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Switch Over To Urgent Care Before You Burn Out

Urgent Care Medicine – The Cure For Your Burnout

The sweet-spot for burning out of medicine is somewhere around age 40 or roughly after seeing 40,000 patients. If you started your medical career later in life then it’s some time after hitting your 10-year mark.

Many physicians think that they won’t burn out so they don’t put much effort into trying to prevent it. When the negative feelings towards their job arise they just tell themselves that they are being lazy or that it’s just temporary. It’s like aging, nobody thinks it will happen to them and they are affected by it more than they think and instead of facing it they spend far too many years in denial of it.

We’ve all been through some sort of burnout either in college or in medical school. The game wasn’t as serious then, many of us didn’t have a family nor much debt to worry about. If you burned out in medical school then the school would work with you to get you back into your groove. They may have delayed your graduation but they would help you through.

Some physicians never display the classic signs of burnout and so technically don’t burn out. Instead their personal life, their health and their attitude goes to shit. These physicians actually have stronger ‘coping mechanisms’. Instead of quitting medicine or taking time off they stop putting effort into their personal relationships and other aspects of their life.

Physicians in the primary care field may experience more burnout than their specialty colleagues because there is just more demanded of you in primary care. Let’s face it, most of us didn’t have the USMLE scores to get into ortho, EM, ophtho, ENT or radiology. So we are stuck with managing way too many patients with way too little time in crammed exam rooms with outdated equipment. I’m not saying that I would rather do a specialty. I’d slit my throat if I had to do the same fucking hip replacement after hip replacement. I do admire the surgeons for what they do but I love variety, I love the fast pace of the urgent care.

It’s no secret that family medicine and outpatient internal medicine sucks major ass. Fine, there are a few out there that love it and kudos to you. Prescribing a shit-ton of meds, adjusting dosages, listening to yet another story of how the glucometer was busted and spoon-feeding patients information on weight loss is the hallmark of primary care.

Those who still believe in primary care and love it and don’t feel overwhelmed by it  have made it their calling. The rest of us have left  or are leaving primary care in record numbers. We have turned to urgent care. The poor-doc’s emergency medicine. It’s basically emergency medicine without the headache; all the fun of EM but in an outpatient setting. In the UC we get to tell patients “That’s probably best discussed with your primary care doctor, a toe that has been tingling on one side for 9 years is just not something that I can address effectively in the urgent care.” And we also get to tell patients “You are far too sick for me to manage you here in the urgent care, it’s better for you to be in the ED so that you can get the proper workup and possibly be admitted for this intra-abdominal abscess you have going on.”

The 2 things that can combat burnout are patient satisfaction and autonomy in what you do. If you are constantly being told by a clinic supervisor that you need to code for this and that, that you need to bill higher or that you need to call back some 77 year-old patient who can barely understand you in person much less over the phone then you are going to hate your job. If your patient comes in wanting to discuss their sex life and their chronic jaw pain but you know that you only have time to discuss their diabetes and their ever-increasing BMI then you will feel disconnected from your job and dissatisfied.

Some may think that income will increase your job satisfaction and that’s just not true. Sure, if you make $10 million a year perhaps there would be more satisfaction but unless you are a scoundrel in medicine ya aint gonna make that kind of money. If instead you are happy doing what you are doing then you are likely going to be content with even less money because you won’t be spending a ton of money to make up for your unsatisfied career.

It just so happens though that you don’t even need to give up a decent income. Well established urgent cares, especially those in larger medical groups, pay very competitive salaries. Most are salary based but some will allow you to increase your income through RVU’s or by seeing extra patients and/or picking up extra shifts.

I recommend urgent care because … well the name of the website is digitalnomadphysician.com so I kind of have to recommend it. I’m kidding, of course I recommend it because by practicing UC you get to avoid all the shit that is wrong with medicine. Your pay is better, your hours are more set, your patients love you for fixing their problems and you have very few people breathing down your neck in comparison to primary care.

The hours at first glance may suck. In most urgent cares you would be expected to work evenings and weekends. But that’s actually wonderful. You would be off while everyone else is at work. If you live somewhere urban you would get the whole town to yourself. And it’s not like you have to work every weekends and every evening. If you’re worried about not seeing your family as much then start home-schooling your kids.

 

6 replies on “Switch Over To Urgent Care Before You Burn Out”

As someone who just made the switch from PC to UC I can attest to your points in this post. Sure, at times I feel like it’s shotgun medicine but it sure beats the hell out of PC. I love it. Best decision of my life

The trend that I’m observing is PC getting more and more pressure put on it to help patients meet certain health goals. Which is absurd when you think about it. If we are to respect a patient’s autonomy and individuality then how are we to ‘convince’ them to bring their A1C’s down further? We doctors couldn’t take our diabetes and insulin meds, hell even abx, on time… but expect patients to do it. And how many PC’s have spent nearly every visit trying to just convince patients to get that LDL a little lower? It’s a losing battle and so PC is left with a lot of frustrated physicians who want to hang on to that patient relationship, which is all that’s left.
In large medical groups at least 20% of patients use urgent care as their way of getting primary care. I suspect this number will go up and I suspect that urgent care copays will go down. Eventually PC panel sizes will decrease and things will flip flop again.

Yuck. The McDonalds of health care. I would want a PCP. At least someone would take the time to care for me. Did you want a fri and drink with that injection?

We can supersize that for you and throw in a CT and unnecessary ultrasound. In the meantime, please note, your PCP has left for greener pastures over to the urgent care. Your friendly PA and NP will be happy to care for you with less pay and in half the time.

I get it, but….having been in urgent care for 6 years and seeing upwards of 60-80 patients/day and having the pressure of getting good google reviews regardless of what the patient actually needs, I’m getting burned out as well. So where to go from here?

Kudos to you though – you have done more for your fellow human than many others. You’ve been there for these people when they really needed someone to look after their health.
We go on cruise control and we maintain that inertia and don’t dare check in with ourselves to see if what we’re doing is still something we want to be doing. Maybe start with what’s the biggest fear you have. What’s the very worst scenario you could imagine that might be tied to your job and income and profession. Once you have that pegged then you have a good central point to make decisions around.
Next is to dissect your day and decide what parts you enjoy, what parts you feel neutral about, and what you want to do a lot less of.
I know for some working less is heaven. For others, they have to completely get out of the urgent care scene. Others just don’t want to do any more patient care. Or some just know that their work quality is really high and they should be earning a lot more money so that they don’t feel like they are being taken advantage of.
Having the flexibility of time to maybe work whenever you want – such as being per diem – could be a wonderful way for you to spend more time doing other things.
You know, being an urgent care doctor allows you the kind of flexibility which many can’t enjoy. You can do primary care, you can do concierge med, you can do telemedicine, you can do consulting, you can do occupational medicine, you can work in employee health, you can do something as simple as reviewing DMV cases, you can consult for a law company and review charts, you can do UM work for a 3rd party company like Nexus, or do UM work in-house for a large insurance group.
I wrote a post a while back of starting your own clinic while doing telemedicine on the side to keep it afloat. But what matters is how much money you will end up needing for your bottom line. The lower your overhead, the less income you need, which means you’ll have so many more options.
But the feeling of burnout won’t get better – it won’t get muted unless you start sabotaging your life and dealing with damage control which simply takes your attention away from feeling burnt out.

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