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!

Almost Halfway Finished with Intern Year!

Still smiling!

I thought I was going to put out a lot more content following my last post, but that clearly didn't happen. Honestly, it hasn't been from having a lack of time since I'm currently off service and have had more free time over the past month and a half than I have had since starting residency. I think I've mostly just been experiencing writer's block, which is super weird given that I've had a lot of new experiences that really wouldn't have been too hard to write about. Oh well, I'll use this post to catch everyone up, and then I'll type a couple of new posts today to let everyone know what's currently happening in my world.

Physician Swag!

When I ended my last post, I was just about to begin my emergency medicine rotation. My first day was a complete culture shock! My first shift didn't start until 930am, so coming from the surgery world of 3am wake ups, it was super odd being able to sleep in. The work load was also much less intense. A couple of weeks prior to starting, I was informed that the service would also include internal medicine call which would begin on my first day. What this meant, is when my ER shift ended at 530pm, I would grab the night pager and head upstairs to function as an internal medicine resident until 6am. My first night was not only super busy, but a complete 180 degree turn from surgery life. We were swamped with new admissions, and notes had to include a lot of information that you typically don't see in surgery. For example, if a patient came in with something simple like a fractured hip from a fall, we didn't just workup that one problem, but we focused on what seemed like every co-morbidity the patient had. Whether it was their blood pressure or an episode of asthma that last occurred years ago, we left no issue unaddressed. That first night was a huge adjustment from my typical focus-based notes, and it was even harder considering the first half of my day was spent functioning as an ER resident, and that I had not been on an internal medicine rotation since my third year of medical school. Nevertheless, I quickly learned to adapt after receiving a few calls and texts from attending physicians the next day when I was post-call, LOL.

Relaxation before work

What I will say that I found to be the most shocking about call on a different service was actually leaving at 6am. During my surgery months, call doesn't typically end until after morning rounds, so you can imagine my disbelief at doing sign out at 530am and being out the door by 6am. Even better, during my ER month I had multiple full 24 hour days where I wasn't scheduled to work. That's right, full days where I wasn't groggy from being post-call and could actually sleep in and still have an entire day of productivity mixed with relaxation. I even had shifts that started later during the day, so a few times I ended up sleeping in, waking up to explore the city for an hour or two, and then getting ready for work. It was really nice being out in the sun each day and doing simple things like walking to the park and watching the calming river.

Post-Boards Celebratory Drink

I guess the best thing about having an emergency medicine month, was the extra time I had to study. Last week, I took the final board licensing exam required for me to obtain a full unrestricted medical license (I'm currently under a training license), so I needed all the extra study time I could get. This exam (COMLEX Level 3) differed from the other ones I had to take in order to graduate from medical school because it was a two day exam that took place over 8 hours each day, and instead of only multiple-choice answers, it included fill-in-the blank responses and questions where you had to select multiple answers. It was definitely long and stressful, but since the two days aren't required back-to-back, I was able to sit for the first portion on Monday and have a couple of days to breath before taking the second portion on Thursday. I won't receive my score until February, but I am so glad to be over the board exam hurdle! Plus, whoever it was who decided to place a Prometric testing center in the same building as a whiskey bar is a true MVP, because a drink was very much needed after making it through 16 hours of testing in one week.

On-Call Selfie

Right now, I am in the middle of an internal medicine month, and it hasn't been too bad. The hours are pretty consistent, and there are a lot of daily lectures and other learning opportunities. Oddly, this month has shown me how much I really enjoy and miss surgery, so I am itching to be back on the general surgery service next month. I'm also learning that I don't do well with free time, and I seem to be happier and more productive when my schedule is busier (I'm weird, I know!). The good news is in a little over two weeks, I will finally get my first true break of the year since I will be off New Year's week, prior to going back to general surgery, and I can't wait!!!!

That pretty much sums up the past month and a half. I know I always say I'll be coming out with more posts shortly, and then get too busy to post, but this month will be different. Not only is my five-year blogiversary approaching (stay tuned for a sweet surprise!), but my writer's block has resolved and I have a lot to say right now. Plus, I'm currently in the middle of working a 24 hour call shift, but rounds are over and my patient list is tidy, which means I actually have time to type a few future posts right now :) Stay tuned and I hope everyone has an amazing weekend!