What are some examples of Family Medicine working schedules? Is it a lifestyle specialty?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Last night I was chatting with a dear friend of mine. He told me his upperclassmate signed a contract with Kaiser LA. 300k plus 50k sign on bonus
Members don't see this ad.
 
  • Like
Reactions: 1 users
Members don't see this ad :)
Blue Dog said:
Cost of living is ridiculous.
Click to expand...

Yep, when you can’t buy a move in ready home in a decent neighborhood that’s got room for more than 2 people for less than $1.5million, and state tax is what it is in Cali, that $300k looks less and less appealing.

But some folks just have to be in LA.
 
  • Like
Reactions: 1 user
Great thread. Lifestyle is important to me, but I also know that anything can happen, so you need to have a backup plan. Here's a podcast about a physician who worked in urgent care for a number of years.



I found this podcast while I was browsing the web. I literally just searched "physician location independent" because that's where I see my career going in the long-term.

Give it a listen, I thought it was fairly informative, and a refreshing perspective.
 
  • Like
Reactions: 1 users
I haven't read through all the posts, but I'm 8 years in practice, I work for a large corporation. I see about 30 patients a day. work 4 days a week with patient scheduled 8-3:30 and rarely leave later than 4, no hopsital or OB. after hours call 1 of every 9 weeks (one of my partners recently took call from Hawaii, he forgot he was on), usually that is 5-8 calls during the week and a handful of bilirubin on Saturday and Sunday. Vacation is when I want it as I get paid on production. I signed a contract for $160,000 base pay out of residency with no signing bonus, I was off the standard pay in 3 months and moved to production. Salary went up significantly the first couple of years and has leveled out over the past 4 with 1-3% increases during those years. I made $320,000 last year.

I'm in the top 10% of patient volume and panel size in my health system (so not entirely indicative of our system as a whole). Semi rural area (small enough that we don't have too many specialists in town, but too large to get loan repayment).
 
Last edited:
  • Like
Reactions: 11 users
jawicobike said:
I haven't read through all the posts, but I'm 8 years in practice, I work for a large corporation. I see about 30 patients a day. work 4 days a week with patient scheduled 8-3:30 and rarely leave later than 4, no hopsital or OB. after hours call 1 of every 9 weeks (one of my partners recently took call from Hawaii, he forgot he was on), usually that is 5-8 calls during the week and a handful of bilirubin on Saturday and Sunday. Vacation is when I want it as I get paid on production. I signed a contract for $160,000 base pay out of residency with no signing bonus, I was off the standard pay in 3 months and moved to production. Salary went up significantly the first couple of years and has leveled out over the past 4 with 1-3% increases during those years. I made $320,000 last year.

I'm in the top 10% of patient volume and panel size in my health system (so not entirely indicative of our system as a whole). Semi rural area (small enough that we don't have too many specialists in town, but too large to get loan repayment).
Click to expand...
What state is this in, or region of the country?
 
Members don't see this ad :)
How can someone see 30 patient a day unless you are working 14+ hrs/day? Most of these patients always have 3+ complaints to address in one visit...

In my continuity clinic, I see 6 patients from 12:30 pm to 4:00 pm, and still find it sometimes overwhelming
 
Splenda88 said:
How can someone see 30 patient a day unless you are working 14+ hrs/day? Most of these patients always have 3+ complaints to address in one visit...

In my continuity clinic, I see 6 patients from 12:30 pm to 4:00 pm, and still find it sometimes overwhelming
Click to expand...
8 hour day, 15 minute appointments gives you 32 patient slots.
 
Splenda88 said:
How can someone see 30 patient a day unless you are working 14+ hrs/day? Most of these patients always have 3+ complaints to address in one visit...

In my continuity clinic, I see 6 patients from 12:30 pm to 4:00 pm, and still find it sometimes overwhelming
Click to expand...
Are you a resident? If not, how do you make money seeing 1-2 patients per hour? They better be billed at level 5 and even then it's still not financially viable.
 
Splenda88 said:
How do you address 3+ complaints in 15 minutes?
Click to expand...
It’s tough. For chronic complaints it’s not as challenging. When they start trying to throw in one or two new complaints is when it gets dicey. Especially if it’s “my back hurts” or “my memory is bad.”
 
