surgeons make a lot less than i thought!?

[surgeon2b forev]

Hi,

First, let me start by saying that I'm certainly *NOT* going into surgery for the money. Nonetheless, I just had a surprising conversation with my surgery mentor.

He graduated from Hopkins (did sugery residency and oncology fellowship there) in 2002/2003 and when he was applying for jobs, he said the salary offers in academia were between 110k-145k. He ultimately settled at my institution (which I will keep anonymous) which is a very good hospital (top us news hospital, etc) for 125k starting. Obviously that included benefits and such (we didn't get into technical stuff).

He *ALSO* told me that had he started in the private sector, he would have made about the same... albeit, he said, that the increase in salary 5 years down the line gets a lot higher.

He then explained that this is how it is for most surgery specialties, with the exeption of CT surgery and some other fields which start off higher.

Now, it made me think. When we see those AVERAGE salary listings for surgery which are like 200k and stuff.... you have to think... that's for ALL surgeons at all levels of experience. So, in short, when I start actually practicing in 5-10 years... with my debt and stuff, it's not that much.

THAT'S CRAZY.

General surgeons and onc surgeons start off so low? EVEN 145k is like LESS than a hospitalist medicine doc makes who only works like half the year!

thoughts?

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[Blade28]

$140-160k for an academic general surgeon? Sounds about right to me (at least here).

 

[Celiac Plexus]

Yeah, one of the chiefs when I was in medical school was made an offer of 85k/yr to start as an associate professor at a name nyc program. He had > 200k in debt, and alimony/child support to pay. Lol. That would have left him with about 100 bucks a month after taxes.

 

[surgeon2b forev]

Blade. I didn't say between 140 and 160k a year! That would actually be a bit closer to what I originally expected.

I said between 110-145! And, this isn't some random surgeon... it's a fellowship trained surgeon from a top place.

Celiac Plexus (cool name!) brings up a good point. Lots of offers are actually way lower.

So when you go on to cnn http://swz.salary.com/salarywizard/layouthtmls/swzl_compresult_national_HC07000026.html
and they say that the average salary of a surgeon if 260k... well, think again. that's NOT what we're gonna be making.

I have a friend who is an endocrine surgeon, and I called him last night after my post to ask him what he makes. He works at a nice hospital in michigan. Fellowship trained endocrine surgeon... granted, he does mostly general 'cuz he's trying to build his name for endo stuff, but anyway... he started there at 105k a year!


Again, i'm not doing surgery for the money! Not at all. But, compensation wise... can someone explain why a hospitalist who trains half as much, and works half as many days/hours makes 50k more! Seriously, here, starting hospitalist salary is 170k, and they only work like 26 weeks a year.

Dr. Cox... what are your thoughts about starting salary offers for general surgeons and the subspecialties? How quickly do they rise? WHere are these average national salary postings for 260k coming from? Will I ever pay off my 200+ debt? My parents don't have a retirement plan, one is sick.... i have a kid, and 200+ school debt... so, i'm basically going to be JUST MAKING it 'til I'm about 50 is the way I calculate it out.

Oh well.. i'll still be in the oR

 

[mitchconnie]

It seems as though salaries very quite a bit with location, but the 110-140K range does not sound low for an academic job in a major metro on the coast.

If one were to rank practice situations based on income, it would probably go:

1. Rural private practice
2. Smaller city academic/private practice
3. urban private practice
4. major metro academic practice

Working for a big name place doesn't guarantee a higher salary. In fact, it's probably the opposite, since people are willing to work for less to get that prestige factor. I had a private practice attending during fellowship who used to brag that he made twice as much money as the head of the department at the Mayo Clinic. I don't doubt it was true.

 

[Pilot Doc]

Post above about rural/urban private/academic is a good one. Except in rare cases (none of which involve new grads) academics pays much less than pvt practice.

Those numbers for academics are starting salaries. From what I've heard they get substantially (50-100%) better over time. Academics is also very pyramidal in that if you make a name for yourself then you can shop around mid career for much better money to come in as the new director of X.

But the thing to keep in mind is that there are lots of saturated markets - people who employ and reimburse physicians take advantage of that. There are plenty of places where cost of living and surgeon supply is much lower. GS live much better there. 200+ to start is not unreasonable.

