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A Case For Becoming An Urgentologist

Urgent Care Medicine As A Career Choice

Yea, I know, the term urgentologist is absurd but that’s what they called me and the 3 other docs in SoCal who got hired on by Kaiser to work in the “same day” clinics.

Urgent care medicine is a tiny slice of the pie. Many don’t consider it as an option because it can sometimes turn into outpatient Emergency Medicine. Nevertheless, it’s a very lucrative career option and lends itself well to either being an employee or an entrepreneur.

What Is Urgent Care Medicine

If you practice Primary Care, chances are that you will come across some urgent matters with patients. They might have URI symptoms that require you to rule out a PNA or they might have UTI symptoms with urinary obstruction.

Let’s not forget the urgent narcotic refills and those who got busted for calling in sick, now needing a work note before being allowed to return. Saving lives baby, saving lives!

If all you do is practice urgent care medicine then you are seeing primarily walk-in patients and same-day appointments. Since anyone can walk in, it makes for a very interesting practice.

In an Urgent Care practice, you will see damn near everything that’s out there in most ER’s. You won’t see major trauma and you won’t have patients brought to you by ambulance unless you are manning one of them Intermediate Care centers. 

ICS, UC, ED

It’s an interesting situation we have in US medicine. UC, urgent care, is right in the middle of family medicine and an ED – and it’s ideal for the practitioner, that way.

ICS stands intermediate care services which is an emerging model in medicine that saves large medical groups quite a bit of money. It replicates inpatient care in an outpatient setting.

ICS’s are often staffed by ED doctors, urgent care doctors, and even hospitalists. They are called all sorts of names and the point of them is to manage a patient outside of a hospital for as long as possible.

ICS locations are often open 24/7 but will only keep a patient for 23 hours. These are silly little games to get around legal issues so as to not be classified as an ED or hospital.

Not As Crazy As ED and Not As Boring As FM

I am board certified in Family Medicine and can’t imagine practicing pure FM, I would be bored to death. The hand-holding, the repetition, the polypharmacy and the laundry list of complaints would gnaw at my soul.

ED is too crazy. My brother-in-law is an ED doctor and the shit he deals with is just nuts, sick patients gone wild. Not to mention he has to do overnight shifts. You’ve seen my ugly mug, I need my beauty sleep.

I Can Float Right In The Middle

I realize that not every Urgent Care doctor practices like I do but I am conceited enough to believe that the way I do it is pretty damn functional.

I work in an Urgent Care to deal with urgent patient issues. Naturally, I’m more than happy to address non-urgent medical problems and I have no choice but to deal with emergent once.

Family medicine stuff. Chief complaints: “knee pain for the past 6 years”. I’m sure the nurses have a blast writing that on the chart because they are probably a bit perturbed that they have to check in this person next to the 3-year-old whose O2 sat is 85% from RSV.

Chances are that the knee pain was just wearing her out and she was finally ready to address it. Naturally, I’ll do the exam and get a good history. I’m even happy to give her my opinion as to what it is and help her control the pain. But in the end, I would refer her back to her PCP for follow-up such as physical therapy, referrals to ortho, etc.

Emergency stuff.  Back to that 3-year-old with desaturation. I’ll do my best to bring his O2 sat back up with neb’s, supplemental O2 or the often useless racemic epi. But unless the O2 sat rests past the low 90’s, that kiddo is getting shipped to the ED.

There is something convenient about being able to refer up and refer down. It’s hard to explain unless you’ve practiced Urgent Care. It’s not punting, though I guess it can seem that way. It’s being able to pick and choose what to manage and what to refer up/down based on the flow of the urgent care.

UC Has Less Liability

Medicine always has a lot of liability in the US. Humans believe they are special creatures on this planet and fragile. They also believe that doctors should get fallible pay but be held to infallible standards.

Defensive medicine has been deemed as the wrong way to prevent lawsuits. Instead, we are taught to be kind, compassionate and show empathy – the trifecta which apparently shields you from a patient’s legal wrath.

Either way, by being able to make sure the patient has follow-up in primary care and escalating emergent cases to the ED, I am able to defer the liability.

Few Urgent Care’s work up high risk chest pain patients. They don’t keep patients for observation after anaphylaxis and they don’t hold on to the kiddos who aren’t compensating well.

You Make A Lot Of Money

Let me clarify why you make a lot of money as an urgent care doctor. It’s not that your hourly pay is higher than your Family Medicine counterpart.

Urgent Care is often overlooked by docs because they think it’s too hard or they don’t like the hours. The volume is higher and they don’t enjoy having to do a lot of procedures.

True, hours can be shitty. You often are stuck working a few weekends and for sure some evenings. However, Urgent Care medicine is becoming more popular and most large medical groups now have daytime Urgent Care hours.

There are no in-basket messages to deal with.

There are no scheduled patients, you can go at your own pace. More on this below.

The extra money comes in the form of being able to pick up extra shifts. Whenever you practice something that isn’t too popular, you get rewarded with having the ability to pick up more hours and getting paid a little overtime during the high-demand seasons.

For The Very Lazy

Let’s call it like it is, we all have colleagues who milk the system and are slow as Christmas. And yet, they still have jobs and work beside us. In a way it’s good that they are around. For one, some patients enjoy the slower docs who spend more time with them and it makes the faster docs look good.

