how can a family doc make it anymore?

[Atlas]

Let's say a starting family doc earns $120,000/yr. Let's also say that roughly half goes to taxes - $60,000/yr. With the remaining $60,000/yr, how is a doctor supposed to pay off nearly $200,000 in loans, malpractice insurance, and still afford to live? Granted, my estimates are approximations. I realize that taxes may or may not consume 50% of you income. So what's a family doc to do about this?

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[ckent]

If you are paying 50% in taxes with an income of 120,000, you do not have a very competetent accountant so your first step would be to fire the one that you have and hire a new one. Fortunately, the 120,000 avg income is after expenses (including malpractice insurance). So, if you pay ~40,000 in taxes, you will still have 80,000. So you won't live in a nice house the first few years of practice, but eventually, you will pay your principal down if you live frugally and don't start a family right away. The best solution would be to marry wealthy of course. Tell your future wealthy spouse that you are loaded since you are a "rich doctor" so there's no need for that prenuptial. Then you can show her your debt after the wedding day. That's my plan anyways.

 

[seattledoc]

One of the docs that graduated from my residency had a similar debt load ~200K. After graduation, he bought a house, nice but not outrageous, in the 'burbs. He went from a residency salary to a fulltime FP salary. His loans and house payment kicked in. After paying those each month he had approximately the same amout leftover as he had while in residency. Very depressing

 

[Atlas]

ckent- that's pretty sick and twisted...I like it!

 

[Atlas]

by the time I'm in practice making that kind of cash, taxes may have gone up too! I may have to pay 60k per year in taxes...then what?!! I guess I have a hard time seeing the benefit of going into family practice with as much bull**** as there is in society...raising taxes, larger and larger educational debt, etc. It doesn't add up to a comfortable life, which is what I'm striving to achieve.

 

[dr_almondjoy_do]

There are many ways to make money with the extra two hours a week you have off, like:

Real Estate (McDonald's can make you income double fold - by owning in it and treating the patrons for the slop they just ate)

Tax Evasion: Who's gonna notice one Dr. not paying taxes?

Expert Witness: As a doctor, you can testify against your peers for cash

Babysitting: Oh, I mean working overtime at the office....

Man, I was joking at first, but some of these points may seem doable!

 

[Anka]

Maybe this is a naive question, but why not take HEAL grants or something that require a service commitment? I think the service commitment is 4 years for 4 years of med school tuition free + stipend... and the service required is family practice, peds, etc. (primary care, residency less than two years).

I haven't researched the program too closely, but my impression was it was a good option for people who want to go primary care.

 

[stoic]

Two words. Elvis Doctor.

Just kidding. I plan on staying in rural Kansas where 80k a year is still quite a bit of money.

 

[grouptherapy]

Expect 25% of your check to go to income tax if you're single. Expect to pay a grand or more per month for your loans. Many docs pay off their debt in 10 years or so. You won't be rich, but you'll live comfortably.

 

[Paws]

I think there are savvy ways of working with your income to try and preserve as much as you can; by that I don't mean anything shady, but if you don't yourself know alot about personal finance (I love finance !) then a good accountant would be able to help out.

I would be very happy to pay 25% in taxes; right now in NYC I lose about 35% of my paycheck to taxes and whatnot. Mostly taxes ...

But a family practitioner would be able to deduct alot of expenses for the office, and then their is one's retirement account which allows I think up to $12,000 pretax (maybe more now ...) to be deducted (15% of your income up to the 12,000) so that would definitely lower your overall tax bite. Then there are other deductions like the student loan interest, mortgage interest, state taxes, children, IRA contributions and there you are looking at some pretty decent deductions ...

Not to mention you are saving for your retirement at the same time

 

[Atlas]

Paws,

Interesting analysis, but even after all the tax breaks and everything...taxes still come out of your check every 2 weeks, you'll probably have to pay taxes at years' end, plus your loans, plus kids if you have them, etc. Like you said, you'll get tax breaks from them, but I don't think they would be great enough to make things work that much smoother. I mean, we're dealing with the government here. There won't be hardly any room to enjoy the money you make.

