What are some examples of Family Medicine working schedules? Is it a lifestyle specialty?

[nebuchadnezzarII]

I think there's a lot of confusion going around about family medicine. Can someone elaborate on the lifestyle of family medicine and the different models of working? What are salary prospects for someone who values free time and lifestyle over money? I imagine thta 8-5, M-F in your own practice isn't the only model. Right?

(I am asking because I want to figure out what I want to do and my limited MS-3 experience is not sufficient. I value lifestyle overall. Money is nice, but working <30 hours a week in a relatively low stress job is ideal).

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[VA Hopeful Dr]

So most jobs expect 36 hours/week for full time, lots of ways to do that.

I work 8-5 4 days a week and 8-12 one day. So basically 4.5 days/week.

You can do 3 urgent care shifts/week and accomplish the same. That way you have 4 days off of work every week.

You can work part time. My wife is outpatient IM and worked 3 days/week.

You could do hospitalist work.

 

[nebuchadnezzarII]

So most jobs expect 36 hours/week for full time, lots of ways to do that.

I work 8-5 4 days a week and 8-12 one day. So basically 4.5 days/week.

You can do 3 urgent care shifts/week and accomplish the same. That way you have 4 days off of work every week.

You can work part time. My wife is outpatient IM and worked 3 days/week.

You could do hospitalist work.

Wow. So you can just do like 3 x 12 hours urgent care shifts? What does the typical workday in this type of setting entail?

Can you do the same thing as a IM (your wife has the right mindset!) doctor in urgent care (3 x 12)?

Is it the same 3 days every week? I had NO IDEA family med doctors could do solely shift work like this. That's freaking awesome.

How much does this usually earn you, if you don't mind me asking?

I really value free time....so that's why I am asking. Apologies if these questions are overwhelming. Any and all answers you provide are helpful!

 

[VA Hopeful Dr]

Wow. So you can just do like 3 x 12 hours urgent care shifts? What does the typical workday in this type of setting entail?

Can you do the same thing as a IM (your wife has the right mindset!) doctor in urgent care (3 x 12)?

Is it the same 3 days every week? I had NO IDEA family med doctors could do solely shift work like this. That's freaking awesome.

How much does this usually earn you, if you don't mind me asking?

I really value free time....so that's why I am asking. Apologies if these questions are overwhelming. Any and all answers you provide are helpful!

Yes, you can do 3 12-hour UC shifts per week. I did that for a year - it sucks. Both the quality of the work and the fact that it ruins the entire day. But not everyone agrees with me about that.

UC doesn't like IM as much since they can't really see kids.

Money is location dependent - I was making $135/hour at that job. You can do that math there.

Problem with UC is you will be expected to work weekends and some holidays (most places close Xmas and New Years but work all other holidays).

If free time is your most important aspect, go for part time clinic work. No nights, no weekends, no holidays. Sure you'll have less money, but there's always a trade off somewhere.

 

[nebuchadnezzarII]

Yes, you can do 3 12-hour UC shifts per week. I did that for a year - it sucks. Both the quality of the work and the fact that it ruins the entire day. But not everyone agrees with me about that.

UC doesn't like IM as much since they can't really see kids.

Money is location dependent - I was making $135/hour at that job. You can do that math there.

Problem with UC is you will be expected to work weekends and some holidays (most places close Xmas and New Years but work all other holidays).

If free time is your most important aspect, go for part time clinic work. No nights, no weekends, no holidays. Sure you'll have less money, but there's always a trade off somewhere.

Absolute last question, I swear. And thank you so much, it's not everyday I get to pick the brain of a practicing family physician, so I really appreciate this. I would buy you a coffee if I could.

1. Why does the job itself suck? The quality, what's so bad about it?

2. You suggested part time clinic work. Is that different than urgent care work?

 

[VA Hopeful Dr]

So urgent care is where your family medicine skills go to die. No continuity of care, no chronic disease management. You spend 90% of your day being an antibiotic dispensing machine to people with colds.

If you're working in a regular office but part time, you'll still have a patient panel that you manage just like you would working 40 hours just working less. Hypertension, preventative care, the usual bread and butter FM stuff.

 

[nebuchadnezzarII]

Are there many procedures involved in family medicine? I know during residency you need to do OB and Surgery (ugh!), but as a practicing physician, let's say in urgent care, do you have to do stitches and stuff like that?

