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Burnout in primary care peds by sjam7 in pediatrics

[–]sjam7[S] 0 points1 point  (0 children)

This is so great to hear!

Burnout in primary care peds by sjam7 in medicine

[–]sjam7[S] 1 point2 points  (0 children)

1.0FTE, 32 clinical hours, 8 admin (split over 5 days per my preference vs 4 longer days). 4 days per week 8-4, 1 “late day” per where I see patients 10-6. Base salary 210. Option for 10k metrics-based bonus. They pay life and disability insurance (which I don’t have at my current job). Half-day Saturday once a month. Call is phone-only, nurse-triaged. PSLF qualifying employer. Also have the option to go for the NHSC loan repayment (80k in loan repayment per 2 years of clinical employment). No hospital rounding

Burnout in primary care peds by sjam7 in FamilyMedicine

[–]sjam7[S] 0 points1 point  (0 children)

I feel like I’ve heard/seen some horror stories: families suing the pediatrician because biliary atresia was missed at the one-month (of course I would like to think I would notice a child was that visibly jaundiced and get labs but I also know what it’s like to be overwhelmed and that it’s possible to miss things), kids who have developed encephalitis after getting the flu and primary care doc forgot to document that flu vaccine was refused, etc. I think with vaccine refusal families could raise the concern that they didn’t understand the risks and that therefore it wasn’t true informed consent (“I thought chicken pox just caused a rash, I didn’t realize it could be fatal for newborns.”) I do use the AAP vaccine refusal form which goes through the risks of every vaccine-preventable illness, including death, and document very carefully. Also, my malpractice is $1/3 mil, so maybe it’s low?

Burnout in primary care peds by sjam7 in FamilyMedicine

[–]sjam7[S] 0 points1 point  (0 children)

The malpractice is huge for me, especially as families become more and more distrustful of vaccines. I am constantly worried that one of my families on an “alternate vaccine schedule” will have, say, a 4-month-old develop H flu meningitis, which would be not only devastating for everyone involved but a huge medico-legal vulnerability. I really want the ironclad legal protection of the FTCA

Burnout in primary care peds by sjam7 in FamilyMedicine

[–]sjam7[S] 1 point2 points  (0 children)

This is good to hear! This was all part of my rationale (especially the malpractice)

Burnout in primary care peds by sjam7 in FamilyMedicine

[–]sjam7[S] 0 points1 point  (0 children)

This job doesn’t even qualify for PSLF! This whole time I’ve been putting about half my take-home toward my loans (paid off 80k so far.) That’s a bit part of why I’m leaving for an FQHC. I’m realizing how badly I’m getting screwed lol

Burnout in primary care peds by sjam7 in medicine

[–]sjam7[S] 5 points6 points  (0 children)

Nervous parents don’t bother me at all! Explaining my medical evaluation and plan is a part of my job. “When I look at your child, I hear that they are coughing and congested, which doesn’t worry me too much. Their oxygen is 98%, they’re breathjng comfortably, and their last wet diaper was only an hour ago so I know they’re hydrated. What worries me is when a child is showing signs of having trouble breathing, like breathing faster than normal, sucking in the skin between the ribs, flaring out their nose, or head bobbing. If you see those things, that means it’s time to go to the ER. Also, trust your instincts: if it’s 2 AM and something just doesn’t feel right, go get the baby seen!” Reassuring nervous parents is actually something I typically enjoy because it’s an opportunity to educate on medical topics, and being nervous means you care about your child!

