New Practice Start up 2013, Obamacare coming, Help!

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OffPiste

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Thinking of starting a new private practice in early 2013, am I crazy with Obamacare coming?

Initially approached by a busy hospital to build a pain practice, and they offered a very nice contract with the ability to transition to private practice.

The hospital admin changed the contract at the last minute completely, and luckily I did not sign, as the new contract is a pile of crap.
Now thinking of just making this a PP from the get go, get 350-400K loan, C arm, etc., and make a go of it. (May end up as hospital employee eventually, but maybe I can get a few more good years and then sell to them for some small profit)
The area is relativly wide open for interventional pain.

Am I nuts?
Thoughts?

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Why do you need 350-400K loan?

should be existing medical space you can lease, lease a C-arm,etc

Think you could start with 100K
 
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when i tried to start a private practice out of fellowship - the most the bank would offer was a 15k loan/credit line since I did not have any real documented income, and I didn't have any assets/collateral (just debt)... good luck finding 350k!
 
Why do you need 350-400K loan?

should be existing medical space you can lease, lease a C-arm,etc

Think you could start with 100K

agree. you dont need 350k.
 
Maybe the OP means that the local hospital may be cajoled into offering such a loan
 
It would be best to wait until the new Medicare fee schedule is determined for next year. If there is a 27% reduction in practice income (medicare=anthem=tied to many other insurers), this translates to a 50-65% reduction in your personal income. It may be prudent to forgo an independent practice under such circumstances, since you would be heavy in debt at the outset and may not be profitable for a long time.
 
It would be best to wait until the new Medicare fee schedule is determined for next year. If there is a 27% reduction in practice income (medicare=anthem=tied to many other insurers), this translates to a 50-65% reduction in your personal income. It may be prudent to forgo an independent practice under such circumstances, since you would be heavy in debt at the outset and may not be profitable for a long time.


27% reduction? Where is this reduction coming from? And all I keep hearing about are cuts. Are most of you planning to simply take it/accept it and continue practicing if incomes keep declining?
 
27% reduction? Where is this reduction coming from? And all I keep hearing about are cuts. Are most of you planning to simply take it/accept it and continue practicing if incomes keep declining?

fiscal cliff.
 
fiscal cliff.

27%? Where did you find this number? So I guess the job market is going to be opening up for a good number of specialties, not to mention the tons of staff that are going to be laid off. Wow.
 
27%? Where did you find this number? So I guess the job market is going to be opening up for a good number of specialties, not to mention the tons of staff that are going to be laid off. Wow.

This 27% cut has been threatened for the past several years, and requires an act of congress each year to delay it.

It's been nicknamed the "doc fix" since a 1997 law linking Medicare payments to the GDP.

Generally delayed at the last min. May be different this year due to fiscal cliff...
 
27%? Where did you find this number? So I guess the job market is going to be opening up for a good number of specialties, not to mention the tons of staff that are going to be laid off. Wow.

It's called the SGR (sustained growth rate) or "doc fix". They threaten, but have passed the fix every time. They will again. A 27% drop in Medicare payments would destroy primary care and bankrupt all PCPs in an instant. For that reason alone, it will be passed again. All this "fiscal cliff" BS is just that. BS. They will keep spending like drunken sailors.
 
My concerns are that the Obamites feel empowered, that they believe they have a clear mandate from the public that their socialist redistribution of wealth policies should take precedence over silly things like the debt or deficits, and that doctors have been targeted as a cause of the health care crisis.
Obama's solutions:
- Tax the middle class with a new 2014 previously hidden $63 a year Obamacare tax on 190,000,000 Americans to pay for the onslaught of healthcare to be provided to the 30,000,000 that will be coming onboard in 2014 and 15 (this is stealing from the middle class to pay for the poor via a newly discovered provision in Obamacare law that was not discussed before now) http://money.msn.com/health-and-life-insurance/news.aspx?feed=AP&date=20121210&id=15884956
- Eliminate independent physicians by eliminating physician ownership of hospitals and physician owned hospital expansion, keeping physicians held at bay from meaningful competition with hospitals via antiquated Stark laws for self referral while giving hospitals free reign to own physician practices and self refer for services at inflated prices 250-1000% more than independent physicians would charge. He is doing this to herd physicians into the confines of hospital employees where they MUST see Medicaid .....they have no choice.
- Dumbing down medical care by permitting the inept, the incompetent, and the ersatz to be paid the same as physicians, regardless of the galactic differences in training, experience, or competence. Sebelius is a fool, but is operating consistently with the even more foolish Obama philosophies of lowering medical care to the lowest common denominator.
- Protecting hospitals from cuts (for now). Protecting the pharmaceutical industry (for now). Protecting the right to sue any doctor for any reason (forever). Sticking it to doctors by reducing fees through bundling of codes, elimination of codes and interventions, RAC audits, refusal of doctors to use electronic medical records, lack of electronic prescribing, and budgetary measures of the administration that have reduced the RVU due to financial prestidigitation regardless of SGR, and of course our beloved SGR. This year congress simply doesn't give a damn about the SGR, and indeed, it may not be repealed (it is already passed law) or it may be partially rolled back.

