Home Forums Discussions General Discussion to all the solo primary care doctors

I was just wondering being a solo doc myself. When I go on vacation, I send my patients to other covering doctors and I will check in by internet, my messages and fax inbox.

Downside of this is I have to check in and never get a chance to go on vacation without thinking about the office.

I was thinking of doing the locum tenens route. At least they can check the labs and do the messages. This way I can take longer vacations and not worry about the office while I am gone.


What does everyone else do when they want to go on vacation?

A vacation is a vacation is a vacation--best enjoyed without internet, phone or beeper. If you have a doc covering for you, let them cover. My patients know that when I'm on vacation, if they have a problem they can contact the covering doc.

In order to remain fresh and able to care for patients with best efforts I need times of rest: a good night sleep (at least when I'm not on call), Sundays to rest (remember the "day of rest"), and vacations to really recharge the batteries. Otherwise, I've discovered that I burn up very quickly. Fortunately, I have three other docs who do a great job covering for me in our call group.

One of the great dangers of an EMR is that we are tempted to never shut it off.

I'll be interested to hear what others think about this issue.

I find it works best to have a trusted colleague or two to cover. (1) Paying for a locums is extremely expensive, probably twice what I make in the office. (2) You never know who you are going to get... at best there will be significant differences in how you practice, and at worst the locums might not be that competent. Finally (3) even the best locums will barely have figured out what drawer you keep the pencils in by the time you get back. He or she will be trying to just keep things patched together until you get back. Better with someone who knows your community and has an idea of your referral sources.

This is all independent of the phone/EMR issue. I find I can just make it clear that I am REALLY out of reach and things sort themselves out. Everyone knows even doctors get a break. After all, if you dropped dead, the patients will shed a short tear and the world will go on.

I handle things pretty much the same way you do. Yes it's a drag to contact the office but generally it takes me less than 5 or 10 minutes and then I can relax. There are some days I tell the office I just plain won't be available but the staff does have pretty clear routines on how to handle things so it's not a big problem. The biggest issue is usually controlled substance refills, which the doctors covering for me don't want to handle and I can't blame them.

Locum tenens is way too expensive and I don't even consider it.

Taking long vacations (more than say 10 days) is probably out of the question for solo doctors -- at least, in small towns. The other doctors in the area are pretty much overwhelmed, and don't appreciate adding my business to their already more than adequate load.
I am lucky, living in Oregon, that Nurse Practitioners can work unsupervised in a small office setting, and luckier that I have two acquaintances that have been small-town, rural NP's for a very long time, and even luckier that they are willing to cover the office now and then for short breaks at a price I can afford.
Still, taking 3 months off (I want to go to Australia by ship, train, bus and small boat, for example) remains a dream.

Even when I'm away, I stay somewhat in touch -- but I don't offer to be instantly available.

I have pretty much been on call 24/7/365 since 1975, including about 30 years of a busy OB practice. I have backed off a lot in recent years -- no OB, and the local hospital has hired "hospitalists". But that is life in the solo lane -- you are your practice in this business, and people want to talk about their hemorrhoids and sore backs and Mom's problems when you see them on the street or in the store.

Most doctors these days don't really want that kind of commitment to practice, so far as I can tell. Lifestyle is more important. No one wants my job -- when I leave practice, it's over. On the other hand, that's what the patients want, and increasingly can't get.

Well said, Tom.
Dave

At least David said our patients would shed a tear when we die - they will have to do it quick knowing that 2,000 other patients will be looking for a new doctor and they have to call quick.

I am doing solo x last three years. I have a local doctor covering for me when I am on vacation. She is physically in my office half days. Otherwise she is doing H&P at psychiatric hospitals and is pretty flexible. I have VPN access and I am able to refill meds, check labs and answer messages remotely. It does not bother me. Two years ago I stuck in Europe during volcano disaster. I seriously considered seeing PTs via Skype - chronic things, refills, etc. I still could have billed based on face to face time. It would have been interesting to see how insurances would react because skype is face to face. But then skies opened (literally)and I flew back.

This issue is coming up with the board of medical licensing in South Carolina right now. The issues aren't ironed out by far. I can foresee this as the future of monitoring rural NPs in underserved areas where physicians aren't.

I was in rural Luxembourg. BTW, american license is accepted there. I was visiting my childhood friend who is noncompliant diabetic patient. So I was able to order labs and write prescriptions for him. I had my pocket card licence from Georgia with me, they looked at it, made a copy and said: go ahead. Copay for 99213 level of visit is 50-60 euro. At least that is what I was told. Zocor is brand name there - cost 50 euro.

Rando - I am happy that there is someone else like me. Some days I feel like just quitting all together. When I go on vacation, I have to log in and do quick labs and refills. Otherwise, it is a mountain of back up work when I get back. Have you gone on a vacation for more than 2-3 weeks at a time?

Tomastria: I know what you mean. I want to go on a 2 week vacation but I can't. Only way is either join a group, you know the advantages and disadvantages of those, or hire a locums for 2 weeks. I know everyone on here talks about how locums are expensive but maybe they might be worth it to be able to go on a 2 week vacation without wondering if something bad is going back on at the office.

I wish I had a job like my solo optometrist friend. She goes on a weekend vacation once a month and a large 2 weeks vacation every 6 months. Her philosophy, if her office burns down while she is gone, oh well nothing she can do about it. She will worry about it when she gets back.

I doubt that for most of human history very many people have ever had the option to to take say, six weeks off and come back to find everything just as they left it.

That scene was, and is, the exclusive right of the fabulously wealthy who could afford to hire trusty lieutenants, or the dispossessed who had nothing to leave, therefore, nothing to return to.

For most of us, "vacation" is a pipe dream. It's better right now for me -- what with hospitalists and urgent care clinics, which suck business, but also provide coverage. But there is no way I could start a private practice in the current scheme of things, and pretty soon, I predict, all doctors will be locked into white-collar jobs with 2 weeks off a year.

I do not have any specific coverage when I am gone (which, because of finances is less and less). Sometimes a patient gets mad and I reply (stealing this from Tom of the Bob and Tom Team), "I don't know about you but there are two people in my life that I want to be fully rested and focused on their job...my airline pilot and my doctor". Most seem to understand that we all need to take time to clear the cobwebs out of our brains.

I've been a rural Int Med doc in solo practice for 23 years. I use to never take vacations. In the past several years I have been blessed with a very competent Dr from 75 miles away who works in my office 2 days a week and more if needed. They cover me 24/7 when I'm gone. I dropped inpatient hospital and now feel like I'm on vacation with little evening call and no hospital headaches. You can not count on other practices to cover your patients while you are gone. Even when they say they will, they don't do as good a job. I had the experience of calling back to the office from overseas and found out the Dr who I thought was covering my practice was out on vacation! Not good.