AtlasMD on hannity show right now

[deleted480308]

Discussing health care solutions

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[deleted480308]

Segment is over, good work doc

 

[F1rstGen]

Hope someone can post a video link to the segment.

 

[VA Hopeful Dr]

Hope someone can post a video link to the segment.

This was one a few weeks back from his TV show:

 

[Ericslv]

This was one a few weeks back from his TV show:

do you set bones in your office

 

[F1rstGen]

This was one a few weeks back from his TV show:

Thanks for the link. I'm glad DPC is getting some national attention and it looks like future legal changes/healthcare policy reform will be friendly toward the DPC model.

Now if we can just get someone to interview Atlas that won't talk over him and let him have longer than a few seconds of air time.

 

[W19]

Most people would think it's propaganda because it's on Hannity show. People would give it more credence if it were on Shepard Smith's show.

 

[VA Hopeful Dr]

do you set bones in your office

I do not, but I know DPC docs who do.

 

[VA Hopeful Dr]

Thanks for the link. I'm glad DPC is getting some national attention and it looks like future legal changes/healthcare policy reform will be friendly toward the DPC model.

Now if we can just get someone to interview Atlas that won't talk over him and let him have longer than a few seconds of air time.

Hannity's podcasts go into more depth since its not limited to 3 minutes of air time.

 

[VA Hopeful Dr]

Most people would think it's propaganda because it's on Hannity show. People would give it more credence if it were on Shepard Smith's show.

Yeah we've actually talked about that, there's been some good luck going straight to democratic Congressmen. Its slower going, but they get a more comprehensive view of it.

 

[Ericslv]

I do not, but I know DPC docs who do.

What do you offer procedural wise in your office?

 

[VA Hopeful Dr]

What do you offer procedural wise in your office?

The usual things that 99% of family doctors do - sutures, skin biopsies, lesion removal, joint/soft tissue injections, IUD placement, stuff like that. I'd do colposcopy if it weren't pretty rare to need these days (and colposcopes pretty expensive).

 

[Ericslv]

The usual things that 99% of family doctors do - sutures, skin biopsies, lesion removal, joint/soft tissue injections, IUD placement, stuff like that. I'd do colposcopy if it weren't pretty rare to need these days (and colposcopes pretty expensive).

The reason I ask is because I see some DPC offices doing fracture care, casting, x ray etc in office. I think it would be difficult to run a clinic like that on a single DPC physician. If I did a DPC it would like yours. Straight forward bread and butter. Although I would favor more of a concierge model. Perhaps something in between DPC and Concierge.

 

[VA Hopeful Dr]

The reason I ask is because I see some DPC offices doing fracture care, casting, x ray etc in office. I think it would be difficult to run a clinic like that on a single DPC physician. If I did a DPC it would like yours. Straight forward bread and butter. Although I would favor more of a concierge model. Perhaps something in between DPC and Concierge.

It depends on the training of the physician more than anything. I've placed exactly 2 casts in the 7 years I've been a doctor, so I have no business doing it when there is ortho literally next door. I'm decent at some ultrasound procedures (AAA Screening, early OB, that sort of thing) and if ultrasound machines ever get cheap enough, you'd better believe I'm buying one and probably taking more courses so I can do more with it.

My first partner out of residency did 14 years in rural Washington State. He was quite good at fracture care so he offered casting in that office. The patients loved not having to go to a second doctor (ortho) to do it.

There's not really a defined line between DPC and Concierge, assuming you do the insurance-free form of the latter. Its just a balancing act of price people are willing to pay, money you want to make, and services you want to offer. The more you offer inclusive, the more you can charge (obviously), and usually the more you can make. You can also just plain charge more, but the more you do that the smaller your potential patient pool is. For example: there is one hospital system in town whose FPs cash rate for an office visit is $90. If my monthly rate is above that, I will lose decent numbers of patients.

 

[Carouselambra]

There's not really a defined line between DPC and Concierge, assuming you do the insurance-free form of the latter. Its just a balancing act of price people are willing to pay, money you want to make, and services you want to offer. The more you offer inclusive, the more you can charge (obviously), and usually the more you can make. You can also just plain charge more, but the more you do that the smaller your potential patient pool is. For example: there is one hospital system in town whose FPs cash rate for an office visit is $90. If my monthly rate is above that, I will lose decent numbers of patients.