As for why hospitalists make more than some surgeons. Surgeons eat what they kill. They bill for operations and pay nurses, rent, malpractice, etc. It's a business and their "salary" is actually the business' profit. Hospitalists are typically hired by someone (HMO, hospital,etc) as a loss leader to keep referring PCP's and specialists happy. They don't have to earn their keep.

 

[surgeon2b forev]

I guess there are other things to consider. Presumably, if you are in academia, you will be doing research and (hopefull) getting grants. With grants, you get additional salary. Thus, if you are an associate professor with say 6 years under your belt as an attending, and have an RO1 and two other smaller grants, you're automatically increasing your income by X amount (I have no clue what that is, but it's not nothing).

So if you start in academics as a general surgery/sub-specialist and start with 110-145k, what is the typical increase in salary over time? Is it 10% a year for 5 years, and then 20% rise thereafter for 5 years?

Again, I'm told that when you start in private practice, the STARTING salary is about the same, but that the increase is exponential over time because you start to become a partner in the practice, and therefore your income increases.


Yeah, I'm not saying that 145k a year is a little! But again, after 7-8 yeras of training (i.e. losing a few years of opportunity that you could have been making 100+k in other fields), the fact that you work more than most other fields.... well, no wonder why people aren't doing surgery. I won't be an attending until I'm at LEAST 35 (assuming I do a fellowship), and if I'm only making 110-145k in the first 5 years with my expenses (debt, children, support my dad, etc), I'll still be renting and literally driving a crap car 'til I'm 40+!


oh well

 

[Pilot Doc]

Oh, and salary surveys are usually garbage.

Any salary.com type place that's not a specific medical survey is useless.

The medical specific ones are some better, but the market is still very, very local.

 

[Pilot Doc]

I guess there are other things to consider. Presumably, if you are in academia, you will be doing research and (hopefull) getting grants. With grants, you get additional salary. Thus, if you are an associate professor with say 6 years under your belt as an attending, and have an RO1 and two other smaller grants, you're automatically increasing your income by X amount (I have no clue what that is, but it's not nothing).

Unlikely. Getting an RO1 as a practicing surgeon is no mean feat. The NIH funding line is about 5-15th percentile now; i.e 9 in 10 grant applications aren't funded. If you do get a grant, the salary support that comes with that will allow you protected research time, but you still make more operating than doing research. You won't get a raise for having and R01. Maybe after 10 years of high quality research (something that perhaps 0.1% of GS grads accomplish) you'll be attractice enough to get good offers elsewhere.

So if you start in academics as a general surgery/sub-specialist and start with 110-145k, what is the typical increase in salary over time? Is it 10% a year for 5 years, and then 20% rise thereafter for 5 years?

Again, very hard to say. Varies wildly between programs.

Again, I'm told that when you start in private practice, the STARTING salary is about the same, but that the increase is exponential over time because you start to become a partner in the practice, and therefore your income increases.

I don't think that's true. If you go somewhere that has to recruit to find GS, you'll make far more than $100-150. And yes, the financial rewards of surgery, particulary return on investment, are hardly what they used to be and compare poorly with other fields. But you get to be a surgeon!

 

[drahr]

I dont know what the different sites are saying but I know for sure that my own cousin who graduated last year from new york with no fellowship got a job in private practice with $245,000.

 

[Leforte]

Establishing oneself as a researcher is not the way to get a salary increase in academics, either. This years R01 applicants had a 9% acceptance rate - ie only 1 of 11 applicants was funded. As an MD or MD/PhD you are competing against PhDs with multiple post-docs for the same funding. To be successful, you have to put in tons of academic time to build your own research interests, and the more time you spend in the lab, the less clinically productive you are and the less income you bring in, and this will show when you negotiate your salary.

I can assure you, your clinical only colleagues will not be very enthusiastic to support your income so you can be off in the lab for 10+ years until you get to the point of being an R01 finalist (which BTW is around 42 years of age during this last round for 1st time awardees).

Also, an R01 may be $400,000 per year - less $200k that the university takes off the top. Then lab costs, research assistants, post-docs, trips, etc - hard to get much of your salary out of what little is left.

I take my hat off to those surgeons who try to do real research and be clinically productive, too. They sacrifice an awful lot, both financially and personally.

 

[Pilot Doc]

Also, an R01 may be $400,000 per year - less $200k that the university takes off the top. Then lab costs, research assistants, post-docs, trips, etc - hard to get much of your salary out of what little is left.

