Academic PCP AmA

[Bropranolol]

Hi all,

Long time lurker, first time poster. I have been following SDN ever since I was a premed. Now as an attending I finally decided to join this community.

A bit about me- IM trained, was going to do nocturnist then switched to PCP. I work in academics. I find this job enjoyable. Now is it my “passion”, no. It is a job as like any other, but it pays the bills.

I wanted to post to introduce myself and if any premeds/residents see this post, I would share info about PCP jobs, academics, life etc

Thanks!

---

Members don't see this ad.

 

[Calizboosted76]

You son of a gun. You left out medical students. Lol jk.

 

[NewYorkDoctors]

cool. what kind of support services do you have in the attending office / resident's clinic you work at?
Hopefully they provide you with lots of services to make primary care "easier" to perform?
on site phlebotomy? medical assistants for EKGs, audiometry screenings, Snellen, Retinavue for DR (if applicable), Pap smear assistance, SBIRt screening, etc? Nurses for vaccinations, IVs, smoking cessation, MMSE, etc? support services for prior authorizations? fairly easy subspecialist and radiology referrals?
someone to help keep track of those BIRADS3, TIRADS 4, LungRADS3 lost to follow up?

the biggest barrier for many residents to do PCP is that their resident clinics are so "dependent on the resident to do all of those above mentioned things" that it turns many of them off to it

 

[Bropranolol]

You son of a gun. You left out medical students. Lol jk.

Haha.

cool. what kind of support services do you have in the attending office / resident's clinic you work at?
Hopefully they provide you with lots of services to make primary care "easier" to perform?
on site phlebotomy? medical assistants for EKGs, audiometry screenings, Snellen, Retinavue for DR (if applicable), Pap smear assistance, SBIRt screening, etc? Nurses for vaccinations, IVs, smoking cessation, MMSE, etc? support services for prior authorizations? fairly easy subspecialist and radiology referrals?
someone to help keep track of those BIRADS3, TIRADS 4, LungRADS3 lost to follow up?

the biggest barrier for many residents to do PCP is that their resident clinics are so "dependent on the resident to do all of those above mentioned things" that it turns many of them off to it

ah yes great question! I will preface this that my experience is NOT the majority in my shop. I am very lucky to work at the "main" clinic of our hospital system, so my experience is different than the "satellite" clinics. Unfortunately I feel like there is a hierarchy in academics in terms of support with the main v suburban satellite clinics.

our clinic is staffed by triage RNs, APNs, full MAs, front desk staff, schedulers, etc. Because we have so many docs in my site we have enough volume/revenue to justify hiring the above. Smaller clinics don't have the volume$ to subsidize this.

yes- on site phlebotomy,
MAs do EKG, vaccines, medicare AWV forms, we have a bunch of metrics we have to hit for quality/revenue reasons so they do all the paperwork.
Pap smears- I am a guy so a lot of patients "want" a women to do it, I punt to our great APNs or send patients to OBGYN down the hall.
For PAs- I don't know how to do them lol, we have a pharmacy in our building so I usually in basket the pharmDs, or I have our Triage team do it on covermymeds.

Specialist referrals are department specific. Some departments are really good (they want the RVU$) so they will see the patient for any reason very quickly. mostly surgeons who need to pay for the second wives or their horses (that was a joke lol)

Cognitive specialties are harder. You can get people in within a couple months. At this point I know all the specialists who I like so I usually just in basket the doc myself to get them in.

for radiology findings, for anything more than BIRADS/lung rads that are abnormal, we have a RN coordinator who manages this. for TR-RADS I usually punt it to the endocrine surgeon who is my friend who likes the FNA.

I feel for the residents, they have to do this themselves. But for the attending there is support.

Keep the questions coming!

 

[NewYorkDoctors]

I assume you have PCP weekend "on call" every certain number of weeks to be available for patient phone calls about meds, urgent results like a urine culture positie no abx, and take the urgent phone call about terrible crushing chest pain and then ask the patient to go to ER?

how are your didactics? if academic I assume you have to teach residents in clinic and block off your attending schedule to supervise resident clinic and also do lectures at times?

