Lessons I Learned from Farrago: Navigating Time Off
While the DPC landscape is constantly changing, many DPCs are solo or couple practices. This begs some questions: How do I take time off? Who will cover me? Will my patients leave me if they need care when I am caring for myself? Don’t fool yourself, that’s what time away/time off is, it’s caring for yourself. Regardless of whether you deserve it; you need it! Again, don’t fool yourself, a healthy physician who cares for himself or herself translates into healthier patients.
Patients are ignorant about much of the process of becoming and the realities of being a physician. Media and cultural narratives don’t help bring truth or clarity to bear on these realities either. This includes the truth that most employed physicians receive 6 weeks of time off for vacation/sick/CME time, in addition to federal holidays. How do you navigate this with your DPC patients?
Doug’s advice to me was straightforward and simple, yet has proven “spot on” when time tested.
Step 1: Start at the meet and greet (so foundationally important – see previous articles). Transparency and education are key! Let patients know that you, the physician, sometimes get sick (gasp). Let patients know that you are mandated to complete CME for licensure and board certification. Let patients know what to expect when you are on vacation. Will you have coverage? Options include none (yep, really!), UC, ED, locums, telehealth service, and other local/regional colleagues. I’m blessed to have a group of local DPC physicians that are willing to have a “gentleman’s handshake” to help cover if it works in their schedule. It often does, but when it’s Christmas Eve, I let patients know at the meet and greet that we’re all with our families, and unavailable.
Back to that “no coverage”. There’s always UC/ED. I was at a recent DPC Alliance conference. The question was asked of the room, how many folks hired a locum for coverage – no hands went up!
Step 2: If you will be gone for a week or more, let your patients know regularly, starting at least a month out. I put it in my weekly newsletter (see previous article), again and again. I use (and shamelessly plug without kickback) AtlasMD as my EMR, which allows me to send an “email blast” to all patients, including the dozen that unsubscribed from the newsletter. I don’t know for sure, but I’d guess other DPC friendly EMRs allow the same.
Step 3: If you’re going to be gone for half a week or less, don’t tell your patients. The vast majority of your ~600 patients won’t need your care, and don’t need to know that you’re gone. The few that call, email or text, you can handle or your team can handle.
Our other professional and vocational colleagues have been doing this for years. Ron the realtor is always showing other homes during March Madness. Pete the plumber always has other work scheduled on fishing opener. Linda the lawyer is always with another client during the country club annual best ball tourney. Sure, this is a little stereotypical. Maybe Pete likes to golf and Linda likes to fish; you get the point. Whether you’re at the lake for a long weekend or at your kindergarten daughter’s “Muffins with Mom” (always schedule mid-morning), your patient can be simply told that you are booked or unavailable (without further details) at the time and be offered the next available appointment.
Step 4: Reinforce regularly. Remember that newsletter? It’s great to remind them about your policies for refills (not at the last minute). Remind them about your mandated requirements for CME. When it’s a week-long or greater vacation, I remind my patients I’m a solo doc and need time away for my personal health, the health of my marriage, the health of my family, and ultimately, so that I can be the best physician for them when I return. Patients can understand and respect this, especially if it’s for a birth, graduation, wedding, family reunion or funeral. If they can’t, let them go back to the system, the free clinic, whatever else!
Admittedly, I was quite anxious the first few times I took time off. Yet I’ve never had a patient leave because they needed care when I was away and they had to go to a colleague, the UC or the ED instead. For the exceedingly few that have made a snarky comment about an absence, I have no problem passive aggressively, but politely, reminding them of one or more of the following:
- You were informed at the meet and greet when you chose to sign up.
- You were informed in the newsletter (which you should read and/or which you shouldn’t have unsubscribed from so you don’t miss important announcements such as this).
- You were informed by an AtlasMD email blast, which you should’ve read.
- You were offered to be seen by a colleague, but chose not to for what reason?!
- While concerning to you and uncomfortable or unpleasant, your symptoms did not require urgent or emergent evaluation; you were given symptom relief and a prompt appointment for as soon as I returned.
Doug’s advice for the repeatedly toxic patient? (Which I haven’t had to use yet…) Just say, “You’re right! I’m just not able to provide the level of service you require. I won’t charge you for the next 30 days while you find another physician. Be well!”
I brought on Dr. Jeff Ponke just over a year ago (that’s another article) and his goal was to have a patient panel of 500. We were able to accomplish that goal within one year! We are both currently full. We have a new waiting list accumulating. We are looking for another like-minded Family Medicine physician. If you happen to know a good Family physician who might like central Virginia with plenty of vacation time…