 

[DrQuinn]

Don't forget that there are a lot of other ways to earn cash as a physician. You can be an expert witness (although FPs aren't as hot a commodity as most other specialties) for the defense in malpractice cases (you could help the plaintiff's side but why would you do that?).

Also, pharm companies offer lots of honorariums (mostly cash, sometimes gift certificates) for attendance at a program or lecture.

Sometimes you can be the lecturer at a drug rep company (although a lot of time these are done by specialists, not FPs).

Q, DO

 

[s42brown]

I think the joke is that a FP only makes a $120,000 a year. My doc back home makes over five times that. get off the low six figures band wagon.

 

[USIMGgrad]

Or you could have your rich uncle payoff your loans for you. hahahahahahahahahahahaha!

 

[USIMGgrad]

I only pay 20% income tax in NY and NJ because I have 2 kids and my wife hasn't started work yet. Thank God for my kids, I get to pay lesss taxes.

 

[BellKicker]

Originally posted by USIMGgrad
I only pay 20% income tax in NY and NJ because I have 2 kids and my wife hasn't started work yet. Thank God for my kids, I get to pay lesss taxes.

USIMGgrad, you're right. I'm in the same situation as you with two kids and a wife in school. I just thank my lucky stars we're not one of those DINK families (Double Income No Kids). I just don't know how we'd make ends meet.

Hey, good luck on the CSA by the way.

 

[oldandtired]

Do not go into FP.

 

[HappyFP]

Listen folks, nobody pays 50% tax rates, especially those with huge student loans. Buy a house first, take out a 2nd home equity loan and pay off your student loan with the home equity loan. If you buy your house in California--pooof, your house value will jump $200,000 in a few years and away goes your problem. That's pretty much what happened to me.
Don't get overly fixated on your income...even though having $200,000 of debt must seem crazy and scary to you. Carrying debt is not shameful or really as cumbersome a problem as most people think--particularly when home loans are going at 6% right now...that is CHEAP MONEY. The home loan rates were 10% when I graduated--youch.
The Rockefellers made their billions not by "earning great incomes" by by borrowing their shorts off and going into huge amounts of debt.
Debt is not your enemy.
Choosing your career based on how much money you will make is your enemy...just my opinion.
HappyFP

 

[bustbones26]

If there is an FP out there that cannot survivie on 120K per year then that mean a few things.

1) he/she is a crappy business manager
2) He/she joined a group that is crappy
3) He/She has a rich ex-spouse

I know there are some fields out there paying big $$ but how can a person making 120K starve?

You know, I am sick of hearing doctors, in general, all specialties complaining they can't make ends meet while they live in 800K homes and drive one or two cars that cost 50K.

Point is, be smart with your money !! A guy I know that just finished his PGY3 year as FP, got a spot with a group practice, and already set his plans to buy a big expensive car. Yet, I know another guy that is a general internist, does primary care just like an FP, but he drives an average car, rents his cheap townhouse, and do you know what? He is ready to retire young, and he just barely barely makes 120K per year!!

Now there are numerous things you can do to bolster your FP practice.

1) Women's health, FP is the best qualified next to an OB/GYN, and you know what, many women think that OB/GYN's are rough and prefer to go to their FP for gyn care

2) How about moonlighting in the ER. Okay, so you can't work at a level one trauma center, but just about any small community hospital will take an FP on their service.

3) If you're a DO, promote your OMT skills, do sports medicine on the side!!!

4) offer procedures that FP's can get reimbursed for like flex sigs, colposcopies, minor derm procedures,etc.

5) Contract your services!! Many institiutions are happy to have FP's do services, prisons, public schools, etc.

So if you go into FP you're not going to make 300-500K like an invasive radiologist does. Guess it would be a damn shame if you became a doctor and couldn't live ian a big fancy house and drive fancy cars. But then again, I suppose that is the real reason why you all wanted to be a doctor anyways.

