going from specialty back to primary care?

[jdenning]

So the family practice clinic 5 minutes from my house is advertising for a PA. Tempting. Ad says full or part time, so that works too. I'm a mom with 3 kids. I have joked at my current job that I might have to quit at some point so I can drive my kids around because I don't know how other parents do it with after school sports and activities. I'm pretty comfortable at current job - things have evened out since I last posted about trying to leave gracefully - and I'm doing a more varied practice and I'm getting paid more etc. It's a 40 min commute each way and I have days that the commute is ok and others that I just cringe. I'm ok with it for the most part and I enjoy neurology. The question I'm asking myself is would I want to do family practice? I've been in my specialty area for almost 6 years and have only moonlighted in primary care. I'm not sure I ever want to do another pelvic exam and I don't know my bugs and drugs well enough to actually do it on a daily basis. I knew enough to pass the PANRE but that's different. Haven't done any procedures for a couple of years but I'm very well versed in TIA and stroke workups, seizure workups, cursory management of headaches, lots of experience with back pain, and LOTS of management of degenerative neurologic disease. I make very good $$ where I am now and have a good benefits package with 401K and profit sharing. I already know that moving would likely be a step down salary wise and I would probably be ok with that. I'm just curious to hear what others have done. Does the specialty experience bring something valuable to primary care? Or is it a headache (no pun intended) for the SP who is going to need to do some mentoring to get me up to speed on everything primary care? Curious to hear some thoughts

[ventana]

dont sell primary care short for income...... it is coming around and might not be at the high end of specialty medicine, but there is such a shortage of PCP's practices are finally starting to pay reasonable - ie nothing under 100k for 4 day work week

 

Also, don't think primary care is easy, if anything, it is as hard if not harder (the pace that is) then a lot of other jobs. It is never ending and can wear you out. With this in mind you have to set a very clear defined max # of patients a day - I would say 15 to get comfortable (assuming you still remember some IM) Then long term a MAX of 20 per day. You also need to make sure that you control the schedule. Not the front office, not the practice manager, not the SP - if they want to add on a patient they have to talk to you, if you want to take off an hour early you decide, not someone else.....

 

It can get very toxic very quick if someone else is controlling the schedule and you are merely a production machine......

 

BUT if you get good pay, see a reasonable # of patients, and are respected and not dumped on you will likely find it a great spot! I love it and being the first one to see the patient then referrer to the specialist is really the key

[KMD16]

I agreed with v.

[jdenning]

No way am I thinking that primary care is easy. I'm worried I would struggle.

 

I'm already a production machine in Neuro but I max out at 14 per day. Today I'm seeing 15 but that's unusual and I never get my note done during the visit so it means a lot of time after work finishing my notes and that is old.

 

I also wonder about working in the same community I live in...

[zepoPA]

Sounds to me like you are doing well at your current job. My question is: why are you considering the change? Is it the commute? Is it the hours? Is it to spend time with your children? Make a detailed list of reasons and prioritize it. Then make a list of the pros and cons of current job, and also a list of your fears about the new job.

When I first switched from trauma surgery to family medicine I really thought I was going to be bored and I would miss the excitement of hospital environment and trauma cases. I picture myself sitting and seeing the same cases over and over and over. Yet, the schedule looked incredible, 40 hrs/wk, 8-5, no call. This was music to my ears since my 3 sons were small and full of energy. I made the move based primarily on wanting to spend time with them and being there for extra curricular activities.

 

Almost 17 years later I can tel you, without a shadow of a doubt, that such decision was the best decision I made. I transitioned Into Primary Care with no problems. I read and read constantly, I carried with me Ped Rx notes, ID guidelines, etc. nowadays it's so simple since you can have all info in your smartphone. I became a pro at the most common Dx of the practice, and whenever things became frustrating, I thought about ending my day at 5 and being able to attend that evening game with my sons. They all played basketball and football for their school and for the city. I went to practices and games.i attended parent-teacher conferences, and I was there for them every night and we ate dinner together. I know all their friends and girlfriends. Last year, when my youngest son won (undefeated) his HS FB championship, he thanked me for not missing a game in his 12 years of playing FB. My oldest son got married recently (to a RN who works nights ER) they both agreed that when they have children, she would work days elsewhere, because of the positive influence I was during my son's growing years.

 

 

I am sure many women can manage working any schedules and still be amazing mothers. No doubt about that. But making the move is what worked for me. I love my career, but my legacy... Is my sons.