Regrets in Urgent Care Full time? Or in FM?

[residentdoc8]

Anyone have regrets going into FM? Or practicing at an Urgent Care center full time? If so, why?

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[smq123]

Anyone have regrets going into FM? Or practicing at an Urgent Care center full time? If so, why?

No regrets about going into FM.

However, I HATE HATE HATE urgent care. I really really hate it. In my opinion, if you took the worst of EM, and the worst of FM, and fused them both together, you'd have Urgent Care.

At our program, you have to do "Same Day Sick" clinic for two weeks, for 2-3 months. You see a ton of viral URIs, and at least 90% of them will give you a dirty look if you don't give them antibiotics. At some point, you start trying to justify in your head why you *maybe* could give them antibiotics, but it's not very medically sound reasoning. All you're trying to do is get them the heck out of your office.

Rarely, you see something interesting...like the lady who came in with SOB and cough, who DID have a viral URI, but also happened to be in rapid a-fib. Or the kid who came in complaining of a stomach bug, but was actually in DKA. That's rare, though.

I saw your other posts in the EM forum. If you love EM, do EM. If you truly like EM, you will be miserable in an FM residency. You will make your personal life fit your job. I know miserable single women in FM, and happy married women in EM. So there's no rhyme or reason...it depends on your personal priorities and how hard you're willing to work to achieve your goals.

 

[cabinbuilder]

No regrets about doing FM

I, on the other hand. LOVE,LOVE,LOVE Urgent care. I am a more see the problem, fix the problem type of person.

I HATE the chronic people in FM. The diabetes, hypertension, morbid obesity, chronic venous stasis ulcers, the high cholesterol, the "F" word ( fibro) patients, the chronic narcotic addicts, the line of people trying to get on disability. The constant "I can't afford my medicine" but I have a cell phone, tattoos, and coach bag complainers. Not to say that I don't take care of these people too but they can be very wearing on your soul if you let them. Makes me crazy that people but in so much energy trying to be sick that they could turn it into the positive and actually have a good life. A lot of it is attitude. If I get up with chronic pain everyday and go to work then so should everyone else.

It's what I call "managing your misery" and living your life.

I enjoy ER and being the hospitalist too.

 

[ghost dog]

No regrets about doing FM

I, on the other hand. LOVE,LOVE,LOVE Urgent care. I am a more see the problem, fix the problem type of person.

I HATE the chronic people in FM. The diabetes, hypertension, morbid obesity, chronic venous stasis ulcers, the high cholesterol, the "F" word ( fibro) patients, the chronic narcotic addicts, the line of people trying to get on disability. The constant "I can't afford my medicine" but I have a cell phone, tattoos, and coach bag complainers. Not to say that I don't take care of these people too but they can be very wearing on your soul if you let them. Makes me crazy that people but in so much energy trying to be sick that they could turn it into the positive and actually have a good life. A lot of it is attitude. If I get up with chronic pain everyday and go to work then so should everyone else.

It's what I call "managing your misery" and living your life.

I enjoy ER and being the hospitalist too.

How long have you being doing urgent care?

This is extremely boring / unchallenging medicine.

 

[cabinbuilder]

How long have you being doing urgent care?

This is extremely boring / unchallenging medicine.

Now, don't get me wrong. I see urgent care as a nice break from clinic jobs. I do random days when I'm needed, it's not a full time day to day gig for me - I agree it would get boring. Since I do locums it can be a nice change. So I have been doing regular clinic medicine since Novemeber and had 4 urgent care days in January to break it up. Then I did 3 months of clinic again and I am doing 15 days urgent care in Texas in April. After than I go back to ER/clinc/hospitalist.

That's probably why I love urgent care so much because it's easy and gives me a break from the chronic folks.

I don't see it as unchallenging, I have had many an odd case come through the doors. Sometimes you are the only doctor that patient can afford to see. I guess it's all about perspective. It's fun for me and easy money.

 

[LouisianaDoctor]

Now, don't get me wrong. I see urgent care as a nice break from clinic jobs. I do random days when I'm needed, it's not a full time day to day gig for me - I agree it would get boring. Since I do locums it can be a nice change. So I have been doing regular clinic medicine since Novemeber and had 4 urgent care days in January to break it up. Then I did 3 months of clinic again and I am doing 15 days urgent care in Texas in April. After than I go back to ER/clinc/hospitalist.

