From ED to UC

[JMPAC]

Has anyone gone from working in the ED to an urgent care position? I would love to hear about anyone's experience with that or other perspectives. Why'd you make the switch? Slower pace? Better hours? Do you get bored? Just curious.

 

 

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[sas5814]

Not directly. I worked a rural ER staffed by PAs with local docs on backup for years. I have been working UC for a few years now with a little FP and IM odd job. In January I moved and started full time UC.

The current job is low stress and fairly low key. I work weird hours (combination of 8, 10, and 12 hour shifts to make 40-45 hrs/week) and have to work 2 weekends a month. That doesn't bother me because we have no kids at home and my wife works 2 weekends a month as well so we just line them up. In the current job it is really UC. Sutures, uncomplicated fractures and dislocations, coughs and colds, back pain and the like. Chest pain, complex illness and injury gets transferred to the ER. The folks I work for are evidence based medicine all the way so no nonsense like steroid and antibiotic injections for every drippy nose that walks through the door. PAs and NPs are treated like respected colleagues. It carries the headaches of corporate medicine but they are fairly minimal.

I recently worked 2 very rural private owned UCs and they were very different. Patient satisfaction was everything. Priorities were 1) make money, 2) patient satisfaction and then 3) follow good science. They did everything they could charge for. Full labs even on a patient that clearly needed to be at a higher level of care. Wring out their wallet before you send them on. One was basically a family practice that had UC capability. People came to the UC for all their routine problems including long term management off diabetes, HTN, seizures etc. 

So yes... now UC is a much lower stress job, good pay and benefits. Other places not so much.

[EMEDPA]

having worked both, UC can be higher volume per shift because the acuity is so much lower. I have seen 60 pts in 12 hrs at a UC during cold/flu season and a busy ER shift is in the 20 range at most places. I hate high volume/low acuity, so made the move to full time rural, which is just the opposite. low volume/high acuity. 12-14 in 24 hrs is a great pace, especially if many of them are actually sick.

[JMPAC]

having worked both, UC can be higher volume per shift because the acuity is so much lower. I have seen 60 pts in 12 hrs at a UC during cold/flu season and a busy ER shift is in the 20 range at most places. I hate high volume/low acuity, so made the move to full time rural, which is just the opposite. low volume/high acuity. 12-14 in 24 hrs is a great pace, especially if many of them are actually sick.

I currently work in the main ED and see mostly higher acuity patients, which I really like. I'm looking to relocate and have interviewed and discussed offers with urgent cares and EM groups. I'm mostly finding that the UCs are paying more and have better benefits and offer relocation, etc. I've also just been feeling exhausted from night and evening busy shifts and having small children so, three twelve hour day shifts a week is starting to sound pretty appealing. I have a couple friends who seem to really like their UC jobs, but I worry that I'll miss emergency medicine. I think with the few years of EM under my belt and then UC experience, I could probably go back to and EM job in the future, if I wanted.
Anyway, I'm just looking for other perspectives on that and I appreciate the feedback I've already gotten.

[DizzyJ]

There are pros and cons to me for each.  Working ED I love true ED patient and solving the mystery they are presenting with.  In UC I wonder how people have survived this long thinking a runny nose will eventually lead to death of course.  It's a give and take.  In the ED we are stress about door-to-doc times and press ganey scores and in the UCs I've been in we don't.  This is a major plus.  I've worked in a money hungry multi-sight UC that just wanted us to crank out patients all day long.  Two of us would sometimes see 100 patients in a day.  This is awful and I didn't stick around long.  Currently working what is more like a step down from UC.  Very basic cold/cough/minor lacs/abscess/cellulitis.  We have no xray and so I have to send everything out.  Most people my judgment tells me fracture is doubtful and I can send them to one of our outpatient xrays and others I strongly suspect fracture and want proper splinting and arranged follow up and so I just tell them to go to the ED.  We have two shifts per day and overlap for 30 minutes or so.  The pace is really manageable.  I miss the good medical cases leading to a slam dunk admission in the ED, but don't miss the politics, holidays, weekends, and narc issues.  All we keep onsite is motrin and Tylenol for pain. 

[JMPAC]

There are pros and cons to me for each.  Working ED I love true ED patient and solving the mystery they are presenting with.  In UC I wonder how people have survived this long thinking a runny nose will eventually lead to death of course.  It's a give and take.  In the ED we are stress about door-to-doc times and press ganey scores and in the UCs I've been in we don't.  This is a major plus.  I've worked in a money hungry multi-sight UC that just wanted us to crank out patients all day long.  Two of us would sometimes see 100 patients in a day.  This is awful and I didn't stick around long.  Currently working what is more like a step down from UC.  Very basic cold/cough/minor lacs/abscess/cellulitis.  We have no xray and so I have to send everything out.  Most people my judgment tells me fracture is doubtful and I can send them to one of our outpatient xrays and others I strongly suspect fracture and want proper splinting and arranged follow up and so I just tell them to go to the ED.  We have two shifts per day and overlap for 30 minutes or so.  The pace is really manageable.  I miss the good medical cases leading to a slam dunk admission in the ED, but don't miss the politics, holidays, weekends, and narc issues.  All we keep onsite is motrin and Tylenol for pain. 

Thanks for that perspective! It sounds like finding the right urgent care company is the key.
I think it would be nice to work at a narcotic-free ER or clinic. As I was ending my shift this morning, we have a man literally screaming F-bombs in the hall about getting pain meds and that he was going to "alert the press about what goes on in this place". I guess he didn't appreciate waiting 45 minutes to be seen for his chronic back pain while my doc dealt with an NSTEMI and I was dealing with my post gastric bypass perforated bowel patient who was tanking. [emoji849]
Usually, I like the action in the ER, but those pain patients have been wearing me out. I've been threatened with lawyers and people have gotten into my personal space and I had a guy do a formal complaint about me the other night because I wouldn't give him opioids. He had a rib fracture but he was also an alcoholic on methadone who could barely stay awake when he first came in so, I had a sincere talk with him about why narcotics were the last thing he needed. I certainly do give narcotics when they're indicated (like when someone has a bowel perforation, for example) but, I really try to be prudent and not add to the opioid crisis if I can help it.
Anyway, didn't mean to turn this into a rant about drug seekers, but it's another example of why I'm considering a change.

[quietmedic]

For me it was the best move, because the ER i was at was a terribly hostile environment...abusive Attendings, directionless administration.  UC was like a breath of fresh air...get to go home at the end of the day without getting reamed out in front of my coworkers or having to take crying breaks.  SUre, can be more patients, but the freedom and respect made up for it.