D
deleted87716
Can't do much about this. The Ontario government sets the fees.
Bingo.
Why Make 150k When 450k Is Out There?
- Thread starter jetproppilot
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Bingo.
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Blue,
I read the "low overhead" article -- kudos to him for breaking from mainstream and actually putting free market philosophies to work. A couple of things to point out as I see them:
1. this deal is best for young, healthy folks who have private insurance and high deductible plans. Elderly folks who have MC & supplemental or MC "Advantage" and a fixed income would probably be better off (from a cash flow standpoint) to stick with traditional providers, thus exluding a rather large portion of the patient base.
2. a low-overhead approach does not have to be a cash only practice model. Proper restraint on space, staffing, etc costs coupled with outsourcing of non-core operations will yield similar results
I read the "low overhead" article -- kudos to him for breaking from mainstream and actually putting free market philosophies to work. A couple of things to point out as I see them:
1. this deal is best for young, healthy folks who have private insurance and high deductible plans. Elderly folks who have MC & supplemental or MC "Advantage" and a fixed income would probably be better off (from a cash flow standpoint) to stick with traditional providers, thus exluding a rather large portion of the patient base.
2. a low-overhead approach does not have to be a cash only practice model. Proper restraint on space, staffing, etc costs coupled with outsourcing of non-core operations will yield similar results
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Ghost,
I would absolutely love to see an income statement and balance sheet for your practice -- that is simply amazing! I understand that there are fundamental differences between the Canadian and the American system, but DAM*... and I thought that I was good at controlling costs.
The two greatest line cost items for my practice (by far) are payroll and collections. Collections are a flat 7%, and I have four full time staff. Costs are predominantly fixed in nature -- the greatest contributor to "overhead percentage" is revenue. I am sure that your collection costs are lower within your system, but would you say that the remainder is similar or true?
I would absolutely love to see an income statement and balance sheet for your practice -- that is simply amazing! I understand that there are fundamental differences between the Canadian and the American system, but DAM*... and I thought that I was good at controlling costs.
The two greatest line cost items for my practice (by far) are payroll and collections. Collections are a flat 7%, and I have four full time staff. Costs are predominantly fixed in nature -- the greatest contributor to "overhead percentage" is revenue. I am sure that your collection costs are lower within your system, but would you say that the remainder is similar or true?
D
deleted87716
Perhaps. There's no single practice/payer model that's ideal for everyone, nor will there ever be. Freedom of choice is always better than freedom from choice. I don't favor a single payer system (note that this is not the same as universal coverage, which I would support, assuming it were done correctly).
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Hi,
I'm not sure I understand your terminology. What do you mean by collections are a flat 7%?
Is this something to do with patients who don't pay their bill?
This is a foreign concept to me, as I charge the govern't directly.
GD.
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GD,
Here we have two payers -- patient and third party (which can be gov't or private insurance). Unfortunately, in this system of insurance, coinsurance, supplemental insurance, and deductibles, the total patient's responsibility is not readily available in real time.
I outsource my collections to a medical billing agency; 7% of collections is what I am charged. This number is fixed at the beginning, but can be adjusted up or down depending upon the amount of work that they have to devote to your account (mine will probably be decreased to 5.5 or 6% in January). This has worked out fairly well as it saves me probably two full time employees (with their associated benefits package, etc). By doing so time off is relatively less costly as well.
Here we have two payers -- patient and third party (which can be gov't or private insurance). Unfortunately, in this system of insurance, coinsurance, supplemental insurance, and deductibles, the total patient's responsibility is not readily available in real time.
I outsource my collections to a medical billing agency; 7% of collections is what I am charged. This number is fixed at the beginning, but can be adjusted up or down depending upon the amount of work that they have to devote to your account (mine will probably be decreased to 5.5 or 6% in January). This has worked out fairly well as it saves me probably two full time employees (with their associated benefits package, etc). By doing so time off is relatively less costly as well.
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This is actually the kind of practice that I have been talking about setting up from the get go. I even brought it up at my med school interview. I didn't know if it would work or not (or if there were practices like this out there) so I'm glad to know now that it can work.
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Four full time staff? That's CrAzY town!
How many doctors practice in your clinic?
At my clinic, it's just me and my secretary (i.e. 1 staff person).
I keep costs down by having a relatively small office space of approximately 500 square feet. I have a reasonably sized waiting room, office / consulting room and 2 exam rooms. I find have more than enough room to meet my needs at the present time.
I would say that my overhead is approximately $65-70,000 per year (Canadian).
I think I'm lucky because rent seems to be very reasonable at the present due to a renter's market (for whatever reason). My largest single overhead item would be that of my secretary, who I pay very well (as she is outstanding).
GD.
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I understand now. Canadian doctors don't have this problem because we are paid directly by the government. It is quite rare to have billing rejections; if this occurs, we simply re-submit the billing, and it is almost always accepted.