I'm just curious as I was in the "primary care track" in my residency years ago and had the 4+1 system and each week was in a pretty good well run clinic setting that got me into doing primary care (on the side anyway. I have a side primary care practice that I run with DNPs seeing the patient but I am lurking in the background making all those big decisions like... calculating 10 year ASCVD and telling the DNPs nope no statins, which sequence of diabetic meds to do based on med coverage and secondary benefits of certain meds, so on so forth...)

(addendum: some might say why don't you hire a doctor? I am... I hire my friend who will graduate residency and make him the 'site director' of a new office opening up. what a gig right out of graduation straight into PP primary care. but I see no reason to hire other doctors in the same physical location when I am present to tackle "harder cases" myself for non-pulmonary issues. The good old CKD, CHF, COPD, venous insufficiency patient, and calcium channel blockers who is now having more leg edema... right up my alley. nothing some ISTAT labs, careful physical exam, weight check, remote home BP monitoring logs, and point of care ultrasound can't help me solve fairly quickly and then make a decision on whether to send to hospital or do some management and follow up in one week... can't have a midlevel tackle that one alone... I don't need to hire an expensive doctor to see URIs, preemployment forms, annual physicals for stable patients, chasing down BIRADS3s etc...)

primary care is very nice.. even in private practice.... asl ong as you have the volume and you have enough support staff to buffer the doctor from the "garbage" that gets in the way of the medical decision making for patients.

 

[Bropranolol]

I assume you have PCP weekend "on call" every certain number of weeks to be available for patient phone calls about meds, urgent results like a urine culture positie no abx, and take the urgent phone call about terrible crushing chest pain and then ask the patient to go to ER?

how are your didactics? if academic I assume you have to teach residents in clinic and block off your attending schedule to supervise resident clinic and also do lectures at times?

I'm just curious as I was in the "primary care track" in my residency years ago and had the 4+1 system and each week was in a pretty good well run clinic setting that got me into doing primary care (on the side anyway. I have a side primary care practice that I run with DNPs seeing the patient but I am lurking in the background making all those big decisions like... calculating 10 year ASCVD and telling the DNPs nope no statins, which sequence of diabetic meds to do based on med coverage and secondary benefits of certain meds, so on so forth...)

(addendum: some might say why don't you hire a doctor? I am... I hire my friend who will graduate residency and make him the 'site director' of a new office opening up. what a gig right out of graduation straight into PP primary care. but I see no reason to hire other doctors in the same physical location when I am present to tackle "harder cases" myself for non-pulmonary issues. The good old CKD, CHF, COPD, venous insufficiency patient, and calcium channel blockers who is now having more leg edema... right up my alley. nothing some ISTAT labs, careful physical exam, weight check, remote home BP monitoring logs, and point of care ultrasound can't help me solve fairly quickly and then make a decision on whether to send to hospital or do some management and follow up in one week... can't have a midlevel tackle that one alone... I don't need to hire an expensive doctor to see URIs, preemployment forms, annual physicals for stable patients, chasing down BIRADS3s etc...)

primary care is very nice.. even in private practice.... asl ong as you have the volume and you have enough support staff to buffer the doctor from the "garbage" that gets in the way of the medical decision making for patients.

Call is 1:9 weekends (9 docs in our group). Weekend call involves the usual med refill or a little old lady whose lonely and wants to talk. I average about 5-10 calls a weekend. Worse in cold/flu season. I used to dread call but with remote access/EPIC I don’t hate hate it.

Our residency is also 4+1, I precept residents in their +1 week. I do 3-5 half days with them. And yes my schedule is blocked off during that week.

And yes I concur, at this point, once I know the patient, as a primary it’s gravy. I do enjoy getting to know patients over time. As I said it’s not that bad!