 

[Ironheme]

Yes, you can do lac repairs. I would suggested reading up on Cabinbuilder's locum as urgent care post.

You're also trained to place casts, shave biopsies, excision, colposcopies, endometrial biopsies, etc.

Also if you like shift work and schedule control, I'd suggest considering locum for a short time. You can work as a hospitalist. The rates I've heard are 150-160$ per hour. That had been my original plan after graduating as I wanted maximum schedule flexibility.

You don't have to continue OB after you finish if you don't want to. You can work as much or as little as you want to. My impression about FM specialty average is around 200K, for a 40 hour work week. 180 if you want to live in a big city, 225 for more rural areas. For outpatient work.

For hospitalist I have heard 220-240k, location dependent.

If you are super productive, and work very hard and say are in it entirely for the $$, then you could potentially make 300-400k per year, but you won't have much of a life outside of medicine.

 

[SLC]

My payment restructure they just announced should net me about $277k annually without too much effort. That’s working 8:15-5 (1.5-2hrs for lunch) from M-Th. Managing a panel of about 2k

 

[Postictal Raiden]

My payment restructure they just announced should net me about $277k annually without too much effort. That’s working 8:15-5 (1.5-2hrs for lunch) from M-Th. Managing a panel of about $2k

4 days a week? No nights/weekends? Rural?

 

[deleted87716]

Outpatient only, 4 days/week, 8:15am - 4:30pm. No nights, weekends, or holidays. Call group with a dozen other docs means weekend (Fri.-Sun.) call (phone-only) once every three months or so, and weekday call (5pm-8am the following day) roughly once/month (call is low-volume). Vacation? Whenever I want ("eat what you kill" compensation model). Been doing it this way for almost 20 years.

 

[nebuchadnezzarII]

How much suturing/procedural stuff did you guys have to do during residency? And now as an attending? If you’re in a big city, do you usually have to do suturing and stuff? What about in urgent care?

 

[septoplasty]

So urgent care is where your family medicine skills go to die.

Can we rename this part of the forum to this?

 

[septoplasty]

How much suturing/procedural stuff did you guys have to do during residency? And now as an attending? If you’re in a big city, do you usually have to do suturing and stuff? What about in urgent care?

This is way variable.
1. "Suturing": Enough to get you to be competent. Lets just say you're not going to be doing multilayered, continuous closures straight out of residency. But seldom is this needed anyways in the UC.
2. "Suturing": Depends on your work place. If you do outpatient or inpatient, probably hardly vs. UC.. tons. I'm suturing a guy right now.
3. Big city means no real changes in the UC settings. Suturing is bread butter for UC.

 

[Ironheme]

Outpatient only, 4 days/week, 8:15am - 4:30pm. No nights, weekends, or holidays. Call group with a dozen other docs means weekend (Fri.-Sun.) call (phone-only) once every three months or so, and weekday call (5pm-8am the following day) roughly once/month (call is low-volume). Vacation? Whenever I want ("eat what you kill" compensation model). Been doing it this way for almost 20 years.

Nice. I almost want to work where you work.

 

[GonnaBeADoc2222]

Can we rename this part of the forum to this?

EM here. Always laugh when I read on the blogosphere that UC is a great alternative to reduce burnout. Yah, worse pay for craptastic work is a sure fire way to achieve workplace satisfaction

 

[deleted87716]

So urgent care is where your family medicine skills go to die. No continuity of care, no chronic disease management. You spend 90% of your day being an antibiotic dispensing machine to people with colds.

 

[SLC]

4 days a week? No nights/weekends? Rural?

Yep, no nights or weekends. No call other than voluntary hospitalist call.

 

[Splenda88]

Yep, no nights or weekends. No call other than voluntary hospitalist call.

You compensation is excellent for a FM doc... Basically, you are making 277k/year working <32 hrs/wk. Is that with benefits (401k, Health insurance, vacations etc...)?

 

[SLC]

You compensation is excellent for a FM doc... Basically, you are making 277k/year working <32 hrs/wk. Is that with benefits (401k, Health insurance, vacations etc...)?

