Am I crazy for thinking that hospital medicine is one of the best lifestyle specialties?

[Osteoth]

I must clarify. I don't mean that ALL hospital medicine will go to midlevels - just enough to destroy the job market. Even at my academic institution, they are hiring midlevels. At smaller hospitals, it's getting close to 50/50.

It’s so dumb they’re not good…consulting ID for CAP management cannot be a good use of healthcare resources

---

Members don't see this ad.

 

[VA Hopeful Dr]

It’s so dumb they’re not good…consulting ID for CAP management cannot be a good use of healthcare resources

That's not the name of the game unfortunately.

I will say in places I'm aware of the midlevels function kinda like interns. They see the patient and present to the attending who then goes in and does a more abbreviated H&P since they don't have to do all the usual generic data collection stuff.

 

[CCM-MD]

I must clarify. I don't mean that ALL hospital medicine will go to midlevels - just enough to destroy the job market. Even at my academic institution, they are hiring midlevels. At smaller hospitals, it's getting close to 50/50.

Same trend in critical care medicine.

 

[Osteoth]

Same trend in critical care medicine.

Been seeing a lot of jobs that are tele-intensivist only. As an internist this gives me indigestion.

 

[CCM-MD]

Been seeing a lot of jobs that are tele-intensivist only. As an internist this gives me indigestion.

eICU is blowing up.

 

[chessknt]

eICU is blowing up.

Eicu is some stupid **** in my experience. A lot of small hospitals with weirdo internists practicing medicine from 20+ years ago ignoring everything I write.

 

[CCM-MD]

Eicu is some stupid **** in my experience. A lot of small hospitals with weirdo internists practicing medicine from 20+ years ago ignoring everything I write.

Stupid from a physician’s perspective = genius from an administrator’s perspective

 

[tantacles]

Eicu is some stupid **** in my experience. A lot of small hospitals with weirdo internists practicing medicine from 20+ years ago ignoring everything I write.

As a new grad nocturnist, I hate having an eICU. Happy to work collaboratively, not happy to be your telephone slave when you want to run the code from your desk. If you want to run the code, you can talk to someone who doesn't have admissions to do.

 

[chessknt]

As a new grad nocturnist, I hate having an eICU. Happy to work collaboratively, not happy to be your telephone slave when you want to run the code from your desk. If you want to run the code, you can talk to someone who doesn't have admissions to do.

You dont want the easiest 4.5 rvus of your life?

Why do they need you there,? The whole point of eicu is to cover stuff that is going on and ideally prevent codes. I try to never interface with nocturnists because I am on the phone for so long that any additional avoidable phone calls make me want to die. I make a half hearted attempt to actually put a differential in my note (because the day/night docs sure as **** dont) and add on absolutely critical medical malpractice level barebones basic workup that is always missed then move on to the next patient. I too would rather not have an eicu--it is massive liability exposure, work that does not generate any billing, and totally reliant on another clinician.

 

[tantacles]

You dont want the easiest 4.5 rvus of your life?

Why do they need you there,? The whole point of eicu is to cover stuff that is going on and ideally prevent codes. I try to never interface with nocturnists because I am on the phone for so long that any additional avoidable phone calls make me want to die. I make a half hearted attempt to actually put a differential in my note (because the day/night docs sure as **** dont) and add on absolutely critical medical malpractice level barebones basic workup that is always missed then move on to the next patient. I too would rather not have an eicu--it is massive liability exposure, work that does not generate any billing, and totally reliant on another clinician.

Our eICU doesn't really get me any RVU's . . . if they did, maybe I would like them more. They generally aren't involved unless a patient is actively coding or acutely worsening to the extent they're likely to code, in which case the patient is likely a 95 year old who wouldn't benefit from CPR or is a covid patient who almost certainly won't. Now granted our ICU acuity is pretty low, but the number of times the patient has put in narcotics for patients for whom the daytime hospitalist has said "no narcotics" outnumbers the times they've actually meaningfully intervened.

But every shop is different.

Edit: The intensivists who are actually here during the daytime seem fine. I'm a nocturnist, so eICU is all I generally see.

 

[rokshana]

Our eICU doesn't really get me any RVU's . . . if they did, maybe I would like them more. They generally aren't involved unless a patient is actively coding or acutely worsening to the extent they're likely to code, in which case the patient is likely a 95 year old who wouldn't benefit from CPR or is a covid patient who almost certainly won't. Now granted our ICU acuity is pretty low, but the number of times the patient has put in narcotics for patients for whom the daytime hospitalist has said "no narcotics" outnumbers the times they've actually meaningfully intervened.

