500k?

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Merely

Merely

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Is doing an FM residency then opening up your own practice and within a few years making 500k/yr reasonable? I ask this because I've spoken to my current FM doc and a few others who seem to be doing this. They own their own practice and are making upwards of 500k as FM docs. Is this crazy or does it just take good business sense and it is reasonable? Thanks.
 
You need to work your ass off to make 500k in any specialty including surgery so then why are people complaining about FM if its possible to make that kind of coin? I mean I doubt the FM is working that much harder than the surgeon to make the 500k? What am I missing here?
 
Just the raw numbers-- 15 min time slots x 8 hour days with half being 99213 ($90) and half being 99214 ($115) x 5 days a week x 51 weeks/yr minus $30k/month overhead equals $478k/yr....add in ancillaries and adjust overhead prn....the hard part is getting booked that much....I've been at my current practice for 3 months and am close to breaking even...I need to be 50 percent booked to do that.....the rest is gravy...
 
Blue Dog said:
Lots of surgeons don't make >$500K.
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So then I don't get what people in FM complain about when they talk about how FM is so underpaid? If people are making 500k, why are people complaining? I guess what I'm asking is can one expect, with some hard work and dedication, to graduate then in a few years open up a practice to make 500k+ or is that unreasonable and more likely in other specialties like GI,cards, etc.
 
Merely said:
So then I don't get what people in FM complain about when they talk about how FM is so underpaid? If people are making 500k, why are people complaining? I guess what I'm asking is can one expect, with some hard work and dedication, to graduate then in a few years open up a practice to make 500k+ or is that unreasonable and more likely in other specialties like GI,cards, etc.
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If you are good with business and marketing yourself, can manage several midlevels and ancillaries, and offer certain extra services, even 500k can be surpassed. It's really all about what you want out of your practice and how hard you're willing to work. Hell, build a big enough practice and you'll end up with hospital groups shopping to buy you, and then you can close out with a nice seven figure deal if you get tired of all the hard work.

http://medicaleconomics.modernmedic...iring-physician-assistant-or-nurse-practition

The economics of managing midlevels are highly in your favor- each one can boost your practice income substantially, but they require you to have a large enough practice to make them worthwhile, which takes time to build. And this neglects the income that can be made from certain gravy services that people sometimes offer (everything from Botox to laser hair removal to physical therapy and the like), which can often be performed by less expensive ancillary staff and can net very healthy profits if you market yourself well.

I actually don't see a lot of pay complaints on SDN in regard to primary care, it's more of a general thought of "if you paid more, primary care wouldn't have so much of a crisis." More demand would crop up, more residencies would open (as FM residencies are a bit easier to build and expand than many subspecialties), prestige would increase, etc.
 
Mad Jack said:
If you are good with business and marketing yourself, can manage several midlevels and ancillaries, and offer certain extra services, even 500k can be surpassed. It's really all about what you want out of your practice and how hard you're willing to work. Hell, build a big enough practice and you'll end up with hospital groups shopping to buy you, and then you can close out with a nice seven figure deal if you get tired of all the hard work.

http://medicaleconomics.modernmedic...iring-physician-assistant-or-nurse-practition

The economics of managing midlevels are highly in your favor- each one can boost your practice income substantially, but they require you to have a large enough practice to make them worthwhile, which takes time to build. And this neglects the income that can be made from certain gravy services that people sometimes offer (everything from Botox to laser hair removal to physical therapy and the like), which can often be performed by less expensive ancillary staff and can net very healthy profits if you market yourself well.

I actually don't see a lot of pay complaints on SDN in regard to primary care, it's more of a general thought of "if you paid more, primary care wouldn't have so much of a crisis." More demand would crop up, more residencies would open (as FM residencies are a bit easier to build and expand than many subspecialties), prestige would increase, etc.
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Thank you for the insight!
 
Mad Jack said:
If you are good with business and marketing yourself, can manage several midlevels and ancillaries, and offer certain extra services, even 500k can be surpassed. It's really all about what you want out of your practice and how hard you're willing to work. Hell, build a big enough practice and you'll end up with hospital groups shopping to buy you, and then you can close out with a nice seven figure deal if you get tired of all the hard work.

http://medicaleconomics.modernmedic...iring-physician-assistant-or-nurse-practition

The economics of managing midlevels are highly in your favor- each one can boost your practice income substantially, but they require you to have a large enough practice to make them worthwhile, which takes time to build. And this neglects the income that can be made from certain gravy services that people sometimes offer (everything from Botox to laser hair removal to physical therapy and the like), which can often be performed by less expensive ancillary staff and can net very healthy profits if you market yourself well.

