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$200k?

Discussion in 'Family Medicine' started by 6ft3dr2b, Nov 29, 2008.

  1. 6ft3dr2b

    6ft3dr2b Junior Member
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    Is it possible to make 200K in northern nj/nyc metro area with a FM practice?
     
  2. OP
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    6ft3dr2b

    6ft3dr2b Junior Member
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    any feedback or thoughts? or was this a shallow question...lol
     
  3. sophiejane

    sophiejane Exhausted
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    It is possible. Lots of things are possible, though--it just depends on how hard you want to work.

    There are more variables concerning income potential in FM than probably any other area of medicine. It truly depends on what you do.

    Now, can you do OB and colonoscopies and lots of office procedures in a suburban area like NYC metro? Can you see volume? Can you keep overhead low?

    People are starting to get hired on, not uncommonly, at $200K and up.


    So, yes, it's possible. With caveats.
     
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  4. OP
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    6ft3dr2b

    6ft3dr2b Junior Member
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    Now, can you do OB and colonoscopies and lots of office procedures in a suburban area like NYC metro?

    Where do I learn these skills? See this is where I'm confused. Don't have I to complete a GI fellowship to do colonoscopies? that's why I keep on hearing to do IM instead of FM residency.
     
  5. Blue Dog

    Blue Dog Fides et ratio.
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    Of course not.

    See: http://www.aafp.org/online/en/home/policy/policies/c/colonoscopyprivileging.html

    That being said, procedures are not an automatic gateway to riches in family medicine. In order to make money doing procedures, you need fair reimbursement and volume. These aren't necessarily a given. Money isn't going to fall into your lap just because you get certified to do something.
     
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  6. IamMDMBA

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    It is completely doable, the question is are you willing to sell your soul to do it. What I mean is - hire midlevels (and contribute to the take over of Primary Care by midlevles), do cosmetics (Botox, Juvederm, etc), sell products (most MD's will view vitamins, power juice as quackery), the list goes on.....A local Family Doc here does Botox half a day every day, along with IPL, Juviderm, and within 2 years the guy moved into a gated golf community, bought a Porche Cayman, and cut his work hours by 15 hours a week - the choice is yours. BTW, I know all this b/c he's my neighbor.
     
  7. sophiejane

    sophiejane Exhausted
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    It's also very regional. I know of an offer of $225 guarantee to start in a rural community in central TX, which includes OB, inpatient, and outpatient. No botox or midlevels.

    That's why questions like yours are so very hard to answer. The answer is yes, and no.

    You can't go into FM with a number like that in your head and a very specific area you want to practice in. You MIGHT make that much, you might make more, you might make less.
     
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  8. sophiejane

    sophiejane Exhausted
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    Absolutely. It's as much about being a good businessperson as it is about what you do and where you do it.
     
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  9. andwhat

    andwhat Senior Member
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    I know FM docs doing Colonoscopies and getting compensated quite well. I plan on getting certified also. You have to do so many to get privelages. Guess what? A Gastroenterologist will probably not teach you how to do them.. politics politics sigh..
    However, there are docs that will teach you how..
     
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  10. medicienne

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    Sorry but I find it very strange that everytime a physician makes money or tries something different that actually generates income ( which the rest of the 'lay people' do all the time) it's referred as "selling your soul" ? :idea:

    I think this is the reason why physicians will always remain underpaid and governed by HMOs and lawyers because they have accepted a fate of self-denial and idealism instead of practicality.
     
  11. Blue Dog

    Blue Dog Fides et ratio.
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    I don't think that's the case. We're talking about appearances, really. There's a right way and a wrong way to do everything.

    If you give the impression (justified or not) that you're trying to sell stuff (whether it's vitamins or cosmetic procedures) to people who are, ostensibly, coming to you with "legitimate" medical problems (e.g., a captive audience), you'll likely be viewed negatively.

    More specifically, you'll probably be viewed as a greedy bastard. Your motives may be questioned even when you recommend medically necessary tests and/or procedures. Your patients will always wonder if you're just doing it to make a fast buck. Fair or not, there's no point in railing against human nature.