That's probably why I love urgent care so much because it's easy and gives me a break from the chronic folks.

I don't see it as unchallenging, I have had many an odd case come through the doors. Sometimes you are the only doctor that patient can afford to see. I guess it's all about perspective. It's fun for me and easy money.

Sir, may you please describe in further detail what you mean by "doing locums"? I understand, I believe, that locum tenens (sp?) is filling for other doctors when they go on extended vacations. So have you made your practice just traveling the country doing locums? And you work at other places when necessary? Do you have to have a license in every state to do this?

 

[cabinbuilder]

Sir, may you please describe in further detail what you mean by "doing locums"? I understand, I believe, that locum tenens (sp?) is filling for other doctors when they go on extended vacations. So have you made your practice just traveling the country doing locums? And you work at other places when necessary? Do you have to have a license in every state to do this?

1. I am not a sir, I am a ma'am.
2. Locum Tenens is working for an agency or agencies that place physicians in clinic who need help with overflow, or there is a shortage there, or vacation relief, etc. There is a shortage of family practice in rural areas so there are plenty of jobs out there to do.
3. Yes, I have not found an agreeable permanent job so I travel on the quest to find a fit for me where I am not treated like a slave and get along with the admin. Locums you get paid by the hour so whatever time you put in, you get compensated for. That is not necessarily true for a salary position.
4.Unless you are working on a military base or on a Federal Indian reservation (they take any state license) you have to be licensed in the state you travel to.
5. I am licensed in TX, MT, CO, OR, NV, and AK
6.Most locums sites want a minimum of 8 weeks commitment with them but others just need weekend or vacation covered - hence the 4 days I did urgent care in January. It was close to my other gig so I could swing both sites.
7. I like locums because it's is very free. If I get to a site and it's terrible, I can leave. There is always an end date, usually I can extend if I want and if I want to take 2 weeks, or a month, or 2 months vacation inbetween jobs I can and I don't have to ask anyone's permission to do so.
8. The placement agency pays for my malpractice for that job. I purchase my own health insurance, it's up to me to withhold taxes and pay at the end of the year.
9.I do not find the jobs, the placement agencies have a list of who needs help and calls me regarding my availability and desire to be "presented" at that site. So it is totaly in my control and I am not the one wasting time trying to find a job.

 

[MumDoc]

Cabinbuilder,
How do you do all of this with a family? Just curious.

1. I am not a sir, I am a ma'am.
2. Locum Tenens is working for an agency or agencies that place physicians in clinic who need help with overflow, or there is a shortage there, or vacation relief, etc. There is a shortage of family practice in rural areas so there are plenty of jobs out there to do.
3. Yes, I have not found an agreeable permanent job so I travel on the quest to find a fit for me where I am not treated like a slave and get along with the admin. Locums you get paid by the hour so whatever time you put in, you get compensated for. That is not necessarily true for a salary position.
4.Unless you are working on a military base or on a Federal Indian reservation (they take any state license) you have to be licensed in the state you travel to.
5. I am licensed in TX, MT, CO, OR, NV, and AK
6.Most locums sites want a minimum of 8 weeks commitment with them but others just need weekend or vacation covered - hence the 4 days I did urgent care in January. It was close to my other gig so I could swing both sites.
7. I like locums because it's is very free. If I get to a site and it's terrible, I can leave. There is always an end date, usually I can extend if I want and if I want to take 2 weeks, or a month, or 2 months vacation inbetween jobs I can and I don't have to ask anyone's permission to do so.
8. The placement agency pays for my malpractice for that job. I purchase my own health insurance, it's up to me to withhold taxes and pay at the end of the year.
9.I do not find the jobs, the placement agencies have a list of who needs help and calls me regarding my availability and desire to be "presented" at that site. So it is totaly in my control and I am not the one wasting time trying to find a job.

 

[cabinbuilder]

Cabinbuilder,
How do you do all of this with a family? Just curious.

My husband stays home. He is retired. I have teenage kids who are very busy with their lives. Even when I am home I only see them a few hours in the day. It works out that I go work somewhere for a few weeks and make trips home on the weekends. Many of the jobs I have worked have been within driving distance from my house so I work a 4 day week and go home for 3. Otherwise I fly back home every 2 weeks to see them. Once the job is over I usually take a few weeks off to be home, stock the house with groceries, etc. I pay all the bills on line so it doesn't matter where I am. I have direct deposit of my checks. We just had spring break and we all went to Vegas for the week while the kids were off. My kids are so used to travelling and being away it's not a big deal because early on they were with their dad every summer for a three month span so got used to me not being there every day.

