Listen to the podcast here: How do I Protect Time Off in DPC?
Episode Summary: In this podcast episode of DPC Pediatricians, Phil and Marina discuss how DPC physicians can intentionally protect their time off while still providing excellent, accessible care to their patients. They share how they structure their weekly schedules around personal and family priorities, block off time for administrative work and self-care, and use tools like online scheduling to give patients flexibility without making themselves constantly available. Phil and Marina emphasize the importance of setting clear expectations with families from the beginning, including when physicians are available, how quickly messages will be answered, and what patients should do when their doctor is away. They also explore different approaches to vacations and coverage, explaining that DPC physicians can choose whether to remain available, arrange coverage with another physician, or completely disconnect as long as patients understand the plan ahead of time. Throughout the conversation, they reinforce that a monthly membership does not mean patients should expect unlimited, around-the-clock access and that maintaining healthy boundaries is essential for creating a sustainable practice. Ultimately, Phil and Marina encourage DPC physicians to take advantage of the flexibility of the model and intentionally design their schedules, availability, and vacation policies around the kind of life and practice they want to build.
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. We are excited today to talk about time off. This is a topic, a question that comes up so frequently in these DPC groups, not just among pediatricians, but among all DPC physicians.
And that is questions ranging from if I open my own DPC practice and I’m the one responsible for all of these patients and they can text me and they can call me, when will I ever get time off? Right. And then also a lot of people think, well, one of the reasons I want to go into DPC is because I don’t want to work and be a slave to some health system for five days a week or even sometimes more. And I really want to have more time with my family and more time for self-care and just more balance in my life in general.
So how do I protect time off during the week if I don’t want to be seeing patients all the time? And so there can be many iterations of this question, but really the overarching worry is how do I make time for myself and also make time
to do the stuff that I have to do as a business owner? And all of that within this DPC model. So Phil, I’m curious, you have a big family, you have, I know you have other things you like to do besides just patient care.
So how did you think about this question as you were exploring the option of DPC and how have you made it work for you?
I think for me, when I was starting, family life is really important to us and we do have a relatively busy family. We have a lot of kids, but we try and stay as unbusy as we can. But I think one of the things was really making sure that we had good bookends
of our My time at work. And so I usually drop the kids off in the morning at school and then I usually make dinner at night. And so like being able to work between those two were kind of like the bookends of how can I design a practice that allows me to do both of those things.
And so when it came to designing the DPC, I mean, I think that was one of the biggest worries is like, is this going to bleed into the evenings and the weekends? And are people going to be calling and texting all night and how are we going to go on vacation and all of those sorts of things?
I think as most things in It turns out that it wasn’t as hard and it wasn’t as big of a mountain as I thought it was going to be to climb. But when I went about starting, it was like, well, how can I give myself some protected time? I love, for example, that we have…
Patients can schedule on their own. That saves us so much time and so much back and forth. And I highly, highly, highly encourage people to let patients schedule on their own because they will do a much better job. They can buy a car from their phone. They can order sushi to get delivered from their phone.
They can absolutely make an appointment from their phone. And that is what they want to do. But if they have a wide open schedule, then I’m kind of stuck always being available for them. And if we’re saying these are our open hours, does that mean that they can go on and book an appointment at Thursday
at four o’clock if I would really like to have that as a protected time? And so one of the things that I always tell people to do when you’re going about designing your schedule is like design the schedule. And create blocks that you’re available and create blocks that you’re not available by default.
And so that’s worked really well for us is like, we’re open these hours, but if somebody just goes on to book their kids checkup, they might not have Thursday afternoons as one of their options. And guess what they’re going to do? They’re going to find a different day that works for them when they see that availability.
Like if you go on and you’re going to order sushi or buy a new Honda Civic and And they don’t have red or they don’t have the salmon roll that you want. You’re going to find a different option that works for you. Or then maybe you’ll call and say, Hey, do you have any red Honda Civics?
I really want a red Honda Civic, but by and large, People will find a time that works for them. And so I always tell people like put those blocks in the schedule and then let people find a place that works for them.
And I think that’s the number one thing that has really helped us to make it so that we can have boundaries and have time off throughout the week or dedicated time for like administrative tasks. What does it look like on your side when it comes to like the day,
the weekly schedule rather than when I want to talk about vacation and evenings and those sorts of things. But in the weekly schedule, how do you manage that?