D
deleted87716
Actually, no...it's pretty much the industry average in FM.
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You would need a lot of doctors in this type of clinic to balance of the amount of overhead generated by four full time staff people.
My secretary does all the administrative work (filing , billing, consults, etc.) No problems thus far.
I don't know if I would trust a nurse practioner to see my patients independently or even "semi-independently". Family medicine is just too broad
a subject.
GD.
D
deleted87716
My two-doctor practice keeps our eight staffers pretty busy. When someone is out sick, we all know it.
We have two dedicated clinical staff per doctor (one nurse, one medical assistant). They work as a team to room patients, do EKGs and spirometry, assist with procedures, draw blood, process in-office labs and studies, give injections, call patients regarding phone messages, prescription refill requests, and test results, schedule tests and consults, handle referrals and prior authorizations, and take care of random walk-in stuff like BP checks, Depo shots, PPDs, and INR monitoring. We have an office manager and three staff in the front who answer the phones, confirm future appointments, check patients in and out, manage faxes and correspondence, pull charts/file charts, etc. One of the front office staff who is cross-trained as an MA draws blood three mornings per week. My office manager is pretty "hands on" during the day (she helps out with everything in the front office), and has additional duties such as charge entry, billing/collections, and (of course) managing the office and staff. We have a busy practice, and there's plenty of work to do.
Furthermore, this is pretty typical for a traditional family medicine office. Again, four FTE's per physician is the industry average.
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GOOD EVENING!
SEVERAL YEARS REMOVED FROM WHEN I INITIALLY POSTED THIS,
I still stand firm with the theme of the thread.
And dudes, as you can see (look at the numbers of people that viewed this....FORTY TWO THOUSAND???? HUH???...holy S%^T, it...uhhhhhhh....struck a cord. FOR GOOD REASON.)
LIKE IT OR HATE IT,
it's THE TRUTH.
The truth hurts sometimes.
TIME TO BUMP THE DISCUSSION OUTTA THE RECENT PAST, into the future so new residents/med students who probably missed it, won't miss it now. NOTHING HAS CHANGED. IT'S APRIL, 2011...if you're waiting, YOU'RE MISSING.
Regards,
Jet
SEVERAL YEARS REMOVED FROM WHEN I INITIALLY POSTED THIS,
I still stand firm with the theme of the thread.
And dudes, as you can see (look at the numbers of people that viewed this....FORTY TWO THOUSAND???? HUH???...holy S%^T, it...uhhhhhhh....struck a cord. FOR GOOD REASON.)
LIKE IT OR HATE IT,
it's THE TRUTH.
The truth hurts sometimes.
TIME TO BUMP THE DISCUSSION OUTTA THE RECENT PAST, into the future so new residents/med students who probably missed it, won't miss it now. NOTHING HAS CHANGED. IT'S APRIL, 2011...if you're waiting, YOU'RE MISSING.
Regards,
Jet
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Let it go, Jet. We're all pleased that you're making bank.
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This bump is timely considering a news release yesterday. Not going to the case for much longer.
Legislation was just introduced to change the process in which compensation for E/M and procedures are valued by the RUC and CMS. It is worth mentioning that the author of this bill is Rep McDermott (D-WA), a psychiatrist and that it is also supported by Rep. Tom Price (R-GA), an orthopedic surgeon - bipartisan support and support by specialists. Interesting
http://www.aafp.org/online/en/home/...vernment-medicine/20110405ruclegislation.html
"The mechanism for how (Medicare payment) codes are evaluated has contributed to the devaluation of family medicine and primary care through the years," said AAFP President Roland Goertz, M.D., M.B.A., of Waco, Texas. He added that it doesn't seem likely the current RUC process will change this imbalance.
However, H.R. 1256, which was introduced by Rep. Jim McDermott, D-Wash., would require CMS to hire independent contractors to identify and analyze misvalued codes for medical services provided to Medicare beneficiaries and to conduct an annual review of these codes. This independent analysis would augment the work of the RUC and could result in greater accuracy and transparency, according to a March 30 press release from McDermott's office.
"Study after study has shown that primary medical care must be the foundation for a high quality, efficient health care system," said Goertz. "If we are to build up our primary care physician workforce to create this foundation, we need a system that recognizes and appropriately rewards the medical expertise and cognitive skills of primary care physicians. This legislation is an important step in that direction."
The Medicare Payment Advisory Commission has found that although the RUC tends to identify and correct undervalued codes, it does not have the same incentives to find and correct overvalued codes. "(Sub)specialists, especially those who derive the majority of their income through procedural codes, have no incentive to reduce the value of potentially overvalued codes, even though the requirements for physician work in many procedures should be generally reduced as time passes and proficiency increases," according to the text of the bill.
