The problem with being a general practioner in 2021 is two-fold -
1) Safety - you are practicing as a physician with an unrestricted license but your training isn't complete. Yes, you're better trained than a PA or an NP - but your training was always geared towards preparing you for the next step, and you never finished the last 2+ years necessary to practice your field. Can you make up for that with significant reading, conferences, etc? Maybe. But sometimes you just don't know what you don't know. Particularly when your intern year wasn't even in IM/FM - it was in psych, where the typical intern might have a month of ambulatory medicine clinic *total* (with the remainder being inpatient medicine, neurology, and the first few months of actual psych training).
2) Reimbursement - you'll basically be able to get credentialed with traditional medicare... and that's it. Very few insurance companies will credential you if you're not board eligible/certified, which means you won't be able to see patients who have that insurance.
This right here is part of the problem with current physician group think. The blinders are so thick against MD/DO graduates. The paradigm that training has to be what it currently is and no room for variance. If this was so imperative where was the uproar in all the medical societies and every physician when ARNPs and PA started out? Then expanded scope of practice, then independent practice and now even renaming themselves to Physician Associate.
We as physicians cannot continue to tear down MD/DO grads, especially those with some residency training and an independent license! Not too many decades ago there were still GPs in mass. One of the worst things we did as physicians was create a FM specialty. We should have preserved GP as GP and not created an FM specialty. Doing so has contributed to this current narrow thinking.
*As evidence I present the bulk of the British commonwealth system that utilizes MBBS / MBCh and those graduates as ~intern year trained are delivering care en mass.
*I also present the current ARNP/PA in US which Physicians have the oddest blinder for. There are ARNPs "reading" and billing for home sleep studies as my most recent discovery of WOW.
*I also now present DC and ND, these folks have trivial medical training and have strategically maneuvered "for billing purposes" to be reclassified as physicians with medicare. Some states actively let them refer to themselves as physicians too. In my state NDs are prescribing everything, benzos, zyprexa for bipolar/schizophrenia, hormones for gender transitions, etc. Infusions with all sorts of cocktails. Venture over to the Pain med threads, there are DCs doing stellate ganglion blocks for PTSD!!! The wild west of medical treatment is here, its on front door step and ramming hard with a military grade ram.
Had we not created a FM specialty GPs would still be ubiquitous and these folks would have easily been able to fill in the roles of PA/ARNP were intended. The system also wouldn't have put up these other billing road blocks with insurance companies, either. We would have all been better off. I continue to advocate for the end of step/level III for state licensure. And end to any GME as part of licensure and permit all MD/DO graduates to seek independent license after graduation. The rise of graduates and increasing numbers going unmatched is just a travesty, this shouldn't be happening. On the other end of the spectrum we have EM starting to show unemployment, and will only get worse. Rad Onc is sinking. Pathology is somewhat sinking. It stands to reason these issues are not immune to impacting other specialties either. Are we to continue to believe that an EM doc shall never be competent in practicing anything outside of EM? That they too have to do an entire new fellowship or residency simply to practice? Hogwash. Or even that a Cardiologist or Endocrinologist or GI can't practice general IM?
The OP, is a licensed physician, they've run the gauntlet enough and deserve respect and deserve, neigh earned the right to practice medicine and are licensed. Now they should go use it. If DC/ND are doing cash practices on every corner and doing fine, so too can this potential GP. But positively, this GP has had the right training
and will have a better grasp of knowing when to refer - because they are a physician. They won't be contributing to the wild west atmosphere out there. I believe your assertion of safety as an issue in 2021 is just plain wrong.
Taking insurance isn't all that important. I'm Psychiatry and only do it because in my local area it pays some what ok and I'll be able to make more than if I just do cash only. Many places in the country, medicare is the best payer! Heck the GP could have a thriving practice just doing medicare! If the person isn't credentialed with commercial insurance, so? They can still see those patients and charge cash, or even provide super bills the patient then in turns submits to the insurance as OON themselves. There are plenty of DPC/Concierge/cash/retainer practices and they are doing just fine. Not taking insurance means so much less overhead, less office staff and even if fees are less than insurance, can actually mean a higher gross despite lower net income.
We try to tell these non-BC/BE docs they are in a cage surround by a massive wall and its not worth being in that tiny cage. No, the security cameras should be pointed in the other direction and view should be different. They have an opportunity, different ones than us, t
hat cage is actually keeping us in, not the other way around. Us under the thumbs of admin, insurance bureaucracy, Maintenance of Certification crud, hospital privilege's politics, etc.