Yep, 401k with matching, health insurance (my company has an arm that is the main health insurance provider in the state), 6wks vacation if I want it, and a pension plan. And yes, I’m rural. But I’m less than an hour from a ~2million sized city.

 

[Splenda88]

Yep, 401k with matching, health insurance (my company has an arm that is the main health insurance provider in the state), 6wks vacation if I want it, and a pension plan. And yes, I’m rural. But I’m less than an hour from a ~2million sized city.

That is still a great deal since you are probably 1hr away from a major airport. I wonder how much revenue do you generate to be able to get such a deal

 

[deleted87716]

That is still a great deal since you are probably 1hr away from a major airport. I wonder how much revenue do you generate to be able to get such a deal

My collections (after contractual write-offs, but before expenses) were around $670K last year. Charges were $1.4M.

 

[DrStephenStrange]

If Family medicine is that great, why is it one of the most uncompetitive specialties to get into? And why do people always condemned primary care heavy schools (especially DO schools)? Asking honest questions by the way. Just curious.

 

[nebuchadnezzarII]

If Family medicine is that great, why is it one of the most uncompetitive specialties to get into? And why do people always condemned primary care heavy schools (especially DO schools). Asking honest questions by the way. Just curious.

MS-3 here, so I don't know anything. But my thinking is that the numbers reported here are far from the norm. We have to consider the type of people who post on SDN. These are usually very high performing students - and their professional counterparts are probably very high performing and successful physicians. They are exceptional earners most likely.

 

[deleted87716]

If Family medicine is that great, why is it one of the most uncompetitive specialties to get into? And why do people always condemned primary care heavy schools (especially DO schools). Asking honest questions by the way. Just curious.

Ignorance.

 

[SLC]

That is still a great deal since you are probably 1hr away from a major airport. I wonder how much revenue do you generate to be able to get such a deal

Don’t know, don’t really care. I’m employed, there are MBA’s and accountants for that. I just see people, write notes, go home.

 

[SLC]

If Family medicine is that great, why is it one of the most uncompetitive specialties to get into? And why do people always condemned primary care heavy schools (especially DO schools)? Asking honest questions by the way. Just curious.

Did you ever see a family doc depicted on a medical drama? It’s not the most glamorous work; doesn’t generate a lot of headlines.

The way I see it, people don’t care about the MI they didn’t have, or the polyp that got removed that didn’t turn into metastatic colon cancer when their primary care doc finally convinced them to get a c-scope.

But they’ll gush all day about the doc that “saved their life” in the cath lab or the operating room. Primary care is fairly invisible, and frequently thankless, work.

 

[Postictal Raiden]

My collections (after contractual write-offs, but before expenses) were around $670K last year. Charges were $1.4M.

Do your overhead expenses mount up to 50% of your collections (670k)?

 

[deleted87716]

Do your overhead expenses mount up to 50% of your collections (670k)?

Pretty close. That's fairly standard in FM.

 

[Postictal Raiden]

Pretty close. That's fairly standard in FM.

Still, take home income of 300k+ plus 3-day weekend year round is pretty sweet deal

 

[deleted87716]

Still, take home income of 300k+ plus 3-day weekend year round is pretty sweet deal

It is, although that's gross income, not take-home, 'cause...taxes. Gross collections belong to the company, so I'm only taxed on the portion that gets distributed to me.

Plus, I'm typically off on Wednesdays, so it's not technically a 3-day weekend most weeks unless I take vacation and rearrange my schedule.

 

[VA Hopeful Dr]

If Family medicine is that great, why is it one of the most uncompetitive specialties to get into? And why do people always condemned primary care heavy schools (especially DO schools)? Asking honest questions by the way. Just curious.

Bunch of reasons. Even very profitable FM practices can't compare to things like ortho.

As mentioned, chronic disease management isn't sexy.

Lots of folks don't like long term relationships with patients.

Med students are stupid. Yes, we make less than most other branches of medicine but we also work less than most. Most bankers work more hours a week than I do. No weekends. No holidays. No nights. When you're young, money seems the most important. As you get older, most people start to value time more.

 

[nebuchadnezzarII]

Am I correct in understanding that you can basically get away with working as little as you want, if you're willing to take the pay cut? For example, if a IM or a FM doc just sees people in hospital's outpatient clinic, 3-days a week, that's a doable thing? I am just looking to maximize free time for myself. Not looking to knock anyone.