By the way, disclaimer: I do not intend on going into FP, I an just defending them because I am sick of people going into specialties just for the money. Well if that makes you all happy, then I suppose you should all be radiologist. Good luck getting a residency since every greedy student will be competing with you.

 

[dj_smooth]

Originally posted by bustbones26
If there is an FP out there that cannot survivie on 120K per year then that mean a few things.

What about the 250k+ FPs we keep hearing about by posters on this forum? I can only imagine they are working crazy hours and seeing beacoup patients. However, I have seen on the internet many places offering $150K+ for those willing to go to IA, KS, IL, etc. and work in rural areas. Maybe FPs can make that kind of cash.

 

[seattledoc]

yes, if you're making $250k, you are working 5 days per week, doing OB most likely, and seeing high volume. But from my perspective, you can make $175-200k per year working 4 days per week, no OB, seeing 25+ patients per day. And this is in a seattle suburb, so not in rural Oklahoma or something.

 

[phd2b]

For those who are D.O.'s, I agree that doing OMT is a very very good idea. From my understanding, you can bill for the office visit AND for OMT treatment (if necessary). That's $70+ per patient more (you have to tell the patients that they have to pay cash for the OMT if their insurance won't cover it, however). Let's say you do 10 patients per day that you treat with OMT (20 minutes/patient) and the rest are typical medical patients, you've just upped your daily income by $700-1000...

Do the math. OMT pays, if you are any good at it and use it judiciously...

There are also folks out there with cash-only practices that charge $150/hour to do OMT and limit their days to 12 patients. Cash-only = no insurance billing and lower overhead + no call...

This is where osteopathy has an advantage over allopathy in FP.

 

[ckent]

Sorry, but 1,000 a day just simply isn't that much. I read somewhere that it takes around 150,000 a year to run a private practice per physician (paying nursing aides (25,000 per year), receptionists (30,000 per year), rent or mortgage on office space(?), office costs (?), equipment (?) and malpractice insurance (15,000 per year, probably higher if you are going to be yanking everybody's neck all day or if you get sued). I have also heard that it takes around 300,000-500,000 to start too. So with 1,000 per day, even working 55 weeks per year (never taking a day of vacation) will only get you 275,000. Taking at least 150,000 out of that will leave you with 125,000. Then you run into the same question of how can you survive with 125,000 and 200,000 in med school debt and 5% (10,000) in interest alone, plus whatever you have to take out in loans to start your practice with interest. Also remember that medicare reimbursements/ insurance reimbursements are continually going down, while cost (inflation, salaries of support staff, rent/property, equipment, malpractice insurance) is going up. I think that it's pretty scary to go into private practice by yourself too, because if you get sued and your insurance caps ( a lot of policies cap at 1-2 million), the rest is up to you to pay. Anyways, you all should lobby congress to increase medicare payments to physicians. It's ridiculous how they shrink payments simply because overall health care costs go up while the economy goes down, you'd think that'd be an indication to increase payments to physicians, not decrease. One legacy of Bill Clinton that I'm not particularly pleased with, balancing the budget on the backs of doctors. Anyways, go here to complain:

http://capitol.aafp.org/

 

[phd2b]

Ckent,
Please read my post carefully. I wrote that you'd *up* your daily income by $1K/day. That is OVER what most FP's make. Now, do the math (up to $5K/week MORE or up to $250K/year MORE). It looks much better. Add that to what you were saying...it's not a bad living.

Cheers.

 

[ckent]

Originally posted by phd2b
Ckent,
Please read my post carefully. I wrote that you'd *up* your daily income by $1K/day. That is OVER what most FP's make. Now, do the math (up to $5K/week MORE or up to $250K/year MORE). It looks much better. Add that to what you were saying...it's not a bad living.

Cheers.

Oh, my fault. Too used to not reading carefully these days. Anyways, I'd still recc that you contact congress through the AFP and tell them that you aren't getting paid enough even if you DO's are bringing in the bank. Even if you are sitting on wads of cash, you should still do it for your poor MD Family practice colleagues .

