Urgent Care As A Career

Discussion in 'Family Medicine' started by Pilgrimage, Nov 17, 2018.

  1. Pilgrimage

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    Hey guys!

    M3 possibly interested in FM here. Taking a look at career paths. I have heard of a few FM grads doing urgent care full-time.

    I'd be interested to know:

    -how common is this?

    -how doable/practical is it?

    -what kind of flexibility and work-lifestyle balance does it afford in scheduling and work-load?

    Thanks! I've searched these forums and surfed some online job postings, but I'd like more perspective on this.
     
    #1 Pilgrimage, Nov 17, 2018
    Last edited: Nov 17, 2018
  2. madiso30

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    So take this with some pre-med lack of knowledge.

    One mentor of mine with an FM background does urgent care and telemedicine only. He started a telemedicine practice that was bought up by a large healthcare network. He then became their “chief of urgent care” and he bounces back and forth between all of their different urgent care clinics.

    That’s just his story. I’m sure there’s various ways to do urgent care as a career.
     
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  3. Blue Dog

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    Most urgent care docs burned out in their original specialty (frequently EM), are semi-retired, or simply can't do anything else for whatever reason. I only know one fellow residency grad who does full-time urgent care. One of these days, I'll have to ask him why.


    brain-in-urgent-care.jpg
     
    #3 Blue Dog, Nov 18, 2018
    Last edited: Nov 18, 2018
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  4. VA Hopeful Dr

    VA Hopeful Dr Senior Member
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    I did full time urgent care for a year. It was the worse year of my life. I frequently said that I was happier in residency and my wife believed me.

    Pros:

    - Defined schedule with no call
    - Money is usually decent
    - Given the explosion of urgent cares, its easy to find work

    Cons:
    - Long shifts, usually 12 hours
    - Weekends and holidays you have to work
    - You're basically an antibiotic dispensing machine. If people go to an urgent care and leave without an antibiotic, they are going to be pissed off. I tried giving meds for symptoms and that doesn't help.
    - You lose a lot of your FM skills like chronic disease management and preventative medicine
    - 90% of your patients will have URIs or some flavor
    - No control over your schedule when working. I had days where in 12 hours I saw 20 people and days where in 12 hours I saw 76 (my highest).
     
  5. Bacchus

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    Don’t do it. It’s a waste of your degree. There’s a reason most health networks hire APCs for these roles, the complexity is low and algorithmic. You will lose important knowledge.
     
    #5 Bacchus, Nov 18, 2018
    Last edited: Nov 18, 2018
  6. AMEHigh

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    I “know” one woman from a non-medical message board that does urgent care full time. I’m not exactly sure how she got in to it, but she seems to love it and talks about all of the benefits. I think she’s worked her way up and is now some sort of director and I’m sure she makes pretty decent money.

    I think the benefits are that it’s shift work and the money is pretty decent. But otherwise I think the day to day can be pretty difficult to make it a full time career with advancement possibilities.
     
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  7. Blue Dog

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    "Shift work" usually means long shifts (e.g., 12 hours), including nights, weekends, and holidays. I'd hardly call that a benefit.
     
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  8. smq123

    smq123 John William Waterhouse
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    My friend did urgent care (not sure if she still is). I think she got a little burned out by continuity clinic, and wanted something where she did not have to follow the patients.
     
  9. septoplasty

    septoplasty Exceptional
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    This should be a sticky, single best post here on the FM forum.

    Basically, Don't do it.. well unless you're in between jobs or need to pay off loans while you're in between jobs.
    I think someone on here said something like "its where FM skills go to die". This is 100% true.
     
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  10. AMEHigh

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    Everyone has different priorities. Some people enjoy the fact that they have 8 or 12 hour shifts 3 to 4 times per week and make more money than traditional 9-5 where you also might be on call and/or finishing your notes or patient calls after hours. (One of the large UC groups near me lets you do 8 hour shifts).
     
  11. TraumaLlamaMD

    TraumaLlamaMD Licensed to chill
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    My husband is working full time at an urgent care while I finish up my training (with the idea that him joining a primary care practice for only two years makes little sense as we will be relocating for my fellowship). He typically works 3 or 4 shifts per week. It’s not something he wants to do forever, and I know he misses some aspects of longterm care management and continuity, but for the time being he seems satisfied enough with the variety of cases and enjoys having a few days a week completely off. Reading over my shoulder he’s commenting that he sees a lot of URIs but enough variety in between that he keeps his sanity. The money is pretty good for the hours worked per week, and he has a scribe there so he’s not finishing notes when he gets home like he had to in residency.
     
