Behind the Scenes: Urgent Care PA Shares Insider Knowledge!

Urgent Care is one of those fields in medicine that is pretty compelling you get procedures you get a very flexible schedule you get paid well but is urgent care something that you could handle something that you would like how difficult is it you know what are you actually doing in Urgent Care what are the patients like that you're seeing these are all questions that I've had and that other people I know have about urgent care so today I'm going to talk to a PA who has worked in Urgent Care for over 20 years and he's going to give us his thoughts on the specialty so if that sounds interesting to you then please stay tuned hi it's Michelle with the medicine couch thank you so much for joining me today thank you for supporting my channel every subscription every like of the video every share of my videos really helps the channel to grow and helps me to continue to bring you videos like this now let's hear from this PA about working in Urgent Care hi my name is Brad Layman I'm a physician assistant and I've been practicing in Urgent Care for about 25 years tell us a little bit about your career path from graduation like did you know you want to work in Urgent Care did you go into urgent care right away or was that something that you transition to after you did something else I was working as a paramedic actually in Ohio and I love being a paramedic because it was exciting it was different when I came out of PA school I started working with an Urgent Care Occupational Medicine Clinic and I like the fast pace of urgent care and I like the different amount of patients that you see with different complaints so yeah urgin care is really interesting I think because there are so many different things that you're seeing like you said anything can walk in the door and so it keeps it kind of fresh and exciting and you can do procedures but it's also a lot for a new grad did you feel that as a new grad or do you think having that paramedic background really set you up so it wasn't as much of a struggle when you started right in Urgent Care yeah it definitely helped quite a bit you know I was a paramedic in an inner city for about 12 years so you you see the patients who are really sick and need intervention right away and it just helps you you know in Urgent Care because when you see a patient walk in the door you'll know if they're really sick or not and you'll know how fast you need to get them back and and get some procedures going or an EKG going and try and get them stabilized if they need to go to the emergency department it definitely helps through the years I'm sure you've worked with new grads that came in to urgent care but but that maybe didn't have that background what did you think of of those people did it seem like it was really difficult if they were a paramedic or if they were a registered nurse they'll do very well in urgent care if you don't have that type of medical background it's horrifying it's horrifying for new grad and it also depends on your Health Care Systems how much time you're going to spend with them and onboard them you know some Urgent Care Systems have like a new grad boot camp and they'll take new grads and they'll do some didactic training and then they'll work in in the Urgent Cares with specific providers for anywhere from 3 to six months and that definitely helps them out so what about like somebody who's not necessarily a new grad but that's coming from maybe another specialty or even Family Practice you know we still spend time with like if somebody came from Family Practice to urgent care it's definitely going to be a learning curve because we're doing more procedures and it's just like if I wanted to go into Family Practice I'm sure I'd be lost for for a couple months also so it is a change okay so let's talk about the patients that you see in Urgent Care do you have any age limits in your Urgent Care I know some urgent cares I think they cut it off at 6 months but yeah some some of our patients will bring in a newborn and you know you quickly assess and get them to the right place certain locations you may see more elderly patients other locations patients generally in the 30s 4S 50s but yeah we see all age patients I think the big scary thing to me or other people may think about Urgent Care is how many patients you're seeing in a day why don't you tell me in your experience what you think is kind of an average number of patients seen in Urgent Care and I know it can vary by season you know 35 about three patients an hour is probably about average for us now if they all came in three patients an hour it would be great but you may not see somebody for an hour and a half and then 10 minutes later eight people in your waiting rooms centers that may be getting into the 40s close to 50 we like to send another provider over there for maybe half the shift and kind of give them a break so they don't get burned out that's a big thing in Urgent Care is is burnout especially during flu season during co uh it gets really intense in Urgent Cares during Fu season and it's a lot of work now some some urgent cares do have scribes so they have a scribe that'll go in with them and if that's the case if they're just talking the history and the exam out loud and their scribe is documenting everything yeah I mean maybe you could get to 50 or 60 would I want to do it absolutely not it's dangerous to me if you're getting close to 50 or definitely 60 patients I don't see how you can do it I wouldn't be able to sleep at night okay did I put that referral in for that patient was that patient allergic to penicilin did I prescribe them augmenting I mean I would just go crazy that's just a lot of patience in 12 hours I'm very cynical about medicine nowadays and with private Equity firms and people coming in thinking they're going to make quick money and in medicine and are starting demand these these higher volumes I know