Really glad I’m no longer running a private California medical practice

[MitchLevi]

Just pay all the employees more, meanwhile physician payments are declining but our administrative requirements are greater.

...make sure the CEO, CFO and COO all make a lot of money, as well as the other administrators.

Pay for the EMR and it's upkeep. Buy laptops so ppl can dictate and work from home. Buy the RFA machine, US and fluoro equipment. Service those too.

Build an ASC...That's not easy depending on the state.

NM the fact the ENTIRE PRACTICE lives and dies by the physicians who bring in all the money, carry all the risk and are by far the most educated, yet indebted ppl in the entire frigging system.

These low SES workers Ducttape is trying to rescue drive full size trucks and nice SUVs. Dodge Chargers, Mustangs. F250s chugging diesel. Door Dash every lunch, including (and this is mind blowing to me) Starbucks!

---

Members don't see this ad.

 

[Doctodd]

Yep. Duct basically wants to be a communist and conveniently forgets how all of those economies went down in flames.

Why do you think that most important and financially successful startups happen in america instead of socialist countries?

why do all the communists and socialists want to come here? Why cant they stay in their utopian systems?

 

[MitchLevi]

why do all the communists and socialists want to come here? Why cant they stay in their utopian systems?

I only recently began using a desktop on this forum, and it's always been my phone where I read threads and make posts.

Your sig is hilarious. Did you lose a bet during the election?


I also want to add this as an olive branch to Ducttape - I have two MA's that go with me everywhere I go M-F. Every time I get an ASC dividend check or a production bonus check, I give both of them cash under the table from that check. In 2017, I fired my first MA (single mother of two kids) one week before Thanksgiving, and obviously that's right before Christmas. I sent cash to her under the table through back channels because I felt bad about doing it but she had to go because she was an utterly catastrophic team member and was stifling the growth of my service line within the practice. She never knew I gave her money either. I did it quietly because I genuinely felt pain doing that to her, but my practice is bigger than her.

It sucks there isn't more money to go around, and that pot is shrinking as we speak. Not only are those dollars becoming fewer, the work required to get them is increased. We spend a tremendous amount of time fighting insurance companies, and have you ever been involved in a situation where an insurance company outright violates its contract with you? That happens, and the only way to correct is litigation.

What about a security breach on your EMR? Ever seen one of those go down? Those get REALLY expensive.

I wish everyone had money, but the COVID distributions should have opened your eyes.

 

[SSdoc33]

I only recently began using a desktop on this forum, and it's always been my phone where I read threads and make posts.

Your sig is hilarious. Did you lose a bet during the election?


I also want to add this as an olive branch to Ducttape - I have two MA's that go with me everywhere I go M-F. Every time I get an ASC dividend check or a production bonus check, I give both of them cash under the table from that check. In 2017, I fired my first MA (single mother of two kids) one week before Thanksgiving, and obviously that's right before Christmas. I sent cash to her under the table through back channels because I felt bad about doing it but she had to go because she was an utterly catastrophic team member and was stifling the growth of my service line within the practice. She never knew I gave her money either. I did it quietly because I genuinely felt pain doing that to her, but my practice is bigger than her.

It sucks there isn't more money to go around, and that pot is shrinking as we speak. Not only are those dollars becoming fewer, the work required to get them is increased. We spend a tremendous amount of time fighting insurance companies, and have you ever been involved in a situation where an insurance company outright violates its contract with you? That happens, and the only way to correct is litigation.

What about a security breach on your EMR? Ever seen one of those go down? Those get REALLY expensive.

I wish everyone had money, but the COVID distributions should have opened your eyes.

there is no doubt that it is getting ever more difficult to survive in private practice. primarily, this is due to the SOS (d) along with layers or administrative nonsense. unfortunately, many private practices turn to cash-based regenerative medicine to stay afloat. that is why we end up seeing so much crappy pain medicine.

if it comes down to a choice between working for a hospital or doing a bunch of stem cells and PRP, what will you do?

 

[Ducttape]

So you all again miss the point and the issue but I can see that money has blinded you. It's common.

This is not about communism. This is about supporting the lower and the middle class.

