Starting a new job in Urgent Care in California after 3 yrs in primary care . Any tips or suggestions appreciated

[Empowred]

Hello Folks ,

Accepted an offer which I thought was reasonable. I have 2 1/2 yrs experience on primary care 

142 K /year , 24 hrs sick leave 

• 56 hours of Paid Time Off.
• Company Paid Licensure for: DEA, PA Lic & DOT.
• Mal-practice insurance coverage.
• Medical, Dental, Vision & Life Insurance.
• Company's 401K Plan.
• Company Paid UpToDate Subscription towards your CMEs.

Additionally, I will also be eligible for an annual bonus up to $8,000 which will be based on your performance and practice development goals

The medical insurance will start after 90 days of employment

 

The questions I have is : 

Is it a common practice to have the medical insurance after 90 days ? 

Any suggestions or tips to prepare would be highly appreciated . I have to start on May 17th . Thank you. 

[Cideous]

What is the volume....

What is the volume....

and....

What is the volume....

 

Those are the questions that anyone who works UC should be asking.

[Komorebi]

Isn't that super low PTO?

You can only take 2 weeks off per year?

That sounds like burnout waiting to happen. You'll never be able to take an "extended" vacation unless you take off no other days all year.

Edited May 6, 2021 by Komorebi

[thinkertdm]

I had a job at a “walk in” clinic.  We had 3 providers, for 12 hour days, 7 days a week.  You could call in sick, but you paid a price, off the books.  And vacations were hell, because they didn’t cover you, the other two covered.  Just make sure that you actually get get those bennies.  No one plans on getting sick, but as humans, we do.

[sas5814]

Its not unreasonable but it isn't great. The PTO seems very low. My last UC started everyone with 240 hours off.

As Cid pointed out patient volume is the single biggest issue. Last UC would not, even after years of discussions about patient safety and provider burnout, set any sort of limits on our 12 hour day. Let me promise you when you get to your 50th patient with 15 more in the lobby you are brain-dead dangerous. Do it multiple times and your safe number goes down further. It is bad for patients and puts you in professional jeopardy. My org would lose half the providers after every flu season and replace them and wouldn't change anything.

If I had a pearl to share it would be this.... many people treat UC like some easy way to make extra money or something old PAs do to semi retire. In the middle of oceans of trivial crap that doesn't need any real care there are drops of critical problems. Not missing them is the magic sauce.

In my last 3 years of UC I had 2 pneumothorax, multiple STEMIs and more non-STEMIs than I can count. There are also tons of people who come to the UC because they don't want to wait at the ER and have no idea what your capabilities are. I have had stabbings, gunshot wounds, dog maulings, big MVAs (with an anterior C3 fracture) etc etc. Don't be complacent and don't be shy about moving things on to the ER even if they give you grief. Your first responsibility is to the patient. Keep your index of suspicion turned up high.

Forgot to add it isn't unusual to have to wait for health insurance to kick in but I have always been able to negotiate a start date within a few weeks of starting work.

 

 

Good luck!

Edited May 6, 2021 by sas5814

[Cideous]

11 hours ago, sas5814 said:

Its not unreasonable but it isn't great. The PTO seems very low. My last UC started everyone with 240 hours off.

As Cid pointed out patient volume is the single biggest issue. Last UC would not, even after years of discussions about patient safety and provider burnout, set any sort of limits on our 12 hour day. Let me promise you when you get to your 50th patient with 15 more in the lobby you are brain-dead dangerous. Do it multiple times and your safe number goes down further. It is bad for patients and puts you in professional jeopardy. My org would lose half the providers after every flu season and replace them and wouldn't change anything.

If I had a pearl to share it would be this.... many people treat UC like some easy way to make extra money or something old PAs do to semi retire. In the middle of oceans of trivial crap that doesn't need any real care there are drops of critical problems. Not missing them is the magic sauce.

In my last 3 years of UC I had 2 pneumothorax, multiple STEMIs and more non-STEMIs than I can count. There are also tons of people who come to the UC because they don't want to wait at the ER and have no idea what your capabilities are. I have had stabbings, gunshot wounds, dog maulings, big MVAs (with an anterior C3 fracture) etc etc. Don't be complacent and don't be shy about moving things on to the ER even if they give you grief. Your first responsibility is to the patient. Keep your index of suspicion turned up high.

