New Grad: Urgent Care vs EM?

[thepalife]

Wondering what the opinions of experienced providers are on the pros/cons of a new graduate taking a job in urgent care vs emergency medicine. Anyone care to share their thoughts? Feedback greatly appreciated.

[EMEDPA]

EM if you have good mentors, otherwise UC is fine for a few years to get the basics down. go where you will learn the most. an em residency would be ideal.

[Febrifuge]

EM all the way because as a new grad, you need the daily contact with mentors, or at least others you can bounce ideas off of. UC tends to be more a solo environment, and is a bad fit for most new grads. If by some magic you have an offer in an UC where there is a more experienced clinician available whenever you're there, and that person is always amenable to coming in to have a look at something you're not sure about, by all means go for it.

[EMEDPA]

EM all the way because as a new grad, you need the daily contact with mentors, or at least others you can bounce ideas off of. UC tends to be more a solo environment, and is a bad fit for most new grads. If by some magic you have an offer in an UC where there is a more experienced clinician available whenever you're there, and that person is always amenable to coming in to have a look at something you're not sure about, by all means go for it.

my first job was at an urgent care run out of a family practice residency. there were many experienced PAs and docs around all the time to talk to. they treated me like a resident. it was an awesome learning experience for me. my sp was the director of the fp residency. he had me work with gradual increases in responsibility and after a few years he had me teaching new residents like I was a senior resident.

[G. Davenport]

I've worked both.  In the ER I have worked rural (solo), remote (solo), and at major urban ER with every resource you could ever want.  In the UCC I was almost always working solo.  I found the UCC to fall between the urban ER and my solo ER experience.  What I mean by that - many patients can't differentiate between what needs an ER and what needs an UCC.  Their decision is often based on the co-pay required by the insurance company.  Hmm, $50 for an UCC visit or $200 for an ER visit, --- I think I will go to the UCC.

 

Therefore, I often saw Cardiac Arrests, CVA's, Multi-lobe pneumonia, DKA, etc. in the UCC.  As an ER guy, I would call 911 while stabilizing as best as the UCC had capacity.  I had no back up and often worked with an MA.  

 

so, I agree with EMEDPA (couldn't you use an easier name to remember???).  If you do decide to work an UCC make sure it is one with experienced support (working when you do), otherwise, you may have a patient coding out and all you know how to do is dial the phone while trying to find a reference on what else can be done.  

 

At least that is my twist on it.

 

G

[Febrifuge]

Exactly, Dr. D. As a former ER tech, my sense of "sick/ not sick" had a head start, and I'm perfectly comfortable being solo in the UC, five years out of school. As a newbie, I would probably have been ridiculously slow and cautious, plus maybe a little well-meaning-but-clueless, and therefore dangerous.

 

To the OP (thepalife), I suggest you go to the EM section and read through the "Fast track disasters" thread. As Hank Hill might say, that's a dose of perspective right there, boy, I tell you hwat.

[EMEDPA]

I've worked both.  In the ER I have worked rural (solo), remote (solo), and at major urban ER with every resource you could ever want.  In the UCC I was almost always working solo.  I found the UCC to fall between the urban ER and my solo ER experience.  What I mean by that - many patients can't differentiate between what needs an ER and what needs an UCC.  Their decision is often based on the co-pay required by the insurance company.  Hmm, $50 for an UCC visit or $200 for an ER visit, --- I think I will go to the UCC.

 

Therefore, I often saw Cardiac Arrests, CVA's, Multi-lobe pneumonia, DKA, etc. in the UCC.  As an ER guy, I would call 911 while stabilizing as best as the UCC had capacity.  I had no back up and often worked with an MA.  

 

so, I agree with EMEDPA (couldn't you use an easier name to remember???).  If you do decide to work an UCC make sure it is one with experienced support (working when you do), otherwise, you may have a patient coding out and all you know how to do is dial the phone while trying to find a reference on what else can be done.  

 

At least that is my twist on it.

 

G

I worked a shift at "that UCC" recently and ended up giving haldol and ativan to a guy methed out of his mind who his GF brought there because she thought(as many do) that it was the local ER.

[thepalife]

Really appreciate the feedback everyone!  Certainly helps guide the thought process on a tough decision as it will certainly impact my future career.

The UC has a 6 - 8 month "training period" where new grads work with other providers daily until they feel comfortable to be on their own.  That's definitely a big plus.

 

Some have advised to be careful with the ED and make sure they are well aware that you would want some "backup" and not get thrown straight out.  The other thing I've heard is that as a new grad in the ED, you would probably be treating most of the "urgent care"/triage stuff.

 

The other question I've been asking myself is whether it would be better to take UC straight out of school with a set schedule, get a few years of experience and be much more comfortable before taking on the ED where it would be more of a swing schedule/different ED's withing hospital system, etc.

 

Again, thanks for the feedback.  I'm all ears, happy to hear any more thoughts.
 

[EMEDPA]

really depends on the mentoring situation. if you can get a job working with senior PAs at your side and/or ER docs willing to teach jumping right into the er is a great idea. if not, start UC and work your way up. I had senior PAs sitting next to me at my first 3 jobs and it made a world of difference.

[waky02]

3nd week, on my first job ever. I was begged/conned into working a 2 week Solo stretch in Urgent Care, (while quite terrifying, there was a very low pt load, as it was in mid-summer, but I think I sent about 5 pt per day to the ER as I did not have the capability/confidence to treat them.)  

 

Sure is a confidence booster, but it's not something I would recommend to a new grad right away

[thepalife]

Thanks again, have some thinking to do!

[emorley]

my first job was at an urgent care run out of a family practice residency. there were many experienced PAs and docs around all the time to talk to. they treated me like a resident. it was an awesome learning experience for me. my sp was the director of the fp residency. he had me work with gradual increases in responsibility and after a few years he had me teaching new residents like I was a senior resident.

 

Can 1-2 years or experience in an urgent care be a good transition into an emergency room?  The clinic I will be working at always has a physician on site and 1-3 PAs depending on the volume.  My passion has been ER, but most want at least 1 year experience.

 

My situation has been unique in that I was accepted into an ER residency, which fell through due to lack of funding to approve my position.  So after months of being credentialed with no timeline of when I would have recruitment approval I started job hunting and took an Urgent Care position (as I needed to get to work!).  Thoughts? Thank you!

[EMEDPA]

UC can be a good transition to a lower acuity/fast track/intermediate type position(from which you can work your way up to main), but it does not prepare you for high acuity.

[PACali]

I also recommend going into an EM residency/fellowship if your goal is to do EM. It will save you a headache to find the right job or mentor who is willing to train you. I would recommend to every new graduate.