u/sjam7

Looking for insight from all primary care docs regardless of specialty!

I’m a primary care pediatrician in private practice, 2 years out of residency. I’m starting to feel pretty burned out and I’d like some advice on how those of you have been in the game for years are handling it. For what it’s worth, I’m leaving private practice to go to an FQHC in 2 months, but I’m interested in hearing from PCPs in any practice setting.

1. Hours. My current practice is open evenings until 8 pm on weekdays and all day Sat/Sun. Visits are 15/30 (15 for wells and most sick, 30 for adolescent wells, concussions, and if requested by provider for medically complex kids.) On Saturdays the place is staffed with the on-call physician seeing patients all day, an NP doing a half day, and during respiratory season, a second physician doing a half-day. The on-call physician also staffs the clinic all day on Sundays. (On our call days, we round on newborns in the hospital and see patients in clinic.) This leads to a lot of weekend time, there have been a few months where I’ve worked 3 weekends in a row, which is obviously nothing compared to residency, but much more than my PCP friends in IM/FM, who work no weekends at all. It also wasn’t made clear to me that I would have clinic on Sundays when I started this job, I assumed I would just be rounding on newborns and taking phone call, since this practice’s web site lists its hours as M-F 8-5 and Sat 9-1 with “evenings and Sundays by appointment only.” In practice this means a full schedule on evenings and weekends but when I started this job I assumed hours would be consistent with what was listed on the Web site. (yes, I was naive!)

2. Parent call. During evenings and weekends, parent phone calls are not triaged through a nurse line until 10PM, so it’s typical to come home on a Sunday at 4 or 5 PM and be answering parent calls for the next 5 or 6 hours on Tylenol dosing, rashes, constipation, in addition to actual triage. From what I have learned from friends in other practice settings, it seems like the parent call line is usually nurse triaged with physician backup - does our office’s set up seem typical?

3. The general primary care feeling of having not enough time. It’s starting to make me so angry that specialists get 1 hour for news, 30 min for wells while I get half the time to work up an undifferentiated patient. For example, I recently had a teenager who presented for evaluation of headache. On history, it turns out she had an unprovoked GTC seizure last month while on vacation (so no ED records available) with in addition to nighttime awakening. So I take a thorough history, including confidential portions (substance use), do a full neuro exam (obviously), manually recheck her BP (initially recorded as high, normal when I checked it), ordered a full workup (CBC, CMP, TFTs, EKG, urine drug screen, brain MRI), urgent neuro referral, talk to the family about my concerns, prescribe rescue Diastat and explain why it’s necessary to break a seizure lasting >5 min, provide a school nurse note to give Diastat if needed, etc. (As far as why I ordered the brain MR instead of deferring to neuro- I practice in a low SES area where people frequently miss specialist visits.) I was given 30 min, obviously this takes an hour and now I’m running behind. When Neuro sees this kid for a new visit, they’ll get an hour even though I packaged everything up for them in a bow. It’s hard not to feel resentful about this.

4. Pressure to work when sick. I have definitely learned that I need to mask in every room, practically every kid under 2 has a URI during their wells, and I just feel like I get sick so frequently! My threshold to call out is really high but in practice this leads to a lot of being at work while I’m coughing behind a mask (prone to lingering bronchospastic cough after viral URIs) and just generally feeling awful.

5. Most of the parents I work with are lovely, but I’m frequently having to tell families things they don’t want to hear - adolescent eating disorder outpatient weight restoration isn’t working, if this trend continues we’re going to have to go inpatient; 3 month old with bronchiolitis and retractions needs to go to the ED, yes I know you have no one who can look after your other kids but I don’t think this can be managed at home - in addition to mandated reporting to CPS (which happens rarely, but sometimes it does) and being a lightning rod for people’s anger/frustration is really tough. One of these interactions is enough to ruin my day even if the other 20+ are positive. How have you all learned to cope with this?

I do think transitioning to an FQHC will be a better fit for me (my residency clinic had a very similar patient population and I loved it) and will have better hours. It also pays better and offers loan forgiveness which will put me in a better place to go part-time in the future if needed. But I would like to hear other perspectives on burnout management. Thanks so much!

