Why Urgent Care As A Career?

Why Make Urgent Care A Career

Short Residency

If you are really eager you can finish 1 year of residency (internship) and start working as a GP in quite a few urgent cares. Now, generally that’s not advisable┬ábecause you won’t have a lot of training/experience and you can become a bit of a malpractice magnet. Furthermore, a day may come when you decide to take on a full-time gig with a large medical group. Such positions are usually reserved for the docs with board certification or board eligibility.

Fast Way To a Good Income

After med school and all the debt that comes with it you have residency to look forward to. You could do something quick like internal medicine, ER, family medicine or pediatrics but that’s about it. Most of the other specialties are tough to get into and need more years of dedication. Not only that, you are gonna have a tougher time finding jobs out of residency. In a few specialties you are gonna do better going out on your own and that has its own risks. The surgical specialties require hospitals that you can be affiliated with. The pay certainly is higher in these specialties to make up for the extra work/time. However, you can make a solid $200k as an urgent care doctor, 300k if you are willing to do some billing work or be employed by a larger medical group and $400k if you are willing to work a little extra or go to less desirable geographies. Is it about the money? I don’t know, that depends on you.

Now, you can get to $500k but you are looking at either working in a very isolated part of the US or you are gonna have to see a huge volume of patients. Of course, you can build up your own urgent care(s) and the income then can be quite a bit higher. But then we are getting into running your own business.

So, let’s say you become a family doc and do the traditional primary care thing, take on a panel of patients, dance to the tune of Medicare, Medicaid, your organization, the lawyers and play the numbers game… A1C<6.5. Well, you could, there is good money there but what about practicing medicine, I mean prescribing meds is a form of practicing medicine but come on now, glyburide vs glipizide… do we really need to even have a discussion about that? 5.7 vs 5.8, really? Well, if you are asking yourself “What is this guy thinking, those are big deals!” then FP is perfect for you. I’m not trying to downplay the role of a family physician. However, in our current medical environment FP docs in traditional roles are underutilized, abused and mismanaged.

Patient Volumes

In the primary care setting you will have a ‘patient panel’ which is a group of patients that you are assigned to. These patients will call you their doctor for however long you stay in that role. This panel size is in the range of 2,000-3,000. In a HMO setting you will handle almost all of their organ system issues. They may have liver disease, renal disease, heart failure, afib, lymphoma, major depression, bipolar disorder or chronic pain. Referrals to specialists are generally discouraged in large HMO medical groups and obtaining imaging and tests may be discouraged as well since lower preference is given to primary care doctors ordering these. As a primary care doctor you will see 8-13 in the morning and about the same in the afternoon.

Urgent cares all vary in volume depending on the season and the time of day and location. One urgent care I worked at for 2 years had a 80-100 patient per day from 8a-10p. At times it would get to 120 and sometimes only 60. Urgent care volumes are generally measured by patients per hour. In the above example the volumes were up to 7 patients/hr. However, there were very few medical workups (chronic low back pain, chest pain, chronic fatigue, abdominal pain, fever of unknown origin) and there were more injury related visits or acute medical issues. Other urgent cares may have patient volumes of 1-2/hr and the majority will have somewhere in the 2-3/hr.

Urgent Care Work Schedule

This one varies quite a bit. Stand-alone urgent cares tend to have all day hours including weekends. Urgent cares that are part of larger medical groups may be called ‘After Hours Clinic’, ‘Emergency Center’, ‘Acute Care Clinic’, ‘Same Day Clinic’ or ‘Walk-In Clinic’. These are all not-so-clever ways for the medical groups to drum up business and to prevent low-acuity patients going to their ED. Most urgent cares will need docs that are willing to work evenings and weekends. Most shifts are either 4, 8, 10, or 12 hour blocks. A few are open 24/7 and these may have more swing shifts available. If you work full-time you can expect to work 1 or 2 weekends a month. You may work some daytime hours but expect to work evenings as well. As you gain seniority or as older physicians leave and new positions become available you may be able to get better hours. Getting a full-time gig working 7-on and 7-off is fairly common.

Flexibility of Urgent Care

Most urgent cares are fantastic places to learn. There is flexibility in terms of what patients they expect you to see and there is flexibility in terms of schedules and hours worked. Liability is a big deal and the owner will need to pay for insurance to cover their docs. If a lot of mistakes or judgments occur then the premium goes up. It’s to the benefit of the owner to make sure that they hire good docs but also let them see what they are comfortable with. They know that with time good urgent care providers will obtain the expertise needed to treat more complex and higher acuity patients. There is flexibility in hours as well. Because there is no patient panel you can work at 50% or 80% of a full-time schedule or even less and still be eligible for some employment benefits. Per diem work is also really popular in the urgent care and once credentialing is out of the way you are generally ready to begin work right away.

Patient Acuity

We discussed patient volumes which is not as big of a factor as patient acuity. It’s quite easy to see 2 URI’s, 1 med refill, a rash, give an off work note and deal with some joint sprains. It gets more complicated when you have a pelvic pain, abdominal pain, child with fever of unknown origin and a chest pain patient. Some urgent cares have developed a reputation in the community to be high acuity and some low acuity. There is a bit of patient self-selection as well especially when no hospitals are close-by. It is perhaps ideal to work in a setting where there is variety because it will help you keep your skills up. Too many medical workups however will quickly wear you down and without on site CT’s, MRI’s, US’s and lab services much less plain film capability you will soon have your fill. Most urgent care centers don’t have access to these more resource intensive ancillaries. I mention this because it’s important for you to inquire from the medical director or recruiter as to what sort of workups you will encounter. Will you get pushback for patients that need direct admission or further monitoring? Are you expected to deal with complex lacerations? Will you have access to specialists? Can you send higher acuity patients to the ER without your medical group having a fit?

Generally, this information can be easily obtained from your colleagues who have already started moonlighting. In my example, I hooked everyone up with all the good moonlighting spots. If anyone asked I was more than happy to help. True, some people get stingy so they may not talk about the good spots because they want to keep the shifts to themselves but they eventually will spill the beans.

In Summary

Urgent care is here to stay as a ‘gig’ so it’s a great work environment to work. It’s similar to being an outpatient hospitalist. Urgent care will lead the way with all the virtual visits so it will get interesting. The income as of this writing (2015) is in the $85-130/hr range. Sure, there are places that pay less but that’s not worth it in my opinion. And yes, some places pay more but there is a reason for that too.

 

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What are your hours as an urgy doc?

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