We have very similar practices. I take about the same ratio as you with medicaid and private. I have no problem with telling them to go to the ER after 2-3 PM. We will triage the problem because many of the "acute" problems are actually not that acute and can wait a day or two.
I have a NP and she is essential. Without her, I would probably burn out, and also would not be able to run 2 offices.
You need to take a break periodically. I head out from Chicago to Michigan about every other weekend in the the summer.
My after hours pages come to my cell phone. By agreement, I take 3 or 4 weeks of telephone but we trade up any time either of us is feeling tired of it. I can handle the phone easier than my NP.
I can have the hospital cover me any time I want, but I still take my own hospital. I have considered dropping it thought.
Next week I will be heading to Reno, you should too! It will make your mind more relaxed. You don't have to talk about AC if you do not want to.
Seriously no pressure, but the patients will do fine if you don't see them all the same day. Yes, you may disagree with the ER, so what! I explain to the patients all the time why their child did NOT have an ear infection I am seeing 3 days later. Not only an easy visit, but encourages them to stay out of the ER. There is enough business for everyone and you can't cover it all. Just set cut off times.