Remember, for every 27% percent reduction in Medicare/Anthem/Commercial insurers tied to Medicare, physicians will experience a 54% reduction in take home pay, even before the new Obama taxes kick in (with the typical 50% overhead of running an office)
 
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My concerns are that the Obamites feel empowered, that they believe they have a clear mandate from the public that their socialist redistribution of wealth policies should take precedence over silly things like the debt or deficits, and that doctors have been targeted as a cause of the health care crisis.
Obama's solutions:
- Tax the middle class with a new 2014 previously hidden $63 a year Obamacare tax on 190,000,000 Americans to pay for the onslaught of healthcare to be provided to the 30,000,000 that will be coming onboard in 2014 and 15 (this is stealing from the middle class to pay for the poor via a newly discovered provision in Obamacare law that was not discussed before now) http://money.msn.com/health-and-life-insurance/news.aspx?feed=AP&date=20121210&id=15884956
- Eliminate independent physicians by eliminating physician ownership of hospitals and physician owned hospital expansion, keeping physicians held at bay from meaningful competition with hospitals via antiquated Stark laws for self referral while giving hospitals free reign to own physician practices and self refer for services at inflated prices 250-1000% more than independent physicians would charge. He is doing this to herd physicians into the confines of hospital employees where they MUST see Medicaid .....they have no choice.
- Dumbing down medical care by permitting the inept, the incompetent, and the ersatz to be paid the same as physicians, regardless of the galactic differences in training, experience, or competence. Sebelius is a fool, but is operating consistently with the even more foolish Obama philosophies of lowering medical care to the lowest common denominator.
- Protecting hospitals from cuts (for now). Protecting the pharmaceutical industry (for now). Protecting the right to sue any doctor for any reason (forever). Sticking it to doctors by reducing fees through bundling of codes, elimination of codes and interventions, RAC audits, refusal of doctors to use electronic medical records, lack of electronic prescribing, and budgetary measures of the administration that have reduced the RVU due to financial prestidigitation regardless of SGR, and of course our beloved SGR. This year congress simply doesn't give a damn about the SGR, and indeed, it may not be repealed (it is already passed law) or it may be partially rolled back.

Remember, for every 27% percent reduction in Medicare/Anthem/Commercial insurers tied to Medicare, physicians will experience a 54% reduction in take home pay, even before the new Obama taxes kick in (with the typical 50% overhead of running an office)

Is it really going to be that bad? Don't physicians in every country in the western world still do very well, with specialists making a little bit more for the extra training? I know Obamacare has severe problems with it and the days of making 7 figures are gone, but is it going to be that bad?
 
Is it really going to be that bad? Don't physicians in every country in the western world still do very well, with specialists making a little bit more for the extra training? I know Obamacare has severe problems with it and the days of making 7 figures are gone, but is it going to be that bad?

either we will all be dead as of Dec 22. due to the Mayan calendar, or it will be some "chicken little" going on.

it will be different, but physicians will still make a decent living. maybe not in the 600K + region that a lot of PP docs have been used to, but physicians in specialties will invariably still be paid in the top 2-3% of the US population.

as someone who made probably 1/4th what algos was making, working 50+ hours as an ED doc, and almost taking a job that wouldnt have even paid 6 figures, those at the bottom will probably be pulled up a bit; those making exorbitant amounts will probably get pulled down a lot.
 
