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Family Practice: the question no one wants to ask

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7 years 4 months ago #84772 by English
Awww... the bashing of other specialties... the truth of the matter is that what I see and then what you see are totally different and the clinical picture can easily change from moment to moment. There are good docs (conscientious, thorough, etc) and bad docs (looking to pass the buck) in all fields. Respect, ladies, respect.

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7 years 4 months ago #84775 by Cabinbuilder
Now, I am not bashing hospitalists at all. I have worked as one. I'm just fed up with the locations that I have been in where there is no sense of commraderie amongst the docs and no one seems to help each other. Just bothers me when patient care is compromised and I'm stuck trying to figure out how to get them some help when the person on the other end of the phone tells me no an hangs up. When I was in Texas, the hospitalists there were great and we all worked for the greater good. In Oregon and Colorado, now that's a whole different story. Just telling my story, I was not putting down any specialist intentionally.

LECOM Class 2006
Osteopathic Family Practice Resdincy 2009
Locum Tenens: Urgent Care/Rural Medicine.

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7 years 4 months ago #84783 by efex101
I do not think we are "bashing" just having a discussion. I stand by what I say, there are some PCP's that love just saying this for any ailment "just to the ER or let me call and have you admitted" for non emergent illnesses that *can* and *should* be dealt with in the outpatient setting.

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7 years 4 months ago #84785 by AmmaMD
I can understand the policy of not admitting directly without going through the ER. As a med student I helped care for a couple of direct-admit patients whose condition was deteriorating more rapidly than, I think, the admitting team had appreciated over the phone - and given the realities at that hospital of the admitting cycle, by the time they were seen in person by an MD a good 4 or more hours after they'd hit the floor, they were way too sick to have been sitting on a ward floor with no orders all that time. Shortly thereafter, partly because of one of my patients in particular, the policy was changed that all patients did have to go through the ER.

I don't think it was a problem at the level of individual doctors so much as the outpatient docs not knowing the current reality of how long a patient might have to sit before being seen, and the inpatient docs not realizing how much the outpatient docs didn't realize this and assuming that they wouldn't consider sending someone that sick not through the ER....

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7 years 4 months ago #84786 by efex101
No, the problem I see at times is PCPs wanting to admit patients that do *not* need a hospitalization. These are problems/issues that are usually dealt with in the outpatient setting. This is more so during Friday after 1300 hours....

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7 years 4 months ago #84794 by English
Well, I usually will call the hospitalist about a direct admit as long as the pt is not critical-- otherwise I will send them through the ER. I know that the ER can get things done faster since they are the ER and usually imaging, lab, antibiotics, etc. happen faster through the ED which is what I try to explain to a patient that doesn't want to go the ER route. If I need to rule out something that could kill the patient then to the ER it is. But if it is something that will take forever to work up in the outpatient arena or the patient is just not able to get everything I need them to get done (transportation issues, comprehension issues, compliance issues, etc.) then I will send the pt to the hospital (direct admit) and give the hospitalist the heads up about it. I have never encountered a hospitalist that said no to me-- as for cellulitis not needing to be an inpt admit-- well, if the cellulitis is spreading, pt has comorbidities, and not responding to oral abx then I think that warrants an inpt admission.

As for the OP question-- I think the amount of money an FP makes depends more on good business vs. good medicine. I know FPs that make $500K, but they make it by doing the type of things that increase revenue--nursing home pts, home health, medispa, etc. I'm not sure how much of a life you'll have doing that all, but I guess you need to determine for yourself how much money is enough for you and how important your free time is.

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