But every shop is different.

Edit: The intensivists who are actually here during the daytime seem fine. I'm a nocturnist, so eICU is all I generally see.

It could be worse… you could have only mid levels…

 

[IMGASMD]

Our eICU doesn't really get me any RVU's . . . if they did, maybe I would like them more. They generally aren't involved unless a patient is actively coding or acutely worsening to the extent they're likely to code, in which case the patient is likely a 95 year old who wouldn't benefit from CPR or is a covid patient who almost certainly won't. Now granted our ICU acuity is pretty low, but the number of times the patient has put in narcotics for patients for whom the daytime hospitalist has said "no narcotics" outnumbers the times they've actually meaningfully intervened.

But every shop is different.

Edit: The intensivists who are actually here during the daytime seem fine. I'm a nocturnist, so eICU is all I generally see.

It could be worse… you could have only mod levels…

Used to cover a rural hospital at night. Every time I go, once a month or two, I can feel the sense of relief when the staff sees me.

From what I heard, most of the time, the mid levels won’t answer pages, won’t take admissions, won’t really round on icu patient.

I didn’t train at an academic institution, but even for me it was a huge eye opener. And also illustrated many shortcomings of having mid levels who really don’t know what they don’t know.

 

[Splenda88]

You might be right. Hospital medicine is arguably on the top 5 most desirable job in medicine in term of flexibility.


Wish I got into medicine early. Wasted 3+8 years in nursing.

 

[chessknt]

You might be right. Hospital medicine is arguably on the top 5 most desirable job in medicine in term of flexibility.


Wish I got into medicine early. Wasted 3+8 years in nursing.

If that was ICU nursing you can probably make more per hour doing locums ICU nursing than being a hospitalist.

 

[Splenda88]

If that was ICU nursing you can probably make more per hour doing locums ICU nursing than being a hospitalist.

Covid will end.

No ICU nurse made $150/hr before covid-19

 

[chessknt]

Covid will end.

No ICU nurse made $150/hr before covid-19

Sure but until that happens 200+/hr in the bad places

 

[Splenda88]

Sure but until that happens 200+/hr in the bad places

You are right. I am going to renew my RN license

 

[Taurus]

I must clarify. I don't mean that ALL hospital medicine will go to midlevels - just enough to destroy the job market. Even at my academic institution, they are hiring midlevels. At smaller hospitals, it's getting close to 50/50.

When the moat separating physician and midlevel is not great, the almighty dollar wins and the administrators will look to have as much of the work done by cheaper labor but under supervision. Hence, the team model of many midlevels to one physician. It’s your license on the line. I’m more surprised that it took this long for hospital medicine to reach this point. I remember 10 years ago many IM residents were thinking that being hospitalists was a great idea and didn’t see this coming.

 

[Splenda88]

When the moat separating physician and midlevel is not great, the almighty dollar wins and the administrators will look to have as much of the work done by cheaper labor but under supervision. Hence, the team model of many midlevels to one physician. It’s your license on the line. I’m more surprised that it took this long for hospital medicine to reach this point. I remember 10 years ago many IM residents were thinking that being hospitalists was a great idea and didn’t see this coming.

I think administrators have done the calculation. These people are not stupid. I think they probably realize it might not be profitable for them.

Most hospital medicine physicians are ok to take care of 18-20 patients. Mid level not so. For instance, at my chop, they cap them at 14, but there is not cap for us. We are ok taking take of 16-20 and sometimes more (during peak of covid I was told). Also, on a daily basis, we discharge ~25% of our census, meaning we make spaces for the hospital to admit more patients. NP might not have the comfort to discharge patient quickly. I am sure these people have data on length of stay (LOS) of NP/PA "hospitalists" vs. physician hospitalists.

As a former nurse, I think another thing that might make them more hesitant to do that is that nurse organizations make crazy demands the moment nurses start to complain about working conditions. On the other hand, there is no one making demands on behalf of these rich/aloof/arrogant physicians.

 

[bronx43]

I think administrators have done the calculation. These people are not stupid. I think they probably realize it might not be profitable for them.