 

[phd2b]

agreed...very few DO FP's actually do OMT, so they are usually in the same (financial) boat as MD's. Go figure...

 

[phd2b]

agreed...very few DO FP's actually do OMT, so they are usually in the same (financial) boat as MD's. Go figure...

 

[Teufelhunden]

On a FP rotation right now --- they can bill $94 for the following:

general office visit for musculoskeletal complaint + 1 Rx + dx & tx of 2 osteopathic lesions

So, pt comes in with neck pain...you write a script for Celebrex, HVLA on cervicals and throracic...out the door in <5 minutes...bill for $94.

OMM can be totally sweet

 

[bustbones26]

I wish I had a copy of an article I recently read, but I'll tell you all about it.

There was this FP that was unhappy with working in a big FP group. So he decided to go solo. This article was amazing, let me give you the low down on how this guy ran his solo practice.

First, he found one of his doctor colleagues that had office space and rented an exam room from his friend. The exam room he rented was large anought to set up his desk and office as well as exam table, etc.

When his patients arrived, his friends receptionist would tell the doc via intercom that his patient had arrived. He would then come out, greet the patient himself, and take them back to the exam room.

He had no appointments. Patients just walked in when they needed to be seen. He stated in this article that he could spend an entire hour with the patient if he wanted. In this hour, he could also do more so that his billing codes were of a higher level.

When the patient left, he did all of the charting and billing procedures himself. He had no secretary, no office manager, no billing agent, he did it all himself. If he needed a chaperone for say a gyn exam, he would go out front and ask one of his friends office staff to chaperone.

He never was on call for hours on end. He handed out his cell phone number to his patients and warned them to use it judiciously. He said that at the most, he may have received a phone call in the middle of the night about 3 times per month. Oh he also did no obstetrics as well.

By doing all of the above, he limited his practice to a small number of patients and physically worked part time. At the end of the article he broke down the numbers, remember before he went solo he used to be in a big FP group.

By breaking down the numbers he showed that he made more money in his solo practice limited to 1500 patients working half of the hours, than he did when he was in a big FP group that had thousand upon thousands of patients and we was overworked. He showed that he made 150K from seeing his 1500 patients and that every penny of it, other than paying the rent for his exam room went directly into his pocket. In addition, with his extra time, he also worked as a consultant for an HMO. All together, his article basically showed that he physically worked part-time as an FP and was raking in more cash than any of his colleagues and was not getting overworked.

When I read this article, I was amazed. I actually thought that if I became ANY kind of primary care doc, I would run my practice this way. The only thing different, is this guy had the priveliege of having a doctor friend rent and exam room and borrow office staff occassionaly to chaperone a sensitive exam.

I wish I could find this article for you all to read! I can't even remember which journal/magazine it was in. But it just goes to show, if you are a smart business manager and are good at handling money, you can have alucrative practice in any specialty.

 

[SupportingOccam]

Originally posted by bustbones26
I wish I had a copy of an article I recently read, but I'll tell you all about it.

I think you're referring to the article(s) written by FP doc Gordon Moore. You can search the www.aafp.org for the articles. A couple links are:


http://www.aafp.org/fpm/20020200/29goin.html

http://www.aafp.org/fpm/20020300/25goin.html

The AAFP site has many articles archived free online for those interested in researching various dynamics, particularly business, in family practice...a good resource.

 

[vigils]

You're all crazy to think you can't make it on a doctors salary. It makes me think you have never had a real job before. If you borrow 250 grand, you better think about how you're going to pay it back. Who borrows 250 grand? When the average debt of med school graduates is about 100 grand, you should think about borrowing less, even if you want to go into the highest paying specialty. So my best guess is that 250 grand should come out to 2500 to 3000 dollars a month to pay back. Anyone should be able to live off 3000 dollars a month, so you have a need of 6000 dollars a month, say they take 1/3 of your money in taxes, thats 9 grand a month you need, 9 times 12 is 108,000 a year to live comfortably. The average peds doc should be able to command that much doe. Check out monster.com to look at where you need to go to earn that much. If you can't deal with that, try borrowing less, go work for the National Health service corps and have them pay back your government loans, or find some other way to get some organization to pay back your school loans for you.

