Income Potential

[JohnnyDoc]

Hi, I'm an OMS1, and am interested in going into family medicine.

I have a question about income potential. Once you finish residency and start working as attending, earning 200k a year (after tax 130k), do you earn that much every year for the rest of your career? Or is there room for it to increase? I guess this question also applies to every other medical specialty.

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[deleted87716]

Hi, I'm an OMS1, and am interested in going into family medicine.

I have a question about income potential. Once you finish residency and start working as attending, earning 200k a year (after tax 130k), do you earn that much every year for the rest of your career? Or is there room for it to increase? I guess this question also applies to every other medical specialty.

It should increase, although maybe not exactly with the rate of inflation.

 

[mabinante]

Here in Southern California, starting is around 220 to 240. If you hired on with a big place like Kaiser your salary would go up for the first three or five years until you make partner. After that it doesn't go up a whole lot. They call it the golden handcuffs though because you're stuck in the big group situation but they give you amazing perks and benefits.

 

[JohnnyDoc]

Would that 220 to 240k be before income tax or after income tax? And would that be true if you enter private practice?

I'm interested in working for a hospital as a hospitalist for the first couple of years, then probably look into working in an office setting too.

Somewhat unrelated, do family physicians go on mission trips (travel, teach premed students, treat people from rural regions) in their off or vacation times? I would be interested in that too.

 

[InternistDO]

Would that 220 to 240k be before income tax or after income tax? And would that be true if you enter private practice?

Pre-tax, definitely.

 

[FrustratedFamDoc]

They typical contracts offer a teaser salary for the first couple years and then there will be an 'adjustment' afterwards for what you're truly worth, ie. what sort of revenue are you bringing in. If you're taking over for another very established physician, then you'll already have a large panel of patients and your days will be full. If you're coming in and asked to build a panel from scratch, especially in a saturated market, you may be in for a surprise 2 years later.

 

[Merely]

They typical contracts offer a teaser salary for the first couple years and then there will be an 'adjustment' afterwards for what you're truly worth, ie. what sort of revenue are you bringing in. If you're taking over for another very established physician, then you'll already have a large panel of patients and your days will be full. If you're coming in and asked to build a panel from scratch, especially in a saturated market, you may be in for a surprise 2 years later.

Can you and others provide insight into how likely it is for someone in the next ten years to graduate residency then right away open up a practice and begin working? Is that reasonable or do you have to be employed first?

 

[FrustratedFamDoc]

The typical grad these days will be coming out of residency with a ton of debt. The wolves (loan servicers) are at the door the moment you graduate. Similar to a starving man making his way through the desert, a hoofed man with a forked tail offering a cup of water it pretty darn appealing. That cup of water is corporate medicine these days.

DPC and starting up your own shop is appealing, but simply not feasible for the grad coming out of residency with debt, unless you've got another way to pay on that loan and have money to survive. They day you open the doors on your new shop, unless you've already done something to lay groundwork (again, $$$), you're probably going to be really, really slow. Getting a patient panel takes time. From what I've seen, expect 12-24 months before your days are full.

So getting back to the point, the majority of family med grads come out of residency with big debt. It has to get paid ASAP... like yesterday. I signed a teaser deal and am in my 4th year of it now. My days are full, but my check is a good bit lighter than it was originally.

 

[FamilymedMD]

DPC and starting up your own shop is appealing, but simply not feasible for the grad coming out of residency with debt, unless you've got another way to pay on that loan and have money to survive. They day you open the doors on your new shop, unless you've already done something to lay groundwork (again, $$$), you're probably going to be really, really slow. Getting a patient panel takes time. From what I've seen, expect 12-24 months before your days are full.

Your assumptions about Direct Primary Care (DPC) are inaccurate and it would be a mistake to rule that out without looking carefully at the DPC options in the regions a new physician is considering. I started a DPC two years ago when I was already in debt from trying to keep a group practice afloat and with three kids in college so I can assure you it is possible to get a DPC started from scratch despite significant personal cash flow issues. Moonlighting at urgent cares, hospitals, addiction clinics, etc. is important but available in many areas. For a new physician joining an established DPC practice or starting a DPC in an area where the market is already familiar with the model, it will be easier than for those of us introducing the concept in each area.

 

[psychMDhopefully]

The typical grad these days will be coming out of residency with a ton of debt. The wolves (loan servicers) are at the door the moment you graduate. Similar to a starving man making his way through the desert, a hoofed man with a forked tail offering a cup of water it pretty darn appealing. That cup of water is corporate medicine these days.

DPC and starting up your own shop is appealing, but simply not feasible for the grad coming out of residency with debt, unless you've got another way to pay on that loan and have money to survive. They day you open the doors on your new shop, unless you've already done something to lay groundwork (again, $$$), you're probably going to be really, really slow. Getting a patient panel takes time. From what I've seen, expect 12-24 months before your days are full.

