Family Doc looking to make a change. What would you do in my shoes?

[fullmetal]

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Hi everyone,

I’m a family doc, graduated about 4 years ago and have been working in the same location since graduation.

I think in the world of family medicine, I made a good choice with this job. I am earning just under 320k with a 10% 401k match and 23 vacation days per year. Patient volume is about 16 per day, though the patients are often very sick with little to no health knowledge, and many don’t speak English.

(Just as an aside - to achieve that 320k I do work an additional 8 hours per week running a specialized program (i.e. a 48 hour work week in total - which is really more like 58 hours with all the charting and inbox stuff).)

I love my job. I love my patients. But I have begun to find the day to day work kind of boring and the workload mentally taxing. I have definitely experienced severe burnout more than once over these 4 years.

I spend pretty much all my free time recovering from the challenges of each day. Seeing patients, reviewing a boatload of information about each one, thinking about the best course of action for them, ordering treatments, fielding questions, documenting, signing forms, prior auths etc. The mental energy required to do all of that takes a toll on me and I’m usually forced to spend most weekday evenings (and weekends) recovering - I don’t want to think about anything, I don’t want to talk to anyone… I mostly just want to do mindless activities to give my brain a rest.

This is a problem for me because my personal life hasn’t exactly gone the way I expected. I’m 36 and I’ve never been married. I’ve been in a few long term relationships (the longest were 6 and 8 years each - both ended due to factors outside of my control).

I find myself needing time to try to sort my personal life out, but all my time is taken by my job, and by my need to decompress after work.

I’m thinking of making a change, but I’m not sure what I should transition into. I don’t want sell my soul to join the dark side of administration, and I don’t think I’d make a good educator either.

I’m curious about technology with the recent A.I. boom and I wonder about entering the health-tech space somehow (but have no idea where to start).

Overall my goals are to 1. Do something new and interesting and 2. Reduce my workload to a more acceptable level (ideally a maximum 40 hour work week with less time needed to decompress).

I don’t care much if this change results in a drop in salary. I’m more than willing to trade the money for the time.

I’m wondering if any of you all have any suggestions as I’m sure at least a couple other family docs feel some of the same pressures as I do.

Thanks for reading.

 

[dozitgetchahi]

Hi everyone,

I’m a family doc, graduated about 4 years ago and have been working in the same location since graduation.

I think in the world of family medicine, I made a good choice with this job. I am earning just under 320k with a 10% 401k match and 23 vacation days per year. Patient volume is about 16 per day, though the patients are often very sick with little to no health knowledge, and many don’t speak English.

(Just as an aside - to achieve that 320k I do work an additional 8 hours per week running a specialized program (i.e. a 48 hour work week in total - which is really more like 58 hours with all the charting and inbox stuff).)

I love my job. I love my patients. But I have begun to find the day to day work kind of boring and the workload mentally taxing. I have definitely experienced severe burnout more than once over these 4 years.

I spend pretty much all my free time recovering from the challenges of each day. Seeing patients, reviewing a boatload of information about each one, thinking about the best course of action for them, ordering treatments, fielding questions, documenting, signing forms, prior auths etc. The mental energy required to do all of that takes a toll on me and I’m usually forced to spend most weekday evenings (and weekends) recovering - I don’t want to think about anything, I don’t want to talk to anyone… I mostly just want to do mindless activities to give my brain a rest.

This is a problem for me because my personal life hasn’t exactly gone the way I expected. I’m 36 and I’ve never been married. I’ve been in a few long term relationships (the longest were 6 and 8 years each - both ended due to factors outside of my control).

I find myself needing time to try to sort my personal life out, but all my time is taken by my job, and by my need to decompress after work.

I’m thinking of making a change, but I’m not sure what I should transition into. I don’t want sell my soul to join the dark side of administration, and I don’t think I’d make a good educator either.

I’m curious about technology with the recent A.I. boom and I wonder about entering the health-tech space somehow (but have no idea where to start).

Overall my goals are to 1. Do something new and interesting and 2. Reduce my workload to a more acceptable level (ideally a maximum 40 hour work week with less time needed to decompress).

I don’t care much if this change results in a drop in salary. I’m more than willing to trade the money for the time.

I’m wondering if any of you all have any suggestions as I’m sure at least a couple other family docs feel some of the same pressures as I do.

Thanks for reading.

I’m not a PCP, but I am a rheumatologist who has faced a lot of the same issues with “brain drain” etc so far during my career. Some suggestions (in no particular order):

- Change jobs, find a less demanding pt population. I completely stopped taking Medicaid, VA, etc because the extra amount of work and issues associated with those patients was not worth it.