    If I were a family physician who wanted to get into the aesthetics biz, I'd set up shop away from my medical office. I think that's the better approach.
     
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  12. IamMDMBA

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    I find it very strange you don't understand. Physicians are viewed as evidence-based, objective, the minute you dabble in things not viewed as evidenced-based (vitamins, drinks), you lose credibility.

    As far as income, do what you must, but how much money is enough for you??
    Latest physician income: http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm
     
  13. secretwave101

    secretwave101 Senior Member
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    200k is over-market almost anywhere in the country. Don't kid yourself. It's about 2.5x the national average salary of entering FP's, so you might be able to hit that, but probably not unless you work 2.5x the number of hours of a typical family doc.

    And the procedures thing is, I think, more dependent on volume than politics. Colonoscopes are hugely expensive, and they aren't cheap to maintain, either. Plus the procedure requires conscious sedation = spendy staff and facilities. You've got to put some pretty good numbers through your little scope-factory to make it worthwhile.

    Colpo's and OB ultrasounds have some merit, however, if you can find yourself good machines for less than the cost of the ranch.
     
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  14. racerx

    racerx ASA Member
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    The national average salary of starting FM docs is $80K?!?! :eek::eek::eek:
     
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  15. iatrosB

    iatrosB trying not to kill anyone
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    negative...unless part timers are lumped in as well
     
  16. Blue Dog

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    I think secretwave has a typo in his post. I'm not exactly sure what he was trying to say, but $200 is not "2.5x the national average salary of entering FP's."

    The table in IamMDMBA's link is pretty close to reality.
     
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  17. emedpa

    emedpa GlobalDoc
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    isn't 160k a more typical fm salary? 1 local group(NW) starts folks at 140k and goes to 170k in 2 yrs when they make partner, although another pays only 90k but does extensive loan repayment..
    my understanding of fm and advanced procedures is that you are also somewhat limited by your malpractice policy costs. for instance we have a local fm group that does their own low risk deliveries. in order for this to make sense financially they have to do at least 4/mo each so only a few of them do it in order to keep their #s high enough to justify the expense of the malpractice. ditto sigs/colonoscopies/vasectomies. volume is key.
     
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  18. montessori2md

    montessori2md Member
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    140k is the starting salary in almost every listing in AAFP for the past few months. And many of those ads go on and on about their commitment to quality of life, so I presume you are neither selling your soul or your ability to sleep.

    Funny how in the link above that FP w/OB make LESS than FP w/o in the south.
    And diagnostic rads makes me want to gag.

    I don't think $200k is out of reach, but I think it's easier if you want to work more hours and live in a more rural area, where the local hospital needs you more. I think in comfy suburban markets saturated w/ specialists it could be harder to do w/o working surgeon hours.

    Realize too that a lot of docs are making $$ of investments vs. straight billing -like purchasing their practice instead of renting, or partnering w/ other docs to invest in medical centers (and perhaps hiring massage therapists, PTs, etc to fill some of the office space there).

    Other ways FPs make extra cash:
    -equipment -have ekgs, xrays, a lab, in house, then you get to bill for all of that in your clinic.
    -sports med -then you can bill for all those related procedures (and see PTs and x-ray, above)
    -work in an ER, urgent care, or as a hospitalist. Yes, you can do that.
    -derm procedures, non-medspa. People have gross stuff on their skin. You take it off. You make $$ and the patient doesn't have to wait 6 wks to get the dermatologist to get rid of their skin tag or whatever.
    -Nursing home MD (often in addition to your practice).

    The rub w/ procedures is you have to be able to do quite a few of them for it to pay off b/c of the extra malpractice. As an ex., an md told me he quit doing vasectomies b/c the malpractice was $5k/year, and each one bills for $500, so he'd have to do 10 just to pay the premium, which wasn't worth it.
     
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  19. FM guy in KC

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    Wow! 5K extra per year for insurance to do vasectomies:eek:!! I knew insurance would be a lot more if you are doing things like OB and scopes, but that seems like a lot just to do an clinic procedure.

