Is it possible for a FM doc to make 500K?

[Anfield rd]

This is a serious question. Do you know of family medicine doctors who

1. Are 1-5 years after residency
2. Make at least 500K profit (NOT revenue).
3. Own and run their own practice


If so, please share some details. Type of practice, patient mix, procedures done, additional training etc. Thanks.

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[GoodmanBrown]

This is a serious question. Do you know of family medicine doctors who

1. Are 1-5 years after residency
2. Make at least 500K profit (NOT revenue).
3. Own and run their own practice


If so, please share some details. Type of practice, patient mix, procedures done, additional training etc. Thanks.

I'm sure that many things are possible if you have no scruples.

 

[DIce3]

Yes, but they sacrifice family time for money. This is simple math, not illegal billing or "no scruples." Solo with overhead of 50%, working 365 days a week, seeing 30 patients a day: net 600K. This ignores all ancillary income.

 

[Dharma]

Yes, but they sacrifice family time for money. This is simple math, not illegal billing or "no scruples." Solo with overhead of 50%, working 365 days a week, seeing 30 patients a day: net 600K. This ignores all ancillary income.

and no time to spend that hard earned cash. doesn't sound fun to me...

 

[cabinbuilder]

This is a serious question. Do you know of family medicine doctors who

1. Are 1-5 years after residency
2. Make at least 500K profit (NOT revenue).
3. Own and run their own practice


If so, please share some details. Type of practice, patient mix, procedures done, additional training etc. Thanks.

Pretty darn hard to do with all the governmental EMR regulations, etc. You would have to already own your building, do cash only practice, no staff, take your own calls. Never have a day off, be sure to stay single.

Could get pretty close doing locums if you never took any time off for yourself.

Avg 7K/week x 52 weeks is $364,000 but that's really working hard in difficult rural places. It wouldn't be worth it.

 

[SnakeOil]

The ER at our hospital pays roughly $300k for 18 eight hour shifts/month (they hire family docs). Fill the rest of your time doing locums and you might be able to make close to that. You'd pretty much be working 365 days/year but I guess it's possible.

 

[civic4982]

Needs quite a bit of procedure billing to bridge the gap from the 300s to half a million. That's with a 70/30 break of private to public insurers as apart of their panel and working quite a bit already. A few ancillary investments in lab and perhaps local DME or other secondary sources of income could make it feasible.

You'd have to be creative and quite an entrepreneur to make those kinds of dollars in family medicine even pretaxes.

Oh and I just noted your request for less than 5 years from training. That's just not plausible and if it does exist its a phenomenon and a very business capable individual.


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[EdibleEgg]

It is possible, but very difficult. Who knows what life will be like in five years. I do know of a couple of FP's that started a large single specialty group with in house lab, rads, and real estate interests that work reasonable hours, but it took more than five years to get there. To get there in less than five years is possible but you would have to work an insane number of hours.

 

[DIce3]

$100 net collection per patient is possible in many locations. See 30 patients per day--> 30 x 365 x 100= $1,095,000. Overhead is fixed and would be less than $500,000/year. Play with these numbers all you like. Addition of hospital and NH patients keeps the 30 patients/day very doable. Reasonable to expect to make $500,000 if you are willing to work 16 hours/365 days at the office + hospital + NH.

 

[deleted87716]

Play with these numbers all you like.

Why...? They're total B.S.

"Overhead is fixed..?" In what alternative universe? In the real world, overhead and volume are directly related.

And, who the hell works 16 hours/day for 365 days per year...?

 

[tiotropium]

Purely anecdotal, but an attending I worked with said he was working out in west Texas and only seeing wealthy oil tycoons, engineers, etc. who had the insurances that paid the highest. They had 9 exams rooms per physician, seeing on average 60-70 patients daily, sometimes upwards to 90 patients a day. They worked 8am-4pm, no lunch break, and did only outpatient with no procedures. He says his partner, who was the primary business owner, was pulling in $750k a year after overhead.

