Thoughts on Urgent Care vs Family Med

[MisterBen]

Hello,

I’m currently a second-year PA student and I’m looking for some advice from people who have more experience than me. I graduate in May and this week I was talking to a health system that has openings in both urgent care and family med. Throughout my rotations I have enjoyed my experiences in both and I’m just wondering if anyone here has experience in either and would like to weigh in with their thoughts. I know personal preference plays a big role in this, but I’d love to get some information on the pros and cons of both areas. Thank you!

[thinkertdm]

I've worked in both, and personally feel that, while there is a place for  clinic that deals with urgencies, urgent cares and walk ins contribute to fragmentation of Heath care, as well as feeding into a decrease of self responsibility on the part of the patient.  It turns medicine into a service industry, and while we have always been oriented towards service of our fellow human being, now we are part of a nice industry where ratings mean more than care.   

[rev ronin]

Having done both, I prefer family medicine.

[LT_Oneal_PAC]

I prefer FM as well. UC has redeeming qualities, but overall I’d be hating life doing it as my main position.

[WeBuyAndSellJunk]

Will the FM group require you to do walk-ins/urgent care? The place I work does and it is a bit of a nightmare. What I typically see in urgent care is very linear management of one patient to the next. What happens in my office is overbooking or placing walk ins in to no show slots (already lost 15 min of a 20 min visit slot because they allow for a 15 min late window). It sucks and the 2nd comment above totally resonates with me. Even within the patient’s own FP office, it causes people to see a different provider every time, patients show up acutely and uncontrolled for chronic issues because they can show up when they want, I have to see brand new patients for acute issues in about a 10 minute slot (if I roll the dice and take the walk in after a no show). Everyone gets worse care and the providers get burned out. My place of employment likes to roll our effort all in to, “but, you are doing a good thing for an at-need community.” As if we can’t put some responsibility on the patient. It is a numbers game now in many places and I would just encourage you to figure out if that is their priority in FP.

[MCHAD]

5 hours ago, printer2100 said:

What happens in my office is overbooking or placing walk ins in to no show slots (already lost 15 min of a 20 min visit slot because they allow for a 15 min late window)

This is one of my biggest pet peeves, I don’t know how many times I can tell the front desk “just because I have an opening at 10:30 doesn’t mean you can put a walk in there when it’s 11:00!”  

[Guest ral]

Do FM.  Urgent Care clinics are predominantly about seeng as many patients as possible, and keeping those patients happy.  That means steroids and Zpaks for everyone, or you will hear about the negative Yelp reviews.  Using your brain in Urgent Care is frowned upon.

[rev ronin]

1 hour ago, MCHAD said:

This is one of my biggest pet peeves, I don’t know how many times I can tell the front desk “just because I have an opening at 10:30 doesn’t mean you can put a walk in there when it’s 11:00!”  

Yep.  But they will, because they don't answer to you, they answer to management, which is more concerned about money than quality of care or patient satisfaction.

The FP/Occ Med gig I work currently, the receptionist is in her late 50s, former legal secretary, and has high expectations of patients.  She'll cancel people off my schedule for lateness sooner than I will, and has never put an "add on" in that I disagreed with. I'm not likely to leave this job. :-)

[GetMeOuttaThisMess]

Yep.  But they will, because they don't answer to you, they answer to management, which is more concerned about money than quality of care or patient satisfaction.
The FP/Occ Med gig I work currently, the receptionist is in her late 50s, former legal secretary, and has high expectations of patients.  She'll cancel people off my schedule for lateness sooner than I will, and has never put an "add on" in that I disagreed with. I'm not likely to leave this job. :-)

You had better hope that SHE doesn’t [emoji1]


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[rev ronin]

24 minutes ago, GetMeOuttaThisMess said:

You had better hope that SHE doesn’t

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Yeah, everyone but me is going to be retirement-ready in the near future, so it could evaporate, but I'm not looking forward to that.

[GetMeOuttaThisMess]

I’m trying to keep my clinic manager, as well as the clinic, around till 9/20.


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[sas5814]

As a "youngster" I really recommend FP. You will get to see a lot and learn and lot and keep learning. I'm getting older and want to ease my life a little so I have transitioned into a low acuity UC. No call, no patient call backs, no send out testing that has to be followed up on, no chronic disease management of any kind, no pain management.

It suits me right now and until retirement. It is, however, pretty boring most days. The magic is to not miss something really serious in the mass herd of the trivia.

[Cideous]

Personally I think every PA should do 2 years of ER.  Until you see sick, it's hard to recognize sick....

[GetMeOuttaThisMess]

Or crocks

[CAdamsPAC]

10 hours ago, sas5814 said:

As a "youngster" I really recommend FP. You will get to see a lot and learn and lot and keep learning. I'm getting older and want to ease my life a little so I have transitioned into a low acuity UC. No call, no patient call backs, no send out testing that has to be followed up on, no chronic disease management of any kind, no pain management.

It suits me right now and until retirement. It is, however, pretty boring most days. The magic is to not miss something really serious in the mass herd of the trivia.

Treat em and street em..........

[CAdamsPAC]

On 1/22/2018 at 11:05 PM, Cideous said:

Personally I think every PA should do 2 years of ER.  Until you see sick, it's hard to recognize sick....

Not all ED's truly let PA's see "sick" patients and get elbows deep into Emergency Medicine. If a new grad can get into an ED that will allow them to learn and grow , yes if shunted to UC or minor care pts, no.

[newton9686]

Sad, but true CAdams. However, you know a good way to make a name for yourself, diagnose a couple of those "flu-like" patients sent to you with CAD, poorly controlled diabetes and hypertension with a silent MI and you will start making a name for yourself. Just because you are a PA working fast track or urgent care doesn't mean you do not get to use your education and grow as a provider.

[CAdamsPAC]

6 minutes ago, newton9686 said:

Sad, but true CAdams. However, you know a good way to make a name for yourself, diagnose a couple of those "flu-like" patients sent to you with CAD, poorly controlled diabetes and hypertension with a silent MI and you will start making a name for yourself. Just because you are a PA working fast track or urgent care doesn't mean you do not get to use your education and grow as a provider.

Adrenal crisis, Acute Renal Failure, Pneumonitis, Pulmonary Emboli are a few "Fast Track" patients triaged to me but again I was an experienced PA in the UC area. All new grads need to be in a good teaching environment with peers and MDs who want them to develop and work at making them better clinicians, not just another drone worker bee! Many ED have discovered that UC/Fast Track is where experienced PA need to be not new grads.