Projected income

[drmdrmd]

Wondering what 20-25 pts per day for 46 weeks of the year would equate to in the OP setting?

would like to hear from the group....

thanks

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[VA Hopeful Dr]

Using $40/RVU (which is national median for 2012 and maybe '13), looking like close to 200k give or take a little bit.

 

[deleted480308]

go the direct care model that atlasmd pushes.....200+ with less patients per day, no insurance hassle

 

[babdoc]

That is 200k pay before taxes?

 

[deleted480308]

That is 200k pay before taxes?

I was thinking that was close to after tax.... @AtlasMD said his practice runs about avg of $50-60/month per patient with a panel of about 600 patients.....they see less than 10 a day if I remember right and it's great money with the time to give a really great amount of time

he has a number of direct primary care threads here

 

[VA Hopeful Dr]

That is 200k pay before taxes?

Yes

 

[Dharma]

Yes

That's a lotta grinding for <200K!!! Man...

 

[AtlasMD]

hi guys, always happy to answer questions. Yes we say a dpc doc can make $200-240k/yr in our mode.

base math: avg revenue of $50/pt/mo x 600 pts x 12 mo = 360k - 30% overhead = 240k. Our actual overhead is close to 80k/yr/doc b/c its cheaper the more docs you have in one location.

we see on avg 5 pts in the office per day for an avg of 45 minutes each. we also answer phones, sms and email from pts.

Its a good life with good income and great job satisfaction. plus, we know we're saving our patients a ton of money with our unlimited visits, no copays, free procedures, wholesale meds/labs for up to a 95% savings and ins that is up to 60% cheaper.

 

[Dharma]

hi guys, always happy to answer questions. Yes we say a dpc doc can make $200-240k/yr in our mode.

base math: avg revenue of $50/pt/mo x 600 pts x 12 mo = 360k - 30% overhead = 240k. Our actual overhead is close to 80k/yr/doc b/c its cheaper the more docs you have in one location.

we see on avg 5 pts in the office per day for an avg of 45 minutes each. we also answer phones, sms and email from pts.

Its a good life with good income and great job satisfaction. plus, we know we're saving our patients a ton of money with our unlimited visits, no copays, free procedures, wholesale meds/labs for up to a 95% savings and ins that is up to 60% cheaper.

Does your typical patient also carry insurance for emergencies? How often to you find yourself working on the weekends? (I'm sure you answer these questions in your podcast, which is on my to-do list, but in the middle of Step 1 study). Thanks AtlasMD!

 

[bronx43]

And... this is why trainees are flocking away from primary care like the bubonic plague. 200k for 20-25 patients a day is a f***ing travesty - high way robbery. Just bend over and hope the CMS uses lube. Not only do you get a pittance for actually seeing the patient, you don' t even get paid for paperwork and coordinating care (which can be half the work). PCPs around the country should grow some balls, take a little risk, and start a direct payment model practice or straight up concierge practice.

 

[deleted87716]

And... this is why trainees are flocking away from primary care like the bubonic plague. 200k for 20-25 patients a day is a f***ing travesty - high way robbery. Not only do you get a pittance for actually seeing the patient, you don' t even get paid for paperwork and coordinating care (which can be half the work). PCPs around the country should grow some balls, take a little risk, and start a direct payment model practice or straight up concierge practice.

Actually, $200K is above average for primary care, and 20-25 patients a day is the low end of the norm. Some of us actually do get paid for paperwork and care coordination (which is nowhere near "half the work"), and most payers are moving away from fee-for-service towards a blended payment model.

Starting your own practice in this day and age takes more than "balls," and it's more than a little risky.

 

[bronx43]

Actually, $200K is above averag, e for primary care, and 20-25 patients a day is the low end of the norm. Some of us actually do get paid for paperwork and care coordination (which is nowhere near "half the work"), and most payers are moving away from fee-for-service towards a blended payment model.

Starting your own practice in this day and age takes more than "balls," and it's more than a little risky.