Most RO1's now are 200-250K/yr. (Over 250k/yr requires special permission) THere are indirect costs above and beyond that which the NIH pays to the institution. You can also draw PI salary support from the grant but the max salary the NIH allows is something like 190K. You can get support up to that max based on the percent research effort you spend. If your time is 50% research, you can draw 85K, etc. Wont' make you rich. Now 10-20 years down the line if you draw 4 million/yr in NIH funding, things are different. But very, very few people make it to that level.

Bottom line: as mentioned above, don't count on research grants to buff your salary.

And as a follow on to the initial post, one of my mentors is a early career academic who draws some NIH salary support. His salary is above the NIH cap and he says its less than the full time academics.

 

[Winged Scapula]

I don't have much to add to the already excellent information given here except some anecdotal evidence.

Academic surgeons do make a fair bit less than those in the private sector, and while their salaries will increase, they almost never, unless they become department chair or some well known name in the field (and the hospital pays to keep them around to bolster its rep), make the same money they could in private practice. A few years ago I know fellowship trained surgeons at Penn State were starting at $145...but it does depend on academic position given and to some extent department as well.

Not to brag, but I am making much more than the estimates you've seen and I frankly consider it low...not because I feel I deserve much more, but because I did take a position in a lower-paying market, and know others who are getting more than I. I had offers with much more $$ and benes but in geographically undesirable places (to me).

I know one person who is fellowship trained and making $150 but she took an admittedly low paying job because she had geographical restrictions due to her husband's employment and preferred an academic arena.

At any rate, its a tricky issue because most people don't want to disclose what they make. I developed a anonymous salary and benes survey for my fellows class and out of nearly 40 people, got 5 responses (one of which was mine), despite me bugging them repeatedly.

AAMC produces a book which your faculty advisor may have which shows salaries based on geographic region and title, for academic positions. You might find it interesting. You have to add a certain "upscale" 20-30% for fellowship trained on top of the general surgery salaries I'm told.

You should also be careful in assuming that what Joe Surgeon makes is the same as what Jack Surgeon makes at the same institution. Contract negotations can yield widely different salaries, benes, etc. for people seemingly doing the same job. Friends and I interviewed for the same positions and got different salary offers. Also important is what your mentor is making...I had the opposite experience as mine seems to make an exhorbitant salary given what he was telling me I should make. NO ONE I knew was getting the offers like he had...sometimes "bigwigs" can be out of touch with what the peons make.

 

[surg]

Surgeon salaries may in fact be in the ~150k range at some academic places, but often those places have bonuses, etc that bring them up. Other places offer more salary but less bonus. The last time I checked the AAMC book, the 50th percentile (e.g. the median) for assistant professors (the typical starting spot) was in the 185-205k range depending on the location of the institution and the type of institution (private/public) for total compensation (salary but expected non-salary bonuses).

Offers I heard over the last year for fellowship trained, fresh out of fellowship, ranged from ~170-220k. Private practice accepted offers that I heard about went from ~180-300+k expected for 1st year total compensation; again depending on location and practice type (multidisciplinary/small group/Kaiser/etc.); Don't think I heard anyone with <150k, though it is entirely possible that they weren't as forthcoming about it either!

It isn't hard to find a decent job that pays more than $150k if you are even the slightest bit flexible in either your geography or your scope of practice. If you are inflexible in both, well then... prepare to enjoy some ramen noodles for a while longer!

 

[Faebinder]

Surgeons f-ed up the day they accepted the 90 day rule where any patient postoperative within 90 days can come back and be treated by the surgeon for free with the label "postoperative complication" slapped on it.

One example we had was this lady with diabetic gastroparesis and dysphagia to the point that she cant swallow pills.... on our service for rectal cancer, got resected but we had one hell of a time controlling her HTN and DM. After we started pooping per ostomy and tolerating food, we sent her home... a few days later she comes in and the ER wants us to take her... she is vomiting and cant take pills (well duh!)... ostomy still has poop coming out of it as normal... we take her.... get all kinda consults to manage her... she is discharged a few days later.... comes back 2 days later with similar symptoms... they try to make us take her and we refuse... it's the colorectal surgery service... not the upper gi surgery service! (yes the ostomy still works). So they consult us... and gets discharged later.. A week later she is in for the SAME symptoms.... and medicine consults us... and I am just thinking.. WTF... all those consults can't be billed cause it's all within 90 days, as if the low anterior resection has anything to do with her preoperative diabetic grastroparesis.