- Adding onto the above: which EMR are you using? I currently use Epic, and it saves a huge amount of effort, time and mental energy over some of the awful EMRs I used previously (Centricity, Intergy). A bad EMR can literally add hours to your day. I have heard of docs literally changing jobs over which EMR they’re using.

- Make sure your staff are doing as much of the busywork as possible. Whatever repetitive tasks can be delegated to staff, should be. Consider scribes etc.

- Work less. If your primary job is too draining and overtaxing, why are you working a second job with a specialized clinic (especially if you don’t care about the money)? If you work a full 5 days a week, you may be really surprised to see how much better you feel at 4-4.5 days/week. See fewer pts if possible.

- Make sure you are sleeping enough, exercising etc.

You may not need to pivot into a different niche…you may just need a different job.

 

[VA Hopeful Dr]

I’m not a PCP, but I am a rheumatologist who has faced a lot of the same issues with “brain drain” etc so far during my career. Some suggestions (in no particular order):

- Change jobs, find a less demanding pt population. I completely stopped taking Medicaid, VA, etc because the extra amount of work and issues associated with those patients was not worth it.

- Adding onto the above: which EMR are you using? I currently use Epic, and it saves a huge amount of effort, time and mental energy over some of the awful EMRs I used previously (Centricity, Intergy). A bad EMR can literally add hours to your day. I have heard of docs literally changing jobs over which EMR they’re using.

- Make sure your staff are doing as much of the busywork as possible. Whatever repetitive tasks can be delegated to staff, should be. Consider scribes etc.

- Work less. If your primary job is too draining and overtaxing, why are you working a second job with a specialized clinic (especially if you don’t care about the money)? If you work a full 5 days a week, you may be really surprised to see how much better you feel at 4-4.5 days/week. See fewer pts if possible.

- Make sure you are sleeping enough, exercising etc.

You may not need to pivot into a different niche…you may just need a different job.

Agree with this. I've had a crazy number of jobs given that I'm only 12 years out of residency. It's a matter of finding the right job.

Unless you really need the extra money, drop the second job. Consider cutting back your hours at your main job if possible, though the numbers you're seeing in a day are not too bad.

Learn efficient inbox management. If a patient question takes more than at most 2 sentences to answer, it needs an appointment. Any new problems need appointments. I don't do this, but my wife lets her nurses authorize refills as long as the patient has an appointment scheduled for follow up.

At this point, most of your management decisions should happen almost instantly in your head. I bet I go to up-to-date less than three to five times a day at this point not do I ponder questions very often. Makes result management very quick.

If patient visits are taking too long, end them and arrange for close follow-up. If you're seeing 16 a day that gives you 30 minutes per appointment. Other than patients that I either enjoy talking to or I feel like they really just need someone to listen to them for a while, I can't remember the last time I spent 30 minutes in a room. It's also a good time to work on their charting and get in all the orders if it's someone who's just very chatty.

 

[Sushirolls]

Open your own PP.
Make it your own.
Set your days, hours, and volume.
Be your own boss.
Once you taste the freedom, you won't go back.
[I'm psych]

 

[FamilymedMD]

Open your own PP.
Make it your own.
Set your days, hours, and volume.
Be your own boss.
Once you taste the freedom, you won't go back.
[I'm psych]

Yes and no. Opening your own FM DPC is very possible and gives lots of control but it's hard work for a couple of years and no/low pay when first building it.
If possible, find a small DPC interrested in growing and run by people you could work with in an area you like. There are lots of advantages to both so you should be able to negotiate something better than most other options.

 

[cabinbuilder]

16 patients a day?? Sounds horribly boring. When I first got out of residency I found it very hard to find a good fit and ended up having 5 disastrous permanent jobs in 5 years (none of which lasted longer than 3 months). This is why I ended up doing locums for 7 years. I would assume you don't have a lot of medical issues so you really only need catastrophic insurance at this time. If I was 36 again and single I would be doing a 6 months stint in New Zealand or Guam or somewhere else really cool. There is an IHS site at the bottom of the Grand Canyon that they have to get you there by helicopter (I never got to do that). I did work on an island in SE Alaska and that of course is always interesting. I had kids when I was doing locums so I had to stay in the country but still did jobs in Alaska, Montana, Nevada, Texas, Oregon and Wyoming. Then I got older and finally needed a job with insurance which is how I ended up where I am now (it was a job I used to come to as a locums provider). Roll over your 401K into Charles Schwab or something similar and go live a little bit. GlobalMedicalStaffing.com Something to think about.