Per Diem in the Urgent Care

Whenever I’m back in California, I like to pick up some shifts in the urgent care. Working per diem in the urgent care is simple but repetitive and requires a lot of attention.

The Income in the Urgent Care

Larger medical groups are tedious to credential with. My credentialing process with UCLA will take 6 months and 2.5 months with another large urgent care group.

Smaller urgent cares and private groups generally only require an interview and an application with their malpractice carrier.

The hourly rate is $120. Some places only pay $100 and others pay $150. The higher the acuity the higher the income.

However, getting $30 more to care for complicated lacerations and chest pains isn’t worth it. I’m not an ER doctor but if I do ER-level work I expect at least $200 per hour.

Staying Sane in the Urgent Care

When I first started, I was an idealist. I didn’t succumb to a single antibiotic pushback or prescribe an unnecessary narcotic.

However, antibiotic stewardship can still exist without me burning out. I pick my battles. If a patient insists and can’t be talked out then I will make the best overall decision.

Narcotics are more straightforward. I don’t prescribe oxycodone or hydrocodone. Severe trauma goes to the ER and so does severe pain.

Neurontin, the “prison opioid”, and promethazine, the drink of choice for some, are on my list of drugs which I don’t refill or prescribe.

For the determined patients, I just pull up their previous medication history to show that they have had the same prescription before. This makes the medication a “chronic prescription,” and I tell them that as an urgent care doctor, I am not trained in chronic care.

Slowing Down Patient Care

It is counterproductive to rush to see the next patient.

When I earn an hourly rate in the urgent care it’s best for me to give the most attention to each patient.

In a productivity-based practice, there are diminishing returns after a few extra patients.

In an 8-hour shift, the first 25 patients are doable. The next 5 patients are draining. The next 5 are risky. And any more likely would burn me out.

I still apologize for keeping a patient waiting too long. Whether they waited 20 minutes or 2.5 hours, anything after 15 minutes feels generally the same for the patient.

2-Day Workweeks

A 2-day workweek for me is a 10-hour Monday shift and an 8-hour Saturday shift.

Mondays are good because you get a higher volume but people are more determined. They often need work notes and are too busy to beat around the bush.

Saturday shifts are good because people still want to enjoy the rest of their day and have a Sunday to look forward to.

They want their antibiotic of choice, medication refill, or just need reassurance about a certain condition.

18 hrs x 4 wks x $125 = $9,000. More than enough to pay for my new mortgage and remodel costs of the $300k Southern California condo.

Per Diem Urgent Care vs Part-time or Full-time

Per diem means, I pick up shifts last minute. I don’t have to give my availability weeks or months in advance.

I also don’t have to attend meetings or know the staff’s names by heart. I can act ignorant and am given the benefit of doubt.

You get more money for part-time and full-time work but most of that money is eaten up by the higher workload due to the higher expectation.

Regarding health insurance, retirement benefits, and life insurance, no thank you, I can purchase better versions of all of that on the open market.

Got questions? My hourly rate is down from $800/hr to $150. Book a session!