I was kind of hoping I would be able to practice full spectrum FM after residency in a high HPSA score area. Your comment makes me think that is less likely. Will I not be doing deliveries of any kind? Can I moonlight in an ED or in inpatient contexts outside of my primary service site in a highly underserved area? I feel like that should be feasible.
It's actually pretty complicated. It seems like it should be easy, but it's not.
To clarify - how high the HPSA score is doesn't necessarily indicate what you will be able to do. Many urban CHCs have extremely high HPSA scores, because HPSA scores are calculated based off of a lot of things, not just how many doctors are in the area. Those patients may live near large urban hospitals that would not be willing to extend Labor and Delivery privileges to a family medicine physician.
To break down your concerns:
- You might be able to do deliveries, especially if you're FM-OB, and especially if you're in a more rural area. That is certainly feasible, although it would be extremely clinic dependent. You would have to be sure to get a lot of OB experience and to keep excellent track of your procedure logs during residency.
- Some rural CHCs may have their doctors admit patients into the hospitals and do rounds. This is certainly not universal, and certainly unpopular with many physicians, but you could conceivably find a clinic and a hospital that would allow you to do this.
Keep in mind that the decision to allow you to see patients both inpatient and outpatient depends on both the clinic AND the hospital. The hospital may not be willing to do the extensive, long, and frankly tedious paperwork required to allow you to have inpatient admitting/treatment privileges.
- Moonlighting is a dicey topic, especially for FQHCs and their providers.
Some CHCs forbid outside moonlighting in their contract. If you continue to push for it, they may decide that you are not worth the effort and will not hire you. If you mess up while moonlighting elsewhere, then you might not be employable and that is a huge loss for them. So they may be really unhappy with you working elsewhere on your off hours.
Even if they were to allow moonlighting, you would be responsible for finding (and paying for) your own malpractice. FQHCs get their malpractice insurance through the Department of Justice and it is, unsurprisingly, extremely good malpractice insurance. However, the malpractice insurance only covers you when you are working for the FQHC - so, if you're moonlighting at an ER or at another hospital, your malpractice insurance doesn't cover you. Most ERs and hospitals do not want to provide malpractice insurance for moonlighters/per diems, so you would have to pay for it on your own. And most people would not find the expense worth it.
The misconception on SDN is frequently that CHCs and FQHCs have looser regulations than big hospitals so "maybe they can accommodate the way that I envision myself practicing." This is absolutely, 100%, unequivocally false. FQHCs have SO MANY federal regulations that they have to meet in order to get federal funding, and they have to be extremely strict with them so as not to lose that funding.