Yeah. Well, first of all, when I onboard families, I tell them, hey, I’m not in the office every day. So just be aware of that. Right. But you can text me and I’m checking my messages a few times a day during those days. But sometimes I’m at the gym or sometimes I’m on a long walk or sometimes.
So I set that expectation really early so that families don’t have an unrealistic expectation that I’m just going to be available Monday through Friday, typical working hours. So My current schedule is like Monday, Wednesday, Saturday. And I don’t mind working Saturday because that way kids don’t have to miss school and I don’t have kids.
So I don’t have to be at home with family on Saturday. And also, I like being able to go shopping and get a haircut and stuff like that on days when not everybody in the world is trying to do those things. Right. So I set the expectations early. But also the days that I’m in a clinic,
I am working, I’m seeing patients from about 9.30 to 6 p.m. So those are long days with like an hour break. And when I was, it got a little tricky when I was trying to balance my MBA program these last two years, thankfully that’s over. But generally speaking,
those clinic days were devoted to seeing patients and were typically pretty full, sometimes with random gaps in there. But then those days that I’m not in clinic, I am Checking my messages in the morning and then around noon and then in the afternoon. I try, I’m trying to get better about setting a schedule that I don’t have
to respond right away to every message because if I’m trying to write something or if I’m trying to focus on the meeting, like I don’t want to have that as a constant distraction.
So I’m trying
to get better about setting the expectation of families. Hey, I don’t, I’m not going to respond right away. Give me, if it’s a text message, I will respond within a few hours. If it’s a phone, if it’s something truly urgent and you need a response within an hour, then call me.
That way I can see that it’s urgent, right? But yeah, when I first, first started out, I wasn’t scheduling a lunch break. And I learned pretty quickly once I started to get busy, hey, I need that lunch break. Like, it’s just ridiculous. You actually need energy? Yeah, exactly. Well, I don’t know.
Sometimes I fall into the trap of like, well, I’d rather just like Work really hard and long. It’s kind of like the ED doctor mentality of like, oh, I’d rather only work maybe three days a week, but work really hard during those. So I had to catch myself in that pattern and say, okay.
And that became really important when I started to have employees because I thought, wait a minute, I’m setting a bad example for my employees when it comes to self-care. So now we have a dedicated hour lunch break. Sometimes I have to block off time for meetings and things like that.
And if I know far enough in advance, right, I have that. But basically my days off are set for things like this, recording podcasts, meeting with my virtual assistants, doing other work that just takes time. But I also, during the week, since during the week is sort of one of my weekend days,
I also have gotten strict about blocking off, hey, From Thursday at like roughly noon to Friday at noon, that’s my protected day off. And that’s the time when I can go get a massage, when I can go on a long walk, when I can do something that’s just for me. So it does,
as you get creative with your schedule, you also have to get creative about how you create those boundaries in your schedule and That makes sure that you have enough time to do the things you need to do with your family, with your loved ones, for yourself. Because for me, it can really easily bleed into this pattern of,
oh, well, technically I don’t have anything on my schedule. So yeah, sure, I can put a meeting here or I can put a meeting there or I can put something for someone else there. And I had to start to get stricter about those boundaries so
that my whole life doesn’t become work because it could easily become like that.
Yeah, I think for me, the same. If I have nothing on the schedule and I don’t have a specific block, I’m like, yeah, we can add that on. Even though I don’t really need to, like they don’t need that acuteness. And I do need protected time to do all that. Everything’s like, we all deserve protected time.
And if you don’t put something on there and you just let it bleed in, people just realize like they, I can just make an appointment like at the last minute. I think it does help for us. There’s a couple of different ways at the practice level that we really make it easy
to get people to schedule when we’re available. And one of them is having dedicated URLs for an acute sick visit versus a non-acute sick visit. So when somebody text messages us, instead of like, Oh, let me go to my computer. Let me pull up the schedule. Let me do those sorts of things.
Instead, we’d just be like, see if you can find a time here and let us know if you can’t. And then send them this link that goes to our acute sick schedule that has same day availability. If it’s something like they’ve had a tummy ache and they’re constipated and okay, perfect.
That sounds like something that you should come in for. Here’s the link to schedule. And it sends them to a non-acute sick link that is booked like two days out so that we’re not getting filled up with these non-acute things taking up Those and stealing away those acute spots. I can tell you that 97,
maybe 98% of the time, people just book the appointment and they don’t say, oh, you don’t have anything or you don’t have anything fast enough for me. And they just find a time that works. Even like this morning, I was texting somebody and just said like,
see if you can find a time that works to come in for your kid’s fever and cough. They go to the schedule, they book it, it puts it into our system right. Whereas I could have otherwise then been like, is this time where I could add on this time? I guess I could see them at this time.
