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deleted87716
Hospital practice can come with pitfalls for doctors
http://www.kevinmd.com/blog/2010/04/hospital-practice-pitfalls-doctors.html
http://www.kevinmd.com/blog/2010/04/hospital-practice-pitfalls-doctors.html
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I'll have my solo practice...make it or bust, thank you very much!
Currently I am not a physician or one in the process of medical school education. But I have to share that I found this article worthy of serious consideration.
My biggest fear is with regard to the whole medical education costs. So, I can see people running to hospital-systems for some security. Apparently this is just as much a risky business as practically anything else.
Enligtening.
My biggest fear is with regard to the whole medical education costs. So, I can see people running to hospital-systems for some security. Apparently this is just as much a risky business as practically anything else.
Enligtening.
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I think a salaried position has its ups and downs just as a "solo practice". However, in the current economic times and expanding costs, a salaried position has perks of being freed from much of the administration and overhead issues.Hospital practice can come with pitfalls for doctors...I'll have my solo practice...make it or bust, thank you very much!
Everyone should consider their priorities. In most professions (maybe all) in the USA, more people are salaried/employed then are sole proprietors. I don't think medicine is much different.There are hundreds of tales of "poor business sense" in healthcare with plenty of bankrupt physicians. If you own your business, very difficult to get fired. If you work for someone, you can get fired and thus must find a new job.
You are a sucker if you expect what is not...
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General medicine is a real estate business. Unfortunately, many communities are currently in flux because of real estate & unemployment. Expect the cost of borrowing (interest rates) to climb (Greece & US credit problems) to make up for pro-inflationary fiscal policy (tax cuts while funding 2 wars). All of this makes it expensive for a small business owners to access reasonable loans to fund their start-up medical practice. Salaried positions for the time being is a safe place to hide until things get better.
That said, if you have the cash, are not exposed to variable interest rates, and can find a stable community, now would be a great time to establish a practice as health policy tips in favor of primary care & as older doctors are seeking to cut back but not quit entirely.
That said, if you have the cash, are not exposed to variable interest rates, and can find a stable community, now would be a great time to establish a practice as health policy tips in favor of primary care & as older doctors are seeking to cut back but not quit entirely.
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deleted87716
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I agree. In general, and simplistically speaking, two types in medicine. There are those that just like the medicine and those that want the business side too. I think plenty of physicians have greater or lesser interest in these aspects. The extreme is the MD administrator that manages a practice but never actually provides direct patient care. Then the physician that just sees patients and knows zip about the business. I think if you want to "run the business", employed is a good place to start. You can learn about the business and develop your own ideas of what you want to do. It gives you a chance to develop knowledge about the business that you often do not get in medical school or residency. This will give you a chance to decide if you really want business or just want to stay employed +/- administrative components. Either way, I think to start, it is good to come in under the wing of an employer.
I have seen folks employed that have zero control and do not want any. I have seen some that stand back and take control only when they choose.
I guess it is a matter of perspective on how you see your role as an "employee". You can be a "pro ball player". You don't have to own the team. If you develop yourself as a comodity, you gain control by your ability to walk.
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deleted87716
That's not control...that's bailing out. A bailout option is another important ingredient for happiness, but isn't the same thing as control.
You won't learn anything about running a practice as an employee. You learn by doing, not by letting somebody else do it for you.
Furthermore, any employee who thinks they control their employer is kidding themselves.
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I think if you are a desired comodity, it gives you some leverage and control. The ability to leverage a hospital/group practice is a form of control.
Again, we can get into nitty griddy about what you define as control vs me.... but I think it is all in your perspective. I understand where you are coming from, though have different feelings what might be right for some and/or others. I don't think one needs to risk it all to learn or have control or some control in this business. Yes, you can open a solo practice or you can be an employee.... either of a private practice or hospital or other entity.... I suspect most are employed initally. They may not be employed by a hospital, but employed none the less by a group/single or multispec/hosp....
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There are different employment arrangements, some more advantageous than others.
