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Urgent care job offer...advice please


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The pay is not the issue - the solo work for a new grad IS the issue.

 

The pay scale is going to have to start somewhere for a new grad - it won't be what someone with 10, 15 or 20+ yrs of experience makes.

 

This job has way too many problems to even consider:

 

Solo work for new grad with questionable support

Spousal involvement by owner/MD

Garbage benefits

And then

The pay could be a smudge higher

 

Priorities, folks - don't walk in the swamp alone - money is not everything

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So this is an urgent care letter of offer in NoVA. They had me do a working interview, which is good. I liked the doctor, the office, and staff. I am a new grad and would be expected to operate solo after 2-4 weeks of onsite supervision by the doctor.

 

*Full time = 32-40 hrs/week. They said it will be closer to 32 for the first few weeks or months and then increase as I get more comfortable.

*Salary is $40/hour, will evaluate me after 6 months and possibly increase it. Quarterly performance bonuses.

*Hours of operation are 9am-7pm M-F, Sat and Sun 10-3. I'd be expected to work 2-4 weekend days per month. They said the hours of operation are "subject to change"

*medical malpractice with tail covered

*They said 401k, dental, vision, health insurance is in the works, but nothing is in writing

*No mention of CME

*10 days PTO includes vacation, sick, personal. No roll over.

*"upon your acceptance and signing of this offer letter, you will receive a contract to be executed."...I find this to be scary. I asked about it, and they brushed it off and said that's just how it works here. Hmm...

 

They gave me the offer in person and wanted me to sign on the spot. I've been on a lot of interviews and don't think this is normal. But I also know they are just eager for someone to start.

 

I actually really like the doctor, staff, and office. I think it could be great experience, and I need a job. The solo provider thing makes me nervous, but it's also a low patient volume. Please tell me if I'm being naive, but is 15-18 patients per 10 hour shift doable as a new grad with supervision only by phone?

 

Here's what I've learned since being on this forum regarding solo newbs in urgent care.  Granted, I'm only an NP, but nonetheless...

 

-If you aren't ready to crack a chest with a sheetrock knife and a crowbar (and close with Gorilla tape) for a dude with triple vessel coronary disease having a STEMI and bypass with IV tubing, you aren't ready for urgent care.

-If you can't open and resect an appy with a 15 blade and a shop vac, you aren't ready for urgent care. 

-If you can't drill a burr hole with a letter opener and decompress an intracranial bleed with a coffee stir stick, you aren't ready for urgent care.

-If you can't cric a 4 year old with a foreign object in the trachea with a pocket knife and a crazy straw, you aren't ready for urgent care. 

-If you can't shove a pilot out of a chopper onto the pavement, take the controls, and fly the 6 year old DKA to definitive care while starting a central line, fluids, an insulin drip and obtaining a K+ by palp, you aren't ready for urgent care.

 

Shout out to Emed. Emed rules (and can probably do everything I just mentioned)... :)

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I told them I was concerned about the solo part and their response was that I'd have to operate solo in any job eventually. They didn't seem to understand the fact that I'd prefer another provider onsite. The doctor also said all the cases here are straightforward. So they made me feel like I was being silly.

 

 

 

Wow so much badness here.

 

1.  2-4 weeks before onsite alone?  You are begging for trouble here.  I've been doing UC for over 20 years, and the thought of dumping a new grad into a clinic alone is just stupid, not to mention dangerous.  You need a minimum of 6 months with a seasoned provider who is willing to teach and answer questions....onsite.  

 

2.  $40 an hour is quite frankly insulting.  I guess it's all relative, but I made more then that on my first job 23 years ago.....

 

3.  No CME seems to be the norm now....honestly, it ticks me off but it is what it is.  For me, good PTO is > all.  My time away from medicine is cherished.  

 

Let me just reinforce one more time what a bad idea it is for a new grad to "fly solo" after only a few weeks.  UC is not family practice.  Hyper Acute stuff walks in all the time.  I have coded people who walked into my UC and dropped right in front of me.  Are you ready to code someone....alone?  I've had broken necks come in to get "checked out" post MVA.  Are you ready to clearly diagnose, stabilize and transport a C2 Fx?  Does the clinic have insta-overread via radiology or are you solo on film as well?

 

I'm not trying to sound neg, or scare off anyone from UC.  I just find it shocking that any provider would say, "everything we see here is routine".  Really?   It is routine...until it isn't. Then you better know what to do.............Btw, how is their malpractice coverage?

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Guest Paula

I worked solo at my first job in family medicine on an Indian reservation, somewhat isolated, with closest ED 30 miles away.  Generally it was an UC position as nearly all the patients just walked in and asked to be seen.  At the time, scheduling an appointment was not the norm.

 

I survived and took care of people who literally got dropped off by their buddies, and the patient crawled into the clinic on their hands and knees (the clinic was a trailer house), btw.  I had patients drop and seize in the waiting room.  I had babies come in with foreign bodies in their throat.  I had small kids with cigarette burns who were abused.   Plus, then the "normal" requests for pap smears, colds, flus, ear aches, asthma exacerbations, COPD, uncontrolled diabetes, etc.    All done on a walk in basis.  We had to send out the patient to a regular clinic nearby for X-rays.  i read my own X-rays .  I had a great LPN and med tech who knew everyone and provide awesome support.  My SP was on a sister reservation in another state 75 miles away. 

 

How did I survive the disasters?  It was because I also was working part time at one of the ED's 30 miles away and learned how to deal with the disasters and got good training and advice and oversight from the physicians there.  I could translate everything I saw and did at the ED to the tribal clinic.  No one died, but in the end, I was mentored by a group of docs who were not part of the tribal system.  My SP was great too, but in times of disaster, who has time to call the SP? 

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In general medicine, especially as a newbie, you'll inevitably get patients that you don't know what to do about. Medicine is not as cut and dry as you read in books. I think you should have more support than over the phone starting out. Otherwise, I think you'll be very stressed at times.

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The hourly and benefits are average in Illinois.  You should demand some sort of CME reimbursement.  Average tends to be $1500-$2000.  You definitely won't be prepared to fly solo after working 2 weeks.  You should get 3-6 months of training.

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