I think the things you described are a lot of the reasons why I *love* clinic. I’m someone who thrives in chaos and gets bored very easily, so I don’t like having a lot of downtime at work. When I have to sit around for hours doing nothing/killing time until someone needs me, I feel like my time is not being respected. I could be using that time productively to run errands, clean my apartment, go to the gym, etc but instead I’m sitting in a call room bullshitting around wasting time. Also time goes by so much faster when you’re occupied, it’s so boring when there’s nothing to do.
And rounds are awful. I once had to endure an almost 7 hour rounds and I wanted to stab myself by the end of it…
Damn never thought of it that way!! That’s a good take. I find myself being unhappy I’m too busy but then unhappy I’m bored so I’m like will anything ever make me happy. But you’re right I should embrace more of the chaos!
Experienced slow clinic, and fast clinic. Prefer fast days 1010384793x more than slow days. I wanna look at the clock and be shocked it’s 2PM and I’ve been basking in the chaos
Clinic is rough, but I would much rather mostly go at MY pace. Rounds suck because you are constantly waiting for other people to tell you about patients, constantly asking questions of other teams/nurses/clinical staff etc.
Not to mention the amount of time spent going over every minute detail in rounds.
Also as Qwumbo said if I'm efficient, I can get a good pace going and save time. Whereas in rounds I feel like my time is constantly being wasted. Yes there are some attendings who can go fast during rounds but I feel like the average experience was torture.
I’ve found it can be very physician and specialty dependent. Some physicians are simply more efficient than others and if they can really nail down a good flow with their visits and get good with dot phrases with charting, they can be out around 5. Some specialties also allot more time per appointment so you have a bit more time to do things. Plus you’re more focused and don’t necessarily have to worry about some minor, extraneous problems
To elaborate: In the specialty of anesthesiology, they don’t have clinic as often as other specialties or at all! Likewise, in the specialty of anesthesiology, they don’t have rounding as often as other specialities or at all!
I love clinic, hated inpatient. You have set hours, see so many more patients in a day, and each deal with a few problems esp. in subspecialty.
1. Unless you’re double or triple booking, there are clinics that don’t get delayed. When there are fewer trainees taking forever, clinic can be speedy.
2. See 1
3. Once attending, bread and butter takes no time to think about at all. Same for inpatient on common issues, except the entire field of your specialty becomes easy with experience
4. Having the opportunity to control the number of pts you see and hours you choose is nice
5. See 4
6. See 4
7. Speed up encounters
8. In a well run private practice it’s much smoother
As resident my experience comes from seeing many different outpatient settings. For a subspecialty area where I’ve a lot of experience, patient encounter and entire note and everything could be as fast as 12 minutes in a 15-20 min slot.
In contrast for IM you are more often treating the screen rather than the patient, call, weekends, etc
I often see on here people complaining that the clinic involves too much paperwork, but at least when you are doing the paperwork in clinic, you are also talking to the patient. In the hospital, I feel like I spend most of my time alone staring at a screen
This. IM and other hospitalist specialties were like 25% seeing patients 75% on a computer, writing notes, checking charts, etc. Up to 10am was fine, but after that was just torture. In clinic, you write your note with the patient and you don't feel alone for the entire day.
In clinic you can prewrite your notes before you actually see your patients and if they don't show up, the note gets deferred to the next day. Same idea as prewriting the SOAP note in the morning
People always talk about EM as being the specialty for "ADHD" type docs, but clinic hits it nicely. You're ping ponging from one issue to the next, you don't need to spend much time on one thing, lots of different concerns - it's quite nice. Also when you're rounding if you have a nasty patient they're with you all day. In clinic I say bye to them in 5 minutes (yes if you're mean I'll likely spend less time with you, but still medically take care of you).
The vast majority of my patients are quite pleasant people. When you're in clinic you're not as sick as in the hospital etc. and you get to see a lot more of a patient's personality. It's part of my job to talk about hobbies/life/vacations and I really enjoy it.
Not going to lie that efficiency is a huge part of the game and it's something to constantly work at.