 

[SnakeOil]

My husband stays home. He is retired. I have teenage kids who are very busy with their lives. Even when I am home I only see them a few hours in the day. It works out that I go work somewhere for a few weeks and make trips home on the weekends. Many of the jobs I have worked have been within driving distance from my house so I work a 4 day week and go home for 3. Otherwise I fly back home every 2 weeks to see them. Once the job is over I usually take a few weeks off to be home, stock the house with groceries, etc. I pay all the bills on line so it doesn't matter wher I am. I have directed deposit of my checks. We just had spring break and we all went to Vegas for the week while the kids were off. My kids are so used to travelling and being away it's not a big deal because early on they were with their dad every summer for a three month span so got used to me not being there every day.

Do the locum agencies pay for your travel?

 

[cabinbuilder]

Do the locum agencies pay for your travel?

No, they set it up for you. The site you work at pays for the travel, housing, rental car, food, gas. Bottom line, I don't have anything out of pocket except for luggage fees and gas that get reimbursed on my timesheet.

 

[MumDoc]

That is pretty sweet. You said you were starting a new job in May. Is that a more permanent one?

My husband stays home. He is retired. I have teenage kids who are very busy with their lives. Even when I am home I only see them a few hours in the day. It works out that I go work somewhere for a few weeks and make trips home on the weekends. Many of the jobs I have worked have been within driving distance from my house so I work a 4 day week and go home for 3. Otherwise I fly back home every 2 weeks to see them. Once the job is over I usually take a few weeks off to be home, stock the house with groceries, etc. I pay all the bills on line so it doesn't matter wher I am. I have directed deposit of my checks. We just had spring break and we all went to Vegas for the week while the kids were off. My kids are so used to travelling and being away it's not a big deal because early on they were with their dad every summer for a three month span so got used to me not being there every day.

 

[cabinbuilder]

Yes, it is permanent but it pays like locums as a contract provider. 2 weeks on/2 weeks off and I get paid per hour instead of salary.

 

[MumDoc]

Nice. You got it good cabinbuilder. You know how to pick the sweet deals.

Yes, it is permanent but it pays like locums as a contract provider. 2 weeks on/2 weeks off and I get paid per hour instead of salary.

 

[cabinbuilder]

Nice. You got it good cabinbuilder. You know how to pick the sweet deals.

Well, I have three years of trial and error. Quitting 3 permanent jobs in the process and paying the bills with locums you learn what is out there and gravitate towards the jobs that are agreeable to your personality.

 

[SnakeOil]

Well, I have three years of trial and error. Quitting 3 permanent jobs in the process and paying the bills with locums you learn what is out there and gravitate towards the jobs that are agreeable to your personality.

401k? Benefits? Or are you pretty much on your own?

 

[ghost dog]

Well, I have three years of trial and error. Quitting 3 permanent jobs in the process and paying the bills with locums you learn what is out there and gravitate towards the jobs that are agreeable to your personality.

If these are rural gigs: do you do ER shifts and admit your own pts?

 

[cabinbuilder]

401k? Benefits? Or are you pretty much on your own?

I have my own IRA I have started through my bank. I have my own health insurance that I purchase. It's a trade that I accept for not having anyone own my soul. I work when I want and am off when I want.

 

[cabinbuilder]

If these are rural gigs: do you do ER shifts and admit your own pts?

Depends on the job site and what they require. Some I have worked ER (I get paid extra) and if the site needs hospitalist I can and have admitted my own patients. Just depends on whether they have hospitalist there already and if that faction needs help too. Some places I take call (I get paid extra for that too), some I don't.

The thing about locums is that you have to be flexible. The agency lets me know what will be required at that site and I have the option of telling them no if I don't feel it would be a good fit then I decline to go there.

Some rural jobs are just straight clinic in the middle of nowhere, like an outreach where you triage and send people to the hospital if needed.

I would rather do all of it and be able to admit my own patients then I know they are taken care of how I think they should be. For example, my last site I had a lady come into clinic with a swollen, tender leg. The US was + for DVT. I called the hospitalist to admit for IV heparin/coumadin since the patient was 80 yrs old. THEY REFUSED TO ADMIT stating she was "stable" so I ended up having her travel twice a day as an outpatient to get lovenox to bridge the coumadin. Now, had I had priviledges there, I would have admitted and saved everyone a huge hassle with transportation and made it move convenient for the patient and family. Makes me crazy when other doctors are lazy.