    Maybe I am just a naive M4, but I figured most malpractice insurance covered basic office procedures like skin lesion removal/biopsies, joint injections, and vasectomies.
     
  20. Blue Dog

    Blue Dog Fides et ratio.
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    For one of my partners, it was more like $12K extra if he did vasectomies. The medmal company basically charged him the same rates they would charge a urologist. Just to break even, he'd have to do at least two per month. Obviously, that wasn't feasible. He'd done over 600 vasectomies in the military and never had a complication, but he couldn't afford to do them as a civilian. Sad.
     
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  21. McDoctor

    McDoctor Over One Billion Cured
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    http://www.healthcaresalaryonline.com/family-practice-doctor-salary.html

    From a reasonable source of information:

    "...The median Family Doctor Salary and General Practitioner Salary is calculated by the US Government Bureau of Labor Statistics from a variety of sources.

    ...On an annual basis the median Family and General Practitioner salary is $140,400. The lowest 10% earn $56,680 per year while the upper 10% earn more than $145,600 per year. These salaries are calculated as a mean or average...

    ...The lowest paid Family and General Practitioners earn less than $56,000 annually while the highest paid Family and General Practitioner s earn as much as $194,610 per year. ...The best paying states for the Family Doctor and General Practitioners to earn a salary are Kansas $174,570, Maryland $165,210, Louisiana $164,100, Arkansas $160,980, and Wisconsin $160,250...."

    The bottom line is that only in the most exceptional circumstances imaginable in our current healthcare system will you earn close to $200K in the region you specified in Family Medicine. As a doctor just coming out of residency as of right now, I would just flat out say no, it's not possible.
     
  22. Joe Richards

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    You have to realize that those salaries don't account for production bonuses. If you look at some of the specialist salaries you will see that they are low. I know many that make much more.

    Merritt Hawkins has several positions that list more than 200K. Most are not in the big city but majority are not very rural either.

    Lets analyze the 200K question.

    The average FP makes 150K per year working 4 day weeks.
    The average FP undercodes most of their visits. In fact it has been estimated that 30 to 50% of FP visits that should be 99214 are 99213.


    So how can the FP make 200K per year starting now?

    1. Work 5 days per week.
    2. Code better. Coding better will result in at least a $30 K increase in your bottom line and the extra day will make the rest.

    Other ways:

    1. Bring your patients back by giving them a reason to come back. Follow strict evidence based guidelines and you will see that you need to bring your patients back more than you have been. Example: close f/u for HTN, Diabetes, Asthma, Cholesterol. etc, etc.

    2. Advertise to your patients with a monthly for quarterly health newsletter. ASK for them to send you their friends and family. and THANK THEM for doing that. This will increase your volume.

    3. Eliminate poor paying insurance groups and market to the patients with the good ones.
    I know this sound a bit harsh. You may ask where will the patient go.
    I will tell you that the patients and employers will find a new company to purchase insurance from when they can't find a doctor to see them.

    4. One easy way is to join a multispecialty group or a large group that can negotiate better contracts. Most well run large group practices show better earnings than Solo practitioners.

    These are just a few ideas. It takes HARD work. But you can make 200K and even more. But it take HARD, HARD work.

    So the questions of "Can I make 200K" is a business question. You don't learn that in medical school or residency.
    You can learn it out of residency through some intensive seminars and through your hard work and determination.

    Also, I believe in the not so far away future you will make 200K + because of the reform in medicine and primary care.
     
  23. skypilot

    skypilot 2K Member
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    I'm sure it can be done pretty easily.

    1. Get a job 4 days a week with a $150k base
    2. Moonlight one or two days a week as a hospitalist, urgent care, or ER doc.

    You can make $200k pretty easily by doing this.

    Or just be a hospitalist and rack up over time during your one week off.
     
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  24. IamMDMBA

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    Really....??? Thank you for setting me straight, I guess I just am hallucinating those job offers I get DAILY in the mail in writing offerring $180k to $275k. Again, thanks all-knowing one.
     
