A question about the physician shortage and practice style

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What is more important to you?

  • Maintaining a certain number of RVUs to maintain salary

    Votes: 3 27.3%
  • Seeing only a certain number of patients in order to provide the best care--that's why I chose FM

    Votes: 8 72.7%

  • Total voters
    11

rachmoninov3

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So I am a recently minted Family physician practicing in a small city of about 75K, and working urgent care for the hospital corporation. I have found that I can easily see 30 patients (or more) in a 10 hour day. These twenty minute encounters would be more than enough to maintain a full patient load an meet RVUs if I wanted to change to the outpatient only FM (which I don't because then I couldn't also work part time as a hospitalist---I know medical care is messed up). The most frequent complaint I see in urgent care is that someone's PCP can't see them for 3 months. It seems like very few people have any kind of open access scheduling. I do not know what the barrier to open access is (hence the poll question). Given the numbers that I see, and with 3 other urgent cares in town, it would seem like someone could easily afford to have 2-3 open access appointments every half day.

So please tell me what the barriers to open access are in your practice. Are you trying to keep RVUs up? Would you rather have less money and a better lifestyle and see less patients but provide better care? Or perhaps something else?

Furthermore, with the current physician shortage (if this is still a real entity) is it correct for one physician to take less patients and therefore send more people to the urgent care or ER? As family physicians we claim to provide the most cost-effective care because we know the patient, however it appears to me in practice that we can only provide that care to small percentage of the population at any given time. Please debate and point out any an all flaws in my argument/rant.

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The risk you run with open access scheduling is you'll have an empty waiting room which equals less money. If you're employed, your employer will not like making less money. If you're private, you won't like making less money.

The biggest problem is that to be cost-effective, we have to have time to know our patients and actually investigate/think about what's going on. That equals less money.

For the claim that we can only provide really good care to a small percentage of the population, that's true. But, if we did better in terms of seeing patients promptly when needed we would cut down on UC and ED visits which would leave those doctors free to come back to regular practice.
 
So I am a recently minted Family physician practicing in a small city of about 75K, and working urgent care for the hospital corporation. I have found that I can easily see 30 patients (or more) in a 10 hour day. These twenty minute encounters would be more than enough to maintain a full patient load an meet RVUs if I wanted to change to the outpatient only FM (which I don't because then I couldn't also work part time as a hospitalist---I know medical care is messed up). The most frequent complaint I see in urgent care is that someone's PCP can't see them for 3 months. It seems like very few people have any kind of open access scheduling. I do not know what the barrier to open access is (hence the poll question). Given the numbers that I see, and with 3 other urgent cares in town, it would seem like someone could easily afford to have 2-3 open access appointments every half day.

So please tell me what the barriers to open access are in your practice. Are you trying to keep RVUs up? Would you rather have less money and a better lifestyle and see less patients but provide better care? Or perhaps something else?

Furthermore, with the current physician shortage (if this is still a real entity) is it correct for one physician to take less patients and therefore send more people to the urgent care or ER? As family physicians we claim to provide the most cost-effective care because we know the patient, however it appears to me in practice that we can only provide that care to small percentage of the population at any given time. Please debate and point out any an all flaws in my argument/rant.
You should think about concierge primary care / direct pay primary care. I don't know if a town of 75k has enough people able to afford such a service, but it's something to think about.
 
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I don't work 10 hours per day (my office is open from 8:15am-4:30pm M-F - with an hour for lunch - and I take most Wednesdays off), but I see 20-25 people on a typical day (full-on primary care, not urgent care). Appointments are 15 min. long (30 min. for new patients and physicals/WCCs - max. of 5 of these per day). I have four same-day appointments available every day (two in the late AM, and two in the PM). So do my two partners. So, on most days, our office has 12 same-day appointments available. It's pretty rare that we can't see somebody the same day they call, if they really want to be seen (e.g., they're flexible on the time, and they don't call at 4:20pm).

