The journey from family practice to urgent care

As you may know, I left Maine to come to Virginia to work in an urgent care center.  It was not how I pictured myself when I trained to be a family doctor 18 years ago but the world has changed.

I like my present job fine and there isn’t a bunch of suits looking over my shoulder all day.  That being said, I want to share my thoughts about the recruitment process as it relates to family medicine.   The supply side is extremely low.  The demand is extremely high.   This should make those hiring us increase their offers but it doesn’t!  That is the insanity of it all.   They would rather have no physician at all or pick crappy ones then raise their offers.  It goes against every rule there is in business.

Wherever I went people would offer me a job but the contracts, incentives, workloads, etc. were all convoluted and complicated with such nuggets as severe noncompete clauses.  Basically, if you took a job and then they changed the contract to screw you it wouldn’t matter as you couldn’t work in the area for two years.

The other irrational issue that is pervasive is the new quality indicators.  All those who are hiring doctors want to get in on this so that they may make more money off our backs.  Forget the fact that this crap is unproven, the suits want every penny they can get.  That makes these contracts even more complicated.   People, it is a mess out there.

Unfortunately, there are not many answers.  One is to jump ship into something else (like I did).  The other is to go concierge or cash pay.   Another, interestingly enough, comes from a weird way.  I just spoke with a friend who is also trying to recruit primary care docs.  He is having a hell of a time.  His system is a Federally Qualified Health Center.   These centers serve very poor patients on Medicaid or the patients pay a very reduced sliding scale fee depending on their incomes.  This is a tough population.   The amazing thing is that the federal government has a set fee for every Medicaid patient seen (i.e. approx $100).  Basically, this is old school fee-for-service.  It is authentic medicine, treating all socioeconomic classes, and making money for each person you treat.  It is almost Marcus Welby like and it makes you want to see that ear infection who calls at 4pm.  That is if you were getting part of that fee.  And that is the answer.

Right now the FQHC doesn’t offer a contract like that but I pitched him anyway.  My point is that recruiting would be much easier if they said they would pay you, as a doctor, $50 per patient visit.  In other words, split the government reimbursement.    How simple is that?  You can do the math in your head and see that it also would be very lucrative.  The more you make, the more they make.  Forget the ten page contract with a ton of qualifiers and confounding variables.  Just $50 a patient.  He was intrigued but not convinced.

So now I am asking you.  If you are a family doctor, would you take a job like this?

Doug Farrago is a family physician who blogs at Authentic Medicine.

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