So getting back to the point, the majority of family med grads come out of residency with big debt. It has to get paid ASAP... like yesterday. I signed a teaser deal and am in my 4th year of it now. My days are full, but my check is a good bit lighter than it was originally.

What was you original salary, and what did you salary drop to?

 

[FrustratedFamDoc]

I'm a pretty modest guy so I don't discuss what I make, but my guaranteed salary decreased in the amount of what could buy a Lexus.

 

[wilberforce72]

I'm a pretty modest guy so I don't discuss what I make, but my guaranteed salary decreased in the amount of what could buy a Lexus.

...I'm not sure what modesty has to do with someone asking you a question. An immodest person would just brag unprompted about how much they make. Your comparison to a Lexus wasn't very helpful as Lexus models range from 30k-120k.

 

[psychMDhopefully]

I'm a pretty modest guy so I don't discuss what I make, but my guaranteed salary decreased in the amount of what could buy a Lexus.

?? Its an anonymous web forum.

 

[FrustratedFamDoc]

So let me get this straight. I take the time out of my day to try and offer up some advice to people interested in the field and am then challenged on my personal beliefs for not wanting to discuss salary.

Y'all have a thing or two to learn about gratitude and manners.

 

[iamdrjohns]

I rotated with a family physician who works in a somewhat rural clinic that is owned by a large hospital corporation. He has an established patient panel, 8 years into practice. His compensation recently changed to productivity based on work RVU. Its about $47 per work RVU.

Monday 8am-5pm, 36 patients
Tuesday 8am-5pm, 36 patients
Wed 8-am-9pm, 48 patients
Thursday OFF
Friday 8am-2pm, 25 patients

Two of the mornings, he sees 4 hospital patients before 8am office each day. Thats 153 patient visits per week, which comes out to about 188 work RVUs per week. He has 3 nurses, one of them helps write his notes which he proofreads at the end of the day with edits. He is most thorough doctor I know. He is efficient. He works 47 weeks out of the year. He makes over $400,000.

 

[wilberforce72]

So let me get this straight. I take the time out of my day to try and offer up some advice to people interested in the field and am then challenged on my personal beliefs for not wanting to discuss salary.

Y'all have a thing or two to learn about gratitude and manners.

Whoops. Sorry you got offended. Please forgive me. Not my intent. You don't have to say how much you make, but could you expand on how much your salary went down percentage-wise?

 

[Merely]

I rotated with a family physician who works in a somewhat rural clinic that is owned by a large hospital corporation. He has an established patient panel, 8 years into practice. His compensation recently changed to productivity based on work RVU. Its about $47 per work RVU.

Monday 8am-5pm, 36 patients
Tuesday 8am-5pm, 36 patients
Wed 8-am-9pm, 48 patients
Thursday OFF
Friday 8am-2pm, 25 patients

Two of the mornings, he sees 4 hospital patients before 8am office each day. Thats 153 patient visits per week, which comes out to about 188 work RVUs per week. He has 3 nurses, one of them helps write his notes which he proofreads at the end of the day with edits. He is most thorough doctor I know. He is efficient. He works 47 weeks out of the year. He makes over $400,000.

Damn 400k only seeing 30-40 patients on average, not bad at all.

 

[vendtex]

"Only 30-40"


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[Merely]

"Only 30-40"


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lol very true but also consider some subspecialists are popping out 70 patients a day so if you have mainly stable followups I wouldn't imagine it would be too bad!

 

[Mjolner]

"Only 30-40"


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Agreed. But if he worked a 5 day week it's closer to 25 which isn't that unusual.


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[vendtex]

Agreed. But if he worked a 5 day week it's closer to 25 which isn't that unusual.


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It's 29 in a five day. My point is just that it's not easy to average that amount day in and day out. If he's seeing inpatients two days a week he's also likely on call 1/3 or close to that which also likely means weekends. In my experience $47/RVU is a little on the high side but this might be a rural health clinic with better reimbursement. Obviously some of those RVUS are hospital based as well. Sometimes hospitals take a loss on the outpatient side for a gain on the inpatient. If it's not a rural health that may not be sustainable or if rural health reimbursement changes.

Just as an aside it isn't always easy to find this kind of situation. I can't tell you how many times recruiters say you can be as "busy as you want to be " but the reality may be quite different. In general it often takes about two years to ramp up to the point of getting to the guaranteed salary. Some people aren't able to see that many patients even if they wanted too.


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[vendtex]

The potential is good but it may take some work and luck to land a good situation.


