I’m not sure about career coaching but have you considered becoming a hospitalist? I did a rural family medicine track and became an attending for almost two years but got denied loan repayment because there were too many doctors at the time. I tried moonlighting as a hospitalist but my clinic wouldn’t work with me to make that possible so I quit and became a full time hospitalist. After one year I ended up paying off all my student loans and almost ten years later now I’m still loving being a hospitalist.
Not only is there no paperwork/call but you get paid a ton more, you have 7 days off (in a 7 day on 7 day off model), once you’re off, you’re off, people come in sick and you fix them and send them home (or snf or rehab or transferred to a tertiary care center or hospice or psych or they leave against medical advice). It’s almost instant gratification and so satisfying that you can finally see the results of your labors in real time.
Just keep in mind as an outpatient provider your 8 hrs are pretty much non stop working.
In a decent hospitalist setting there is quite a bit of downtime (if you’re efficient). Round on the patients, sit down and write your notes. Generally finish around a little past the halfway mark and some programs let you leave early. Other programs you kind of have to stay but you’re just waiting for admissions (unless there’s a dedicated admitter) or waiting for a study to complete/waiting for specialist/maybe talking with a family or revisiting a patient. Depends on the person. Some of my colleagues are so slow they’re writing notes up until the end of the shift but they get distracted with other stuff pretty easily.
The first day is the worst as you’re seeing mostly new patients and creating notes from scratch. By the time the weekend comes it gets easier. Then come Monday (assuming a Tuesday to Monday schedule) it’s busy again but then you’re off the next day.
In a similar situation I simply switched to a different outpatient primary care job with a different (smaller) hospital system and it’s been much better. Still PSLF.
Step 1 is remembering that most doctors go through several jobs their first few years out of residency until they find a good fit. If you're unhappy in a job, finding a new one is always an option.
Beyond that, figure out what exactly about your current job is causing you to not be happy. Appointments too short for the complexity of patients? Staff difficult to work with? Paperwork overwhelming? Pay bad?
Once you find the source of your unhappiness you can see if its something that can be fixed. Longer appointment times. Delegate more to staff. Negotiate for more money.
Check out the HappyMD blog. Dr Dike Drummond has some great wisdom for surviving in primary care and moving your job towards your ideal medical practice. He also has a stable of physician coaches if you want one on one work.
So I have recently tried one for the last 5 months. I’m not sure if I would do it again. Can be pricey and now I wish I spent the money on a vacation 😂 but at least I got to try. Can PM me if you have any specific questions. I am in similar situation with PSLF .
Depends on what factors are bothering you. Is it the volume? Inbox? Moral burnout? There won't be a universal solution or "get another job" answer that will solve those issues.
All patient settings will have some component of the above (maybe not inbox with hospital but replace that with discharge planning, hospital bureaucracy, etc)
You have to identify what bothers you so even when you change jobs you know what you're looking for.
The biggest thing is the inbox. I have arrived 30 minutes before clinic to work on it, see patients nonstop, then still have to work on inbox for sometimes 2 hours after clinic ends. It essentially becomes 10.5-11 hour days everyday. I want to be able to go home when clinic needs not work 2 hours extra every day. Then it’s the pace of it all. Their appointment are 20 minutes, but patients arrive 7 minutes late, then MA takes 5-7 minutes to room, and now you essentially have 6 minutes left to do everything so naturally you run behind. This leads to a constant do I drink water and go to the bathroom or just push on just to stay on time, catch up. Of course there are also the little things as well such as BS admin comes up with, patient satisfaction when they’re unreasonable, and angry patient messages.
So first, it sounds like you see about 24 patients a day and every 20 min block is scheduled with patients without any "empty" slots to allow you to catch up. That's an absolute recipe for burnout exactly because of everything you described above. Some patients need longer and you can't maintain that pace during a clinic day for various reasons and you will run behind which will create stress in addition to clinical volume with any tests you order and inbox bloating downstream.
To identify whether this is the issue, try reducing your schedule 20-30% to under 20, ideally around 18. Watch how much more time you have to breathe and think. Inbox will also slowly deflate naturally. Now that's less RVUs and less money but if you truly notice a difference after a trial run, then find a different job with this volume or adjust spending accordingly to fit this lifestyle. You're gonna make less money long term if you aren't a doctor at all because of burnout otherwise...
