Over the past month, I’ve been living in Los Angeles, an inarguably expensive US city. I’ve managed to live here without a car though I hitch a ride with my girlfriend from time to time and piece the rest together by bus and ride-sharing apps. I’ve managed to live here comfortably working only 2 days a week in the urgent care. Here’s the breakdown.
2-Day Work Week
For me, a 2-day work week is a Sunday and a Monday. I work 9a-5p on Sunday and 8a-8p on Monday. These tend to be the busiest days for this particular urgent care.
Working 2 days a week leaves me a lot of time to do other things. I have been able to go rock climbing 3 days a week and work on my side consulting projects.
Despite feeling a bit burnt out still from medicine it’s easy for me to dedicate my time those 2 days purely to medicine. I feel less burdened dealing with a difficult patient or having to call around a bunch to get an appointment for a patient.
I go to bed at 10-11p on Saturday and I’m up by 7a on Sunday. I make my coffee and listen to my audiobook and do my yoga. It’s really pleasant.
I get to work either with the 94 bus or the 251. Only takes about 25 minutes. And I get dropped off just far enough that I can get a 10-minute walk in and pick up some healthy food to have for my shift.
The Clinic Shift
I see about 40-60 patients per shift. On a Sunday it’s somewhere around 30 which makes the day go by rather fast.
On Mondays, I’ll see about 50. Many of these patients are COVID-19 screenings and influenza cases. They are rather easy since that workflow is established.
I’ll get 1-2 complex patients per shift. These require calling around or convincing the patient to go to the ER. I don’t see anything with high acuity so in that regard it’s very pleasant.
The last patient can come in right before closing so I might stay an extra hour but that’s not common. And if they might require a longer workup we have the freedom to send them to the ER.
I’ll see some coughs, sore throats, UTI’s, many STD’s, sprains, rashes, and aches and pains.
We have x-ray on site but because of costs and insurance billing and limitations of what studies I can get and how good the film output is I don’t utilize it as much as I would otherwise.
I don’t prescribe controlled substances so I don’t have to worry about refilling Concerta or prescribing Norco or Oxycontin. It’s a shame in a way because some patients who for example are passing a kidney stone might really need it. But on the other hand, I don’t have to worry about the inevitable arguments with patients denying them their opioids or benzodiazepines.
The antibiotic stewardship thing – what can I say about it publicly? Well, wrote about abx stewardship
I don’t think there is anything wrong or more difficult with having higher acuity patients as long as you are adequately rewarded for taking the extra risk and have tools at your disposal.
Fortunately, most urgent cares run best when seeing lower acuity patients. And it’s not different at this place that I work at. It’s mostly a walk-in clinic and other than the occasional x-ray I don’t have to order a lot of tests to figure out what is going on with the patient.
I’ll see a patient with potentially new onset CHF or new-onset DM but rarely are they life threatening cases. All I have to do is either get them into an ER or plug them into one of the local specialists who is able to manage them.
The 251 bus will take me all the way south towards Downtown. And the 90 or 94 bus will take me straight through to the south end of Downtown Los Angeles.
Because of the pandemic, they aren’t charging for bus rides so I ride for free. These are clean buses which are climate controlled and they run on time.
Once the sun goes down you get a lot of weirdos. The seats by then are a bit stained from homeless butts and trash hauling. And you’ll deal with some really interesting odors. But, that said, as a dude, I feel safe riding on these buses at night.
Uber and Lyft have been amazing as well. I don’t need a driver’s license, I don’t have to worry about car maintenance, nor accidents. I just open an app and get chauffeured to my destination.
Not knowing any better I was rather friendly the first 2 rides and the drivers sounded like they had cabin fever and laid into conversations of all sorts of topics. Now, I know better: headphones. If that fails, pretend you’re from Iran and only speak Farsi.
On average I see 4-5 patients per hour. Sound a bit high, doesn’t it? But most of these are quite straightforward. And it’s worth mentioning that my MA’s have done a lot of the work for me already.
A patient with a sore throat will already have had a rapid strep, a COVID-19 antigen, and maybe a mono spot test done. A patient with a UTI will have had a UA and urine HCG. Not a lot left for me to do.
There is also this beautiful waiting room phenomenon – when patients pile up in the waiting room people will walk out and others won’t bother. This is why the volume stays rather consistent in most urgent cares.
I get my income paid to me as a contractor, often referred to as a 1099. For this gig it’s $120 per hour. I likely could have negotiated up to $140 since I didn’t care for the employment benefits they were offering.
In a 2 day work week, I work 20 hours.
That’s $2,400 earned per week.
Around $9,600 per month.
Working only 20 hours a week and earning this kind of money @ a rather low $120 per hour … not bad.
I suspect that if I did a good enough job, saw enough patients per hour, made myself valuable to them, I could negotiate up to $140 per hour. Or maybe even ask for free health insurance benefits.
The BLS outlines that the average service-providing employee works only 33 hours per week. Obviously, physicians will work on average over 40 hours a week.
My malpractice insurance is covered. And I don’t get health insurance, retirement contributions, disability insurance, or life insurance.
I have talked about the price and value of employment benefits. I still think they are overvalued. It’s not worth it to give up my freedom for things I can obtain myself.
Picking up Extra Shifts
The value of working only 20 hours per week or working only 2 days a week is that I can pick up extra shifts whenever I want.
But it’s not the other way around. If I commit to a full-time or even part-time schedule I can’t cut shifts out.