again you can't speak to everything but I hope that's not a trend in Urgent Care I don't think it's a trend in Urgent Care you know I've heard of some systems that well they just want you to see 60 patients a day with two two team members but I don't hear that very often you know the the urgent cares you know I have a lot of friends in Urgent Care and that that's that's just not the case Okay most in your experience and in the years you've been working Urgent Care what kind of tests uh and labs and things you have usually on site Urgent Care is definitely should have x-ray capabilities we have lots of point of care tests covid flu strap you know we can do your analysis pregnancy tests monos spots um some urgent cares will be able to do a CBC on site and so I assume that you're doing the initial read on the x-rays and then are they overread they're usually overread within 20 minutes or 24 hours just depends what kind of other support staff have you seen in Urgent Care that's kind of standard most of our centers if there's one solo provider uh we will generally have three team members uh Mas radiological texts if we have a center that has two providers we like to have four maybe five team members to support the providers support the volume but most of our Mas are are very good they know how to do injections they know how to draw blood do splinting so yeah most of that is a team member function and so when you have a PA or an NP working with a physician is there any kind of division as far as what patients each person gets whoever's ready to get the next patient they'll just see the next patient I can think back to my early days of urgent care back then it was paper charting they would kind of Stack the chart on the counter and if it was a real thick chart and I was ready to see a patient I would look at him like oh my God what is that maybe i' go back get a snack come back and hopefully the physician that was working grabbed that chart and I'm like oh yeah I'm good yeah you can't do that now yeah it's just whenever you're ready to see the next patient if you're a newer provider and you have a physician or another provider working with you pick up that chest pain uh chart go see the patient you have somebody there that can help you out and it's just going to make you better I guess that's probably my biggest nightmare is I get this scenario in my head that you're going to have a lot of people coming in who are you know over 65 who are on like 20 30 meds have a very complicated history and they're coming in with something that could be life-threatening or or potentially very serious but it it could just be a mild exacerbation for them I I get in my head that that is a large part of the patients that you see tell me if I'm wrong no you are you are spoton I mean we definitely see a lot of elderly patients uh who are on you know 12 different medicines and they have six allergies and they come in for a simple UTI but they're allergic to backr and Macrobid and CYO and now now you're kind of scrambling well this antibiotic would work but it may interact with their blood pressure medicine I mean it it it can be very challenging in cases like that definitely do you spend much time in Urgent Care Consulting primary cares about patients that come in definitely especially on the patients that you know again are are kind of on that border do they need to go to the emergency department can I call their primary care provider or their cardiologist or if I do an x-ray and there there's something a little weird here yeah I will definitely call the radiologist he what do you think of this x-ray um so yeah we still do a fair amount of you know Consulting with Specialists uh somebody who I think is pretty stable now but they could get bad uh we use epic EMR so I can send a message to their PCP or to their specialist and say look you know I saw this patient today a little bit concerned about them uh you know maybe you definitely want to follow up with them pretty quick and then they're always very responsive to that they'll send me a message back you know thanks for letting me know will get them on the schedule tomorrow what about like lab followup do you ever have people come in that you are sending Labs out for any reason and have to you know follow up with them later now that's a great question I'm glad you asked because the Health Care system I work for we actually have two providers who do nothing but go through the in basket so when that urine culture comes back or an STD blood work or culture comes back they will take care of that for us and and that's great because you know it's bad enough if you're seeing 35 patients a day and maybe doing a couple procedures throughout the day and then you look at the in basket and you've got like 60 new results it it's just overwhelming there so we talked a little bit about some procedures uh that you do but could you go through and and kind of give people an idea of the most common procedures that that you are going to have to know how to do in Urgent Care of course most common procedures are going to be your laceration repairs we do a fair amount of inds of esses we do a lot of you know ingrown toenail partial toenail removals and we'll do some foreign bodies in the eye some of our providers do joint injections you know and knee injection maybe a shoulder injection and again a lot of finger dislocations a lot of nursemaids elbows so what happens though when You' get those things that are you're just unsure of uh if it's more complicated than it than it's looking at first or you just feel like that they need a higher level of care I feel like that may be a struggle with some people do people fight you on having to go to the ER um do they refuse to go by ambulance a lot what kind of struggles do you have there yeah that that is definitely a concern in Urgent Care because you know most people when they come in with a complaint like that when you ask them you know you