This is also a good read about the RUC process, also released yesterday: http://www.kevinmd.com/blog/2011/04/relative-scale-update-committee-ruc-impact-health-care.html
Legislation was just introduced to change the process in which compensation for E/M and procedures are valued by the RUC and CMS. It is worth mentioning that the author of this bill is Rep McDermott (D-WA), a psychiatrist and that it is also supported by Rep. Tom Price (R-GA), an orthopedic surgeon - bipartisan support and support by specialists. Interesting
http://www.aafp.org/online/en/home/...vernment-medicine/20110405ruclegislation.html
"The mechanism for how (Medicare payment) codes are evaluated has contributed to the devaluation of family medicine and primary care through the years," said AAFP President Roland Goertz, M.D., M.B.A., of Waco, Texas. He added that it doesn't seem likely the current RUC process will change this imbalance.
However, H.R. 1256, which was introduced by Rep. Jim McDermott, D-Wash., would require CMS to hire independent contractors to identify and analyze misvalued codes for medical services provided to Medicare beneficiaries and to conduct an annual review of these codes. This independent analysis would augment the work of the RUC and could result in greater accuracy and transparency, according to a March 30 press release from McDermott's office.
"Study after study has shown that primary medical care must be the foundation for a high quality, efficient health care system," said Goertz. "If we are to build up our primary care physician workforce to create this foundation, we need a system that recognizes and appropriately rewards the medical expertise and cognitive skills of primary care physicians. This legislation is an important step in that direction."
The Medicare Payment Advisory Commission has found that although the RUC tends to identify and correct undervalued codes, it does not have the same incentives to find and correct overvalued codes. "(Sub)specialists, especially those who derive the majority of their income through procedural codes, have no incentive to reduce the value of potentially overvalued codes, even though the requirements for physician work in many procedures should be generally reduced as time passes and proficiency increases," according to the text of the bill.
This is also a good read about the RUC process, also released yesterday: http://www.kevinmd.com/blog/2011/04/relative-scale-update-committee-ruc-impact-health-care.html
D
deleted87716
HCR is changing things.
We want to be family doctors.
http://money.cnn.com/galleries/2011...lery.primary_care_students_doctors/index.html
Med students rush to primary care programs.
http://money.cnn.com/2011/03/23/news/economy/more_medical_students_pick_family_medicine/index.htm
We want to be family doctors.
http://money.cnn.com/galleries/2011...lery.primary_care_students_doctors/index.html
Med students rush to primary care programs.
http://money.cnn.com/2011/03/23/news/economy/more_medical_students_pick_family_medicine/index.htm
I am strongly considering FM, however, when I add up the numbers, I don't see too many dollar signs (and I'm not in it for the bucks but do want to pay off my loans and have a semi-descent life!).
I know my numbers are probably off, but if a FM doc saw 20 patients/day at $50 per patient (I've heard some Medicaid patients only reimburse for $26.00) which would equal $1000 per day or $5,000 gross per week. 50 weeks at $5,000 per week equal $250,000 gross. As Bluedog mentioned, you will have four office people probably drawing $30k each or more for $120,000 in employee salaries, rent, malpractice insurance (around $10,000/year), insurance, utilities, etc. and the $250,000 gross is now down to about $80-90,000 per year less with holding for income taxes, self-employment tax, etc. It doesn't leave a whole lot.
Are these numbers in the ballpark or am I missing something? Please Blue dog or someone with some personal experience provide us with some more reliable estimates.
Thanks!
I know my numbers are probably off, but if a FM doc saw 20 patients/day at $50 per patient (I've heard some Medicaid patients only reimburse for $26.00) which would equal $1000 per day or $5,000 gross per week. 50 weeks at $5,000 per week equal $250,000 gross. As Bluedog mentioned, you will have four office people probably drawing $30k each or more for $120,000 in employee salaries, rent, malpractice insurance (around $10,000/year), insurance, utilities, etc. and the $250,000 gross is now down to about $80-90,000 per year less with holding for income taxes, self-employment tax, etc. It doesn't leave a whole lot.
Are these numbers in the ballpark or am I missing something? Please Blue dog or someone with some personal experience provide us with some more reliable estimates.
Thanks!
Why make 150k when 450k is out there? Quite simple actually. Heres a sampling:
- Because regardless of specialty, we all live good lives and retire comfortably anyway. Some pay off their loans in 5 years, some in 10 years, but I dont know any docs whove retired with med school loans still to pay off.
- Because people point to me at the supermarket and say hes my doctor!. Nobody points to jetprop and says hes my anesthesiologist!
- Because people stop me in public places to shake my hand (or hug me) and tell me how glad they are that I saved their son/daughter/grandpa/grandmas life. Nobody stops an anesthesiologist at the supermarket to tell him thanks for the intubation!
- Because tilting and raising tables for other doctors isnt part of my job description.
