My patient population is 90% minorities. Mainly Hispanic. Some Asian and Black patients. The occasional White patient.
Hi friends, I know at least one of the active members of our community works at an FQHC.- I think anonperson?
I saw the recent post about the malpractice insurance and had some more questions and have become interested in this population. I'm kind of getting tired of the metric for my bonuses raising higher and higher in private practice. It's getting too stressful.
For general OBGYN, is FQHC patient population worse than a tertiary care residency hospital?
Are there issues with working for a federal clinic- ie administrative holdups like at academic centers or VA?
Not all FQHCs are created equal.
Some are better run/funded and have strong leadership. Others are basically sweatshops giving substandard care with disinterested leadership.
The patient population can be challenging and is similar to what you see in residency. It is an underserved community with a lot of the following: obesity, diabetes, HTN, casual drug use-typically marijuana. Basically a large number of your OB patients in an FQHC will be on low dose aspirin.
Very high risk things like placenta accreta etc I ship out. I have done a few in practice (before joining an FQHC) and although I can deal with a straightforward case, the infrastructure is just not their in the clinic and local hospital I typically work out of. Similarly, if the baby has significant anomalies that would require a lot of sub specialty care, I transfer the patient to the local tertiary care center with better pediatric subspecialty support. The hospital I mainly operate out of has a Level 3 NICU but they have certain limitations as well.
Administration can be hit or miss. Some understand how to help you care for patients while others don't know a thing. This can be a big hindrance.
I am expected to see ~20-21 patients a day in clinic. I am usually booked to 21 to 24 to account for no shows etc.
My colleagues in the hospital affiliated practice I left several months ago are pushed to see anywhere from 25-50 patients a day in clinic.
My main reason for joining were as follows:
1. No OB or GYN call
2. No ED call
3. Malpractice is FTCA and I have a secondary policy they provide as well. I don't have to worry about tail coverage or other BS related to that.
4. Stable salary
5. Fit my geographic preference
The job is reasonable. It is not perfect by any means
-Patient's can be entitled, especially the OB medicaid/(Medi-Cal in CA) patients
-Probably a sicker patient population
-Less English speaking patients. I don't have any personal problem with non English speaking people (I'm a minority) but it slows down visits and makes the consent process for procedures more of a time suck/difficult
I had some negative experiences with my previous jobs:
-I joined a pure private practice after fellowship and did a little bit of everything (OB/GYN/Urogyn). Place was a sweatshop. Practice owner (retired doc) wanted more volume out of us. He had his whole family on payroll. It was a miserable experience. The practice was teetering on the edge of ruin (unknown to me when I signed) because of his bad management and eventually collapsed after 6 months. Call was from home but it was so busy you would be in the hospital all night often times and then have a full clinic the next day. I was stuck with a $20,000 tail that I luckily got paid from the next job (hospital based practice) I joined.
-I then joined the local hospital and helped support their hospital based practice. Initially started out well but the call was bad. 5 in house calls covering the ED as well was brutal. Plus administration felt we were overpaid and by year three introduced a contract that would have resulted in a $15,000 pay cut. It was insulting and I left. Administration never appreciated the skills I brought or the service my colleagues and I provided, hence the attempt at slashing pay.
My current compensation/set up is as follows:
-Base salary: ~$320,000.
If I stay for 3 years, there is an automatic $20,000 bonus that is given each year after.
Cost of living increase is 1-3%/year based off base salary.
There ae bonus/quality incentives etc that are worth up to $26,000 per year. I don't really focus on this too much to be honest.
I work M-F, with one half Saturday a month.
Operate on Mondays, do C sections as needed through the week.
The W/F I have 24 patient slots and T/Th 21 patient slots.
1 hour of admin time on T/Th morning.
I am done by 4 or 5pm every day.
22 days of PTO/CME for years 1-3
27 days for years 4,5
32 days for years 6+
All federal holidays off.
CME money: $3000.
403b with a 4% match. Match starts after 1 year but is immediately vested.
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I could be making more elsewhere for sure but I don't have the desire to do overnight work anymore on a regular basis. Doing deliveries or ruptured ectopics at 2am was physically difficult. Even taking phone calls etc is not pleasant. I just don't like being on call like that anymore. Some GYN examples when I was on call:
-Patient had a c section and the delivering OB somehow lacerated the bladder and didn't realize it. I had to take her back to the OR and fix the problem. Did the case alone with the scrub as my assist. Worked out but it was a pain to do.
-Patient had a TLH at a Kaiser facility. Discharged same day. Passed out next day and taken by ambulance to a tertiary referral ED. They deemed her stable and since my hospital had an agreement with Kaiser, patient was transferred to the hospitalist. Come to realize patient has a belly full of blood. I take her back to the OR and there is an active bleeder near the cuff. Did the case on a Sunday night at 10pm. Not fun and very annoying to deal with the situation.
I will say that I feel much better physically and mentally. My family is happier since I am around more.
The job is not perfect but I honestly don't mind the inadequacies of the FQHCs that much. I do what I can to help the patient. If they want it, great. If not, not my problem. I document appropriately and I clock out at 5pm and enjoy the rest of my afternoon/evening.
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I will never ever take a job where the tail coverage is not entirely covered by the employer or there must be an occurrence type policy. The cost of a mature tail for an OBGYN is insane and can easily be $100,000 with payment in full. It is such a scam from insurance companies. This can handcuff you to a bad job and easily deplete your cash reserves.
