Link to podcast: Weekends & Your Schedule
Welcome to DPC Pediatrician. We’re Dr. Phil Boucher and Dr.
Marina Capella, two DPC Pediatricians who are on a mission to share our love of direct primary care
with you.
Welcome everyone to another episode of the DPC Pediatricians podcast. Today we are addressing a topic that came up from a listener. They reached out with a comment on our YouTube channel saying, Hey, one of the things that still worries me and I would love to hear addressed is the issue of weekends.
So a lot of people worry about this, right? When you think about going out into a solo DPC practice or even a solo private practice of any kind, the worry might be, do I have to be available all the time? Will I ever get a break? Can I have weekends still with my family?
That’s a completely legitimate concern. And so hopefully today, we will address that for you and many other listeners. So Phil, start us out. Did you first of all worry about this when you started out? And how have you addressed it?
Totally, definitely a worry because you never know what it’s gonna be like. I came from a fee-for-service practice. I was a partner with 10 other pediatricians. We had Saturday hours, we had Sunday hours. And so like the mind, thoughts of the mind thoughts, the thoughts around, okay, well,
how am I gonna take care of people on the weekend was a big question and consideration because I went from one in 10 Saturdays and one in 10 Sundays to like, what do we do for weekend coverage?
And as all of the big anxieties and worries when it comes to DPC, it was not as big of a deal. as it felt when going through it, I will say that we have a fantastic weekend plan in our practice. It is very non, it just isn’t hard to handle the weekends despite having 700-ish patients now in
our practice. to handle the weekends. In fact, it’s summer right now, the past three weekends, like we have Saturday morning hours, I can tell you more about our weekend hours and those sorts of things. But we’ve had one patient over the last three Saturdays, like one patient total over those three Saturdays, two weeks,
we had zero Saturday visits at all. And so I think that helps sets the context of okay, it’s not that common of a thing where you’re going to need to have a lot of weekend coverage. The way that our practice works when it comes to weekend coverage is, I mean, people still text a lot.
It slows down and our response time significantly slows down. We have set office hours for about two hours on Saturday morning. It’s myself, Linda, our PA, and Clara, our nurse practitioner. We just split the Saturdays. So one of us will do one and one of us will do the next and one of us will do the next.
And it’s about two hours. I usually do earlier in the morning because my kids are just kind of like getting up and doing their thing. So usually it’s from like eight to 10 and we see anybody that needs seen. We don’t typically do checkups on the weekends,
although we will if parents really need it and we have the availability to plan that in advance and to do that. We don’t do a lot of ear piercings in the summer on the weekends because most people are available at some point during the weekday, but we do by request on Saturdays.
And so it’s mostly just like cleaning up any sick visits that didn’t get seen on Friday because they weren’t sick yet or they kind of wanted to wait. And now it’s Saturday and they really want to be seen to check their kids’ ears. test them for strep. Those are the things that end up on Saturdays.
And then once it’s 10 o’clock-ish rolls around, parents know, okay, they’re not open anymore. We’re not open anymore to be seen. And so we try and encourage people, like if you have a Saturday issue, text us at six, text us at seven, which is fine because most people,
their kid is either sick at seven o’clock in the morning on Saturday, or they’re not going to be sick till later in the day. And then we’re figured out over the course of the weekend as well. So we’ve just trained our patients to, if you need something on a Saturday,
make sure and reach out on the early side. And that’s worked really well for us. And we get very few afternoon Saturday text messages, and there’s no expectation that we’re going to drop going to the pool or being with our families. to go and you know see a kid on on saturday afternoon or saturday evening or sunday
parents know expect and are understanding of that i’ve never had anyone complain like you don’t have weekend availability because they know that when we’re available we’re available and we’re really good at taking care of them and then when we’re closed we’ll still do what we can remotely over text message but otherwise parents figure it out
Gotcha. So I’m curious, what is your text availability? So you have those two hours and it’s not always you. It’s sometimes some of your staff. But what about text messaging? What can parents expect over the weekend?