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[VA Hopeful Dr]

lol very true but also consider some subspecialists are popping out 70 patients a day so if you have mainly stable followups I wouldn't imagine it would be too bad!

Its easy to do with a single organ system and getting to ignore everything else, not as easy to do in family medicine - at least not if you want to do a good job.

 

[FrustratedFamDoc]

Whoops. Sorry you got offended. Please forgive me. Not my intent. You don't have to say how much you make, but could you expand on how much your salary went down percentage-wise?

No problem at all. My salary decreased by about 23%.

I was given a 2 year guaranteed salary that was competitive with the market back in 2012 when I graduated. I started seeing some of the overflow just to get started, while seeing new patients on my own. Our practice had stopped seeing medicaid several years before I came along so I continued with that. My numbers really sucked for a good 10 months before I realized that I had to do something. I opened up to anybody and everybody. I started getting anywhere from 3-4 new patients a day, mostly medicaid, some more difficult than others. At the 2 year "re-evaluation" they looked at my numbers/revenue generated for the last year and came up with a new base salary that was 23% less than what my starting rate was. My contract has a base plus a certain amount for each patient I see after I see 280 on the month. I also get to keep any additional money in the good that my side makes after the corp takes their "contractual obligation."

Working for 'the man' has drawbacks but also has positives as well. The more physicians in your group, the more clout you have to negotiate reimbursement from insurance companies. They take care of my staffing, facility, billing, etc.

I don't regret my decision but going in, I was really blindsided by some things that I won't the next time. The salary re-evaluation and the contractual obligation are the two big ones.

 

[psychMDhopefully]

No problem at all. My salary decreased by about 23%.

I was given a 2 year guaranteed salary that was competitive with the market back in 2012 when I graduated. I started seeing some of the overflow just to get started, while seeing new patients on my own. Our practice had stopped seeing medicaid several years before I came along so I continued with that. My numbers really sucked for a good 10 months before I realized that I had to do something. I opened up to anybody and everybody. I started getting anywhere from 3-4 new patients a day, mostly medicaid, some more difficult than others. At the 2 year "re-evaluation" they looked at my numbers/revenue generated for the last year and came up with a new base salary that was 23% less than what my starting rate was. My contract has a base plus a certain amount for each patient I see after I see 280 on the month. I also get to keep any additional money in the good that my side makes after the corp takes their "contractual obligation."

Working for 'the man' has drawbacks but also has positives as well. The more physicians in your group, the more clout you have to negotiate reimbursement from insurance companies. They take care of my staffing, facility, billing, etc.

I don't regret my decision but going in, I was really blindsided by some things that I won't the next time. The salary re-evaluation and the contractual obligation are the two big ones.

How long was your contract for? Did they do maybe a 5 year contract, with 2 years being guaranteed salary, then the next 3 based on production?

 

[FrustratedFamDoc]

How long was your contract for? Did they do maybe a 5 year contract, with 2 years being guaranteed salary, then the next 3 based on production?

You nailed it.

 

[Carouselambra]

Please forgive my ignorance as I'm not a doctor but I've always been curious about certain aspects of income generation for docs. As I search for PCPs to shadow I see quite a few PCPs and concierge doctors offering chelation therapy, IV vitamin/nutrition therapy (which seems like overkill to me for most people but again I'm no expert), appetite suppressants, dubious terms like "preventative aging." Some of these are medi spas but others are standard primary care offices that offer extra stuff on the side. Do a lot of physicians utilize these therapies? For IV "nutrition" is it truly for say anemic patients who qualify for iron injections vs. giving injections because someone asks for it/whats the harm/easy money? I'm not trying to point fingers or anything, truly just curious since clearly at least some doctors are offering it.

I'm very interested in becoming a PCP but I'm not particularly on board with things like chelation and weight loss programs with appetite suppressants/injections. I bust my butt in the gym to stay in good shape and couldn't imagine prescribing a suppressant so you could lose weight. Can you guys just shed some light on me please? Is this stuff proven and legitimate to offer or is it more in line with OMM having some benefit but not much proof/anecdotal?

Perhaps I see a lot of this because I live in Florida where everyone goes to die but still wants to look good doing it?

 

[VA Hopeful Dr]

Please forgive my ignorance as I'm not a doctor but I've always been curious about certain aspects of income generation for docs. As I search for PCPs to shadow I see quite a few PCPs and concierge doctors offering chelation therapy, IV vitamin/nutrition therapy (which seems like overkill to me for most people but again I'm no expert), appetite suppressants, dubious terms like "preventative aging." Some of these are medi spas but others are standard primary care offices that offer extra stuff on the side. Do a lot of physicians utilize these therapies? For IV "nutrition" is it truly for say anemic patients who qualify for iron injections vs. giving injections because someone asks for it/whats the harm/easy money? I'm not trying to point fingers or anything, truly just curious since clearly at least some doctors are offering it.