I suppose it depends on your perspective. French docs make $65K a year. German surgeons make $90k.....the workers at the BMW factory make more than doctors in Germany. Canadian docs make more money than US docs if you are a PCP but 1/3 less if you are a specialist than in the US, but the very high tax rates bring the take home pay down substantially. So the incomes are far far less in other countries than in the US.
 
they will kick the can down the road again with a temporary "doc fix". the 27% cut wont happen right now.
 
It's called the SGR (sustained growth rate) or "doc fix". They threaten, but have passed the fix every time. They will again. A 27% drop in Medicare payments would destroy primary care and bankrupt all PCPs in an instant. For that reason alone, it will be passed again. All this "fiscal cliff" BS is just that. BS. They will keep spending like drunken sailors.

Ok, I thought you guys meant something different regarding the 27% cut. Yes I am aware of the SGR formula. I guess I simply don't quite understand how it works. I mean patients have healthcare needs, they come see the doctor, so what's spent is spent. If they don't want to pay that much maybe they need to start cutting elsewhere. I guess this does not work like this in any other industry. It makes no sense that it would work like this in this industry.

I agree with you that I doubt they would pass it. There is mass shortages of PCPs as it is, and if this passed I'm sure a lot of PCPs would retire, go into a different line of work, etc. and be a disaster for healthcare and patients. Also agree with you that this whole fiscal cliff thing is a bunch of BS, sort of like the whole Y2k thing many years ago. Nothing will happen, it's more of a scare tactic so they can rationalize their tax increases on the "wealthy."
 
I suppose it depends on your perspective. French docs make $65K a year. German surgeons make $90k.....the workers at the BMW factory make more than doctors in Germany. Canadian docs make more money than US docs if you are a PCP but 1/3 less if you are a specialist than in the US, but the very high tax rates bring the take home pay down substantially. So the incomes are far far less in other countries than in the US.

You are not looking at this correctly I'm sorry to say. First your figures are way way off. French doctors make about 150 EU, which translates into roughly 180k. Second, EVERYONE in other countries makes less. Look at some of the overpaid nurses, marketing managers, IBs, etc. here. Doctors are still at the top of the pack in most other countries. So you have to look at the whole picture. So while doctors may make less comparatively in europe than the US, so does everyone else. Good luck getting a job in France as a marketing manager for 200k or a consultant for 180k or whatever.

Also they work far less (about 35 hours). Canadian doctors, both PCPs and specialists, make more. Someone recently posted a list of what they make. Radiologists, anesthesiologists, orthopods, ophthos. etc make bank. Look at the list.
 
My concerns are that the Obamites feel empowered, that they believe they have a clear mandate from the public that their socialist redistribution of wealth policies should take precedence over silly things like the debt or deficits, and that doctors have been targeted as a cause of the health care crisis.
Obama's solutions:
- Tax the middle class with a new 2014 previously hidden $63 a year Obamacare tax on 190,000,000 Americans to pay for the onslaught of healthcare to be provided to the 30,000,000 that will be coming onboard in 2014 and 15 (this is stealing from the middle class to pay for the poor via a newly discovered provision in Obamacare law that was not discussed before now) http://money.msn.com/health-and-life-insurance/news.aspx?feed=AP&date=20121210&id=15884956
- Eliminate independent physicians by eliminating physician ownership of hospitals and physician owned hospital expansion, keeping physicians held at bay from meaningful competition with hospitals via antiquated Stark laws for self referral while giving hospitals free reign to own physician practices and self refer for services at inflated prices 250-1000% more than independent physicians would charge. He is doing this to herd physicians into the confines of hospital employees where they MUST see Medicaid .....they have no choice.
- Dumbing down medical care by permitting the inept, the incompetent, and the ersatz to be paid the same as physicians, regardless of the galactic differences in training, experience, or competence. Sebelius is a fool, but is operating consistently with the even more foolish Obama philosophies of lowering medical care to the lowest common denominator.
- Protecting hospitals from cuts (for now). Protecting the pharmaceutical industry (for now). Protecting the right to sue any doctor for any reason (forever). Sticking it to doctors by reducing fees through bundling of codes, elimination of codes and interventions, RAC audits, refusal of doctors to use electronic medical records, lack of electronic prescribing, and budgetary measures of the administration that have reduced the RVU due to financial prestidigitation regardless of SGR, and of course our beloved SGR. This year congress simply doesn't give a damn about the SGR, and indeed, it may not be repealed (it is already passed law) or it may be partially rolled back.

