Monday, December 9, 2019

Life as an Urgent Care Physician

Managing more than just colds and coughs!

Since I've started practicing, a lot of you have reached out to me wondering what it's like working as an urgent care physician, and what a typical day entails. This post will hopefully give you a glimpse into my current role and answer a lot of your commonly asked questions.

How would you describe urgent care?

The best way to describe urgent care would be something along the lines of "Emergency Medicine meets Family Medicine (with a sprinkle of Surgery)." I manage patients from 3 months old to 100+ years old, and I get to do a little bit of everything. Whether I'm treating an asthma exacerbation, performing vaginal exams, managing fractures, suturing lacerations, doing incision and drainage procedures, or treating something as simple as a UTI (just to name a few), urgent care pretty much does it all. We don't treat super complex things like heart attacks or other life-threatening issues, but oftentimes these patients will come to the urgent care instead of going to the emergency room, and it is my job to stabilize them until EMS transport arrives to take them to the emergency room. We perform x-rays, EKGs, place splints and boots, and can even provide IV hydration if needed. We then refer to specialists for ongoing management if a patient requires continued care. Urgent care offers a great deal of variety and I think it's a really great way to keep clinical skills current while avoiding burn out.

What are the hours like?

Urgent care offers a very flexible lifestyle and the hours are pretty nice. The practice where I currently work has two locations, one that is open 9am - 1030pm seven days a week and the other that is typically open 9am - 8pm (with slightly earlier closing times on Fridays and on the weekend). At the location with longer hours, shifts are 9am - 4pm and 4pm - close. The other location usually just has one shift that lasts the entire day until closing time. I usually work until about an hour or so after closing time since we have a rule that as long as a patient walks in the door before the official closing time, they will be seen. Usually someone will walk in around 10:28pm with something more complex to deal with, which means I'm working until at least midnight or whenever that patient is fully managed. Despite this, the hours are still insanely better than any day in residency since I never worked less than a 12 hour shift on any given day during my training. 

What is the patient load?

I typically see an average of 20 patients per shift, but this number can vary by more or less depending on the day. It is a job that requires quick thinking and efficient management, but I have never felt super overwhelmed. Sometimes a ton of patients will all come into the waiting room at once, and other times it is a more steady flow of about 3 patients per hour.

Is there help?

When I work, I am the only physician on staff, so I am responsible for seeing and managing all the patients. There is a front desk person that checks everyone in, a medical assistant who does triage and any procedures I may need done (such as x-rays, injections, strep tests, giving IVs, etc.), and at the busier location, I also have a scribe who follows me into the room and types up the majority of my notes so that I can focus on patient care. During my training, I often split my work with at least one other individual and I usually had more senior residents and attending physicians to step in if I needed help. Urgent care differs in that I do not have anyone to split the load with, but I never truly feel alone as I can always call up one of the other physicians in the group for advice, to provide a second set of eyes on an x-ray image, or to even come in if I feel swamped and need help (thankfully I have not had to do this yet *knocks on wood*). Our medical malpractice insurance company also provides helpful resources such as UptoDate for free, so I always have access to the most current medical information and treatment guidelines for my patients.

How is your work-life balance?

My work-life balance now is spectacular compared to how it was during my training. Before I worked no less than twelve hour shifts per day at least six days a week with every third day consisting of a full 24 (which almost always turned into a twenty-eight) hour shift. Right now, I work an average of three days a week with shifts that range from seven hours to eleven hours. The most hours I have worked in one day since starting urgent care was 14.5 and that is only because I picked up another physician's shift and worked a double. I work less than half of what I did during my training, am more than fairly and doubly compensated, and I have time to explore my passions and do some of the things I love outside of medicine. Even better, we are asked for our desired work schedules in advance of each month's schedule being made, so I am able to plan trips and spend more time with my daughter. The work-life balance is without a doubt one of the best things I've got going for me right now, and it will surely be missed if I end up going back to residency.

What new insights have you gained from working at an urgent care?

