Family Medicine Salaries Continue to Climb

[Ericslv]

Are all these offers from hospital systems or is physician owned private practice still clinging to life in some areas?

There are many physician owned practices (single specialty and multi specialty) who are hiring and going strong. Many are not offering partnership. That seems to be the trend. And many of the old partners are working longer. The issue is when or if the big groups will sell to the hospitals and if they do what happens to the employee doctor. Will they stay or leave. I guess that would depend on the contract negotiations and the individual situation of each doctor.

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[deleted87716]

There are many physician owned practices (single specialty and multi specialty) who are hiring and going strong. Many are not offering partnership.

We certainly are.

 

[Ericslv]

We certainly are.

Hiring, offering partnership or both?

 

[FiveRivers]

I'm sure there are some of us (residents) who would like to join a private practice, buy into one, or eventually start our own. However, the tricky part is, that there appears to be a greater amount of job opportunities (found online, from recruiters, emails, etc.) that are either hospital owned groups or positions that simply hire you as an employee.

How are we to find private practice opportunities? Email private practices directly? Even then, why would a private doc or a group of private docs want a fresh grad to join their practice? It just seems so hard to find a way into the private practice world.

On a side note, it seems more feasible to be the owner of your own urgent care than to start a family medicine private practice? Is this correct?

 

[deleted87716]

Hiring, offering partnership or both?

Yes.

 

[Ericslv]

I'm sure there are some of us (residents) who would like to join a private practice, buy into one, or eventually start our own. However, the tricky part is, that there appears to be a greater amount of job opportunities (found online, from recruiters, emails, etc.) that are either hospital owned groups or positions that simply hire you as an employee.

How are we to find private practice opportunities? Email private practices directly? Even then, why would a private doc or a group of private docs want a fresh grad to join their practice? It just seems so hard to find a way into the private practice world.

On a side note, it seems more feasible to be the owner of your own urgent care than to start a family medicine private practice? Is this correct?

Well it seems there is a position open in blue dogs group practice. There are many practices that hire fresh grads.

Spending a year or two working and paying off student loans is not a bad thing. Use the hospital and corp med for a couple of years. Make money, get experience. Do locum and find out where you want to live if your not sure. Why jump into something permanent right away.

Opening your own urgent care takes business skills. Opening a DPC takes business skill but there are many resources out there. Even if you did a DPC you would need to moonlight for at least two to three years.

Your question tell me that you need to get some financial and professional skills. Go to white coat investor a couple of hours a weeks and learn.

 

[VA Hopeful Dr]

Why would you think that...?

In all fairness ACA plans in my area pay worse than anyone accept Medicaid so if that is a substantial part of your practice and you don't change volume then you will earn less money

 

[VA Hopeful Dr]

Well it seems there is a position open in blue dogs group practice. There are many practices that hire fresh grads.

Spending a year or two working and paying off student loans is not a bad thing. Use the hospital and corp med for a couple of years. Make money, get experience. Do locum and find out where you want to live if your not sure. Why jump into something permanent right away.

Opening your own urgent care takes business skills. Opening a DPC takes business skill but there are many resources out there. Even if you did a DPC you would need to moonlight for at least two to three years.

Your question tell me that you need to get some financial and professional skills. Go to white coat investor a couple of hours a weeks and learn.

Two or three years moonlighting might be a bit much for DPC. I was at 50% capacity by month 11 and Josh at Atlas was at full capacity by year 2

 

[deleted87716]

In all fairness ACA plans in my area pay worse than anyone accept Medicaid so if that is a substantial part of your practice and you don't change volume then you will earn less money

Is anyone forcing you to accept these plans?

 

[deleted87716]

Well it seems there is a position open in blue dogs group practice.

Several openings, actually. We're in growth mode, and a few docs have retired recently.

 

[Brahnold Bloodaxe]

Is anyone forcing you to accept these plans?

That's the point isn't it. The ultimate goal of Obamacare is to make these ACA rates the norm rather than the exception. Being "forced" to accept them will be a moot point if they end up being the only thing on offer. So at the end of the day, Obamacare's creation of ACA plans and its popularizing of bottom of the barrel reimbursement schemes is a valid reason why people expected and still expect Obamacare to adversely impact physician salaries.

