NHSC/FQHC Lifestyle

[Chachapoyas]

Hey MDs and DOs,

Can you comment on your typical day? How many hours do you work, what time do you usually get to go home, how intensive is all the administrative work (charts/other types of paperwork)? What about the on-call schedule? Do you feel burned out? What about vacation time? Can you include your geographic location (urban vs. rural)? NHSC is an amazing opportunity, but commitment to a single place for 3-4 years with (potentially) unhealthy lifestyle sounds scary to me.

I appreciate your honesty,
-C.

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[styphon]

I would think it is site dependent.

I am in the NHSC loan repayment program and I work for a local native american tribe. I currently do outpatient only here, about 40-45 hours a week, M-F, 8-4:30, I work thru my lunch. I take phone triage call 1 week a month. I am in an rural area (kind of the definition of an indian reservation). I have 4 weeks vacation +2 weeks personal time + normal holidays + native american holidays.

 

[Chachapoyas]

Thanks. Can anyone else chip in if this is more or less the same across the board?

 

[Amicable Angora]

What is the workload like? Yes, I know it's 40-45 hours a week, but is it really busy? I can't imagine it to be.

 

[aerodoc]

I'm in the NHSC s2s program and currently a first year FM resident, however I did a month rotation at an IHS site in New Mexico. I can tell you that if you choose to work out on a reservation it's very different from the city and has it's pros and cons. Obviously you miss out on much of the cultural attractions that you find in a big city however I found that all the doctors were much more close knit (ie they often had get-togethers multiple times per week) and there are tons of outdoor opportunities if you like that sort of thing.

As far as the workload, for the most part it's no different than working in the city, maybe 40-50 hours per week, however the nice thing is that the work is much more diverse. We had clinic/ER/ob/gyn, inpatient, adults, peds, school clinic, etc. all in the same week. True full-spectrum family medicine.

If you're interested in the NHSC I'd recommend doing a rotation either at an FQHC near you or trying to do an away at a rural site or IHS site. It's an amazing experience either way. PM me if you want to ask more specific questions, I'll be happy to give you my input!

 

[smq123]

Hey MDs and DOs,

Can you comment on your typical day? How many hours do you work, what time do you usually get to go home, how intensive is all the administrative work (charts/other types of paperwork)? What about the on-call schedule? Do you feel burned out? What about vacation time? Can you include your geographic location (urban vs. rural)? NHSC is an amazing opportunity, but commitment to a single place for 3-4 years with (potentially) unhealthy lifestyle sounds scary to me.

I appreciate your honesty,
-C.

Thanks. Can anyone else chip in if this is more or less the same across the board?

I am in an urban setting - Family Medicine, no OB. I had originally signed up for a 2 year service commitment, but have now stayed on. (No Loan Repayment).

I probably end up working about 60-70 hours a week, but I also have additional administrative duties (Quality improvement, training new physicians/NPs) that not everyone has. If I did not, and otherwise stayed fairly focused, it would be closer to about 50-60 hours.

The charts and administrative work can get intensive, but it seems to come in waves.

The on call schedule is extremely light. We do not have admitting privileges, which helps.

Sometimes I feel a little burned out. They're tough patients, with a lot of needs. Put insurance bureaucracy on top of that, and it can get to be a bit much. I am still glad that I did it though - if I had had a fairly cush NHSC placement fresh out of residency, I don't think I would know as much, or be as experienced, as I am now. I feel pretty confident that I could walk into any outpatient clinic, anywhere, and hit the ground running pretty fast.

 

[stillers]

Late on replying, but here are some thoughts from someone who is now a pulm-crit fellow after working for the IHS for 4 years.
I worked in an IHS hospital with a group of about 8-10 internists, providing full spectrum internal medicine (outpatient, inpatient, some ICU
care). I would do it again in a heartbeat.

Pros:
Job was amazing. Extremely rewarding, appreciative patients. Learned a ton. Practiced medicine in a pragmatic way and was able
to make a significant impact in the health of many people.
Lots of clinical responsibilities and as time went on took on administrative responsibilities
as well. Physicians had a lot of control over how the hospital was run. Extremely close-knit department, most of the physicians
lived on the same street a short walk from the hospital and socialized together. Kids played together.
Lots of time off - start with 30 days off per year and accumulate more - impossible to use it all and when you leave it is paid out to you.
Unlimited outdoor activities, conducive to a healthy lifestyle.

Cons:
Lots of call and potentially long hours. Worked anywhere from 50-80 hrs per week. Would take overnight call and work the entire next day (36 hrs
straight), which was commonplace previously but is now becoming a thing of the past. Limited resources - had to manage many complex medical problems without subspecialty assistance - tough at first but became easier and one of the appealing aspects of the job as time went on. Salary not so great but still more than enough.

 

[Chachapoyas]

Late on replying, but here are some thoughts from someone who is now a pulm-crit fellow after working for the IHS for 4 years.
I worked in an IHS hospital with a group of about 8-10 internists, providing full spectrum internal medicine (outpatient, inpatient, some ICU
care). I would do it again in a heartbeat.

Pros:
Job was amazing. Extremely rewarding, appreciative patients. Learned a ton. Practiced medicine in a pragmatic way and was able
to make a significant impact in the health of many people.
Lots of clinical responsibilities and as time went on took on administrative responsibilities
as well. Physicians had a lot of control over how the hospital was run. Extremely close-knit department, most of the physicians
lived on the same street a short walk from the hospital and socialized together. Kids played together.
Lots of time off - start with 30 days off per year and accumulate more - impossible to use it all and when you leave it is paid out to you.
Unlimited outdoor activities, conducive to a healthy lifestyle.

Cons:
Lots of call and potentially long hours. Worked anywhere from 50-80 hrs per week. Would take overnight call and work the entire next day (36 hrs
straight), which was commonplace previously but is now becoming a thing of the past. Limited resources - had to manage many complex medical problems without subspecialty assistance - tough at first but became easier and one of the appealing aspects of the job as time went on. Salary not so great but still more than enough.

Thanks for your reply. How easy was it for you to sub specialized further on? Was it competitive? Was it difficult to go back to "school" after years as an attending? Was your experience with NHSC considered in fellowship application in any positive or negative way? Thanks in advance. I am planning to go into general IM, serve with NHSC, and then perhaps do a fellowship after that. These are just some questions that I have.

 

[stillers]

Thanks for your reply. How easy was it for you to sub specialized further on? Was it competitive? Was it difficult to go back to "school" after years as an attending? Was your experience with NHSC considered in fellowship application in any positive or negative way? Thanks in advance. I am planning to go into general IM, serve with NHSC, and then perhaps do a fellowship after that. These are just some questions that I have.

I don't think it is too difficult to sub-subspecialize after serving in NHSC/IHS as long as you are motivated. I would suggest doing your obligatory
research during residency prior to working for the NHSC, and speaking to your anticipated letter-writers before you graduate residency. I met with faculty
at my residency program again before I applied for fellowship to fill them in on what I had been doing after residency so they could write accurate letters.
Pulm-crit is overall not as competitive as Cardiology, and I trained at a strong program, so those factors also worked to my advantage.

I perceived my experience to generally be viewed positively during interviews. It gave me a lot of perspective and maturity, and if nothing else I had a lot of interesting things to talk about. I'm not sure that it played much of a role in matching, but it has made me a much better doctor and person. I don't think anyone viewed working for the IHS in negative way.

It was not difficult for me to go back to being a learner - I just remind myself that I'm in fellowship to absorb and learn as much as possible. However, going back to academia has made be appreciate that our IHS practice was ridiculously efficient and pragmatic compared to most healthcare entities in our country.