Most hospital medicine physicians are ok to take care of 18-20 patients. Mid level not so. For instance, at my chop, they cap them at 14, but there is not cap for us. We are ok taking take of 16-20 and sometimes more (during peak of covid I was told). Also, on a daily basis, we discharge ~25% of our census, meaning we make spaces for the hospital to admit more patients. NP might not have the comfort to discharge patient quickly. I am sure these people have data on length of stay (LOS) of NP/PA "hospitalists" vs. physician hospitalists.

As a former nurse, I think another thing that might make them more hesitant to do that is that nurse organizations make crazy demands the moment nurses start to complain about working conditions. On the other hand, the is no one making demands on behalf of these rich/aloof/arrogant physicians.

From the hiring patterns that a lot of people are seeing, administrators ARE hiring legions of midlevels for hospital medicine. So, if they did the calculations, then it turns out that it does make sense financially. Or they didn't do the calculations. Or they did the calculations and are stupid.

Not sure which it is, but it doesn't matter because the hiring train is chugging along.

 

[Splenda88]

From the hiring patterns that a lot of people are seeing, administrators ARE hiring legions of midlevels for hospital medicine. So, if they did the calculations, then it turns out that it does make sense financially. Or they didn't do the calculations. Or they did the calculations and are stupid.

Not sure which it is, but it doesn't matter because the hiring train is chugging along.

Let's see. I have a 10-yr plan. Hoping things do not get out of control within these 10 yrs.

Personally, I dont think the healthcare system is sustainable in term of cost. I think every physician should have a formulated exit plan

 

[PrimaryCareDOToBe]

Let's see. I have a 10-yr plan. Hoping things do not get out of control within these 10 yrs.

Personally, I dont think the healthcare system is sustainable in term of cost. I think every physician should have a formulated exit plan

direct primary care

 

[shotgunlagoon]

direct primary care

I've heard a little about direct primary care, but I don't fully understand it, particularly how it benefits patients over a traditional health insurance plan.

How does direct primary care work when considering that patients might need referrals to specialists, or have an emergency that requires going to the hospital? Do they pay the direct primary care membership on top of regular health insurance? Why would a patient choose direct primary care over seeing whoever their insurance covers?

 

[PrimaryCareDOToBe]

I've heard a little about direct primary care, but I don't fully understand it, particularly how it benefits patients over a traditional health insurance plan.

How does direct primary care work when considering that patients might need referrals to specialists, or have an emergency that requires going to the hospital? Do they pay the direct primary care membership on top of regular health insurance? Why would a patient choose direct primary care over seeing whoever their insurance covers?

Typically they survive in areas where people have money / higher medical needs and know they need more time with the physician.

Most times, they will require their patients have at least emergency insurance just in case anything happens.

For those truly with no insurance, some doctors partner with specific labs / radiology offices to ensure they will provide certain cash prices for certain labs / imaging studies.

I think the model really benefits elderly patients, new mothers, and large families with money who know they want 24/7 access to a personal physician, have jobs that offer them insurance / or are receiving medicare anyways, and have the money to pay for the additional support and longer visits.

Also, I have started to also see that small businesses would rather pay 50$/employee / month to a physician to take care of all their employees rather than provide all their employees private insurance, especially since most younger hard working employees are usually on the ~healthiesh~ side of things rather than those who are unemployed etc .

 

[Crayola227]

Given all this don't know that it's great one size fits all escape plan.

Wonder how much you can reduce headache in your practice by taking on more stuff people generally are happy to pay out of pocket for, like cosmetic stuff.

 

[VA Hopeful Dr]

I've heard a little about direct primary care, but I don't fully understand it, particularly how it benefits patients over a traditional health insurance plan.

How does direct primary care work when considering that patients might need referrals to specialists, or have an emergency that requires going to the hospital? Do they pay the direct primary care membership on top of regular health insurance? Why would a patient choose direct primary care over seeing whoever their insurance covers?

Couple different ways. If you want longer visits, minimal waiting, better access. If you have a high deductible health plan, it can be cheaper especially if the DPC doc has deals for labs/meds/imaging.

Every DPC doctor strongly encourages patients to have health insurance to cover major expenses. DPC fees are outside of regular insurance payments.

Specialists can either be seen using regular insurance or its not uncommon for DPC practices to have cash-price deals with local specialists.

The idea behind DPC is a combination of better value since overhead is sharply reduced and better quality since physicians aren't rushed to see lots of patients every single day.