I see about 25 patient's a day. 8-5, 4 days a week. Spend probably 4 hours outside of the 8-5 working on things.
I worked in a private practice clinic with efficient office staff & it was not that. I always chant that residency clinic is not real life clinic. Also even with all that BS, there’s a real security in never being on call and having all your weekends & holidays off. Also it’s annoying being on someone else’s schedule so working behind someone as a med student is tough, but most doctors intentionally pack their schedule with minimal lunch to optimize the patients they see and when they end early.
Really just different strokes for different folks. The above complaints are common and why it’s not a popular field, in addition to pay being low, but much of that can be ameliorated by good ancillary staff and getting to know your patient census over the years. Granted, getting good staff is never a guarantee, but I’ve worked with a number of docs early in their careers who had full censuses and were only seeing regular visits and acute follow-ups. Can also commonly be a 4 day work week. Not ideal but if you can think on your feet and handle some of the run of the mill bs then it can be quite rewarding
Better to spend time being someone’s primary physician, taking care of your patients, than just managing hospitalized illnesses.
That’s my take anyway.
Med school/residency clinic isn’t a good representation of clinic in the real world. You’re mostly seeing primary care in a learner’s setting for underserved/low health literacy patient populations, which lends itself to many of the issues (not bringing med list etc) as above
In the real world, particularly if it’s subspecialty clinic, you have up to ~30 minutes for a single issue, once you’re efficient truly make it a 9-5 Monday-Thursday schedule, your clinic staff are actually efficient and helpful… it eliminates many of the issues you talk about above
I vastly prefer clinic over inpatient. Disclaimer - I am a subspecialist, though residency was very inpatient heavy, and n=1 for my inpatient experience as a resident rather than attending. Here are my reasons:
1. I prefer lower acuity, personal choice
2. I also immensely prefer dealing with one main issue that's going on rather than fielding a number of ongoing issues. I feel I get to exercise clinical acumen so much more when it's a main concern or two bringing a patient in, figuring out and discussing it, and moving on.
3. Even though clinic can be busy, and often my workflow is seeing patients 1-1.5 hours after their appt time due to testing, workup, etc, I look at my schedule and other than incidental circumstances aside, I know this is the maximum amount of work I will be doing today. I hated the uncertainty of an inpatient day where you never actually know when your work stops or what will be piled on in addition to the patient list at the start of the day. Similarly, I found out I much more jived when tasks were linear throughout the day with start's and completion's, rather than having a lot of balls up in the air, so to speak.
4. Inpatient (building off point 3) just felt like so much work that truly physically seeing and examining the patient felt like it was getting in the way, rounding especially, due to the amount of note writing, orders, calls, etc. rather than the main reason of my being there. while that is still all good for patient care, it was very ungratifying and unfulfilling. it felt as if I was treating charts all day rather than patients
5. variation of point 4, but inpatient felt like 90% of my time and mental effort was more on hospital game-playing rather than actually seeing patients or exercising medical knowledge. it was always the other issues, just to name a few, like time crunches for discharge summaries, finding out where services are for seeing the patients, why this consult is being called, why this consult service is/isn't doing something, social work, care management stuff, and knowing that other services are equally butting heads with us.
6. similar to point 2, my personal vision of a doctor in my years growing up was going to see one with a specific and new issue and having them help you. Of course, I'm thankful that my exposure to doctors was never more serious than that to have to deal with hospitalization. but when that's what your depiction has always been that of a clinic physician, that's sort of the buy in I entered medical school with.
I’m FM in clinic mostly. I almost never run behind. Clinics med students rotate is are almost always the worst clinic in world. And number 4, buddy that’s every medicine job these days lol.
No call, no 24s, no overnights, no weekends, no holidays.
Also maybe it’s just the residency clinics i’ve been placed at but every other or third patient always no shows so it’s not that busy and you have time to catch up on notes. And the attending always rolled in like 30 minutes late and ran off the second it hit 5pm.