The reason you all can have businesses is because the US had previously been supportive of the middle class. Our big boom post WW2 was because the government invested so much in improving this class, through the GI bill, jobs that paid well compared to pre war, more disposable income, more goods to buy, affordable mortgages, etc.

Now, we have money increasingly consolidated in a few individuals and big corporations paying CEOs millions of dollars as the middle class increasingly becomes lower class.

Theses multimillionaires get these marvelous tax breaks and do not pay their share compared to pre Reagan. And we are still waiting for trickle down economics to kick in.

So you want to support business. I'm all for that. But the best way to support the US economy and business is to get more consumers overall, not have a lot fewer consumers who happen to have more money.

And this communist talk is as always just tripe and diversion and frankly stupid fear mongering. No one here wants communism.

And frankly, those saying that "libs want communism" don't really know what communism truly is, just like they don't know what CRT or socialism or "wokeness" really is...

 

[Pain Applicant1]

No olive branches in here, please. We need to keep it lively, lol.

Not to be a downer but consider reconsidering the documentation of under-the-table employee payments.

Of course, do what you will. Up to you but I'm just putting it out there.

 

[buddababa]

NM the fact the ENTIRE PRACTICE lives and dies by the physicians who bring in all the money, carry all the risk and are by far the most educated, yet indebted ppl in the entire frigging system.

This 100%.

 

[MitchLevi]

if it comes down to a choice between working for a hospital or doing a bunch of stem cells and PRP, what will you do?

Not sure. Probably go to the hospital if I had to choose to between only orthobiologics and doing traditional pain.

 

[RoloTomassi]

if it comes down to a choice between working for a hospital or doing a bunch of stem cells and PRP, what will you do?

Option 3--build an ASC

 

[drrosenrosen]

Might invite attention from tax authorities.

 

[Pain Applicant1]

I too was concerned about his documenting illegal payments. Nice gesture, keep doing

Good point. Edited it. Consider editing out my quote in your post, lol.

 

[cowboydoc]

Agree with avoiding implicating yourself in illegal activity on a public e-forum, but how is giving an employee cash illegal? I could see tax avoidance arguments, but the IRS isn't coming after someone for giving an employee $500 cash for a holiday bonus, which would be essentially equivalent. Am I missing something else? I know a guy that frequently gives staff cash gifts for performance, holidays and whatnot.

 

[drrosenrosen]

Agree with avoiding implicating yourself in illegal activity on a public e-forum, but how is giving an employee cash illegal? I could see tax avoidance arguments, but the IRS isn't coming after someone for giving an employee $500 cash for a holiday bonus, which would be essentially equivalent. Am I missing something else? I know a guy that frequently gives staff cash gifts for performance, holidays and whatnot.

You're right. Illegal was an inappropriate word and has been edited. Might cause undesired attention from tax authorities, for employer or employee. (is there such a thing as desired attention from IRS)

 

[Pain Applicant1]

Agree with avoiding implicating yourself in illegal activity on a public e-forum, but how is giving an employee cash illegal? I could see tax avoidance arguments, but the IRS isn't coming after someone for giving an employee $500 cash for a holiday bonus, which would be essentially equivalent. Am I missing something else? I know a guy that frequently gives staff cash gifts for performance, holidays and whatnot.

You can't give cash to employees without reporting it. When I first started I had a great fee schedule and was generating much revenue. University hosptial moves in and takes over the whole town and our PHO was dissolved. Insurances then kick me in the balls and tell me take it or leave it. My revenue probably dropped by like 30 percent. State tax authority sees this and thinks I'm up to no good. Triggers an audit, but random of course according to the investigator. Anyway, I got off scott free but I spent some time speaking with the auditor. You and the employee must report any exchange of money. From my understanding, it's illegal not to and is tax fraud. You and the employee are essentially stealing from the gov.

 

[cowboydoc]

You can't give cash to employees without reporting it. When I first started I had a great fee schedule and was generating much revenue. University hosptial moves in and takes over the whole town and our PHO was dissolved. Insurances then kick me in the balls and tell me take it or leave it. My revenue probably dropped by like 30 percent. State tax authority sees this and thinks I'm up to no good. Triggers an audit, but random of course according to the investigator. Anyway, I got off scott free but I spent some time speaking with the auditor. You and the employee must report any exchange of money. From my understanding, it's illegal not to and is tax fraud. You and the employee are essentially stealing from the gov.