 

[VA Hopeful Dr]

Given all this don't know that it's great one size fits all escape plan.

Wonder how much you can reduce headache in your practice by taking on more stuff people generally are happy to pay out of pocket for, like cosmetic stuff.

Most DPC doctors I know that tried that sort of stuff didn't much like it. The patient population who pays out of pocket for cosmetics is prickly at best, they can be a huge headache.

Plus, if I'm paying $500 for Botox I'd rather pay the dermatologist/plastic surgeon versus the FP/IM doctor.

 

[IM.MD]

I can get you a hidden gem IM outpatient job right now. My wife is IM. Works 4 days/week 8-4, 1.25h lunch. Max patients/day is 22. 6 weeks vacation. Came within a rounding error of hitting 300k last year. Oh, and an actual retirement pension. Works out to about 55-60% of salary.

Speaking more generally, outpatient tends to have more flexibility and more income potential per hour. I see patients from 8-4 with a 90 minute lunch. I have a partner who skips lunch and so works 7:30-2:30. I have a friend who takes a very short lunch and so only works 4 days per week. None of us work nights or weekends ever. No holidays. If my kid is sick, I just call and cancel for the day.

If I want more money, I see more patients. Since I'm paid on production and not an hourly rate, its pretty easy to manage.

But, there's more busy work - refill requests, calls, portal messages. Not everyone likes longitudinal care. And outpatient isn't generally as interesting as hospital medicine, or so my former hospitalist wife keeps saying.

22 primary care clinic patients with their many medical needs and questions in 7 hours in the midst of refill requests, calls, portal messages, following up on labs, etc sounds horrible. Definitely worse than EM or hospital medicine where you are mainly concerned with acute issues. Many PCPs I have talked to need to chart at night or on their days off.

 

[tylerb1800]

22 primary care clinic patients with their many medical needs and questions in 7 hours in the midst of refill requests, calls, portal messages, following up on labs, etc sounds horrible. Definitely worse than EM or hospital medicine where you are mainly concerned with acute issues. Many PCPs I have talked to need to chart at night or on their days off.

The key to primary care is efficiency as well as setting patient expectations. You have to have a good nurse and MA to take the load off of you. The only refill request that I deal with are for controlled substances. My nurse either refills as appropriate or requires follow up. Portal messages go directly to my MA and nurse. I do not see them unless it is something that I need to handle. Majority of the time if it is something that I need to handle then the patient needs to come in and be seen.

A big issue that I have seen with PCPs since I have been out practicing is doing work for free. Paperwork needs to be completed? You must be seen in office and we will complete the paperwork together in the room. Otherwise it does not get completed. There are definitely pros and cos to primary care. It is easy to see 22 in a day and be home between 4:30 and 5pm with an 1hr 15min for lunch. I do absolutely no work when I leave the office except on my half day if there is something urgent that my nurse needs help handling.

 

[Osteoth]

The key to primary care is efficiency as well as setting patient expectations. You have to have a good nurse and MA to take the load off of you. The only refill request that I deal with are for controlled substances. My nurse either refills as appropriate or requires follow up. Portal messages go directly to my MA and nurse. I do not see them unless it is something that I need to handle. Majority of the time if it is something that I need to handle then the patient needs to come in and be seen.

A big issue that I have seen with PCPs since I have been out practicing is doing work for free. Paperwork needs to be completed? You must be seen in office and we will complete the paperwork together in the room. Otherwise it does not get completed. There are definitely pros and cos to primary care. It is easy to see 22 in a day and be home between 4:30 and 5pm with an 1hr 15min for lunch. I do absolutely no work when I leave the office except on my half day if there is something urgent that my nurse needs help handling.

I think primary care is one of the most “giving” specialties because of the deep connections you make with patients. So much work done without reimbursement.

 

[CCM-MD]

I think primary care is one of the most “giving” specialties because of the deep connections you make with patients. So much work done without reimbursement.

Give a lot and take it really deep.

 

[Crayola227]

The key to primary care is efficiency as well as setting patient expectations. You have to have a good nurse and MA to take the load off of you. The only refill request that I deal with are for controlled substances. My nurse either refills as appropriate or requires follow up. Portal messages go directly to my MA and nurse. I do not see them unless it is something that I need to handle. Majority of the time if it is something that I need to handle then the patient needs to come in and be seen.