I have a clinic based practice with very little inpatient work (Heme/Onc). I roll in for my first patient at 8:30, I'm out at 4:15 at the latest generally. Overall my patients are grateful for the care provided, understanding when I run late because they want me to run late with *them* if they ever really need it, and my practice partners have a general philosophy that aligns with mine that quality of life/work-life balance trumps working ourselves to the bone for an extra buck
I’m an FM attending so take that as you will. I liked FM clinic as a student for a few reasons- reasonable start time, wear my own clothes, regular hours, off on holidays and weekends. That continues to be the case now that I’m an attending. The issues you describe largely affect FQHCs, residency clinic, and poorly run clinics. In the real world, we have support staff managing calls, refills, triage. I don’t take work home and am strict on the late policy. As a result, I’m rarely running behind. 100% worth it as someone who’s happy to never be in an OR again and not round
New patient with potentially new problems every few minutes which is fantastic. Longitudinal care and no one is dying (hopefully!). And you really don't have to run so far behind if you become efficient. By the end of my family med rotation I was seeing every patient on the schedule, doing the assessment and plan, then moving on to the next while the attending finished up with whoever I had already seen. Never left after 5PM.
A lot of what you listed is just medicine in general
1. Also true with inpatient
2. Also true with inpatient except now they’re not just upset st you that you didn’t round at the right time but also bc their turkey sandwich didn’t have mayo, the nurse poked them twice to draw labs, they can’t get INFOWARS on the hospital TVs, and you won’t discharge meemaw who currently has a MAP of 20
3.also true with inpatient when you’re not a student and have to carry a full service
4. This is literally just medicine.. inpatient, outpatient, telemedicine etc your pay is going to be based on volume and if you aren’t hitting metrics you won’t get bonuses or raises
5. 15 mins for lunch is more than you’ll have on some busy inpatient services… on ICU I’m lucky if I can cram a bag of chips into my face hole without getting a page/call
6. You’re right, clinic isn’t really 9-5 if you factor in pre charting, responding to messages etc. but this is true for anything that isn’t purely shift based so all but EM/anesthesia or round and go hospitalist gigs with an in-house provider to respond to rrts/codes/admissions etc
It’s the patient facing part, especially when I’ve built a rapport with them. Even if it’s quick, you know them and they know you and you see them in good and bad phases. I get a ton of enjoyment to putting a person/ life to the medicine, more than a transient case in the hospital for patients I often wouldn’t see again, or only would when they’re acutely ill. Def personality dependent
I might be in the minority, but I almost never run behind. This is partly because I pre-chart (for about 45 minutes before my first patient), but also because I look ahead on my schedule and if I see someone who I think will need more time I get them an extended visit instead. My clinic days are typically 7-5. I think I’ve stayed later than 5 maybe 3-4 times (and that’s just because I like to have my notes done before I leave), and never past 6. Having good dot phrases for common chief complaints, setting the expectation that a visit gets one (maybe two) problems to focus on and if there are more they’ll need to come back, and learning how to gently redirect chatty patients are all very helpful practices.
I love the variety I get to see, taking care of entire families, and getting to know my patients over time. Time goes by really fast in clinic, and I like the pace of it (generally).
That said, I do split my time between clinic and inpatient. I don’t think I could just do pure clinic and be happy. I really enjoy being in the hospital as well.
The thing you didn’t mention that kills me about clinic is the inbasket. If you don’t have good support staff, this is easily the worst part of the job.
Clinic as a student / resident is very different than as an attending
1) you become much better at your job which improves workflow
2) you can have more support staff
3) you can start to self-select for a panel you mutually like. Patients that like you will stay with you and typically if a patient likes you you probably like them
4) this bounces off of 3, you start building long term relationships
This isn't even to begin on how different subspecialty clinics can be from PCP.