This volume is perfectly fine with me. I'm busy, but I can typically stay pretty much on schedule (save for the occasional train wreck), and I get all of my work done before leaving the office at 5:00-5:30pm. Income-wise, I'm slightly above average for my group. That's also perfectly fine with me. We're paid based on revenue, not RVUs (e.g., revenue - expenses = paycheck).

FWIW, many urgent care centers schedule 6 patients/hour, not 3. You're lucky.
 
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We have a certain number of reserved slots for same day appointments too (part of the whole being a patient center medical home). These typically fill up, especially during cold and flu season. I work at an FQHC and my pay is salary. We also don't have an urgent care within 30 mins of the town either.
 
Most of the places I work none of the family practice docs will see their own sick patients the same day so they all get shuttled to urgent care (pretty sad when they are in the same building as I am). My urgent care is not scheduled, it's first come first served but I see about 4 patients an hour on average depending on how simple/difficult the workup.
 
Thanks for the responses. I'm going to see what it would take to change to open access. My UC is also a first come-first serve basis and I typically about 7pt/2 hours, sometimes less, sometimes more depending on procedures and case complexity.
 
If we had more primary care docs willing to to have open access scheduling, patients would get better care. I don't disagree with that statement. It seems rather intuitive to me. But there is a limit to how many slots you can leave open, before you start making your non-acute patients wait more. And if you make them wait too long, they'll find a different office.

Furthermore, with the current physician shortage (if this is still a real entity) is it correct for one physician to take less patients and therefore send more people to the urgent care or ER?
Yes it is. If a physician wants to see 16 patients a day and work 3 days a week, and that is correct for them, then it is correct.
 
So how many of us are there? (FM docs in the country?), how many are working part time vs full time and in what capacity (traditional, urgent care, etc). I hate to be so communistic, but if we really do have a doctor shortage and we boast about increasing FM residency numbers, how many only part time? We need full time, 20-25 pt a day FPs that see urgent as well and yearly patients. It just seems like we can preach all we want about primary care, but when few people have access to a PCP (either they have one and can't be seen or they don't have one), all the preaching is just empty promises.
 
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My thoughts -

First - I reject the standard model of seeing 15-30-60 people a day. I see on average 5 people in the office per day (and about the same amount by phone, text email) and make $240/yr.

I have a direct primary care (DPC) model that I've talked extensively about


http://time.com/3643841/medicine-gets-personal/

I think that insurance billing (RVU etc) for primary care is inefficient for the patients and the providers.

I haven't coded anything for insurance since i left residency and i couldn't be happier.

Is there a physician shortage? maybe but probably not. We have enough physicians, the problem is an efficiency issue - http://ideas.time.com/2013/07/02/the-epidemic-of-disillusioned-doctors/ --> 22% of a docs time is spent on non-clinical paperwork (yeah...right...just 22%) which is the equivalent of 165k full time providers back in the workforce.

Yes, i think DPC is a viable model for most pts and docs and will actually help reverse the physician shortage.

Thoughts?
 
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Most of the places I work none of the family practice docs will see their own sick patients the same day so they all get shuttled to urgent care (pretty sad when they are in the same building as I am). My urgent care is not scheduled, it's first come first served but I see about 4 patients an hour on average depending on how simple/difficult the workup.


Understandable that urgent care and ED is available; but with my family's PCP, it seems like it depends on the urgency. What I mean is that he has gone out of his way to fit a family member or me in, even if it means he stays a little later, and he has a great practice. But it's a sensible kind of thing too. I have even had to make peds calls for certain kids where they squeeze them in, b/c for some folks, they are put at more of a risk if they are forced to go to the ED--mostly immune compromise or such. But I think once a doc gets to know his/her regulars, he/she is more likely to know who is abusing the "squeeze-in" factor and who is not. I mean if people generally set appointments in advance and keep them, and they have sense about what is going on with them, well, it makes more sense to go the extra and see them when it's important enough, but not necessarily a true emergency. It's a two-way street kind of relationship between pts and docs. But if the general feeling of the pt is that the pt feels that the doc is bottom-line, no matter what--s/he is generally gonna be done--so too bad, go to the ED, the pts can feel like the caring factor isn't there. You can't abuse it (your PCP); but it's nice to know when your PCP knows you and really gives a damn, even though s/he definitely has his/her own life.