 

[VA Hopeful Dr]

Is anyone forcing you to accept these plans?

I take no plans, so no... but I get what you're saying.

However, the statement "The ACA will result in lower doctors' salaries" is true-ish. If your insurance mix didn't change at all with the ACA, then nothing has likely changed with your income. If, for whatever reason, you chose to/had to accept ACA plans then your income likely did take a hit.

 

[Ericslv]

I take no plans, so no... but I get what you're saying.

However, the statement "The ACA will result in lower doctors' salaries" is true-ish. If your insurance mix didn't change at all with the ACA, then nothing has likely changed with your income. If, for whatever reason, you chose to/had to accept ACA plans then your income likely did take a hit.

In my opinion the biggest threat is if they make it mandatory. Like Canada. I don't think that will happen. I think it will most likely be like UK or Australia. Public and private. This model will work well with DPC or specialty etc.

 

[VA Hopeful Dr]

In my opinion the biggest threat is if they make it mandatory. Like Canada. I don't think that will happen. I think it will most likely be like UK or Australia. Public and private. This model will work well with DPC or specialty etc.

You mean like Hawaii or Mass. did with their state medicaid plans?

I do agree that if we go in a single-payer direction it will be a 2-tiered thing. The only good thing about that will be watching hospital systems implode...

 

[Ericslv]

You mean like Hawaii or Mass. did with their state medicaid plans?

I do agree that if we go in a single-payer direction it will be a 2-tiered thing. The only good thing about that will be watching hospital systems implode...

You what I can tell you without any doubt? My cash patients are the happiest patients I have. Insurance patients complain about something. But cash patients just don't seem to do that.

 

[VA Hopeful Dr]

You what I can tell you without any doubt? My cash patients are the happiest patients I have. Insurance patients complain about something. But cash patients just don't seem to do that.

Yeah I've noticed that too. Heck, I am an insurance patient and will often bitch to my PCP about how awful the plan is.

 

[needachange2017]

Honestly though, if you can make 300k after 3 yrs of what is generally considered a middle of the road difficult residency, all the power to you guys.

I, for one, am jealous.

 

[Ericslv]

Honestly though, if you can make 300k after 3 yrs of what is generally considered a middle of the road difficult residency, all the power to you guys.

I, for one, am jealous.

In DPC to make 300K you will need about 800 patients. Medlion DPC is around 800 to 1000. Atlas states 600 but that makes about 240K.

So you see about 8 to 12 pt/day. Some may not be face to face. Vahopeful and others doing DPC can shed more light on that.

But 300K in insurance practice in FM is harder. Seeing 30+ pt per day or being procedure heavy or rural which means more pt. per day and probably increased acuity.

 

[VA Hopeful Dr]

In DPC to make 300K you will need about 800 patients. Medlion DPC is around 800 to 1000. Atlas states 600 but that makes about 240K.

So you see about 8 to 12 pt/day. Some may not be face to face. Vahopeful and others doing DPC can shed more light on that.

But 300K in insurance practice in FM is harder. Seeing 30+ pt per day or being procedure heavy or rural which means more pt. per day and probably increased acuity.

Assuming an employed position at $40 per wRVU you'll need 7500 wRVUs to make 300k (naturally partnership arrangements like Blue Dog will calculate that differently). Now you and I both know that the majority of patient encounters can be coded 99214 so worth 1.5 wRVUs so that's only 5000 patient encounters/year. Assuming 20 patients per day, that's 250 working days or 50, 5-day work weeks. Now most doctors will see more like 22-25, if its 25 patients/day that's only 40, 5-day work weeks per year.

 

[Mad Jack]

You mean like Hawaii or Mass. did with their state medicaid plans?

I do agree that if we go in a single-payer direction it will be a 2-tiered thing. The only good thing about that will be watching hospital systems implode...

That plan got shut down in Mass, as far as I can tell, and nothing has passed in Hawaii. It is highly doubtful that such legislation would pass, and even if it did, that it would hold up to a SCOTUS challenge. Legal rate-setting would be a possibility, but forcing someone to accept a form of payment they do not want to has no basis in case law that I know of.