Does anyone report the gifts they get and give during the holidays?

How could this be adjudicated? I understand there are levels here. (paying an employee thousands of dollars in cash for tax avoidance), but what I’m thinking here seems like going 5 over the speed limit; yes it’s illegal, but no one is getting prosecuted for it.

 

[MitchLevi]

This is ridiculous.

WTF yall?

 

[Pain Applicant1]

Does anyone report the gifts they get and give during the holidays?

How could this be adjudicated? I understand there are levels here. (paying an employee thousands of dollars in cash for tax avoidance), but what I’m thinking here seems like going 5 over the speed limit; yes it’s illegal, but no one is getting prosecuted for it.

They're supposed to report everything. $500 multiplied by many businesses adds up. I'm not sure to the degree it's enforced, I'm just letting you know what I've been told by the auditor. Do what you will.

Also, you can't 1099 someone if it's a job that would be considered part of your business. eg, if i hire a temp receptionist I can't 1099 this person.

 

[cowboydoc]

They're supposed to report everything. $500 multiplied by many businesses adds up. I'm not sure to the degree it's enforced, I'm just letting you know what I've been told by the auditor. Do what you will.

Also, you can't 1099 someone if it's a job that would be considered part of your business. eg, if i hire a temp receptionist I can't 1099 this person.

So, post-audit, you report the cash value of any produce you give away from your farm, too?!?

 

[Pain Applicant1]

So, post-audit, you report the cash value of any produce you give away from your farm, too?!?

You mean to my friends? No I don't report that but it's not the same scenario from a tax perspective.

I only produce enough profit on my farm to keep it in agriculture use anyway. I purposely limit any profit to the absolute minimum. This way I can I just enjoy it with no pressure. Honestly, it's better than going on vacation.

 

[gaseous_clay]

Typically paying someone less than $17,000 in a calendar year doesn’t trigger gift tax requirements.

Gift Tax: How It Works, Rates in 2023-2024 - NerdWallet

Gift tax is a federal tax on a transfer of money or property to another person while getting nothing (or less than full value) in return. See 2023-2024 exclusion amounts and rates.

www.nerdwallet.com

 

[callmeanesthesia]

Does anyone report the gifts they get and give during the holidays?

How could this be adjudicated? I understand there are levels here. (paying an employee thousands of dollars in cash for tax avoidance), but what I’m thinking here seems like going 5 over the speed limit; yes it’s illegal, but no one is getting prosecuted for it.

If you’re giving that money from your business and/or deducting it as a business expense then it’s not kosher. However, if it’s from your own personal post-tax dollars, then I believe that falls under the $17,000 gift tax exclusion amount. It’s between you and the recipient, not your business and your employee.

 

[callmeanesthesia]

Typically paying someone less than $17,000 in a calendar year doesn’t trigger gift tax requirements.

Gift Tax: How It Works, Rates in 2023-2024 - NerdWallet

Gift tax is a federal tax on a transfer of money or property to another person while getting nothing (or less than full value) in return. See 2023-2024 exclusion amounts and rates.

www.nerdwallet.com

You beat me to it.

 

[MitchLevi]

Typically paying someone less than $17,000 in a calendar year doesn’t trigger gift tax requirements.

Gift Tax: How It Works, Rates in 2023-2024 - NerdWallet

Gift tax is a federal tax on a transfer of money or property to another person while getting nothing (or less than full value) in return. See 2023-2024 exclusion amounts and rates.

www.nerdwallet.com

Yep.

This thread is why a 23 yo college senior with a panic attack ends up with a 5k ED bill after a cardiac workup. Yall are freaking crazy.

 

[RoloTomassi]

It depends on your relationship with the gift recipient. If they're your employee, the gift has to meet "de minimis fringe benefit" criteria or else it needs to be taxed.

If you're both employees of an organization, then it just has to be under the $17k personal gift maximum.

 

[callmeanesthesia]

It depends on your relationship with the gift recipient. If they're your employee, the gift has to meet "de minimis fringe benefit" criteria or else it needs to be taxed.

If you're both employees of an organization, then it just has to be under the $17k personal gift maximum.