  25. sophiejane

    sophiejane Exhausted
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    I'm not getting them daily (yet), but similiar starting salaries are not uncommon in my area. Quite a number of our 3rd years start off in the $175-185 range. $150 is on the low end.

    I think McDoctor was referring specifically to the Metro NYC/NJ area in response to the OP's query.
     
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  26. medicienne

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    Evidence-based does not mean you have to close your mind. I personally don't know anyone who is selling vitamins or herbs or even working in a medspa apart from what I have read on news or something. I don't view them the same way as someone selling Oxycodone or Marijuana though.

    Talking about credibility, I don't know how much respect you get from other specialties? There is a lack of collegiality among physicians anyways these days and Family Physicians atleast should be more understanding and open-minded.

    Sorry but I would rather not be judgmental, as long as physicians are practising medicine at the time when they are in their physician role. What other business they have with the rest of the time is perfectly fine as long as they are harmless and ethical.
     
    #26 medicienne, Dec 8, 2008
    Last edited: Dec 8, 2008
  27. McDoctor

    McDoctor Over One Billion Cured
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    You yourself linked to a site which lists the typical starting salary at $130,000.

    Check back in next year, superstar, and let us know how your start up $275K booming enterprise is going. You won't even be credentialed with most insurers within 6 months.

    And before you lay down another barrage of glib jackass responses, realize that these to good to be true spam offers litter all of our in-boxes. Most of us are just smart enough to not give the recruiters our home address.
     
  28. Joe Richards

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    If you give the impression (justified or not) that you're trying to sell stuff (whether it's vitamins or cosmetic procedures) to people who are, ostensibly, coming to you with "legitimate" medical problems (e.g., a captive audience), you'll likely be viewed negatively.

    [/quote]


    Just curious but do you feel a dermatologist shouldn't take "legitimate" cosmetic patients along with "legitimate" medical problems in his practice?

    Personally I think patients can figure out when they are being sold to.

    If I send a patient out for labs for a medical problem I don't think they are going to ask me if I'm trying to make money from them. Or, they might. I then say to them they should get a second opinion.

    Many patients want the cosmetic procedures.

    I can't speak the same for vitamins and herbs.
     
  29. Blue Dog

    Blue Dog Fides et ratio.
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    I think most people recognize that cosmetic problems are a big part of what derm is all about, so it's less of an issue for them. Even so, we've all known dermatologists who have moved big-time into the cosmetics arena. Needless to say, they're not the ones I'm likely to send my medical patients to.
     
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  30. DrJosephKim

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  31. Blue Dog

    Blue Dog Fides et ratio.
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  32. andwhat

    andwhat Senior Member
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    Hospitalist definitely start higher, and make more.. RVUs, and incentives, -- plus look at lifestyle, I mean good grief half a year off.. can it possibly get any better than that? :thumbup::thumbup:
     
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  33. Blue Dog

    Blue Dog Fides et ratio.
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    Incidentally, Joe...that was a great post. I meant to say something earlier. :thumbup:
     
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  34. andwhat

    andwhat Senior Member
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    ummmm I dont know whom you are referring to, but I make well over $130 K, there must be several other incentives if the salary is on that side. Or you work for the VA, which is a great lifestyle with benefits.
    Jackass responses, dude what exactly is your gripe??? Wow... I could easily make $275 K if I actually worked near full time -- like maybe one or two extra shifts every two week stretch... but then again I am not giving up quality family time, basketball and traveling and sleep.... plus I love two weeks off per month...
    Earning over $200 K is not all that hard work in Primary Care. I know of FM docs making that working 4-4.5 work weeks, call every other week, one day.
    It is about coding, and you do not have to hurt yourself seeing tons and tons of patients.
    I would hang myself if I were stuck in a monotonous specialty, or doing Surgery after Surgery stuck in the OR for life...
    I pride myself, on not allowing my attention span to exceed twelve hours per shift. Sometimes even 4-8 hours on light rounding days.....
    And if you are not exactly sure about something, you can always get a consult, or ask for advice -- specialists are awesome.... then again you are a specialist, managing several several issues successfully, and obtaining gratitude from the specialists, for helping out with their patients -- for instance Ortho and Rehab..... very, very appreciative....
    Hospital life is very very good... and it is not at all difficult to make over $200 K.
    It is challenging, when you realize that almost 40% - 50% of what you do relies heavily on your communication skills, not only medical knowledge and diagnostic capabilities.
    Sorry for my jackass response, as you describe it. I just wish that your gripe more accurately reflected reality -- which it does not at all.
     