I have a dentist and vet that operates the same way. And heck, even if the unscheduled visit is up-charged for say a WE, it still beats being sick enough and waiting in the ED and the charges from going that route. And in some cases, you could go to urgent care, and they have limited diagnostics, so they have to send you to the ED anyway.
 
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My thoughts -

First - I reject the standard model of seeing 15-30-60 people a day. I see on average 5 people in the office per day (and about the same amount by phone, text email) and make $240/yr.

I have a direct primary care (DPC) model that I've talked extensively about


http://time.com/3643841/medicine-gets-personal/

I think that insurance billing (RVU etc) for primary care is inefficient for the patients and the providers.

I haven't coded anything for insurance since i left residency and i couldn't be happier.

Is there a physician shortage? maybe but probably not. We have enough physicians, the problem is an efficiency issue - http://ideas.time.com/2013/07/02/the-epidemic-of-disillusioned-doctors/ --> 22% of a docs time is spent on non-clinical paperwork (yeah...right...just 22%) which is the equivalent of 165k full time providers back in the workforce.

Yes, i think DPC is a viable model for most pts and docs and will actually help reverse the physician shortage.

Thoughts?


Here's what I don't understand, though--and what really clashes with the whole 'why I became a doctor' part of me:

Doesn't your model leave out literally hundreds of thousands of people who cannot afford the fees or don't have employers? They are generally the more high-cost people. If people started doing what you're doing by the masses, you'd have even worse of discrepancy in healthcare between the the have's (top) vs the have-nots (bottom). I feel like your model just takes an already flawed system and is just exploiting the gaps under the pretense of "capitalizum roolz!!"

Surely I'm not the first person to postit this to you. How do you respond to this?
 
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@addy I'm pretty sure if you watch AtlasMD's 10 minute video he actually addresses your concerns about direct primary care (DPC). Short gist is that the poorer patients that require visits to the free clinic (ie they have no where else to go) wind up breaking even if not saving money by becoming a part of his practice. At least according to his experience.

I feel like your model just takes an already flawed system and is just exploiting the gaps under the pretense of "capitalizum roolz!!"

DPC isn't exploiting a flawed system. It is bypassing it. Physicians used a form of DPC a century ago, before the dominance of health insurance.

It also seems practicing this type of model is restoring primary care physician sanity and lowering burnout rates (not sure if there are studies though, but anecdotes seems to be suggesting this). I don't know about you but the thought of having hospital bureaucrats with MBAs from University of Phoenix telling me how to run my clinic boils my blood.
 
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Here's what I don't understand, though--and what really clashes with the whole 'why I became a doctor' part of me:

Doesn't your model leave out literally hundreds of thousands of people who cannot afford the fees or don't have employers? They are generally the more high-cost people. If people started doing what you're doing by the masses, you'd have even worse of discrepancy in healthcare between the the have's (top) vs the have-nots (bottom). I feel like your model just takes an already flawed system and is just exploiting the gaps under the pretense of "capitalizum roolz!!"

Surely I'm not the first person to postit this to you. How do you respond to this?
Atlas gives unlimited primary care to seniors for less than my wife and I spend on our cell phones.