Technically, I'm employed - although I'm a shareholder in my group, which basically means I work for myself. Our group is physician-led. This is a vastly different arrangement than if I worked for one of the local hospital systems. I talk to friends who work for these other groups on a regular basis, and very few of them are happy, whereas most of the docs in my group are. The difference is autonomy.
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No disagreement on anything you just said.
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Why is it that I hear over and over again that family med has little control over their lifestyle? I hear this from attendings in IM and OB and see this a good bit in the media stating why medical students do not want to pursue FM. Do you think this is the perception of the "old school" FM doc who sees patients in the morning, rounds at the hospital at lunch, works all afternoon and then may be up for deliveries at night? Based on my experience in community preceptorships with well run private groups, this seems to be the oposite and they have control over their schedules, salaries in the sense of seeing more or less patient's each day as they please, picking up ER/Urgent care shifts etc. Part of what is attracting me to FM right now are these perceived options. Hopefully I am not just focusing on a small subset of FM practice and taking this as an acheivable reality?
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Because a lot of people don't know what they're talking about.
Seriously, though...the main reason that people avoid primary care is because of the money. However, they don't want to admit that, so they have to come up with other "excuses." Most of the time, these are B.S.
If FM paid as well as any other specialty, it would be the most popular field in medicine.
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He's right.
The big downside in being a salaried employee is that you lose out on some of the upside potential and you have to put up with some stupid people who may run the practice in a totally irrational/illogical manner.
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I think BD is correct in his answer above. I have never heard the argument of "little control over their lifestyle" in relation to FP/FM. That is not what I have heard from media either. I would wonder what an OB is talking about in relation to lifestyle and control of life? The media I have heard relates to income being low. As for lifestyle, look at some of the threads in this forum.
http://forums.studentdoctor.net/showthread.php?t=676050&page=2
In general, FP/FM is often regarded as a lifestyle field. Maybe not a wealth field.
I am not sure that is true. The argument from the other side would then be why are folks going into it without the money? The answer is, because that is the field they most enjoy/matches with what they like/find satisfying in medicine. Yes there are some in any number of specialties that find most satisfaction in what they receive in money. But, I don't think everyone falls in that category. I also do not feel money would solve all of FP's problems. I don't believe quality care would be provided at the FP/FM level if it was flooded with people that have money as the primary motivator.
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deleted87716
I didn't say that everyone would go into family medicine.
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deleted87716
Mmmkay...name one (just one) of "FP's problems" that doesn't relate to money.
You're missing the point. If there was less of a gap between primary care incomes and specialty incomes, people would be able to choose a field based solely on what they wanted to do, not on how much they could make doing it. Nobody would pick primary care for the money, but they wouldn't avoid it because of the money, either.
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The problem is folks in general would love to make large sums of cash with limited work obligation. You look in the next thread over.... FPs that see 60+ patients per day make large sums. FPs that do moonlighting shifts make large sums. Yet, I often see future grads and recent grads wanting to make $200+k/yr for 4-5 day work weeks with almost zero weekends, almost zero call, and no OB.
I don't know the relative dollar value per hour for an FP. I am certain plenty around here will talk about their greater value then sub specialists, etc.... But, the general surgeons/vascular surgeons/thoracic surgeons all work very significant hours, significant on-call, significant weekends, etc... The reimbursement for operative procedures includes the pre/op/post care.... outwards of about 30 days. The average starting incomes for gsurgery is running about $250/yr and vasc/thor about $300/yr. Every med student I speak with says, "I enjoy surgery... find it exciting... but don't want to work these hours/want a life". They almost universally say they do not want that level of stress or work intensity.
I just don't think all the folks (or a majority of folks) that have chosen subspecialty practice with the associated lifestyle did so for the money. Most folks I speak with going into subspecialty see the writing on the wall with dropping incomes and still choose these long hour, worse life-style fields because it is what they want to do... The same for folks going into FP/FM. They usually tell me they choose the field because they like it AND the lifestyle/different intensity workload is what they want. Further, they cite that reason as to why they also do NOT plan to do OB.