Remember, for every 27% percent reduction in Medicare/Anthem/Commercial insurers tied to Medicare, physicians will experience a 54% reduction in take home pay, even before the new Obama taxes kick in (with the typical 50% overhead of running an office)


I say let's stop working for a bit. What are they going to do? Let's have every doctor stop working for a few days a month a the same time.

I am sick and tired of this ridiculous punishing mentality. When our incomes are the same as those working in marketing and consulting, it is insulting.

I'm seriously considering getting the heck out of healthcare and doing something where being successful is rewarded. It's sad and pathetic what we get paid, and there are all these punishing ridiculous laws out there. What is the intention?

I say let's do something about it. Let's have the nurses who "do all the doctor's work" actually do something. I'd like to see how a hospital runs without the greedy evil doctors.

Heck what's the point of going through med school if you can't expect a decent salary when you can come out of undergrad and land a 6 figure job at a ton of companies.
 
Do it, start your practice out of fellowship. I did it last year and I recommend it. Overall it's a lot of fun and it's great to watch it grow, kind of like a kid. Of course, it's a lot of work. If you play your cards right you won't need anywhere close to 350 for startup. I was in positive territory after about 6 week so when it came down to it it only cost me a few thousand to get started. Just keep your overhead as low as possible. Use the hospital's Carm in the beginning to save money until you can purchase your own.
 
You are not looking at this correctly I'm sorry to say. First your figures are way way off. French doctors make about 150 EU, which translates into roughly 180k. Second, EVERYONE in other countries makes less. Look at some of the overpaid nurses, marketing managers, IBs, etc. here. Doctors are still at the top of the pack in most other countries. So you have to look at the whole picture. So while doctors may make less comparatively in europe than the US, so does everyone else. Good luck getting a job in France as a marketing manager for 200k or a consultant for 180k or whatever.

Also they work far less (about 35 hours). Canadian doctors, both PCPs and specialists, make more. Someone recently posted a list of what they make. Radiologists, anesthesiologists, orthopods, ophthos. etc make bank. Look at the list.

Algos is actually pretty close and not way off as you suggested.

http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/

French primary care make $92K and German specialist make $77.
The tax rate is obviously much higher, the hours might be better but they do not have any educational loans. Also you need to factor in malpractice. A friend of mine who practices in Toronto pays $120 a month for malpractice and he does procedures.
 
algos is actually pretty close and not way off as you suggested.

http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/

french primary care make $92k and german specialist make $77.
The tax rate is obviously much higher, the hours might be better but they do not have any educational loans. Also you need to factor in malpractice. A friend of mine who practices in toronto pays $120 a month for malpractice and he does procedures.


2004?
 


Not only are those stats super old as you point out, but I don't think they are accurate either. And unless the WHOLE picture is put into perspective, it's not comparable.

First, I highly doubt that French GPs make 92 $$$, second they work FAR less than here. So a lot of the salaries that are higher here also take into account far more hours. In France, I think the mandated work week hour is 35. So making almost 6 figs for working 35 hours is not bad, and 6 weeks of vacation, with no educational loans, shorter training, and almost no liability.

Here, we work like dogs, have huge liability, most people have tremendous debt. So it's not comparable. Also let's not forget the fact that here everything is expected within 5 minutes. Consult ordered-5 minutes later it's expected to be done. Xray ordered-better be read in 2 minutes. Pain med-oh it's past 10 minutes, let's start calling the administrator as to why it was not done.

Please. In Europe you are lucky if you get an MRI in 3 months. Good luck getting transplants, and certain surgeries, dialysis, etc if you are past 65.

Unless you can factually look at everything, there is no comparison to make here.

And again, EVERYONE is paid less in France and the rest of Europe.

And let's not talk about Canada, doctors there are making quite a bit, many more than us, under far far FAR better working conditions. I have 3 buddies who have gone onto positions there recently because they got fed up wth the working conditions here. They love it. No constant fear of getting sued, reasonable work hours, and very similar or better pay than here.

One of them is in anesthesia, recently accepted a position for almost 400k. One of them is in Rads, and got a position for something similar. So let's not talk about how "poor" doctors in other countries are.

That is a joke.
 
