Part time clinic possible?

[SansaStarkMD]

Is part time clinic as a hospital employee possible? ..2-3 days a week?

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[JamaicanHerb]

Anything is possible if you put your mind to it, except understanding magnets.

 

[VA Hopeful Dr]

Yep, doc down the road from me works 2.5 days per week employed.

 

[vendtex]

Yes but be aware that some groups may still expect you to take an equal share of call as if you were full time.


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[SansaStarkMD]

How common are clinic jobs with no call, and can you take phone call while working at another site (moonlighting etc)?

 

[FrustratedFamDoc]

Most clinic family doc call these days is phone only. Really a piece of cake. If you have your patients, you'll likely be expected to be available to your patients 24 hours a day during the week and in some sort of call pool on weekends.

 

[vendtex]

So you want c section privileges with no call working 2.5 days a week and you want the employer to allow you to moonlight at a competitor clinic? I'm guessing that job doesn't exist.


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[SansaStarkMD]

So you want c section privileges with no call working 2.5 days a week and you want the employer to allow you to moonlight at a competitor clinic? I'm guessing that job doesn't exist.


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No, I'm trying to figure out how to have a good income doing full scope family medicine while living in a city that isn't too rural. Thanks to the answers to my random questions I think I'm figuring it out.

My current plan is to do clinic 3 days a week (call is fine, slowly build a panel) while commuting to one 24 hour ER shift per week at whichever ED is paying the best. I'd also like to do OB without help (c-sections) in developing countries that I plan on continuing to visit. Sounds like OB in the United States is a pissing contest, but there's no reason I can't pick up those skills during residency, first assist occasionally, keep those skills fresh, and practice full scope FM abroad. In the states, I'll have less call/liability with a good income and I'll save the OB as a part time, no liability, much needed, practical skill that I can freshen up before traveling. If I want to retire into teaching later, I can also take a faculty spot at a FM residency and do full scope OB there without the turf wars.

 

[FrustratedFamDoc]

Typically, the ERs that staff family docs are going to be very small cities or rural locations. That can make a commute quite arduous after a 24 hour shift. Don't equate small ER with slow. They can be quite the opposite. I'm curious how you plan to keep your OB skills fresh doing 3 days of clinic and also doing a 24 hour ER shift per week. the 3 clinic days and 24 hour shift has you at about 54 hours/week already.

I'm not trying to knock your idea or enthusiasm, but some of the things are wanting to do are not really compatible, Especially if you want any sort of life outside of medicine.

 

[SansaStarkMD]

In my state there are 26 ER's within two hours that are actively seeking EM/IM/FM physicians. It's very common to get 4 hours sleep per night at the 15,000 volume places. With a light clinic schedule and three days off every week, frankly, most Americans would agree that's a walk in the park for 350-400k/year. The flexibility to not pick up an ER shift and take four days off each week is also nice. I may have not have said this clearly but I don't plan to maintain my OB skills, only to acquire them and then get them back before traveling abroad by assisting.

 

[vendtex]

Do you already have an offer to work like that in a clinic? Do those ERs have contracted ER companies or could u independently contract?


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[JamaicanHerb]

Do you already have an offer to work like that in a clinic? Do those ERs have contracted ER companies or could u independently contract?


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OP is a student.

 

[SansaStarkMD]

Student. No offer, just basing my info on internet job searches at the moment. Looks like most ED's are contracted ER companies that are going to prefer a boarded EM doc but their first priority is coverage so they will hire the whoever is willing to take the job.

 

[vendtex]

So, some things to consider. I think you would want to negotiate benefits, e.g. health insurance, life insurance, retirement with the part-time gig. Also the ER things if you'd have to privately contract it could be a pain in terms of credentialing, malpractice, self-employment tax, etc. If you were with a company they may assist with a lot of those things, but you want to consider that when estimating your income.

Regarding the c-section thing, it might be worth trying to get credentialed at the hospital with the group for some surgical assist possibilities upfront when it's fresher in terms of recent training than wait until later and try to refresh. I'm not sure how that would work to do it in a developing country but it may be possible to work out.

It will likely be harder to establish a practice if you only are available to patients half the time. Also, I think you might be underestimating the fatigue with working in the ER for 24 hours especially if you have to drive 2 hours or so to the location. But you are still young.

 

[cabinbuilder]

Student. No offer, just basing my info on internet job searches at the moment. Looks like most ED's are contracted ER companies that are going to prefer a boarded EM doc but their first priority is coverage so they will hire the whoever is willing to take the job.

Man are you going to have a huge wake up call in the future. Nice to have aspirations but you will never sleep.

 

[SansaStarkMD]

Man are you going to have a huge wake up call in the future. Nice to have aspirations but you will never sleep.

Three days of clinic and a 24 hour shift is torture? What am I missing?

 

[FrustratedFamDoc]

Three days of clinic and a 24 hour shift is torture? What am I missing?

I think you are seriously underestimating just how exhausting mentally, physically and emotionally this job can be.