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deleted87716
You didn't answer the question.
Name one (just one) of "FP's problems" that doesn't relate to money.
I never understand what you're trying to say when you nest a bunch of unrelated quotes together with little boldfaced sections. You seem to be saying that all doctors don't deserve to be paid the same, which nobody has suggested. There is no valid reason that the gap should be as large as it is, however.
Name one (just one) of "FP's problems" that doesn't relate to money.
I never understand what you're trying to say when you nest a bunch of unrelated quotes together with little boldfaced sections. You seem to be saying that all doctors don't deserve to be paid the same, which nobody has suggested. There is no valid reason that the gap should be as large as it is, however.
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I suspect you have a better understanding then you let on... but granted, I am not a mind reader. As too "paid the same", it goes back to the earlier comment of "I don't know the relative dollar value per hour for an FP". I can not say a an FP/FM is making less then say a surgeon. So, I can not speak to the gap per se. If an FP/FM works 4 days per week, limited to no on-call, limited to no weekends/hollidays and gets $200+/yr and a GSurgeon makes $350/yr with Q2-3 on-call, 3 of 4 weekends on, etc.... is there a gap? If so, in what direction is the gap really? I have seen FP/FMs produce on a 4-5 day/wk schedule as described above and have ~$280k/yr. I know of no general surgeons that can earn that income with those limited hours. When physicians work production based, they do generally take home more. This is true about FP/FMs as with subspecialists.
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deleted87716
I'm still waiting for you to name one (just one) of "FP's problems" that doesn't relate to money.
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I think accross the board in almost all fields you can usually find some relationship to money somewhere. My comment was that it would not solve all its problems....I also do not feel money would solve all of FP's problems...I'm still waiting for you to name one ...of "FP's problems" that doesn't relate to money.
If there is a problem you think would be solved by money, tell me.
You already know my thoughts are that increased income by itself is not necessarily the solution to recruitment. I actually think rational thought process and consistent message would help recruitment.
Yes, I think money is related to unfilled training spots and folks in FM/FP. But, I also think the bigger problem is poor and confusing marketing on the part of FP/FM.
One minute "we" hear how FP/FM is "not about the money but about caring"...That is the latest quote I heard on the evening news..."all these students are going into it because they want to serve, they aren't concerned about the future of medicine cause it's not about the money to them...". Then you hear plenty on the news about the FP/FM almost broke. The fight for more money seems to also promote these impressions and simultaneously conflict with the monk like image often promoted.
Continuing along those lines, FP/FM folks often try to point at the end of year income comparison between FP and subspecialists and then propogate the belief that it is unbalanced and unfair. I rarely hear the FP/FM comment on the income to work and lifestyle issue. FP/FM seems to disregard this component of the equation. Instead focus on the end of year pay stub without acknowledging the lifestyle and income combination (some may say balance) that an FP/FM physician may enjoy. Med-students will often comment they don't want the workload require to make the income of say a general surgeon. They seem to get this during medical school. They often comment it is the balance/benefit of this career that drew them into FP/FM. Then, it seems, as if some spend the next three years being told how unfair life and healthcare industry is treating them.... It's almost a "penile envy" type problem with some. Definately a half empty as opposed to half full glass perspective by some.
So, yes, it "relates" but I don't think it solves all the problems..... Maybe spend some money on marketing a consistent message. Because, one thing I have seen and learned from FP/FMs in real life and what is reported on these boards is that there is money to be made if an FP/FM chooses to surrender some of that lifestyle balance as do the general/vasc/thoracic surgeons. Market that instead of the "poverty".
Finally, the way politics work in this healthcare industry, there are plenty with vested interest in keeping FP/FM "unattractive". It gives them ammunition to fight for more money. There is almost a cottage industry promoting the plight of FP/FM and the injustice of it all. If all the residencies filled and were overflowed tomorrow, 1. that revenue stream would be ahard to maintain and 2. the president would claim his 2000+ page healthcare bill is the source of this great success.