And yes the services of a doctor cost money but if you go into private practice you will expect your people to pay. You have the lixury of ignoring payment right now because thw hospital pays a room full of people to chase money from patients/insurance/medicare. Those money chasers are expensive and innefficient in that they are a healthcare cost that doesn't actually provide healthcare
 
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Here's what I don't understand, though--and what really clashes with the whole 'why I became a doctor' part of me:

Doesn't your model leave out literally hundreds of thousands of people who cannot afford the fees or don't have employers? They are generally the more high-cost people. If people started doing what you're doing by the masses, you'd have even worse of discrepancy in healthcare between the the have's (top) vs the have-nots (bottom). I feel like your model just takes an already flawed system and is just exploiting the gaps under the pretense of "capitalizum roolz!!"

Surely I'm not the first person to postit this to you. How do you respond to this?
The trick is, fees for most DPC offices are quite reasonable. AtlasMD, for example, is $50/month for most adults, $10/month for kids. I hardly think that restricts care to the "haves".

Beyond that, Atlas in particular (not all DPCs do this) dispenses wholesale medications. Having seen the price lists, a large number of people will pay for their monthly fee in savings on drugs alone.
 
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The trick is, fees for most DPC offices are quite reasonable. AtlasMD, for example, is $50/month for most adults, $10/month for kids. I hardly think that restricts care to the "haves".

Beyond that, Atlas in particular (not all DPCs do this) dispenses wholesale medications. Having seen the price lists, a large number of people will pay for their monthly fee in savings on drugs alone.


Wait, in his talk, though, he says he gets the rest from the employers...did I misunderstand something? I was doing QBank and had this in the background so it's entirely possible.
 
I'm sorry, what question can i help with? If the question is about employer's paying the membership fee ($50/pt/mo) - yes some employers pay all of it and some only 1/2 of the monthly fee.

Feel free to contact me directly anytime either by email or cell. [email protected] and C 316.734.8096
 
[QUOTE="It also seems practicing this type of model is restoring primary care physician sanity and lowering burnout rates (not sure if there are studies though, but anecdotes seems to be suggesting this). I don't know about you but the thought of having hospital bureaucrats with MBAs from University of Phoenix telling me how to run my clinic boils my blood.[/QUOTE]

Yes i can show that we decrease the physician burn out rate!
 
Wait, in his talk, though, he says he gets the rest from the employers...did I misunderstand something? I was doing QBank and had this in the background so it's entirely possible.
You might have misunderstood. The $50/month is the price. Some employers will pay this to the office as part of a benefit package to employees. It is not a case of the patient paying $50 and the employer paying more on top of that (which seems to be what you're thinking, though I could be wrong).
 
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You might have misunderstood. The $50/month is the price. Some employers will pay this to the office as part of a benefit package to employees. It is not a case of the patient paying $50 and the employer paying more on top of that (which seems to be what you're thinking, though I could be wrong).


Ohhhhh. Wow, now I feel like an idiot. That's wild that he's making 240k/year doing this. I know he's transparent, does he have his books up somewhere for people to see? I feel like this could very much be a "location, location, location" thing with regards to feasibility at that low of a monthly rate.
 
Ohhhhh. Wow, now I feel like an idiot. That's wild that he's making 240k/year doing this. I know he's transparent, does he have his books up somewhere for people to see? I feel like this could very much be a "location, location, location" thing with regards to feasibility at that low of a monthly rate.

I don't think he needs to "open his books". He's highlighted other places how simple of math it really is. Not to use his exact numbers, but for sake of argument--$50/patient with 600 patients (this how many patients he aims for--one could do less or definitely even more). That = 360k/yr. if you take out 20k for rent, 60k for staff salaries, and another 40k for advertising and other overhead, you still have 240k. His practice has 2 other physicians. I would imagine this would definitely help keep overhead low. But you don't need much staff when you're not wasting all your time talking and billing insurance companies.