Believe it or not, I have learned a lot working in urgent care and not all of it is medical. The main thing I have learned is the power of collaborative relationships. I don't think I truly appreciated the power of collaboration during my training (probably due to fatigue and the type of environment I was in), but now it is more evident than ever and a daily necessity. Whether I'm speaking to a radiologist about a patient I sent for an outpatient CT scan, getting advice from a specialist, or working with my staff to make sure a patient is fully taken care of, I am so appreciative of the collaboration that urgent care involves. It has also enhanced my teaching skills as I am frequently educating patients on things like why I will not prescribe antibiotics for their colds or the importance of seeing their primary care physicians for follow up care. Medicine truly is a team sport, and it sometimes takes many individuals working together to ensure a patient gets the most appropriate care. Additionally, working at an urgent care has strengthened my critical thinking and self-directed learning skills, and the beauty of having work-life balance has taught me a lot about self-worth and recognizing the signs of burn out. Lastly, I've gained more insight into my self as an individual. Whether it's been learning to trust my own inner knowledge base or recognizing my limits as a physician, I continue to work on myself daily and being in the urgent care setting has truly allowed me to continue to learn and grow as a physician.

I hope this sums it up and answers most of your questions, but if not, feel free to ask away in the comments below!

Sunday, December 1, 2019

Thankful Vibes

I originally planned to type this post on Thanksgiving Day, but decided to truly bask in the day and relax. Then I had the bright idea that since I was working a double shift on Black Friday, and it would likely be quiet due to everyone being out shopping (wishful thinking), I would just type this up while I was at work. But after a crazy busy day filled with managing things like what a patient thought was a hemorrhoid that actually turned out to be a huge abscess (and the most satisfying incision & drainage procedure I've ever performed!), a hand versus chainsaw accident (put my suturing skills to work!), and even a feather stuck in the ear (who knew down feather pillows could be so dangerous?!?!), I learned my lesson about planning for any leisurely activities while at work during a time when most people are not working. Moving onto yesterday, I found some time to start the typing process, but ended up putting it on hold to attend an event, and then I decided to go to the movies afterwards (I saw Queen & Slim and thought it was really good). With that being said, I finally found a moment to write about a few things I've been thankful for this year :)

I guess the most obvious thing I am thankful for this year is having a job! I can't tell you how many nights (and days) I spent worrying last year about what this year would bring. Would I have a job? Would I be homeless? Would I be working somewhere completely unrelated to my medical degree? Would I be living in another new state, away from all family and friends, and working yet again another 24 hour call shift during the holiday? There was so much anxiety! But here I am a year later, a working physician, with an incredible job, living in an area that makes me happy, and able to spend time with those people who mean the most to me whenever I want. It's honestly really hard to put into words all the feelings that surround my current state of mind, but one thing I can say for sure is that God's plan is the best plan, and everything always works out perfectly and at the right time.

Another thing I am thankful for is my family and the friends who have become like family (or I guess "Framily" as they call it). My family always comes through for me, provides me with so much help with my daughter, and they're always super supportive even if they don't completely understand my path. I'm even more thankful to have a child who doesn't mind being away from me and who tells me on a daily basis how proud she is of me. And even though I am absolutely horrible at keeping in touch with people, I am thankful for those who still check on me and don't trip when I don't reach out often, and for those who can deal with me and all of my craziness. Over the past year, I have been amazed by the amount of friends who text me to make sure I'm okay, take time out of their busy schedules to travel to hang out with me, and even those who are quick to send me the latest postings on open surgery residency positions so that I can continue to pursue my goals. I might not be the best at expressing it, but I am thankful for each and every individual I interact with, and your love and friendship mean a lot to me. 

Lastly, I am thankful for YOU. Next month will make six years of blogging, and some of you have been around from the very beginning. You've followed my journey from newly accepted medical student to navigating life as Dr. Ward, encouraged me through various struggles, and continued to cheer for me when things are going right. I am beyond grateful for the support you give just by reading my posts, and there have been numerous times where I wanted to give up or quit, but then I receive an email sharing your success story or inspiration that you gained from reading one of my posts. This has really kept me going.

So in my attempt to keep this post relatively short, I'll just end by saying every year I grow more and more thankful for life and all it's ups and downs. I'm thankful for the dark times that allow me to enjoy the happy times, the people who make life worth living, and for being able to live my dream as a physician. I honestly couldn't feel more blessed at the moment, and for that I am truly thankful. I hope everyone reading this had a very happy Thanksgiving, and I wish you all a wonderful holiday season ahead.

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