Like you’re playing text message tag back and forth. It’s very inconvenient and a lot of unnecessary energy going to scheduling something that they can very well do themselves. So that also allows you then, if you kind of get into the habit of that, To put blocks on your schedule and say Thursday afternoons, I’m blocked out.
Hey, I know that your kid needs to come in for constipation. Here’s the link to schedule an appointment. They don’t see appointments on Thursday then, and they pick Friday or they pick next Monday, or they say, Hey, none of these times work. Is there a different time?
You will find that people just find a time that’s available to them. And so that allows you then to have that protected time for whatever it is that you want to do. And that’s worked really well for us to avoid getting into the back and forth. Does 9.45 work? How about 10.15? The vast majority of the time,
people will find a time that works for them and it saves you that mental back and forth. How has it worked for you in the bigger picture with things like vacation? Or how does that work when you’re talking about not just like a couple hours here or there or an administrative day sort of thing,
but we’re talking in the big picture about vacation and time off for vacation. How have you handled that?
Yeah, great question. I’ll get to that. I did want to backtrack a little bit. The robustness of self-scheduling options is going to vary based on your EMR and the technology stack that you have, right? Phil, you’re really good at harnessing every power available of technology and inserting those nuances of like, you have a different,
like for this type of visit and that kind of visit, and you’ve set up your appointment slots so that that works. Not everyone is as sophisticated, including me. And I started out with Atlas, MD as an EMR, and I’ve just, I’ve seen the newer systems that have more capability,
but From a cost savings perspective and from the pain of having to switch EMRs and losing all the data that I have, or like some of the data that I have, it just has not been worth it. And Atlas, unfortunately, the Umbers, if you’re listening up, please change this, but the Atlas functionality of self-scheduling is pretty limited.
So I have to send them a link and then it’s only one hour blocks and it doesn’t allow you to differentiate between acute visits, non-acute visits, all that. I wish it did. So when it’s a routine physical and a parent is texting me, my panel’s pretty small. Like my members,
like I’m at about 150 and that’s my sweet spot because of the type of care I provide. So when they, when they need a physical, I’ll send them the self-scheduling link and it’s the one hour slot. That’s perfect. If it’s a sick visit, they do text me.
It’s a little more work for me, but because my panel is smaller, it works out okay. And I say, I have an open access slot. I put these little half hour open access slots in my schedule once a day so that I know if a member needs me, I will be available.
Or I can come in a half hour earlier at nine instead of 930 to see them. So I have that worked in my schedule, but I wish I had a more robust thing. I don’t need it because my panel is smaller, but if you do end up in a practice with A much larger panel,
those sorts of systems are really important to have in place to save you time and energy and your team time and energy. But going back to your question then about vacations, yes, I definitely take vacations. In fact, that’s one thing that I tell families at onboarding is like,
I really like to go to conferences because I’m always learning and I’m bringing that back to you. And also I take a vacation sometimes. And so in two weeks, in fact, my husband and I are going to go spend a week in San Diego, which is where we used to live.
And I feel like my heart is still partly in San Diego. So I just need my time in San Diego at least once or twice a year. So we’re just going to be there for a week. I will still be fielding some text messages from my families.
And I have a pediatrician who works in my office and she helps cover for me if someone needs to be seen. If it’s something that I can handle over text, then I’m just going to field it. Now I did two months ago, go to South Korea.
And when I went to South Korea, I could not be fielding text messages. And I said, Margie, I’m just going to have an auto reply for this and you’re in charge and I will compensate you for that time that you’re covering for me. So she fielded everything for me while I was in South Korea for eight days.
But with this San Diego trip, I’m just going to be working on writing my book and enjoying time by the beach. And so I thought I don’t need to incur the cost of paying her to see all my patients and to field all my messages.
Plus, I know my patients better and it’s faster if I just field it. So for me, I decided that’s what’s right for that vacation. But definitely I take vacations and I go to conferences and Sometimes I just make that decision on a case-by-case basis.
Is this something where I need to be fully present or where I just need to be off the clock and enjoying completely me time? Or is this a type of conference where it’s just a two-day conference in Boston and I’m okay fielding some messages twice a day? So I just play it by ear. And again,
I have a smaller panel, so it’s not as cumbersome as it might be for someone who has a three or four or five hundred patient panel. If I had that size panel, I would not be doing it the way that I’m doing it. Totally. And actually, Phil, you’re, oh, go ahead.