  • Like
Reactions: 1 users
Freezeout said:
It’s tough. For chronic complaints it’s not as challenging. When they start trying to throw in one or two new complaints is when it gets dicey. Especially if it’s “my back hurts” or “my memory is bad.”
Click to expand...
I got these things all the time in my continuity clinic as PGY1 IM resident... That is why I was asking how can someone see 30 patients/day
 
Splenda88 said:
I got these things all the time in my continuity clinic as PGY1 IM resident... That is why I was asking how can someone see 30 patients/day
Click to expand...
Yea what you have to do if you don’t have time to really address something is say you can’t give that issue the attention it deserves hope addressing chronic issues and bring them back quickly for just that issue.
 
nebuchadnezzarII said:
How much suturing/procedural stuff did you guys have to do during residency? And now as an attending? If you’re in a big city, do you usually have to do suturing and stuff? What about in urgent care?
Click to expand...
I suture almost every day in urgent care. I do manipulation. I splint. I do joint injections, Take moles off, nails off. I trim nails. You have to gauge your residency to what you want to expect to be doing. You have to be pro-active and have them teach you suturing, scopes, nail, splints, injections, etc.
 
nebuchadnezzarII said:
Absolute last question, I swear. And thank you so much, it's not everyday I get to pick the brain of a practicing family physician, so I really appreciate this. I would buy you a coffee if I could.

1. Why does the job itself suck? The quality, what's so bad about it?

2. You suggested part time clinic work. Is that different than urgent care work?
Click to expand...
I do strictly urgent care. 12 hour shifts. I have to work 10 days a month. I do Th, Fri. off the weekend. Work the following M,T,W. then I'm off 7 days and it repeats. I can pick up extra shifts if I want to.
 
Splenda88 said:
How do you address 3+ complaints in 15 minutes?
Click to expand...

Or you try not to .. If they're giving you 1 new complaint, that's good enough for a 214 (depending on problem), by doing 2 new problems, you're not really billing that much more, so just increasing your workload w/o having much more benefit (also, really not being able to do a good job if you really only have 15 min to address all concerns).
 
Just curious. I've spoken with VA about DPC before. But does anyone do a combination of traditional insurance and DPC? Such as, including a monthly option where you pay and get unlimited e-mail communication with the physician? Is such a thing possible? Would it even be worth it as it would be more work with not that great of gain?
 
KeikoTanaka said:
Just curious. I've spoken with VA about DPC before. But does anyone do a combination of traditional insurance and DPC? Such as, including a monthly option where you pay and get unlimited e-mail communication with the physician? Is such a thing possible? Would it even be worth it as it would be more work with not that great of gain?
Click to expand...
Yes, it's what MDVIP does
 
  • Like
Reactions: 1 user
Blue Dog said:
No, it's just true, especially in a suburban area. If you're rural, YMMV.
Click to expand...
Guess I have never felt that way and feel like we truly make a difference here. It really keeps a lot of folks from falling through the cracks either who don't have a doctor or who don't feel they are sick enough to go to the ER. I suits me and I'm happy with my choice.
 
  • Like
Reactions: 1 user
Splenda88 said:
How can someone see 30 patient a day unless you are working 14+ hrs/day? Most of these patients always have 3+ complaints to address in one visit...

In my continuity clinic, I see 6 patients from 12:30 pm to 4:00 pm, and still find it sometimes overwhelming
Click to expand...
Sounds like you are still a resident. Speed comes with time. In urgent care, I see 6 patients an hour.
 
  • Like
Reactions: 1 users
Splenda88 said:
I got these things all the time in my continuity clinic as PGY1 IM resident... That is why I was asking how can someone see 30 patients/day
Click to expand...
You learn the patients. Once they are managed correctly the check up get easier and the complaints that are new get less.
 
  • Like
Reactions: 1 user
cabinbuilder said:
Guess I have never felt that way and feel like we truly make a difference here. It really keeps a lot of folks from falling through the cracks either who don't have a doctor or who don't feel they are sick enough to go to the ER. I suits me and I'm happy with my choice.
Click to expand...

Horses for courses.
 
You'll get more efficient as time goes on, outside of residency, you see fewer residency type patients, and you learn to rob Peter to pay Paul.

We all have those patients who will nuke your schedule. We also have those who take care of themselves, you see them 2-3 times a year and they really just want to get out and go back to work/home. Keep small talk to a minimal with these people, they're out in 5-7 minutes perfectly satisfied (as you're doing the PE, let them know about their last labs/colon screening/mammo, etc so they know you're on top of things and not just hurrying them out the door. Ask them about how the beach trip last summer that they mentioned to you at the last apt.) and you've made up some ground where things got off track 3 patients ago.