Yet people still do it - like AtlasMD. Obviously, when you're talking about risk and return, it's all a spectrum. Certain people are more risk-adverse, sure. Honestly, if you're ok seeing 30+ patients a day and making less than $200k, then do it. Don't take the risk. If you have the balls, business acumen, perseverance, then start your own gig like Atlas.

I'm knee deep in home health forms here at resident clinic. But yeah, paperwork is much better in real practice.

 

[Dharma]

And... this is why trainees are flocking away from primary care like the bubonic plague. 200k for 20-25 patients a day is a f***ing travesty - high way robbery. Just bend over and hope the CMS uses lube. Not only do you get a pittance for actually seeing the patient, you don' t even get paid for paperwork and coordinating care (which can be half the work). PCPs around the country should grow some balls, take a little risk, and start a direct payment model practice or straight up concierge practice.

Mix in state after state giving NPs the nod to go off and practice autonomously and I doubt many students who originally wanted to be in primary care will end up there. Sure there will be those who still want it and dive in, but I can guarantee many very good students with an interest will steer clear of what looks like a dismal climate from afar.

 

[deleted87716]

Yet people still do it - like AtlasMD. Obviously, when you're talking about risk and return, it's all a spectrum.

I'll let AtlasMD speak to the specifics, but I'm sure he's taken some pretty significant risks, and I have no doubt that he's working for his money, just like the rest of us.

 

[bronx43]

I'll let AtlasMD speak to the specifics, but I'm sure he's taken some pretty significant risks, and I have no doubt that he's working for his money, just like the rest of us.

I'm sure he's working for his money, but I also suspect he's working less than your typical PCP for more money than your typical PCP. It's up the individual to decide if that is worth whatever the risks may be.

 

[Mad Jack]

I'm sure he's working for his money, but I also suspect he's working less than your typical PCP for more money than your typical PCP. It's up the individual to decide if that is worth whatever the risks may be.

Regardless of how hard he's working, not dealing with insurance companies and minimizing bureaucratic headaches is priceless.

 

[Silent Cool]

@AtlasMD , what are your/your partners' tpyical retirement contributions? Are they pre- or post-tax?

 

[deleted87716]

I'm sure he's working for his money, but I also suspect he's working less than your typical PCP for more money than your typical PCP.

But...so am I. The trick is not to be a "typical PCP."

 

[DermViser]

And... this is why trainees are flocking away from primary care like the bubonic plague. 200k for 20-25 patients a day is a f***ing travesty - high way robbery. Just bend over and hope the CMS uses lube. Not only do you get a pittance for actually seeing the patient, you don' t even get paid for paperwork and coordinating care (which can be half the work). PCPs around the country should grow some balls, take a little risk, and start a direct payment model practice or straight up concierge practice.

Aided and abetted by the govt. Esp. with the PCMH BS being thrown at primary care physicians, to give patients a semblance that they're still being taken care of by doctors.

 

[bronx43]

But...so am I. The trick is not to be a "typical PCP."

What's your approach to the primary care business?

 

[SuckySurgeon7]

hi guys, always happy to answer questions. Yes we say a dpc doc can make $200-240k/yr in our mode.

base math: avg revenue of $50/pt/mo x 600 pts x 12 mo = 360k - 30% overhead = 240k. Our actual overhead is close to 80k/yr/doc b/c its cheaper the more docs you have in one location.

we see on avg 5 pts in the office per day for an avg of 45 minutes each. we also answer phones, sms and email from pts.

Its a good life with good income and great job satisfaction. plus, we know we're saving our patients a ton of money with our unlimited visits, no copays, free procedures, wholesale meds/labs for up to a 95% savings and ins that is up to 60% cheaper.

Does your typical patient also carry insurance for emergencies? How often to you find yourself working on the weekends? (I'm sure you answer these questions in your podcast, which is on my to-do list, but in the middle of Step 1 study). Thanks AtlasMD!

I'll let AtlasMD speak to the specifics, but I'm sure he's taken some pretty significant risks, and I have no doubt that he's working for his money, just like the rest of us.