start having chest pain it's going into your left shoulder why did you come to the Urgent Care well I I didn't want to wait in in the emergency department and then some people are just fearful that they know they're having a heart attack but they they seem to just not want to admit it and hopefully you'll do something and tell them a you're fine you'll be good but it is a struggle pretty much all the time we're going to send that patient to the emergency department definitely want to call EMS to transport the patient some will still oh I don't want to go I can drive and it's like you really shouldn't be driving and so if that's the case then we can talk to a family member and then they can talk to the the patient and get them okay I'll go to the emergency department by the ambulance so it it is a struggle what about the the pressure to prescribe antibiotics is it as big of a struggle as I think with antibiotics when you work in Urgent Care I think it was a struggle three to five years ago because I think that's when at least in Urgent Care we really started focusing on antibiotic stewardship and I think Co actually helped that because when somebody came in with their upper respiratory infection and you swabbed them for Co they didn't have Co they'd be like yeah I don't have Co and they leave I actually think Co helped quite a bit with that now we're starting to get into steroid stewardship so we'll be uh focusing on that here so besides procedures what's kind of like the bread and butter of urgent care that you're going to see day in and day out for conditions all the upper respiratory sinus you know you get your bronchitis and you know we're getting into the season where everybody's going to be outside working so we'll start to see a lot of our Orthopedic injuries a lot of back pains some beasting lacerations poison ivy is going to be coming out let's talk holidays in Urgent Care I assume most of the time urgent cares are open every day of the year most of them are I believe you know some urgent cares will be closed certain days of the year but our health care System we're open 365 days a year let's talk a little bit about the the schedule because we've been talking about 10 or 12h hour days and again this is something that's highly variable by urgent care centers but what do you see is kind of the the norm on schedules like how long are the shifts and usually how many days a week do people normally work in urgent care a lot of the Urgent Cares that I know uh providers that work at in a two week period you generally work six to seven days in that twoe period you know during the week a lot of urgentes are open 12 hours so you're work in a 12h hour shift weekends some urgent cares are just 12 hours every day some have maybe eight hours on the weekends our providers work every other weekend so like the first week they would work Monday and Tuesday be off Wednesday Thursday then they work Friday and Saturday and then the next week they work Sunday off Monday Tuesday work Wednesday Thursday then they're off Friday Saturday Sunday so you get a three-day weekend every other week you know with the exception of working a Friday Saturday and SU Sunday you only work two days in a row during the week so you have a couple days off to you know do all that other stuff that you need to do during the week it's a great schedule the one other the thing I really did hit on with Urgent Care is once you are done for the day you're done you don't have to go home and do any charting or go through the in basket like in maybe Family Practice once you leave there you're done another thing I've seen in forums is that it just seems to really run the gamut of how people are treated in Urgent Care I've seen some people talk about that they're expected to just see a ton of patients and there's no cut off time so sometimes they may be there for hours after you know they're supposed to to be off sometimes I I've seen the opposite I've seen people say that sometimes that they get sent home if there's not enough volume and then but they still have to be available to come back in if the volume picks up have you seen things like that happening in Urgent Care the worst thing about urgent care it's exactly what what we're going to talk about now yeah you're if you're open from 8 in the morning till 8 at night yeah I mean generally you're expected to see somebody even if they show up at 7:58 at night I struggled with that early on I really did because we I we were busy but I've learned to accept it I think last year I learned to accept it so only took me 24 years but and especially if you know the the first half of the shift you know maybe you see 15 people and then the last three hours of the shift 15 people show up it's it can be frustrating but for me all it really takes now is one of those patients to say hey I know you've had a hard day thanks for seeing me this late at night and that makes it worth it I I assume the ones that they talk about that are sent home must be in a an urgent care that has like two providers on staff have you have you ever heard of things like that happening is that a common practice that you're aware of I don't think it's very common but I have seen it happen even even with us you know we we try not to send providers home because soon as you send somebody home 12 patients show up at the center and it's it just makes for a better day I mean some of the health care administrators may not want to hear me say that but if you have two providers at a clinic all day and they see 35 patients yeah it's not great for the bottom line but fantastic day for both providers and they probably deserved it because there's many days you know again you're seeing 35 40 patients by yourself and you're exhausted so but speaking of like being sent home so the the problem with that is I assume most people in Urgent Care get paid hourly or is Am I Wrong is it mostly salary are there rvus that come into play again in