A big issue that I have seen with PCPs since I have been out practicing is doing work for free. Paperwork needs to be completed? You must be seen in office and we will complete the paperwork together in the room. Otherwise it does not get completed. There are definitely pros and cos to primary care. It is easy to see 22 in a day and be home between 4:30 and 5pm with an 1hr 15min for lunch. I do absolutely no work when I leave the office except on my half day if there is something urgent that my nurse needs help handling.

The paperwork thing makes me feel pretty bad for the patient who has to miss work or whatever, just so you can earn more money. Altruism anyone?

This is why some doctors work for "free." The hit to us with the paperwork is small compared to our average patient.

 

[tylerb1800]

The paperwork thing makes me feel pretty bad for the patient who has to miss work or whatever, just so you can earn more money. Altruism anyone?

This is why some doctors work for "free." The hit to us with the paperwork is small compared to our average patient.

It is one thing if it is a basic form that needs to be signed. FMLA paperwork, short-term disability paperwork, recertification for long-term disability, etc should not be done without a patient in office at least in my opinion. Many of these forms are legal documents so you are attesting to the truth and validity of them. I want a patient in an exam room with me while I am filling it out so everyone is on the same page.

At the end of the day, you can practice how you want. Doing uncompensated work will lead to burn out. Your career is a marathon and not a sprint. I do not work for free and you should not either

 

[bronx43]

The paperwork thing makes me feel pretty bad for the patient who has to miss work or whatever, just so you can earn more money. Altruism anyone?

This is why some doctors work for "free." The hit to us with the paperwork is small compared to our average patient.

Taking this logic, then why charge any patients at all? Just so you can earn more money? Where's the altruism?

 

[Splenda88]

Taking this logic, then why charge any patients at all? Just so you can earn more money? Where's the altruism?

It's amazing how medicine works. Everyone expects physicians to work for free.

Also, people who have neglected to take care of themselves for years expect you to fix them in no time. Family members who have not done anything to help their love ones expect the hospital to do everything for them.

 

[tylerb1800]

It's amazing how medicine works. Everyone expects physicians to work for free.

Also, people who have neglected to take care of themselves for years expect you to fix them in no time. Family members who have not done anything to help their love ones expect the hospital to do everything for them.

This is why I have mentioned patient expectations in my previous post. I let the patient choose one or two problems to discuss which allows me time to discuss a more important issue if needed. If you have multiple problems that all need management, then we are following up very close and regular until things get handled.

 

[VA Hopeful Dr]

22 primary care clinic patients with their many medical needs and questions in 7 hours in the midst of refill requests, calls, portal messages, following up on labs, etc sounds horrible. Definitely worse than EM or hospital medicine where you are mainly concerned with acute issues. Many PCPs I have talked to need to chart at night or on their days off.

Those PCPs are inefficient. I'm FM and even on my busy days when I see 30+ I am out of this office by 5pm at the absolute latest. I get here at 8 and take a 90-ish minute lunch (admittedly I work during at least half of that on charts, messages, paperwork), last patient scheduled at 4pm. My partners are similar, some are busier but they use scribes which helps.

 

[Splenda88]

Those PCPs are inefficient. I'm FM and even on my busy days when I see 30+ I am out of this office by 5pm at the absolute latest. I get here at 8 and take a 90-ish minute lunch (admittedly I work during at least half of that on charts, messages, paperwork), last patient scheduled at 4pm. My partners are similar, some are busier but they use scribes which helps.

How do you do that? Even with dragon it takes me ~15 minutes to write a note

 

[rokshana]

How do you do that? Even with dragon it takes me ~15 minutes to write a note

You need better templates… most of your note should self populate and the part you dictate is the HPI and some portion of the A/P. Have dedicated templates for the most common admissions so you really don’t have to adjust the A/P.
A cp r/o mi should not take more than 5 mins to write, for example.

 

[Splenda88]

You need better templates… most of your note should self populate and the part you dictate is the HPI and some portion of the A/P. Have dedicated templates for the most common admissions so you really don’t have to adjust the A/P.
A cp r/o mi should not take more than 5 mins to write, for example.

My problem is that I always go back reading my notes since I have an accent and dragon sometimes do not pick up correctly some of my words.

