Emed to Urgent Care...Thoughts?

[Salesian]

Hey folks,

I've been working in emergency medicine for about 1 year in a setting with a good mixture of high acuity and fastrack patients at a teaching institution. I've also worked during this time per diem at a low volume urgent care. While this has been an outstanding first job in terms of resume building and learning, it of course has the downside of wild hours, nights, weekends, holidays, etc. at a rather noncompetitive hourly rate/salary. I don't hate the job, but I also don't see myself doing emergency medicine forever. Or at least...not at this salary.

For those who started in emergency medicine, what are your thoughts on transitioning to an urgent care job? I have heard some describe a miserable existence of patient volumes upwards of 60 patients a day, but I am guessing this is very dependent on the institution. Are there other specialties that make for a natural transition from emergency medicine? Am keeping all my options open at this point. Thanks!

[cc56]

I did not start UC, but I used UC to "hop" over to ER.  The UC I worked at was slow then got more and more busy.  I came in 1 year after being open and within 1 more year we went from 14 pt a day to like 30's.  I heard they are doing 40's now, solo provider.  Given occasional procedures, complexity, required paperwork, that makes for a busy long 12 hour day.  Basically don't expect the UC to stay slow and low volume. 

 

Around me the UC pays a lot less than ER.   The hours were not that much better as I had to work every other weekend.   Also the UC I worked at did workman's comp which I hated, everything else UC I didn't mind.  We were also freestanding with only onsite x-ray, and no blood labs.

 

To answer the question personally I don't want to go to UC again any time soon from ER.   Then again some of these UC out there see basically 90% of the "fast track" patients from ER.  You also have CT, blood labs, monitors in rooms, ability to direct admit.  Maybe that would not be bad V.S. the UC that are like Walgreens Minute clinics.   

[PAtoMD]

I work UC on an as needed basis and my full time job is in a complete different field. The problem I found with urgent care at first was deciding who I could comfortably send home. You don’t have the tools and support staff you do at an ER. When I was in my training phase I brought it up to the PA who i was training with and they told me in their opinion it’s a common misconception a PA should start in urgent care then go to ER. That being said the urgent care I work in sees a volume of about 20-30 patients a day. We are in a rural area so acuity can be high. A physician and a PA split the work. I think if you find a good urgent care gig you’d be pretty happy given your previous experience. 

[Cideous]

3 hours ago, PAtoMD said:

I work UC on an as needed basis and my full time job is in a complete different field. The problem I found with urgent care at first was deciding who I could comfortably send home. You don’t have the tools and support staff you do at an ER. When I was in my training phase I brought it up to the PA who i was training with and they told me in their opinion it’s a common misconception a PA should start in urgent care then go to ER. That being said the urgent care I work in sees a volume of about 20-30 patients a day. We are in a rural area so acuity can be high. A physician and a PA split the work. I think if you find a good urgent care gig you’d be pretty happy given your previous experience. 

Anyone who does UC should of first done Emergency Medicine.  I tell people all the time, it's impossible to do UC right if you don't know what sick looks like (i.e. spent time in the ER).

[sas5814]

I agree except it does't have to necessarily be ER. I spent years in the military and then rural health and remote locations with a smattering of ER in the middle somewhere.

I think your core point of "you have to know what sick looks like" is spot on. The magic sauce of UC is not missing something bad in the middle of all the trivia.

[dphy83]

I think you have a bad EM job. Those should consistently be near top end of salary range for an area (but often trumped by derm and some surgical subspecialties). But if you dont like EM altogether then I think family med/outpatient internal med or a hospitalist position would be a relatively smooth transition. Dont get me wrong, there will still be a learning curve with many new things to learn, but EM exposes you to a wide range of stuff. You'd just have to learn how to manage this stuff long term.

[GMM2019]

I know many PAs who made the transition and seem happy with it, from the ED to UC.

