300k

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Ngo3

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Can fam docs earn well over 300k?
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Sure. If you're willing to sleep in ERs and pick up other stuff. I made over $500k last year as a family doc w/o OB, unfortunately had to work about 80-100 hrs/week to do it. I haven't made under $300k since residency 8 years ago. My residency buddy has been in the $700s for a few years but he also does OB. A partner of mine makes about $360k just doing clinic and ob, but he sees an obscene amount of patients in clinic every day and still does old school 5 line notes. My other 2 partners are around $250k just doing clinic w/o OB, 4 days/week 8:30-5.
 
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5150man said:
Sure. If you're willing to sleep in ERs and pick up other stuff. I made over $500k last year as a family doc w/o OB, unfortunately had to work about 80-100 hrs/week to do it. I haven't made under $300k since residency 8 years ago. My residency buddy has been in the $700s for a few years but he also does OB, which I don't. A partner of mine makes about $360k just doing clinic and ob. My other 2 partners are around $250k just doing clinic w/o OB, 4 days/week 8:30-5.
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Why are salary averages for fam med so low then?
 
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I would say the average family doc is not working 80 hours/week. I don't know what averages are listed. In Utah where I practice I'd say $230k is average for someone working normal clinic hours (40 hours/week) and having been in practice over 5 years. My partners making that are seeing about 25-30 patients/day and working 4 days/week with no OB and only seeing newborns in the hospital. We are a private practice but friends from residency that work for IHC (the 500 pound gorilla in the state) are making similar money with better benefits but also the joys of working for a large corporation.
 
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Ngo3 said:
Why are salary averages for fam med so low then?
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Procedures garner the majority of compensation in our current system. Furthermore, most family docs have divorced inpatient responsibilities unless they're doing hospitalist work.

To do well in family medicine in a traditional fee for service plan, you need volume, procedures a good payor mix and/or a combination of all three. There is a multi-speciality group in town that actually subsidizes their family docs and the specialists HATE it. If you're seeing mainly government insurance working 8-10 hours a day 4 1/2 days a week and seeing less than 20 patients a day with few procedures, you're not going to do well.
 
mark v said:
Procedures garner the majority of compensation in our current system. Furthermore, most family docs have divorced inpatient responsibilities unless they're doing hospitalist work.

To do well in family medicine in a traditional fee for service plan, you need volume, procedures a good payor mix and/or a combination of all three. There is a multi-speciality group in town that actually subsidizes their family docs and the specialists HATE it. If you're seeing mainly government insurance working 8-10 hours a day 4 1/2 days a week and seeing less than 20 patients a day with few procedures, you're not going to do well.
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"going to do well" being very relative. There are not many other fields (professional and highly educated included) where one can easily make over 150K with a similar schedule even with time/experience. I would suggest that primary care salaries are not "so low", they are actually the most realistic salary for education/profession in the US with most specialist salaries being far too high. If compared to the vast majority of the rest of the world, US provider salary is extremely high. If economic forces are ever allowed to freely act in healthcare, I would expect all medical provider salaries to decrease substantially. At least those of us in primary care wont feel like we are losing a limb if/when it happens.
 
300k wouldn't be that hard to do.

Let's assume an employment agreement of $40/wRVU. To make 300k/year you need 7500 wRVUs. On average, a single patient encounter will get you 1.25 wRVUs so that's 6000 patient encounters/year. Let's assume you see 25 patients/day. That means you have to work 240 days/year. A work week is 5 days so if you work 48 weeks out of the year at that volume level you'll hit 300k for the year.

Now there are several parts of that which are fluid. A local hospital system, for family medicine, averages 1.4 wRVU per patient encounter. If everything else stays the same, now you only have to work 43 weeks/year at that same rate to make 300k.
 
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also wanted to point out VA Hopeful Dr's words.. employed this tends to be an important factor in your overall salary as well.

Granted the trend is now favouring employed, there are people in private practice who can make similar figures w/o working as much.. but nobody wants to deal with insurances/overhead etc.
 
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VA Hopeful Dr said:
300k wouldn't be that hard to do.

Let's assume an employment agreement of $40/wRVU. To make 300k/year you need 7500 wRVUs. On average, a single patient encounter will get you 1.25 wRVUs so that's 6000 patient encounters/year. Let's assume you see 25 patients/day. That means you have to work 240 days/year. A work week is 5 days so if you work 48 weeks out of the year at that volume level you'll hit 300k for the year.

