How partnering with urgent care created a dream primary care job

I have a dream job.

I make my own hours, working three 12-hour shifts on Tuesday, Wednesday, and Thursday.  I’m off Friday through Monday, and I don’t take any call.  I take as much vacation as my budget will allow, and if I wake up with the flu, I call off from work without the usual feeling of guilt and anxiety.

It wasn’t always this way.  Like all new doctors recently out of training, I followed all the rules that had been engrained during medical school and residency.  Pull your weight, don’t dump on your colleagues, even if that means coming in sick with a fever of 103.

Always be there for your patients, even answering your cell phone at 3 a.m. to patiently explain why calling in antibiotics is not appropriate.  Continue to work on paper charts when your electronic health record is down, despite your anxiety that you might miss something important, and don’t forget to spend a few extra hours re-entering data when the EHR comes back up so that you pass your corporate chart audits.

And over time, this often self-induced sacrifice led to resentment and anger.  Even though I was showing up for work every day, I found myself caring less and less about my patients, and began to succumb to compassion fatigue and burnout.

So when my large hospital outpatient group was swallowed by an even more enormous organization with its layers of bureaucracy, I decided to make an escape from corporate medicine and transition to what I hoped would be a kinder, simpler way of practicing medicine.

The only problem:  After years of relying on an organization to manage the minutiae of billing, HIPAA compliance, staffing and HR, etc., the idea of taking on the administrative challenges of modern medicine on my own was daunting.

Fortunately, I found a perfect solution: a collaboration with my local urgent care center.

Partnering primary care with urgent care is a complete win-win.  For the urgent care, the benefit is two-fold:  When I am in the office seeing patients, the urgent care takes a percentage of my collections to cover overhead.  When I am out of the office, the urgent care sees my patients for acute issues.

As a primary care physician, I benefit by sharing space and overhead, as well as enjoying the freedom and flexibility of 7-day per week coverage, which allows me to create my own schedule.

The logistics

I am an employee of the urgent care, but I am not an urgent care physician; I see only my own primary care patients.  I receive an hourly salary and productivity bonus based on percentage of collections.  The urgent care pays for overhead, supplies, and staffing, as well as managing the billing and administrative elements associated with medical offices such as licensing and malpractice coverage.

During my office hours I see any and all of my patients with medical needs, as well as keeping a schedule for routine appointments.  On days when I am not in the office, patients with acute issues are seen by the urgent care medical provider available that day — either a physician or physician assistant.

To make the transition between primary care and urgent care more seamless, my patients receive a special card called a “fast track” card that identifies them as my patient.  This card facilitates the sharing of medical records, and also expedites my patients to the front of the line, unless there are sicker patients waiting to be seen.

When I return to the office on my next clinic day I review the urgent care notes of any of my patients that were seen while I was away, and follow-up as appropriate.

The good

I’m happy.  I have a dream schedule and essentially an unlimited capacity for vacation time.  I don’t have to manage any of the business aspects of the practice, and I have a guaranteed salary and bonus schedule based on my productivity.  My staff is ensured full-time hours even when I am out of the office, as additional shifts are almost always available within the urgent care.

My schedule allows me to offer early morning and late afternoon/early evening appointments, which is appreciated by working patients and students.  And when I am away, my patients have access to team-based medical care seven days per week, with my oversight.

The bad

I often have to explain to my colleagues and my patients that I am not an urgent care doctor, a not uncommon misperception.  And while I have control of my own staffing, I don’t directly supervise the other health care providers that work at the urgent care.  Fortunately, the physicians and PAs that work for the organization have been excellent.

Most importantly, not all my patients like my schedule.  Many patients want me to be available more days of the week, and I have had some patients elect to change to another primary care doctor.

The ugly

I still struggle with guilt — as physicians, we are trained to work more, see more patients, and constantly do more.  By restricting my schedule, I have had to learn to say “no,” something that does not come easily.  I have to limit my practice panel by not accepting every new patient that calls for an appointment, and I have to dismiss those patients that create an excessive burden on me and my staff.

Overall, however, collaborating as a primary care physician with an urgent care has truly improved my quality of life.  If you are unhappy in your current practice environment, consider alternate work situations outside of the cookie-cutter employed practice.  By creating your own practice situation, you may find that the antidote to burnout is physician empowerment.

Rebekah Bernard is a family physician and the author of How to Be a Rock Star Doctor:  The Complete Guide to Taking Back Control of Your Life and Your Profession.  She can be reached at How to Be a Rock Star Doctor.

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