How many "unpaid" hours after clinic do you do

[tealeafexplorer]

Something not talked about a lot, but seems to be quite common in Family Medicine (Other specialties as well?) is time spent after clinic hours finishing up charting/documentation/phone calls to patients.

8-5 M-F FM jobs seem great, but how much unpaid time is spent after clinic doing these tasks above?

I know it varies and for some of you it will be little to none, and others quite a lot, but it does seem like there are more hours spent in FM doing unpaid work like this than other specialties. If I am wrong (which I probably am) please inform me.

I guess one can go into urgent care and avoid a lot of this "unpaid" work as there is no continuity of care, but i've seen many people on here rip into urgent care.

Anyways I guess I am just curious as to how many "unpaid" hours are you doing a week past your 8-4/9-5 that eats into you family or hobby time? Do all specialties have "unpaid" hours of work that they have to do after clinic? It would be nice to be DONE WITH WORK, when you are done with work. FM already doesnt get paid a lot per hour, and depending on the hours a week of unpaid work you have to do, it seems daunting.

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[AMEHigh]

I think most professional level/high-paying jobs these days have hours outside of the 9-5.
I think it's really hard to compare against other specialties as the practice environments can be vastly different.
I'd rather do the occasional work outside of 9-5 than have to wake up at 4am every morning or be on-call or work 24 hour shifts.

To answer for me personally, I do my best to true have the magical "work-life" balance. I don't have my work email on my phone and I try to finish all my notes on the same day. If I don't then I typically do them the next day during lunch. Yes occasionally I have to finish notes in the evening or in the morning, but I try not to have to do that.

Also, most jobs offer admin time. I ran screaming from a job that said you had 9 patient sessions and only 1/2 day of admin, hell no. I currently work 4 days a week in my main job, get compensated well for my area and am not working super long hours.

 

[VA Hopeful Dr]

Zero

 

[deleted87716]

It depends less on what specialty you're in and more on how efficient you are.

 

[Candidate2017]

Quickly peruse the chief complaints on your schedule and you should be able to formulate a tentative assessment and plan that turns out to be correct most of the time. When I rotated in FM I had a good senior (parents had a FM clinic), and learned to start the note and A&P while the patient checked in and finish it while seeing the patient.

Usually, 5 sentences are sufficient for FM. In med school and sometimes residency, your notes are longer because... academia. Our notes are longer in psych, but I usually finish by 5 pm. Although our patients tend to be needier, I rarely get calls because I communicate. Think about the most common reasons patients call (hint: side effects and refills) and address them beforehand.

BTW in residency everything is unpaid work.

 

[deleted87716]

BTW in residency everything is unpaid work.

You didn't get paid as a resident...?

 

[Keona]

I work a 4 day in clinic and 1 day of nursing home/admin. If I wanted to use my off day/nursing home/admin day to work I would have 0 hours of work outside of office hours. I usually spend it playing with kids, watching tv, doctor and dentist appts, etc. I get to work early right after dropping kids off at school and catch up on labs and any notes from day before. I try to leave work and not take papers home with me. Yesterday I left at 6:30 after a fairly busy week and have absolutely nothing to catch up on. (Friday going into a holiday weekend). We are probably changing ehrs soon and I think my charting time will greatly diminish after initial adjustment period.

 

[cabinbuilder]

Something not talked about a lot, but seems to be quite common in Family Medicine (Other specialties as well?) is time spent after clinic hours finishing up charting/documentation/phone calls to patients.

8-5 M-F FM jobs seem great, but how much unpaid time is spent after clinic doing these tasks above?

I know it varies and for some of you it will be little to none, and others quite a lot, but it does seem like there are more hours spent in FM doing unpaid work like this than other specialties. If I am wrong (which I probably am) please inform me.

I guess one can go into urgent care and avoid a lot of this "unpaid" work as there is no continuity of care, but i've seen many people on here rip into urgent care.

Anyways I guess I am just curious as to how many "unpaid" hours are you doing a week past your 8-4/9-5 that eats into you family or hobby time? Do all specialties have "unpaid" hours of work that they have to do after clinic? It would be nice to be DONE WITH WORK, when you are done with work. FM already doesnt get paid a lot per hour, and depending on the hours a week of unpaid work you have to do, it seems daunting.

Don't think for a minute that urgent care does not have extra unpaid hours. When you are on the last day of the weeks schedule and you have 7 people walk in the door in the last 15 minutes you still have to stay afterwards to chart. My last day I charted for 1.5 hours after everyone left and I came in the next day to review my labs and urines. For the most part I try to get out on time but it doesn't always happen.

 

[FrustratedFamDoc]

Almost all flavors of medicine have side stuff that needs to be dealt with. Typically, primary care will have more just by the nature of what we do, and we tend to run thinner on ancillary staff than more lucrative specialties.