I actually don't see a lot of pay complaints on SDN in regard to primary care, it's more of a general thought of "if you paid more, primary care wouldn't have so much of a crisis." More demand would crop up, more residencies would open (as FM residencies are a bit easier to build and expand than many subspecialties), prestige would increase, etc.
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Dumb question: "Midlevel" means nurse practitioner/PA?
 
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Merely said:
So then I don't get what people in FM complain about when they talk about how FM is so underpaid? If people are making 500k, why are people complaining? I guess what I'm asking is can one expect, with some hard work and dedication, to graduate then in a few years open up a practice to make 500k+ or is that unreasonable and more likely in other specialties like GI,cards, etc.
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Because its uncommon. Could some of us pull it off with a well-run clinic and multiple midlevels? Sure. It it anywhere close to the average? No. The reason FM is considered underpaid is that on an hourly basis, we make a good bit less than most other specialties.
 
VA Hopeful Dr said:
Because its uncommon. Could some of us pull it off with a well-run clinic and multiple midlevels? Sure. It it anywhere close to the average? No. The reason FM is considered underpaid is that on an hourly basis, we make a good bit less than most other specialties.
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I think what he's missing is that most physicians want to be physicians, not businessmen. If you want to just get paid for doctoring, FM is underpaid. If you want an opportunity to build a practice that makes you money off of the work of others and successful practice management, FM has some decent opportunities.
 
There tends to be an expectation amongst some (many?) med students that money is just going to fall into their lap. That isn't true in any field.
 
It's not true in derm, ortho, nsurg, plastic surgery, etc?
 
Merely said:
It's not true in derm, ortho, nsurg, plastic surgery, etc?
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Nope.

Everyone I know who's making bank in those fields has an appreciation of the business aspects of medicine. They may figure it out on their own (unlikely), or hire people to figure it out for them (more likely), but...trust me...the money didn't fall into their laps.
 
JustPlainBill said:
Just the raw numbers-- 15 min time slots x 8 hour days with half being 99213 ($90) and half being 99214 ($115) x 5 days a week x 51 weeks/yr minus $30k/month overhead equals $478k/yr....add in ancillaries and adjust overhead prn....the hard part is getting booked that much....I've been at my current practice for 3 months and am close to breaking even...I need to be 50 percent booked to do that.....the rest is gravy...
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I really wonder, why would anyone pass on an opportunity to be their own boss and make this type cash and instead be someone's worker for less than half the income?
 
Ibn Alnafis MD said:
I really wonder, why would anyone pass on an opportunity to be their own boss and make this type cash and instead be someone's worker for less than half the income?
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Because a lot of people really don't like the business side of medicine. It's exhausting if you're not interested in it, and time consuming even if you are.
 
Mad Jack said:
Because a lot of people really don't like the business side of medicine. It's exhausting if you're not interested in it, and time consuming even if you are.
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True. I understand the lure of a guaranteed paid check without having to deal with all the stress and responsibilities that come with being a business owner. However, I didn't study my @ss off all these years and went through all these sacrifices to become someone's salaried bi***.
 
Ibn Alnafis MD said:
True. I understand the lure of a guaranteed paid check without having to deal with all the stress and responsibilities that come with being a business owner. However, I didn't study my @ss off all these years and went through all these sacrifices to become someone's salaried bi***.
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Nor did I. Unfortunately, many of our younger millennial colleagues want to cash a paycheck and go home and not have any of the headaches.
 