 

[Carouselambra]

That shift work is what is gonna get you imo. It ain't easy. I'm just a nurse but man, I come from an athletic background having played baseball in college, and I still stay very fit, but shift work is simply exhausting mentally and physically. I've never had to do a 24 hr shift. I'm sure I could handle them but in the long run I'd be miserable and exhausted.

After your 24 hr shift your day will be spent sleeping. You're young so the next day will be fine. After 6-12+ months you probably won't be able to bounce back like you used to and it'll take two days just to get back on track. At least that's how I felt working nights for 1 1/2 years.

 

[TableMD]

Sansa

It seems like you are super interested in surgical OB, and the rest of this is stuff being put into place to pay for/allow you to travel abroad to do it. I don't think the sacrifice of residency should be made for a feature of your job that is a sporadic side gig.

I would strongly consider shadowing OB Gyns and Family Docs who do OB and deciding whose day to day activities interest you the most. I get it, I was very close to doing my AI in OB, because I enjoyed L&D, but I just don't particularly like hospitals.

 

[cabinbuilder]

Three days of clinic and a 24 hour shift is torture? What am I missing?

What you are missing is the charting, the drug seekers, the lab results that have to be reviewed, the coding that didn't get done right that needs to be fixed, the staff drama, the admin meetings, the after hours calls. I just finished (3) 12 hr shifts and I am TIRED. I don't have call. I pick up locums gigs on the weekends occasionally and that wears on you too. You don't understand the amount of responsibility you will have and how that drains you.

 

[SansaStarkMD]

I'm assuming it's not difficult to get OB privileges if you just want to do normal deliveries and no c sections? One option would be to do that for a few years to build up my panel and then drop OB. The residency I'm considering that has strong OB also has a level one trauma center so it's not like I'm giving up ER training to get good at OB.

 

[SansaStarkMD]

What you are missing is the charting, the drug seekers, the lab results that have to be reviewed, the coding that didn't get done right that needs to be fixed, the staff drama, the admin meetings, the after hours calls. I just finished (3) 12 hr shifts and I am TIRED. I don't have call. I pick up locums gigs on the weekends occasionally and that wears on you too. You don't understand the amount of responsibility you will have and how that drains you.

Admin meetings and after hours calls? I've never heard of that before. Must be a small ER thing?

 

[cabinbuilder]

Admin meetings and after hours calls? I've never heard of that before. Must be a small ER thing?

NO, that is having a job thing. There are clinic meetings that every jobs requires. If you have a family practice clinic then yes, you are responsible for your patient's after hours. Most calls go through the answering service but sometimes you will have to take calls for your own patients. Especially if you do OB - your patient's will want to take to you.

 

[SansaStarkMD]

NO, that is having a job thing. There are clinic meetings that every jobs requires. If you have a family practice clinic then yes, you are responsible for your patient's after hours. Most calls go through the answering service but sometimes you will have to take calls for your own patients. Especially if you do OB - your patient's will want to take to you.

Oh, I thought you were talking about ER.

 

[cabinbuilder]

Oh, I thought you were talking about ER.

Not necessarily but ER docs are part of a group and they have meetings too.

 

[galactus]

Ah yes. The meetings on meetings! I thought I had a lot of meetings in residency/chief year, but man the clinic staff meetings, grand rounds, department faculty meetings, hospital(s) faculty meetings, school wide faculty meetings, and all those specialty organization meetings just crushes your ideal schedule. Last week I had evening meetings Mon-Thurs!

 

[Shinken]

Ah yes. The meetings on meetings! I thought I had a lot of meetings in residency/chief year, but man the clinic staff meetings, grand rounds, department faculty meetings, hospital(s) faculty meetings, school wide faculty meetings, and all those specialty organization meetings just crushes your ideal schedule. Last week I had evening meetings Mon-Thurs!

So true! Every week I average about 2-3 meetings. Sometimes I tell med students that I'm not a family physician, I'm a specialist in meetingology.

 

[SansaStarkMD]

Yikes

 

[AMEHigh]

I'm assuming it's not difficult to get OB privileges if you just want to do normal deliveries and no c sections? One option would be to do that for a few years to build up my panel and then drop OB. The residency I'm considering that has strong OB also has a level one trauma center so it's not like I'm giving up ER training to get good at OB.

That completely depends on where you live. Even in moderately sized towns/cities getting privileges is difficult for FPs, so your assumption is incorrect.

Also, remember that you only get so many electives during residency. So it may be difficult to spend extra months doing OB and ER in order to be fully competent to practice those as an attending.

 

[SansaStarkMD]

So when most urban FM docs say they don't do OB, what they mean is they can't do OB. That's incredibly sad. I think I'll do all of my electives in ER and if I find an area that wants me for a decent OB set up, I'll do a fellowship. This gives me the most flexibility,and I'm not investing in skills that might not get used. I know I can definitely do clinic and rural ER.

 

[vendtex]

Lots of FPs that I've seen in various locations don't want to be around the hospital let alone do OB. Some states the malpractice is a deterrent as well even to OBs.


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[letsdoit]

Yes. I know 3 FMs who work 3 days a week and employed by the county hospital system.