SDN Members don't see this ad. (About Ads) besides just fee for service direct pt/third parter billing....are there any?? Yes, I know we can hire lpcs and such on salary, but this is usually less advantageous(and sometimes a loss leader) than just referring to them(and getting referrals in the other direction).....simply because if they aren't getting to bill for themselves they are going to want benefits and with those and the payroll tax for them there just isn't enough margin there after their salary. The lack of ancillary service possibilties and other revenue streams is what is holding our salaries down...and unfortunately I can't think of any. when you look at the numbers comparing us to outpt family med, internal med outpt, etc...the pt pt billing codes are fairly similar and(if you dont do therapy) the time interactions are probably similar, but there is room for an entrep fm or IM guy to branch out and make a s***ton on ancillary services, other revenue streams, etc..... just right now in the fam med forum there are several guys doing over 400k in net profit with such streams, including one at 600k due to other revenue streams and optimization of inhouse labs..... the lack of possibilities in breaking away from per pt fee for service stuff(whether you are seeing medicare, insurance, or cash pay pts) is frustrating....I mean I knew all this going in, but watching other providers(including other providers like fm whose 'reported' salaries are also at the bottom with us) making gobs of extra money from ancillary services and such is disheartening.