Pediatrician but would love to hear input from FM/IM PCPs as well!

I’m a primary care pediatrician in private practice, 2 years out of residency. I’m starting to feel pretty burned out and I’d like some advice on how those of you have been in the game for years are handling it. For what it’s worth, I’m leaving private practice to go to an FQHC in 2 months, but I’m interested in hearing from PCPs in any practice setting.

1. Hours. My current practice is open evenings until 8 pm on weekdays and all day Sat/Sun. Visits are 15/30 (15 for wells and most sick, 30 for adolescent wells, concussions, and if requested by provider for medically complex kids.) On Saturdays the place is staffed with the on-call physician seeing patients all day, an NP doing a half day, and during respiratory season, a second physician doing a half-day. The on-call physician also staffs the clinic all day on Sundays. (On our call days, we round on newborns in the hospital and see patients in clinic.) This leads to a lot of weekend time, there have been a few months where I’ve worked 3 weekends in a row, which is obviously nothing compared to residency, but much more than my PCP friends in IM/FM, who work no weekends at all. It also wasn’t made clear to me that I would have clinic on Sundays when I started this job, I assumed I would just be rounding on newborns and taking phone call, since this practice’s web site lists its hours as M-F 8-5 and Sat 9-1 with “evenings and Sundays by appointment only.” In practice this means a full schedule on evenings and weekends but when I started this job I assumed hours would be consistent with what was listed on the Web site. (yes, I was naive!)

2. Parent call. During evenings and weekends, parent phone calls are not triaged through a nurse line until 10PM, so it’s typical to come home on a Sunday at 4 or 5 PM and be answering parent calls for the next 5 or 6 hours on Tylenol dosing, rashes, constipation, in addition to actual triage. From what I have learned from friends in other practice settings, it seems like the parent call line is usually nurse triaged with physician backup - does our office’s set up seem typical?

3. The general primary care feeling of having not enough time. It’s starting to make me so angry that specialists get 1 hour for news, 30 min for wells while I get half the time to work up an undifferentiated patient. For example, I recently had a teenager who presented for evaluation of headache. On history, it turns out she had an unprovoked GTC seizure last month while on vacation (so no ED records available) with in addition to nighttime awakening. So I take a thorough history, including confidential portions (substance use), do a full neuro exam (obviously), manually recheck her BP (initially recorded as high, normal when I checked it), ordered a full workup (CBC, CMP, TFTs, EKG, urine drug screen, brain MRI), urgent neuro referral, talk to the family about my concerns, prescribe rescue Diastat and explain why it’s necessary to break a seizure lasting >5 min, provide a school nurse note to give Diastat if needed, etc. (As far as why I ordered the brain MR instead of deferring to neuro- I practice in a low SES area where people frequently miss specialist visits.) I was given 30 min, obviously this takes an hour and now I’m running behind. When Neuro sees this kid for a new visit, they’ll get an hour even though I packaged everything up for them in a bow. It’s hard not to feel resentful about this.

4. Pressure to work when sick. I have definitely learned that I need to mask in every room, practically every kid under 2 has a URI during their wells, and I just feel like I get sick so frequently! My threshold to call out is really high but in practice this leads to a lot of being at work while I’m coughing behind a mask (prone to lingering bronchospastic cough after viral URIs) and just generally feeling awful.

5. Most of the parents I work with are lovely, but I’m frequently having to tell families things they don’t want to hear - adolescent eating disorder outpatient weight restoration isn’t working, if this trend continues we’re going to have to go inpatient; 3 month old with bronchiolitis and retractions needs to go to the ED, yes I know you have no one who can look after your other kids but I don’t think this can be managed at home - in addition to mandated reporting to CPS (which happens rarely, but sometimes it does) and being a lightning rod for people’s anger/frustration is really tough. One of these interactions is enough to ruin my day even if the other 20+ are positive. How have you all learned to cope with this?

I do think transitioning to an FQHC will be a better fit for me (my residency clinic had a very similar patient population and I loved it) and will have better hours. It also pays better and offers loan forgiveness which will put me in a better place to go part-time in the future if needed. But I would like to hear other perspectives on burnout management. Thanks so much!