Do you have any documentation on that? Everything I can find on line is regarding definition of de minimis fringe benefits from the employer, but I and my medical practice are separate legal entities.

 

[wendalltwolf]

Now I see the appeal of decentralized currency or the original crypto dream

 

[emergentmd]

Another one of these threads that gets derailed.

The left is great at wanting it all. They want equal pay but would never give half their salary so they will be closer to the mean. They want to help the homeless but would never open up their home.

I know lots of rich liberal left leaning social warrior people but I can not think of one that have opened their home or one of their rentals to the homeless. NONE, never.

 

[RoloTomassi]

Do you have any documentation on that? Everything I can find on line is regarding definition of de minimis fringe benefits from the employer, but I and my medical practice are separate legal entities.

No sorry that's my rudimentary understanding if gift came out of business account. Probably best to ask your accountant.

 

[MitchLevi]

Personal checking account.

 

[bedrock]

Another one of these threads that gets derailed.

The left is great at wanting it all. They want equal pay but would never give half their salary so they will be closer to the mean. They want to help the homeless but would never open up their home.

I know lots of rich liberal left leaning social warrior people but I can not think of one that have opened their home or one of their rentals to the homeless. NONE, never.

Completely agree. The left are masters of NIMBY behavior, and total hypocrisy if they have to sacrifice anything to help others that are less fortunate.

This is a wonderful example of the liberal hypocrisy in housing. Amazing that it comes from the New York Times!

 

[drusso]

there is no doubt that it is getting ever more difficult to survive in private practice. primarily, this is due to the SOS (d) along with layers or administrative nonsense. unfortunately, many private practices turn to cash-based regenerative medicine to stay afloat. that is why we end up seeing so much crappy pain medicine.

if it comes down to a choice between working for a hospital or doing a bunch of stem cells and PRP, what will you do?

...the latter. Definitely, the latter.

#theywillneverloveyouback

 

[drusso]

Not sure. Probably go to the hospital if I had to choose to between only orthobiologics and doing traditional pain.

Why not both?

 

[emergentmd]

Rich Left and Rich right want the same. Rich left wants to make themselves feel better virtual signaling. Rich right just want solutions.

If a Rich left want equal pay, equal opportunity then they can give their income and retirement $$ to the poor or IRS. If they want higher taxes, then just give it to the IRS, they will take it and you can set whatever percentage you want. If they want reparation, take half their wealth and go down to the black communities and hand it out, Bang you did your job. If they want equal opportunity, then when their rich kids get into a good school, just send them to an avg school so another kid who likely is less privileges' gets in.

Hollywood is all about virtual signaling but most of them have private jets, private cooks, and send their kids to elite private school.



This is a great video. The white self loathing guy keeps wanting to push help on the black panel essentially saying he knows what is good for them when they all tell them they don't need his self pity or help. These black panelists want to achieve on their own merits but the white guy can't stand by and allow them to do it.

 

[drusso]

there is no doubt that it is getting ever more difficult to survive in private practice. primarily, this is due to the SOS (d) along with layers or administrative nonsense. unfortunately, many private practices turn to cash-based regenerative medicine to stay afloat. that is why we end up seeing so much crappy pain medicine.

if it comes down to a choice between working for a hospital or doing a bunch of stem cells and PRP, what will you do?

BTW, this is the stupidest post I've read from you in a long time.

 

[MitchLevi]

Why not both?

In the scenario given I had to choose!

 

[Pain Applicant1]

Rich Left and Rich right want the same. Rich left wants to make themselves feel better virtual signaling. Rich right just want solutions.

If a Rich left want equal pay, equal opportunity then they can give their income and retirement $$ to the poor or IRS. If they want higher taxes, then just give it to the IRS, they will take it and you can set whatever percentage you want. If they want reparation, take half their wealth and go down to the black communities and hand it out, Bang you did your job. If they want equal opportunity, then when their rich kids get into a good school, just send them to an avg school so another kid who likely is less privileges' gets in.

Hollywood is all about virtual signaling but most of them have private jets, private cooks, and send their kids to elite private school.



This is a great video. The white self loathing guy keeps wanting to push help on the black panel essentially saying he knows what is good for them when they all tell them they don't need his self pity or help. These black panelists want to achieve on their own merits but the white guy can't stand by and allow them to do it.

