The very first case I saw on my own in a clinic while moonlighting was a GI bleed whom I had to babysit overnight until we could get a transfer approved. I was in my second year of residency – it was the middle of October. It was the most exhilarating and frightening experience but I developed some pectoral hirsutism after that experience.
Looking back, I wanted to reflect on whether family medicine and urgent care medicine were the right choice for me. As usual, I’ll figure out the answer once I write the post. For now, I’m leaning towards a strong yes.
I have written a previous post on choosing urgent care medicine as a career path.
Family Medicine Residency
Word on the wards is that family medicine is now 4 years long. My program at UCLA lasted only 3 years, though I stayed on an extra year as a chief.
Family medicine is a very easy residency, at least at UCLA. The hardest parts are some of the inpatient rotations through the ICU and general surgery. Not so much because they are difficult but because it’s hard getting along with some of those personalities.
I was able to moonlight during residency and definitely would recommend choosing a residency program which allows you to practice independently.
You can learn so much moonlighting and, yes, the money is good but that matters less. You will learn how medicine is practiced in your community and develop a better context for the advice your attendings give you.
On my resume I have 7 different moonlighting gigs listed from my 2nd year of residency through my chief year. I tried all sorts of gigs and that’s how I decided on urgent care medicine as a profession.
Urgent Care Medicine
Urgent care medicine is run by either family medicine doctors or ER doctors. I think it makes sense for ER doctors to retire into urgent care medicine – the pace is slower, the acuity is lower, and the patients are much nicer.
For family medicine doctors urgent care medicine seems like a stretch. They are often worried about the procedures or missing something of higher acuity.
The rest are worried about losing their primary care skills. I am not sure that’s something to worry about. Titrating medications isn’t all too complicated and you will often get plenty of opportunities to practice primary care medicine, even in the urgent care.
Back in 2006 when I started moonlighting, urgent care medicine didn’t pay more than family medicine. Now, there is a good bit of a premium paid for practicing urgent care medicine.
What’s great about urgent care medicine is the pace, the simplicity of the visit, and, overall, a much happier patient population. Primary care was too boring and there were far too many complaints compacted into a single visit.
If a resident chooses to go into urgent care medicine then they’ll gain some experience with routine care, urgent care, and emergency care.
This broad range of experience provides you lots of options in the future. You can work in a primary care clinic, in a walk-in clinic, an occupational medicine clinic, or in an emergency room – usually in the fast-track.
You can do telemedicine, aesthetic medicine, boutique medicine, concierge medicine, or you can do consulting.
You also don’t need to be affiliated with a hospital which allows you to live damn near anywhere you want.
One thing residents may not be aware of is that if you become an emergency medicine doctor and decide to open a primary care clinic, you won’t get the juicy insurance contracts. As a competent urgent care doctor, however, you can get a job in many ER’s with on-par salaries.
It’s easy to work overtime in the urgent care. In fact, I think most urgent cares are in need of doctors working overtime. This may not be true in areas where there is a high doctor saturation but if you’re willing to work the shitty shifts, there is always plenty of extra hours to be had.
You can do the same for family medicine but at the end of a long primary care shift the last thing I wanted to do is see more primary care patients. I always found primary care more draining than urgent care.
Working in the Urgent Care
The first 4.5 years of urgent care medicine were a ton of fun. It’s hard to put it into words because you learn so much, help so many people, and there is so much camaraderie with your staff.
The hours can suck for some people though I enjoyed them. You generally start later in the day and finish work at night. You get your mornings free but give up your nights and a few weekends.
You often have adequate support in the urgent care. Upstaffing is abundant in the urgent care to make sure all the treatments and procedures get completed. Some doctors feel there is inadequate staffing but that’s usually because they are working with over-ordering colleagues.
As for camaraderie, there is also a lot of support from your fellow urgent care doctors or NP’s and PA’s. It’s rare to be in an urgent care where the clinicians hide in their offices – most tend to be collegiate and try to discuss clinical cases with each other.
The Ideal Urgent Care Career
Here is my recipe for the ideal urgent care career; start moonlighting for a few years in or after residency to get a sense of the kind of work you want to do long-term.
Next, work full-time for a large medical group to optimize your income, pay down the debt, and stash some money in a retirement account. If you need to, work some overtime shifts to meet financial goals. I learned a ton by working at Kaiser Permanente. Though, I should have recognized when I overstayed my welcome at a large medical group and when it was time for me to go either solo.
If you’re going to work overtime, I would recommend it in your first 5 years out of residency – after that you’ll risk burning yourself out which is something I may have done by working overtime past my prime.
After a few years of doing urgent care medicine full-time, drop down to part-time and augment some income with telemedicine or working in a primary care clinic as a float to change things up.
You can even consider being the medical director of a medical spa, for which there are plenty of job listings on LinkedIn or Indeed.
Once you have enough money then you can become a per diem. You can pick up all sorts of different gigs in different settings or even different cities/states. Some of my friends have done some locums work in Australia and New Zealand.
By the time you’re in your 60’s you can either start a small walk-in clinic and staff it with other clinicians or do some consulting on the side. Chart reviews can also earn you a little income and keep your clinical mind sharp.
I would have done a few things differently. Working overtime was great but it would have been better to cut back on overtime as I was getting older.
I would have moved to a lower cost of living area sooner. San Diego was fun but it wasn’t a great place for a single doctor to live. Portland was a better option for me.
I should have dropped down to part-time as soon as I became financially independent. Instead I waited too long and feelings of burnout started surfacing. Out of necessity, I went per diem.
I am really enjoying working per diem here and there. It would have been nice to have started it sooner, especially because the pay is even better.