I always wondered what the difference between concierge and DPC was myself. To me it's just money. I finally got around to asking one of the concierge docs how many patients they have in their practice. There's three former pulm/crit care doctors and they have about 900 patients total. One of their patients actually told me how much they pay a year. 7500. They also take care of them in the hospital and usually round on their hospitalized and SNF patients twice a day (morning and afternoon) but no guarantee on the 2x. Outside services, labs, xrays, and specialists ordered but provided by others will still be billed to insurance or medicare. I'm no expert on how doctors get paid but I assume they're making money seeing them in the hospital as well. I'm surprised however that they have a really big staff. A manager, 3 RNs, 3 medical assistants, and like 5 patient relations/receptionists. But with that yearly fee they're still netting an obscene amount of money. I'm not sure what their setup is but it seems that one of them has always just gotten back from a vacation and the other 1 or 2 on will cover / take call on the weekend.

 

[deleted87716]

One of their patients actually told me how much they pay a year. 7500.

Wonder no more, unless you're bad at math.

 

[smq123]

Wonder no more, unless you're bad at math.

That would have paid for 2 years of med school for me....

But then again, a physician on a Facebook Physician Mom Group just posted that she is deliberating sending her children to a daycare that costs $28K per child, for 1 year. 28,000! For daycare! A year of college cost less than that!

 

[Carouselambra]

Wonder no more, unless you're bad at math.

The thing is the two docs that I usually see are phenomenal. I would take them over any one of our hospitalists or anyone else I've seen. But I think it's just because they have so much more time with the patients. They're usually in the room for at least 20-30 minutes either thoroughly discussing the plan of care or more often shooting the breeze with them. I guess time and money are great motivators..

 

[VA Hopeful Dr]

The thing is the two docs that I usually see are phenomenal. I would take them over any one of our hospitalists or anyone else I've seen. But I think it's just because they have so much more time with the patients. They're usually in the room for at least 20-30 minutes either thoroughly discussing the plan of care or more often shooting the breeze with them. I guess time and money are great motivators..

Bingo. I don't assume I'm any better a doctor than your average FP, but I have more time to address more problems and be more thorough doing it. Not everything needs that of course, but its nice to have when its an issue.

Plus, the 2 biggest complaints patients have these days is too long in the waiting room and not enough time with the doctor. I don't have that problem.

 

[VA Hopeful Dr]

Wonder no more, unless you're bad at math.

No kidding. My most expensive patients pay me $960/year. Granted I don't round in the hospital at all, but I know DPC docs who do and they certainly don't charge that much.

 

[Ericslv]

Bingo. I don't assume I'm any better a doctor than your average FP, but I have more time to address more problems and be more thorough doing it. Not everything needs that of course, but its nice to have when its an issue.

Plus, the 2 biggest complaints patients have these days is too long in the waiting room and not enough time with the doctor. I don't have that problem.

Sounds like you need to charge more.

 

[VA Hopeful Dr]

Sounds like you need to charge more.

Nah. When I hit capacity I'll be grossing around 220k. No need to get greedy, plus charging more will lose patients.

 

[Ericslv]

Nah. When I hit capacity I'll be grossing around 220k. No need to get greedy, plus charging more will lose patients.

I prefer the concierge model. The way I see it if I charge 60 -70 bucks per month and offer unlimited visits etc. I will be providing personalized services. Returning calls right away, seeing the patient within 24 hrs or same day etc.

So if I'm going to provide concierge level care I want to get paid concierge level pay. It takes longer to build that type of practice. But then I'm from the camp that says don't marginalize your skills, expertise and services. You earned them. Lawyers don't, engineers don't, marketing people dont' for sure and in my opinion neither should doctors.

 

[FamilymedMD]

It depends where you live and what you want out of your business.
I live in a town with plenty of wealthy retirees and could probably be full by now and doing very well at 200-300 patients total with a more concierge style model.
Instead, I went with a lower than average pricing model and my panel of 500 (with a goal of 600) is mainly blue collar workers, esp. lobstermen, with chronic illnesses.
I'm happy either way but my current model could work in almost every town in Maine and elsewhere, hopefully encouraging more docs to do this.

 

[Yadster101]

Nah. When I hit capacity I'll be grossing around 220k. No need to get greedy, plus charging more will lose patients.

Would you mind telling us approximately what you are grossing now and how many years it took to get there? If an FM doc were to open up a DPC tomorrow would they make enough money to pay their bills and put food on the table for the first year?

 

[VA Hopeful Dr]

Would you mind telling us approximately what you are grossing now and how many years it took to get there? If an FM doc were to open up a DPC tomorrow would they make enough money to pay their bills and put food on the table for the first year?