So the same way that it works on our last episode when we were talking about the we’re closed text message goes out on Saturday morning or Saturday afternoons and those sorts of things. We’re closed. If you’ve got a non-acute issue, leave it here and we’ll get back to you.
If it’s something that you know needs to be seen, here’s the link to book an appointment. If it really can’t wait, here’s what to do. i typically keep a moderate eye on saturday afternoons and then on sundays too just to tidy up anything that’s quick and easy my kid has a fever what should i do
typically those are okay they’re outside of the newborn period so we’re going to do this that and we’ll see on monday depending on how things go or how things progress at the back of everything is okay if this kid is sicker or if they’re a newborn or
something like that if they’re a newborn that has a fever we’re going to send them to the hospital to do, you know, the new fever workup and everything like that. Like that’s pretty easy and straightforward of, oh yeah, you, you’re, you’re three week old has 101. Okay. Go to the Brian ER.
I will call and let them know that you’re coming and then they’ll take things from there. And here’s what to look for and that sort of thing. They can also, sometimes parents will go to urgent care because it makes more sense to them. We offer them a Monday appointment,
but they really want to get their kids strep swab done on Sunday because they want to know going into the week. Urgent care is perfect. Never had anyone complain that they went to urgent care on a Sunday because that is what urgent care is good at is taking care of those, you know,
low hanging fruit of does my kid have strep? I want to get them started today rather than wait. And that makes sense.
Yeah. And urgent cares exist for a reason, right? Like we are not, the DPC community is not responsible, sorry, the DPC community is not responsible for putting urgent cares out of business,
right?
Like that’s not our role. That should not be the expectation. I think most families, in my experience, everybody understands that we are human also, right? We are not superhuman physicians, right? that don’t have families and don’t have other responsibilities. I think if you set clear expectations and I always harp on this, right?
Set clear expectations from the beginning. And I will continue to harp on that because it really makes such a difference in that onboarding. When people are signing up, I tell families, Hey, I’m not, I usually won’t respond in the middle of the night. I’m human.
I need to sleep like everybody else in order to function and be my best during the day. So in the middle of the night, you can try calling, but if I don’t answer, then,
you know,
this is the nearest urgent care. This is the nearest ER. Right. And people are fine with that. And I also say, Hey, I sometimes take vacations and I have a, I have a dynamic schedule, so if you’re willing to work with that, but you can always reach me via text. Even if I’m out of town,
I was out of town visiting my family this past week in California, and I was still responding to text messages. There was one kid who needed to be seen in person, and I handed it off to my covering pediatrician, the one who shares the office with me, and she was able to see the kid diagnose a UTI,
take care of them. et cetera. There was another one who just needed a phone call, but I was still busy dealing with the health emergency with my dad. And so I handed it off to her and she was happy to take it for me. Everything else that was really simple, I was able to just manage.
And it wasn’t that much. It was maybe eight messages over the course of a couple of days. I mean, once people are kind of trained and you know the families and you don’t have to be looking at their chart or And figuring things out and asking a ton of questions because you don’t know the person. You know,
the fact that we know our patients pretty well makes that telecommunication much easier and much quicker.
Right. I think you can often like open up whatever texting app you’re using and like know who’s going to need what just based on seeing their names typically. Like I have my spruce pulled up right here in the background of our thing and I’m
just seeing the messages come in and you get like the little thing and like, okay, not urgent, not urgent, not urgent, not urgent at all.
Yeah.
A really good sense of that. So, you know, what people are going to need, what, and when you set the expectation of, Hey, I’m a human and Hey, I am out of town or I have this thing going on that I’m dealing with. They understand that because you have a relationship.
You’re not just kind of like whomever was available because I think a lot of parents before they discovered DPC go to these groups, huge practices where they rarely see their actual assigned pediatrician, whoever was available. And so they feel like they’re always available. And it’s just a different person that’s getting plugged in to look in their kid’s
ear when they know you and you’ve talked and you know their family and they know, you know, about your family and your life circumstances and all those sorts of things, then they get it that you are also a human.
Yeah, definitely. Yeah. And circling back to this question of weekends, I will add that The DPC pediatrician community is a little bit unique because I would say most of us kind of go into it with the expectation that we have to have some sort of weekend coverage. There is a huge discrepancy there with the adult DPC world.
