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deleted6669
cambie-no ob, more wards and less psycho-social stuff...isn't that called med-peds?
20 years from now, FP MDs will be obsolete
- Thread starter MacGyver
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Hi Emedpa,
you raise a valid point. The difference is fp is one year less and no dual certification or board eligibility. I think that fps need to increase their skill to remain viable.
I mentioned removing ob from the curriculum because very few fps perform deliveries. It still happens but that is very uncommon at this point. Our time in training would be better served learning taks that we actually perform in the real world.
CambieMD
you raise a valid point. The difference is fp is one year less and no dual certification or board eligibility. I think that fps need to increase their skill to remain viable.
I mentioned removing ob from the curriculum because very few fps perform deliveries. It still happens but that is very uncommon at this point. Our time in training would be better served learning taks that we actually perform in the real world.
CambieMD
the aafp and rrc are not going to eliminate the ob requirements from fp just because not everyone will deliver babies. there is a reason its in the fp curriculums...to get that well rounded education and training that people chose the field in the first place. if you dont want to do ob or have any training in it, you should go med/peds. there are actually more people doing ob that you think. if you ever want to get a faculty position at a teaching hosp where there is an fp program they will need staff/ faculty to precept and backup deliveries for the fp residents.
people also choose fp for urgent care/er purposes and you have better have some ob experience and skills to do that because who knows when you will need it.
besides...theres much more of the world outside the "burbs"!
people also choose fp for urgent care/er purposes and you have better have some ob experience and skills to do that because who knows when you will need it.
besides...theres much more of the world outside the "burbs"!
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What they are saying Cambie is that urban and suburban FP is nothing like rural FP, and there are many more rural areas than city areas. FP needs OB training, and city FP's who are nothing more than referral specialists need not be surprised when their jobs start to dissappear. Rural FP is where FP really is!!!
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what a bunch of bs. city fp as a referal service. It could be that some city fp choose to be this way but most that I work with and most that I know of choose to manage many conditions on their own and do many procedures on their own. In fact, the trend is too keep the pt. in the office and do more for them and not to send them out.
I don't know who give you guys your information but you need to get more informed.
Go to the aafp.org website and read about how practices are being managed and what procedures fps are doing. It's all in there.
I don't know who give you guys your information but you need to get more informed.
Go to the aafp.org website and read about how practices are being managed and what procedures fps are doing. It's all in there.
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Het Eric, I am just curious about your credentials. I was a PA in a large FP in Houston, Texas, and every city practice I knew of (including my own) was basically a referral mill. Yes we did minor derm stuff, toenails, etc..., but we did not do the big cash cows like Flex Sigs, Stress tests, OB, etc. Why do it when there is someone across the hall who is a specialist, and why would hospitals give priviledges to do OB, minor surgery, when there are specialists. You are dreaming if you think the average city FP office is anything more than an ambulatory care clinic. Its the rural FP's that can get credentialed to do these procedures because there is no one else to do them!! And the standard of care and liability are much less in the rural area because of the fact that there are no specialists. Sure, as an FP you can do Stress Tests, but the liability is high when the cardiologist is across the hall. Patients should be offered the best of a particular specialty, and FP is not usually that person in the city. Its about patient care and common sense, not a turf war. I am going rural to do these things, but don't think for a minute that I am arrogant enough to think that I will be doing these high risk things as well as a city specialist. Again, your credentials please so we can understand your viewpoint?
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You'd better rethink your perspective on liability/standard of care in rural vs. urban FP. In the past, it may have been true that rural docs were cut some slack, but in the last 15-20 years, if you provide a service that a secondary specialist provides, you are held to the national standard of care in whatever specialty that service fits in. Now, that doesn't mean that a good lawyer and a sympathetic jury won't work in your behalf, but I wouldn't bet the summer home on it.
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Koehler,
You are talking out your a$s!! The standard of care is completely based on geography. I have done a lot of medicolegal consulting and you are just plain wrong. I have seen many cases where even obvious wrongs were committed by rural physicians, but they were held to a much lower standard of care because they were rural FP's. I had a case just last year of an FP who admitted a 47 year old female with an MI, and followed her without specialist intervention. Her diagnosis was a non-complicated non-q WAVE MI, and he released her on day 3 without even an echo, stress test, or specialist visit (when there had been a cardiologist in the hospital on one of those days) to be seen by cardio in 4 days outpatient. She died of a massive MI 3 hours later on returning home. First of all, anyone who knows anything about medicine knows that this violates ANY standard of care for MI's regarding length of stay or even assessment of true pump function prior to release. We couldn't find an FP within 300 miles willing to give us a negative opinion and testify against this doc. We ended up finding a big city cardiologist as an expert but of course his opinion was called the ivory tower perspective. The case barely made it past the judges initial scrutiny because there was not a physician of same board certification and of equal education and job description willing to say he had done wrong. The case ended up settling for a minimal chunk of change when in a city this case would have been worth millions. You are comparing two different worlds, and rightly so. You can always find a specialist to say an FP or other rural doc has done wrong, but remember that these docs are members of their small communities as are the judges and juries. They don't take kindly to some big city know-it-all coming in and explaining how their doctor is wrong, while he lives somewhere in Manhattan and would never have moved to Timbuktoo!!!