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deleted87716
So, you can't think of even one. That's what I figured.
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We are talking accross different lines. You want me to find anything in the USA that can not be related to money in some fashion? I already answered that:
So, it doesn't have to be something you "figured". In fact, in my last reply as re-posted above I stated it relates in almost everything. I also, specifically described how I think it relates to the issue of recruitment.
I answered, you have not. You're just being argumentative and avoiding everything else. It seems like you are set to simply generate a distraction. Again, I never denied money may "relate". I guess the relationship I draw is probably not what you had in mind?
I am not going to argue a "con" position on something I never endorsed to begin with... Name me the problem/s in surgery that do not relate to money? or psychiatry? or OB/Gyn?......
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deleted87716
I'm not being the least bit argumentative. You can't avoid answering a question by asking another question.
You said, "money won't solve all of FP's problems." I asked you to specify which of "FP's problems" doesn't relate to money. Apparently, you can't.
If anyone's being argumentative, it's you. Do you even read what you post...?
You said, "money won't solve all of FP's problems." I asked you to specify which of "FP's problems" doesn't relate to money. Apparently, you can't.
If anyone's being argumentative, it's you. Do you even read what you post...?
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What? You obviously are not reading. I was not avoiding a question by asking another. I was trying to stick to what I did say. I have not taken the position at any point that "...doesn't relate to money....". I think I have now stated that 3 or more times. Why are you pushing me to argue or take a position that I have not. In fact, I have taken the oposite position.:
Again, I am pretty sure, in reference to what I was commenting/discussing, I stated I believe money probably DOES relate... In fact, I said it probably relates to just about everything accross this country. I just don't see it solving all problems. You will have to contact someone else if you are looking for the oposite answer. This is a fairly pointless line of back and forth.
regards
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deleted87716
Well, plenty of others can.
http://www.kevinmd.com/blog/2010/05/medical-students-choose-primary-care-lose-millions-income.html
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Well, again, it seems like folks are looking at the end of the year (or end of career) total and leaving out time spent or work hours put in for that sum. Just to keep what I said in context:
Aside from only years of training, I would like to actually see a break down that shows the income related to on-call, weekends worked, hollidays worked, etc... I think knowing the trade off of lifestyle for income would be relevant. Just looking at what you EARNED at the end of career is somewhat arbitrary and 1 dimensional. The real argument is was that income EARNED? Again, I don't know. Should FP/FMs be given lump sums at the end? should they all just be given an automatic 100K per year for being FP/FM? Is there an additional workload that needs to be applied to earn that additional revenue? Again, I don't know. What I do know is that when FP/FMs work similar patterns to general surgeons they earn income very comparable if not in excess of what average general surgeons earn. i.e.:
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I can name a problem with FP that isn't directly about money. Many people view it as boring and feel like they will be relinquished to hypertension and diabetes all day everyday for the rest of their life. I'm not saying that is true, but it isn't uncommon for med students to believe that. Saying one has "control" isn't really helpful simply because it is a very hard concept to grasp and one never really knows. Also, some would consider it psuedo-control due to things like market forces and policies guiding decisions to some degree. It is easy to say one is the boss and has control, but I HAVE seen multiple instances where the employees have had the boss over a barrel where he/she needed to comply or risk disaster.
That usually stems from being a bad boss or in an area where good help is hard to come by, but it still does exist.
I do agree if the money were better then I think far more people would go into it and be very happy. I think many people would be very happy if they chose what they loved instead of following dollar signs anyway.
That usually stems from being a bad boss or in an area where good help is hard to come by, but it still does exist.
I do agree if the money were better then I think far more people would go into it and be very happy. I think many people would be very happy if they chose what they loved instead of following dollar signs anyway.
Surgery: brutal hours and stress in residency, long hours and lots of call, especially in rural areas, malpractice claims (I know malpractice is somewhat money related, but GS adn OB get sued more often... and I don't want the hassel of being sued)
OB: babies don't know the difference between night and day, malpractice claims
Psych: you have to treat psych patients
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All relate to money.... the brutal hours are to make the money. the additional call is to earn the money (i.e. can not have large number of partners to split the call and revenue with limited number of cases). Malpractice is not just "somewhat" related to money. That is exactly what it is about.