- Because to regular lay people Im a real doctor who knows how to diagnose and treat disease. Im not simply someone who was trained to perform a set of procedures over and over so that surgeons can perform their magic.
- Because spending the majority of my day reading a magazine or newspaper would be extremely boring to me, no matter how high the pay. Im action-oriented and enjoy interaction with people. I enjoy diagnosing and treating disease with only a few non-specific symptoms. I have to be doing something all the time while at work and sitting around waiting for a surgeon would just kill me.
- Because at work I call the shots. I see patients at my pace. I have patients scheduled or not scheduled or double-booked if I wish. I dont have to wait for a surgeon to finish before Im allowed to get to work on the next case.
- I can find good work with good pay anywhere in the country, in every town of every size of every state. Im not confined to an area with a hospital or an area with surgeons.
- Because no matter how much anesthesiologists think theyre above primary care docs, reality is that nurses with a couple of years of advanced training can replace the both of us.
- Because when little boys and little girls put on a stethoscope around their necks and a long white coat and carry a little black bag and play pretend doctor or dress up as doctors for Halloween, they really are imitating me, not jetprop.
- Because its a great feeling knowing that Im what people think of when they think of the word doctor and that feeling is something no amount of money can buy.
- Because my lifestyle rocks compared to anesthesiology (yes, you read that right).
- Because regardless of specialty, we all live good lives and retire comfortably anyway. Some pay off their loans in 5 years, some in 10 years, but I dont know any docs whove retired with med school loans still to pay off.
- Because people point to me at the supermarket and say hes my doctor!. Nobody points to jetprop and says hes my anesthesiologist!
- Because people stop me in public places to shake my hand (or hug me) and tell me how glad they are that I saved their son/daughter/grandpa/grandmas life. Nobody stops an anesthesiologist at the supermarket to tell him thanks for the intubation!
- Because tilting and raising tables for other doctors isnt part of my job description.
- Because to regular lay people Im a real doctor who knows how to diagnose and treat disease. Im not simply someone who was trained to perform a set of procedures over and over so that surgeons can perform their magic.
- Because spending the majority of my day reading a magazine or newspaper would be extremely boring to me, no matter how high the pay. Im action-oriented and enjoy interaction with people. I enjoy diagnosing and treating disease with only a few non-specific symptoms. I have to be doing something all the time while at work and sitting around waiting for a surgeon would just kill me.
- Because at work I call the shots. I see patients at my pace. I have patients scheduled or not scheduled or double-booked if I wish. I dont have to wait for a surgeon to finish before Im allowed to get to work on the next case.
- I can find good work with good pay anywhere in the country, in every town of every size of every state. Im not confined to an area with a hospital or an area with surgeons.
- Because no matter how much anesthesiologists think theyre above primary care docs, reality is that nurses with a couple of years of advanced training can replace the both of us.
- Because when little boys and little girls put on a stethoscope around their necks and a long white coat and carry a little black bag and play pretend doctor or dress up as doctors for Halloween, they really are imitating me, not jetprop.
- Because its a great feeling knowing that Im what people think of when they think of the word doctor and that feeling is something no amount of money can buy.
- Because my lifestyle rocks compared to anesthesiology (yes, you read that right).
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Enjoy managing that chronic T2DM, HTN, HLD... etc etc.
Enjoy the non-compliant patients
Enjoy the lortab and percocet-junkies
Enjoy all the "patient education" that you spew like a broken record, and again, refer to point #2
Enjoy the paperwork, the frustration, getting dumped on by EVERYONE (if you work in the hospital)
Enjoy the mental masturbation of endless rounds
Enjoy consulting everyone, and asking a ton of ridiculous questions.
Anesthesiologists know how to diagnose and treat. They do so all the time in the ICU, which involves very sick patients in a more acute setting. They get to do procedures without waiting on someone to do a certain procedure. I like to see my results quickly. I also don't need others to tell me I'm doing a good job to know I'm doing a good job. The results speak for itself. I also have found that while I do enjoy interaction with people, I don't care to sit there listening to some patient ramble on about some worthless nonsense.
That's why I chose anesthesiology over FP/IM.
I'm in a more rural area, so FP (in addition to IM) attendings work as hospitalists. They also work the ED. I can honestly say, the ED should stick with ED-trained physicians. The FP docs that worked there never did a complete work-up, and were quick to call for an admit... guess who got dumped on by the ED and ortho/gen surg? Yep, hospitalists.
Enjoy primary care, it's definitely for some, but not for others.
If you want a lifestyle in primary care, be prepared to take a pay cut, or open up a spa/boutique on the side... BTW.
Enjoy the non-compliant patients
Enjoy the lortab and percocet-junkies
Enjoy all the "patient education" that you spew like a broken record, and again, refer to point #2
Enjoy the paperwork, the frustration, getting dumped on by EVERYONE (if you work in the hospital)
Enjoy the mental masturbation of endless rounds
Enjoy consulting everyone, and asking a ton of ridiculous questions.