 

[JustD0it]

how do u find partnerships like these?

how come residents don't go into partnerships over kaiser for example?

 

[deleted6669]

Lee is right about hmo's working over the newbie primary care docs. in my area the local hmo starts fp/im/peds at 110k for the 1st 2 years then raises over 20 yrs to max 140 k. the senior pa's there make more than the new docs until they become partners...

 

[ckent]

There are still many reasons for physicians to not start up a private practice by themselves, even if it does turn out to be more lucrative in the end. Besides having to deal with the financial aspect of things (managing a small business, taxes, advertising, getting start up money, equipment), I also understand that there is an increased amount of risk associated with being in a private solo practice with respect to liability. A family doc that I once worked with told me that if she was sued and the patient awarded an amount greater then her liability coverage, she would not be personally responsible because she is an employee whereas if you are a private practioner (ie you own the business) and are sued, you are responsible for the difference between the settlement and your liability coverage. Also, with starting any small business, there is the inherent risk that your business will fail and you will lose a lot of money on the endeavor. Personally, I'd rather be someone's employee for life. The idea of trying to learn small business tax codes, having to worry about hiring and firing staff, and getting and keeping new patients just seems too stressful to me. I dislike having to think about using equipment and ordering tests from a financial perspective too (ie how much is using this tongue blade going to cost my business) even though I know that's a reality of medicine wherever you work these days. On a side note, a lot of physicians are choosing to work in the VA system for these very reasons. The starting salary is lower then most HMO's and private practices, but you never really have to worry about being fired, never have to worry if your patients can afford meds, and you never have to worry about seeing X number of patients per day in order to stay in business. The benefits are nice as well. Of course, the same benefits of the VA system (not worrying about being fired, no pressure to see a lot of patients or work hard) also represent some of the VA's inherent flaws and contribute to the backlog of patients they have waiting to see a doctor in the VA system.

 

[phd2b]

ckent,
The beauty of the current American delivery system (and of capitalism in general) is that there is a choice of being an employee or an employer in the delivery of good medicine. For those who are good managers and good clinicians, solo or small group is a very attractive option that provides an equitable return for their risk and hard work. For those who are risk-adverse, there are plenty of employers who will readily hire you and pay you 'market' wages in exchange for stability.

 

[white daisy]

just wondering... the average annual income of FP around the country that we hear about... are they just average salaries of FP who work for HMOs? So i'd assume that it doesn't include those who own their own practices, right? they must make much more than the official average salary.

 

[phd2b]

Should be the mean (avg) for FP's, regardless of practice type. That said, always pay attention to the number of years post-residency when citing these numbers. In many circumstances, the first 3 years post-residency is a significantly lower avg salary than older, more established physicians. Also recall the definition of an average (mean), which is total salaries divided by total physicians in that cohort. The relatively large number of physicians who might make low (<$120K) are skewing the curve to the right (the mean to the left). Although I've never analyzed the data, I'd guess that the *median* salary would be somewhat higher, although that is pure conjecture on my part.

 

[JustD0it]

how is it risky when there is a shortage of primary care docs and a lot of people can't get same day appointments?

 

[CambieMD]

I think that an FP can make it if they understand what they are getting into and act accordingly. Do not run up a medical school debt of 200+ k if you can avoid it. You simply have to live within your income. The soaring cost of medical school is the biggest barrier to physician recruitment and retention in FP. If one has a passion for FP they should persue it. Read the AMA news and other publications to find out what is really going on in the market place.

 

[neo]

Originally posted by JustD0it
how is it risky when there is a shortage of primary care docs and a lot of people can't get same day appointments?

who told you there is a shortage of primary care docs? its just not true. there are in certain parts of the country but overall, there is no shortage.

now with fewer people going into FP perhaps there might be a shortage in the future but currently there is not.

in some parts of the country, it is downright impossible to get a job as an FP.