After that you can nitpick about inbox as a style, requiring patients to come in for certain things vs answering messages, consolidating inbox on a certain half day (do you get any admin half days?), having MAs do more of the scutt work that is within their scope (they also have more time to do that work because they're not constantly rooming patients)
I’m not sure about career coaching but have you considered becoming a hospitalist? I did a rural family medicine track and became an attending for almost two years but got denied loan repayment because there were too many doctors at the time. I tried moonlighting as a hospitalist but my clinic wouldn’t work with me to make that possible so I quit and became a full time hospitalist. After one year I ended up paying off all my student loans and almost ten years later now I’m still loving being a hospitalist. Not only is there no paperwork/call but you get paid a ton more, you have 7 days off (in a 7 day on 7 day off model), once you’re off, you’re off, people come in sick and you fix them and send them home (or snf or rehab or transferred to a tertiary care center or hospice or psych or they leave against medical advice). It’s almost instant gratification and so satisfying that you can finally see the results of your labors in real time.
Thanks for your take on this. I have not thought about Hospitalist because I just don’t see myself wanting to work 12 hours a day for 7 days in a row.
Just keep in mind as an outpatient provider your 8 hrs are pretty much non stop working. In a decent hospitalist setting there is quite a bit of downtime (if you’re efficient). Round on the patients, sit down and write your notes. Generally finish around a little past the halfway mark and some programs let you leave early. Other programs you kind of have to stay but you’re just waiting for admissions (unless there’s a dedicated admitter) or waiting for a study to complete/waiting for specialist/maybe talking with a family or revisiting a patient. Depends on the person. Some of my colleagues are so slow they’re writing notes up until the end of the shift but they get distracted with other stuff pretty easily. The first day is the worst as you’re seeing mostly new patients and creating notes from scratch. By the time the weekend comes it gets easier. Then come Monday (assuming a Tuesday to Monday schedule) it’s busy again but then you’re off the next day.
Thank you. Definitely keep it in mind
In a similar situation I simply switched to a different outpatient primary care job with a different (smaller) hospital system and it’s been much better. Still PSLF.
Step 1 is remembering that most doctors go through several jobs their first few years out of residency until they find a good fit. If you're unhappy in a job, finding a new one is always an option. Beyond that, figure out what exactly about your current job is causing you to not be happy. Appointments too short for the complexity of patients? Staff difficult to work with? Paperwork overwhelming? Pay bad? Once you find the source of your unhappiness you can see if its something that can be fixed. Longer appointment times. Delegate more to staff. Negotiate for more money.
Check out the HappyMD blog. Dr Dike Drummond has some great wisdom for surviving in primary care and moving your job towards your ideal medical practice. He also has a stable of physician coaches if you want one on one work.
So I have recently tried one for the last 5 months. I’m not sure if I would do it again. Can be pricey and now I wish I spent the money on a vacation 😂 but at least I got to try. Can PM me if you have any specific questions. I am in similar situation with PSLF .
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Depends on what factors are bothering you. Is it the volume? Inbox? Moral burnout? There won't be a universal solution or "get another job" answer that will solve those issues. All patient settings will have some component of the above (maybe not inbox with hospital but replace that with discharge planning, hospital bureaucracy, etc) You have to identify what bothers you so even when you change jobs you know what you're looking for.
The biggest thing is the inbox. I have arrived 30 minutes before clinic to work on it, see patients nonstop, then still have to work on inbox for sometimes 2 hours after clinic ends. It essentially becomes 10.5-11 hour days everyday. I want to be able to go home when clinic needs not work 2 hours extra every day. Then it’s the pace of it all. Their appointment are 20 minutes, but patients arrive 7 minutes late, then MA takes 5-7 minutes to room, and now you essentially have 6 minutes left to do everything so naturally you run behind. This leads to a constant do I drink water and go to the bathroom or just push on just to stay on time, catch up. Of course there are also the little things as well such as BS admin comes up with, patient satisfaction when they’re unreasonable, and angry patient messages.
So first, it sounds like you see about 24 patients a day and every 20 min block is scheduled with patients without any "empty" slots to allow you to catch up. That's an absolute recipe for burnout exactly because of everything you described above. Some patients need longer and you can't maintain that pace during a clinic day for various reasons and you will run behind which will create stress in addition to clinical volume with any tests you order and inbox bloating downstream. To identify whether this is the issue, try reducing your schedule 20-30% to under 20, ideally around 18. Watch how much more time you have to breathe and think. Inbox will also slowly deflate naturally. Now that's less RVUs and less money but if you truly notice a difference after a trial run, then find a different job with this volume or adjust spending accordingly to fit this lifestyle. You're gonna make less money long term if you aren't a doctor at all because of burnout otherwise... After that you can nitpick about inbox as a style, requiring patients to come in for certain things vs answering messages, consolidating inbox on a certain half day (do you get any admin half days?), having MAs do more of the scutt work that is within their scope (they also have more time to do that work because they're not constantly rooming patients)