my FP position back in 2008 when the tribal council did not renew the FP doc's contract and replaced him with an IM/BC internist. They had no idea what they were doing and I got caught in a web. IM doc says he would be able to be the SP and would cover me for peds, gyn, ob, women's health, no problem and the council bought the hook. Then to me in private tells me he won't see peds, women with any female complaints, provide family planning consults, see any babies. I knew my time was coming to an end when he reminded me of that over and over. So i left as I would be the one who was in violation of state laws and they hired a FP NP, the IM doc was only part-time so he didn't care. This was one of the defining moments when I realized PAs are screwed without full practice authority and our jobs dependent on a physician. It's bad for rural health and bad for medicine bad for PAs.

[cupojava]

An internist is one who has completed either a three years of adult (18y and above) medicine residency training and should have no business treating pediatric pt or supervising PA in an Urgentcare if the PA will be treating pediatric patients. Correct me if I'm wrong? The legal implications are too many to tract. Particularly, treating peds, if the SP is IM trained. A good friend in NY is in this circumstance!

Is the SP board certified in Urgent Care Medicine?

[ToppDog]

Is the SP board certified in Urgent Care Medicine?

 

I didn't know there was such a thing. I know there is for emergency medicine, but I hadn't heard of one for urgent care specifically. My experience working in urgent care was that the physicians were either family practice, IM, or ER docs.

[cupojava]

I didn't know there was such a thing. I know there is for emergency medicine, but I hadn't heard of one for urgent care specifically. My experience working in urgent care was that the physicians were either family practice, IM, or ER docs.

Here's the link: http://aaucm.org/Professionals/BoardCertifications/Certification/default.aspx

[EMEDPA]

urgent care can be done as a fellowship after fp. most folks just take the exam to become certified if they so desire(there is a practice pathway)..

[ToppDog]

Thank you both :)

[KMD16]

Is the SP board certified in Urgent Care Medicine?

 

The Urgentcare Ctr is AAUCM recognize Ctr. The owner is IM by training. I'm not sure if the SP is BC in UC medicine.

 

I think I would prefer an SP who's BC by training in FM or EM as an SP in an urgentcare practice and not an SP who is BC in UC medicine via certificate exam administer by the AAUCM.

 

A similar certification pathway exist for dermatology. I've seen instances where family med, internist and OB/ trained doc sit for certificate exam for minor dermatological procedures like Botox injection and running spa Ctr thus breaking into dermatologist market. This doc are not BC dermatologist by training.

 

A PA in Urgentcare been supervise by an IM doc. What would happen if the PA is sued and the case involves a pediatric patient?

 

I can certainly assure you that the training of the SP would be examine in determining if the PA was practicing within the scope of practice of the SP or state applicable law that govern PA practice. The mere fact that the SP became BC in UC med through a certificate exam administered by the AAUCM I think will be irrelevant in the court of law.

[jdumoch]

At the UC I work in, there is a mix of ER doc's, FP docs, and 2 IM docs. One refuses to see anyone under 18 (per diem) and the PA becomes the pediatrician. They are accredited by the AAUCM and by the Joint Commission (0.34% of UC clinics are actually JC accredited). I think FP IM and ER docs are fine as long as there is decent experience throughout the spectrum. I just pray that I never get sued for a pedi case when that per diem doc is working who refuses to see anyone under 18.

[Gordon, PA-C]

At the UC I work in, there is a mix of ER doc's, FP docs, and 2 IM docs. One refuses to see anyone under 18 (per diem) and the PA becomes the pediatrician. They are accredited by the AAUCM and by the Joint Commission (0.34% of UC clinics are actually JC accredited). I think FP IM and ER docs are fine as long as there is decent experience throughout the spectrum. I just pray that I never get sued for a pedi case when that per diem doc is working who refuses to see anyone under 18.

 

Uh oh, careful here. We wouldnt want anybody to get the wrong idea and think that PAs were passing themselves off as pediatricians! :rolleyes:

[cupojava]

I think I would prefer an SP who's BC by training in FM or EM as an SP in an urgentcare practice and not an SP who is BC in UC medicine via certificate exam administer by the AAUCM.

 

I actually agree with you but if the SP is UC-board certified, wouldn't it mean that AAUCM has taken into consideration that physician's training prior to conferring certification, no? Afterall, board certification means that the physician has shown expertise in that specialty. Also, AAUCM will consider training in all specialties to be board certified (including OB/GYN/peds/ER/FP/IM). Not trying to be a smart aleck; I am merely trying to get more clarification-devil's advocate if you will.

Now if the SP is UC-board certified, then he/she should only be doing things related to urgent care e.g no well child exams since this would be more of FP/Peds arena. The clinical tasks should only be limited to urgent care needs.

 

A similar certification pathway exist for dermatology. I've seen instances where family med, internist and OB/ trained doc sit for certificate exam for minor dermatological procedures like Botox injection and running spa Ctr thus breaking into dermatologist market. This doc are not BC dermatologist by training.

Also happens with FPs who do laser vein surgeries but they are allowed legally to do those procedures even though they are not surgeons. Yes, they are certified to do which means they have demonstrated they are capable of doing the procedure.

 

A PA in Urgentcare been supervise by an IM doc. What would happen if the PA is sued and the case involves a pediatric patient?

I can certainly assure you that the training of the SP would be examine in determining if the PA was practicing within the scope of practice of the SP or state applicable law that govern PA practice. The mere fact that the SP became BC in UC med through a certificate exam administered by the AAUCM I think will be irrelevant in the court of law.

Of course the training of the SP will be called into question--no doubt about that. I have to disagree though that UC-certification would be irrelevant. I think it would be very relevant. If a doc is UC and IM board certified, it would make for a better argument in court. One only has to prove one is competent. Maybe....

[KMD16]

 

Of course the training of the SP will be called into question--no doubt about that. I have to disagree though that UC-certification would be irrelevant. I think it would be very relevant. If a doc is UC and IM board certified, it would make for a better argument in court. One only has to prove one is competent. Maybe....

 

The UC certification is relevant to the internist to some degree but irrelevant protecting the PA if the PA were to be sued and the case involves a pediatric patient. Hope this clear things up.

 

What define the scope of practice of a supervising physician? From a legal standpoint, the scope of practice of a supervising physician are solely base on their residency training and board certification by that specialty; not a post-residency certification outside their specialty of training.

[Gordon, PA-C]

The UC certification is relevant to the internist to some degree but irrelevant protecting the PA if the PA were to be sued and the case involves a pediatric patient. Hope this clear things up.

 

What define the scope of practice of a supervising physician? From a legal standpoint, the scope of practice of a supervising physician are solely base on their residency training and board certification by that specialty; not a post-residency certification outside their specialty of training.

 

 

State laws give wide lattitude for doctors to do whatever they want, regardless of what residency they completed or what board certifications they have. The only true restrictions are at the hospital credentialing level and the medical malpractice barriers.

 

For example, it is perfectly legal for a family practice MD to do brain surgery. Now, would any hospital be willing to credential them for it? No, but it is still technically legal.