Many times, just because a patient brings something up, doesn't necessarily mean they want or need the million dollar work right away, and it doesn't mean that their presenting concern has anything to do with what's really going on with them. If it's something you think will go away with time and exam findings back that up, it's perfectly ok to suggest no imaging be done, try something fairly benign and see them back in an amount of time you believe it'll take to start feeling better. Don't be your own worst enemy and think that weird shooting pain that starts in the left heel and radiates to the right ear lobe should be seen again in a week. Secondly if you failed to ask, "hey, so how's your nerves been lately," you may have missed the boat on that one. Experience will teach you what to ask (and to a greater extent what NOT to ask), how to ask it and when.

If it's someone who is insistent on addressing the list on every visit, I'll let them know that there's no way of doing justice to all of their concerns in one visit, but what we can do is meet EVERY WEEK until we begin to FIX (gotta use that fix word) some of the things you have going on, addressing a few each time. "I've gotta get you doing better." To the people who (very strangely) don't want things to get better (or aren't willing to change to get better), this is like kryptonite.
 
Last edited:
  • Like
Reactions: 4 users
Clinic from Mon-Wed 9-5, Thu 7 or 9-7pm
One week per month either inpt or newborns 7ish-9am depending upon census
Thursday morning nursing home until noon
Weekend phone call every 6 weeks
Base salary is 220k, another at least 50k from non-clinic work, 20k loan repayment, another 20k from state for working in rural area
Fridays and most weekends off forever
 
  • Like
Reactions: 2 users
nebuchadnezzarII said:
Wow. So you can just do like 3 x 12 hours urgent care shifts? What does the typical workday in this type of setting entail?

Can you do the same thing as a IM (your wife has the right mindset!) doctor in urgent care (3 x 12)?

Is it the same 3 days every week? I had NO IDEA family med doctors could do solely shift work like this. That's freaking awesome.

How much does this usually earn you, if you don't mind me asking?

I really value free time....so that's why I am asking. Apologies if these questions are overwhelming. Any and all answers you provide are helpful!
Click to expand...
Generally don't see many IM docs in urgent care - they don't really do procedures that I've seen.
I am FP trained an solely do urgent care. I work 10 shifts a month, 12 hours a shift. I can pick up extra if I want.
I don't do any chronic management anymore.
As far as pay, its as much as you want to work. My base pay is 220K but I can easily double that if I pick up shifts with extra hourly pay, plus RVU, plus quarterly quality incentive bonus.
 
I get full benefits with only working 32 hours per week in clinic including 4 hours of admin time, which is pretty sweet. I chose this lifestyle because I am a mom. I am choosing to take on some more things now but I don't have to. Call only about 1 in 8 and phone only. So in my experience definitely would meet criteria for a "lifestyle" specialty. I know some docs who work part-time (like half-time) as a hospitalist and only do 1 week of work per month, which also sounds amazing.
 
  • Like
Reactions: 1 users
cabinbuilder said:
Generally don't see many IM docs in urgent care - they don't really do procedures that I've seen.
I am FP trained an solely do urgent care. I work 10 shifts a month, 12 hours a shift. I can pick up extra if I want.
I don't do any chronic management anymore.
As far as pay, its as much as you want to work. My base pay is 220K but I can easily double that if I pick up shifts with extra hourly pay, plus RVU, plus quarterly quality incentive bonus.
Click to expand...

I did U/C full-time for 2 years. There was one older IM doc who was per diem. He was OK with procedures but pretty lost when it came to pediatrics. "'3 year old rash and fever'.... Dr. Brody, you want to take this one?" FM background also was a big help with pregnant pts.

Pay was similar to above.. 200k base, plus....the RVU bonuses- 40-50k quarterly. Bonuses were easy to get seeing 25-30 pts per 12 hr shift, It was 37hr/week, ~14 shifts/mo, mostly 12hrs, some 8s.

The downside of u/c, and the main reason I left the 400k income doing it, is the drain it has on you psychologically and clinically as a physician, seeing patients with absolute zero restriction or barrier to accessing you. They can and will walk in for literally anything. I would say that in the case of about half of pts the only appropriate place for them to be is at their own PCP or at the ER. And a good portion of the remaining half shouldn't even get seen for their complaint by a medical provider, in any setting, at all. Things like "exposure to MRSA, no symptoms" or a mom with 5 kids, having every one of them checked in for "bed bugs." Or on the other hand, a 93 yr old "fatigue, confused, fever, UTI?" and 2 month old for "sinus infection." On days before major holidays you'll get asymptomatic people looking for antibiotics "in case I get a runny nose" and on weekends a noticeable % of people will come in for chronic problems they've had for years- why presenting that particular day? "because I had the day off." Insurance usually pays for this, and pt satisfaction surveys hold you accountable in how you provide for it. Many u/c companies are moving toward midlevel driven models now, and it is understandable why- we as physicians are probably too well-trained and educated for the cognitive dissonance involved.
 