Anesthesiologists know how to diagnose and treat. They do so all the time in the ICU, which involves very sick patients in a more acute setting. They get to do procedures without waiting on someone to do a certain procedure. I like to see my results quickly. I also don't need others to tell me I'm doing a good job to know I'm doing a good job. The results speak for itself. I also have found that while I do enjoy interaction with people, I don't care to sit there listening to some patient ramble on about some worthless nonsense.
That's why I chose anesthesiology over FP/IM.
I'm in a more rural area, so FP (in addition to IM) attendings work as hospitalists. They also work the ED. I can honestly say, the ED should stick with ED-trained physicians. The FP docs that worked there never did a complete work-up, and were quick to call for an admit... guess who got dumped on by the ED and ortho/gen surg? Yep, hospitalists.
Enjoy primary care, it's definitely for some, but not for others.
If you want a lifestyle in primary care, be prepared to take a pay cut, or open up a spa/boutique on the side... BTW.
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Do you have a Napoleon complex in the room poor guy? Grow up and I wonder if your another one of the big bad internet boys but off the pc you are the most socially awkward person in the room....
To both PCP/Ane-See the post above the previous one. He makes the most sense. We shouldn't be bickering with each other we should be fighting the CRNA/NP encroachment. It seems people forget the important battles....
Also I am leaning between EM/FM/GAS as my choices in medical school.
And to your ED trained Physician comment-if they would be willing to work in rural America then that argument would fly but most young EP's probably don't want to work in some rural ER due to losing skills(I have actually seen this experiment tried in my hometown and the EPs dont last due to the boredom and lower pay.)
D
deleted87716
Yes, some of your figures are off. There are way too many variables to really play that sort of numbers game accurately, but I can tell you that my average revenue (not charges before write-offs, but actual revenue) per patient is in the $100-120 range (thanks to a good payer mix and appropriate coding and billing). I see 20-25 patients per day and work four eight-hour days per week (outpatient only). I'd be earning well above the national average even without the additional income from group ancillaries, bonuses, etc.
Regarding staffing, we've added a third doctor since my last post two years ago, and only added one additional MA since then. So, now we have nine staff supporting three doctors, or three FTEs per physician. We have a central billing department for the group that lets us offload some of that work, although we're still paying for it (our overhead includes an admin fee to support our centralized infrastructure, which includes an imaging center and central lab).
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If you just throw your loans into a Federal Direct Consolidation Loan, select the income-based payment setup, make 120 consecutive payments (10 years) while working in public service/not-for-profit (most residencies and academic centers are), your federal loans will be forgiven. Perhaps making a little less will transform into paying less for your loans? It will be nice to have no loans after 10 years with a monthly payment based on % of income.
You can live comfortably while paying and will live comfortably on a salary that still ranks as one of the top-paying jobs in the country. Make poor decisions and live too lavishly and you can end up just like many athletes, celebrities, and others who make a bunch more but make poor investment choices.
Lifestyle is a huge factor - but what lifestyle are you looking for? Because we are physicians, does that mean we're entitled to luxuries? How much is too much? Do you need a luxury sports car and a huge house to be happy? There may be other issues and forces besides a love for medicine at hand here if that's the case.
You can live comfortably while paying and will live comfortably on a salary that still ranks as one of the top-paying jobs in the country. Make poor decisions and live too lavishly and you can end up just like many athletes, celebrities, and others who make a bunch more but make poor investment choices.
Lifestyle is a huge factor - but what lifestyle are you looking for? Because we are physicians, does that mean we're entitled to luxuries? How much is too much? Do you need a luxury sports car and a huge house to be happy? There may be other issues and forces besides a love for medicine at hand here if that's the case.
D
digfast
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For the most part, I agree with this wholeheartedly. That being said, I liked my anesthesia rotations and even considered the field for a short time but after deliberation decided it wasn't for me. I like having an office. I like knowing my patients and following them. I like being "in charge"...etc.
I think one thing that really bothered me about the field was all the "supervision" and downtime during/between cases waiting and waiting and waiting. It felt way too "hurry up and wait" like my old job. I don't do well in "support personnel" type positions, so Gas, Path, Rads, etc...were all gonna be a tough sell for me.
For me, it came down to Surgery (Uro mostly) and FP. I'm pleased with where I'm headed, and will likely do sports med...or I also plan to get an MBA during residency...so i may be an administrator someday in charge of negotiating contracts with Anesthesia groups....who knows.
FP is for me cause I like having an office...I like being independent, I like following patients and their outcomes, I like the schedules you can work as an FP and still make 200+, I have to have variety (would have gotten incredibly bored in many of the specialties I rotated through) and most importantly, I LOVE spending time with my son, and not having my work be dictated by pretty much anyone but ME.
I have no animosity toward most any field, but do wonder why so many do.