 

[VA Hopeful Dr]

That plan got shut down in Mass, as far as I can tell, and nothing has passed in Hawaii. It is highly doubtful that such legislation would pass, and even if it did, that it would hold up to a SCOTUS challenge. Legal rate-setting would be a possibility, but forcing someone to accept a form of payment they do not want to has no basis in case law that I know of.

Since a medical license is generally considered a privilege, I bet it would stand up to legal challenges - if they can make hospitals/doctors work for free (EMTALA) I can easily see accepting Medicaid as a condition of licensure passing muster.

 

[Ericslv]

Since a medical license is generally considered a privilege, I bet it would stand up to legal challenges - if they can make hospitals/doctors work for free (EMTALA) I can easily see accepting Medicaid as a condition of licensure passing muster.

Or they could say all hospital have to accept it and then the hospital can say if you want privileges you have to accept it. Like emtala. Then insurance companies can require that you have privileges at some hospital (like many do now) and there you have it. You now have a practice full of patient like that and not long after that you will be out of business or take a 50% pay cut because a 25% loss in revenue translates into about a 50% pay cut due to fixed and variable cost of running a practice.

The point is they can manipulate you in a 1000 ways. Hopefully I will either be retired by then or in a non-clinical setting.

 

[Mad Jack]

Since a medical license is generally considered a privilege, I bet it would stand up to legal challenges - if they can make hospitals/doctors work for free (EMTALA) I can easily see accepting Medicaid as a condition of licensure passing muster.

It would be interesting to see. The difference between the two is pretty substantial- one is life-saving treatment, while the other is routine care. Regardless, I don't think any policy makers would risk the backlash that would come from trying to implement such a plan, as it would likely end poorly, as it has in every state that's brought it up thusfar.

 

[Ericslv]

It would be interesting to see. The difference between the two is pretty substantial- one is life-saving treatment, while the other is routine care. Regardless, I don't think any policy makers would risk the backlash that would come from trying to implement such a plan, as it would likely end poorly, as it has in every state that's brought it up thusfar.

They will try it. It will fail and now the seeds are placed. Then the next guy and the next until one makes it through.

 

[Mad Jack]

Or they could say all hospital have to accept it and then the hospital can say if you want privileges you have to accept it. Like emtala. Then insurance companies can require that you have privileges at some hospital (like many do now) and there you have it. You now have a practice full of patient like that and not long after that you will be out of business or take a 50% pay cut because a 25% loss in revenue translates into about a 50% pay cut due to fixed and variable cost of running a practice.

The big thing is whether you can opt out of the system entirely. Which I really doubt any policy makers would want to approach, aside from the most hard-left. My biggest fear is such a law passing, as even in most universal healthcare systems physicians can opt out of accepting government insurance and go private and that is what I would want to do, but I just don't see such a law happening before I retire (hopefully).

 

[Mad Jack]

They will try it. It will fail and now the seeds are placed. Then the next guy and the next until one makes it through.

We don't need to hold out forever, we only need to do so until we're kicking back and retired. They've been trying to do the universal healthcare thing for fifty years now with no luck- all I need is another 25 before I can cash my chips out. Pretty sure we can make it.

 

[Ericslv]

We don't need to hold out forever, we only need to do so until we're kicking back and retired. They've been trying to do the universal healthcare thing for fifty years now with no luck- all I need is another 25 before I can cash my chips out. Pretty sure we can make it.

I hope you're right. I don't think we are going to be like Canada. I believe there is going to be a private and govt. option. Even if universal healthcare were to happen today private would still be an option. Once people have to wait in line like the DMV they will want to pay for things they value.

But if it does happen then I would forced (and I mean forced because I don't want to do this) to hire a bunch of PAs and supervise them. Do volume care and sit in the office doing chart reviews. Skim off the top of their work.

 

[Mad Jack]

I hope you're right. I don't think we are going to be like Canada. I believe there is going to be a private and govt. option. Even if universal healthcare were to happen today private would still be an option. Once people have to wait in line like the DMV they will want to pay for things they value.

Part of the justification for forcing physicians to accept payment in such systems is that medical school is subsidized, therefore it is the government paying your way into a government position. While they do subsidize our residencies, we are paying out of pocket and with loans for school. We paid for an education that entitles us to some self-determination, unlike systems that are centrally planned. Who knows though, it could go ugly, in which case I'd rather walk than stay in this country and practice as a physician.