Sorry, I hope that answered your questions.

 

[MumDoc]

Cabinbuilder, would you say your IRA is as good as a 401k?

I have my own IRA I have started through my bank. I have my own health insurance that I purchase. It's a trade that I accept for not having anyone own my soul. I work when I want and am off when I want.

 

[cabinbuilder]

Cabinbuilder, would you say your IRA is as good as a 401k?

No, because I don't have an employer matching funds. My retirement is weak right now since I just got out of residency. It will come in time.

 

[residentdoc8]

From what i've gathered-- UC would be a good option via a FM route, but FM also allows for much flexibility (hospitalst, UC, outpt clinic, private practice, locum tenems, nursing homes, ED in a rural area where there's a great need although this is becoming more rare, etc.)-- the one thing I worry about is the supply vs. demand (lots of FM Physicians and the future demand).

I've heard of a Physician shortage....but with the new Obamacare, it sounds as though mid-level professionals (nurses, PA's, etc.) would have an advantage and replace existing FM Physicians-- in your opinion, how stable of a career is the future of FM?

 

[Dharma]

...the one thing I worry about is the supply vs. demand (lots of FM Physicians and the future demand).

I've heard of a Physician shortage....but with the new Obamacare, it sounds as though mid-level professionals (nurses, PA's, etc.) would have an advantage and replace existing FM Physicians-- in your opinion, how stable of a career is the future of FM?

Sounds like a good question for a new thread to get the attention of the other attendings as well. I'm just a lowly to-be-med student, but I like one of the quotes a regular (Blue Dog I believe) on these forums states (I'll paraphrase): "If you think you could be replaced by a midlevel, then maybe you should be." My interpretation of this is that a competent and skilled family medicine physician has nothing to fear.

Of all the specialities in medicine, I'd gather to say that primary care has the brightest future amongst all of this doom-n-gloom speculation. Skilled FPs will always be needed.

 

[deleted87716]

I like one of the quotes a regular (Blue Dog I believe) on these forums states (I'll paraphrase): "If you think you could be replaced by a midlevel, then maybe you should be." My interpretation of this is that a competent and skilled family medicine physician has nothing to fear.

Of all the specialities in medicine, I'd gather to say that primary care has the brightest future amongst all of this doom-n-gloom speculation. Skilled FPs will always be needed.

No doubt about it.

 

[tony montana]

No regrets about doing FM

I, on the other hand. LOVE,LOVE,LOVE Urgent care. I am a more see the problem, fix the problem type of person.

I HATE the chronic people in FM. The diabetes, hypertension, morbid obesity, chronic venous stasis ulcers, the high cholesterol, the "F" word ( fibro) patients, the chronic narcotic addicts, the line of people trying to get on disability. The constant "I can't afford my medicine" but I have a cell phone, tattoos, and coach bag complainers. Not to say that I don't take care of these people too but they can be very wearing on your soul if you let them. Makes me crazy that people but in so much energy trying to be sick that they could turn it into the positive and actually have a good life. A lot of it is attitude. If I get up with chronic pain everyday and go to work then so should everyone else.

It's what I call "managing your misery" and living your life.

I enjoy ER and being the hospitalist too.

I LOVE LOVE LOVE LOVE URGENT CARE

Keep the chronics and the hospital patients give me the urgents please

 

[cabinbuilder]

From what i've gathered-- UC would be a good option via a FM route, but FM also allows for much flexibility (hospitalst, UC, outpt clinic, private practice, locum tenems, nursing homes, ED in a rural area where there's a great need although this is becoming more rare, etc.)-- the one thing I worry about is the supply vs. demand (lots of FM Physicians and the future demand).

I've heard of a Physician shortage....but with the new Obamacare, it sounds as though mid-level professionals (nurses, PA's, etc.) would have an advantage and replace existing FM Physicians-- in your opinion, how stable of a career is the future of FM?

I would say FP is VERY stable. I just flew to Texas today for a weekend shift in urgent care because THEY COULDN'T FIND ANYONE LOCAL WHO WOULD WORK EASTER. They are paying me double, flew me here, flying me back, rental car, and the hotel suite. Then I am going back home for 4 days and flying back for another 9. For those of you fearing there is no future for FM - I'm just not buying it. We are the most versatile of all the specialities and can work anywhere.