  12. VA Hopeful Dr

    VA Hopeful Dr Senior Member
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    If you're making more money doing 36 hours/week of urgent care (average at the places I've moonlighted) than someone working the same hours in regular FM then either you're paid exceptionally well or those primary care jobs are paying very poorly.
     
    #12 VA Hopeful Dr, Nov 21, 2018
    Last edited: Nov 21, 2018
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  13. VA Hopeful Dr

    VA Hopeful Dr Senior Member
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    To expound upon that a little. When I was full time UC, it was the most I've made at any UC - roughly $130/hour (moonlighting was paying $100/hour).

    If we compare that to an average outpatient FP in regular practice, we find that this number isn't all that great. At my current job, we're paid via RVUs. Based on the weekly figures I'm seeing, our established doctors (meaning have been working here more than 2 years) are pulling closer to $160/hour. Many significantly more.

    That's the big difference. If when I was working for that urgent care, I had been paid on production, my hourly rate would have been significantly more (almost double). But I was paid the same whether I saw 20 patients or 60. Ignoring how demoralizing that is, it limits your income to a significant degree.
     
  14. septoplasty

    septoplasty Exceptional
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    Doesn't MGMA data point to UC being better paid than FM?

    Again, these are strictly numbers, doesn't take into account hours/effort put in.
     
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  15. VA Hopeful Dr

    VA Hopeful Dr Senior Member
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    Possibly, I haven't looked at MGMA numbers in several years and didn't pay any attention to urgent care at the time.

    But that's not what I'm seeing on the ground in my specific area.
     
  16. septoplasty

    septoplasty Exceptional
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    So numbers in 2016 (2017 release) said $270k in midwest, lowest was in the eastern part with $248k.
     
  17. DrMeowMeow

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    It's easier to find work in Urgent Care over a normal clinic. I get a bunch of spam emails and calls for Urgent Care/Locums.
     
  18. raptor5

    raptor5 Fooled by Randomness
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    At my institution urgent care is integrated into the health system as we have about 24 urgent care facilities throughout the state. A few are within the hospital but most are within multi-specialty clinics. Only a couple of stand alones. Most docs are FM. Several IM. A few IM/Peds, a few EM. Shifts are 8-12 hours. Volume is 30-60 per 12 hour shift. If full time about 14 shifts per month which includes a sick call in doc, one midnight shift, and two Saturday’s and two Sunday’s. We submit preferences about 2 months ahead of time.


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  19. cabinbuilder

    cabinbuilder Urgent Care Physician
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    I do urgent care exclusively. Everyone I work with only does urgent care
    I work 10 days a month on my contract. I can pick up extra shifts if I want for hourly wage
    Depending on whether it's flu season or not, I see anywhere from 25 -50 people in a 12 hours shift.
     
  20. cabinbuilder

    cabinbuilder Urgent Care Physician
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    I do urgent care full time because I hated FP and I don't like people dying on me in ER. I like the variety, the procedures. I don't have to do f/u. I only work 10 days a month. I don't have to take call. I make plenty of money and am free on my off days to do what I want. I can pick up more shifts if I want.
     
  21. cabinbuilder

    cabinbuilder Urgent Care Physician
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    Yes, I work 12 hour shifts (7a-7p). My schedule is set Thurs, Fri then the next M,T,W. Then I have 7 days off in a row and it repeats. I only work holidays if that is how they fall on my schedule. I don't work nights. My days and hours never change. I basically have two weeks vacation every month.
     
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  22. AMEHigh

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    Well I’m in the NE, so yes in general typical FM positions don’t pay like in other areas of the country. Typically anywhere from 150k to 180k to start. A few recent grads decided to do UC to start for a year due to life/family circumstances and they all were set to make more than typical FM positions in our area. Obviously this is dependent on location and type of FM environment you practice in.
     