 

[thuc]

agree with the above. in general, higher productivity = higher income. that could change in the future. this year, our medical groups are undergoing a trial of performance-based pay that will generate a bonus if we hit certain metrics.

another consideration for higher income is concierge medicine. either join a network or start one yourself. ie, mdvip doctors charge 1500-1800 annual fee per patient. 500 goes to mdvip as a franchise fee. the rest is for you to balance. max 600 patients per doctor.


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[DIce3]

Why...? They're total B.S.

"Overhead is fixed..?" In what alternative universe? In the real world, overhead and volume are directly related.

And, who the hell works 16 hours/day for 365 days per year...?

I work > 12 hours/day on the weekdays and take about one week off per year. My overhead is relatively fixed assuming I don't hire a new employee or buy new equipment/EMR etc.

 

[cabinbuilder]

I work > 12 hours/day on the weekdays and take about one week off per year. My overhead is relatively fixed assuming I don't hire a new employee or buy new equipment/EMR etc.

EEWWWW, I really like my 5 months of vacation. More power to ya.

 

[deleted87716]

I work > 12 hours/day on the weekdays and take about one week off per year. My overhead is relatively fixed assuming I don't hire a new employee or buy new equipment/EMR etc.

...or give anyone a raise, or see any price increases in rent, utilities or supplies, etc. Never mind the cost of living. Overhead is never "fixed."

As for only taking one week of vacation per year, let us know how that's working out for you five years from now.

Sure, anyone can work all the time and make more money, but nobody can go full speed forever. There's more to life than money.

 

[lowbudget]

Sure, anyone can work all the time and make more money. There's more to life than money, however.

True, but the original question was whether or not it is possible to make $500k, and the answer is yes. I think what's underappreciated is what it takes to make (i.e. "earn") that money. Some people think you can just show up to work, check your email, and walk away with a paycheck without putting forth any effort and without taking on financial risk. I feel that many medical students and residents forget that graduation is merely the end of the beginning. Now, you have something called the real world to contend with.

 

[okhandsome]

This is a serious question. Do you know of family medicine doctors who

1. Are 1-5 years after residency
2. Make at least 500K profit (NOT revenue).
3. Own and run their own practice


If so, please share some details. Type of practice, patient mix, procedures done, additional training etc. Thanks.

Hi all,
I have not been on SDN since my residency.
I have been in employed practice in rural TX for the past 2.5 yrs and made about average 320K/year. I am projected to about 270k this year.

During the first two years I worked
M-F clinic 8-5 with admin responsibilities
Weekday ER for 22hours/wk every week
Weekend ER (Sat-Sun) for 48hours every 2 weeks

I admit patients to the hospital too. I get monies from Patient collection for admits only.
Clinic pay is 180K and ER pays 60$ per hour
I get about 3weeks payed time off AND national holidays and I have used all those days!
I don’t do NH.

Now I am burned out and am cutting down on ER over the weekends and am doing one 48hour call every 4 weeks starting 2013.

To answer your question, I guess, you could do 500k/ year but it is difficult, trust me. Now that I have a 6month old baby it is becoming very difficult and have no time for my self or my family. Hence I have cut down on ER. YES, family comes first!!!

One other reason that made me cut down on ER is i did not want to make mistakes and lose my license. I am not looking forward to getting up in middle of the night to see a pt with URI either – its not worth it!

One question that lingers on in my mind is…

Should I call it quits( to practicing in rural area) and move to a bigger city and join an existing practice or open a private practice AND still be able to make around 300K by working ONLY the clinic M-F/ 8-5 ? (I don’t mind seeing 20-30 pts a day)

Sorry about the long post. I appreciate your time and thank all those who contribute to SDN
Regards

 

[DIce3]

As for only taking one week of vacation per year, let us know how that's working out for you five years from now.

Sure, anyone can work all the time and make more money, but nobody can go full speed forever. There's more to life than money.

This is my 12th year in private practice and I agree with you 100 percent. My main focus has been how to work less. You are completely right there.

 

[deleted87716]

There are a lot of variables that go into determining how much you take home.

That being said, I work with a number of folks who routinely top $300K/year working 8-5 M-F, outpatient only. They typically see at least 30 patients per day.

