As soon as I hit US soil in Ocrober 2021 I decided I would send out applications to local urgent cares so that I could get some clinical medicine under my belt. The past few years I had been mostly doing consulting work and I didn’t want to run afoul with the medical boards. Fortunately, I got a chance to spend 3 months in the urgent care doing clinical medicine and reflecting on what clinical medicine means to me.
My first email to this urgent care I passed while walking resulted in a job. In fact, I didn’t have to do any credentialing work. They didn’t care about my medical board investigation or 30-day license suspension. They were looking for physicians with urgent care experience to work across their 30+ urgent cares.
3 months in the urgent care is enough to give me insight into how medicine has been since I’ve been away.
As my girlfriend and I constantly reflect on I still don’t know how I feel about clinical medicine. I love it and I hate this shit out of it.
In theory, it’s incredible to connect with another human being and help them. In practice, you are a salesperson and have far less support than it appears.
I had good cases. Mostly coughs and colds but a few vaginitis and lacerations and one stroke. You feel a sense of accomplishment when you can immediately help someone. But you feel as useless as tits on a bull when you’re having the bacteria versus virus discussion regarding someone’s 2 days of sniffles.
3 months of urgent care has reminded me of all the procedures I hadn’t done for a long time. And I got back into the groove within a few days. Once I had my uptodate and Google, I was set.
The Art of Medicine
Around the same time I’m working in this urgent care I was reading the book Cutting for Stone. A novel written by a physician about a physician who does incredible things in his career and also lives in the shadow of his biological father who is gifted surgeon.
A part of me always wants to find the gold at the end of the clinical rainbow. I want to do something meaningful in medince. And I’ve heard all advice in this regard; go practice in Africa, they say. Or open a free clinic in the middle of nowhere. Volunteer in a clinic or become a naturopath.
I am convinced now that there isn’t just magical rainbow, just my unrealistic, burdensome expectations of medicine. I am expecting so much of medicine and poor medicine can only deliver so much.
When I can have a real relationship with clinical medicine then I think it will finally deliver what it’s capable of. Until then it’s almost as if I’m dooming it to fail.
Private Urgent Cares
I’ve worked in every type of urgent care you can imagine. From the free FQHC to UCLA to concierge cash and to private urgent cares.
I will say one thing about the private urgent cares which may not come as a surprise to those who’ve worked there. It is by far the most satisfying and easiest place to work in.
It’s like a really successful mechanic shop. The customer comes in, you tell them what’s wrong, and they decide what they want done. Just a transmission flush? Of course! You want the whole transmission rebuilt? Absolutely. Bridgestone tires? Why not.
In private urgent cares, it’s all about customer service. A sinus congestion for 3 days? How about a course of Augmentin – no, wait, Z-pack, with a side of a Medrol Dose Pack, and a shot of Rocephin. Let me know how that suits you and we can always consider something else.
There is no pain med issues in these urgent cares. It’s not worth the hassle. Nobody prescribes controlled substances. But Flexeril, Neurontin, prednisone, Solumderol injections, and antibiotics, those flow like water from the fountain.
The Hours of Work
12 hours of work isn’t easy. It used to be. But now at 43 it drags a big. I get up at 6 am so that I can take a shit, have a coffee, read, and Lyft over to work. I usually start by reading the latest and greatest about COVID-19 and start seeing the first patient by 8:15.
I have to order food from a local restaurant because we can’t live the premises. Usually, I find plenty of good vegan places but I’m sick of eating out.
I look at the clock once around noon. Eat. And again at 4 pm where I go make myself a Folger’s coffee. And again at 7 pm, 7:10, 7:15, 7:25, 7:30… Well, I basically can’t wait to get out by 8 pm.
During COVID-19 peak I see 100 patients a day. Other days maybe 40-50 patients. I’m often out by 8:15 pm and home before 9 pm.
When I have back to back days in the urgent care, man, that’s tough. But at $120 per hour, meh, it’s not bad. And I only work 2 days per week.
I didn’t negotiate too much because I wasn’t sure how long I wanted to stay with this group. We agreed on $120 per hour.
I recently interviewed with UCLA who offered me $150 per hour plus $25 per RVU. If you do the math on their patient volume it wouldn’t be hard to hit $250 per hour. That’s $20k per month for two 12-hour shifts per week.
For the kind of work you do the income is really good. And it’s not hard finding more lucrative jobs than the $120 per hour.
I am not planning on staying in Los Angeles. I thought I did. For a minute I considered moving here, living here, and working here. But I feel that I’ll always have that opportunity and it’s just not the right time right now.
I have my ticket back to Spain, I land there on January 5th. I’ll be in Madrid for a week and then go back to my house in Santiago de Compostela.
I’ll work remotely doing some consulting work. I’ll do a little telemedicine with a company that allows me to be overseas. And I’ll do my rock climbing.
The Personal Finance Side
I would be remiss not to mention the personal finance side of this whole thing. I mean, I’m getting up and leaving a lucrative gig. I am going back on the road and working as a digital nomad.
I can do that because I am debt-free. At least I think that’s why. I’m able to do it because I have money invested in conservative index funds and in real estate.
I have living options where I don’t have to pay much rent or overhead. And I can rent out my apartments to tenants for some income.
Of course, they say that this is all coming to an end. We are going into crazy high inflation and devaluation of current and real estate. That index funds will never return what they once returned.
Fortunately, I’ve heard all these same predictions since 2008 when I started investing. I believed them, too, sadly. But by 2012 I decided I would only look at the facts and let the prognosticators jerk each other off.