I have friends/family who are physicians in Europe --- they do well compared to the remainder of the population, but no where as well as we have it in the US...

I have seen PCPs make anywhere from 150k to 600k (depending on how much private practice they do with rich folk) - and some of the newly negotiated NHS contracts in England provide some nice/hefty bonuses to the PCPs

I have seen specialists making 150k to 1million (again all depends on how much of their practice is outside of the socialized system)...

I don't have averages - but those ranges are not that far off from american salaries - although anecdotally they are generally closer to the lower end of the range.

1) They have no real malpractice issues/costs -
2) Their education for the most part is free
3) Their education starts in college - since college/med school are combined - instead of doinf 4 years college and 4 years med school, most can have their MD by age 24-25...
4) They get paid nicely as residents with far better hours (ie: they also get paid overtime and paid for taking call !!!)...
5) While they may have a higher income tax rate they don't have to worry about saving for school/college for their kids, they typically will get pensions and have access to state health care...

so it sounds like they should be happy? they still envy our salaries over here (partially because they can't comprehend defensive medicine and the stresses of potentially being sued for every little thing we do).
 
I am looking into the same thing. Talked to a bank... The absolute most they thought was possible was 250k and that was pushing it. I'll prob hold off on C arm and do procedures at a hospital or surg center to keep costs down and keep it as tight as possible for a year until I get some chips stacked.
 
Do it, start your practice out of fellowship. I did it last year and I recommend it. Overall it's a lot of fun and it's great to watch it grow, kind of like a kid. Of course, it's a lot of work. If you play your cards right you won't need anywhere close to 350 for startup. I was in positive territory after about 6 week so when it came down to it it only cost me a few thousand to get started. Just keep your overhead as low as possible. Use the hospital's Carm in the beginning to save money until you can purchase your own.

Where are you practicing? Don't want to be a jerk, but I don't believe it. After 6 weeks you were in positive territory? Impossible. It takes 4 months just to get signed up with Medicare and then even longer with other payors!

You must mean 6 months... that I can believe. And a "few thousand" to get started? Does that mean 3k? 5k? 10k? Again, no disrespect, but it'll take a good 50k to get up and running. I agree with others though... you will NOT be able to get 350k. Guarantee it. However, you def dont need that much cash for a start up.

I say go ahead and do it tho. no one else does anymore. every fellow these days look for a job at the hospital to be an employee. ugh.
 
Where are you practicing? Don't want to be a jerk, but I don't believe it. After 6 weeks you were in positive territory? Impossible. It takes 4 months just to get signed up with Medicare and then even longer with other payors!

You must mean 6 months... that I can believe. And a "few thousand" to get started? Does that mean 3k? 5k? 10k? Again, no disrespect, but it'll take a good 50k to get up and running. I agree with others though... you will NOT be able to get 350k. Guarantee it. However, you def dont need that much cash for a start up.

I say go ahead and do it tho. no one else does anymore. every fellow these days look for a job at the hospital to be an employee. ugh.

I was positive by the end of my second month, so somewhere between 4-8 weeks or so, I just average 6 weeks. I do my accounting and look at my P and L and balance sheets on a monthly basis, not weekly, so I can't be sure. I joined a PHO which helped streamline my contracts with the payers. Medicare does not negotiate with PHOs so I signed up with Medicare prior to opening the practice. It does not take 4 months to get on Medicare if you go through PECOS and make no errors. It took me a few thousand only to get started as I became positive by the end of my second month so I only needed to float myself for that short time period. I was busy from day 1 because I marketed before I opened up.

You need to have a good business sense to do it and from my experience, most physicians have little as most of their time is focused on studying medicine and the like. Just because you cannot do it, you should not underestimate others with more capability. I invite you to make a financial wager with me on whether I did this or not. If you choose to do so, I will be more than happy to show you my bookkeeping and bank statements.
 
I was positive by the end of my second month, so somewhere between 4-8 weeks or so, I just average 6 weeks. I do my accounting and look at my P and L and balance sheets on a monthly basis, not weekly, so I can't be sure. I joined a PHO which helped streamline my contracts with the payers. Medicare does not negotiate with PHOs so I signed up with Medicare prior to opening the practice. It does not take 4 months to get on Medicare if you go through PECOS and make no errors. It took me a few thousand only to get started as I became positive by the end of my second month so I only needed to float myself for that short time period. I was busy from day 1 because I marketed before I opened up.