 

[deleted87716]

I HATE HATE HATE urgent care. I really really hate it. In my opinion, if you took the worst of EM, and the worst of FM, and fused them both together, you'd have Urgent Care.

At our program, you have to do "Same Day Sick" clinic for two weeks, for 2-3 months. You see a ton of viral URIs, and at least 90% of them will give you a dirty look if you don't give them antibiotics. At some point, you start trying to justify in your head why you *maybe* could give them antibiotics, but it's not very medically sound reasoning. All you're trying to do is get them the heck out of your office.

 

[ghost dog]

I LOVE LOVE LOVE LOVE URGENT CARE

Keep the chronics and the hospital patients give me the urgents please

So young.

It gets old in a hurry. and annoying.

When the tenth person on your shift asks your for abx for a viral illness or is drug seeking - this is not a satisfying way to practice.

Good return on investment - yes, perhaps.

A good way to spend a significant amount of time / career - hells to the NO.

 

[SnakeOil]

I have my own IRA I have started through my bank. I have my own health insurance that I purchase. It's a trade that I accept for not having anyone own my soul. I work when I want and am off when I want.

Just out of curiosity, what type of IRA do you have? I'm guessing your income is too high to make contributions to a roth or traditional unless you're doing a backdoor or stealth roth. Do you feel like the pay doing locum makes up for the loss of benefits?

 

[cabinbuilder]

Just out of curiosity, what type of IRA do you have? I'm guessing your income is too high to make contributions to a roth or traditional unless you're doing a backdoor or stealth roth. Do you feel like the pay doing locum makes up for the loss of benefits?

I have traditional IRA. What types of benefits do you think I have lost? My health insurance is actually better or the same as what I was getting with the last company I worked for. I have tons of vacation time when I want it. Locums is cash upfront so the government isn't using my money - I'm using it and I pay the taxes at the end of the year.

I would much rather have 15-25K a month to do what I want rather than having everything taken out before I get the check that drops me down to 9.5K (that's on 15K). I pretty much know how much I will have to pay at the end so I work extra the last three months to save for the IRS. Many would not like that but it works for me.

 

[andwhat]

Urgent care is quite annoying. Patients are almost never satisfied, even if you do everything, including talking to their doctor. It is a frustrating thing Urgent Care, also doesn't pay the best. Cabinbear must be part of a good Urgent Care gig, if it is procedurally oriented, and of course pays well, it is nice.
By the way, I am a strong believer of Fibromyalgia doesn't exist.

No regrets about going into FM.

However, I HATE HATE HATE urgent care. I really really hate it. In my opinion, if you took the worst of EM, and the worst of FM, and fused them both together, you'd have Urgent Care.

At our program, you have to do "Same Day Sick" clinic for two weeks, for 2-3 months. You see a ton of viral URIs, and at least 90% of them will give you a dirty look if you don't give them antibiotics. At some point, you start trying to justify in your head why you *maybe* could give them antibiotics, but it's not very medically sound reasoning. All you're trying to do is get them the heck out of your office.

Rarely, you see something interesting...like the lady who came in with SOB and cough, who DID have a viral URI, but also happened to be in rapid a-fib. Or the kid who came in complaining of a stomach bug, but was actually in DKA. That's rare, though.

I saw your other posts in the EM forum. If you love EM, do EM. If you truly like EM, you will be miserable in an FM residency. You will make your personal life fit your job. I know miserable single women in FM, and happy married women in EM. So there's no rhyme or reason...it depends on your personal priorities and how hard you're willing to work to achieve your goals.

 

[SnakeOil]

I have traditional IRA. What types of benefits do you think I have lost? My health insurance is actually better or the same as what I was getting with the last company I worked for. I have tons of vacation time when I want it. Locums is cash upfront so the government isn't using my money - I'm using it and I pay the taxes at the end of the year.

I would much rather have 15-25K a month to do what I want rather than having everything taken out before I get the check that drops me down to 9.5K (that's on 15K). I pretty much know how much I will have to pay at the end so I work extra the last three months to save for the IRS. Many would not like that but it works for me.

The long-term tax benefits + employer matching you get with a 401k is pretty substantial. Health insurance, paid vacation, CME, and malpractice are just a few other benefits you may miss out on if you're doing contract work.

