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!

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