Related to money again. Take smaller income, larger cadre of partners and can split call more and decrease this.
Seeing these patients to earn money. That is the career... we chose to earn a living seeing a certain patient population.
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Which is part of my point. The FP/FM supporters and folks going into it know what the current incomes have been and still chose the field. The folks choosing "brutal" training and "brutal" hours of work in surgery, know the reimbursement declines and such, still go into it. As I said, I believe the money "issue" related to recruitment for FP/FM is largely a result of poor or conflicting marketing. Students I speak with that go into FP/FM almost universally express an understanding that they are choosing lifestyle and less work hours for less income. They also express an understanding that higher income via surgical career requires, according to them, a significant sacrifice of lifestyle with significant increase in workload. So, I don't believe money solves all problems in this matter. I have read plenty of proclaimed "med-students" on these forums say they have heard how horrible it is, underpaid, etc....
...seen FP/FMs produce on a 4-5 day/wk schedule as described above and have ~$280k/yr. I know of no general surgeons that can earn that income with those limited hours...
I don't know of any FP's that do that either. There are FP's in this area that make that kind of money, but they work at least as hard as the GS's here. I usually put in about 40 hours/week in the office, but I'm on call every other week, and I average 50 hours a month in the ER. I round in the hospital and scope for about 2 hours before I see patients in the office. I'm sure there are places where you can make that kind of money in a strictly out patient/low call situation, but they are few and far between. You have to be in a partnership situation and see LOTS of patients. I'm skeptical of anyone seeing 60 patients a day, but if someone can pull it off while keeping the patients around and not getting sued, they deserve the money.
I don't know of any FP's that do that either. There are FP's in this area that make that kind of money, but they work at least as hard as the GS's here. I usually put in about 40 hours/week in the office, but I'm on call every other week, and I average 50 hours a month in the ER. I round in the hospital and scope for about 2 hours before I see patients in the office. I'm sure there are places where you can make that kind of money in a strictly out patient/low call situation, but they are few and far between. You have to be in a partnership situation and see LOTS of patients. I'm skeptical of anyone seeing 60 patients a day, but if someone can pull it off while keeping the patients around and not getting sued, they deserve the money.
You are being short sighted. You are basically saying surgery is a job and catching babies is a job. People have jobs to make money, so every aspect of the Surgery and OB is about money. That's just not true.
Let me give you an example outside of medicine. I grew up on a farm, we grew lots of things, but poultry supplied a large portion of the income. I dislike shoveling chicken $h!t. I dislike the smell. I dislike the beaty little chicken eyes. However, to be a chicken farmer, all of those things are fundamental to your job. It has nothing to do with the amount of money a chicken farmer makes. Chicken farmers that make a million dollars a year and chicken farmers living in poverty all have to smell that smell.
There are places where surgeons form large groups and have little call. There are even places where you can pay some one to take call (I met a surgilist sp?? for the first time a couple of weeks ago). The work is still there for someone to do. If I hire a squad of PA's to do do my job and I sit back and smoke cigars and drum my fingers, I become an administrator and not a Family Physician. The surgeons here don't have that option anyway. If they brought in enough surgeons to make call rare, not only would they be broke, they wouldn't do enough procedures to continue to be surgeons.
By the way, getting sued is not just about money. I've luckily never been there, but several friends have. It's psychologically difficult and a real pain in the rear. Other than an insurance premium increase, it didn't directly cost any of them any money, but it was still a devastating process. This is why caps on awards make insurance premiums go down, but they don't decrease defensive medicine.
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You are speaking of a job and the aspect of it being integral to the job... that makes your money. I am not sure how you are demonstrating it does not relate to money... but it doesn't matter.
Exactly.
What? This makes no sense.