 

[Ericslv]

We don't need to hold out forever, we only need to do so until we're kicking back and retired. They've been trying to do the universal healthcare thing for fifty years now with no luck- all I need is another 25 before I can cash my chips out. Pretty sure we can make it.

I thought doomsday won't happen. Then tump and brexit happened. So who knows.

 

[Mad Jack]

I thought doomsday won't happen. Then tump and brexit happened. So who knows.

Those are entirely in the opposite direction of socialism though, so I'd say we're in good shape as reactionary politics takes hold lol.

 

[Doctor4Life1769]

I thought doomsday won't happen. Then tump and brexit happened. So who knows.

That was a revolt against liberalism

 

[Ericslv]

That was a revolt against liberalism

I don't think bigotry is a revolt against liberalism. I'm more in the middle on things but crazy is crazy and common sense is important.

 

[Brahnold Bloodaxe]

I don't think bigotry is a revolt against liberalism. I'm more in the middle on things but crazy is crazy and common sense is important.

Completely agree. That's why it's important to vote Trump and finally get off the path to inevitable disaster. We have tried liberalism for decades and the results are clear. To paraphrase somebody or other, the definition of crazy is doing the same exact thing and expecting a different result.

The choice is obvious: vote for anyone but Trump and you vote for a continuation of economic, demographic, and societal decline with an accelerating drift toward leftist tyranny.

 

[Ericslv]

Completely agree. That's why it's important to vote Trump and finally get off the path to inevitable disaster. We have tried liberalism for decades and the results are clear. To paraphrase somebody or other, the definition of crazy is doing the same exact thing and expecting a different result.

The choice is obvious: vote for anyone but Trump and you vote for a continuation of economic, demographic, and societal decline with an accelerating drift toward leftist tyranny.

Sorry dude. I don't drink crazy cool aid. But good luck with that.

 

[Brahnold Bloodaxe]

Sorry dude. I don't drink crazy cool aid. But good luck with that.

Great. If you don't drink crazy koolaid, it means you are on the Trump Train. Welcome on board!

 

[Ericslv]

Great. If you don't drink crazy koolaid, it means you are on the Trump Train. Welcome on board!

NO I'm not. I hate bigots, racists and Trump who is both a racist and a bigot and only out for himself. I hate what he stand for. Just like I have the KKK.

 

[Doctor4Life1769]

I don't think bigotry is a revolt against liberalism. I'm more in the middle on things but crazy is crazy and common sense is important.

I was talking about Brexit.

 

[Ericslv]

I was talking about Brexit.

I know. I was replying to the other guy. Sorry.

 

[Mad Jack]

I don't think bigotry is a revolt against liberalism. I'm more in the middle on things but crazy is crazy and common sense is important.

Your statement drives home exactly why people are reacting against the left right now.

Wanting strong borders, an end to illegal immigration, removal of those residing in the country illegally, etc doesn't make one a racist, but that is how the democrats paint it. Not wanting to elect an untrustworthy political hack that has only gotten to where she is today through nepotism that holds stances that many of us find deplorable makes us the bad guys. The same goes for the Brexit- people were tired of having their national sovereignty eroded away by people they didn't elect in a city outside their country. Some of them were racists, but the vast majority weren't. Sovereignty is valuable to some of us, because we don't believe that lifetime politicians have anything but their own interests in mind, and the closer they are to being able to be booted out of office if they lose their minds or do something we dislike, the better.

Really, I'd prefer Johnson to win. But because of my priorities, I've got to settle for Trump.

 

[Ericslv]

Your statement drives home exactly why people are reacting against the left right now.

Wanting strong borders, an end to illegal immigration, removal of those residing in the country illegally, etc doesn't make one a racist, but that is how the democrats paint it. Not wanting to elect an untrustworthy political hack that has only gotten to where she is today through nepotism that holds stances that many of us find deplorable makes us the bad guys. The same goes for the Brexit- people were tired of having their national sovereignty eroded away by people they didn't elect in a city outside their country. Some of them were racists, but the vast majority weren't. Sovereignty is valuable to some of us, because we don't believe that lifetime politicians have anything but their own interests in mind, and the closer they are to being able to be booted out of office if they lose their minds or do something we dislike, the better.