Last edited:
  • Like
Reactions: 4 users
Marcus Brody said:
I did U/C full-time for 2 years. There was one older IM doc who was per diem. He was OK with procedures but pretty lost when it came to pediatrics. "'3 year old rash and fever'.... Dr. Brody, you want to take this one?" FM background also was a big help with pregnant pts.

Pay was similar to above.. 200k base, plus very substantial RVU bonuses- 40-50k quarterly. 37hr/week, 14-15 shifts/mo, mostly 12s, some 8s. Usually saw about 25-30 pts in a 12 hr shift.

The downside of u/c, and the main reason I left the 400k income doing it, is the drain it is psychologically and clinically on you as a physician, seeing patients with absolute zero restriction or barrier to accessing you...they can, and will, walk in for literally anything. I'd say for about half of pts the only appropriate place for them to be seen is at their own PCP or at the ER. And a good portion of the remaining half shouldn't even be seen by a medical provider, in any setting, at all. Things like "exposure to MRSA, no symptoms" or on the other hand, a 93 yr old "fatigue, confused, fever, UTI?" and 2 month old for "sinus infection," or a mom wwith 5 kids, every one of them checking in for "possible bed bugs." On days before major holidays you'll get asymptomatic people looking for antibiotics "in case I get a runny nose" and on weekends a noticeable % of people will check in for chronic problems they've had for years, why presenting that particular day?- "because I had the day off." Insurance pays for all of this, and pt satisfaction surveys hold you accountable for it. Many u/cs are moving toward midlevel driven models now and it is understandable why- we as physicians are probably too well trained and educated to tolerate the cognitive dissonance involved.
Click to expand...
Yep. Sounds like a normal day. Have to learn to say no. I dont do chronic management or med refills as a general rule. Some days are painful but to me primary care clinic is worse.
 
BigSib said:
Clinic from Mon-Wed 9-5, Thu 7 or 9-7pm
One week per month either inpt or newborns 7ish-9am depending upon census
Thursday morning nursing home until noon
Weekend phone call every 6 weeks
Base salary is 220k, another at least 50k from non-clinic work, 20k loan repayment, another 20k from state for working in rural area
Fridays and most weekends off forever
Click to expand...
So you make 290k/yr working ~40 hrs/wk. That is a good gig.
 
  • Like
Reactions: 2 users
I never wanted a high stress / high pay lifestyle. I work at a small RHC clinic in a coastal/rural area. My wife is also a family physician. We have 2 kids. I work 3 days a week which is considered 0.75 and I get health insurance/benefits. My wife works 2 days a week. We both have monday off so every weekend is a 3 day weekend. I'm on call for a week like once every 3 months.

We aren't getting rich but we are comfortable. We own a normal house and drive normal cars. We do a lot of free stuff and generally live like any normal middle class family, but due to the low cost of housing, our mortgage payment is quite small for the house we live in, compared to a city. And that enables us to live well. Bottom line is that I spend more time with my family and friends, and doing hobbies, than I spend at work. It's doable. You just won't make as much money. Only you can decide what your balance will be. Some places you can really fill up all your time with various "stuff" in addition to clinic, like the nursing homes, inpatient stuff, etc. I've learned that while that stuff can be fun, it can make your life very busy and hectic. Personally I'd rather make 100k a year and have virtually unlimited free time, than make 200-250k/year and not have that. It also depends on where you are in life. I have two young children and I want to be there as they grow up. When they're' older, I'll spend a few years working harder to put some money away for retirement.
 
Last edited:
You must log in or register to reply here.
Next unread thread

Similar threads

S
Family medicine working in occupational medicine
Replies
0
Views
759
scharnhorst
S
ResidentSwap
Faculty Family Medicine Position in Arizona
Replies
0
Views
456
ResidentSwap
ResidentSwap
S
Family Medicine Physician and Resident Perspectives on OTC Hearing Aids
Replies
1
Views
596
I_Cant_tell_you
I
A
AOA Osteopathic Addiction Board Certifications with Primary DO vs MD Family Medicine Board
Replies
1
Views
380
AlbinoHawk DO
AlbinoHawk DO
drmsb93
Medicine’s Worst-Paying Specialty Is Luring Billions From Wall Street. What are your thoughts out there?
Replies
25
Views
3K
VenusinFurs
V
Top