Apply this case to other surgery service. That's how medicare got the power over surgeons. Medicine can bill for every note they write but you cant bill for postoperative daily management.

 

[Winged Scapula]

Surgeons f-ed up the day they accepted the 90 day rule where any patient postoperative within 90 days can come back and be treated by the surgeon for free with the label "postoperative complication" slapped on it.

So true.

My PCP can make money every time he sees me. I was tachycardic before the boards, almost assuredly due to anxiety. But he wanted to see me 3 times after he gave me some Toprol, to recheck my BP and HR.

I've seen the insurance bills...he got paid for each and every visit, despite the fact that my HR and BP were stone cold normal the first visit post-boards. Try seeing a surgeon get paid for routine post-op wound checks.

 

[SocialistMD]

My PCP can make money everytime he sees me. I was tachycardic before the boards, almost assuredly do to anxiety. But he wanted to see me 3 times after he gave me some Toprol to recheck my BP and HR.

True story: there is an endocrinologist in town who does not put patients on a sliding scale, but instead orders accuchecks and has the nurses call/page him at home and he adjusts the insulin dose from home. Yeah, he is awakened nightly, but he bills for each dose adjustment/call/patient and I think the nurses bundle calls so it is only 1-2 calls/night.

 

[mdjobexchange]

Three of my friends are finishing up their payback to the military and are taking private practice general surgery jobs. Their average pay is about $250,000. They will be working 50-60 hrs a week and on call every 4th night or so. They will definitely be busy. They have taken jobs in Oregon and Texas. Texas makes more than Oregon. Oregon has that whole socialist thing going on.

Academia makes less, but (in general) there is less work and academic surgeons have residents and medical students to scut around, while the private practice guys do most everything themselves. In private practice, they have to go to the ER, evaluate the patient, wait around for an hour for the OR crew and anethesiologist to show up, do the operation, tuck the patient into the ICU and deal with any phone calls for bleeding, acidosis, etc. In academia, the surgeon usually gets to show up after the residents have done most of the busy work, do the operation and go home.

Even $240k-$260k is low for the amount of work and stress general surgeons have. I have heard that the ACS is getting things together to fight their low reimbursement. I will be interested to see how it turns out. One way that some groups are buffing up their income is via "call stipends" and stipends for uninsured patients. Some people are getting $1000 to upto $2000/nite for taking ER/trauma call. I heard of one hospital that pays surgeons $250 to come in an evaluate ER patients because so many of the surgeons had dropped the privileges (most had developed surgery center based practices.)

 

[doc02]

Talking about salaries is really silly, isn't it? I used to think that surgeons only made like $110K or something (I was a med student). I asked my Chief how he could do it making that much and he almost hit me. He said he had a job lined up where he expected to be making close to $500K five years after starting (he's fellowship trained). Not unrealistic because the guy that had joined a few years before him did that. The thing is, you guys will drive yourselves crazy because everybody lies about salary, either high or low. The EM guys talk about how $250K for 40 hrs/wk is average for them, I have no idea where that is because I know EM attendings and they're not making anywhere near that much. It's just an attempt at making people jealous. If you work hard and do your thing as a surgeon, trust me you'll be rolling in the dough and not just because you're working on a mountain in Utah. So don't get all worked up about it.

 

[jubb]

If you work hard and do your thing as a surgeon, trust me you'll be rolling in the dough and not just because you're working on a mountain in Utah. So don't get all worked up about it.

Working hard and doing your thing aren't always enough to make it in private practice anymore. You gotta know how the system works or you'll be surprised how little you actually end up making in comparison to how much it ends up costing you(in time and money). You have to be informed about your costs and your reimbursements or salaries will continue to plummet. Check out the article and the comments in this thread.

http://forums.studentdoctor.net/showthread.php?t=391207

No matter how you slice it, at some level the practice of medicine is a business. You have costs to cover before anyone gets to take anything home. I apologize for diverting the thread but willful ignorance about costs and reimbursement is a pet pieve of mine. I just want doctors to be more informed so we can be more responsive in the market.

Justin

 

[Asdf77]

When I was deciding what field to go into, I went thru a list my school provides of alumni willing to host medical students during interview season. I didn't explicitly ask about salary, but a few were forthcoming with the information. One surgeon practiced in Oregon in a town of about 25,000-50,000 folks in a practice group of 7. Call was q7 weekday and q7 weekends. 6 weeks vacation a year. $350-$450 per year. Not bad in my book.