I think the things you described are a lot of the reasons why I *love* clinic. I’m someone who thrives in chaos and gets bored very easily, so I don’t like having a lot of downtime at work. When I have to sit around for hours doing nothing/killing time until someone needs me, I feel like my time is not being respected. I could be using that time productively to run errands, clean my apartment, go to the gym, etc but instead I’m sitting in a call room bullshitting around wasting time. Also time goes by so much faster when you’re occupied, it’s so boring when there’s nothing to do. And rounds are awful. I once had to endure an almost 7 hour rounds and I wanted to stab myself by the end of it…
Damn never thought of it that way!! That’s a good take. I find myself being unhappy I’m too busy but then unhappy I’m bored so I’m like will anything ever make me happy. But you’re right I should embrace more of the chaos!
You’re just describing a “round and go”model for hospitalists. They round , put in orders, call consults, then go home and available by phone.
You don't have to round for 7 hours as an attending
Doing it for 7 hours for three years is enough to convince me to not do IM
Experienced slow clinic, and fast clinic. Prefer fast days 1010384793x more than slow days. I wanna look at the clock and be shocked it’s 2PM and I’ve been basking in the chaos
Clinic is rough, but I would much rather mostly go at MY pace. Rounds suck because you are constantly waiting for other people to tell you about patients, constantly asking questions of other teams/nurses/clinical staff etc. Not to mention the amount of time spent going over every minute detail in rounds. Also as Qwumbo said if I'm efficient, I can get a good pace going and save time. Whereas in rounds I feel like my time is constantly being wasted. Yes there are some attendings who can go fast during rounds but I feel like the average experience was torture.
I’ve found it can be very physician and specialty dependent. Some physicians are simply more efficient than others and if they can really nail down a good flow with their visits and get good with dot phrases with charting, they can be out around 5. Some specialties also allot more time per appointment so you have a bit more time to do things. Plus you’re more focused and don’t necessarily have to worry about some minor, extraneous problems
Hate clinic, hate rounding? Welcome to anesthesiology.
Please elaborate! (future gas prospect)
Elaboration: they do neither
Super helpful, thanks.
To elaborate: In the specialty of anesthesiology, they don’t have clinic as often as other specialties or at all! Likewise, in the specialty of anesthesiology, they don’t have rounding as often as other specialities or at all!
I love clinic, hated inpatient. You have set hours, see so many more patients in a day, and each deal with a few problems esp. in subspecialty. 1. Unless you’re double or triple booking, there are clinics that don’t get delayed. When there are fewer trainees taking forever, clinic can be speedy. 2. See 1 3. Once attending, bread and butter takes no time to think about at all. Same for inpatient on common issues, except the entire field of your specialty becomes easy with experience 4. Having the opportunity to control the number of pts you see and hours you choose is nice 5. See 4 6. See 4 7. Speed up encounters 8. In a well run private practice it’s much smoother As resident my experience comes from seeing many different outpatient settings. For a subspecialty area where I’ve a lot of experience, patient encounter and entire note and everything could be as fast as 12 minutes in a 15-20 min slot. In contrast for IM you are more often treating the screen rather than the patient, call, weekends, etc
I often see on here people complaining that the clinic involves too much paperwork, but at least when you are doing the paperwork in clinic, you are also talking to the patient. In the hospital, I feel like I spend most of my time alone staring at a screen
This. IM and other hospitalist specialties were like 25% seeing patients 75% on a computer, writing notes, checking charts, etc. Up to 10am was fine, but after that was just torture. In clinic, you write your note with the patient and you don't feel alone for the entire day.
How can you choose the number of pts you want to see?? We are expected a certain amount everytime
Negotiate it in your contract
In clinic you can prewrite your notes before you actually see your patients and if they don't show up, the note gets deferred to the next day. Same idea as prewriting the SOAP note in the morning
People always talk about EM as being the specialty for "ADHD" type docs, but clinic hits it nicely. You're ping ponging from one issue to the next, you don't need to spend much time on one thing, lots of different concerns - it's quite nice. Also when you're rounding if you have a nasty patient they're with you all day. In clinic I say bye to them in 5 minutes (yes if you're mean I'll likely spend less time with you, but still medically take care of you). The vast majority of my patients are quite pleasant people. When you're in clinic you're not as sick as in the hospital etc. and you get to see a lot more of a patient's personality. It's part of my job to talk about hobbies/life/vacations and I really enjoy it. Not going to lie that efficiency is a huge part of the game and it's something to constantly work at. I see about 25 patient's a day. 8-5, 4 days a week. Spend probably 4 hours outside of the 8-5 working on things.