I know one who makes >$500K. He's a machine. He has a full-time outpatient practice, does hospital work, nursing home, receives multiple medical director stipends, etc. I don't know how much time he spends with his kids, though.

 

[EdibleEgg]

Why 60 bucks an hour for the ER. That seems pitifully low. What's the volume?

 

[okhandsome]

Why 60 bucks an hour for the ER. That seems pitifully low. What's the volume?

the volume is low about 400pts per month. During office hours M-F 8-5, pts with minor/trivial complaints are triaged from the ER and fastracked to the clinic!

 

[okhandsome]

There are a lot of variables that go into determining how much you take home.

That being said, I work with a number of folks who routinely top $300K/year working 8-5 M-F, outpatient only. They typically see at least 30 patients per day.

I know one who makes >$500K. He's a machine. He has a full-time outpatient practice, does hospital work, nursing home, receives multiple medical director stipends, etc. I don't know how much time he spends with his kids, though.

Yes, i think a practice should have the right patient mix...

 

[microscp2]

Why 60 bucks an hour for the ER. That seems pitifully low. What's the volume?

What is the average ? I am going to an urgent care interview this Monday, and have no clue what is the pay scale for a soon to be fresh from residency doc.

 

[cabinbuilder]

What is the average ? I am going to an urgent care interview this Monday, and have no clue what is the pay scale for a soon to be fresh from residency doc.

$60/hr is disgraceful= PA pay

Minimum should be $80/hr to $125 depending how busy the ER is.

Urgent care is usually $75-80/hr.

 

[EdibleEgg]

It all depends on the volume. The PA's here make more than 60 dollars an hour. The only way that is acceptable in the ER is if you have super low volume and basically take call from home. I know PA pay for urgent care here is about 55-75 dollars. No idea what docs are making.

 

[MJB]

What is the average ? I am going to an urgent care interview this Monday, and have no clue what is the pay scale for a soon to be fresh from residency doc.

Really depends on the situation, but I wouldn't do it for less than 100/hr...and that's if you're not a private contractor.

 

[cabinbuilder]

Really depends on the situation, but I wouldn't do it for less than 100/hr...and that's if you're not a private contractor.

Gonna be pretty difficult to get $100/hr for urgent care. Going rate right now for locums is $80/hr. Not likely to get hired.

 

[MJB]

Gonna be pretty difficult to get $100/hr for urgent care. Going rate right now for locums is $80/hr. Not likely to get hired.

Interesting. Moonlighting gigs at urgent care are paying 100-150/hr from what I've seen.

I assume the 80/hr gigs are with some pretty nice benefits?

 

[cabinbuilder]

Interesting. Moonlighting gigs at urgent care are paying 100-150/hr from what I've seen.

I assume the 80/hr gigs are with some pretty nice benefits?

I'm sure it's location dependent. Where I am licensed, I'm not seeing that high. More power to you.

 

[Toohotinvegas33]

To the OP, you can make 500k in FM with the right set up. docs doing a lot of botox and/or concierge medicine can make in that range without working 24/7 365.

also i doubt an urgent care will pay 150/hr that must has been miss read for ER shifts. if so please provide me with a link to verify and apply

 

[michaelrack]

I believe the 60/hr mentioned earlier was for coverage of the ER (some by phone) and not for continuously working in the ER

 

[okhandsome]

I believe the 60/hr mentioned earlier was for coverage of the ER (some by phone) and not for continuously working in the ER

True...call from home. But ofcourse have to 'see' every pt that comes to ER.

 

[jl lin]

...or give anyone a raise, or see any price increases in rent, utilities or supplies, etc. Never mind the cost of living. Overhead is never "fixed."

As for only taking one week of vacation per year, let us know how that's working out for you five years from now.

Sure, anyone can work all the time and make more money, but nobody can go full speed forever. There's more to life than money.

Economics tells you that capital and overhead are not fixed in the long-term.

Working those hours indefinitely is a sure path to physical, psychological, emotional, or family ruin. It's insanity that leads to more insanity. Plus it builds inner resentment, and this can come out in terms of how other people, patients, colleagues, or staff get treated.

