Clinic is killing me

[deleted648625]

Current junior resident spending what feels like way too much time in clinic (4-5 days a week). I am not sure if this is a byproduct of being in a top-heavy program, a potentially clinic heavy residency program, COVID related, or whether this is inherent to the field. I joined urology because I loved the OR cases I saw as a student and didn't hate the clinic (especially compared to eg my FM, peds, etc clerkships in med school) but I am feeling ground down and possible regretting my choice of surgical specialty.

For those with a few years of practice under their belt, can you comment on whether this is something every urology resident goes through? Is there a way to structure your practice to minimize clinic time?

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[DoctwoB]

Current junior resident spending what feels like way too much time in clinic (4-5 days a week). I am not sure if this is a byproduct of being in a top-heavy program, a potentially clinic heavy residency program, COVID related, or whether this is inherent to the field. I joined urology because I loved the OR cases I saw as a student and didn't hate the clinic (especially compared to eg my FM, peds, etc clerkships in med school) but I am feeling ground down and possible regretting my choice of surgical specialty.

For those with a few years of practice under their belt, can you comment on whether this is something every urology resident goes through? Is there a way to structure your practice to minimize clinic time?

Very program related unfortunately. In my program I was in clinic 0-2 days/week depending on the rotation.

Now as an attending obviously you will have clinic. All Surgeons do, and the clinic to OR ratio will be higher in Uro/ENT then most general surgeons or orthopods. If you want to minimize this, then subspecializing in a more OR heavy field like onc or MIS/endo and building up a sub specialty practice may be your best bet.

 

[cpants]

This does sound unusual. In my program we were dragged kicking and screaming to our 1/2 day per week of clinic, and we otherwise operated all day every day. I would be worried about getting enough operative experience in that setting. Make sure you make the most of your time in clinic and learn how to do a good TRUS biopsy, vasectomy, and cystoscopic exam. You can learn a lot there.

Clinic at least 3-4 days per week will be the reality as an attending, but it's just not as painful as resident clinic. You get really good at it for one thing, unlike as a resident. Also, you aren't running plans by an attending and sitting around a lot of the time. Lots of procedures scattered throughout the day to keep things spicy.

 

[JeterIsStud]

Current junior resident spending what feels like way too much time in clinic (4-5 days a week). I am not sure if this is a byproduct of being in a top-heavy program, a potentially clinic heavy residency program, COVID related, or whether this is inherent to the field. I joined urology because I loved the OR cases I saw as a student and didn't hate the clinic (especially compared to eg my FM, peds, etc clerkships in med school) but I am feeling ground down and possible regretting my choice of surgical specialty.

For those with a few years of practice under their belt, can you comment on whether this is something every urology resident goes through? Is there a way to structure your practice to minimize clinic time?

Agree with the above, definitely depends on the residency but a few are quite top heavy from an operative experience standpoint. We have an very high volume experience at a couple hospitals and so as a senior resident I'm operating daily, but the juniors are also operating almost daily because there's almost too many cases and not enough residents. I have friends at other programs who say the same, but a couple who state they did a lot of clinic their first couple urology years.

In the real world, you're definitely looking at least a couple days of clinic a week and usually only one or two days in the OR per week. Clinic is where urologists make most of their money - I've heard private practice guys say they actually are losing money in the OR. So take that for what its worth.

 

[cpants]

Agree with the above, definitely depends on the residency but a few are quite top heavy from an operative experience standpoint. We have an very high volume experience at a couple hospitals and so as a senior resident I'm operating daily, but the juniors are also operating almost daily because there's almost too many cases and not enough residents. I have friends at other programs who say the same, but a couple who state they did a lot of clinic their first couple urology years.

In the real world, you're definitely looking at least a couple days of clinic a week and usually only one or two days in the OR per week. Clinic is where urologists make most of their money - I've heard private practice guys say they actually are losing money in the OR. So take that for what its worth.

For most clinic is probably more lucrative, but it depends on how fast you and your team are and what kind of case mix you do. I can often squeeze in 8 or 9 stone cases in an OR day and that is gonna beat any clinic day. Doing a big cancer case and one or 2 smaller cases will not beat clinic.

 

[DoctwoB]

Agree with the above, definitely depends on the residency but a few are quite top heavy from an operative experience standpoint. We have an very high volume experience at a couple hospitals and so as a senior resident I'm operating daily, but the juniors are also operating almost daily because there's almost too many cases and not enough residents. I have friends at other programs who say the same, but a couple who state they did a lot of clinic their first couple urology years.

In the real world, you're definitely looking at least a couple days of clinic a week and usually only one or two days in the OR per week. Clinic is where urologists make most of their money - I've heard private practice guys say they actually are losing money in the OR. So take that for what its worth.

It all depends on your case mix. A typical clinic for me is about 50 or 55 RVUs. It’s not hard to beat that with a day of cases, say 6-7 stone cases at 8-12 RVUs per or 2 prostates with node dissections at 35 each. But most big cases will also involve rounding and post op visits in a global period which pay 0. Also there are plenty of cases that don’t pay well for the time involved like a huge TURBT or complex spermatocele for 5 Rvus, or doing a stent or vasectomy or circ in the OR, which is a quick case but turnover makes it inefficient, and so on.

Overall it’s kind of nice. I don’t worry about making or losing money based on my case mix for the month. Mostly it’s a wash.

 

[nimbus]

For most clinic is probably more lucrative, but it depends on how fast you and your team are and what kind of case mix you do. I can often squeeze in 8 or 9 stone cases in an OR day and that is gonna beat any clinic day. Doing a big cancer case and one or 2 smaller cases will not beat clinic.

My cousin says same. He’s in his 50s. Only does cysto cases. Ships out big cancer cases. He says financially Clinic beats OR for him most of the time.

 

[non prostate owner MD]

It is a problem that you are in the office so much. I believe this is partially a consequence of many EMRs and documentation requirements making clinic less effective and attending wanting more support in the clinic. It should improve as you progress in residency. I would recommend voicing your concern about not getting enough operative exposure as an issue (obviously not by saying you dislike clinic). Many programs are hiring NPs or PAs to help with this. As to the real world, urology is one of the most versatile fields for being able to build a practice and choose partners/setups that allow you to develop the amount of surgical cases you want. I love to operate but if i operate every day for a few days i look forward to a clinic day, at different times in your career your desires will also change.