I would say most adult DPC providers that I’ve met, they just don’t respond to messages over the weekend. Right. And they set that expectation in the beginning. They say, Hey, I’m available these times. I will check my email and I will respond to messages Monday through Thursday or Monday through Friday from this time to this time.
Outside of that, you know, you’ll wait. And with kids, yeah, with kids, I think we just as pediatricians have… I don’t know if it’s softer hearts or just more, more experience with anxious parents who we know sometimes have emergencies, you know, at inconvenient hours.
But I think the point that I’m trying to make is it’s completely up to you, what boundaries you set and what schedule you set, what expectations you set in the beginning. If you really are burned out and want to have your weekends completely free and
You have the option to set an auto reply to your email and your texts over the weekends saying, Hey, I’m not available until Monday. I will get back to you by then. But if this is an emergency, these are your options of where to go.
Right. And you can say, Hey, I really like this urgent care because they, if, if I need something, this is where I typically send people and then people can go there.
Yeah, exactly. You just have to, you have to be confident in that decision. I’d say pediatricians often second guess themselves or feel like, wait, but I’m trying to like get these people to choose me and to pay my monthly fee. And therefore I have to go above and beyond and I have to be available all the time.
And no, that’s not true. I mean, people you can expect people to pay you just for being their excellent pediatrician from Monday through Friday from nine to five or whatever you choose. Right. When I first set out to open my practice, I actually wanted to work three days a week.
And that is still sort of my, my goal is like three clinical days per week. And now I do a lot of other work. I have a nonprofit on the side. I have, some consulting work that I do and I’m doing an MBA program. So part of it was like, I know myself.
I know that I like to not just do the same thing every day. And I want to have the flexibility in my schedule to balance all of the different things that I like to do. And if I give myself that ability, I’m actually a better pediatrician because I’m learning on the side and I’m
bringing those things that I learn into my practice and I’m happier overall. I’m not getting burned out. And you have the ability to do that too. So I’m not usually during the regular year school year, I’m not in the office on Tuesdays or Fridays.
And so parents that know me and that have been in the practice a while, they kind of get to know that. And so they know that I will offer a next day appointment. I do work some Saturdays because that works for me, but that is not at all the expectation.
the pediatrician I share my clinic with, she has kids. And so during the school year, she has to pick them up by 2 p.m. So she works typically from the time she drops them off to the time she picks them up. And then once in a while,
if a patient really needs to be seen urgently in the evening, she’ll bring her kids, they’ll tag along, they’ll play somewhere else, you know, in the backyard or in the clinic, and she will have that patient visit with them. sometimes on weekends as well. But I would say,
don’t feel like it’s not achievable because you want to take weekends off or you want to have a non-traditional schedule. That is truly one of the beauties of DPC is that you get to decide for yourself what your schedule is, what your boundaries are, as long as you practice reinforcing them and establishing them.
And you really, my team teases me that I have a lot of I have a tendency towards dynamic scheduling. And I completely own up to that because I will say, you know what, this summer, I only want to work Mondays and Tuesdays, and I’m willing to work really long days.
But my husband and I own a cabin up in the mountains and it’s only accessible during the summer. And so I said, you know what, this summer, I really want to have Wednesday, Thursday and Friday up in the mountains. And I have a satellite up there. So I’m able to still get text messages and everything. And
address patient concerns. And I have someone else who can help me out if it’s truly urgent or I can drive down. It’s a 40 minute drive.
It’s not terrible.
And yeah, but I just decided. And so my, you know, I asked my team, are you guys willing to modify the schedule? They were all on board. And so I really appreciate my team for being, for being okay. And kind of going with my dynamic, my tendency towards dynamic scheduling.
Well, I think that also is just a good example of, okay, I’m not exactly sure how this will work out. There’s a little bit of risk that it could all fall apart. But the upside is that I might be able to be at the cabin for five days, like, or three, four days, whatever it might be.