It's definitely not solely "location, location" either. There are some good articles with a basic google search that will show that DPC is EXPLODING all over the country. I think I read somewhere that 4k physicians switched into this model over the last couple years. And I imagine the rate of growth will continue to increase
 
I think one of the big ideas that gives DPC an ability to help resolve any physician shortage is that DPC significantly raises primary care providers satisfaction and lifestyle. Sure, each DPC provider is treating fewer patients, but they are happy with their practices, and giving really good care to their patients. As more students start to see a viable way to practice primary care, a larger portion begin to choose primary care over higher reimbursing specialties. As this plays out over time, the overall number of primary care providers increases.
Here's an analogy: Imagine if facebook had a tenth of the servers that it actually has. With current traffic levels the servers would be way overloaded. Facebook would be really slow and crash all the time. The end result is that users would want nothing to do with facebook, and the staff wouldn't really want to stand behind it because they know that even if what they offer is great, the end result just doesn't really work for the consumer.
So how do they go about fixing the problem? Do they say "Hey, lets just explain to our customers that this is how things have to be. They should expect crashes and downtime simply as the way this business is done."
Or would they say " Clearly we can see that our servers can't handle the traffic. Instead of making excuses and trying to shift the blame for the broken system elsewhere, what if we simply make more servers? We won't try to overtax our servers with unrealistic amounts of traffic. Rather, we will optimize our server/traffic ratio. Yes we will have less traffic per server, and yes there will be lag time as we build and integrate our new servers, but ultimately we will have a better user experience. The end result? More use over all."
 
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I don't think he needs to "open his books". He's highlighted other places how simple of math it really is. Not to use his exact numbers, but for sake of argument--$50/patient with 600 patients (this how many patients he aims for--one could do less or definitely even more). That = 360k/yr. if you take out 20k for rent, 60k for staff salaries, and another 40k for advertising and other overhead, you still have 240k. His practice has 2 other physicians. I would imagine this would definitely help keep overhead low. But you don't need much staff when you're not wasting all your time talking and billing insurance companies.

It's definitely not solely "location, location" either. There are some good articles with a basic google search that will show that DPC is EXPLODING all over the country. I think I read somewhere that 4k physicians switched into this model over the last couple years. And I imagine the rate of growth will continue to increase


See, that's why I want to see the numbers myself.

Let's say you do 900 pts at $50 per = $540,000 - [x% for taxes] - [rent; can range from 12k per year to $70k per year hence my location location location comment] - [salaries; my assumption is there would be at least 1 front office person and a nurse or two for patient triage/flow, no way you're doing that for 60k no matter where you live] - [marketing to Republicans who hate the government] - [start up costs for first couple of years]

There is no way you're walking away with 240k in my city (not a bit city by any means) with that structure. This is why I want/need to see his books. A lot of people I've talked to have gone the route of not taking insurance but ALL of them have taken (steep) pay cuts.
 
I think one of the big ideas that gives DPC an ability to help resolve any physician shortage is that DPC significantly raises primary care providers satisfaction and lifestyle. Sure, each DPC provider is treating fewer patients, but they are happy with their practices, and giving really good care to their patients. As more students start to see a viable way to practice primary care, a larger portion begin to choose primary care over higher reimbursing specialties. As this plays out over time, the overall number of primary care providers increases.
Here's an analogy: Imagine if facebook had a tenth of the servers that it actually has. With current traffic levels the servers would be way overloaded. Facebook would be really slow and crash all the time. The end result is that users would want nothing to do with facebook, and the staff wouldn't really want to stand behind it because they know that even if what they offer is great, the end result just doesn't really work for the consumer.
So how do they go about fixing the problem? Do they say "Hey, lets just explain to our customers that this is how things have to be. They should expect crashes and downtime simply as the way this business is done."
Or would they say " Clearly we can see that our servers can't handle the traffic. Instead of making excuses and trying to shift the blame for the broken system elsewhere, what if we simply make more servers? We won't try to overtax our servers with unrealistic amounts of traffic. Rather, we will optimize our server/traffic ratio. Yes we will have less traffic per server, and yes there will be lag time as we build and integrate our new servers, but ultimately we will have a better user experience. The end result? More use over all."

Status: Pre-medical. TL;DR.
 