 

[VA Hopeful Dr]

Am I correct in understanding that you can basically get away with working as little as you want, if you're willing to take the pay cut? For example, if a IM or a FM doc just sees people in hospital's outpatient clinic, 3-days a week, that's a doable thing? I am just looking to maximize free time for myself. Not looking to knock anyone.

Yes.. ish.

You have to have partners who are OK with potentially dealing with your overflow the other 2 days and patients who are OK with only being able to access their doctor 3 days a week. Plus lots of places you have to work X hours per week to qualify for benefits and you may be short that.

No one is going to be willing to work with you if you only want to work 1 day/week in an outpatient clinic (you can easily moonlight in urgent care for 4-5 days/month if that's all you want to work). But 3 days a week is not uncommon at all. It will reduce the job opportunities somewhat, but there's such a huge need for primary care that it won't slow you down much.

 

[Sardonix]

My payment restructure they just announced should net me about $277k annually without too much effort. That’s working 8:15-5 (1.5-2hrs for lunch) from M-Th. Managing a panel of about 2k

For crying out loud every time I see you post your set up sounds more and more amazing. Stop it.

 

[SLC]

For crying out loud every time I see you post your set up sounds more and more amazing. Stop it.

Don’t get me wrong, that’s based on a wRVU count that’s a little higher than I’ve put in so far, but I’m inching ever closer all the time. These are projections for the average full time established doc in my company, who sees about 400 wRVU’s per month and meets quality metrics and has an average sized patient panel with an average pooled HCC score.

I’m new, but I am forecasting that I can be there in the next 6-8 months most likely. I’m already averaging 350rvu’s for the past few months, and I’m seeing a sharp increase in visits and patients requesting to establish care.

I’m also in the middle of building my panel size since a not insignificant part of my income in the next fiscal year is going to be based on panel size and HCC coding. I was fairly laissez-faire about it until the past month or so, but I’ve redoubled my efforts and added 150-200 new patients during the past 2 weeks. I’m approaching 800 patients now. I think I can get to 2000 by years end at the current rate I’m getting requests. Next year is when the new compensation model takes effect.

It’s hard work, but only during my work hours. I don’t chart after hours. I tend to be very thorough, and my workflow makes closing HCC gaps and completing quality metrics almost automatic.

I’m not going to need to do any extra-curricular activities to get to that $277k number, that’s just for an average, outpatient only FM doc in our system. It will actually be a little bit higher for guys like me because for the first time ever, they're also paying more/wRVU to rural doctors starting next year, and that projection was based on the urban/suburban rate. But all compensation for hospital work is separate from this model, and just additional cash I earn.

With the additional call I do, I should push into the $310-$320 range.

 

[deleted87716]

Am I correct in understanding that you can basically get away with working as little as you want, if you're willing to take the pay cut? For example, if a IM or a FM doc just sees people in hospital's outpatient clinic, 3-days a week, that's a doable thing? I am just looking to maximize free time for myself. Not looking to knock anyone.

Totally depends on the situation. Four days/week is considered full-time in my group (although some people work more), and you'll have no trouble earning a decent income as long as you're reasonably busy, don't take an inordinate amount of vacation, and don't let your overhead spiral out of control.

 

[Matthew9Thirtyfive]

It is, although that's gross income, not take-home, 'cause...taxes. Gross collections belong to the company, so I'm only taxed on the portion that gets distributed to me.

Plus, I'm typically off on Wednesdays, so it's not technically a 3-day weekend most weeks unless I take vacation and rearrange my schedule.

I love having a day off in the middle of the week. At my first command I used to take random one-day leave requests on Wednesdays and Thursdays just to break up the week. Really helped since we had duty every 6 days in addition to the regular work week.

 

[fldoctorgirl]

Don’t get me wrong, that’s based on a wRVU count that’s a little higher than I’ve put in so far, but I’m inching ever closer all the time. These are projections for the average full time established doc in my company, who sees about 400 wRVU’s per month and meets quality metrics and has an average sized patient panel with an average pooled HCC score.

I’m new, but I am forecasting that I can be there in the next 6-8 months most likely. I’m already averaging 350rvu’s for the past few months, and I’m seeing a sharp increase in visits and patients requesting to establish care.