Highly variable depending on overhead, marketing, and local market.

I'm at 5k/month currently. It would be more but my office space is pretty pricey - 5200/month compared to others sitting closer to 1500/month or so. I will have been open 2 years in June.

My break even point was around 300 patients. Other docs I know broke even at more like 80-100 so they would pay themselves earlier than I did.

It would be pretty easy to just from scratch you'd just want to moonlight to make ends meet while the practice was getting going.

 

[Ericslv]

Why not 250 x 1800 = 450000 - about 180000 overhead (if that) = 270000

Average patients per day perhaps 4 to 6.

 

[SpaceLeftBlank]

don't marginalize your skills, expertise and services. .... Lawyers don't, ... and in my opinion neither should doctors.

Haha, that's pretty funny. Actually lawyers routinely do, but I think it's because there's too many damn lawyers (source: have been a damn lawyer for almost 14 years) and they feel the (real or perceived) need to lowball "the competition." Also, it frequently surprises physicians when I tell them that their malpractice insurance companies, who retain us to represent y'all when the need arises, pull the same kind of crap on us compensation-wise that health insurers pull on you.

But I'm also in your "your skills are worth it, charge for it" camp, and physicians frequently have the supply/demand thing on their side, so if you can provide concierge service and command the concierge fees, why not?




Sent from my iPhone using SDN mobile

 

[Atlas Shrugged]

I prefer the concierge model. The way I see it if I charge 60 -70 bucks per month and offer unlimited visits etc. I will be providing personalized services. Returning calls right away, seeing the patient within 24 hrs or same day etc.

So if I'm going to provide concierge level care I want to get paid concierge level pay. It takes longer to build that type of practice. But then I'm from the camp that says don't marginalize your skills, expertise and services. You earned them. Lawyers don't, engineers don't, marketing people dont' for sure and in my opinion neither should doctors.

Lowly beginning MS4 in the army, but this seems to be the way to go. In the future, I'll probably practice DPC or concierge with 2-4 weeks/year of volunteering for indigent local or global populations. You can make money in primary care and still provide some selfless care.

 

[Yadster101]

Highly variable depending on overhead, marketing, and local market.

I'm at 5k/month currently. It would be more but my office space is pretty pricey - 5200/month compared to others sitting closer to 1500/month or so. I will have been open 2 years in June.

My break even point was around 300 patients. Other docs I know broke even at more like 80-100 so they would pay themselves earlier than I did.

It would be pretty easy to just from scratch you'd just want to moonlight to make ends meet while the practice was getting going.

Feel free to correct me. Are you saying you are currently bringing in ~10200/month and then 5200 goes to total overhead (or just rent)? If you are taking home 5k/month then you're making 60k/yr? I assume thats at around 40hrs/wk?

 

[VA Hopeful Dr]

Feel free to correct me. Are you saying you are currently bringing in ~10200/month and then 5200 goes to total overhead (or just rent)? If you are taking home 5k/month then you're making 60k/yr? I assume thats at around 40hrs/wk?

No, I'm bringing in much more as I have expenses besides just rent and my pay. I'll elaborate later.

 

[Ericslv]

Lowly beginning MS4 in the army, but this seems to be the way to go. In the future, I'll probably practice DPC or concierge with 2-4 weeks/year of volunteering for indigent local or global populations. You can make money in primary care and still provide some selfless care.

Right out of residency that will be hard to do. You either hare to moonlight for the next 5 years or buy a practice that is viable for this type of model or work for several years to build a regular practice and then convert OR be in a group that you become a partner in and then convince them so go concierge.

I've seen a couple employment ads for this type of practice over the past couple of years. That may become more available.

Since you are an MS4 you can even choose to not go into primary care if you have the scores and avoid the pain.

 

[Atlas Shrugged]

As I said, I will be in the army for at least 14 years. No DPC right after residency.

 

[FamilymedMD]

As I said, I will be in the army for at least 14 years. No DPC right after residency.

Send us all your HPSP colleagues when they get done with their 3-4 year commitment. We'll have DPC everywhere by the time you get out (and I retire).

 

[VA Hopeful Dr]

Feel free to correct me. Are you saying you are currently bringing in ~10200/month and then 5200 goes to total overhead (or just rent)? If you are taking home 5k/month then you're making 60k/yr? I assume thats at around 40hrs/wk?