Mad Jack said:
Nor did I. Unfortunately, many of our younger millennial colleagues want to cash a paycheck and go home and not have any of the headaches.
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This is the path I have been seeing in those coming out of residency 3-5 years ahead of me. All of them I speak with went to a large group practice and then are looking to get out after 2-3 years. They are overworked and underpaid. Agree with the above that our specialty is really underpaid when it comes to per hour. Hired a lawyer recently: $700/hour. Accountant too: $500/hour. But for some reason when you are a doc, $110/hour is asking too much? #killMACRA
My continuity clinic attending showed me what income he actually claimed in his practice over the past 10 years. It was really sad to see. I think he said he has 4000 patients. He employs two MA's and subs out billing at the usual 7%. Rents out half of the office to an OB, rents his rooms out 2 half days per week and rents another room out to a lab. He works 8 half days a week....Brought home $350k in 2011 and since then it keeps plummeting....Brought home $165k this year. That is before he gets hit with probably a 30-40% tax. Now I'm sure he could make more if he worked more and brought in midlevels but who really wants to do that at 54 years old?
Worked with a very smart, young osteopathic doc. He pointed out that reimbursements from insurance/medicare has not kept up with inflation and has even gone down some years. He said that if you aren't growing your practice, you are actually losing money. You have to expand the practice every year in order to keep your income at the same level. Seems like there is a flaw in the system, IMHO.
 
I wonder how my IM cousin makes 375k+/year in a solo practice... I know he does not pay rent since the he owns the place outright and he also cover a nursing home as medical director... Is paying rent a huge part of your overhead cost?
 
W19 said:
I wonder how my IM cousin makes 375k+/year in a solo practice... I know he does not pay rent since the he owns the place outright and he also cover a nursing home as medical director... Is paying rent a huge part of your overhead cost?
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No, rent is ~10-20k/year. Salaries are the biggest overhead.
 
Ibn Alnafis MD said:
No, rent is ~10-20k/year. Salaries are the biggest overhead.
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Are you saying rent is between $800-1.6k/month? That seems extremely low when I know he purchased that place for 475k and paid cash for it. I don't think a 2,300 sqft office across the street from a hospital would charge that little in rent.
 
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W19 said:
Are you saying rent is between $800-1.6k/month? That seems extremely low when I know he purchased that place for 475k and paid cash for it. I don't think a 2,300 sqft office across the street from a hospital would charge that little in rent.
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Depends on the building. My office is in a medical building with a bunch of other doctors. For about the same space, I pay 5k/month.

When I was looking for space, offices in just a regular office type building were at least 50% less if not more.
 
W19 said:
Are you saying rent is between $800-1.6k/month? That seems extremely low when I know he purchased that place for 475k and paid cash for it. I don't think a 2,300 sqft office across the street from a hospital would charge that little in rent.
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Purchasing a place with your own land is expensive. However, renting an office in a building or in a center is not too that expensive. Before med school I had a cellphone store. My stepfather had a 700sqft office rented for 400 a month. It's a small office but even if it was 2000sqft it wouldn't exceed 1500 a month.
 
All this doom and gloom is confusing as a third year medical student trying to figure out his life. Some say FM is great. Some say it's terrible... There's so much variation. Sounds like FM's future is in running a business well.


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BlackDynamite said:
All this doom and gloom is confusing as a third year medical student trying to figure out his life. Some say FM is great. Some say it's terrible... There's so much variation. Sounds like FM's future is in running a business well.


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There isn't enough doom and gloom to avoid family medicine. You will own a home, a nice car, pay off your loans, be able to help your kids with college and be able to vacation regularly. There are plenty of opportunities in FM to make nearly 200k a year or significantly more depending on where you're going to live and what you want to do. Throw in a spouse with a professional degree (and using that degree) and there will be no issue to be in the top 5-10% of earners. You're not going to make as ouch as the Koch brothers, but they're dingus anyway.
 
VA Hopeful Dr said:
Depends on the building. My office is in a medical building with a bunch of other doctors. For about the same space, I pay 5k/month.

When I was looking for space, offices in just a regular office type building were at least 50% less if not more.
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5k/month seems to be more or less the amount he would pay for that place if he was renting it. Basically, he pockets about 60k/year from not paying rent. I guess that why his salary is so high.
 