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Someone got their panties in a wad.
I was using Shinken's language pretty much. It sounded like he was out-right bashing anesthesia. So, I did the same by stating all the negatives in his specialty. I could care less about what one decides to do for their lives, b/c it is THEIR life. Some people are into primary care, other's aren't. I've had every attending in primary care specialties comment to me (and in my evals/LORs) how I'd make an excellent PCP. That's great, and I know I have the ability to do it. However, it's just not my love. I notice you're an MS-0, so I'm not even sure why you're posting. Plus, I've matched, and don't care what you think.
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Again bro grow up. I am a med student at DCOM(I notice you go here from the post in the Osteo board) and just hadn't changed the header. Didn't med. school to teach you to be the bigger person? How will you deal with Attendings that put you down? It will happen I will bet you a great sum of money.As far as caring what I think that is great and I don't care for your opinion in the FM board is why I commented. Also I am in DCOM all the time why don't you come visit me sometime so we can chat face to face and figure somethings out about why you have such a poor attitude? If I were in your spot I would be happy and not on the board stirring the proverbial pot in FM since you have nothing to gain in that field.
Inbox me if you would like to chat.
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I'm free to post in this forum, just like the next person.
Sure, it might have been "inflammatory," but this thread is one big flame. Not sure what your deal is, or why you've zeroed in on me, but I honestly don't feel any responsibility to respond to you, regardless of you attending my school or not. Plus, a lot of what I posted was more in jest, in case you could not tell. Also, if anything, I have posted several times that each should do what makes them happy. I don't have a poor attitude about anything. I have plenty of friends doing IM/FP and that is great that they enjoy the field.
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Best of luck to you. You will figure IT out one day. I noticed some comments you made at me before you edited the post. Again good luck and I hope you figure things out soon.
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Take it easy everybody. This thread was hot button when it was started ages ago and looks like nothing has changed.
Please be respectful of others, particularly when you are outside of your "home" forum.
Please be respectful of others, particularly when you are outside of your "home" forum.
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Actually, I do. I get a lot of satisfaction from the patients who HAVE managed to control their HTN, DM, etc. To me, it's very frustrating to go into the ICU or the PACU and see patients who have had major medical interventions because of completely preventable diseases - the COPDer who is impossible to wean because he smoked like a chimney, the BKA who has uncontrolled diabetes, etc.
I don't get why people make such a big deal out of non-compliant patients. They're non-compliant. And....? It's their kidneys/peripheral nerves/vision/peripheral vasculature, not mine. I do my best to warn them; I'm not going to break my back or my emotions trying to save everyone.
Plus, any specialty with any continuity of care suffers from non-compliant patients. The orthopedic surgeons see that - the people who refuse to go to PT/OT after shoulder surgery, and end up with frozen shoulders and worse ROM than they had before. The general surgeons, vascular surgeons, OB/gyns, pulmonologists, cardiologists....they all have to deal with non-compliant patients.
We discharge those from our practice, if they get to be abusive. Otherwise...meh.
Besides, you're way behind the times. Lortab is SOOOOO 5 years ago; Xanax is the new thing to ask for.
Everyone has paperwork. Everyone has frustration. Everyone feels dumped on. Don't know why FM is supposedly worse in this regard.
What endless rounds?
You're thinking IM. Although, in all honesty, the LONGEST rounds that I had to endure were SICU rounds with....wait for it....surgery residents and anesthesia residents. How we managed to go 15 feet in 3 hours was kind of beyond me.
C'mon, you know as well as I do that your level of intellectual laziness depends on you, not your field. True, but I guess it isn't fair to go into another specialty forum and ADD to the flames. I don't post in the anesthesia forum that "All of you gas people are horrible people for chasing $$$$ when there is a healthcare crisis in this country!! We need PCPs, and you should ashamed of yourselves that you chickened out!" Nor would I add to a thread like that. What's the point?
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JPP - I had the same thought as you....how to minimize my debt, and still be happy.
Unlike you, though, I did not specialize and still chose to go into primary care.
And, unlike you, by the time I am done residency, I will be DEBT FREE.
I took advantage of primary care scholarships. There are also a lot of government loan repayment programs for primary care. In many locations, FP practices will pay off some of your debt for you, as an incentive.
I don't have any debt AND I am still happy.
You don't have to specialize to pay off your debt in a reasonable time. I will make less than you, true....but it's plenty for me. Being debt free is all that I really want, to be honest. That, and having a fairly decent lifestyle. The job opportunities for FP are plentiful, and it's a field that offers a lot of flexibility. For me, that's enough.
BOOM!!!
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.Actually, I do. I get a lot of satisfaction from the patients who HAVE managed to control their HTN, DM, etc. To me, it's very frustrating to go into the ICU or the PACU and see patients who have had major medical interventions because of completely preventable diseases - the COPDer who is impossible to wean because he smoked like a chimney, the BKA who has uncontrolled diabetes, etc.
