tealeafexplorer

2+ Year Member
Jun 1, 2016
124
104
Status (Visible)
  1. Medical Student
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.
 
  • Like
Reactions: 1 user

AMEHigh

10+ Year Member
Jul 25, 2008
2,221
2,715
Status (Visible)
  1. Attending Physician
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.
 
  • Like
Reactions: 1 users
About the Ads

Candidate2017

2+ Year Member
Oct 14, 2016
595
1,066
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.
 

Keona

10+ Year Member
Jul 14, 2008
588
303
Status (Visible)
  1. Attending Physician
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

Urgent Care Physician
15+ Year Member
Nov 21, 2005
4,610
2,524
Texas
Status (Visible)
  1. Attending Physician
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.
 

mark v

Junior Member
15+ Year Member
Dec 14, 2004
339
408
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

7+ Year Member
Jan 14, 2012
647
506
Status (Visible)
  1. Attending Physician
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

Senior Member
Volunteer Staff
15+ Year Member
Jul 28, 2004
24,292
40,463
Status (Visible)
  1. Attending Physician
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

7+ Year Member
Jan 14, 2012
647
506
Status (Visible)
  1. Attending Physician
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

Senior Member
Volunteer Staff
15+ Year Member
Jul 28, 2004
24,292
40,463
Status (Visible)
  1. Attending Physician
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.
 
About the Ads

mwsapphire

Office of the medical examiner.
2+ Year Member
Jan 5, 2017
3,507
2,777
Status (Visible)
  1. Medical Student
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.
 

cj_cregg

5+ Year Member
Jul 25, 2014
691
4,027
Status (Visible)
  1. Resident [Any Field]
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.
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.
 
  • Like
Reactions: 1 user

mwsapphire

Office of the medical examiner.
2+ Year Member
Jan 5, 2017
3,507
2,777
Status (Visible)
  1. Medical Student
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 😛
 

cj_cregg

5+ Year Member
Jul 25, 2014
691
4,027
Status (Visible)
  1. Resident [Any Field]
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 😛
Notes- definitely can be done later in the evening, people do it all the time. When I was doing notes after clinic I would jot some bullet points in the room to refresh me. I do feel like my notes are a little better when I do them at the time of the appt, but it's not really a significant enough difference that it's worth doing for that reason alone.

Calling - usually needs to be done during the work day if I'm actually physically calling someone, but most of the time I'm not physically calling someone. The #1 thing that I found to be helpful with my efficiency in clinic is delegate, delegate, delegate. Our clinic nurses and staff can handle most calls, and the physicians should be focusing on tasks that only they can do. I'd estimate 5-10% of lab results, messages, etc. I actually need to pick up the phone myself to handle. Example: pt recently had a well visit, got lab results today that told me she needed to be started on ASA/statin and some labs/imaging to work up abnormal LFTs. I called her myself - it requires some counseling on medication risks/benefits, interpretation of labs, plans for next steps that I don't expect my nurses to do. But a normal pap smear or mammo, the nurses can call her about that. We have a lady that does PAs, so usually for insurance issues I don't have to get involved unless a peer to peer is required or the PA is rejected. Our triage nurses are also very good and can manage most calls into the office with "Mrs. Jones has a question about her medicine" or "little Johnny has a fever and ear tugging" or "Mr. Smith has back pain" with just a message or two back and forth with me. If it's going to take more than that, they should probably be seen for an appt anyway. They will page/phone message us with anything more urgent, otherwise I batch that stuff to do right before lunch and right before I go home, or if I have any downtime e.g. a no show. It is not common that I have to directly call a specialist in the middle of my clinic day, usually just for emergencies (or sometimes calling over to our ER/OB triage if I need to send a patient over). Not more than a few times a month.
 
  • Like
Reactions: 1 user

hallowmann

SDN Lifetime Donor
7+ Year Member
Mar 13, 2012
6,340
7,562
Status (Visible)
  1. Resident [Any Field]
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

Office of the medical examiner.
2+ Year Member
Jan 5, 2017
3,507
2,777
Status (Visible)
  1. Medical Student
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..
 

mark v

Junior Member
15+ Year Member
Dec 14, 2004
339
408
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.
 
  • Like
Reactions: 2 users

Fatalis

7+ Year Member
Jan 14, 2012
647
506
Status (Visible)
  1. Attending Physician
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.
 
  • Like
Reactions: 1 users

mwsapphire

Office of the medical examiner.
2+ Year Member
Jan 5, 2017
3,507
2,777
Status (Visible)
  1. Medical Student
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

2+ Year Member
Sep 30, 2018
53
31
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.
 
  • Like
Reactions: 1 users

Sardonix

10+ Year Member
Sep 6, 2010
769
2,036
Status (Visible)
  1. Resident [Any Field]
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.
 
  • Like
Reactions: 1 user

Prehealth1011

5+ Year Member
Nov 29, 2015
598
1,143
Status (Visible)
  1. Medical Student
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?
 
About the Ads

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.