And so I’m gonna try it. I’m gonna see what happens because the risk is tolerable to me because the worst thing that can happen is I have to drive back to see, you know, something in particular that I can’t handle remotely or can’t figure out that needs it.
But I bet I’ll learn something as I do that and I’ll learn, oh, this was actually possible to do Long Days Monday and Tuesday and then have more time for all the other things. And I think that’s one of the beauties, like you said, of DPC is you can make it your own.
You can also test and see what works and what doesn’t work. No, my patients hated this. This was a huge mistake. All these sorts of things. And then you can just pivot backwards or pivot sideways, depending on how things go. These are things that people would just say. They’d give you this really side eye if you said,
hey, I’m in this busy fee-for-service practice, but I only want to work Mondays and Tuesdays. And then by appointment only the rest of the week, they’d be like, okay, go for it. But you can do that. And I think that’s the beauty of what you see. And like I said, and like you said,
and if people are binging these episodes, they’ve heard us say a million times, is that you get to make it your own. And when you set the boundaries, Patients respect those boundaries. The example that I always give when I’m talking with physicians who are like leery of this sort of thing of like,
they’re gonna bother me all the time is we go to a pool in the summer. It’s a community pool. You have to pay a membership for access. It’s very affordable. There’s a sign that says, here’s the pool hours. I can’t, just because I paid for a membership to the pool for access, just go whenever I want.
Because I paid for access. There’s a sign that tells what the hours are. Okay, guys, it’s time to go home. The pool’s closing. Yeah, we paid for this, but it’s also the pool’s closing. I can’t bring nachos into the pool, even though maybe I want to, because there’s another sign that says no food in the pool.
Like we, people… learn to follow the rules when the expectations are made clear. Now, if the pool was open all the time and it was two in the morning and I wanted to go to the pool and no one had ever put up a sign or lock the gate or something like that, then I’d get used to,
it’s two in the morning, I wanted to go swimming. But if there’s a sign and there’s expectations, then people follow those expectations. And if they make sense and they’re told in advance, they say, oh, that makes sense. You’re here Mondays and Tuesdays. And then the rest of the week, you’re available by text message. Perfect.
That makes total sense. Oh, and you have a plan for what to do. If my kid, skins their knee or has a fever on Thursdays, here’s what I’m supposed to do. Great. Makes sense. You’ve got a plan.
Absolutely. Yeah. And again, people know that we’re human also. So I was really nervous when I set out this summer schedule. This is the first time I’ve attempted that sort of thing. And I do work also some Saturdays to kind of make up some of that time. But
a couple of parents reached out about scheduling things during the summer. And I had to say, I just decided to be honest and say, hey, I’m going to send you my scheduling link, but just know that my summer schedule is modified because of this reason. And I just was honest about that reason.
And both of the parents were lovely and they said, Oh, that’s wonderful for you. Like, we hope, you know, you get some time to enjoy and we will completely work with that. So it was really nice to hear that. Oh, okay. A lot of that anxiety is just in my mind because of that expectation that I’m like
letting people down, but most people are going to be completely fine with it.
Yeah. I think that that is just a really good note to end on is like, you are human. You can set boundaries. Parents and patients will respect those because they know you and they value the relationship and they know what you offer and are willing to make it work.
And I will say that in four years now as a DPC pediatrician, I’ve never had a patient leave the practice or even complain that we weren’t there for them when they needed it, despite the boundaries that we put in place and that we enforce on a regular basis
so that we can enjoy our practice and enjoy our lives and make all of those things work. No one has ever complained. No one has ever left and said, you weren’t available as often as I needed. And so I think that hopefully helps hammer home that like you can do this too.
You can set those boundaries and expectations.
Yeah. And if once in a while you have a patient who does not respect those boundaries, then you can say goodbye.
You guys really have a very specific need that I’m afraid that I’m not able to meet. And so it’s not going to work out. It’s not going to be the best for you to keep going. And it’s not going to be the best for me to keep going.
So here’s some other ideas of who you might see that might be able to help you with the expectations that you have. Bye.
Absolutely.
Yeah.
All right, everyone. Well, thanks for listening. We hope you found this helpful until next time.