 

[Fatalis]

I take call basically for free once a week... it is "built in my contract", ya don't ask. My contract was quite misleading. Funny thing is that SDN just released an article regarding contracts and it was touched upon that a single phrase can actually mean a 7 pg document. It is one of the reasons why I hate my current job; pro-bono work galore.

 

[VA Hopeful Dr]

I take call basically for free once a week... it is "built in my contract", ya don't ask. My contract was quite misleading. Funny thing is that SDN just released an article regarding contracts and it was touched upon that a single phrase can actually mean a 7 pg document. It is one of the reasons why I hate my current job; pro-bono work galore.

Depends what kind of call that is. Home phone call? That's just part of being a doctor. Anyone not 100% hospital based deals with this.

If its anything else, could be getting exploited for free labor.

 

[Fatalis]

Depends what kind of call that is. Home phone call? That's just part of being a doctor. Anyone not 100% hospital based deals with this.

If its anything else, could be getting exploited for free labor.

I wish it was just phone calls; it is full call and ya its exploitation. It always has me thinking "what battle did I lose to be working like this?" They are sponsoring me for a visa and it is too common to hear about international docs getting crap jobs strictly bc they know we are desperate.

 

[VA Hopeful Dr]

I wish it was just phone calls; it is full call and ya its exploitation. It always has me thinking "what battle did I lose to be working like this?" They are sponsoring me for a visa and it is too common to hear about international docs getting crap jobs strictly bc they know we are desperate.

Yep, there's your answer right now.

 

[FutureInternist]

Come over to hospitalist medicine.

 

[Fatalis]

Come over to hospitalist medicine.

I was originally supposed to but that fell through right at the worst time (before visa applications were due)

 

[mwsapphire]

Actually, is it alright if I bump this up?

I'm a first year DO student, and I'm interested in primary care ( or other outpatient based specialties). I've always wondered, how much of a PCP's work can be done from home? I know 50 hours a week is the standard week, but how much of that is charting that can be finished up at home, vs actually seeing patients? The FM doc I shadowed only sees patients 9-5 , 5 days a week, and does the rest of charting responsibilities at home. Is that common? She does that so she can be home with her ( 4!) kids.

I'd always thought if I had a child I may want to finish up some of my charting responsibilities at home.

 

[deleted87716]

Just get it done while you see the patients. I’ve done it that way for nearly 20 years, both with paper charts and EHR.

 

[mwsapphire]

Resident, so take this with a big old grain of salt: I have worked with PCPs who bring home their work laptop and do some charting at home at the end of the day. I've certainly done that. I probably spend 60-70% of my clinic time actually with patients and 30-40% charting, following up on labs, dealing with insurance/prescription stuff, responding to patient/triage phone calls and messages, etc. So a decent amount could be done from home. My personal preference though is to finish everything before I go home...nothing I hate more than not leaving work at work.

Also, worth noting, when I switched from finishing all my notes at the end of the day to finishing my notes during/immediately after the appointment, I also got WAY faster and started going home an hour or two earlier than I had before. I do note prep ahead of time pretty significantly, which I usually find time to do during downtime within the few days before the appt and don't often have to do it after hours, although I do only have clinic 3x/wk and this would definitely be harder if you're in a busy clinic all day every day. Obviously I am a resident and still learning so other factors may have contributed to increasing efficiency, but I do feel like it made a big difference. Fresher in my mind, less time to worry about dumb stuff like nice prose and formatting when my next patient is waiting for me.

Thank you this answer. I wonder if noting and answering calls can actually be done in the later evening though- whether you remember everything or if the other doctor you need to speak to is available (or whoever you're calling).
Hm. Oh well, I'll figure it out when the time comes 😛

 

[sloh]

FM docs at kaiser pretty much drown in uncompensated work done after hours (inbox messages, phone calls, notes)

 

[hallowmann]

Actually, is it alright if I bump this up?

I'm a first year DO student, and I'm interested in primary care ( or other outpatient based specialties). I've always wondered, how much of a PCP's work can be done from home? I know 50 hours a week is the standard week, but how much of that is charting that can be finished up at home, vs actually seeing patients? The FM doc I shadowed only sees patients 9-5 , 5 days a week, and does the rest of charting responsibilities at home. Is that common? She does that so she can be home with her ( 4!) kids.

I'd always thought if I had a child I may want to finish up some of my charting responsibilities at home.

Its not easy to do charting at home when you have multiple kids. Its sometimes easy to do it in the morning the next day, but it still takes much longer than doing them the same day between patients. I'm also terrible at finishing them the same day, so do as I say and not as I do.

 

[mwsapphire]

Its not easy to do charting at home when you have multiple kids. Its sometimes easy to do it in the morning the next day, but it still takes much longer than doing them the same day between patients. I'm also terrible at finishing them the same day, so do as I say and not as I do.

