financial success

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define financial sucess.
 
250-325, 000 is what I would call financial success in medicine. something comprable to what the specialists are earning, and this is really a low range. In the world of FP, how is it done? thanks
 
Making an average of $140,000/year isn't financial success? 😕
 
Shinken said:
Making an average of $140,000/year isn't financial success? 😕
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Average annual income in family medicine is closer to $170,000.

If your goal is to earn upwards of a quarter of a million dollars a year doing family medicine, you're going to need to be smart, creative, or (ideally) both. The money's not going to fall into your lap.

You'll probably stand a better chance of accumulating wealth simply by investing well, regardless of your annual income.
 
People don't go into general surgery for the great lifestyle, and they don't go into FM for the money.

You better be happy with the average income if you choose FM. If you surpass it (usually by working harder or doing more procedures/cosmetic derm/some kind of side schtick) then great. But you need to know that's not the norm.
 
So kent how is it done? The article or rather the website of the Xnavy guy doing derm in Texas was great! I see legislature stepping in on this, as they already have in Florida- nurse practitioners and medical assistants can operate most of the cosmetic derm toys- yes? (of course under an MD/DO name tag. Im suprised The american society of dermatologists aren't actively lobbying against this? I honestly would enjoy doing some of this stuff if I could acquire adequate training- I just dont think it will last for long. Im in anesthesia and the potential money is great, and I can see myself doing a pain fellowship. Honestly- the OR gets old, so Im fishing a bit to see what my options are. Contemplating change.

As of 2007, the rules regarding pain fellowships are changing, an FP can apply for an interventional fellowship- although in my opinion (in general) good luck competing with anesthesia graduates.

When you have close to 270, 000 dollars debt and no equity these decisions become important.

I did note that FP salaries are on the rise by 2010 as you quoted, this is interesting.

Can an FP market to a certain payer group, for better reimbursemen? Any other procedural tricks that an FP ca ge his/her hands on for better reimbursement?
 
medicineman1 said:
So kent how is it done?
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"It's like saying to Pavarotti, 'Teach me to sing like you.'" - George Costanza (Seinfeld) 😉

Seriously...there's no one way to maximize your income in FM.

Running an efficient practice, billing and coding properly, choosing your payer mix wisely, etc. are certainly the basics. Multispecialty groups can offer economies of scale and negotiating clout with payers. Office procedures, cosmetic or not, can augment your income. Personally, I wouldn't touch pain management with a ten-foot pole, but that's just me.
 
medicineman1 said:
Im in anesthesia and the potential money is great, and I can see myself doing a pain fellowship. Honestly- the OR gets old, so Im fishing a bit to see what my options are. Contemplating change.
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If I was 270K in debt and doing an anaesthesia residency, I would finish residency, work hard and live modestly for a few years, pay off my debt, THEN contemplate change.

Why reinvent the wheel?

You are in great shape to be able to pay off what is a fairly above average debt.

FM will always be there when you burn out. Of course you will have to do another residency, but if you sock away some cash and plan wisely, you can do it.
 
This thread post an interesting question. Is there a debt cut-off for going into FM? Is 250,000+ too much? I would think that it shouldn't really matter. With loan repayment programs and living within reason, I think a debt like this could be manageable. What do you guys think?
 
Come on lets be real...

Seeing as how FP gets out of residency 2 years or 3 sometimes before surgeons or other subspecialties of IM or whatever..... that means they would have gotten paid maybe 200k give or take more than the surgeons/IM-specialists etc by the time those people get out of residency/fellowships. Dump the 200k into the loan and live as if you are an intern for three years after getting out of residency and you will be debit free or mostly debit free after that..
 
Faebinder said:
Come on lets be real...

Seeing as how FP gets out of residency 2 years or 3 sometimes before surgeons or other subspecialties of IM or whatever..... that means they would have gotten paid maybe 200k give or take more than the surgeons/IM-specialists etc by the time those people get out of residency/fellowships. Dump the 200k into the loan and live as if you are an intern for three years after getting out of residency and you will be debit free or mostly debit free after that..
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Absolutely, that's an excellent point. Time of training and loss of income should be factored in to income comparisons.

Only problem with the theory of paying back loans with the difference in income is that it doesn't always work out that way. It takes extreme discipline to pay back student loans instead of trading the old Ford in.
 
1. Learn how do code the visits correctly. It has been shown that this can increase your earnings by up to 30%.

2. Learn procedures that are cash based and assess if they can be done in your office. Do a cost analysis.

3. You can start by analyzing and purchasing a practice that has had a successfull growth pattern.

4. Once your practice grows, hire Mid-level providers to help increase volume.

5. Advertise, to grow your practice.

6. Do periodic evaluation of insurance companies.

7. Have a good accountant.

8. Reduce overhead costs as much as possible.

9. build your referal base.

10. Consider that 300 K + is not easy to make as an FP.
 
erichaj said:
1. Learn how do code the visits correctly. It has been shown that this can increase your earnings by up to 30%.