You need to have a good business sense to do it and from my experience, most physicians have little as most of their time is focused on studying medicine and the like. Just because you cannot do it, you should not underestimate others with more capability. I invite you to make a financial wager with me on whether I did this or not. If you choose to do so, I will be more than happy to show you my bookkeeping and bank statements.

that's great! you must be the only guy in a moderately sized community and moderate to large catchment area. pretty easy to do that, but congrats nonetheless. trying that in a populated area with competition is a lil different. so where are you?
 
My concerns are that the Obamites feel empowered, that they believe they have a clear mandate from the public that their socialist redistribution of wealth policies should take precedence over silly things like the debt or deficits, and that doctors have been targeted as a cause of the health care crisis.
Obama's solutions:
- Tax the middle class with a new 2014 previously hidden $63 a year Obamacare tax on 190,000,000 Americans to pay for the onslaught of healthcare to be provided to the 30,000,000 that will be coming onboard in 2014 and 15 (this is stealing from the middle class to pay for the poor via a newly discovered provision in Obamacare law that was not discussed before now) http://money.msn.com/health-and-life-insurance/news.aspx?feed=AP&date=20121210&id=15884956
- Eliminate independent physicians by eliminating physician ownership of hospitals and physician owned hospital expansion, keeping physicians held at bay from meaningful competition with hospitals via antiquated Stark laws for self referral while giving hospitals free reign to own physician practices and self refer for services at inflated prices 250-1000% more than independent physicians would charge. He is doing this to herd physicians into the confines of hospital employees where they MUST see Medicaid .....they have no choice.
- Dumbing down medical care by permitting the inept, the incompetent, and the ersatz to be paid the same as physicians, regardless of the galactic differences in training, experience, or competence. Sebelius is a fool, but is operating consistently with the even more foolish Obama philosophies of lowering medical care to the lowest common denominator.
- Protecting hospitals from cuts (for now). Protecting the pharmaceutical industry (for now). Protecting the right to sue any doctor for any reason (forever). Sticking it to doctors by reducing fees through bundling of codes, elimination of codes and interventions, RAC audits, refusal of doctors to use electronic medical records, lack of electronic prescribing, and budgetary measures of the administration that have reduced the RVU due to financial prestidigitation regardless of SGR, and of course our beloved SGR. This year congress simply doesn't give a damn about the SGR, and indeed, it may not be repealed (it is already passed law) or it may be partially rolled back.

Remember, for every 27% percent reduction in Medicare/Anthem/Commercial insurers tied to Medicare, physicians will experience a 54% reduction in take home pay, even before the new Obama taxes kick in (with the typical 50% overhead of running an office)

this is a fantastic summary
 
My numbers on France were based on 2002 figures that did use an inverted ratio of the value of the euro to the dollar during that time. More current practice figures show for French family doctors surveyed in 2010, the average income is 101k Euros for a fee for service practice for GPs. These docs work an average of 11 hours a day for 4.63 days per week and have an average consult time of 30 min. They also have to travel to the houses of those that cannot come to their offices, do mandatory epidemiological surveys, be called to the hospital ER or on site for traumas, and are on call during nights and weekends (and are called in not infrequently). Their fees are 23 euros per visit paid by the patient who is reimbursed 70-85% of this amount by the government. Specialists require referral from the generalists otherwise the specialists are paid at generalist rates, therefore unless referred through a gateway doc, the specialists refuse to see patients.
http://www.biomedcentral.com/1471-2296/13/94/table/T2
 
My numbers on France were based on 2002 figures that did use an inverted ratio of the value of the euro to the dollar during that time. More current practice figures show for French family doctors surveyed in 2010, the average income is 101k Euros for a fee for service practice for GPs. These docs work an average of 11 hours a day for 4.63 days per week and have an average consult time of 30 min. They also have to travel to the houses of those that cannot come to their offices, do mandatory epidemiological surveys, be called to the hospital ER or on site for traumas, and are on call during nights and weekends (and are called in not infrequently). Their fees are 23 euros per visit paid by the patient who is reimbursed 70-85% of this amount by the government. Specialists require referral from the generalists otherwise the specialists are paid at generalist rates, therefore unless referred through a gateway doc, the specialists refuse to see patients.
http://www.biomedcentral.com/1471-2296/13/94/table/T2



on the other hand, they do get 5.6 weeks of vacation a year.

so in todays dollar, the GP makes roughly $130,000 a year.

looking at various websites, the average salary for a GP in the US is $168,000-$172,000 (salary.com).