Forgot to add it isn't unusual to have to wait for health insurance to kick in but I have always been able to negotiate a start date within a few weeks of starting work.

 

 

Good luck!

Mods can we PIN Scott's post and label it...."Before you take an Urgent Care job, read this". ???

Seriously, this is EXACTLY my experience in UC over the last 25 years.  I am a firm believer that no one should do UC unless they have done a minimum of 2 years in the ER.  Coming from Family Practice, unless you had very very very heavy ER training in school, would scare the crap out of me.  

Most established UC's are big money makers but also heartbreakers.  The crap that walks in will make you want to quit medicine.  UTI, URI, ABSCESS.....OD!  Grab the Narcan.......STEMI!  Grab the AED.  And yes...I have shocked patients who went down sitting in my UC exam room (she lived btw).  It's crazy volume of simple stuff interrupted with sheer F'ing panic.  

That's why what your volume is MATTERS in UC.  If you are seeing over 30 a day to start, god help you.

Edited May 7, 2021 by Cideous

[EMEDPA]

Agree with above. I ran several codes at a UC I worked at a few years ago, intubated a few people, almost weekly heroin ODs, stabbings, etc. Last pt there was a multiple gunshot victim.

[TeddyRucpin]

1 hour ago, EMEDPA said:

Agree with above. I ran several codes at a UC I worked at a few years ago, intubated a few people, almost weekly heroin ODs, stabbings, etc. Last pt there was a multiple gunshot victim.

Are all UC expected to have the equipment to run a code? I mean legit ACLS/ALS not solely AED/BVM.

[sas5814]

I worked at several different ones over the years. One had a pretty full lab including cardiac enzymes and full ACLS capabilities. The last one belonged to an org run by physicians who had to dumb everything down to keep PAs and NPs "safe" and we didn't do anything hard. Chest pains got transferred 100% of the time.

No matter what your actual capability you have to manage everything that walks in the door in some fashion. 

[Cideous]

1 hour ago, TeddyRucpin said:

Are all UC expected to have the equipment to run a code? I mean legit ACLS/ALS not solely AED/BVM.

Most now a days have an AED with basic meds.  The problem with having a crash cart are two-fold.

1.  It's expensive to maintain, those meds are not cheap and expire pretty quickly.

2.  If you have it and don't use it when someone goes down you are F'ed.

[sas5814]

It is a 2 edged sword which is why my last org removed them from the UC. We had Tnkase in the box and it alone was $7000 a dose. 7 UCs .....2 doses in each cart. Fairly short expiration date. $$$$

[TeddyRucpin]

1 minute ago, Cideous said:

Most now a days have an AED with basic meds.  The problem with having a crash cart are two-fold.

1.  It's expensive to maintain, those meds are not cheap and expire pretty quickly.

2.  If you have it and don't use it when someone goes down you are F'ed.

Are you required to maintain ACLS or any other certs besides BLS/BCLS? I agree if you are not doing these skills regularly and then expected to run a code (in a UC of all places), it will be challenging.

[sas5814]

Varies by location. They used to require us to be ACLS and PALS certified. When they removed all the high dollar supplies they removed the requirement. It is a waste of time and training IMHO to require everyone to be ACLS qualified when you have no ACLS supplies.

As said above...if you have a crash cart and trauma supplies you will be expected to use them.

[ohiovolffemtp]

The urgent care I worked at was a high volume low acuity site.  No ACLS meds.  For a long time, no AED.  So, the answer to any suspected badness was to call 911.  One of the other providers had seen someone with chest pain, done an EKG, and sent them to the nearby hospital's lab for a stat troponin, then called the on-call cardiologist.  NOT the way I handled any sort of suspicious chest pain: patient got the choice of a 911 call or them driving 1 mile to the ED.

The key is not what you can handle in the UC, it's having the proper level of suspicion of potential badness to send the patient to the ED right away.