Now there are several parts of that which are fluid. A local hospital system, for family medicine, averages 1.4 wRVU per patient encounter. If everything else stays the same, now you only have to work 43 weeks/year at that same rate to make 300k.
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To pile on-- also depends on how your contract is negotiated if you go with private practice employment --- This can be wildly variable --

In private practice, I know of a local suburban physician in a major burb in Dallas who sees patients Q10min, is well established, worked 7 to 1 or 2, refuses to use EMR, has one front desk and one RN who has worked with him for about 5 years --- according to him, he's making between $300-$500K/year. It can be done but it's a combination of factors -- either lower numbers with higher acuity/use of ancillaries (and having a portion of those ancillaries come back to you -- have to be watchful that you're using them as medically appropriate -- i.e. would you really have changed your management with that peak flow/spirometry or did you get it just because it was available) or lower acuity with high volume.

most physicians I know of generally see 20-25/day and bring home around $250-300K/year in FM; to be honest, once you start seeing patients as $$, you probably should retire or take a long sabbatical to rethink what you're doing....
 
JustPlainBill said:
To pile on-- also depends on how your contract is negotiated if you go with private practice employment --- This can be wildly variable --

In private practice, I know of a local suburban physician in a major burb in Dallas who sees patients Q10min, is well established, worked 7 to 1 or 2, refuses to use EMR, has one front desk and one RN who has worked with him for about 5 years --- according to him, he's making between $300-$500K/year. It can be done but it's a combination of factors -- either lower numbers with higher acuity/use of ancillaries (and having a portion of those ancillaries come back to you -- have to be watchful that you're using them as medically appropriate -- i.e. would you really have changed your management with that peak flow/spirometry or did you get it just because it was available) or lower acuity with high volume.

most physicians I know of generally see 20-25/day and bring home around $250-300K/year in FM; to be honest, once you start seeing patients as $$, you probably should retire or take a long sabbatical to rethink what you're doing....
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Its a fine line for most of us. You shouldn't see patients purely as income, but you can't ignore that either.

If money doesn't matter, why don't you just bill all your visits as level 2? It would save the patient and their insurance company money, and since you don't see patients as $$ why would it matter to you?

Why not also only see 8 patients/day with hour-long appointments? Sure, most patients don't need that much time but I'm sure you have some that would love to have that much time. It would also cut down your wait times drastically.

Snark aside, I think the vast majority of us do what they think is right without actively trying to do things that border on greed. That's why I do like the idea of separating out as much ancillary revenue as you can. If I earn $10 for every BMP I order, then that temptation is going to always be there - I like to think it wouldn't change how I practice, but its a risk. If I earn nothing for it, I can guarantee 100% that I will only order it if I think its needed.
 
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VA Hopeful Dr said:
Its a fine line for most of us. You shouldn't see patients purely as income, but you can't ignore that either.

If money doesn't matter, why don't you just bill all your visits as level 2? It would save the patient and their insurance company money, and since you don't see patients as $$ why would it matter to you?

Why not also only see 8 patients/day with hour-long appointments? Sure, most patients don't need that much time but I'm sure you have some that would love to have that much time. It would also cut down your wait times drastically.

Snark aside, I think the vast majority of us do what they think is right without actively trying to do things that border on greed. That's why I do like the idea of separating out as much ancillary revenue as you can. If I earn $10 for every BMP I order, then that temptation is going to always be there - I like to think it wouldn't change how I practice, but its a risk. If I earn nothing for it, I can guarantee 100% that I will only order it if I think its needed.
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Right -- I've run into a few that reminded me of used car salesmen and continually mention all the ancillaries available and always caveat with,"While we wouldn't want to do anything inappropriate, this helps with better patient care" --- sure it does --- but I always think -- perhaps incorrectly -- that medicine got along just fine without all of the ancillaries and people were pretty well taken care of by docs who used their brains, hands and stethoscope, thank you very much.....but that's me ---

Yes, I would dearly love to get back to the day of charging $25 a visit, see people who didn't run to the doctor they minute they got a sniffle, be trained well enough to set bones, cast things up, do hospital rounds and go old school -- the glory days of medicine --- but it ain't gonna happen --

As you said, it's a fine line -- do you treat the patient for what they came in for and regularly schedule physicals, etc. or do you see them as an opportunity --- either way, you still have to be able to look at yourself in the mirror.....
 
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JustPlainBill said:
As you said, it's a fine line -- do you treat the patient for what they came in for and regularly schedule physicals, etc. or do you see them as an opportunity --- either way, you still have to be able to look at yourself in the mirror.....
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That's the metric I use as well
 
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VA Hopeful Dr said:
Its a fine line for most of us. You shouldn't see patients purely as income, but you can't ignore that either.

If money doesn't matter, why don't you just bill all your visits as level 2? It would save the patient and their insurance company money, and since you don't see patients as $$ why would it matter to you?

Why not also only see 8 patients/day with hour-long appointments? Sure, most patients don't need that much time but I'm sure you have some that would love to have that much time. It would also cut down your wait times drastically.

Snark aside, I think the vast majority of us do what they think is right without actively trying to do things that border on greed. That's why I do like the idea of separating out as much ancillary revenue as you can. If I earn $10 for every BMP I order, then that temptation is going to always be there - I like to think it wouldn't change how I practice, but its a risk. If I earn nothing for it, I can guarantee 100% that I will only order it if I think its needed.
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I don't get why people want extra long doctors visits, when I go to the doctor I want to be in and out as soon as possible.
 