It totally frustrated me on my inpatient medicine months to see a patient come into for the 3rd time in 1-2 months for COPD exacerbation. You treat the patient, they get better, then they start lighting up in the bathroom of their room. Yep, you're getting discharged now. That's just one example.
I don't get why people make such a big deal out of non-compliant patients. They're non-compliant. And....? It's their kidneys/peripheral nerves/vision/peripheral vasculature, not mine. I do my best to warn them; I'm not going to break my back or my emotions trying to save everyone.
On my primary care/inpatient medicine months, I put all my effort to being really good and learning as much as I can. I took each rotation and acted like I was going into that specialty. That was the only way I felt I could learn something out of a particular rotation. I also counseled patients all the time. Even when the patient would say "I smoked for 60 years, what good is quitting going to do for me now?" I still counseled. I praised patients that did quit (or did comply with whatever). No, I never got personally involved with my patients... but at the same time, it did frustrate me.
Plus, any specialty with any continuity of care suffers from non-compliant patients. The orthopedic surgeons see that - the people who refuse to go to PT/OT after shoulder surgery, and end up with frozen shoulders and worse ROM than they had before. The general surgeons, vascular surgeons, OB/gyns, pulmonologists, cardiologists....they all have to deal with non-compliant patients.
Exactly why I did not pursue those specialties.
We discharge those from our practice, if they get to be abusive. Otherwise...meh.
True. Still not my thing. I'm currently on a rotation that has pain clinics twice a week, but only for CA patients. I'm fine with most of the patients. If I decide to do a patient fellowship and practice accordingly, I'll never be writing pain pill scripts.
Besides, you're way behind the times. Lortab is SOOOOO 5 years ago; Xanax is the new thing to ask for.
So, it's bigger than Vitamin D? Yeah, I know about Xanax... had one patient in the pain clinic today ask for a Xanax script. We asked, why can't you get one from your PCP? The patient dropped the topic, then my attending checked the controlled substance page, turns out they had a refill a few days ago... so yeah, I know
Everyone has paperwork. Everyone has frustration. Everyone feels dumped on. Don't know why FM is supposedly worse in this regard.
I mixed in hospital medicine into this. So no, FM probably isn't worse in this regard, especially if all you do is office medicine. However, the paper work is A LOT more than most other specialties have. Dealing with Medicare/Medicaid, etc.
What endless rounds?
Again, that was more in regards to hospital medicine. Like I stated, rural hospital... FPs are also hospitalists. The SICU rounds were attending-dependent. The anesthesia CC attendings I worked with were efficient. However, it was the trauma/critical care surgeons that LOVED to destroy the clock with super long rounds... so, I'll give you that much. At any rate, I'll give you that one... that is more IM.
Again, I posted in jest. However, I do stick with my notion. ED should be worked by ED-trained attendings. However, that issue of ED-trained physicians not working in rural areas makes it difficult. I get that...
True, but I guess it isn't fair to go into another specialty forum and ADD to the flames. I don't post in the anesthesia forum that "All of you gas people are horrible people for chasing $$$$ when there is a healthcare crisis in this country!! We need PCPs, and you should ashamed of yourselves that you chickened out!" Nor would I add to a thread like that. What's the point?
It's not right for one of the posters to post crap about anesthesia either. Plus, I don't feel that I chickened out. Like I stated above, I probably could do a decent job as a PCP. I just don't love it. I felt burned out by it. I didn't enjoy it. I don't feel that anyone should go into a specialty just because there is a "national need" for PCPs. You should go into it if you enjoy it. Financial issues also play a role. If you're unable to pay off your debt, then you're just not going to attract people into that specialty. Tuition these days are insane. Plus, yeah, anesthesia makes decent money, but it's not derm/rads/plastics. Don't forget, anesthesiologists are very much like the medicine attendings within the OR/PACU/SICU. It's more acute, and that's why I like it. I'm not into long-term management.
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Im just going to throw this out there; has anyone considered moving to Canada for FM benefits?
http://forums.studentdoctor.net/showthread.php?t=757659
(few posts down)
http://forums.studentdoctor.net/showthread.php?t=757659
(few posts down)
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Note that that's not how I truly feel - if you want to do anesthesia, great. I'm just using it as an example. I've worked with a lot of anesthesiologists that I really admired and respected; I don't think that they chickened out.
Whether or not posters post crap about anesthesia is irrelevant. The point that I was getting at is that no one is going into the anesthesia forum, openly disparaging those who chose Anesthesiology. Why is it fair for anesthesiologists to come into the FM forum and disparage those of us who chose FM? Or add fire to the flames of others who have?
If you're in FM, and can't figure out how to pay off your debt in a timely manner, that's your own fault. To be honest, though, I can very easily see how anyone in any specialty, anesthesia included, could have difficulty paying off their debt if they weren't smart about budgeting their first "real" paycheck.