You couldn't be more wrong. Some have superyachts. Damn right winger spreading lies.

"Outspoken climate activist Steven Spielberg sailed his mammoth superyacht just to enjoy the Italian Riviera. The $250 million vessel, which is longer than two Olympic-sized swimming pools, burns around 700 liters of diesel every hour even when it is not moving."

Outspoken climate activist Steven Spielberg sailed his mammoth superyacht just to enjoy the Italian Riviera. The $250 million vessel, which is longer than two Olympic-sized swimming pools, burns around 700 liters of diesel every hour even when it is

Climate champion or not, there is no keeping a superyacht owner from witnessing the wonders of the world aboard their pleasure craft. Outspoken climate

luxurylaunches.com

 

[MitchLevi]

People are complicated.

You can have an opinion that's hypocritical and doesn't jive with your lifestyle.

What makes Leftist hypocrisy so maddening is the push for virtue signaling public policies that we all know are only being passed so people can say they voted for it.

Like this BS in California with electric vehicles when we all know very well the limitations of that industry. Teslas are amazing vehicles. Incredibly fast. Smart. Lots of options. They apparently are resilient vehicles from a manufacturing standpoint. Many Teslas are driving around with 400k miles on them...

But when the power goes out and you can't charge? How filthy is the mining process?

What about Apple? The Left idolizes Tim Cook and that dude sells phones made from slave labor FFS. Then again, Apple released that ridiculous video taking place in a board room with Mother Nature sitting at the head of the table and every demographic was represented in that video in a very specific and controlled manner. As long as Apple says the right stuff and gives us iPhones, we don't GAF who makes them or what happens overseas...I need to AirDrop stuff.


Here's another one:

Progressives in NYC have for many years railed against border states trying to enforce the border. NYC has called for sanctuary cities, and called itself a sanctuary city. Nope...Not for real though...NYC progressives just like that moniker. Those migrants can't ACTUALLY come here...I pay too much to live in this apartment.

"Mayor Eric Adams has called it a humanitarian crisis that will cost the city about $12 billion over three years. In the fall, he declared a state of emergency. In recent weeks, city officials have said they are running out of room.

The mayor has repeatedly asked the federal government — and has even traveled to Washington — for more funds and for expedited work authorizations for migrants, so they can become self-sufficient. He has said that President Biden has “failed” the city by not doing more."



This one right here though!!!

Mayor Adams has "asked a judge to relieve the city of some of its legal obligations under its unique 'right to shelter' mandate. He used an executive order to suspend some of the requirements under the mandate this spring, in anticipation of an influx of new migrants."

Hahahahaha!!!!


Migrants are crossing the border from 160 different countries. There are ENTIRE VILLAGES that have crossed as a group! There are a vast number of Africans flying into Central America en masse, and from there they migrate across the border. I have no problem with migrants from ANY country if they come legally, and my mentioning of Africans is just to show they're flying from all over the world. It isn't just Mexicans.

 

[Ducttape]

Another one of these threads that gets derailed.

The left is great at wanting it all. They want equal pay but would never give half their salary so they will be closer to the mean. They want to help the homeless but would never open up their home.

I know lots of rich liberal left leaning social warrior people but I can not think of one that have opened their home or one of their rentals to the homeless. NONE, never.

see now this opinion is worthless.

as soon as i saw the words "the left", i could tell it was a diversionary post meant to deflect rather than address the underlying issue.

and you clearly ignored multiple posts that i have made saying explicitly that 1 person will not make a difference, that this is a societal problem that needs to be changed en mass.

it is an idiotic assumption "oh well you do it and it will make it right". 1 person, or a subsegment of the population, will not affect societal change on inground patterns of behavior that are made and kept in place by the wealthy.

an example of how things should work - leaded gasoline. people loved their leaded gasoline. but it was killing us, as Claire Patterson found out. he spent his life trying to get rid of leaded gasoline.

we currently dont use leaded gasoline, but that is mostly irrespective of his work on lead. its because the US outlawed leaded gas due to catalytic converters. the Ethyl Corporation, leading distributor of leaded gasoline over the last 100 years, still exists. patterson was ostracized and ignored due to the power of corporations, and died a bitter man.

we now know how much he did to help overall humanity, but it is fools gold to think that 1 person without changing society will affect any meaningful change.