You are talking out your a$s!! The standard of care is completely based on geography. I have done a lot of medicolegal consulting and you are just plain wrong. I have seen many cases where even obvious wrongs were committed by rural physicians, but they were held to a much lower standard of care because they were rural FP's. I had a case just last year of an FP who admitted a 47 year old female with an MI, and followed her without specialist intervention. Her diagnosis was a non-complicated non-q WAVE MI, and he released her on day 3 without even an echo, stress test, or specialist visit (when there had been a cardiologist in the hospital on one of those days) to be seen by cardio in 4 days outpatient. She died of a massive MI 3 hours later on returning home. First of all, anyone who knows anything about medicine knows that this violates ANY standard of care for MI's regarding length of stay or even assessment of true pump function prior to release. We couldn't find an FP within 300 miles willing to give us a negative opinion and testify against this doc. We ended up finding a big city cardiologist as an expert but of course his opinion was called the ivory tower perspective. The case barely made it past the judges initial scrutiny because there was not a physician of same board certification and of equal education and job description willing to say he had done wrong. The case ended up settling for a minimal chunk of change when in a city this case would have been worth millions. You are comparing two different worlds, and rightly so. You can always find a specialist to say an FP or other rural doc has done wrong, but remember that these docs are members of their small communities as are the judges and juries. They don't take kindly to some big city know-it-all coming in and explaining how their doctor is wrong, while he lives somewhere in Manhattan and would never have moved to Timbuktoo!!!
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To PAC to DOC,
Sorry, bro, that : 1) you have to resort to profanity and , 2) you haven't really refuted what I said.
We are both relating an opinion and I can stack my anecdote against your anecdote. I was sued as a moonlighting resident in an ER in a rural area. Won the case, had a good lawyer who argued on local standard of care as well as other points, but he privately said that a good plaintiff lawyer will argue a national standard of care. Have had other insurance personnel and lawyers say the same thing thru the years.
Your contention that rural judges and juries don't like city people coming in and telling them how to do things supports my contention that a sympathetic jury can certainly override a good case.
There are too many variables involved in a malpractice case to make sweeping statements. I'm just saying that if one goes into a rural area BETTING that they are immune from losing a case BASED on a local standard of care, one might be in for a rude surprise.
Sorry, bro, that : 1) you have to resort to profanity and , 2) you haven't really refuted what I said.
We are both relating an opinion and I can stack my anecdote against your anecdote. I was sued as a moonlighting resident in an ER in a rural area. Won the case, had a good lawyer who argued on local standard of care as well as other points, but he privately said that a good plaintiff lawyer will argue a national standard of care. Have had other insurance personnel and lawyers say the same thing thru the years.
Your contention that rural judges and juries don't like city people coming in and telling them how to do things supports my contention that a sympathetic jury can certainly override a good case.
There are too many variables involved in a malpractice case to make sweeping statements. I'm just saying that if one goes into a rural area BETTING that they are immune from losing a case BASED on a local standard of care, one might be in for a rude surprise.
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Its not realistic to think that an FP in a rural area can provide the same standard of care as a specialist. And there is no such thing as a national standard of care. By definition the standard of care is completely variable based on geography, and any lawyer worth his/her weight in dirt will tell you that. Do you think the same standard of care exists in McGrath, Alaska as Manhattan? Your dreaming if you don't mind me saying so. And I was not cursing; that is why there was an $ in ass!!! But now I am...oooops (nothing you can't hear on national TV)
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I don't disagree that it is unrealistic for a rural FP to be expected to provide the same standard of care as a secondary specialist-in fact, I totally agree with that. I'm just saying that if one is sued for negligence in a matter where the service could have been provided by a secondary specialist, one had better be prepared to be held to the standard the secondary specialist is held to-again, there are many variables, but I would suggest anyone in urban OR rural settings discuss this with their insurance carrier if they want to be sure of coverage, etc.
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BTW, PACtoDOC, your perception of urban FP clinics is similar to mine, though I am sure there are exceptions as some will surely post here to illustrate
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The problem Koehler is that there is no OB available to deliver newborns in McGrath, Alaska!!! Your argument holds true only IF there was a specialist within reasonable proximity to the rural area. If you are a medivac flight away from a ruptured appy, it stands to reason the FP doing the emergency appy (assuming they are priviledged and had adequate residency training) is not going to do it as well as the GS who has 1000 of them. But its better than letting someone die, and that is where the standard of care is different. Glad to see you find urban FP similar to what I think of it.
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The physician in the mentioned case was lucky. He should have lost. The standard of care is the same everywhere. This sounds like a case of substandard care.
The replies on this forum should never be directed at an individual if it very negative and strongly worded. Offensive language has no place here. This is a forum where medical professionals exchange ideas. Television is not the medium to use is setting the bar. Call me old fashioned. Good manners still count.
CambieMD
p.s.
Good luck with the match JK
The replies on this forum should never be directed at an individual if it very negative and strongly worded. Offensive language has no place here. This is a forum where medical professionals exchange ideas. Television is not the medium to use is setting the bar. Call me old fashioned. Good manners still count.
CambieMD
p.s.
Good luck with the match JK
Macguyver
Your statements would make much more sense if you actually backed them up with URL's from reputable sites. I don't know of 25 states that authorizes naturopaths full script rights.
Sounds like you got ego bruised and now you are making up facts to save face. I would quit while I was ahead
Your statements would make much more sense if you actually backed them up with URL's from reputable sites. I don't know of 25 states that authorizes naturopaths full script rights.
Sounds like you got ego bruised and now you are making up facts to save face. I would quit while I was ahead
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