Clinical setting limitations?

[BloodnGuts]

I am considering applying for the National Health Service Corp scholarship as I am very interested in working in primary care. At this time I feel as if family medicine is the specialty for me, mostly be because of its wide scope of practice.

If I do take the scholarship and go on into FM will I be limited in my career path? For instance will I be "barred" from working in an ED or UC clinic, or would those options still be available to me as long as I can find an ER or UC clinic in a sufficiently undeserved area?

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[smq123]

I am considering applying for the National Health Service Corp scholarship as I am very interested in working in primary care. At this time I feel as if family medicine is the specialty for me, mostly be because of its wide scope of practice.

If I do take the scholarship and go on into FM will I be limited in my career path? For instance will I be "barred" from working in an ED or UC clinic, or would those options still be available to me as long as I can find an ER or UC clinic in a sufficiently undeserved area?

Well, the scholarship specifies that, if you are in FM, you need to work at least 40 hours in an outpatient setting, which generally does not include the ER or urgent care. You might do that on top of your 40 hours of clinic duties, but I don't think that they will let you spend the bulk of your time in ER/UC.

 

[BloodnGuts]

What about inpatient care? I would hope that IM and Peds would not be limited to clinic only. I am most concerned about skill deterioration. I would hate to go through a long and arduous residency program and then be limited to only clinic work for the rest of my career because I lost those skills during the payback.

 

[smq123]

Sorry, my original statement wasn't quite accurate, but wasn't that far off either.

From the NHSC website:

Scholars fulfill their service commitments by providing full time clinical care (at least 40 hours each week), with at least 32 of those hours in the ambulatory care setting. (Except obstetricians/gynecologists, certified nurse-midwives, and family practitioners who practice obstetrics on a regular basis, who must work in outpatient clinical practice at least 21 hours per week with delivery and other clinical hospital-based duties making up the remaining 19 hours).

 

[montessori2md]

You could easily moonlight in UC to keep up your skills, as far as LP/suturing go. You could do joint injections, derm procedures on site, some sites have xray on site, you can read your own images. In a rural setting you might do some suturing/casting/splinting on site, and you can always be the team doc for the local football team.....If you are willing to live just about anywhere, you could tailor your NHSC site to a place where you would have a lot of procedures/Ob/freedom to moonlight. The thing you might have trouble finding could be ultrasound. I'm not sure if many clinics can justify the expense.

My first 2 years, I was worried about this -after half of 3rd year, I'm not concerned at all. Why? I would guess about 85% of my admissions were "cookbook" (chest pain, go. pneumonia, go. DKA, go. Sepsis, go. Do what the orderset/redbook says). Not that you don't need to know what to do, and not that I always knew what to do, but I can see how, by the end of residency, it'll be ok, with maybe a little moonlighting and CME to keep your head in the game. And if you work with good people, that 15% you'll be able to call someone and say, hey, what do you think about this? Just make sure you're logging your procedures so when you request privileges it'll be easy to be approved for them.

 

[simpler2]

Inpatient medicine counts. In many very rural settings its required even. This goes the same for OB. As far as job availability in the NHSC goes FM is the way to go. The scholarship doesn't offer an enormous amount of opportunities in general but qualifying jobs are very limited in psych/ob/peds. If you want to look at what is currently available this is the site:
http://nhscjobs.hrsa.gov