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If you are a chicken farmer, i.e. farming chickens is your job = source of income, then you have to deal with the chickens, their eyes, their smell, etc.... Larger farms have more chicken waste, chicken eyeballs, etc... in exchange for larger production. So, dealing with these aspects does relate to money.
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1 hour of FM work does not equal 1 hour of Gen Surg work. Much of what we do is in the interest of the patient & unreimbursed (see posts on "invisible cost" of primary which refer to the recent NEJM article on the subject). It's not about hours of work. We work plenty.
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I definately did not say 1 hour of FM work does equal 1 hour of Gen Surg work.
Though, I have not really seen a good argument; I understand plenty of folks will try to explain how there 1hr or 4 days is worth more value... I just find pointing to a balance sheet at the end of the year or end of the career and trying to compare it to another specialty is pretty arbitrary if not downright deceptive. It doesn't tell the whole story.
I know FPs that work as described above and make 200+/yr with the lifestyle as described. I guess the question is are you/they paid plenty? What I have been reading, fairly often, is that should be able to receive that income without having to work at that level. In general, I believe physicians are often underpaid.
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1 hour of a general surgeon's time consists of more reimbursed activity (procedures, consults, rounds, clinic visit, & postop visits already paid for by global fees) than an FP's 1 hour because in our 1 hour we have to squeeze in more unreimbursed work like lab review/imaging review, care coordination, paperwork, education & counseling. Hence an FP's hourly rate will be less than a surgeon's hourly rate if we all do the same activities & procedures. Calm down, it's just math.
What you will see in the near future is that corporations & industry (like IBM) will, YES, pay FP's *just because* FP's practice FM. That is, self-insured companies (& hopefully soon everyone) will pay a care coordination fee that will cover much of the unreimbursed work we currently do. Practices that have been designated patient-centered medical homes have reported to receive between $5-40 per patient per month (don't ask me for a citation, I don't have one). This fee will be in addition to what we bill for, which by Obama's plan will be 10 pct higher rates for E&M codes for those whose practices are largely E&M (like FM's) AND primary care practices that take Medicaid will get reimbursed rates closer to Medicare (at the chagrin of states). All that will help.
What you will see in the near future is that corporations & industry (like IBM) will, YES, pay FP's *just because* FP's practice FM. That is, self-insured companies (& hopefully soon everyone) will pay a care coordination fee that will cover much of the unreimbursed work we currently do. Practices that have been designated patient-centered medical homes have reported to receive between $5-40 per patient per month (don't ask me for a citation, I don't have one). This fee will be in addition to what we bill for, which by Obama's plan will be 10 pct higher rates for E&M codes for those whose practices are largely E&M (like FM's) AND primary care practices that take Medicaid will get reimbursed rates closer to Medicare (at the chagrin of states). All that will help.
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Not sure what that's about.... am pretty calm.
I do understand what you are saying about un-reimbursed activities. It is difficult to quantify accross specialties. I do still wonder what the answer is... in general, ~how much of one's life (days, hours, weekends, hollidays, on-call, etc...) is required towards your practice to obtain that dollar amount at the end of the year? There are only 365 days/year with an associated amount of time per day.
So you are saying every aspect of every job from chicken farming to rocket surgery is all about money, but for some reason, this rule doesn't apply to Family Medicine. For us, it's all about marketing? Are you seriously implying that FM residencies wouldn't become competive tomorrow if suddenly FP and ROAD incomes were reversed?
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No, no, no, no..... Never said that.
I have not said it is all about money. I have not said there is NO relation to money. I have not said money will solve all problems.....
Not going to spend a half dozen replies explaining to you as well that I didn't say that.
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This is probably my biggest hang up...along with the fact that you don't get to do anything in the OR. I literally thought I was going to die while on my IM rotation...and during my FP rotation when I spent time with the guy that functioned more as an "internist" I wanted to hurt myself. Nothing, to me, is more annoying than "managing" the care of a bunch of DM, HTN, CAD patients that couldn't care less about whether they take their meds or not.
That is my fear.