 

[drdrew267]

why discuss this now? Are you going to go on strike? Are you going to protest and camp out in the lobbies of HMOs and the Medicare administration? Seriously, I can think of a million other things that will get you a similar salary (even at the optimistic levels mentioned on this thread) about a DECADE sooner than it would take to get thru post-grad training. That's why I have to raise my eyebrows when this is such an issue for some people b/c a part of my mind says well, then maybe medicine is wrong for you and good luck with whatever you do - seeya!

Of course - there's absolutely nothing wrong with getting involved politically and trying to influence political changes, etc just like any other socio-economic group in the country to protect our revenue.

 

[Faebinder]

why discuss this now? Are you going to go on strike? Are you going to protest and camp out in the lobbies of HMOs and the Medicare administration? Seriously, I can think of a million other things that will get you a similar salary (even at the optimistic levels mentioned on this thread) about a DECADE sooner than it would take to get thru post-grad training. That's why I have to raise my eyebrows when this is such an issue for some people b/c a part of my mind says well, then maybe medicine is wrong for you and good luck with whatever you do - seeya!

Of course - there's absolutely nothing wrong with getting involved politically and trying to influence political changes, etc just like any other socio-economic group in the country to protect our revenue.

must be a year 1 or 2 medical student... hasnt seen the truth of year 3 and 4 yet.

 

[ESU_MD]

All the guys I know who went into general make 250+ (in rural areas), one vasc fellow started 325, and the other CT started at 350 last yr

nobody in their right mind goes into academia from my community program so I cant comment on their salaries

 

[CTS]

I know a guy. He is RN with an associate degree made 110000 last year working 50-60 hours a week. That's ridiculous. 2 years of studying vs. 13-16 years? Where are we going?

 

[Blade28]

The SICU nurses at our county hospital can make up to $100-150k if they have anywhere from 5-10 years of experience. Almost all of them work three 12-hour shifts a week.

 

[MacGyver]

So true.

My PCP can make money every time he sees me. I was tachycardic before the boards, almost assuredly due to anxiety. But he wanted to see me 3 times after he gave me some Toprol, to recheck my BP and HR.

I've seen the insurance bills...he got paid for each and every visit, despite the fact that my HR and BP were stone cold normal the first visit post-boards. Try seeing a surgeon get paid for routine post-op wound checks.

And despite all that I'm sure he pulls in a full 100k less than you. Cmon thats not a fair comparison and you know it. Surgeons get paid a couple hundred per case, an internist is lukcy to make $20 for each visit.

 

[MacGyver]

The SICU nurses at our county hospital can make up to $100-150k if they have anywhere from 5-10 years of experience. Almost all of them work three 12-hour shifts a week.

I'm calling BS on that. Whats your hospital name, it should have those salaries listed in their nursing jobs section of the website.

 

[surgeon2b forev]

that's definitely true. it's part of the reason we have nursing shortages is BECAUSE THERE ARE NO FACULTY THAT ARE WILLING TO TEACH for 60k when you can WORK as an RN for more! It's a disincentive for RN's to get PhD's and do academia....

it's a bottleneck in demand and supply. WE NEED NURSES, and there aren't enough (40000 qualified applicants were rejected last year because there weren't open slots) classroom slots BECAUSE there are no faculty.


Nurses make a **** load. While 100k is more than the average, it's definately out there.

 

[Blade28]

I'm calling BS on that. Whats your hospital name, it should have those salaries listed in their nursing jobs section of the website.

I'll try to find their job postings (listing hourly salaries by experience level) and report back.

I'm at the biggest county hospital in my city.

 

[Celiac Plexus]

As for RNs making 100k... and CRNAs making 150k... that's comparing apples to oranges since each field has its own unique set of economic/market pressures. You may feel that having an MD after your name automatically entitles you to a higher salary than a nurse, and many physicians would agree. However, incomes in each field are set by their own unique set of market forces, and not one of them includes "initials after name".

In retrospect, I think it's tragic that my medical education included courses that discussed homeopathic medicine, poetry in medicine, etc... but failed to set aside any meaningful time to educate us on the economics of medicine in America today. Every now and then, I'd hear someone utter the phrase "medicine is a business", and I would quickly dismiss any ideas I had that tied medicine and money together since these thoughts were distasteful to me. Now that I have been out of med school for a few years, and have seen the CEO of our hospital system earning 1.3 million plus dollars per year even while we have cut back on care to the indigent, do I realize that physicians seem to be the only group in the equation that collectively refuses to participate in the "business" of medicine. As long as this is the case, physicians will continue to be financially marginalized, and at some point our ability to offer any type of care to any type of patient will become irreparably compromised.