2. Learn procedures that are cash based and assess if they can be done in your office. Do a cost analysis.

3. You can start by analyzing and purchasing a practice that has had a successfull growth pattern.

4. Once your practice grows, hire Mid-level providers to help increase volume.

5. Advertise, to grow your practice.

6. Do periodic evaluation of insurance companies.

7. Have a good accountant.

8. Reduce overhead costs as much as possible.

9. build your referal base.

10. Consider that 300 K + is not easy to make as an FP.
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11. In house x-ray machine, ekg, treadmill
12. In house lab
13. move to Texas
 
allendo said:
11. In house x-ray machine, ekg, treadmill
12. In house lab
13. move to Texas
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The list can go on. You can get a spirometry machine, or do joint injections.

Texas? Too hot for me. lol

P.S. a word on xrays. You only get paid for the interpatation of the xray. some insurer require that a radiologist do that as well. It's kind of a costly machine.
 
erichaj said:
P.S. a word on xrays. You only get paid for the interpatation of the xray. some insurer require that a radiologist do that as well. It's kind of a costly machine.
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We used to have in-house x-ray, but it was always break-even...no real profit. Kinda convenient, though. The cost of keeping a tech finally got prohibitive. They're in short supply around here, and can earn more working in the hospital.
 
KentW said:
We used to have in-house x-ray, but it was always break-even...no real profit. Kinda convenient, though. The cost of keeping a tech finally got prohibitive. They're in short supply around here, and can earn more working in the hospital.
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Even after you read the x ray, if you miss something you are liable. I would rather send it to radiology and have them send me a copy.

Most of the time, if it's that acute, the patients end up in urgent care or ER anyway.

But to get back to the original question, I think many people in here are worried about the student loans they have and want to do FP but fear that it will take them too long to pay back their student loans. They have a good point. It is not easy to earn 250K in FP. But even if you earn 160 and increase it by 20% its 192K.

Its those first few years out of residency that are hard.
 
on site xray is so nice and convienent. but, cant your medical asst or nurse shoot plain films in offices? the urgent care center where i moonlight in MI uses the M.A.'s working at the center do the xrays. maybe its a state to state issue. the films are overread though.
 
dr.smurf said:
on site xray is so nice and convienent. but, cant your medical asst or nurse shoot plain films in offices? the urgent care center where i moonlight in MI uses the M.A.'s working at the center do the xrays. maybe its a state to state issue. the films are overread though.
Click to expand...

X-ray techs in Virginia need to be licensed.

Even if films are overread, you're still liable for any management decisions made based on your own reading.
 
Shinken said:
One word: Botox

Check this out:

http://www.memag.com/memag/article/articleDetail.jsp?id=301442
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It's not that easy. You can't just put up a sign and have the people line up for botox. In almost any given area there are plastic surgeons, dermatologist, FPs, IMs, Ob/gyns and medical spas advertising for botox and all those other cosmetic procedures.

The salesmen want you to believe that if you build it they will come. It just does not work that way. The margin on botox is not very high. Your first 10 patients will pay for the advertising to get them in. It may cost even more if you are in a competitive market.

I had a laser salesmen tell me the lease will be 2000/month and you will make a bunch of money from it. When I cornered him down as to how much a "bunch" really was, the most amazing thing happened.

"Well I can't really make claims on how much you can make".

Word to wise: How do you know if a laser/botox salesmen is lying to you?

They open their mouth and start talking.

That article is very misleading. I know that in california very few people sell botox for more than $12 per unit. That is a $6 per unit profit. The average patient may neet from 30 to 50 units. so in fifteen minutes it takes to inject it will make you from 180 to 300 dollars. Not bad, but now you have to take out the marketing cost from that. Since so many people are marketing it, you will need to be aggressive. In english that means spend money. It will take about a year to build up a practice where you make 20 to 30 K from botox. Now, minus that from the patients you will have to not see to fit in the botox patients. You end up coming close to breaking even the first year. Remember, you cant charge for the consult for botox patients. It is a cosmetic procedure. No on charges for the initial consult.

So if you are in it for the long term (several Years) you can not build you practice where it will make a good profit from botox. You also have to think why would someone come to you when they can go to a full service Medical spa and get the treatments there.
 
I have heard that in addition to botox and other lucrative "procedures" FP can perform colonoscopies.

Is this true?

What about restalyn?

Thanks
Pureride
 
Pureride said:
I have heard that...FP can perform colonoscopies.
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Discussed at length in this thread. It doesn't reimburse as well as it used to, however. In order to make much from doing colonoscopies, you'll need volume.

What about restalyn?
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I don't see why not. However, like any purely cosmetic procedure, your financial success will be dependent on how well you market yourself.
 
I have recently heard of many different types of cosmetic procedures using restylane.

One that stood out was its use in rhinoplasty. MD's are performing blade-less rhinoplasties using this compound. For example, if you have a parge bump on your nose, restylane is used to fill in the aread around the bump so that it is less pronounced looking.