My other choice is OB/GYN because I enjoyed the relatively young and healthy patients...loved the surgical aspect, but not too crazy about the thought of all the call and OB...deliveries specifically.
So, I'm lost..and looking for a 'calling'.
FP is attractive because of the "lifestyle" and the ability to kind of find a niche and go with it, but I've had so little exposure to what's available in terms of practice opportunities within the specialty, I feel like I can't make an educated decision.
As for "control"...I worked in Big Pharm before Med school...while there was a certain comfort in knowing you were pretty well secure and the paycheck was coming and the benefits would be paid, etc...it's still a "job".
On the other hand, growing up on a farm, I saw what being the sole owner of a business that can consume you will do to a person. I'm not sure I want that much "control". I have absolutely no desire to be married to my job. I wanna do my work, hopefully enjoy it, then head home to my family and enjoy my time away from the office.
any pointers? seriously.
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That's an interesting retrospective chart/business review of a single practice of internal medicine...
employs 5 physicians that work total of ~4 full time equivalent. The combined total for the year worked out to ~ 119 scheduled hours per week (i.e. ? 24 hrs each if based on 5 or 30 if divided by 4). However, they, "We regard this schedule as equivalent to the work of four full-time physicians, with physicians typically working 50 to 60 hours per week...did not provide hospital care". None of this is related from me read to the actual income each is making.
Again, it is interesting. It seems the presumption by many folks is that general surgeons/surgical or subspecialists are not dealing with ~after hours emails/phone calls/consults. The after hours information is not really well quantified. The actual hours stuff is far below the quantifiable hours of most general surgeons. I don't know if the practice described has an unusually large amount of staff.
What is described above does not seem like it would be solved by increased income. I think again folks need to do what works for them.
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deleted87716
I agree. That's why I dismiss patients who are flagrantly and repeatedly non-compliant. Let them be someone else's problem. You determine what sort of practice you have.
That's a big problem in academic medical centers. Most academic primary care clinics suck. I wouldn't want to work there, either. You have to get out into the "real world" and work with some docs in private practice. That's the only way to see what's possible.
As for the "control" issue, I've found that a well-run, physician-owned single- or multispecialty group can provide the best of both worlds...autonomy in how you run your practice, combined with the security and administrative assistance of a larger group.
No, no, no, no..... Never said that.
I have not said it is all about money. I have not said there is NO relation to money. I have not said money will solve all problems.....
Not going to spend a half dozen replies explaining to you as well that I didn't say that.
Well, I'm not sure what you have said then.
FM residencies are not filling as well as some other specialties. Money is absolutely the reason why. It's not a marketing issue. If FM income was raised to near the level of some specialists, then there would be no shortage. It's that's simple. Sure, lots of people really love FM and become FM physicians regardless. If GS made 90K a year, there would still be some surgeons. There are some inherent aspects of the job, that have nothing to do with money, that some people just enjoy. The same goes for FM or any other speciality. However, market forces aren't allowed to work, the money isn't there, and thus there are shortages.
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Then you didn't read it well... and not going to spend time explaining it....
Pretty definitive absolute there. However, doesn't seem to be what most of the medical students are saying to me or what some are saying on this forum. I understand it is hard for you to believe that folks are choosing fields other then FP/FM cause they do not like FP/FM or even maybe cause they do not understand what FP/FM real life practice is (i.e. poor marketing).
as for money:
Probably half the discussion has been about what exactly is the money. Are you saying you think, believe, or know (since you express absolutes), FP/FM working 4 days a week, limited to no on-call, limted to no hollidays, no OB, all outpatient for ~$200k/yr is underpaid as compared to General surgeon working Q2-3 call, most weekends, plenty of hollidays, etc... and earning $300-350K/yr?
The point is that folks are just trying to look at the number at the end of the year and not the actuall amount of time/life expenditure put in during the year for said income. Nobody has really given good comparatives of work per pay. So, to say not paid near the level of the specialists I think is innacurate representation, IMHO. The medical students that choose FP/FM often tell me they choose the lesser work to pay ratio of FP/FM because they want that lifestyle.
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