That's my rant, er 2 cents for the year.

 

[Faebinder]

I'm calling BS on that. Whats your hospital name, it should have those salaries listed in their nursing jobs section of the website.

It's not the first time that i hear a sicu nurse making that much.

 

[Winged Scapula]

And despite all that I'm sure he pulls in a full 100k less than you.

I have no idea how much he makes gross per year and it certainly may well be that much less than me, but the fact that I trained for several years longer than he did and have a much higher malpractice risk that he does must count for something.

Surgeons get paid a couple hundred per case, an internist is lukcy to make $20 for each visit.

Sorry...the insurance paid him $110 for each visit according to their own records (I can view all bills submitted against my policy, see what was paid, how much, etc.)

 

[core0]

I have no idea how much he makes gross per year and it certainly may well be that much less than me, but the fact that I trained for several years longer than he did and have a much higher malpractice risk that he does must count for something.



Sorry...the insurance paid him $110 for each visit according to their own records (I can view all bills submitted against my policy, see what was paid, how much, etc.)

Well part of this is that you have insurance. This pays more than Medicare. However, I am guessing that the $110 is the physicians typical charge which is discounted by the insurance company. The only time you see a true physician or hospital charge on the bill is when you have to pay a percentage of the bill. Then they have to show what they paid to show that you are actually paying 20%. There were a number of companies that used to make you pay 20% of the typical charge and then discount the remaining. This meant they were paying something like 50-60% of the bill. The state insurance boards were less than amused when they found out.

David Carpenter, PA-C

 

[Pilot Doc]

Let's put the calculator to the quotes above and see what we get.

1st example: 110K for 50-60 hrs/wk. Call that 55 on average of which 15 is time and a half to that amounts to 62.5 hrs/week at the nominal hourly wage.

62.5 hrs/wk * 50 wks/yr = 3125 hrs/yr
$110,000/3125 hrs = $35.20 / hr
Doesn't make me want to be a nurse. Plenty of moonlighting jobs available at 2-3X that pay.

2nd example: $100-$150/yr. 36 hrs/week.
36 hrs/wk * 50 weeks/yr = 1800 hrs
$100K/1800 = $55/hr
$150K/1800 = $83/hr

That starts to get more attractive (and harder to believe as well.) Doesn't wildly fail the sniff test either, especially if the higher numbers include no benefits.

 

[jubb]

In retrospect, I think it's tragic that my medical education included courses that discussed homeopathic medicine, poetry in medicine, etc... but failed to set aside any meaningful time to educate us on the economics of medicine in America today. Every now and then, I'd hear someone utter the phrase "medicine is a business", and I would quickly dismiss any ideas I had that tied medicine and money together since these thoughts were distasteful to me. Now that I have been out of med school for a few years, and have seen the CEO of our hospital system earning 1.3 million plus dollars per year even while we have cut back on care to the indigent, do I realize that physicians seem to be the only group in the equation that collectively refuses to participate in the "business" of medicine. As long as this is the case, physicians will continue to be financially marginalized, and at some point our ability to offer any type of care to any type of patient will become irreparably compromised.

Amen!

Just thought I'd post these. Just to compare the take home to the amount of work that goes into these procedures and their post operative management(in hospital and in clinic). Then you gotta figure in that some of these are emergent procedures so you have to do the full work up and wait around for the staff on call to arrive in the middle of the night and tuck the patient in after the procedure.

 

[Pilot Doc]

If that's from the recent Bulletin of the ACS article that I recall (which also had a chart showing veterinary insurance charges) those profit numbers are optimized to make the point that GS reimbursements and managed care contracts are horrible.

They calculated "profit" by assuming that their surgery practice was a business that had to hire surgeons at $250K/yr. The profit numbers for all those operations was what was left after paying the surgery salary and all practice expenses. So all that means is that surgeons make $300K in a competitive market with high HMO penetration.

 

[jubb]

Really?

I hope that's true because those numbers are pretty depressing. I'll have to look into that.

 

[Pilot Doc]

Article

p. 30, 3rd paragraph notes that physician salaries (but not bonuses) are counted as expenses before profit is calculated. I thought the article said what the base salary was, but I can't find it at a casual read. Without that information, the profit numbers don't have much value.