So as I look over my books for March, it is something like this:

Rent: 5200
EMR: 350
Wages for my MA: 2200
Internet: 200
Advertising: 1900
Practice Loans: 1400
Malpractice: 200
Website: 40
E-Faxing: 40
Tech Support: 600

So total fixed expenses run around 12k. I add in another 2k/month just for random expenses so up to 14k. In March I brought in 20k in subscription fees, so 6K profit for the office. I paid myself 5K because its never wise to spend all the profit you bring in every month.

Since November, my profit has been increasing right at 1k/month. So January I paid myself 3k, February 4k, March 5k, you get the idea.

The office is open 40 hours, but I'll be honest I'm not here every one of those hours. If no one is scheduled after 3pm, I'll usually leave around 330 or 4 and go home. If I wake up and no one is scheduled until 10am, I'll stay home longer. If I have a big break at lunch, I'll treat myself to lunch somewhere. I just got back from skipping out to take my girls to the pediatrician. You get the idea.

 

[Ericslv]

So as I look over my books for March, it is something like this:

Rent: 5200
EMR: 350
Wages for my MA: 2200
Internet: 200
Advertising: 1900
Practice Loans: 1400
Malpractice: 200
Website: 40
E-Faxing: 40
Tech Support: 600

So total fixed expenses run around 12k. I add in another 2k/month just for random expenses so up to 14k. In March I brought in 20k in subscription fees, so 6K profit for the office. I paid myself 5K because its never wise to spend all the profit you bring in every month.

Since November, my profit has been increasing right at 1k/month. So January I paid myself 3k, February 4k, March 5k, you get the idea.

The office is open 40 hours, but I'll be honest I'm not here every one of those hours. If no one is scheduled after 3pm, I'll usually leave around 330 or 4 and go home. If I wake up and no one is scheduled until 10am, I'll stay home longer. If I have a big break at lunch, I'll treat myself to lunch somewhere. I just got back from skipping out to take my girls to the pediatrician. You get the idea.

Why is your rent so high? 5500 ouch.

 

[Yadster101]

So as I look over my books for March, it is something like this:

Rent: 5200
EMR: 350
Wages for my MA: 2200
Internet: 200
Advertising: 1900
Practice Loans: 1400
Malpractice: 200
Website: 40
E-Faxing: 40
Tech Support: 600

So total fixed expenses run around 12k. I add in another 2k/month just for random expenses so up to 14k. In March I brought in 20k in subscription fees, so 6K profit for the office. I paid myself 5K because its never wise to spend all the profit you bring in every month.

Since November, my profit has been increasing right at 1k/month. So January I paid myself 3k, February 4k, March 5k, you get the idea.

The office is open 40 hours, but I'll be honest I'm not here every one of those hours. If no one is scheduled after 3pm, I'll usually leave around 330 or 4 and go home. If I wake up and no one is scheduled until 10am, I'll stay home longer. If I have a big break at lunch, I'll treat myself to lunch somewhere. I just got back from skipping out to take my girls to the pediatrician. You get the idea.

Wait so you're income, after two years, is ~5k/month = 60k/year? Am I missing something? Doesn't the typical FM doc make ~150-200k?

 

[VA Hopeful Dr]

Wait so you're income, after two years, is ~5k/month = 60k/year? Am I missing something? Doesn't the typical FM doc make ~150-200k?

It's what happens when you start your own practice from scratch

 

[VA Hopeful Dr]

Why is your rent so high? 5500 ouch.

Yeah, way more space than I need in a medical office building. But, they cover all utilities, cleaning, security, landscaping, only thing I pay for is internet and phone. Plus good for expansion.

 

[Yadster101]

It's what happens when you start your own practice from scratch

Well then its nice to see that you are able to start such a practice...but would you say this is a viable option for the typical student that is graduating med school now? I know many students that will have 300k+ in debt from school. Many of us will be paying 30k/yr x 10 years for debt alone. I thought DPCs were a good alternative to working for a hospital/established practice. Do you agree that this is something the typical grad with significant debt cannot do?

 

[deleted480308]

Well then its nice to see that you are able to start such a practice...but would you say this is a viable option for the typical student that is graduating med school now? I know many students that will have 300k+ in debt from school. Many of us will be paying 30k/yr x 10 years for debt alone. I thought DPCs were a good alternative to working for a hospital/established practice. Do you agree that this is something the typical grad with significant debt cannot do?

on IBR if you have no income you actually have no payments....
as for getting started, if I was to start cold out of residency I would moonlight a shift per week in an EM somewhere and do my starting visits as housecalls/office calls or in my home. If you "open" with 25 patients you certainly can pull that off. All other hours of the day not with patients would be spent recruiting patients, treat building a business as your day job.