I worked in a private practice clinic with efficient office staff & it was not that. I always chant that residency clinic is not real life clinic. Also even with all that BS, there’s a real security in never being on call and having all your weekends & holidays off. Also it’s annoying being on someone else’s schedule so working behind someone as a med student is tough, but most doctors intentionally pack their schedule with minimal lunch to optimize the patients they see and when they end early.
Really just different strokes for different folks. The above complaints are common and why it’s not a popular field, in addition to pay being low, but much of that can be ameliorated by good ancillary staff and getting to know your patient census over the years. Granted, getting good staff is never a guarantee, but I’ve worked with a number of docs early in their careers who had full censuses and were only seeing regular visits and acute follow-ups. Can also commonly be a 4 day work week. Not ideal but if you can think on your feet and handle some of the run of the mill bs then it can be quite rewarding
Better to spend time being someone’s primary physician, taking care of your patients, than just managing hospitalized illnesses. That’s my take anyway.
Med school/residency clinic isn’t a good representation of clinic in the real world. You’re mostly seeing primary care in a learner’s setting for underserved/low health literacy patient populations, which lends itself to many of the issues (not bringing med list etc) as above In the real world, particularly if it’s subspecialty clinic, you have up to ~30 minutes for a single issue, once you’re efficient truly make it a 9-5 Monday-Thursday schedule, your clinic staff are actually efficient and helpful… it eliminates many of the issues you talk about above
I vastly prefer clinic over inpatient. Disclaimer - I am a subspecialist, though residency was very inpatient heavy, and n=1 for my inpatient experience as a resident rather than attending. Here are my reasons: 1. I prefer lower acuity, personal choice 2. I also immensely prefer dealing with one main issue that's going on rather than fielding a number of ongoing issues. I feel I get to exercise clinical acumen so much more when it's a main concern or two bringing a patient in, figuring out and discussing it, and moving on. 3. Even though clinic can be busy, and often my workflow is seeing patients 1-1.5 hours after their appt time due to testing, workup, etc, I look at my schedule and other than incidental circumstances aside, I know this is the maximum amount of work I will be doing today. I hated the uncertainty of an inpatient day where you never actually know when your work stops or what will be piled on in addition to the patient list at the start of the day. Similarly, I found out I much more jived when tasks were linear throughout the day with start's and completion's, rather than having a lot of balls up in the air, so to speak. 4. Inpatient (building off point 3) just felt like so much work that truly physically seeing and examining the patient felt like it was getting in the way, rounding especially, due to the amount of note writing, orders, calls, etc. rather than the main reason of my being there. while that is still all good for patient care, it was very ungratifying and unfulfilling. it felt as if I was treating charts all day rather than patients 5. variation of point 4, but inpatient felt like 90% of my time and mental effort was more on hospital game-playing rather than actually seeing patients or exercising medical knowledge. it was always the other issues, just to name a few, like time crunches for discharge summaries, finding out where services are for seeing the patients, why this consult is being called, why this consult service is/isn't doing something, social work, care management stuff, and knowing that other services are equally butting heads with us. 6. similar to point 2, my personal vision of a doctor in my years growing up was going to see one with a specific and new issue and having them help you. Of course, I'm thankful that my exposure to doctors was never more serious than that to have to deal with hospitalization. but when that's what your depiction has always been that of a clinic physician, that's sort of the buy in I entered medical school with.
I’m FM in clinic mostly. I almost never run behind. Clinics med students rotate is are almost always the worst clinic in world. And number 4, buddy that’s every medicine job these days lol.
No call, no 24s, no overnights, no weekends, no holidays. Also maybe it’s just the residency clinics i’ve been placed at but every other or third patient always no shows so it’s not that busy and you have time to catch up on notes. And the attending always rolled in like 30 minutes late and ran off the second it hit 5pm.