No, I was going to say, I think that makes great, that’s really helpful for people to hear is how you do it and how you are able to say like, hey, I’m off the grid a little bit versus I’m going to be out of the country and I need to, you know, find something else out.
You were going to ask, sorry.
Yeah. No, I would also add that I also have a team, right? I have a virtual assistant, the fields, all new inquiries, right? When I was alone and I was doing all that, it was harder. It was more work. To be fielding new inquiries while I was on vacation and things like that.
I have, yeah, I have a whole team that’s there in the office still when I’m on vacation. They find other things to do typically when I’m out of town and there are two other physicians in the practice that still need things. And so they kind of help them out while I’m gone.
That’s a whole other complicated story, but that’s how it works for me. But going back to this theme of vacations, I know that you and your family are taking a vacation to Minnesota next week. So tell me about how do you work it out for yourself? How do you negotiate and plan?
I’ll start because I have a team now too. So I feel like most people probably don’t have as robust of a team that you and I have because they haven’t been at it quite as long. So I opened my practice in January of 2021 or 2022. It feels like a long time ago now.
I think it was 2022. Okay. And we already had had, like before I even had planned this DPC, we had a vacation on the books for February of 2022 to go to Florida for a week. We didn’t realize it at the time, but it was on an island with no roads.
So we had to like last minute figure out how to get to the island. So that was its own adventure. And you should… Just as an aside, you should really read VRBOs carefully before you book so that you can drive to it. But we had this planned before I even had the idea of DPC.
And then it’s like, well, what am I going to do? I’m going to be out of town and unavailable. And so we did what you said here was I have a pediatrician friend in town who I said, can you kind of watch things for me? And I will of course compensate you for that. So I paid her,
she came over and saw a couple of kids that just needed like their ears checked or strep throat or swab or something along those lines as a way to make sure that people could still Be taken care of if they needed it. Obviously we didn’t book any well checks for that week or anything along those lines.
It was maybe one or two kids per day and max some days zero kids needed in or anything along those lines. And I let people know, Hey, thank you for joining my practice. FYI, my family and I are taking this trip. I’ll send you some pictures when we get back. This is a relationship based practice.
You understand that. That we are humans and we have other interests and things on our list and we need to take time for family, blah, blah, blah. Everyone understood, was perfectly fine with that. And so I think there are probably pediatricians in your community that are retired, that are working part-time,
that would be happy to help you or somebody that could help to manage things so that you can still go on those vacations, which you very much need and deserve.
Absolutely.
At this stage, we have other clinicians in our office. So I have a nurse practitioner that’s part-time and a full-time PA that works in our practice. And so it makes it much easier to go on vacation. We just make sure they have enough slots to take on the additional burden of sick visits or those sorts of things.
And if they need something, if they’re not sure what to do, then they’re going to reach out to me. Like I’m not off the grid. I’m in Minnesota, but we still have Wi-Fi. And the things like that. And they’re very competent. We’ve been working together for years.
They know how I would do the things if they have questions. And so I doubt that I will hear from them, but if they do, then it was a legitimate reason that they reached out to say, Hey, what would you do in these circumstances? I’m not quite sure that this hasn’t come up before.
And so I think that that’s very reasonable and appropriate and has allowed us to Take vacations and have time off. I like to go to conferences too. Same sort of approach when it comes to conferences and things along those lines is just make sure coverage exists. And even from day one,
you can figure out how to set that up so that you don’t have to feel like I’m beholden to my phone for 24, seven, 365.
Yeah. Yeah. And I will say, so for some people who just They don’t have coverage near them or they don’t want to have to budget for that or they can’t in the beginning. Right. You don’t have to be available in the DPC model, at least as it currently is.
You do not have to be available all of the time to your patients. In fact, I think people in the internal medicine and family medicine DPC world do a much better job than us pediatricians at setting those boundaries. I share my office with a family, lovely family medicine physician,
and she just tells her patients, Hey, I’m in clinic three days a week. And after 5 PM, I do not respond to messages. And on weekends, I don’t respond, right? Like she sets very clear expectations because she has kids and a husband and he likes to go skiing during the winter and do other things.
So she just is very transparent. And if a patient says, well, I think there was one snarky patient one time that said back to her when she was explaining her model, she said, Oh, because my body is not going to get sick after 5pm on a Friday.