People are complicated.

You can have an opinion that's hypocritical and doesn't jive with your lifestyle.

these individuals are living in a society that has put rails on the side. they cannot change those, but they can advocate for all of us to make the change.

 

[MitchLevi]

these individuals are living in a society that has put rails on the side. they cannot change those, but they can advocate for all of us to make the change.

Speaking of rails...Think Spielberg's ever gotten sea sick and puked over the rails of that yacht, or is it too big to rock enough for that?

 

[Doctodd]

ummmmm people didnt care if their gasoline was leaded or unleaded. Maybe you should go back to using the racist roads of New York where they built the bridges shorter on purpose so the poor people couldnt go to the rich white man's beaches on the tall busses. Ridiculous.

 

[Ducttape]

you really dont know what lead does to a person, do you.

also, this is a diversionary argument, as that point has nothing to do with the example, which is to show that 1 person will not affect a societal problem, which is the problem with healthcare (including finances for PP) and living wages for healthcare workers.

 

[SSdoc33]

BTW, this is the stupidest post I've read from you in a long time.

that is because it goes to the heart of how you practice.

i would personally rather not practice medicine than sell snake oil.

your hatred for hospitals and your love for what you perceive as independence blinds you to providing the best possible care.

is there a place for regenerative medicine in what we do? yes. but it is a very narrow subset

 

[drusso]

that is because it goes to the heart of how you practice.

i would personally rather not practice medicine than sell snake oil.

your hatred for hospitals and your love for what you perceive as independence blinds you to providing the best possible care.

is there a place for regenerative medicine in what we do? yes. but it is a very narrow subset

Orthobiologics have already been proven for many orthopedic conditions.

HOPD employment has already been proven to be an Obamacare boondoggle and the leading cause of escalating healthcare costs.

That goes to the heart of how you practice.

 

[SSdoc33]

ummmmm people didnt care if their gasoline was leaded or unleaded. Maybe you should go back to using the racist roads of New York where they built the bridges shorter on purpose so the poor people couldnt go to the rich white man's beaches on the tall busses. Ridiculous.

 

[Ducttape]

he added the comment about racist roads after i responded to his comment about leaded gas.

it is hard to ignore racist tropes, and i do struggle doing so.

robert moses was racist but probably typical for his times and generation. he probably didnt built bridges specifically to prevent buses bringing in minorities.

 

[callmeanesthesia]

Orthobiologics have already been proven for many orthopedic conditions.

HOPD employment has already been proven to be an Obamacare boondoggle and the leading cause of escalating healthcare costs.

That goes to the heart of how you practice.

It’s a pretty smooth curve from the 70s on up.

 

[Doctodd]

When all you read is from journalists who attack our country saying it’s racism, and say we are racist, then you begin to believe what they write because you can’t think for yourself. I’m not calling you racist. I’m calling you blind.

 

[Doctodd]

you really dont know what lead does to a person, do you.

also, this is a diversionary argument, as that point has nothing to do with the example, which is to show that 1 person will not affect a societal problem, which is the problem with healthcare (including finances for PP) and living wages for healthcare workers.

No, that’s not what I said at all. I said that most people didn’t care about it at the time. I don’t disagree with transitioning to unleaded gasoline. And here we are again now saying the planet is doomed because we use gasoline because those catalytic converters the govt mandated now aren’t enough to save the planet?!?! It’s hilarious.

And you know I’m a fisherman who uses lead, but you think I don’t know the dangers of lead?!?

 

[Doctodd]

you really dont know what lead does to a person, do you.

also, this is a diversionary argument, as that point has nothing to do with the example, which is to show that 1 person will not affect a societal problem, which is the problem with healthcare (including finances for PP) and living wages for healthcare workers.

I think the problem with your logic is that you assume the govt is ethical and moral and just. You completely miss that in every argument you try to make.

For example…..here is a nice car in Cuba. Hint….it isn’t owned by a physician.

 

[cowboydoc]

It’s a pretty smooth curve from the 70s on up.
View attachment 377939

Let’s get out our crayons and discuss curves and their meanings.