That is true, I would try to finish it while still at work , but it's more...I don't know..to have the option in case I feel like I need to go home? Idk. Most docs I work with seem to do some work at home..

 

[FrustratedFamDoc]

Improving overall efficiency will make it so your don't have as much to do after hours. Don't write manifestos. Keep the small talk to a minimum. Don't try to make something a 10 minute explanation when 2 will do just fine. After exchanging brief pleasantries, get down to business. "Mr/Mrs x, it's great to see you again. Is there anything I can help you with today?" "How is everything?" should never come out of your mouth if you're not wanting to hear... everything. this, along with coming in 30 minutes in the morning when it's quiet made a drastic improvement in my work flow.

 

[Fatalis]

Actually, is it alright if I bump this up?

I'm a first year DO student, and I'm interested in primary care ( or other outpatient based specialties). I've always wondered, how much of a PCP's work can be done from home? I know 50 hours a week is the standard week, but how much of that is charting that can be finished up at home, vs actually seeing patients? The FM doc I shadowed only sees patients 9-5 , 5 days a week, and does the rest of charting responsibilities at home. Is that common? She does that so she can be home with her ( 4!) kids.

I'd always thought if I had a child I may want to finish up some of my charting responsibilities at home.

tackle all your work at work. i don't take lunch or leave the office until my notes are done and as others have said, doing the note right after the encounter saves a ton of trouble. Working part time in clinic would be nice however make sure that is what you are after when you are done residency because it would be rare to only see a low patient volume like that.

 

[mwsapphire]

tackle all your work at work. i don't take lunch or leave the office until my notes are done and as others have said, doing the note right after the encounter saves a ton of trouble. Working part time in clinic would be nice however make sure that is what you are after when you are done residency because it would be rare to only see a low patient volume like that.

Thanks for your reply. I would hope to work full time, only doing part time if I had small kids and full time was too much, or later in my career if I started to feel burned out (so I could work for longer before wanting to retire).

 

[Reboa]

You can bill for time spent working on a chart with the new insurance changes. Anything within the day of service. But I also finish all my charts while I'm seeing patients, it's very doable.

 

[Sardonix]

Improving overall efficiency will make it so your don't have as much to do after hours. Don't write manifestos. Keep the small talk to a minimum. Don't try to make something a 10 minute explanation when 2 will do just fine. After exchanging brief pleasantries, get down to business. "Mr/Mrs x, it's great to see you again. Is there anything I can help you with today?" "How is everything?" should never come out of your mouth if you're not wanting to hear... everything. this, along with coming in 30 minutes in the morning when it's quiet made a drastic improvement in my work flow.

Damn. It's like you see me right through the exam room door.

 

[sloh]

"Mr/Mrs x, it's great to see you again. Is there anything I can help you with today?" "How is everything?" should never come out of your mouth if you're not wanting to hear... everything.

I was taught to ask open-ended questions though!

 

[VA Hopeful Dr]

I was taught to ask open-ended questions though!

you learn over time which patients you can ask those of and it'll be considered a good thing and which patients if you ask it will ruin your day

 

[Prehealth1011]

You can bill for time spent working on a chart with the new insurance changes. Anything within the day of service. But I also finish all my charts while I'm seeing patients, it's very doable.

Has this been implemented already?

 

[VA Hopeful Dr]

Has this been implemented already?

Yes

 

[scharnhorst]

FM docs at kaiser pretty much drown in uncompensated work done after hours (inbox messages, phone calls, notes)

please elaborate if you can thanks

 

[PikminOC]

please elaborate if you can thanks

Seems pretty explained

 

[PikminOC]

Has this been implemented already?

Yes

 

[Keona]

I left work at 6:30 today having addressed every single thing I needed to and I won’t open computer again until late Sunday evening to clear out anything that comes into inbox over weekend. Starting with a fresh slate each weeks makes a huge difference. I also have become a much better delegator. I had several very complicated patients who wanted “all their meds refilled”. We have a new ehr so doing that for each patient was going to take 30 minutes. I asked the nurses to help out by putting the Rxs into my note and then I linked to the correct diagnosis. When I first started I would have felt wrong asking for help to make prescriptions.

 

[deleted87716]

I left work at 6:30 today having addressed every single thing I needed to and I won’t open computer again until late Sunday evening to clear out anything that comes into inbox over weekend. Starting with a fresh slate each weeks makes a huge difference. I also have become a much better delegator. I had several very complicated patients who wanted “all their meds refilled”. We have a new ehr so doing that for each patient was going to take 30 minutes. I asked the nurses to help out by putting the Rxs into my note and then I linked to the correct diagnosis. When I first started I would have felt wrong asking for help to make prescriptions.

This is the way.