And, and she said, Well, this might just not be a good model for you. And she is completely confident. And In saying that of like, this is not everyone’s cup of tea. This is not the right fit for everyone. These are my boundaries. And this and also she she explains it like I’m human and I have.
In order to be able to take really good care of my patients and to keep practicing medicine, I have to do it in this way. So I think as pediatricians, we can learn from that and not have the expectation of 24 seven because you do not have to be 24 seven.
I want to bust that myth right now. You do not have to do that to be successful in pediatric DPC. And you can work three days a week if that’s what you want to work. My colleague Margie, she has kids that she has to pick up from school sometimes at two.
And so she comes in at nine after she drops them off and she’s done by two and headed out. And her families know that like that’s her availability in the office. Obviously, there are other times that she will bend over backwards and have the
The nanny take care of the kids in the evening while she’s going and doing a home visit, right? But these are very negotiable things that you get to decide for yourself. How much vacation time you take is completely up to you. You can tell patients at onboarding, hey, when I’m on vacation, I’m not available.
And that’s what Dr. Jackson, the family medicine doctor, does. She goes to Europe. She’s gone a couple of times. She’s gone to A few places and she just tells her patients, she sends out an email in advancing, I will not be available during these times. This is the urgent care or this is what you do.
And I think we need to understand that that is okay to do as well. But you have to be honest and transparent, have that in your contract, tell people ahead of time so they know what they’re signing up for. So yeah, you can do it however you want is the beautiful thing.
As we always say in DPC, right? When you’ve seen one DPC, you’ve seen one DPC and you get to decide How much vacation time you take and how you manage when you’re out of the office.
Well, and I think that what you said earlier in the episode is so important that set those expectations with families so that they are aware. And then it’s not a surprise. And then they will be like understanding and they’ll, they’ll call and they’ll be like, Oh yeah, I forgot.
I saw that email that she’s out of the country or that sort of thing. Like that is very normal. And people don’t just abandon their pediatrician over those sorts of things. And if they do, then they weren’t Probably the right fit for you. You’re not going to make them happy no matter what you do.
And even if you do go to their house at 2 a.m. to give them a Decadron for their little bit of croup, they’re still going to be like, but they weren’t available for me when I wanted that. It’s not going to be a good fit at the end of the day, no matter what.
So you can hold those boundaries. And especially if you explain them and explain them and explain them. Then parents will understand. And I think that the fact that they’re paying you a monthly membership fee does not mean that you are their personal pediatrician
that will row in a canoe to get to them to put a Band-Aid on their kid’s ouchie. That’s not the level that they’re paying for. Just like we go to a pool, it’s a community pool that we pay a membership to go to. But that doesn’t mean that I can go there at two in the morning.
That doesn’t mean I can take glass bottles in the pool. Like there’s still rules and expectations about what I’m allowed to do at the pool just because I’m paying to access the pool. And in the same way, you can share those boundaries and expectations with your families.
Yeah. And if once in a while people try to treat you like you’re not human. In fact, this happened to my good friend and colleague Margie that a family had signed up and they had been members for many months and They needed something and the mom texted, needed something in the morning.
And she said, well, I can see you this afternoon. It was only five hours away, but it was a home visit out to like a town 45 minutes away. And she had patients that she had to see. So she couldn’t drop everything and her kids and all that stuff.
And the family ended up dropping because they wanted to be seen immediately. And I told her good riddance. This was not a family that is going to have a healthy relationship with you over time. And they can go out into the wild west of what else exists out there and try to find someone like you,
but they’re not going to find it because you already were willing to bend over backwards for many of your families. So it’s okay to like lose those types of people once in a while if it happens. I also had someone enroll just a few weeks, I don’t know, maybe two months ago.
They had enrolled through my website before I had kind of closed that off. And then they were texting my VA angrily saying, hey, we enrolled online. And then we were texting her at two in the morning and she wasn’t responding. Well, I hadn’t even onboarded them. So I didn’t even know this family existed.
And I said, refund their money. This is not a good fit. Goodbye. Like, I just don’t want that energy of that type of family in my practice. Well, anyway, thanks everyone for listening to this episode. We hope you found it helpful. We hope you find our stories and our sharing our experiences helpful in helping
to negotiate your own vacation time and your own clinic schedule in a way that works for you. We thank you for listening to this podcast. We love hearing from you. Feel free to Put comments in Substack if you’d like. If you have any questions that you’d like us to talk about in the future, feel free to share there or also in the DPC Pediatricians Facebook group. We also love to hear your ideas and until next time.