I have a friend who has been looking for a job for almost a year now because she moved to a new state. a board certified FP physician who graduated from a US med school and residency WITH 2 years of post residency work experience who is unemployed. almost unbelieveable but true.

 

[Adapt]

There is a shortage of primary care doctors...

http://www.slu.edu/readstory/newsinfo/3263

http://www.amsa.org/news/pr/99/npcw.html

http://www.chiroweb.com/archives/11/10/28.html

There are several articles about the shortage of primary care doctors in several parts of the country.

 

[Teufelhunden]

Originally posted by Slickness
There is a shortage of primary care doctors...

Too bad the laws of supply and demand aren't at play here, as most primary care docs earn abysmal salaries.

I know countless people, myself included, who have profound interest in primary care but won't even consder it because of the low pay.

 

[dksamp]

>who told you there is a shortage of primary care docs? its just
>not true. there are in certain parts of the country but overall,
>there is no shortage.

WTF??? Have you been smoking some of Rick James' "special blend"?? cause only someone doing so would make a statement as RIDICULOUS as that.
As a Board certified FP practicing in a MAJOR metropolitan area with an AMPLE supply of docs of MANY diff specialties and 5 different area hospitals (of which I have admitting privelages in 3), I'll be the FIRST to say that what you said is a LOAD OF CRAP. Despite the huge population, and the sizeable population of docs, I still see on a DAILY basis a population that DOES NOT have access to good quality primary care. Yes, this situatio is a little more magnified in the smaller rural towns, but don't be fooled by the myth of the big cities. Despite appearances, Numbers of docs DO NOT NECESSARILY translate into broad access.

>now with fewer people going into FP perhaps there might be a
>shortage in the future but currently there is not.

Here's a novel concept...Sheer numbers of physician "BODIES", DO NOT necessarily translate into widespread access NOR quality.

Like I said, abundance of "raw numbers if docs" do NOT necessarily translate into access, cause if that were the case, EVERY single person in this town would have access to someone


>in some parts of the country, it is downright impossible to get a
>job as an FP.

Here is my challenge to you......NAME ONE !!!
I challenge you to name the part of the country where it is impossible or FP's to get a job. Now, let me qualify that by saying that if you attach a bunch of impossible conditions to your employment such as...

1. I will only work for "$$$" salary...PERIOD
2. I want a practice with ZERO medicaid
3. I want to do x,y,z procedure (not taking into account the local politics of the area, which may prevent you from doing so)
4. I want to be made an offer. I don't want to lift a finger to look for anything.
5. Her ability to get along and "play well with the other kids"
6. previous licensure/legal/liability trouble
7. one's desire for one SPECIFIC area of the US with ZERO flexibility.

These and other factors may preclude one finding a job that they would want.

>I have a friend who has been looking for a job for almost a year
>now because she moved to a new state. a board certified FP
>physician who graduated from a US med school and residency
>WITH 2 years of post residency work experience who is
>unemployed. almost unbelieveable but true.

Whenever I hear stories like this I try to dig deeper, and I usually find that there is something that is not being told. I vividly remember my 2nd and 3rd year of Fp residency, I would get BOMBARDED on a DAILY basis with mail and phone calls from recruiters (some of which I STILL get today), offering positions in every part of the country. Of the offers, I picked the one that had the most appeal to me based on my particular tastes and preferences. Hereare my questions for your friend....

1. What methods is she using to LOOK for an opportunity?
2. Did she "expect" an opportunity to fall in her lap?? How agressively did she pursue different angles??

Ther has to be more to this story....PEACE!!

-Derek



Even in this big city which is supposedly "saturated", I still get made offers and propositions for extra opportunities to make more $$. I am NOT in ANY WAY trying to sugar-coat anything and say that every area is perfect, but the fact is that Americans are STILL in search of a GOOD primary care provider that CARES for them and addresses their needs.