I don't think he needs to "open his books". He's highlighted other places how simple of math it really is. Not to use his exact numbers, but for sake of argument--$50/patient with 600 patients (this how many patients he aims for--one could do less or definitely even more). That = 360k/yr. if you take out 20k for rent, 60k for staff salaries, and another 40k for advertising and other overhead, you still have 240k. His practice has 2 other physicians. I would imagine this would definitely help keep overhead low. But you don't need much staff when you're not wasting all your time talking and billing insurance companies.

It's definitely not solely "location, location" either. There are some good articles with a basic google search that will show that DPC is EXPLODING all over the country. I think I read somewhere that 4k physicians switched into this model over the last couple years. And I imagine the rate of growth will continue to increase

I think you can pull in such a decent income at least in part because you have eliminated all the extraneous costs associated with a complex system. By pulling out the middle man (trying to make as much profit as possible from the doctor-patient transaction) you can offer yourself to the patient at a much cheaper cost and still profit. If you as a doctor really believe that you have the final word as to the treatment of your patients, why allow so many extra players into the doctor patient relationship?
Keep it simple, easy to understand, and efficient.
 
Status: Pre-medical. TL;DR.

I appreciate the call for honesty.
However, without knowing anything about you, chances are good that I've got at least a few years on you in the private business sector. I also understand that this section of the forum is for practicing physicians. This is a subject that I'm passionate about, and I am thoroughly enjoying the discussion.
 
See, that's why I want to see the numbers myself.

Let's say you do 900 pts at $50 per = $540,000 - [x% for taxes] - [rent; can range from 12k per year to $70k per year hence my location location location comment] - [salaries; my assumption is there would be at least 1 front office person and a nurse or two for patient triage/flow, no way you're doing that for 60k no matter where you live] - [marketing to Republicans who hate the government] - [start up costs for first couple of years]

There is no way you're walking away with 240k in my city (not a bit city by any means) with that structure. This is why I want/need to see his books. A lot of people I've talked to have gone the route of not taking insurance but ALL of them have taken (steep) pay cuts.
Atlas has 1 full time nurse and one part time nurse for 3 doctors, no other staff. A single doctor would only need 1 nurse and you could do that for 60k including benefits lots of places.

Obviously this will be somewhat location dependent. NYC or SF will have higher overhead on all fronts (rent, utilities, taxes). I suspect you could make up for that with somewhat higher fees since folks in those places are used to paying more for most things.

Start up costs are surprisingly low. The biggest cost will be renovating office space and initial equipment, the latter can be done for under 50k (I've priced it). Not sure about the former yet, but I'd bet about 50k assuming you start small and don't go overboard.
 
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great conversations!! congrats to everyone.

1) don't forget, i'm right here :) no need to speculate, just ask.

2) Yes the math work out. $50/pt/mo x 600 pts (yes you 'could' do more) = 360k/doc/yr with overhead about 20% for a solo doc. Our % overhead is actually less b/c of economies of scale.

Rent 5k/mo -- waaaay higher than most docs need. I'm seen dpc docs do rent for 1k/mo.

Staff. $27/hr. Thats better than hospital nurses makes. No need for reception, triage, etc. 1 RN per 2 docs. Thats ample.

Location - sure location matters and you adjust your price accordingly (up or down). NY NY, yeah prices are going to be different but the model will be different too. Adjust to the population.

Does it really work - Yes, i went from 1 doc and zero pts to 3 docs and 1800+ pts in 4 years. We helped launch about 57 docs in 45 clinics over the last 15 months or so

Server Analogy - BEST. ANALOGY. EVER.
 
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great conversations!! congrats to everyone.

1) don't forget, i'm right here :) no need to speculate, just ask.

2) Yes the math work out. $50/pt/mo x 600 pts (yes you 'could' do more) = 360k/doc/yr with overhead about 20% for a solo doc. Our % overhead is actually less b/c of economies of scale.