Sure, what you take home every 2 weeks may be more than what it would be if you had taxes taken out of your check upfront but the bottom line when you enter retirement is a lot more important than what you take home now IMO.

To make up for the lost benefits of being a paid contractor vs FTE most say you should be making at least 15% more than you would as a FTE to make up it. I guess my question is whether you feel like what you make on top of what you'd be making as a FTE makes it worth it.

As far as your traditional IRA goes, have you considered converting your contributions into a roth IRA? Your income is probably too high to make direct contributions to a roth but as long as you don't have any existing pre-tax traditional IRAs you can convert your contributions to a roth without penalty.

Since your income is likely too high to deduct any of your traditional IRA contributions all a traditional account is doing for you is extending the date by which taxes on investment earnings will need to be paid. In a roth those earnings would be withdrawn tax-free at retirement.

I don't know if this would help your situation or not but something worth looking into if you haven't already.

 

[residentdoc8]

Urgent care is quite annoying. Patients are almost never satisfied, even if you do everything, including talking to their doctor. It is a frustrating thing Urgent Care, also doesn't pay the best. Cabinbear must be part of a good Urgent Care gig, if it is procedurally oriented, and of course pays well, it is nice.
By the way, I am a strong believer of Fibromyalgia doesn't exist.

So what does "not paying the best" mean? I have looked at hourly pay- depending on geographical location- i've seen anywhere form $70-$100/hr (more on weekends and holidays)-- if working 4- 12hour shifts per week, yearly salary ranges from $161K-$230K-- how is that not being paid well? Yes, compared to derm or optho, anesthesia, rads, etc.it is not being paid as well, but is that a realistic salary figure?

 

[SnakeOil]

So what does "not paying the best" mean? I have looked at hourly pay- depending on geographical location- i've seen anywhere form $70-$100/hr (more on weekends and holidays)-- if working 4- 12hour shifts per week, yearly salary ranges from $161K-$230K-- how is that not being paid well? Yes, compared to derm or optho, anesthesia, rads, etc.it is not being paid as well, but is that a realistic salary figure?

Yeah, figures for UC jobs that I've seen seem to be higher than average for FM jobs. Maybe in certain areas urgent care pays less, IDK.

 

[andwhat]

So young.

It gets old in a hurry. and annoying.

When the tenth person on your shift asks your for abx for a viral illness or is drug seeking - this is not a satisfying way to practice.

Good return on investment - yes, perhaps.

A good way to spend a significant amount of time / career - hells to the NO.

agreed one thousand percent

 

[andwhat]

So what does "not paying the best" mean? I have looked at hourly pay- depending on geographical location- i've seen anywhere form $70-$100/hr (more on weekends and holidays)-- if working 4- 12hour shifts per week, yearly salary ranges from $161K-$230K-- how is that not being paid well? Yes, compared to derm or optho, anesthesia, rads, etc.it is not being paid as well, but is that a realistic salary figure?

it is subjective, higher than 70 for sure though. Paid the best meaning pay for the number of patients that you see, the ratio, which rarely happens you are paid a flat rate. 161 to 230 K with no nights is great!

 

[residentdoc8]

I would have to say that I would worry about being replaced by a mid-level because of their salary could be less with the same amount of work, and no nights is nice but I would say the hours aren't the greatest either (i've seen the latest getting out at 10pm...so you'd be off-schedule from the rest of the world even though you don't do nights)-- also, private practice makes more sense in the long-run because when you are ready to retire, you have something to sell and get a chunk of change back in return from what you invested. Hospitalist jobs sound alluring too-- there are some places with two weeks on and two weeks off with a salary over 200K-- that means 2 weeks of the entire month you have off, but the 2 weeks when you are on-- you are working hard and have one week of call. So I guess it all depends.

 

[andwhat]

I would have to say that I would worry about being replaced by a mid-level because of their salary could be less with the same amount of work, and no nights is nice but I would say the hours aren't the greatest either (i've seen the latest getting out at 10pm...so you'd be off-schedule from the rest of the world even though you don't do nights)-- also, private practice makes more sense in the long-run because when you are ready to retire, you have something to sell and get a chunk of change back in return from what you invested. Hospitalist jobs sound alluring too-- there are some places with two weeks on and two weeks off with a salary over 200K-- that means 2 weeks of the entire month you have off, but the 2 weeks when you are on-- you are working hard and have one week of call. So I guess it all depends.

agreed completely, hours are highly variable. Believe it or not, some higher volume institutions have thought of replacing Hospitalists with midlevels to cut costs. That is scary.