For instance, I used the word mastectomy in a note the other day, but dragon picked up vasectomy. The billing people emailed me and ask if that was the word I wanted to use. Lol

 

[IM.MD]

Those PCPs are inefficient. I'm FM and even on my busy days when I see 30+ I am out of this office by 5pm at the absolute latest. I get here at 8 and take a 90-ish minute lunch (admittedly I work during at least half of that on charts, messages, paperwork), last patient scheduled at 4pm. My partners are similar, some are busier but they use scribes which helps.

Please don't take it personally but an efficient / fast doctor does not mean a good doctor especially from a patient's perspective and especially in primary care. 30 patients in 6.5-7 hours with all the behind the scenes work those encounters generate sounds awful. No wonder docs and patients are loving direct primary care. If you enjoy being a healthcare system employed FM doc why not do urgent care or EM given you like those settings for higher hourly pay and more time off?

 

[tylerb1800]

Woo 30+ per day is a lot. I am still seeing 4 to 5 new patients per day so I do not want to see more than 22. I will move to 22 to 26 once I am only taking one or no new patients a day. I bill appropriately so I don't have a reason to really see more than 26. I am more than pleased with my income and value-based bonuses.

With dragon and templates, my notes take 1 to 3 min per patient. I do not copy forward from the previous note either. At the same time, I do not have a difficult accent for dragon to pick up so I do feel for physicians that have that issue

 

[Bbsixty]

What is your income like with that kind of patient volume?

 

[VA Hopeful Dr]

How do you do that? Even with dragon it takes me ~15 minutes to write a note

Lots of templates and macros.

 

[VA Hopeful Dr]

Please don't take it personally but an efficient / fast doctor does not mean a good doctor especially from a patient's perspective and especially in primary care. 30 patients in 6.5-7 hours with all the behind the scenes work those encounters generate sounds awful. No wonder docs and patients are loving direct primary care. If you enjoy being a healthcare system employed FM doc why not do urgent care or EM given you like those settings for higher hourly pay and more time off?

That's absolutely true and the biggest determinant there is knowing what your day typically looks like. My day is usually a pretty even mix of stable chronic visits that are very easy - young people with ADHD and nothing else, middle aged HTN/lipids that are stable, yearly thyroid checks; acute visits which are mainly ortho or URI/rash type complaints that are also pretty quick and easy; and then you have the uncontrolled chronic diseases, complicated acute visits (chest pain) or multiple new problem visits. Those take time but since the rest of the day doesn't it balances out.

You also have to build your practice such that you end up with patients who like the way you do things. I took over for a retiring FP who would spend 30 minutes per patient chatting and catching up even beyond the actual medical part of the visit. I do not do that. Some of his patient left when they saw I didn't, some of them seem to prefer it because it means a visit to the doctor doesn't take up 2 hours of their day minimum. My patients also know that since I work hard, they don't have much trouble getting same/next day visits when they need them.

I did DPC for several years. I was bored, I much prefer to be busy. That's not to say DPC isn't a great option for some people because it absolutely is. It just wasn't for me.

Why would I work urgent care? I like chronic disease management. I also make way more than the vast majority of urgent care doctors. And I don't work nights or weekends. Plus I did urgent care for a year, hated it.

I'm FM trained, and did the bare minimum of EM in residency. I have zero business working in an ED.

 

[VA Hopeful Dr]

Woo 30+ per day is a lot. I am still seeing 4 to 5 new patients per day so I do not want to see more than 22. I will move to 22 to 26 once I am only taking one or no new patients a day. I bill appropriately so I don't have a reason to really see more than 26. I am more than pleased with my income and value-based bonuses.

With dragon and templates, my notes take 1 to 3 min per patient. I do not copy forward from the previous note either. At the same time, I do not have a difficult accent for dragon to pick up so I do feel for physicians that have that issue

I don't usually see 30, my schedule maxes out at 31 but usually its more 25-28 or so between no shows, cancellations, and just not filling up every day.

 

[VA Hopeful Dr]

What is your income like with that kind of patient volume?

I should end the year close to 400 give or take.

 

[CCM-MD]

I should end the year close to 400 give or take.

While working bankers hours. Amazing.

 

[ortnakas]

I’m feeling quite lucky with my managed care job right now. Ten patients is a busy day.

 

[VA Hopeful Dr]

I’m feeling quite lucky with my managed care job right now. Ten patients is a busy day.

That's one of the great selling points of primary care: the very diverse job market.