For the what, the when and the where
For a job with inpatient care
I could compromise
On the salary size
But not things that I wouldn’t dare.
Synopsis: I’m a family practitioner from Sioux City, Iowa. I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went for adventures working in out-of-the-way locations. After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took a part-time position with a Community Health Center. I used vacation time to do two short assignments in Petersburg, Alaska. I left the Community Health Center this month because of a troubled Electronic Medical Record (EMR) system.
I’m talking to more recruiters these days. When I tell them I’ve recently left a position I can hear an optimistic catch in their voices. Two days ago, I said, “I imagine you have to deal with a lot of rejection in your job.” Yes, she admitted, she does.
My ideal job, I tell the locums agencies, runs something like this (translation to follow): Hospitalist, 7 on/7 off, 12 hour AM shift, ER codes, intensivists on staff, no procedures, in Alaska.
Translation with explanation:
Hospitalists take care of patients sick enough to need hospital care. The hospitalist movement goes back no more than 10 years in this country. The US remains the only industrialized nation where outpatient doctors care for patients in the hospital. During residency in the 80’s, the older docs would point out that hospital work brought in money with no overhead aside from billing; but 20 years ago we started to look at the time we spent getting to and from the patient. A decade ago we looked hard at the inefficiency of drive time. Yet when, for a multitude of reasons, I took over my practice’s inpatient duties at one hospital, I found economies of movement which increased productivity with no shrinkage of patient contact time. And when I came to the Community Health Center, my contract specified I would work half-time as a hospitalist. That operation dropped adult inpatient work last December because the midnight-to-morning workload became unmanageable.
7 on/7 off refers to a work schedule of seven consecutive work days followed by one week of continuous rest. While an 84 hour work week sounds brutal, it affords the opportunity of going home in between stints.
12 hour AM shift is not really AM, but in the business it means 12 daylight hours, as opposed to the night-time hours. I really have paid my dues at this point and put in more than my share of sleepless nights. With the hospitalist movement has come the sub-genre of nocturnalist, so new that the position is sometimes called nocturnist; by whatever name, someone gets paid to take calls in the hospital all night.
ER codes means that the ER physician responds when a patient’s heart stops beating, to attempt resuscitation. Some docs, not me, enjoy the action, and compare it to “going to the Super Bowl”.
Intensivists on staff: With subspecialization, we now have doctors that do nothing but care for ICU patients. Sick enough to need an ICU means sick enough to needs a lot of doctor time. Trying to combine those patients with the less sick frequently means irreconcilable time conflicts.
No procedures recognizes that my skills at intubation, central line placement, and arterial line placement faded before the turn of the century.
In Alaska: self-explanatory.
Of course I expect to compromise on at least one of those parameters. I don’t demand my first choice, and so far I’ve said yes to three positions that haven’t happened. Yet I’ve learned how to have a good time anyway.
Talking to recruiters.
For the what, the when and the where