 

[Prncssbuttercup]

What I (incoming student) am getting from this is: Work as a hospitalist and do locum UC work on my week off here/there to have my vacation in Tahiti
This thread is really informative so thanks

 

[elfmonkey]

agreed completely, hours are highly variable. Believe it or not, some higher volume institutions have thought of replacing Hospitalists with midlevels to cut costs. That is scary.

Shouldn`t the medical community do something about that ?
I did some training in a nearby hospital where they have an e-ICU with lots of mid-levels running the wards . I thought they did that because they didn`t have enough trained doctors in town !
I`m confused .
FP`s struggle to get hospital privileges, but when it comes to cutting cost, MD hospitalists can be easily replaced with PA`s and NP`s ?!

 

[tony montana]

So young.

It gets old in a hurry. and annoying.

When the tenth person on your shift asks your for abx for a viral illness or is drug seeking - this is not a satisfying way to practice.

Good return on investment - yes, perhaps.

A good way to spend a significant amount of time / career - hells to the NO.

Who cares if the tenth patient has a similar problem as the previous ten (not too different from many other specialties or jobs for that matter)...they got a problem I do my best to fix it, instant gratification, they go home happy, I go home happy and get the rest of my satisfaction from the real world outside of medicine.

Maybe to others medicine is some romantic idealistic part of their life...to me medicine is my job. Once my job ends my life starts.

 

[cabinbuilder]

The long-term tax benefits + employer matching you get with a 401k is pretty substantial. Health insurance, paid vacation, CME, and malpractice are just a few other benefits you may miss out on if you're doing contract work.
My health insurance cost is less what I paid out on a salary job by about 300/month
I have all the vacation I want, the salary jobs only give you 4 weeks/year. I have 26 weeks
The CME cost is minimal and I do most of mine free online anyway.
My malpractice is paid for by the locums agency at no cost to me.
Right now I don't really care about my 401K because that means I have to be some corporate slave again and I am not ready to give up my freedom for long-term tax benefits when in the short term I was miserable.

For me, these "benefits" are irrelevant I would rather have my freedom.

Sure, what you take home every 2 weeks may be more than what it would be if you had taxes taken out of your check upfront but the bottom line when you enter retirement is a lot more important than what you take home now IMO. For me in the here and now, I would rather have the cash up front to do things with my kids as they will be out of the house soon.

To make up for the lost benefits of being a paid contractor vs FTE most say you should be making at least 15% more than you would as a FTE to make up it. I guess my question is whether you feel like what you make on top of what you'd be making as a FTE makes it worth it.

Yes, to me it is totally worth it. I make way more money as a contract, have more time off, and more freedom to dictate my schedule.

 

[andwhat]

Shouldn`t the medical community do something about that ?
I did some training in a nearby hospital where they have an e-ICU with lots of mid-levels running the wards . I thought they did that because they didn`t have enough trained doctors in town !
I`m confused .
FP`s struggle to get hospital privileges, but when it comes to cutting cost, MD hospitalists can be easily replaced with PA`s and NP`s ?!

good luck with that. Its about cost cutting. Quantity (more providers less money) over quality any day. Fortunately this doesnt happen everywhere, and thank goodness.

 

[ghost dog]

Who cares if the tenth patient has a similar problem as the previous ten (not too different from many other specialties or jobs for that matter)...they got a problem I do my best to fix it, instant gratification, they go home happy, I go home happy and get the rest of my satisfaction from the real world outside of medicine.

Maybe to others medicine is some romantic idealistic part of their life...to me medicine is my job. Once my job ends my life starts.

I'll see you in 5 years.

I will bet you a virtual beverage of your choice that your sentiments are entirely different.

Considerable research has been done showing that , while dolla bills are nice, job satisfaction is surprisingly important.

Me: Ms. Jones you have a viral illness that does not require an antibiotic today. The only thing that an antibiotic will do for you is likely
give you a nasty case of diarrhea, and not help your cough.

Ms. Jones: but my usual doctor / nurse quacktioner always gives me an antibiotic for my nasty cough - and it goes away. Can't you just give me an antibiotic ?

Head-desk #1.

Drugseeker 100001: Doc, I have this awful dental pain.

Me: Mr. Hendrix I see no dental problems, and your on-site drug screen is positive for cocaine, methadone, meth-amphetamines, and marijuana. I see that you informed the nurse that you are allergic to all NSAIDs, and codeine. Unfortunately , I am unable to help you today.