Not worth it. After a while, you'd no longer love what you do.

 

[altap]

$60/hr in urgent care is low. Physicians should not be working in urgent care for less than $100/hr.

 

[tony montana]

$60/hr in urgent care is low. Physicians should not be working in urgent care for less than $100/hr.

Finally!! Some comon sense!

 

[JustPlainBill]

Interesting comments --

we had 2 residents, both 2 years out, drop by our recent class block to let us know how life was outside of residency...

both are working for Baylor in a urban setting, both are seeing about 9 patient's per half day and we were told that you need to see about 9 in order to make $150K. 20 minute visits, minimal procedures, half day off during the week and work a half day on the weekends, some start 10AM to 7PM, others more conventional 8-5/9-6.

While having money sure beats not having money, it's not all about the cash.....now the OP may want to consider his goal of $500K + a short term thing - say 5 years....so he can invest in other things that earn an income while he sleeps....and then scale back, play golf and be at peace with the world, write a best selling book on the trauma of medical training, go on Oprah and then run for Congress......not a bad plan....

 

[MJB]

From what I know for our region, basically if you bring in the average RVU's for an FP, and have a conversion factor somewhere near the median, you should bring in around 200K.

The RVU's basically are about 100/week, or 20/day. That's averaging each patient seen to 1 RVU. So, 20 patients a day, 5 days a week.

 

[JustPlainBill]

From what I know for our region, basically if you bring in the average RVU's for an FP, and have a conversion factor somewhere near the median, you should bring in around 200K.

The RVU's basically are about 100/week, or 20/day. That's averaging each patient seen to 1 RVU. So, 20 patients a day, 5 days a week.

So taking a look at your figures -- 20 patients at 99213 which is usually .83 RVU turns into 24 actual patients to make 20 RVUs. So 24 patients at BCBS reimbursement rates of $133/hr turns into $3204.00 per week x 50 weeks = $160, 240.96 per year give or take...

if you do medicare at a reimbursement of $33, end up with $792 per week x 50 weeks with a grand total of $39,600.00

So it sounds like if you want to make $160K per year, you need to see 12 patients per half day at 99213 levels.....99214's turn into about 1.2 RVUs and you still need to be moving.....

 

[primadonna22274]

Why 60 bucks an hour for the ER. That seems pitifully low. What's the volume?

I make $65/hr in EM as a PA--my docs make $180-200/hr.

 

[Silent Cool]

This is a serious question. Do you know of family medicine doctors who

1. Are 1-5 years after residency
2. Make at least 500K profit (NOT revenue).
3. Own and run their own practice


If so, please share some details. Type of practice, patient mix, procedures done, additional training etc. Thanks.

OP,

I assume this is a serious question. I've read the answers thus far. My answer is this:

1) Don't be an FM
2) Consider: Psych, Pain Med, ER, Rural Hospitalist (IM).
3) Don't neglect the value of owning medical equipment. In other words, be a businessperson.

Those are your best options.

g'luck

 

[okhandsome]

I make $65/hr in EM as a PA--my docs make $180-200/hr.

thats good to know....how much do FP docs with ER fellowship make? i guess seasoned ones make about 150$...
Whats the volume at your hospital and how many shifts do they do a month? (avg in my neck of the woods in 14-16/month)

 

[deleted87716]

Those are your best options.

You forgot "marry well."

 

[DCFamilyMed]

Yes it is in the private practice world if run correctly. I see 20 patients a day, have a high complexity CLIA COLA lab, have an EMR that works efficiently and collects well. I work from 9-330 no weekends and very happy. Been here 10 years and buying my practice. Family medicine is the way to go.


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[deleted87716]

Yes it is in the private practice world if run correctly. I see 20 patients a day, have a high complexity CLIA COLA lab, have an EMR that works efficiently and collects well. I work from 9-330 no weekends and very happy. Been here 10 years and buying my practice.

You're taking home >$500K seeing HIV patients in inner-city D.C...? Impressive.