Urgent care was not for me... but I might not be the emergency med type either. I struggled a lot with it as a newer grad, and didn't feel like there was much training or support. I'd be getting out late almost every night (30min to an hour after closing), and would go home with 1-2 hours of charts every shift, because it took me a while to adapt to the pace. Didn't get compensated extra for getting out late or finishing charts. No one really met with me about how I was doing, or checked in with me. I worked mostly with another new grad PA, which seems insane to me even now lol. I get a little nauseous thinking about what I might've missed due to inexperience.... I also prefer being detailed in my charts, but felt like I couldn't do this in the urgent care setting. UC felt like a sweatshop to me, truthfully. 

[Corpsman2PA]

On 10/25/2019 at 6:40 AM, Cideous said:

Anyone who does UC should of first done Emergency Medicine.  I tell people all the time, it's impossible to do UC right if you don't know what sick looks like (i.e. spent time in the ER).

^This all day. 
 

I did 4 years of ER, then went Primary Care for about 6 months (Shutters in agaony) before jumping back to (a different) ER.

Full-time gig is At an ED w/ separate UC facility. We split time between both UC and ED which is nice. The UC has access to all the imaging and labs of the ED. I do this 130-140 hrs/month, 22 patient cap. 

My separate UC job is 2-3 days a month, (20-30/hr’s) and pays almost as much as my FT job per hour (low $80/hr) and is FQHC. I see max 20-25, most is about 15-20. (And I’m keeping this location all to myself because I don’t want any of you taking my job!) 
 

 I see myself doing this for many years, as the work is manageable, and both places have a “cap” on how many patients we see per shift (I know, craziness right?).

I’ve found that I enjoy my days at work more, and am fine not seeing “super sick” people and all the stress that comes with it. 
 

But I agree with what’s been said, having ED experience is crucial in UC so you can recognize sick/not sick. I think it all depends on the type of UC. Sadly, many are all about the numbers at the expense of the Medical provider’s sanity.

 

[surgblumm]

It's all been said with a couple of different opinions. Compared to EM in a real hospital, UC is  semi-retirement. That said, UC affords you an opportunity to really screw up if this is a first job as you,  A. Lack experience in seeing sick patients, B. Lack experience in seeing patients, C. Lack radiological expertise and suturing techniques. All in all, there are patients who need to be seen in an ER STAT who walk into UC in their ignorance and if the PA or NP present is not experienced, you can easily "fail to diagnose" and either kill or make a patients problem far worse as well as get early LITIGATION. i GUESS i AM AN HONEST CREPE HANGER.

[RadAssPA]

I know a guy working UC that gets paid $33 per patient seen. His gross pay for the month of October was just shy of $18,000 working 5-6 days a week. Can I work around the clock with you too please?

[surgblumm]

That yam exception to the norm. I saw up to sixty patients a day with no Doc. I am tabulating about now.

[logos]

I spent my first 4 years working in emergency medicine seeing a mix of acuity before going to UC. I then worked at a busy UC for five years and then transitioned to a largeHMO type practice doing cross coverage/UC within a fm/IM department.

 

In the ER you have the benefit of working with ER docs who often offer some more mentoring then you’ll get at an UC. You’ll see sicker patients and you’ll likely be presenting them. You’ll be looked at more critically and you’ll need to strive to practice at a different standard of care then you would at an UC.

 

Going from the ED to UC will give you an edge in recognizing sick, you’ll be better equipped to know when to transfer/admit and have more experience presenting to specialists. You’ll also already have a more “inside” understanding of how the hospital works.

 

In the UC you’ll mostly be working with FP docs and semiretired ED docs. You’ll likely feel much more respected. You’ll present less, but also have less people around to present too.

 

UC is a great gig if you can handle the numbers, self motivate to stay up to date(less mentorship) and work in a collegial clinic.

 

I find it to be more interesting then a fast track in a ED in that you can choose to work up a sicker, but stable patient if you want.

 

I have worked at several UCs that all work a bit different based on the available in house labs/imaging available. I believe very few UCs out there still see only low acuity. The business of medicine really doesn’t allow this only low acuity entity to survive, but maybe that’s my bias living in a large urban setting.

 

The main UC at my institution that I moonlight at has CT/mri/us,stat and labs/troponin in house. However most of the UCs in my city I have stat send outs. In some cases I could get stat send out labs resulted at these stand alone UCs faster then at my shop with the lab next door!