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VA Hopeful Dr said:
Because obviously everyone thinks exactly as you do about doctor visits...
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Exactly. I want to be in and out because right now I'm healthy and likely there for strep throat. My mom wants more time to get an understanding of my dad's problems so she can try to keep that stubborn dude alive longer.

Both of us want the option either way
 
sb247 said:
Exactly. I want to be in and out because right now I'm healthy and likely there for strep throat. My mom wants more time to get an understanding of my dad's problems so she can try to keep that stubborn dude alive longer.

Both of us want the option either way
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Too bad we can't let patient's decide how much time they can have with us.. I wonder how that would work out.. haha
 
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JustPlainBill said:
Right -- I've run into a few that reminded me of used car salesmen and continually mention all the ancillaries available and always caveat with,"While we wouldn't want to do anything inappropriate, this helps with better patient care" --- sure it does --- but I always think -- perhaps incorrectly -- that medicine got along just fine without all of the ancillaries and people were pretty well taken care of by docs who used their brains, hands and stethoscope, thank you very much.....but that's me ---

Yes, I would dearly love to get back to the day of charging $25 a visit, see people who didn't run to the doctor they minute they got a sniffle, be trained well enough to set bones, cast things up, do hospital rounds and go old school -- the glory days of medicine --- but it ain't gonna happen --

As you said, it's a fine line -- do you treat the patient for what they came in for and regularly schedule physicals, etc. or do you see them as an opportunity --- either way, you still have to be able to look at yourself in the mirror.....
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There was a survey done a few years ago (not by ancillary care company, but I forget who) that showed patients want us to ask them about services we offer. For example: if you offer a weight loss service they want to be asked and given options etc. Ancillary isn't a bad word. It doesn't mean you are going to offer services they don't need. People are capable of deciding that for themselves. If you offer a cosmetic treatment and don't ask the patient may never bring it up because they may fee insecure. But the minute you bring it up they will want to talk about it. It's like screening for anything else like depression or anxiety.

But if you want to go back to the day in the past like you described, that's ok as well. There is room for everyone to practice the way they want. As long as you offer a service that has value and the patient sees the value then you are ok.
 
Ericslv said:
There was a survey done a few years ago (not by ancillary care company, but I forget who) that showed patients want us to ask them about services we offer. For example: if you offer a weight loss service they want to be asked and given options etc. Ancillary isn't a bad word. It doesn't mean you are going to offer services they don't need. People are capable of deciding that for themselves. If you offer a cosmetic treatment and don't ask the patient may never bring it up because they may fee insecure. But the minute you bring it up they will want to talk about it. It's like screening for anything else like depression or anxiety.

But if you want to go back to the day in the past like you described, that's ok as well. There is room for everyone to practice the way they want. As long as you offer a service that has value and the patient sees the value then you are ok.
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I see your point -- what I'm referring to are things like -- patient presents for a cough -- let's get a peak flow, depending on length let's get a CXR, if fever/pharyngitis -- swab flu/strep -- c/o ears feeling clogged -- tympanometry -- provide steroids/rocephin/cough syrup with codeine -- if BP elevated, let's adjust HTN meds, be sure they're labbed up to date -- let's get an ABI if also diabetic dx in the chart --- and if we can, let's schedule a physical -- i.e. look to pack as much into one visit as possible while utilizing all available ancillaries -- all in the same visit.

Rather than -- present for a cough -- ok, good hpi, ROS, vitals, physical -- been going on for a week, afebrile, CTAB -- ok, supportive care, discuss steroids and possible abx if no improvement in 3-4 days.
 
As long as the test is justifiable based on the particular situation, I don't see the problem. Stark laws prevent ancillaries from providing any direct remuneration to ordering physicians, and we essentially break even on our CLIA-waived (in office) tests.
 
Blue Dog said:
As long as the test is justifiable based on the particular situation, I don't see the problem. Stark laws prevent ancillaries from providing any direct remuneration to ordering physicians, and we essentially break even on our CLIA-waived (in office) tests.
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But if you own the practice and that CBC machine earns more than it costs...
 
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JustPlainBill said:
I see your point -- what I'm referring to are things like -- patient presents for a cough -- let's get a peak flow, depending on length let's get a CXR, if fever/pharyngitis -- swab flu/strep -- c/o ears feeling clogged -- tympanometry -- provide steroids/rocephin/cough syrup with codeine -- if BP elevated, let's adjust HTN meds, be sure they're labbed up to date -- let's get an ABI if also diabetic dx in the chart --- and if we can, let's schedule a physical -- i.e. look to pack as much into one visit as possible while utilizing all available ancillaries -- all in the same visit.

Rather than -- present for a cough -- ok, good hpi, ROS, vitals, physical -- been going on for a week, afebrile, CTAB -- ok, supportive care, discuss steroids and possible abx if no improvement in 3-4 days.
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Yeah, I agree.
 
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