 

[Smokemont]

Yes it is in the private practice world if run correctly. I see 20 patients a day, have a high complexity CLIA COLA lab, have an EMR that works efficiently and collects well. I work from 9-330 no weekends and very happy. Been here 10 years and buying my practice. Family medicine is the way to go.


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Please elaborate on this. Don't tease us. We could use more quality contributors here, in addition to the couple we have.

 

[DCFamilyMed]

As private practice family physicians in 2013 we have to be innovative. We have to translate "all in one shop" and "labs performed at the time of a patient visit" to reality. An excellent EMR is a good start. Purchasing lab equipment though initially pricey is doable. Beyond a CBC, metabolic panel, we perform TSH PSA and testosterone levels in 15 minutes. A patient visit is longer with us but patients are highly satisfied because time is taken to explain each and every single lab result. No waiting for 1-3 days. Our EMR communicates to our lab equipment and the data is populated into the EMR. We start to establish trends for the patient in comparison to the population in the area and to themselves. Patients are motivated. Our mean hemoglobin A1C for my very large diabetic population was 6.24 last month. This is truly meaningful use of lab data. Email me more if your interested or work with residents or colleagues looking to work in DC.


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[civic4982]

As private practice family physicians in 2013 we have to be innovative. We have to translate "all in one shop" and "labs performed at the time of a patient visit" to reality. An excellent EMR is a good start. Purchasing lab equipment though initially pricey is doable. Beyond a CBC, metabolic panel, we perform TSH PSA and testosterone levels in 15 minutes. A patient visit is longer with us but patients are highly satisfied because time is taken to explain each and every single lab result. No waiting for 1-3 days. Our EMR communicates to our lab equipment and the data is populated into the EMR. We start to establish trends for the patient in comparison to the population in the area and to themselves. Patients are motivated. Our mean hemoglobin A1C for my very large diabetic population was 6.24 last month. This is truly meaningful use of lab data. Email me more if your interested or work with residents or colleagues looking to work in DC.


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I concur.

Finding ways to provide more services that leave patients satisfied and save them time as well as providing relief opens up a wide variety of things that an FP can do to add ancillary incomes to their practices.


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[septoplasty]

As private practice family physicians in 2013 we have to be innovative. We have to translate "all in one shop" and "labs performed at the time of a patient visit" to reality. An excellent EMR is a good start. Purchasing lab equipment though initially pricey is doable. Beyond a CBC, metabolic panel, we perform TSH PSA and testosterone levels in 15 minutes. A patient visit is longer with us but patients are highly satisfied because time is taken to explain each and every single lab result. No waiting for 1-3 days. Our EMR communicates to our lab equipment and the data is populated into the EMR. We start to establish trends for the patient in comparison to the population in the area and to themselves. Patients are motivated. Our mean hemoglobin A1C for my very large diabetic population was 6.24 last month. This is truly meaningful use of lab data. Email me more if your interested or work with residents or colleagues looking to work in DC.


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What do the start up costs for the equipment you mention look like?

Feasibility in the short term is just as important as in the long term imo.

 

[DCFamilyMed]

I would start with instruments that perform CBCs and and comprehensive metabolic panel. Waived tests such as hgba1c and cholesterol panels are great to start. Before purchasing an EMR look for connectivity to the instruments as well as the ability to communicate with outside labs. The ability to perform tests in house automatically results in higher level coding because in my office, I have results before the patients see me and I'm already providing face to face interpretation while they are there. The patients know what has been ordered, and hence there is "transparency." I have relative ballparks on what individual insurance plans pay through research. There also is a bonus of much less hospitalization because of my one stop shop. Over time you can perform an analysis of the frequency of testing and which tests work in your population. I now perform TSH, PSA, testosterone, INR, ESR, vitamin D levels within 20 minutes and patients are happy. Less call backs for labs saving my nurse hours. I can immediately respond to issues and start to establish trends in a patients health and can pull data easily for insurance companies or other agencies,


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[deleted87716]

I see no real advantage to same-day results for most of that stuff.

I get the same benefits (review labs with patient, no call-backs, etc.) from having routine labs drawn a few days in advance of appointments. I'm also not limited to labs that can be done in the office setting (e.g., LDL-p, etc.)