Idle musings.

[justaregularmed]

Lets pick on a random state, Michigan. They reimburse 25 dollars for an office vists (medicaid).

I has a big long rant about this but essentially if you see a patient every 20 minutes every single weekday of the year you can make 13,000 dollars a month.

Oh wait taxes.

So if you started your own practice your total tax burden would be AT LEAST 40%. So knock that down to 7,800.

Oh yeah education loans, and the loan I took out to start my practice ~300,000 dollars. Take off another 2,500-3,500 a month.

4,300-5,300 is left.

I'll be generous and say your malpractice costs 20,000 dollars a year (which is really ~25,000 on average), and I'll round down 1,600 a month.

That leaves you with 2700-3700 a month or, 32,400-44,400 a year to live on, practice costs after your loan runs out, etc.



So yes, I posted a similar replay somewhere else. I was just bored and decided to run some numbers.

What does everyone think?

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[cpants]

Uh, you forgot some major things, like leasing an office, paying staff, supplies, utilities, equipment. The reality is almost any physician LOSES money each time they see a medicaid patient, which is why no physicians see exclusively medicaid patients (unless they are paid a salary to do so by a hospital).

 

[justaregularmed]

Uh, you forgot some major things, like leasing an office, paying staff, supplies, utilities, equipment. The reality is almost any physician LOSES money each time they see a medicaid patient, which is why no physicians see exclusively medicaid patients (unless they are paid a salary to do so by a hospital).

That was the ETC part .

So my retort is how can any medical student support the current vein of healthcare reform, because this is our future. Now the thing is, the new reform supposedly makes everything reimburse at Medicare rates. States can hardly afford Medicaid as it is. How are they supposed to support this bill when they have to foot the bill?

 

[BigRedder]

The major drain on Medicaid isn't poor people going to their doctors, it's old people in nursing homes. Yet again, decrepit old people are draining all our money, and they ain't dying anytime soon.

 

[werd]

the amount of office visit reimbursement depends on new vs. return patient and the level of the encounter. i can only speak for the (specialty) practice i work at but it's more like $30-110 per encounter that medicare pays. and procedures generally reimburse a lot more. also, many physicians in an office practice see 40 patients per day (8 hour day, that's 1 per 12 minutes). some attendings in my office see 60+ patients per day.

so... i think your estimate of patients/day is low, and you don't account for all of the procedures that bring in much more reimbursement. i agree with you that seeing 1 patient/20 minutes and not doing procedures can't sustain a practice. cheers.

 

[justaregularmed]

the amount of office visit reimbursement depends on new vs. return patient and the level of the encounter. i can only speak for the (specialty) practice i work at but it's more like $30-110 per encounter that medicare pays. and procedures generally reimburse a lot more. also, many physicians in an office practice see 40 patients per day (8 hour day, that's 1 per 12 minutes). some attendings in my office see 60+ patients per day.

so... i think you're estimate of patients/day is low, and you don't account for all of the procedures that bring in much more reimbursement. i agree with you that seeing 1 patient/20 minutes and not doing procedures can't sustain a practice. cheers.

Appreciated, I've seen quite a large spectrum and I tried to shy away from the extremes. I agree completely with the whole new-patient vs. follow up, I suppose the average is a bit low, maybe 30-35 would be better. Remember in reality too we will have days off, holidays, etc as well. I don't know how to enumerate procedures on an annual basis, (frequency vs. reimbursement) maybe someone will drop by who does. Our grand experiment is some sort of adult internal medicine or pediatrics I guess maybe family practice.

 

[cpants]

The major drain on Medicaid isn't poor people going to their doctors, it's old people in nursing homes. Yet again, decrepit old people are draining all our money, and they ain't dying anytime soon.

Old people are on mediCARE. It's different.

 

[dpmd]

Old people are on mediCARE. It's different.

Old people in nursing homes who have run out their medicare benefit and their savings (or whose families have managed to take assets out of their names) are then funded by medicaid. So the demented old lady/man with multiple medical conditions who lives in the nursing home for years doing nothing but screaming and ****ting on themselves until they die is doing it on mediCAID's tab. And for some reason they all seem to be full code

 

[oldiebutgoodie]

Old people in nursing homes who have run out their medicare benefit and their savings (or whose families have managed to take assets out of their names) are then funded by medicaid. So the demented old lady/man with multiple medical conditions who lives in the nursing home for years doing nothing but screaming and ****ting on themselves until they die is doing it on mediCAID's tab. And for some reason they all seem to be full code

Saw a 101-year old lady being transported to the OR the other day for a small bowel obstruction. There is not enough education in our society on the difference between DNR, hospice (eek! you're going to kill grandpa!), comfort care. Thank you, Sarah Palin.

Oldiebutgoodie