 

[Yadster101]

on IBR if you have no income you actually have no payments....
as for getting started, if I was to start cold out of residency I would moonlight a shift per week in an EM somewhere and do my starting visits as housecalls/office calls or in my home. If you "open" with 25 patients you certainly can pull that off. All other hours of the day not with patients would be spent recruiting patients, treat building a business as your day job.

How much would moonlighting add to salary? Like 30k? The thing is we already delay our gratification by so much. I couldn't see many recent grads being happy moonlighting and building a practice to make 60-90k. Also if it takes two years to make 60k/yr then its almost financially irresponsible for someone, with 200k+ debt, to take that job over making ~175k. Even if that salary doubles to 120k by year 4, ppl would be missing out on 300k+ that they could have made at a regular job.

 

[deleted87716]

Starting a DPC practice from scratch is no different from starting any other kind of business. Your startup costs will need to be borne either by yourself, or somebody else, and you can expect your income to start out low (or nonexistent) and gradually build up over time. How that affects student loan repayment, etc. will depend on your financial situation. In many cases, it simply won't be feasible.

If you're transitioning an existing practice from an insurance-based model to DPC, you may have the advantage of a faster patient acquisition phase, and a shorter loss-to-income period. There are lots of variables, however, and there is still risk involved.

 

[deleted480308]

How much would moonlighting add to salary? Like 30k? The thing is we already delay our gratification by so much. I couldn't see many recent grads being happy moonlighting and building a practice to make 60-90k. Also if it takes two years to make 60k/yr then its almost financially irresponsible for someone, with 200k+ debt, to take that job over making ~175k. Even if that salary doubles to 120k by year 4, ppl would be missing out on 300k+ that they could have made at a regular job.

First, I'd propose that you can absolutely make more money faster in "take home". VA has a real "full scale" expense from the beginning, but @2ys is bringing in 20k/month. That's a lot of money for a new business. And if pocket money was all that mattered, they could have more pocket money.

Second, and this is hard to get across, having your own thing where you control everything is a valuable commodity to some folks that is hard to quantify in dollars. I watch DPC docs talk about how excited they are to provide care the way they do and it's unrecognizable from how docs in a normal insurance based "turn and burn" model talk. It's just a different universe. But you have to build that universe if you want to own all the money when the office is bringing in 400k.

 

[Yadster101]

First, I'd propose that you can absolutely make more money faster in "take home". VA has a real "full scale" expense from the beginning, but @2ys is bringing in 20k/month. That's a lot of money for a new business. And if pocket money was all that mattered, they could have more pocket money.

Second, and this is hard to get across, having your own thing where you control everything is a valuable commodity to some folks that is hard to quantify in dollars. I watch DPC docs talk about how excited they are to provide care the way they do and it's unrecognizable from how docs in a normal insurance based "turn and burn" model talk. It's just a different universe. But you have to build that universe if you want to own all the money when the office is bringing in 400k.

I'm not saying those are bad points. I'm sure many of these DPC docs are very satisfied. I'm just saying that if these are the typical numbers then I think a majority of the students I know would not go into DPC.

 

[VA Hopeful Dr]

I'm not saying those are bad points. I'm sure many of these DPC docs are very satisfied. I'm just saying that if these are the typical numbers then I think a majority of the students I know would not go into DPC.

That's true, but a majority of practicing docs aren't doing it yet either.

For new grads there are essentially two paths to take. Lots of us are actively hiring, so you'd come in to an established practice often with a salary. Or, start lean and moonlight a lot. I know a fair number of new grads doing both. In the latter case, they do take an income hit, but to them it's worth it.

 

[VA Hopeful Dr]

How much would moonlighting add to salary? Like 30k? The thing is we already delay our gratification by so much. I couldn't see many recent grads being happy moonlighting and building a practice to make 60-90k. Also if it takes two years to make 60k/yr then its almost financially irresponsible for someone, with 200k+ debt, to take that job over making ~175k. Even if that salary doubles to 120k by year 4, ppl would be missing out on 300k+ that they could have made at a regular job.

My fixed costs are higher than most. My break even point was around 300 patients. Most folks run leaner and their break even is around 100-150 patients.

I did some urgent care moonlighting, running 100/he so you can do the math on that.