Drug seeker: But doc, can't you just give me a few percs? I'm in real bad withdrawal, and missed my methadone today !

Me: I thought you had dental pain.

Drug seeker: Uh, oh - yeah that too. ( Eh , ah , oh - pantomiming dental pain).

Me: Head-desk # 2.

 

[Prncssbuttercup]

What about "omg I'm having an anxiety attack & I'm all out of my xyz controlled substance" please give me more before I have an MI

 

[cabinbuilder]

What about "omg I'm having an anxiety attack & I'm all out of my xyz controlled substance" please give me more before I have an MI

I would say, "go ahead and have your MI as I have a cardiologist friend who would be happy to cath you today". It will hurt real bad and be very expensive but you will be alive tomorrow. Usually they jump off the exam table and leave after that.

 

[cabinbuilder]

The long-term tax benefits + employer matching you get with a 401k is pretty substantial. Health insurance, paid vacation, CME, and malpractice are just a few other benefits you may miss out on if you're doing contract work.

Sure, what you take home every 2 weeks may be more than what it would be if you had taxes taken out of your check upfront but the bottom line when you enter retirement is a lot more important than what you take home now IMO.

To make up for the lost benefits of being a paid contractor vs FTE most say you should be making at least 15% more than you would as a FTE to make up it. I guess my question is whether you feel like what you make on top of what you'd be making as a FTE makes it worth it.

As far as your traditional IRA goes, have you considered converting your contributions into a roth IRA? Your income is probably too high to make direct contributions to a roth but as long as you don't have any existing pre-tax traditional IRAs you can convert your contributions to a roth without penalty.

Since your income is likely too high to deduct any of your traditional IRA contributions all a traditional account is doing for you is extending the date by which taxes on investment earnings will need to be paid. In a roth those earnings would be withdrawn tax-free at retirement.

I don't know if this would help your situation or not but something worth looking into if you haven't already.

I will have to say I initially took this post as rather irritating. My retirement issue is very complicated at the moment due to the nature of my income and the fact that I just incorporated. So until I visit with my tax accountant, to fund any IRA at this point really doesn't help me in any way. I'm not rushing into anything at the moment because bottom line: I MAKE TOO MUCH MONEY. Well above the 15% you mentioned as a FTE. I will NEVER be salary employed again. It's just not worth the pay:hour ratio. I hope this ends everyone's concern that I won't have a retirement fund and will be living on the street at at 70.

 

[ghost dog]

I will have to say I initially took this post as rather irritating. My retirement issue is very complicated at the moment due to the nature of my income and the fact that I just incorporated. So until I visit with my tax accountant, to fund any IRA at this point really doesn't help me in any way. I'm not rushing into anything at the moment because bottom line: I MAKE TOO MUCH MONEY. Well above the 15% you mentioned as a FTE. I will NEVER be salary employed again. It's just not worth the pay:hour ratio. I hope this ends everyone's concern that I won't have a retirement fund and will be living on the street at at 70.

Do you make too much money ?

Have your friends overstayed their welcome at your ski chalet ?

Can you not find that perfect sweater vest at the gap that Thad pointed out to you the other day ?

Stay tuned.This, and other important issues , will be covered on the next episode of: white people problems.

 

[cabinbuilder]

Hmm nice to see that the haters are out in full force this evening. Thanks so much for the backup.

 

[SnakeOil]

I will have to say I initially took this post as rather irritating. My retirement issue is very complicated at the moment due to the nature of my income and the fact that I just incorporated. So until I visit with my tax accountant, to fund any IRA at this point really doesn't help me in any way. I'm not rushing into anything at the moment because bottom line: I MAKE TOO MUCH MONEY. Well above the 15% you mentioned as a FTE. I will NEVER be salary employed again. It's just not worth the pay:hour ratio. I hope this ends everyone's concern that I won't have a retirement fund and will be living on the street at at 70.

Making too much money is a serious problem indeed. I can now see clearly why you can't save for retirement - you make way too much

It's perfectly fine with me if you don't save for retirement. If every wealthy person exploited the tax shelters the government offers, I'm sure they would put a quick end to them. This would make it much harder to save for my own future so I in reality I should be thanking you.

All joking aside, I know saving is tough and everyone's circumstances are different. Best of luck with your finances. I promise not to offer any more advice.