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    #34 andwhat, Dec 18, 2008
    Last edited: Dec 19, 2008
  35. Joe Richards

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    Thank you.
     
  36. ghost dog

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    Are you a family doctor? Your status indicates "post-doc", so I would imagine not. Clown is more like it.

    I made $ 335,000 this past tax year. The above statistic you quoted is not that meaningful. Family medicine is what you make of it.

    Ass clown.
     
  37. iatrosB

    iatrosB trying not to kill anyone
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    :caution:
     
  38. andwhat

    andwhat Senior Member
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    agreed.... FM docs make at least $200 K, you may be referring to straight salary.. and not taking into account, bonus incentives, coding, moonlighting opportunities etc.
    FM is a great lifestyle -- it is what you make of it.
     
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  39. Joe Richards

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    Hello ghost dog,

    I agree that the information on the post you responded to is not accurate.

    But, don't you think name calling is a little beneath your professional ATTENDING PHYSICIAN standing?

    Besides who care if this guy doesn't know how to run a practice. It's his practice.
     
  40. zxc1234

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    This have to be a joke. If fm docs could make that much, why medical students frown upon this profession? Yes, specialists make more. If you make at least $200,000 a year, why bother with the other specialty? I hear stories from family doctors about how they regret going into medicine or the family medicine residency because of the pay and the lifestyle.
     
  41. Blue Dog

    Blue Dog Fides et ratio.
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    Because they typically earn 2-3 times that much.
     
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  42. DaveinDallas

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    I'm just a pogue MS3.....but based on my former 18 year career....you'll hear people griping about their choices in any profession. The grass is ALWAYS greener on the other side. I listen to physicians tell me how they wish they were engineers. I'm a former engineer who thinks,'Umm, let's get a reality check about what it's really like to be an engineer vs. physician'. Every career is what you make of it. Find what YOU really enjoy doing and would do no matter the remimbursement and go do it. Believe me, I was making over $100K as an engineer and my wife had to force me to go to work because I hated it so much. I was actually relieved when I was laid off. It provided the boot in the glutes to do something I wanted to do....

    Your stat says Pre-Health.....if you're not sure about this ride called medicine/medical school, go down to you local community college and take an aptitude test. Figure out what fits you and then choose and go.....

    As far as cashola, since I'm a student member of AAFP, I'm getting mailings from various employers. Here in Irving, Tx., suburb of Dallas, I have had in my little paws an offer for $200K guaranteed with a $40K signing bonus working a hospital outpatient clinic. My personal physician is living large, got a good practice in a master planned community with weekends off, no call and a good family life.

    One of my mentors asked me a question which I'll put to you.....

    Without consideration of reimbursement, would you rather spend your career helping people as a doctor or plumber?
     
  43. DaveinDallas

    10+ Year Member

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    A side bar question to the attendings --- I'm considering FP/EM/IM (hospitalist) right now. Obviously I'm starting the second half of
    third year and starting to think about audition rotations.

    Would either of you mind sharing your thoughts about FP vs the
    other two choices?

    Also, what are the things to look for in an FM residency program?
    I've been talking with some of the clinicians at school and gotten
    opinions about a few programs in Texas but thought I'd ask
    about what to look for?

    If you'd rather do this offline via PM, please feel free....
     