We as a profession are doing much better in the US than around the world, except...

The place to move to is Netherlands or Australia, not New Zealand according to 2004 data... http://mdsalaries.blogspot.com/


(this is for Willabeast, who keeps mentioning New Zealand. Go halfway down the page to chart 2 for the 2004 data.)
 
either we will all be dead as of Dec 22. due to the Mayan calendar, or it will be some "chicken little" going on.

it will be different, but physicians will still make a decent living. maybe not in the 600K + region that a lot of PP docs have been used to, but physicians in specialties will invariably still be paid in the top 2-3% of the US population.

as someone who made probably 1/4th what algos was making, working 50+ hours as an ED doc, and almost taking a job that wouldnt have even paid 6 figures, those at the bottom will probably be pulled up a bit; those making exorbitant amounts will probably get pulled down a lot.

Agree. At least Pain as a specialty has something even left to fight for and preserve at this point. Certain other specialties have been decimated already and make Pain look like heaven.

"Pain" compared to "Pain-ten-years-ago" might look ugly. But Pain compared to other specialties that get paid half (or less) or work horrendous schedules, nights, holidays, brutal call..........you can have 'em. In comparison we don't have it too bad.
 
My concerns are that the Obamites feel empowered, that they believe they have a clear mandate from the public that their socialist redistribution of wealth policies should take precedence over silly things like the debt or deficits, and that doctors have been targeted as a cause of the health care crisis.
Obama's solutions:
- Tax the middle class with a new 2014 previously hidden $63 a year Obamacare tax on 190,000,000 Americans to pay for the onslaught of healthcare to be provided to the 30,000,000 that will be coming onboard in 2014 and 15 (this is stealing from the middle class to pay for the poor via a newly discovered provision in Obamacare law that was not discussed before now) http://money.msn.com/health-and-life-insurance/news.aspx?feed=AP&date=20121210&id=15884956
- Eliminate independent physicians by eliminating physician ownership of hospitals and physician owned hospital expansion, keeping physicians held at bay from meaningful competition with hospitals via antiquated Stark laws for self referral while giving hospitals free reign to own physician practices and self refer for services at inflated prices 250-1000% more than independent physicians would charge. He is doing this to herd physicians into the confines of hospital employees where they MUST see Medicaid .....they have no choice.
- Dumbing down medical care by permitting the inept, the incompetent, and the ersatz to be paid the same as physicians, regardless of the galactic differences in training, experience, or competence. Sebelius is a fool, but is operating consistently with the even more foolish Obama philosophies of lowering medical care to the lowest common denominator.
- Protecting hospitals from cuts (for now). Protecting the pharmaceutical industry (for now). Protecting the right to sue any doctor for any reason (forever). Sticking it to doctors by reducing fees through bundling of codes, elimination of codes and interventions, RAC audits, refusal of doctors to use electronic medical records, lack of electronic prescribing, and budgetary measures of the administration that have reduced the RVU due to financial prestidigitation regardless of SGR, and of course our beloved SGR. This year congress simply doesn't give a damn about the SGR, and indeed, it may not be repealed (it is already passed law) or it may be partially rolled back.

Remember, for every 27% percent reduction in Medicare/Anthem/Commercial insurers tied to Medicare, physicians will experience a 54% reduction in take home pay, even before the new Obama taxes kick in (with the typical 50% overhead of running an office)


As always, Sir, a brilliant synopsis.
 
As always, Sir, a brilliant synopsis.

ditto....i cut and pasted for others. Ive been transitioning to cash based practice. I suggest others do the same before Obama passes a new law against it.
 
ditto....i cut and pasted for others. Ive been transitioning to cash based practice. I suggest others do the same before Obama passes a new law against it.

Really?

Please please explain.

Are you intervention only?

Most of my "self pays" want only one thing: inappropriate meds, don't want to pay for imaging, UDS, PT or injections. I say no and they want their money back. I'm thinking of taking no self-pay, unless its for non-opiate management.
 
Really?

Please please explain.

Are you intervention only?