If you are one of the lazy docs then the best thing to do is to work for a large medical group in the urgent care. It’s impossible for them to fire you, the wrongful termination accusation is too costly for medical groups to defend.

In order to prove that you are too slow to safely run an urgent care they would have to prove that the patients you see are, in fact, as complex as the roster of other patients your colleagues are seeing in half that time – no es posible!

For The Churners And Burners

If you’re Speedy Gonzalez in the clinic then the urgent care can be incredibly lucrative, especially if you are working in a medical group where volume and billing can increase your pay.

I am that beastly doctor who sees twice as many patients as my colleagues. Not because I am less thorough, at least I don’t think so. And not because I rush patients out of the door, in fact my patient satisfaction scores are well above the majority of my colleagues.

Despite my ability to get through patients like a fat boy through a box of Oreo’s, I decided to stay with a medical group which doesn’t pay me more for seeing more patients.

However, I still used my abilities to my advantage. By being able to see patients so fast, I was able to build a nice reputation for myself with my bosses and schedulers. So when it came down to offering extra shifts during the busy season, they would offer me the shifts first. Cha-ching!

What I Love About Urgent Care

Man, I could fill a book about what I love about Urgent Care medicine. It’s an absolutely awesome field in medicine… even though it’s not a field in medicine.

One thing I love about it is that it flies under the radar. Most docs don’t know how sweet it is and quite a few ER docs who receive my patients think I’m just a lowly little Family Doctor who doesn’t know the sharp end from the blunt end of a scalpel.

But seriously, patients who come to the urgent care actually are there because they have one main issue that they need addressed. They are frustrated, hurting and bewildered.

I have one of those funny, bubbly, energetic, and positive personalities in the urgent care (not in my personal life, there I’m a dud). I can liven patients up without paddles and I am really comfortable breaking awkward barriers – yes, I have little shame. These personality traits are great to have in the Urgent Care setting.

As an ED doc, you really can’t miss a damn thing. The pressure is immense and you have probably seen so much crazy shit that every upper back pain is an aortic dissection unless proven otherwise. I am not sure I could handle that level of constant pressure.

A patient walks into the Urgent Care, they have one complaint, I ask the right questions, I lead them down the line of my top diagnosis, I order any supporting tests which are necessary and then I treat. It’s gratifying and rewarding, what else could I want out of medicine?

What I Hate About Urgent Care Medicine

The only thorn in my shoe is when I am having a bad day or my nurse couldn’t give a damn about the patients. Whenever I get paired with the union nurse who instigates every other patient or decides to not measure the O2 sat on a sick patient, I grow a wrinkle on my liver.

A bad day for me is when I am just not confident with my decisions and I end up ordering too many tests or consulting too many specialists. It pulls at my ego strings.

I hate having to take a nurse in with me for a pelvic exam and I despise having to argue with a patient about why they won’t get an antibiotic. And no, I don’t want to see your vajayjay any more than it’s necessary, I just don’t want to have to wait around for nurse to come in with me. And yes, I did go to medical school in the US, and I still don’t think it’s bacterial. And no, green snot doesn’t mean it needs antibiotics.

And no, I don’t want to see your vajayjay any more than it’s necessary. It’s just that I don’t want to have to wait around for a nurse to come in with me. And yes, I did go to medical school in the US, and I still don’t think it’s bacterial. And no, green snot doesn’t mean it needs antibiotics.

Why Is The Name Of The Blog Urgent Care Career?

Since I’ve been asked that now about a dozen times, let me answer it here… at the very bottom of this unrelated post… that most of you probably didn’t even read to the end.

I keep the blog to track my journey through medicine. I decided early on that I wanted to make urgent care a career path, knowing that very few doctors out there solely practice Urgent Care medicine.

In the process, I would be learning a lot about the financial side of medicine and personal finance. I wanted to document all of it in detail with full disclosure, to help others who come after me.

I realized that the medical system was enabling patients and doing everything possible to prevent the doctor from empowering them; that diagnosing illness was more lucrative than preventing it.

I decided that the only way I could vote in the medical system was with my independence from its income. So, I set out to achieve financial independence.

I went into medicine thinking that “someone” out there would have my back and that I could focus on educating patients, healing the sick and empowering the frail.

Instead, I realized that I went nearly $200k into debt in order to push treatments that legislators and pharmaceutical industries deemed necessary and appropriate.

So, I decided to pay back my student loan debt, make enough to cover the years I lost to medicine and to make up for the lies told by the medical profession to future potential doctors.

2 replies on “A Case For Becoming An Urgentologist”

I like this article; the author writes the truth of the situation. It is direct and so true. Urgent care is SO much more economical than ER medicine plus the wait times are not as long.

Too many legislators got their hands on how emergency medicine should be practiced. It drove the cost up sky high and it increased the liability 100-fold. Now, emergency medicine is a check-box of steps to take for each disease complaints. Not that there aren’t amazing emergency room doctors, but even some of them are deluded in thinking that everything they do is for purely for the sake of the patient’s health. Which then begs the question, why are we getting 7 different vital signs for someone who is in the ER for a cough medication or a refill of their eczema cream or even a work note.
Urgent care medicine is still pure and untainted. It can be practiced in nearly any setting and many doctors still are comfortable discharging a 25 year old with chest pain without getting troponins. That, too, will change. Until then, it’s a very satisfying setting to practice in.

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