 

[dj_smooth]

Is it realistic to earn $200k as an FP within a reasonable amount of time, say <3 years? What sort of other opportunities are there for you to earn more? I don't know about others, but I will have considerable debts to pay off and that is worrisome.

 

[phd2b]

How many patients do you want to see per day? 12? 60? Do you want to do procedures? What kind of payer mix will you have? How much hospital work do you want to do?

All of these questions lead to quantifiable answers...

In rural eastern KY, for example, FP docs fill their panels quickly (6-9 months), see 50+ patients per day, and make substantially over $200K/year. There is a severe shortage of physicians in eastern KY, as you might imagine.

 

[mongoose]

Originally posted by phd2b
How many patients do you want to see per day? 12? 60? Do you want to do procedures? What kind of payer mix will you have? How much hospital work do you want to do?

All of these questions lead to quantifiable answers...

In rural eastern KY, for example, FP docs fill their panels quickly (6-9 months), see 50+ patients per day, and make substantially over $200K/year. There is a severe shortage of physicians in eastern KY, as you might imagine.

i can vouch for the eastern ky bit. i know one fp doc back home in eastern ky in particular that started practice at 100 grand in debt....within five years she lived in a million dollar home that was completely paid for. had a thriving practice and simply had no room for more patients, and she practiced solo.

 

[dksamp]

>Is it realistic to earn $200k as an FP within a reasonable
>amount of time, say <3 years? What sort of other opportunities
>are there for you to earn more? I don't know about others, but I
>will have considerable debts to pay off and that is worrisome.


It never ceases to amaze me the amount of bizarre and UNREALISTIC perceptions and expectations medical students have about the world of private practice. As someone in private practice, I can tell you that there are an ENORMOUS amount of variables that play into how much you eventually make. The majority of them are NON-medical. Here is a PARTIAL list of the variables that determine how much you make.

-The type of deal you strike (fixed salary vs. % of production)
-competency of your STAFF
-HONESTY of your staff (docs get embezzled every day, and most of the time right under their noses)
-Who is your biller/coder (is he/she a coding genius or a $hit for brains?)
-How well you get along with the other practicioners in your community (if you are an a$$hole, you wont get referrals)
-How many patients you see per day
-The insurance plans that you accept and the contract you are able to negotiate with the insurances (medicare=good reimbursement; medicaid=crappy reimbursement; Blue Cross=LESS than medicare...GET THE PICTURE??)
-are you on a capitated plan or a non-capitated plan
-How fast are you in cranking out patients. If you are a slowpoke, you won't make as much.
-Do you do procedures?
-DO you work for a hospital?? or in a private office?
-How many partners do you have (more partners = sharing of expenses)
-Do you practice good medicine?? If you are a crappy practicioner, word gets around. If you are GOOD practitioner, people WILL come to you.
-Do you have any added skills?? many docs are adding things such as botox, laser hair removal, cosmetic stuff etc..all this brings in PURE CASH
-How many other docs who do exactly what you do are in your area?
-Do you appeal to any niche markets that many of your colleagues don't? (International Patients, Tourists, the gay community, etc)
-Do you speak more than one language?? (more languages = expanded patient bases)
-LOCATION, LOCATION, LOCATION....still the old standard rings true as ever.
-Do you do both inpatient and outpatient?? Outpatient only?? Inpatient only?? What proportion of time do you devote to each?? And, what is the daily volume of each??
-Do you take call at the local hospitals? if so, How many hospitals you go to?? What is the patient mix at these places (mostly self pay [read: UNINSURED]??, Mostly medicaid? (crappy reimburser), mostly medicare (ideal)?? most of the private insurers (blue cross, Humana, Avmed) pay LESS then medicare
-DO you do any extra work (like in other clinics, ER, etc)
-Do you live WITHIN YOUR MEANS when you first start out??? If you are insistant on getting the MACK-DADDY house/car/toys that cost $$$$, don't expect much to remain in your pocket at the end of the day.
-Are you a SMART investor who uses money wisely?? or are you a gullible $hit for brains that falls for every money scheme that people offer you??
-Who is doing your accounting/Taxes?? that can make a HUGE difference.
Are you INCORPORATED?? LLC?? M.D. P.A.?? The tax benefits of each make a BIG diffference.