 

[Faebinder]

I am just waiting till the day that surgeons say... screw you.. pay up front then I operate.

The problem is too many surgeons butt heads together to agree... a corporation on the other hand will easily agree with another to produce a monopoly of the business.

 

[MacGyver]

I am just waiting till the day that surgeons say... screw you.. pay up front then I operate.

The problem is too many surgeons butt heads together to agree... a corporation on the other hand will easily agree with another to produce a monopoly of the business.

Medicare is quickly approaching monopsony status with over 50% of all healthcare dollars spent. Once they reach that critical mass, doctors of all specialties wont have any choice but to accept what Medicare pays, because otherwise they wont have enough patients to stay afloat.

 

[MacGyver]

Is a "level 3 office visit" one of those where I can send the RN in to see the patient and never have to waste time on it myself? I'm guessing that a level 3 is something like a routine BP check.

 

[-Goose-]

I am just waiting till the day that surgeons say... screw you.. pay up front then I operate.

I want to see this for ALL physicians... I'm so tired of paying witness to the giant raping that is taking place in modern healthcare.

 

[jubb]

Well I found those numbers. Those are profit to the practice based on each surgeon making a salary of 200k a year.

As far as the pay up front thing. I think that the patient should pay up front and then they can fight it out with the insurance companies to try and get it covered. Then we'll see how the insurance companies like denying claims when the patients are pissed off and have all day long to call in and harass them to cover it and they have to pay someone to handle it. I don't know why the doctor should be the one dealing with the insurance companies anyway. It seems like we have a lot more effective things to do with our time and resources. I think it would fix a lot of the problems with the insurance companies dynamics if they viewed the patient as the client instead of seeing themselves as some screwed up middle man standing somewhere between the business or organization that is offering the insurance and footing the billl, the patient who actually has to use the service, and the doctor who just wants to get paid for the work he already did. It'd just put a lot more responsibility on the insurance company and off the doctor.

There are practices that run this way. The first one I ever heard of was a doctors office off cozumel that covered tourists and cruise ships and was cash only. Talk about a dream job, instead of dealing with insurance companies you get to sit on the beach.

The other thing that kills me is when I look at number needed to treat for some primary care stuff. I wish patients understood number needed to treat and that it was involved in their discussions about their healthcare decisions. I know that if patients were footing a portion of the bill and understood the difference in price and in the number needed to treat between a slightly outdated diagnostic/drug/treatment modality and the latest and greatest, they would chose a slightly outdated. But since WE are the ones held accountable we offer and recommend the latest and greatest no matter the cost.

 

[Pilot Doc]

Is a "level 3 office visit" one of those where I can send the RN in to see the patient and never have to waste time on it myself? I'm guessing that a level 3 is something like a routine BP check.

Nope, non-physician visit is level 1.

Level 2 is the most cursory of physician involvement

Level 3 would probably be something like E&M of an inguinal hernia in an uncomplicated patient.

Level 4 & 5 visits are more complex

 

[core0]

Is a "level 3 office visit" one of those where I can send the RN in to see the patient and never have to waste time on it myself? I'm guessing that a level 3 is something like a routine BP check.

Nope thats a level 1. Or specifically a 99211. A 99213 requires a low level of decision making - wound check with no problems.
For requirements:
http://www.ackdoc.com/Forms and Templates/SUPERBILLS/coding documentation requirements.pdf

David Carpenter, PA-C

 

[Miami_med]

Well I found those numbers. Those are profit to the practice based on each surgeon making a salary of 200k a year.

As far as the pay up front thing. I think that the patient should pay up front and then they can fight it out with the insurance companies to try and get it covered. Then we'll see how the insurance companies like denying claims when the patients are pissed off and have all day long to call in and harass them to cover it and they have to pay someone to handle it. I don't know why the doctor should be the one dealing with the insurance companies anyway. It seems like we have a lot more effective things to do with our time and resources. I think it would fix a lot of the problems with the insurance companies dynamics if they viewed the patient as the client instead of seeing themselves as some screwed up middle man standing somewhere between the business or organization that is offering the insurance and footing the billl, the patient who actually has to use the service, and the doctor who just wants to get paid for the work he already did. It'd just put a lot more responsibility on the insurance company and off the doctor.