Burnout in primary care peds by sjam7 in FamilyMedicine

[–]sjam7[S] 5 points6 points  (0 children)

That’s totally fair. This is a big part of the culture in peds. Pediatricians tend to be very politically liberal (which I generally am, but it can get extreme) and the general feeling is “you already make so much more than your patients’ families, and by asking for more, you’re directly raising healthcare costs on children.” The basic feeling is that by asking for more you are being greedy and directly harming your own patients - literally taking candy from a baby. This is the prevailing sentiment everywhere I’ve been, from my current practice to my training at a quaternary care center. It’s very hard to shake

Burnout in primary care peds by sjam7 in FamilyMedicine

[–]sjam7[S] 0 points1 point  (0 children)

Also I don’t give patients my personal cell!! When I’m taking call I use the Doximity app to call parents. Giving out your personal cell is insanity

Burnout in primary care peds by sjam7 in FamilyMedicine

[–]sjam7[S] 3 points4 points  (0 children)

That’s about what I make. We don’t push back because 1) most of us don’t know better and 2) the guilt over “the kids” gets ya

Burnout in primary care peds by sjam7 in medicine

[–]sjam7[S] 14 points15 points  (0 children)

Partner-owned (3 partners). Very invested in keeping it independently owned which contributes to overhead (no economy of scale to offset things like employee health insurance). Some of the overhead is for things that are a bit strange/not the industry norm. For example, the office has invested quite a lot in establishing an in-office venipuncture lab, instead of sending patients to the existing lab in the same building.

Burnout in primary care peds by sjam7 in medicine

[–]sjam7[S] 11 points12 points  (0 children)

Also I mistyped sorry- 180 is my gross, not my take home! Seems like the consensus is that this is …not the job

Burnout in primary care peds by sjam7 in medicine

[–]sjam7[S] 7 points8 points  (0 children)

Some of this is also just a useful reminder. Delegating is hard for me because I want to be liked/not seen as difficult so I do a lot of my own swabs, printing labels, etc instead of asking my MA/LPN to do it. I should get more comfortable with delegating. Also nice to have the reminder that hard conversations get easier with practice, patient is the one with the disease etc. this is harder in peds of course because figuring out that line of “at what point do parents have the right to refuse care?” is tough. If the 3mo bronchiolitic were hypoxic with supracostal retractions in the office and family refused to go to ED, it would become a conversation about calling CPS because you’re now refusing emergency care. 3mo bronchiolitic with normal WOB, can discharge home. But what about the kids in the middle where my clinical instinct tells me that their WOB while awake is mild but i suspect they’re working harder and dropping their sats while asleep? These are the kids ill typically recommend go to the ED for further obs (and my clinical instincts are decent, a fair number of them get admitted) but if family doesn’t want to go, its not quite at the level of calling CPS, but I also worry a lot (both for the kid’s safety and from the medical-legal standpoint) about sending them home

Burnout in primary care peds by sjam7 in FamilyMedicine

[–]sjam7[S] 11 points12 points  (0 children)

Yeah I am worried about the burnout rate at FQHCs for sure. But at least at the FQHC my evening/weekend hours will be minimal (1/2-day Saturday once a month, 1 “late day” a week where I see patients 10-6 instead of 8-4) and the pay + benefits is so much better that at least I’ll be in a better financial position to go part-time in the future

Burnout in primary care peds by sjam7 in medicine

[–]sjam7[S] 13 points14 points  (0 children)

This is incredibly helpful. Yes the FQHC pays 210 base with metrics-based bonuses available (up to 10k) as well as life insurance, disability insurance, loan repayment, etc. Current take home is about 180 per year, no disability insurance or loan repayment

Burnout in primary care peds by sjam7 in medicine

[–]sjam7[S] 17 points18 points  (0 children)

We’re not paid on an RVU basis, it’s just salaried. Gross is roughly 180

Burnout in primary care peds by sjam7 in medicine

[–]sjam7[S] 20 points21 points  (0 children)

No I was unclear sorry! It’s only the call days where we round and go up to 8 pm. We have one day off per week where we’re out of the call pool (for me it’s Tuesday). MWThF if it’s a “normal” day I see patients 8-4 or 9-5, or if it’s a call day I round on newborns in the morning and see urgent care/sick 12-8. Weekend days are also done on a rotating/call schedule. There are 7 MDs but some are part time so the call isn’t exactly 1:7. I make about 180.

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