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But...but...don't you just want to get that shiny new 3 series with your first paycheck?
Seriously though, i've thought about those NHSC scholarships (I assume that's what you were referring to). But, is it true that if you apply for them, you cannot pick the underserved locale you want to work in, and that when you do work in their designated locale, your income is lower than the average salary, and you could have just made those payments working wherever on a regular income?
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I would love a new car but it just isn't that high on my list of priorities for now. Plus I enjoy banging around town in a hunk of junk that I don't have to worry about trying to keep it looking spiffy.
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There are a bunch of primary care scholarships; the NHSC is a nationwide program, while many of the scholarships are state-based.
For the NHSC, yes, you CAN pick the underserved locale. The clinic/site has to have a certain HPSA score, though.
Your income is supposed to be commensurate with nearby clinics.
The NHSC Loan Repayment Program is a little bit more flexible.
It's not a perfect program, but it's something to look into if you're really into primary care.
+1.
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It probably involved giving lots of money to the government.
D
deleted87716
I paid mine off early, too.
Typically, you just pay more than the minimum amount per month. I threw a few bonus checks and income tax refunds at mine, too. Any excess is applied directly to the principal. There is no penalty for early repayment, so you save money on interest.
There are also several repayment options that allow you, among other things, to pay more per month over time as your income increases. See link for more info:
http://www.staffordloan.com/stafford-loan-info/faq/
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Keep in mind a LOT of our predecessors were paying on loans that carried a MUCH lower interest rate.
The government has pretty much screwed my class and beyond. You can get a mortgage way cheaper than you can get a loan for med school....and the best part is, they give you a job making 40-55K a year and don't allow you to defer without juice.
You bet your ace I'm gonna look for any program I can find to let someone else pay those suckers off FOR me.
The government has pretty much screwed my class and beyond. You can get a mortgage way cheaper than you can get a loan for med school....and the best part is, they give you a job making 40-55K a year and don't allow you to defer without juice.
You bet your ace I'm gonna look for any program I can find to let someone else pay those suckers off FOR me.
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No argument that they've definitely raised the rates for education loans these days, but there are also programs in place that can reduce the difficulty of it. I don't know what year you are, but I'm looking with interest at the IBR.
You never pay more than 10% of your discretionary income toward your loans and if you work at certain non-profits, your loans can be forgiven within 10 years (with residency counting toward those 10). That's not so bad, no matter what your debt burden. Add in other scholarship programs, and I think <10 years is doable for any specialty without really having to mess up other aspects of your finances. And this is for any specialty in any location. There are no restrictions on the IBR, though loan forgiveness after 10 years only applies to non-profits.
Additionally, SMQ is right that there is the NHSC loan repayment program and many states have primary care loan repayment as well. You can stack those repayments and get upwards of $50K/yr. paid back by the 2nd and 3rd years of service if you're doing primary care in an underserved area.
Lots of ways to skin the cat if you're interested in primary care, even if you do have $200K+ in loans.
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Agree completely with you....that being said, there are absolutely no guarantees that the IBR "promises" will be held. How much would it suck to start paying on IBR and be planning to have it forgiven after 10 years only to have congress renig on their "deal" about 8 years into it...think they'd be kind enough to give you credit for all the interest that's accrued in that time?
I'm paying those suckers off asap, hopefully with some help from federal and state programs that pay cash.
I don't trust politicians at all.
D
deleted87716
Actually, no...overall, Stafford loan interest rates have been going down, not up. Mine were >8%. See link: http://www.finaid.org/loans/historicalrates.phtml
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I was referring to folks consolidating loans at 2-4% for much of the last 10 or so years before I entered MS.
Now, the government has monopolized Student Loans. And actually put most people at my local provider I had chosen as my lender out of work in doing so.
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Right, the plan was to pay more than the minimum, I'll probably be on IBR, just cause I can't afford 800$/mon for loans.
I was just wondering if he got any extra $$ from some where.
I was speaking to a person with my loan holders, I am currently still in deferment, and apparently any payment i send them goes to interest first then principal. which is super annoying. Even when I start making payments, according to this person, they will always go to interest until outstanding interest on the loan is paid off.
I don't think that last part is correct, once I start making payments, I can specify an additional amount to go to the principal.
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As this thread has become very inflammatory to many of the regular users of this forum, and since there was not any particular reason for this thread to be bumped from 3 years ago other than to stir up more controversy, this thread is being closed.
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We've decided to reopen this thread for continued discussion. The topic of disparate compensation amongst specialities is relevant to SDN, but I can also see how the discussion as framed so far could be insulting to primary care physicians. Moving to the Topics in Healthcare forum which is a more "speciality neutral" environment. I only ask that you keep the discourse civil and respectful.