I'm very interested in becoming a PCP but I'm not particularly on board with things like chelation and weight loss programs with appetite suppressants/injections. I bust my butt in the gym to stay in good shape and couldn't imagine prescribing a suppressant so you could lose weight. Can you guys just shed some light on me please? Is this stuff proven and legitimate to offer or is it more in line with OMM having some benefit but not much proof/anecdotal?

Perhaps I see a lot of this because I live in Florida where everyone goes to die but still wants to look good doing it?

Only the unscrupulous ones. Most of us are just doctors...

 

[bronx43]

Please forgive my ignorance as I'm not a doctor but I've always been curious about certain aspects of income generation for docs. As I search for PCPs to shadow I see quite a few PCPs and concierge doctors offering chelation therapy, IV vitamin/nutrition therapy (which seems like overkill to me for most people but again I'm no expert), appetite suppressants, dubious terms like "preventative aging." Some of these are medi spas but others are standard primary care offices that offer extra stuff on the side. Do a lot of physicians utilize these therapies? For IV "nutrition" is it truly for say anemic patients who qualify for iron injections vs. giving injections because someone asks for it/whats the harm/easy money? I'm not trying to point fingers or anything, truly just curious since clearly at least some doctors are offering it.

I'm very interested in becoming a PCP but I'm not particularly on board with things like chelation and weight loss programs with appetite suppressants/injections. I bust my butt in the gym to stay in good shape and couldn't imagine prescribing a suppressant so you could lose weight. Can you guys just shed some light on me please? Is this stuff proven and legitimate to offer or is it more in line with OMM having some benefit but not much proof/anecdotal?

Perhaps I see a lot of this because I live in Florida where everyone goes to die but still wants to look good doing it?

Just don't prescribe it...

I don't know what "IV nutrition" is, but I'm guessing they just inject some B12 or something. From my perspective, if you tell a patient that there is no data to support these "alternative" therapies, and they STILL want it due to whatever reason, then I wouldn't think less of physicians who are offering this service for an out-of-pocket fee... as long as you are doing something that is not outright harmful to the patient.

 

[simpler2]

I rotated with a family physician who works in a somewhat rural clinic that is owned by a large hospital corporation. He has an established patient panel, 8 years into practice. His compensation recently changed to productivity based on work RVU. Its about $47 per work RVU.

Monday 8am-5pm, 36 patients
Tuesday 8am-5pm, 36 patients
Wed 8-am-9pm, 48 patients
Thursday OFF
Friday 8am-2pm, 25 patients

Two of the mornings, he sees 4 hospital patients before 8am office each day. Thats 153 patient visits per week, which comes out to about 188 work RVUs per week. He has 3 nurses, one of them helps write his notes which he proofreads at the end of the day with edits. He is most thorough doctor I know. He is efficient. He works 47 weeks out of the year. He makes over $400,000.

I don't see how any PCP can be a thorough provider when seeing 153 patient per week. Even in the healthiest of populations the numbers provided above would mean a patient every 14 minutes without lunch/bathroom break. I suppose if you simply did clerical work for healthy individuals this could work...

 

[Merely]

I don't see how any PCP can be a thorough provider when seeing 153 patient per week. Even in the healthiest of populations the numbers provided above would mean a patient every 14 minutes without lunch/bathroom break. I suppose if you simply did clerical work for healthy individuals this could work...

I shadow a solo guy that sees 60 a day so 300 a week

 

[VA Hopeful Dr]

I shadow a solo guy that sees 60 a day so 300 a week

And if that's an 8 hour day then it's not very good care.

I did that routinely in a 12 hour UC day and anything more complicated than a cold or poison ivy didn't get great care.

 

[sazerac]

Just don't prescribe it...

I don't know what "IV nutrition" is, but I'm guessing they just inject some B12 or something. From my perspective, if you tell a patient that there is no data to support these "alternative" therapies, and they STILL want it due to whatever reason, then I wouldn't think less of physicians who are offering this service for an out-of-pocket fee... as long as you are doing something that is not outright harmful to the patient.

Looks like it... vitamins B, C, glutathione, and just plain hydration. There is an outfit in New Orleans that promotes IV nutrition as a hangover cure. I can't find their prices online, but the last time I checked it was somewhere between $100 and $300 cash per treatment. Some emergent care clinics offer it as a service too, especially those in the hotel / bar district.

You can even make appointments ahead of time, in case you know you are going to have a hangover Tuesday morning after the Saints play Monday night football.

http://www.theremedyroom.com/2013/01/the-story/

 

[Carouselambra]

Thanks for the answers guys/gals