There are practices that run this way. The first one I ever heard of was a doctors office off cozumel that covered tourists and cruise ships and was cash only. Talk about a dream job, instead of dealing with insurance companies you get to sit on the beach.

The other thing that kills me is when I look at number needed to treat for some primary care stuff. I wish patients understood number needed to treat and that it was involved in their discussions about their healthcare decisions. I know that if patients were footing a portion of the bill and understood the difference in price and in the number needed to treat between a slightly outdated diagnostic/drug/treatment modality and the latest and greatest, they would chose a slightly outdated. But since WE are the ones held accountable we offer and recommend the latest and greatest no matter the cost.

Patients dealt with insurance companies until the late 70s/ early 80s, as Medicare suddenly shifted its policy and demanded that physicians deal directly with it. The insurance companies follwed suit. Yet another folly brought to you by the US government .

 

[doc02]

I am just waiting till the day that surgeons say... screw you.. pay up front then I operate.

This does happen for lots of non-emergent operations. I used to be like the medical students (when I was one) and was upset when a surgeon said they don't accept any insurance and it was out-of-pocket or nothing. And yet now I am a huge proponent of this because you put such time into training and you are at such high risk for frivolous lawsuits that it just makes sense. Nobody in America is going to cry when a doctor says they are working hard and yet their practice is going broke, they just shrug. But if a doctor works hard and makes lots of money, people become angry. You could be on call q3 and work 100 hrs/week, but if you make $300,000 suddenly you're "profiteering." I have neurosurgery colleagues who are upset that they "only" make an average of $650,000/year and some people get upset with that. I'm no neurosurgeon, but I fully support them in this. They work harder and longer than me, they are subject to higher rates of suits. If they make more than me then it is not the same as when an EM doctor works 12 10-hour shifts in a month and makes the same as me or a Derm doctor works 10-3 and makes twice as much as me because they don't have to work with reimbursement issues.

If medicine is socialized, the first thing I'm doing is jumping ship, getting an MPH, joining the bureaucracy that does nothing but make money and create meaningless rules, and let the pro-socialists be the ones who provide free health care. I believe in working hard and getting paid for working hard. Working hard and getting nothing is for fools, especially when you get nothing because someone who isn't doing the work is dictating that.

 

[jubb]

If medicine is socialized, the first thing I'm doing is jumping ship, getting an MPH, joining the bureaucracy that does nothing but make money and create meaningless rules, and let the pro-socialists be the ones who provide free health care. I believe in working hard and getting paid for working hard. Working hard and getting nothing is for fools, especially when you get nothing because someone who isn't doing the work is dictating that.

Is this the new if you can't beat them join them. Sort of a If their screwing everyone over then Join them. I bet MPH programs will get a lot more competitive. MPH will be the new radiology or dermatology where people can't understand why it's so competitive. If medicine goes south I whole heartedly support people leaving the field. We can't just keep taking and and saying "Thank you sir can I have another". I'd have a very hard time hanging up my spurs for good. I love Medicine/Surgery and while I have plenty of other interests and a few other talents, I can't see myself completely leaving medicine. I'd wanna go all outpatient and maybe mix a couple of moonlighting jobs in there just enough to stay in the game. I'm sure that's wishful thinking cuz it'll be even more all or none then than it is now.

 

[elwademd]

another part of the discussion that it's sometimes overlooked is physicians and their understanding (or lack thereof) of the business side of running a surgical practice, office/clinic, and providing hospital services.

if you look around a community, there may be a few surgeons who practice independently in small 2-4 man /woman shows, and maybe a few 5 person or more groups. so, each of these practices has their own overhead costs. if these practices joined as a multisurgical group, or multispecialty group, they might be able to lower their overhead costs (a group can get a better rate on malpractice then an individual, less office space, less staff), while maintaining the same level of reimbursement... and end up with more profit.

surgeons, as many other physicians do, like individuality. we don't like being told what to do, we like being in control. as such, many physicians don't see the benefits of starting or joining a group. that's not to say that there aren't downsides to a group practice. however, if you're interested in going into a surgical field, but are scared of declining income, a group practice is something to think about.

Sorry...the insurance paid him $110 for each visit according to their own records (I can view all bills submitted against my policy, see what was paid, how much, etc.)

being paid $110 doesn't mean it's $110 in his pocket. given that, by current figures, an efficient primary care practice spends 52-56% of its revenue on overheard costs, then the profit may "only" have been around $60. and if his office is not so efficient, the profit may have been less.