Rent 5k/mo -- waaaay higher than most docs need. I'm seen dpc docs do rent for 1k/mo.

Staff. $27/hr. Thats better than hospital nurses makes. No need for reception, triage, etc. 1 RN per 2 docs. Thats ample.

Location - sure location matters and you adjust your price accordingly (up or down). NY NY, yeah prices are going to be different but the model will be different too. Adjust to the population.

Does it really work - Yes, i went from 1 doc and zero pts to 3 docs and 1800+ pts in 4 years. We helped launch about 57 docs in 45 clinics over the last 15 months or so

Server Analogy - BEST. ANALOGY. EVER.

Thanks Dr. Josh.

Freely given!
Feel free to put that one in the ol' AtlasMD podcast!

or not.
or do!
 
ohhhh yes, i'll be using that analogy and i'll try to give you credit :)
 
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A question for Atlas:

Do you do inpatient? If so, how is that covered? (How are you paid and how is the hospital paid?) If not, any thoughts on how to do inpatient as well as outpatient.
 
No, we don't do inpatient for a variety of reasons, but you could. You don't have to take insurance to work in the hospital.
 
great conversations!! congrats to everyone.

1) don't forget, i'm right here :) no need to speculate, just ask.

2) Yes the math work out. $50/pt/mo x 600 pts (yes you 'could' do more) = 360k/doc/yr with overhead about 20% for a solo doc. Our % overhead is actually less b/c of economies of scale.

Rent 5k/mo -- waaaay higher than most docs need. I'm seen dpc docs do rent for 1k/mo.

Staff. $27/hr. Thats better than hospital nurses makes. No need for reception, triage, etc. 1 RN per 2 docs. Thats ample.

Location - sure location matters and you adjust your price accordingly (up or down). NY NY, yeah prices are going to be different but the model will be different too. Adjust to the population.

Does it really work - Yes, i went from 1 doc and zero pts to 3 docs and 1800+ pts in 4 years. We helped launch about 57 docs in 45 clinics over the last 15 months or so

Server Analogy - BEST. ANALOGY. EVER.


Atlas MD, seriously, very interesting stuff.

About the part in bold, well, I would say that is better than only some hospital nurses make. Even south of the Mason-Dixon Line, the modifier "some" is applicable. It's common knowledge to experienced RNs that they will usually make considerable less working in a doc's office than in hospital or even in doing case mgt. Of course, the pluses for some nurses in working in physician offices are that it's often a much less stressful environment, it may be closer to home--or nearer to their children if they have them, day hours with limited evenings and weekends, and no holidays, and they may actually get to eat their lunches most days. :) So, for some RNs this works out fine. For others it is would be a > $20,000 loss is yearly wages, excluding overtime, if available. Cost-savings is why more offices use medical assistants (not nurses) or LPNs (1 year practical nurses, who probably in most cases have little to no acute or more serious-care experience). I mean I get it. You have to cut costs where necessary. Just saying, in many places, even in south, as far as hospitals and other certain areas, that's low for an experienced RN.
 
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Re: the poll:

The 2/3 answer is great; but I mean both forces are strongly at play, no? And aren't their most complex cases thrown in that will naturally require more time? I mean, complexity/acuity are factors too, no? I think this would be hard to juggle at times. There are some folks that you will naturally have to give more than 15 minutes to, one way or another--even if it means following up with labs, other diagnostics, etc, later.

As a patient, however, I would be grateful for the 2/3rds that choose the second answer. If I felt like it was a robotic, assembly-line kind of deal, yea, that would affect me staying with a particular practice. Thankfully, my FP doc is awesome in this respect, while also being careful in his work. :)
 
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Oh yes, some patients need more time than others. Our shortest appointments are 30 minutes but we'll often schedule 60 minutes for pts that need more. Thats the beauty of the model - flexibility. And its great knowing that the prices are set. I can watch a lot of movies or a few on netflixs but my price is the same. And a pt can use more time as needed w/o a change in cost.
 
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