  23. Marcus Brody

    Marcus Brody Already has the grail.
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    I think as far as compensation it depends on #1 geography/location and #2 the particular type of clinic you are working at. Some tiny UC clinics do literally nothing but sore throats, runny noses and DOT physicals. They are staffed by LPNs and don't even have labs. Others are practically like ERs sans attached hospital, doing imaging (even on-site CT), IV meds, IVF, staffed by ER RNs, etc. If you are at one of those and it has a steady amount of volume, and it is in the right geographic area, $250-275k is about average. More if you want to work an extra 1-2 shifts per month.

    The downside to full-time urgent care imo is it will slowly...and painfully.. destroy your f#%@ing soul, and also your desire to practice medicine. Remember explaining over and over again back in college and med school in your interviews, how you "like people" (and you actually meant it!) ? Well now imagine a job that has you on a daily basis saying over and over, out-loud to yourself and to your colleagues around you, "I %#@ing hate these people." I mean the 19 year old checking in for abdominal pain for 2 months, sore throat and a cough, a lesion on the penis, and anxiety. To urgent care. :annoyed: Also the 85 year old with exertional SOB/chest pain who insists it's just a cold and that she simply wants a z-pak. The kids who keep being brought in because mom is too lazy to go to their pediatrician. Many if not most of the complaints you were glad to deal with in either the inpatient setting or outpatient primary care setting become infuriating in urgent care for some reason, whether it's the lack of resources/capabilities, the anonymity, the unrealistic expectations, etc. I mean.... "Chest pain," really? At urgent care? Then there are the administrators who are fixated on nothing but productivity numbers and dollars and wait times and patient satisfaction statistics (IE: Press Ganey surveys! :barf: ) and who are perpetually trying to push pre-op clearance visits, DOT physicals, etc on you and your colleagues. And last but not least, of course... the antibiotic fetish the general population in the USA seems to have. "I think I have a sinus infection (ie: runny nose 2 days) I need my z-pak (not even the appropriate abx for bacteral sinusitis) !" and how you are seen as the obligate dispensary of these medications. This **** will burn you out. So yea, $250k/year to do shift work 37.5hr/week is nice in theory but the question is how long can you keep it up?
     
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  24. cabinbuilder

    cabinbuilder Urgent Care Physician
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    My urgent care job is on RVU's. I can pick up shifts at an hourly rate on top of that but I get the RVU's from both my hourly shifts and my scheduled shifts. Working extra this past quarter so other can have time off for the holidays. I am averaging 725 RVU's/month, my minimum is 296. So anything over the 296 I get bonus for at $54.57/RVU. Adds up quickly along with my regular pay and my hourly extras.
     
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  25. cabinbuilder

    cabinbuilder Urgent Care Physician
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    While all this is totally true and I believe there should be an ICD-10 code for "Intolerance to Life" & "Millenial Snowflake Syndrome", I see urgent care as a safety net for many patients who would not otherwise gone to the ER and died at home. I still have fun even on the hard days and enjoy it.
     
  26. VA Hopeful Dr

    VA Hopeful Dr Senior Member
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    And that's the ideal, but I haven't seen that around anywhere I've been.
     
  27. VA Hopeful Dr

    VA Hopeful Dr Senior Member
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    I think you are fairly unique. Your locums career was impressive but I've not met anyone else who did it like you did. So I'm not surprised you can find meaning in UC when most of us can't.
     
  28. Bacchus

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    I thought this was the case working in the NE. It simply is not. The 2 systems in my area are starting anywhere between 200-225. 1.5h from NYC and PHL. That said, my pay has quickly escalated, nearly 80k in 2 years.
     
  29. cabinbuilder

    cabinbuilder Urgent Care Physician
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    Probably because I live where there is a huge doctor shortage and while admin sucks just like anywhere else, they are not around to be bothersome, and really do try hard to make it worth while not to lose providers.
     
  30. VA Hopeful Dr

    VA Hopeful Dr Senior Member
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    I did UC in a pretty big shortage area too and had I been paid in RVUs I'd have cleared 300k that one year. Interestingly, after I quit they never replaced me - just made their EM group fill in until the practice was sold to a large UC chain.
     
  31. cabinbuilder

    cabinbuilder Urgent Care Physician
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    Interesting since there is still a huge shortage. I still get calls almost every day from recruiters looking for help. Can't complain about the pay. Should clear $400K this year. But I have put in a lot of extra shifts this last quarter due to lack of help.
     
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  32. raptor5

    raptor5 Fooled by Randomness
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    Our median in the mountain west is about 265k.


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