@AtlasMD , what are your/your partners' tpyical retirement contributions? Are they pre- or post-tax?

Figured he might respond if someone quoted one of his messages.

@Dharma Atlas has previously stated that he encourages patients to buy insurance for any disasters. The analogy he likes to throw around is buying car insurance for a car crash (hospitalizations) as opposed to simple gas and tire needs (PCP visits). Patients save money by buying higher deductible insurance because his services cover all non-emergent issues. To conclude the analogy: DPC offers patients a Honda Civic for their daily commute (to save gas) rather than medicare and insurance's 18-wheel gas guzzler.

Source:

Sorry for the delayed response, holidays

Thanks for your interest and i'm happy to answer anything. For a really comprehensive article, check out http://www.theobjectivestandard.com...h-umbehr-on-concierge-medicine-revolution.asp

What lead us to come up with this: I could see as a pre-med, med student and resident that practicing doctors were burning out on insurance based practice and i didn't want to hate my patients a few years after training like so many others. Plus, insurance just never made sense for family medicine....after all you don't have care insurance for gasoline....insurance is meant for catastrophic costs/loss, not for daily expenses. And yes, primary care is/can be affordable.

Bold move - you're telling me we started straight of residency with no patients and a dream!

Insurance companies - at first didn't see the value but now they do, in large part b/c we made them 100% profit several times on large groups over the course of a 12 month cycle b/c the employees didn't have to file ins claims to get care. Now they are starting to work WITH us to accept our fees towards deductibles (based only on our invoice, no coding) and to lower premiums.

ACA - despite what many people think/say, the ACA will drive the development of direct care practices like never before. If you don't have insurance and pay the fines, then we are the most affordable option available. If you do get exchange based insurance, your premiums/deductibles are going to be high and there's no coverage until you meet your deductible = we're the most cost effective option available.

OB - we don't but it would be a great model!

sorry to be short but i know that its hard to read long answers on forums.

 

[deleted87716]

What's your approach to the primary care business?

Join the right group.

 

[bronx43]

Join the right group.

Right but what makes your group the right group?

 

[deleted87716]

Right but what makes your group the right group?

Because we're doing it right. We're taking good care of our patients (and have the data to prove it), we're in control of our own destiny, we're well-positioned for the future, and our people are happy. None of us are working our fingers to the bone, and most of us are earning well above the MGMA mean in our specialty.

 

[DD214_DOC]

hi guys, always happy to answer questions. Yes we say a dpc doc can make $200-240k/yr in our mode.

base math: avg revenue of $50/pt/mo x 600 pts x 12 mo = 360k - 30% overhead = 240k. Our actual overhead is close to 80k/yr/doc b/c its cheaper the more docs you have in one location.

we see on avg 5 pts in the office per day for an avg of 45 minutes each. we also answer phones, sms and email from pts.

Its a good life with good income and great job satisfaction. plus, we know we're saving our patients a ton of money with our unlimited visits, no copays, free procedures, wholesale meds/labs for up to a 95% savings and ins that is up to 60% cheaper.

How do you handle over-utilizers?

 

[trailblaze]

What if a volume based outpatient practice adopted a hospitalist type approach (i.e. work lots in bursts for more time off)??
You could have 2 teams each consisting of 1 doc and 2 PA's. Each team works 12 hour days and see 75 patients per day (25 each avg) for 3 days. One team works Mon-Wed, other team Thurs-Sat. Practice is open 6 days, 7am-7pm. Everyone gets 1 month vacation.
Assume average gross is $75/visit (is this high?).
$75 x 75(patients/day) x 6 days/week x 48 weeks x 0.9 (90% collection) =
$1.4 million
subtract PA's salaries ($400,000) and assume 50% overhead and you are left with: $500,000
or $250,000 / doc for working 48 weeks, 3 days per week.

This seems like a good set up. 3 days on, 4 off with a decent salary. Is this feasible or are my numbers problematic?
I like the direct care model, but its weaknesses are getting patients to come on board and the doc having to be available 24/7/365. I'd much rather work 3 days hardcore and have 4 off. Thoughts?