I’m also in the middle of building my panel size since a not insignificant part of my income in the next fiscal year is going to be based on panel size and HCC coding. I was fairly laissez-faire about it until the past month or so, but I’ve redoubled my efforts and added 150-200 new patients during the past 2 weeks. I’m approaching 800 patients now. I think I can get to 2000 by years end at the current rate I’m getting requests. Next year is when the new compensation model takes effect.

It’s hard work, but only during my work hours. I don’t chart after hours. I tend to be very thorough, and my workflow makes closing HCC gaps and completing quality metrics almost automatic.

I’m not going to need to do any extra-curricular activities to get to that $277k number, that’s just for an average, outpatient only FM doc in our system. It will actually be a little bit higher for guys like me because for the first time ever, they're also paying more/wRVU to rural doctors starting next year, and that projection was based on the urban/suburban rate. But all compensation for hospital work is separate from this model, and just additional cash I earn.

With the additional call I do, I should push into the $310-$320 range.

Are you saying you're making $277k pre- or post-tax?

 

[VA Hopeful Dr]

Are you saying you're making $277k pre- or post-tax?

Every dollar figure anyone ever quotes for income is pre-tax.

Not sure why this keeps coming up.

 

[SLC]

Are you saying you're making $277k pre- or post-tax?

That would be pre-tax. And that’s a projected average under next years compensation restructuring.

 

[Sephirakra]

Every dollar figure anyone ever quotes for income is pre-tax.

Not sure why this keeps coming up.

Most pre-meds and med students have never had a real salary before, so they don't know the conventions.

 

[nebuchadnezzarII]

Most pre-meds and med students have never had a real salary before, so they don't know the conventions.

To everyone thinking take-home pay, just consider whatever amount they have here and assume you'll get to take home 60%. So, $200,000 salary? In reality, this is $120,000 take-home.

 

[fldoctorgirl]

Every dollar figure anyone ever quotes for income is pre-tax.

Not sure why this keeps coming up.

Well, he wrote "should net me about $277k annually". I've always taken net income to mean post-tax, but I likely just misinterpreted his use of the word. That's why I asked for clarification in this case.

 

[SLC]

Well, he wrote "should net me about $277k annually". I've always taken net income to mean post-tax, but I likely just misinterpreted his use of the word. That's why I asked for clarification in this case.

Yeah that was an unfortunate word choice, I meant it in the fishing use of the term.

 

[Splenda88]

If you're only taking home 120k on a 200k salary then either A- you need a new accountant or B- you need to hire one, and one who wouldn't net you 60% return.

I guess that poster was alluding to all deductions (taxes, health insurance, 401k, disability, etc...) 40% deduction overall seems accurate.

 

[nebuchadnezzarII]

I guess that poster was alluding to all deductions (taxes, health insurance, 401k, disability, etc...) 40% deduction overall seems accurate.

Yeah, that's what I was alluding to. It also really frustrates me that the salary figures posted online are all over the place. Does anyone know a reliable place to look to find job offer salaries in specific cities? Some places say that nationally, a psychiatrist's average income is 270k while other places are saying it's 150k. This is insane.

 

[Splenda88]

Yeah, that's what I was alluding to. It also really frustrates me that the salary figures posted online are all over the place. Does anyone know a reliable place to look to find job offer salaries in specific cities? Some places say that nationally, a psychiatrist's average income is 270k while other places are saying it's 150k. This is insane.

MGMA is a reliable source for that and If I remember correctly, 270k average seems accurate. The range will probably be between 200-300k depending on location (excluding academia).

 

[Link0358]

https://s3.amazonaws.com/s3.doximity.com/press/doximity_third_annual_physician_compensation_report_round4.pdf

If this is to be believed, then making close to 300K is realistic in many major US cities like Seattle, Dallas, and Los Angeles.

 

[Splenda88]

https://s3.amazonaws.com/s3.doximity.com/press/doximity_third_annual_physician_compensation_report_round4.pdf

If this is to be believed, then making close to 300K is realistic in many major US cities like Seattle, Dallas, and Los Angeles.

It is... Spoke to PGY3/4 psych and they said it is not difficult to make 400k/yr if you are ok to practice in suburbs located 45-60mins from some major cities in the south, but you have to be willing to work ~50 hrs/wk.