  44. foil

    foil Junior Member
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    Please check out :

    Salary.com
    It allows you to checks salaries based on zip codes



    Then kick yourself in the rear.
    With a high school education , you can make this in the City of Los Angeles

    ELECTRIC DISTRIBUTION MECHANIC $88,343 - $101,998/Annually Continuous Open/Promotional Exam

    LOAD DISPATCHER $82,538 - $127,138/Annually

    This Salary is almost doubled in overtime.

    http://personline.lacity.org/job_list/jobs.htm


    Foil
     
  45. andwhat

    andwhat Senior Member
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    thats exactly why you are premed... no clue... that is natural dont take it personally... if you want, google Hospitalist Salary, come back and tell me what you come up with... I went into family med... and there are no regrets whatsoever..
    what you hear son, are just that.. 'stories'.... not the real world..
    It is about the greatest combination of lifestyle and money.
    http://www.acponline.org/clinical_information/journals_publications/acp_hospitalist/may08/itn.htm

    so is this article a 'joke' or a lie?
     
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  46. andwhat

    andwhat Senior Member
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    with the addition of overhead and call.... in other words, taking home a bit less than half of what you make on paper as a specialist.
    Being a specialist means more money agreed.. but significantly more responsibility in certain specialties. GI is probably the best one, considering lifestyle and money.. however you still have to take quite a bit of call....
     
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    #46 andwhat, Dec 25, 2008
    Last edited: Dec 25, 2008
  47. michaelrack

    michaelrack All In at the wrong time
    Physician Verified Expert 10+ Year Member

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    Since you referenced the ACP, I am going to jump into the discussion even though I am an internist (who formerly did some primary care) rather than a FP.

    It is very difficult for a primary care doc to make an income of $200,000 from seeing patients (outpt and/or inpt) and billing E+M codes. However, there are many primary care docs making $200,000- they reach that figure either by having their income subsidized (as many hospitalists do by the hospital they work at) or by receiving medical directorship or nursing home directorship fees. Other ways for a primary care doc to reach $200,000 is by catching ancillary revenue or by performing profitable procedures (ie stress testing).

    There are many ways to do well in primary care, but a doc will struggle financially if he limits himself to seeing one outpt after another.
     
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  48. andwhat

    andwhat Senior Member
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    sorry to hear that -- there is more and more pressure to see a larger volume of patients in a smaller time slot in outpatient Medicine, with no increase in income. That just does not make any sense to me at all. Very very disappointing.
     
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  49. Blue Dog

    Blue Dog Fides et ratio.
    Physician Gold Donor Verified Expert Verified Account 10+ Year Member

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    I considered all three fields, as well, as I knew I wanted to be a generalist. EM was quickly ruled out once I recognized that I pretty much hated working in the ED. I chose FM over IM primarily because I preferred the outpatient setting, and wanted to be able to see kids as well as adults.

    Generally speaking, look for lots of American-trained residents and a relatively unopposed setting. Other than that, it's largely a matter of personal preference.
     
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  50. McDoctor

    McDoctor Over One Billion Cured
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    Blue Dog and Joe Richards have alot of experience, and I respect their knowledge, but I assumed the question was in reference to a new graduate. No new graduate is going to be in position to make near $200 K in 1 year. Not in metro New york, pretty much not anywhere.

    There are too many barriers to getting started out of the gate. New graduates pretty much have to enter an employment model. Existing multispecialty practices like Blue Dog's probably have more financial incentive to hire a mid-level than offer partnership to any new resident. As far as "hanging a shingle", you simply won't be credentialed wihin 6 months with most insurers, let alone have leverage to negotiate favorable fee schedule and have the capital to put out a quarterly newsletter to market yourself.

    I personally don't have any interest in owning my own practice. I am a 2007 graduate, and currently work in an employment model, but my salary basically depends on productivity. I probably have more input into the day to day management of the practice I am at than most employment models, but I generally don't exercise this because I don't like the business side of things at all. In the end, I am just an employee and I am not that disgruntled with it. I am not inept in any way, and by every numeric measure (board scores, grades, evaluations, etc.) I have always way above the mean, despite what others suggest.

    The bottom line, however, is that whether I know how to run a practice or not is moot, because I generally do not have the opportunity and would not for the forseeable future. Neither will most new graduates. The people on this board can decide whose perspective is most applicable to their current scenario, someone who got into the field in the 1990's and has been in a bubble of a successful multispecialty practice for 10 years, or a recent graduate of a Family Medicine residency.
     

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