Most of my "self pays" want only one thing: inappropriate meds, don't want to pay for imaging, UDS, PT or injections. I say no and they want their money back. I'm thinking of taking no self-pay, unless its for non-opiate management.

An ETHICAL cash based practice is a goal of mine for the future. First of all, a large number of pain physician have to do it as well, so you are not seen as the "dirty" pain guy.

My reasons for wanting to do it:

1. It will SIGNIFICANTLY lower overhead. No more billing department. No more time spent with hassling insurance companies/medicare to pay you. NO MORE EMR! etc, etc, etc.

2. It would lower cost. I can charge reasonable prices for procedures AND my overhead is lower.

3. Less headaches. See #1. No more medicare police, insurance company refusal to pay, EMR, etc, etc....

While I am not getting this started at the moment, it would be great to do it in the future. One medicare cut of 27% is all it will take for a lot of us to reach that point. Hopefully in the future.
 
An ETHICAL cash based practice is a goal of mine for the future. First of all, a large number of pain physician have to do it as well, so you are not seen as the "dirty" pain guy.

My reasons for wanting to do it:

1. It will SIGNIFICANTLY lower overhead. No more billing department. No more time spent with hassling insurance companies/medicare to pay you. NO MORE EMR! etc, etc, etc.

2. It would lower cost. I can charge reasonable prices for procedures AND my overhead is lower.

3. Less headaches. See #1. No more medicare police, insurance company refusal to pay, EMR, etc, etc....

While I am not getting this started at the moment, it would be great to do it in the future. One medicare cut of 27% is all it will take for a lot of us to reach that point. Hopefully in the future.

Not to be critical, but I don't understand how this model would be viable. Patient is now responsible for a specialist office visit co-pay and they get treated including procedures for $40. The insurance company pays the rest of the allowable amount. Even if I reduced my charge to the allowable minus overhead the resultant patient obligation would be hundreds of dollars vs the $40. I can't see that making patients happy.
 
An ETHICAL cash based practice is a goal of mine for the future. First of all, a large number of pain physician have to do it as well, so you are not seen as the "dirty" pain guy.

My reasons for wanting to do it:

1. It will SIGNIFICANTLY lower overhead. No more billing department. No more time spent with hassling insurance companies/medicare to pay you. NO MORE EMR! etc, etc, etc.

2. It would lower cost. I can charge reasonable prices for procedures AND my overhead is lower.

3. Less headaches. See #1. No more medicare police, insurance company refusal to pay, EMR, etc, etc....

While I am not getting this started at the moment, it would be great to do it in the future. One medicare cut of 27% is all it will take for a lot of us to reach that point. Hopefully in the future.

I agree it's ideal but has to be non-narcotic to avoid the cash-for-procedures-for narcotics crowd. Absolutely must be non-opiate.

Here's the pricing of a group in OK doing it (link below):

Lumbar Epidural Steroid $1,100.00

Cervical Epidural
$ 1,400.00

Lumbar Sympathetic
$ 1,580.00

Stellate Ganglion Block
$ 1,100.00

Reblock for Acute Postop Pain
$ 1,200.00


http://www.surgerycenterok.com/pricing.php


Apparently it's working for them. Read the article here:

http://reason.com/archives/2012/11/15/the-obamacare-revolt-oklahoma-doctors-fi
 
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It's hard to tell though bc it says they also accept insurance. Who knows the ratio? Once you get on the insurance bitch panel and the medicare bitch panel, you aren't allowed to accept cash for those pts. I knew a family med guy that went concierge and charged pts about 1k/yr extra. He was promptly dumped from his networks.

I hope the cash practice model works in the end because that's the only hope we have for this profession. Otherwise it looks pretty grim.
 
You just need to make a slow transition and not draw the ire of networks. The most revenue will come from your CURRENT patients. Dentists and chiros have a successful model so it's not much different from them. I'm doing regenerative medicine to get the ball rolling. When MC kills itself, I think the majority of patients will just stick with you. I do not prescribe opiates for cash at all. I've already arranged for good quality MRI's for $350. Labs are also a la carte.

I started this "investment" in myself in the spring. I'm about 25% no insurance and growing rapidly. But it will take about 6 months to reap fruit.....maybe less if you hustle.

I've been told urgent care and international medicine are other avenues, but I have enough on my plate.
 
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