You see, I just BARELY SCRATCHED THE SURFACE on the NUMEROUS variables that all factor in into how much you make. If you can answer all these questions, you MIGHT get a general idea, but You STILL may not get an accurate figure. There are still MORE variables that you have to consider (both medical and non-medical). Expecting to walk out of residency making $$$ "beacuse I am XXX specialty" is unrealistic, incomplete, and does NOT take into account of all the variables. Since we are all different, what may be my level od success, may not be yours, So any figure you get is PURE SPECULATION!
Yes, loans are an issue, but in the history of medical practice, I have YET to hear of a practitioner who has had to declare bankruptcy because of student loans. I have not heard any doc that is starving or having to have Sally Struthers visit their home because of student loans. Practice good medicine, exercise GOOD business judgement, and success WILL come. RELAX and choose the field that WILL MAKE YOU THE MOST HAPPY. And with that I close. PEACE!!!

Derek Sampson, MD

Board Certified in Family Practice

 

[sasaadasuzy]

Thank You Dr . Sampson for generously sharing your experiences.I did print your reply and that is a rare.I browse a lot thru med forums but print occasionally.I really liked it and do believe that you take a great care of your pts.

Sincerely Alex IMG

 

[CambieMD]

I can see that Dr. Sampson put a lot of work and passion into his post. I can see that he is enjoying himself. That is good for him. I have made comments in the past. I do not share the enthusiastic view that others may share. The decline in interest in FP reflects the flux in this sector. Medicine is changing rapidly and everyone must keep moving to stay relevant. The gatekeeper model has failed. Less gatekeepers will be needed. Those who predicted a dire shortage of pcps and an oversupply of specialists were very wrong. The greater complexity of medicine has resulted in more procedures and greater specialists care.

I am in practice and have witnessed the struggles that some speak of. Med students can pick FP if the understand the realities of practice and have lower expectations. Someone mentioned a doc in KY seeing 50 pts daily and making $$$. It is just about impossible to see that many patients a day.The average FP sees about 130 pts a week. 50 pts a day would equal about250 pts a week. The average number for physicians overall is about 120. No matter how you slice it an FP works harder forl less $$.

Please don't say that" money does't matter we are here to help people." If we really wanted to save the world we could have joined the peace corps

I suspect that areas with very high malpractice rates will cause a reduction in the number of solo docs in areas like Chicago and Miami. High malpractice premiums will also hasten a departure of FPs from OB. Not like many deliver babies now.

Retainer practices are growing and will continue to do so. I think that this is going to be very big in five years. The concept is great. Top quality care for top dollar.

I hate long posts so I will stop before I break my own rule.

CambieMD

p.s.
no spell check sorry

 

[phd2b]

CambieMD,

I was being conservative at 50 patients per day b/c I wasn't including the patients that are rounded in the hospital. The docs I know in eastern KY work an avg of 10-11 hours per day, which is about 5 patients per hour, or one every 12 minutes. It is crazy!There is such a need for primary care docs in eastern KY.

One extreme example is a doc who has a patient panel of >5000! He has been here for 20+ years and works like a dog, but he makes substantially more than urban/suburbanan PCP's.

I don't exactly follow your logic about why you think we need more specialists and fewer PCP's. Perhaps in urban areas, but not in rural areas. These folks need simple primary care. You don't need an MRI and radiologist to diagnose and treat otitis media or manage HTN. These people end up not getting what many of us would consider 'standard care', and thus overutilize the ED at the local hospital.

I certainly respect your point of view, b/c I shared it until I actually experienced life in a rural area with a shortage of PCP's in a low-managed care penetration environment (there are no capitated plans, few HMO's, PPO's, etc).