Has anyone else heard of this?

Obviously, if you have a horrible a roxanne nose, a simple filler is not going to do the trick but, for small imperfections this seems great.

Also, if FP's can do them, its a great way to
1) Improve a pt's self esteem without having the risks of surgery
2) Divert some of the cash from plastic surgeons pockets into the much needed (in certain circumstances) pockets!

This is great news for FP's!!!!

Agree or disagree?


http://www.restylane.com/
 
Well I'll bite on the question of financial success. I have been thinking about this myself and I ran some numbers.

Hypothetical: You have your own practice: see 25 patients a day with an average net billing of ~$100 a patient (new patients you get a little more and return a little less and if you do any procedures it helps offset the return patients). So $2500 a day or $12500 a week or $50000 a month or $600,000 a year (assumming a 4 week vacation/holidays etc...). Overhead varies from 40 to 60%. So lets assume 50% overhead results in $300,000.

Am I missing something?? Local guys that I have talked to have an overhead ~40%. And if you add a midlevel or lab or etc.......

What do you guys think??
 
HeyDoc said:
Well I'll bite on the question of financial success. I have been thinking about this myself and I ran some numbers.

Hypothetical: You have your own practice: see 25 patients a day with an average net billing of ~$100 a patient (new patients you get a little more and return a little less and if you do any procedures it helps offset the return patients). So $2500 a day or $12500 a week or $50000 a month or $600,000 a year (assumming a 4 week vacation/holidays etc...). Overhead varies from 40 to 60%. So lets assume 50% overhead results in $300,000.

Am I missing something?? Local guys that I have talked to have an overhead ~40%. And if you add a midlevel or lab or etc.......

What do you guys think??
Click to expand...


Here is a breath of fresh air. someone who does the math rather than speculate.

I did the same exact numbers analysis on another post.

Except I used an average of 75 dollars per visit. I felt that you might only get about 20% new patients. The average may be lower.

However, even with that thinking you can make between 235 and 255K per year.
This is only true if all of your patients show up every day and you actually do see 25 patients per day. You can solve this problem by double schedualing or working an extra 1/2 day to make up for the no-shows. If you add another provider, (as much as I can;t stand the idea of feeding the troll PAs, they can be you 3rd year resident forever) can increase your bottom line. You do have to have enough volume to be able to bring in another guy.

But let me ask you this, Even if you made 250K per year working 4 1/2 days a week, wouldnt that be worth it?
 
Yes,
like many things in life- sounds great, yet on average doesnt happen! Why does the average FP make 120-140 k? Im sure its multifactorial! erichaj what is your background? At times it seems as if you are speaking as if in the drivers seat, and at others as if you are considering FP yet arent quite sure yourself?

For me- Im in anesthesia and want to make a change - am considering PM&R and FP- PM&R at this point is slightly more appealing, as I feel its still a reasonable springboard for interventional pain management, although its a tougher road than if I just buck up and finish anesthesia training. I am just finding the OR to be way boring! the day drags!!!!

Also for me- the concept of FP is doable, yet the lack of reimbursement makes me steer away- too much freakin debt here! sad to say- its unfortunate that economics drives the bus- but lets face it- in reality - gotta pay the bills!

I dunno- shoulda been a high profile attorney, laugh!
 
medicineman1 said:
Yes,
like many things in life- sounds great, yet on average doesnt happen! Why does the average FP make 120-140 k? Im sure its multifactorial! erichaj what is your background? At times it seems as if you are speaking as if in the drivers seat, and at others as if you are considering FP yet arent quite sure yourself?

For me- Im in anesthesia and want to make a change - am considering PM&R and FP- PM&R at this point is slightly more appealing, as I feel its still a reasonable springboard for interventional pain management, although its a tougher road than if I just buck up and finish anesthesia training. I am just finding the OR to be way boring! the day drags!!!!

Also for me- the concept of FP is doable, yet the lack of reimbursement makes me steer away- too much freakin debt here! sad to say- its unfortunate that economics drives the bus- but lets face it- in reality - gotta pay the bills!

I dunno- shoulda been a high profile attorney, laugh!
Click to expand...

I'm board certified FP in private Practice. And I understand your hesitation in FP. Just a thought, you might be bored in anesthesia right now. But when you are done you can do pain as you want and all you have to put up with is another few years of anesthesia. Is it worth quitting and changing.

Both PM&R and FP have lots of clinic time. That means back to back patients. That can be frustrating and tiring. When I post in here I have to be objective. Not every practice is going to make 250K per year. It depends on where you open that practice or where you buy your practice. If you want to live in a big city, you will have lots of competition. Therefore, your cash flow may go down.

By the way the average FP makes more like 160K. thats working for someone. It includes production bonus. The benefits and malpractice are paid if you work for someone and no included in the number above.

The average PM&R makes about 190 to 200K. If you do pain it's more and sometimes much more. You know all about that.
 
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