Cross-posting from r/pediatrics, would like to hear input from IM/FM PCPs as well!

I’m a primary care pediatrician in private practice, 2 years out of residency. I’m starting to feel pretty burned out and I’d like some advice on how those of you have been in the game for years are handling it. For what it’s worth, I’m leaving private practice to go to an FQHC in 2 months, but I’m interested in hearing from PCPs in any practice setting.

1. Hours. My current practice is open evenings until 8 pm on weekdays and all day Sat/Sun. Visits are 15/30 (15 for wells and most sick, 30 for adolescent wells, concussions, and if requested by provider for medically complex kids.) On Saturdays the place is staffed with the on-call physician seeing patients all day, an NP doing a half day, and during respiratory season, a second physician doing a half-day. The on-call physician also staffs the clinic all day on Sundays. (On our call days, we round on newborns in the hospital and see patients in clinic.) This leads to a lot of weekend time, there have been a few months where I’ve worked 3 weekends in a row, which is obviously nothing compared to residency, but much more than my PCP friends in IM/FM, who work no weekends at all. It also wasn’t made clear to me that I would have clinic on Sundays when I started this job, I assumed I would just be rounding on newborns and taking phone call, since this practice’s web site lists its hours as M-F 8-5 and Sat 9-1 with “evenings and Sundays by appointment only.” In practice this means a full schedule on evenings and weekends but when I started this job I assumed hours would be consistent with what was listed on the Web site. (yes, I was naive!)

2. Parent call. During evenings and weekends, parent phone calls are not triaged through a nurse line until 10PM, so it’s typical to come home on a Sunday at 4 or 5 PM and be answering parent calls for the next 5 or 6 hours on Tylenol dosing, rashes, constipation, in addition to actual triage. From what I have learned from friends in other practice settings, it seems like the parent call line is usually nurse triaged with physician backup - does our office’s set up seem typical?

3. The general primary care feeling of having not enough time. It’s starting to make me so angry that specialists get 1 hour for news, 30 min for wells while I get half the time to work up an undifferentiated patient. For example, I recently had a teenager who presented for evaluation of headache. On history, it turns out she had an unprovoked GTC seizure last month while on vacation (so no ED records available) with in addition to nighttime awakening. So I take a thorough history, including confidential portions (substance use), do a full neuro exam (obviously), manually recheck her BP (initially recorded as high, normal when I checked it), ordered a full workup (CBC, CMP, TFTs, EKG, urine drug screen, brain MRI), urgent neuro referral, talk to the family about my concerns, prescribe rescue Diastat and explain why it’s necessary to break a seizure lasting >5 min, provide a school nurse note to give Diastat if needed, etc. (As far as why I ordered the brain MR instead of deferring to neuro- I practice in a low SES area where people frequently miss specialist visits.) I was given 30 min, obviously this takes an hour and now I’m running behind. When Neuro sees this kid for a new visit, they’ll get an hour even though I packaged everything up for them in a bow. It’s hard not to feel resentful about this.

4. Pressure to work when sick. I have definitely learned that I need to mask in every room, practically every kid under 2 has a URI during their wells, and I just feel like I get sick so frequently! My threshold to call out is really high but in practice this leads to a lot of being at work while I’m coughing behind a mask (prone to lingering bronchospastic cough after viral URIs) and just generally feeling awful.

5. Most of the parents I work with are lovely, but I’m frequently having to tell families things they don’t want to hear - adolescent eating disorder outpatient weight restoration isn’t working, if this trend continues we’re going to have to go inpatient; 3 month old with bronchiolitis and retractions needs to go to the ED, yes I know you have no one who can look after your other kids but I don’t think this can be managed at home - in addition to mandated reporting to CPS (which happens rarely, but sometimes it does) and being a lightning rod for people’s anger/frustration is really tough. One of these interactions is enough to ruin my day even if the other 20+ are positive. How have you all learned to cope with this?

I do think transitioning to an FQHC will be a better fit for me (my residency clinic had a very similar patient population and I loved it) and will have better hours. It also pays better and offers loan forgiveness which will put me in a better place to go part-time in the future if needed. But I would like to hear other perspectives on burnout management. Thanks so much!