general what are you seeing out there in general it's pretty variable um you know I think nowadays a lot of urgent cares pay their full-time providers mostly for that shift okay it wouldn't be like hourly you'll get paid for that shift like some of our preem providers or part-time providers they're usually paid hourly but most most places that I've talked to you you get paid for the shift it's almost like a salary but if you work extra somebody calls off and they call you hey can you go help out with this clinic today yeah you would still get paid for that shift money should never be why somebody goes into a specialty but it certainly plays a part in decisions so can you give us kind of an idea of what people could expect for salary and Urgent Care I think for as long as I've been in Urgent Care it's it's usually paid above the average I think it sits somewhere in between emergency medicine providers and family practice nrad is probably anywhere from 120 to 125 somewhere in there so it's it's very good pay do you see it generally pretty equally split in your organization between NPS and PAs in Urgent Care or do you guys skew one way or the other we're we're fairly split between NPS and PAs and and that you mentioned that too you know some of our preem providers we have one preem provider who works in dermatology and I love working with her because when I see that ration I'm like she'll say oh it's this didn't you know that so it's great because we have a lot of specialty Pas and NPS who work per deemed for us and they're they're tremendous resources to have well so that was leading me to my question is if somebody was working as a PA or an NP already and they were thinking about getting into urgent care what do you think are some of the best Specialties that transition over or does it even matter do they do you feel like they're all pretty equal to transition over well definitely emergency medicine um Pas and NPS when they just had enough of the emergency department they'll come to urgent care so they're great and we've had a some Cardiology uh pas come and work first I think doesn't matter the specialty or if whatever they were in before most of them do very well transitioning into Urgent Care there may be a a few shifts that we kind of work with them and you know make sure procedural stuff is pretty good you know reading EKGs reading uh radio graphs uh but yeah I think it's a fairly easy transition for for most Pas and nurse practitioners yeah it made me curious when you said when they get tired of the Ed what do you think is the advantage or the appeal to urgent care over emergency department I think it's a little bit more laidback obviously than the emergency department you know I worked yesterday with a physician and we had about an hour and a half where we didn't see a patient and it was great because you know you get to talk to the the other provider and you get to talk to the team members and it's just great to have a little bit of downtime I think emergency department it's just it's just a constant chaos and Urgent Care is it's chaotic but not as much as the emergency department and there's times where it's just more more chill more relaxing and uh just better mentally somebody is is looking to go into urgent care and they're interviewing with places what are like the top questions that you would ask to kind of make sure you're not walking into a nightmare type situation if if there's a Health Care system that has eight positions open my first question is why do you have so many positions available are you opening new centers or did you make those providers see 60 patients a day and they just quit you can definitely ask about volume you know what is the expectation to see how many patients per day you know what is my support uh Team Member Staffing line do I have one other person do I have three that is those are probably three of your most important questions tell us in general the things that you have come to really love about working in Urgent Care and what you think would appeal to people most uh to work in this specialty again I like the Variety in the patients I think it's a great for new graduates because when you have a new grad that comes in they're going to do procedures they're going to see a lot of Ortho they're going to see a lot of Dermatology you're going to get your chest pain your Cardiology patients your abdominal pains your gastro uh intestinal patients I me you're going to see a lot of different Specialties and then what I've seen happen frequent is this provider you know came in they've been here two years and they love seeing Orthopedics and then they go specialize in Orthopedics but again it's a great first job I think because you get to see a variety of everything Urgent Care is great it's a great schedle again it's Dynamic it's energetic and it's reward great well thankk you so much for letting me pick your brain and and learning more about Urgent Care well I appreciate you having me on thank you if you've liked learning about urgent care and wonder what it's like working in other Specialties then click on this playlist here and it'll take you to a bunch of interviews I have with Pas and NPS working in all different areas of medicine thank you so much for joining me today and as always take care stay sane and I'll see you next time on the medicine couch bye

Channel: The Medicine Couch

Views: 472

Keywords: urgent care, day in the life urgent care, day in the life of an urgent care nurse, day in the life of an urgent care PA, choosing a medical specialty, medical specialties for physician assistants, best medical specialties for PAs, best medical specialties for NPs, nurse practitioner specialties, best nurse practitioner specialty, which PA specialty is best for me, urgent care vs primary care, urgent care vs er, best specialities in medicine, PA career, NP Career, PA Jobs

Id: xJh668527l0

Length: 29min 29sec (1769 seconds)

Published: Mon Mar 25 2024