Really, I'd prefer Johnson to win. But because of my priorities, I've got to settle for Trump.

I disagree. I lived in NYC. And I'm old enough to know about him.

But you know what I'm no longer replying to post that have to do with the election. Arguing online about it or in person goes nowhere. People have made up their minds. Any further post about it to me will simply be ignored.

 

[Doctor4Life1769]

I think if enough people had their heads out of their asses, they would band together and vote Libertarian. The problem is they don't.

Trump and Hillary are both incapable individuals for the White House.

 

[azhrei]

Your statement drives home exactly why people are reacting against the left right now.

Wanting strong borders, an end to illegal immigration, removal of those residing in the country illegally, etc doesn't make one a racist, but that is how the democrats paint it. Not wanting to elect an untrustworthy political hack that has only gotten to where she is today through nepotism that holds stances that many of us find deplorable makes us the bad guys. The same goes for the Brexit- people were tired of having their national sovereignty eroded away by people they didn't elect in a city outside their country. Some of them were racists, but the vast majority weren't. Sovereignty is valuable to some of us, because we don't believe that lifetime politicians have anything but their own interests in mind, and the closer they are to being able to be booted out of office if they lose their minds or do something we dislike, the better.

Really, I'd prefer Johnson to win. But because of my priorities, I've got to settle for Trump.

If you think success is with the republicans than look to Kansas where the state legislature is controlled by Republicans. Look at their economic difficulties and their inability to provide public services while the rich buy up property because their homes can't be taken away in Kansas by bankruptcy.

Look to Massachusetts for how liberals mess up a state. They are doing well economically, provide the best mental health services, and have some of the highest achieving public schools. Yet, the liberal elite, like the Republicans, allow for the widening income gap between the haves and have nots.

Voting for Trump is votin for someone who encourages racist remarks, bigotry, sexism, and violence. Look at the domestic terrorism by Christians against "outsiders" after Brexit. I don't want that for our country.

 

[Brahnold Bloodaxe]

Racism, xenophobia, bigotry, blah blah blah. A bunch of empty insults meaning nothing in this day and age. Here is racism in action for you:

http://www.huffingtonpost.com/entry/racist-brownies-3rd-grade-party_us_577541e9e4b042fba1cf5ccc

So fine. Trump is racist. He's a bigot. He's a xenophobe. Islamophobe! If there is any other pejorative I'm missing that has a place of special significance in yall's bleeding hearts just let me know and I'll add it to the mix. If you want to call me those names as well, have at it. I couldn't care less.

I'm with the guy who wants to stop and reverse the decades long decline of this country. You are with stupid.

 

[Doctor4Life1769]

Just anecdotal, but a friend that recently graduated had an offer from a large system and an offer from an independent hospital and the smaller hospital was much more open to negotiating. Further, the large system made a bunch of promises in the interview that weren't actually written in the contract. When they asked for those to be written in, they refused. If they're not willing to work with you, it's probably better to look elsewhere.

That's what I did

 

[surrender903]

R
So fine. Trump is racist. He's a bigot. He's a xenophobe. Islamophobe! If there is any other pejorative I'm missing that has a place of special significance in yall's bleeding hearts just let me know and I'll add it to the mix. If you want to call me those names as well, have at it. I couldn't care less.

did you wake up and decide to troll the FM board?

 

[smq123]

Let's get back on topic. If we can't do that, then the thread will have to be closed.

Thanks.

 

[psychMDhopefully]

It would be interesting to see. The difference between the two is pretty substantial- one is life-saving treatment, while the other is routine care. Regardless, I don't think any policy makers would risk the backlash that would come from trying to implement such a plan, as it would likely end poorly, as it has in every state that's brought it up thusfar.

What states have brought it up? I wouldnt be surprised if they made accepting low paying government insurance mandatory and because med schools only seem to admit ultra leftist, Bernie Sanders worshiping, spineless " why is 100k not enough for doctors?" worms, It would probably pass in our practice time.

 

[smq123]

...and we're done here.

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