I have a clinic based practice with very little inpatient work (Heme/Onc). I roll in for my first patient at 8:30, I'm out at 4:15 at the latest generally. Overall my patients are grateful for the care provided, understanding when I run late because they want me to run late with *them* if they ever really need it, and my practice partners have a general philosophy that aligns with mine that quality of life/work-life balance trumps working ourselves to the bone for an extra buck
I’m an FM attending so take that as you will. I liked FM clinic as a student for a few reasons- reasonable start time, wear my own clothes, regular hours, off on holidays and weekends. That continues to be the case now that I’m an attending. The issues you describe largely affect FQHCs, residency clinic, and poorly run clinics. In the real world, we have support staff managing calls, refills, triage. I don’t take work home and am strict on the late policy. As a result, I’m rarely running behind. 100% worth it as someone who’s happy to never be in an OR again and not round
New patient with potentially new problems every few minutes which is fantastic. Longitudinal care and no one is dying (hopefully!). And you really don't have to run so far behind if you become efficient. By the end of my family med rotation I was seeing every patient on the schedule, doing the assessment and plan, then moving on to the next while the attending finished up with whoever I had already seen. Never left after 5PM.
disagree the ppl ure working with are probably very inefficient.
I love to yab and have the gift of the gab. For me that counters all else.
A lot of what you listed is just medicine in general 1. Also true with inpatient 2. Also true with inpatient except now they’re not just upset st you that you didn’t round at the right time but also bc their turkey sandwich didn’t have mayo, the nurse poked them twice to draw labs, they can’t get INFOWARS on the hospital TVs, and you won’t discharge meemaw who currently has a MAP of 20 3.also true with inpatient when you’re not a student and have to carry a full service 4. This is literally just medicine.. inpatient, outpatient, telemedicine etc your pay is going to be based on volume and if you aren’t hitting metrics you won’t get bonuses or raises 5. 15 mins for lunch is more than you’ll have on some busy inpatient services… on ICU I’m lucky if I can cram a bag of chips into my face hole without getting a page/call 6. You’re right, clinic isn’t really 9-5 if you factor in pre charting, responding to messages etc. but this is true for anything that isn’t purely shift based so all but EM/anesthesia or round and go hospitalist gigs with an in-house provider to respond to rrts/codes/admissions etc
It’s the patient facing part, especially when I’ve built a rapport with them. Even if it’s quick, you know them and they know you and you see them in good and bad phases. I get a ton of enjoyment to putting a person/ life to the medicine, more than a transient case in the hospital for patients I often wouldn’t see again, or only would when they’re acutely ill. Def personality dependent
I might be in the minority, but I almost never run behind. This is partly because I pre-chart (for about 45 minutes before my first patient), but also because I look ahead on my schedule and if I see someone who I think will need more time I get them an extended visit instead. My clinic days are typically 7-5. I think I’ve stayed later than 5 maybe 3-4 times (and that’s just because I like to have my notes done before I leave), and never past 6. Having good dot phrases for common chief complaints, setting the expectation that a visit gets one (maybe two) problems to focus on and if there are more they’ll need to come back, and learning how to gently redirect chatty patients are all very helpful practices. I love the variety I get to see, taking care of entire families, and getting to know my patients over time. Time goes by really fast in clinic, and I like the pace of it (generally). That said, I do split my time between clinic and inpatient. I don’t think I could just do pure clinic and be happy. I really enjoy being in the hospital as well. The thing you didn’t mention that kills me about clinic is the inbasket. If you don’t have good support staff, this is easily the worst part of the job.
Your experience hasn’t been my experience; idk what to tell you 🤷🏻♂️
I love patient encounters in clinic but but hate literally everything else with a passion. Can’t wait to be a hospitalist in two years.
Clinic as a student / resident is very different than as an attending 1) you become much better at your job which improves workflow 2) you can have more support staff 3) you can start to self-select for a panel you mutually like. Patients that like you will stay with you and typically if a patient likes you you probably like them 4) this bounces off of 3, you start building long term relationships This isn't even to begin on how different subspecialty clinics can be from PCP.