Ibn Alnafis MD said:
Purchasing a place with your own land is expensive. However, renting an office in a building or in a center is not too that expensive. Before med school I had a cellphone store. My stepfather had a 700sqft office rented for 400 a month. It's a small office but even if it was 2000sqft it wouldn't exceed 1500 a month.
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I don't think his place would rent for only 2k/month based on its location... But now I understand one can find business office for cheaper price than I thought...
 
mabinante said:
This is the path I have been seeing in those coming out of residency 3-5 years ahead of me. All of them I speak with went to a large group practice and then are looking to get out after 2-3 years. They are overworked and underpaid. Agree with the above that our specialty is really underpaid when it comes to per hour. Hired a lawyer recently: $700/hour. Accountant too: $500/hour. But for some reason when you are a doc, $110/hour is asking too much? #killMACRA
My continuity clinic attending showed me what income he actually claimed in his practice over the past 10 years. It was really sad to see. I think he said he has 4000 patients. He employs two MA's and subs out billing at the usual 7%. Rents out half of the office to an OB, rents his rooms out 2 half days per week and rents another room out to a lab. He works 8 half days a week....Brought home $350k in 2011 and since then it keeps plummeting....Brought home $165k this year. That is before he gets hit with probably a 30-40% tax. Now I'm sure he could make more if he worked more and brought in midlevels but who really wants to do that at 54 years old?
Worked with a very smart, young osteopathic doc. He pointed out that reimbursements from insurance/medicare has not kept up with inflation and has even gone down some years. He said that if you aren't growing your practice, you are actually losing money. You have to expand the practice every year in order to keep your income at the same level. Seems like there is a flaw in the system, IMHO.
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If you have an accountant that charges 500$/hr, then you are a really poor business person. No accountant that I know charges that for one. If you can't find an accountant that charges much less (and 99.9% of accountants don't charge per the hour btw), then you are doing something terribly wrong. Our accountant does miracles and he charges by the job not the hour.
Second there are TONS of lawyers these days, so if you have one of the few that charges that, then simple - get a new lawyer. Tons and tons of lawyers charge by the job, and not the hour. You simply need to become a better business person. Sorry.
 
Some of you are commenting about making 200k/yr which is obviously attainable. I think what a lot of us are interested in is knowing if we can hit the 500k, 750k, 1m+ mark. I know there are certainly GI docs running scope factories def hitting that so I was wondering if that is possible in FM as well. Keep in mind, money is not worth anything if you are unhappy with your life and job. If you are going to be working that hard, you better love what you do. I'm just talking about the person who loves FM and would also love running a successful practice to hit that 1m+ mark. Is that possible or is the ceiling around 500k?
 
$1M would be tough to produce as an individual physician doing traditional FM in an insurance-based model. I don't think there are enough hours in the day. You'd likely have to do high-end concierge, aesthetics, and/or own a practice employing a bunch of mid-levels to have a shot at that kind of income.
 
Lostin_space said:
If you have an accountant that charges 500$/hr, then you are a really poor business person. No accountant that I know charges that for one. If you can't find an accountant that charges much less (and 99.9% of accountants don't charge per the hour btw), then you are doing something terribly wrong. Our accountant does miracles and he charges by the job not the hour.
Second there are TONS of lawyers these days, so if you have one of the few that charges that, then simple - get a new lawyer. Tons and tons of lawyers charge by the job, and not the hour. You simply need to become a better business person. Sorry.
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I agree about the accountant hourly part, but just because you can find a cheap lawyer doesn't mean you should. It is absolutely worth some extra money to get a lawyer who does everything right the first time.
 
Merely said:
So then I don't get what people in FM complain about when they talk about how FM is so underpaid? If people are making 500k, why are people complaining? I guess what I'm asking is can one expect, with some hard work and dedication, to graduate then in a few years open up a practice to make 500k+ or is that unreasonable and more likely in other specialties like GI,cards, etc.
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Location, type of services, number of doctors working for you will determine how much you make. You won't make that in a couple of years of practice. You will need time to build it up and hire sufficient employees to make you that kind of profit. It will take WORK.
 
Merely said:
Some of you are commenting about making 200k/yr which is obviously attainable. I think what a lot of us are interested in is knowing if we can hit the 500k, 750k, 1m+ mark. I know there are certainly GI docs running scope factories def hitting that so I was wondering if that is possible in FM as well. Keep in mind, money is not worth anything if you are unhappy with your life and job. If you are going to be working that hard, you better love what you do. I'm just talking about the person who loves FM and would also love running a successful practice to hit that 1m+ mark. Is that possible or is the ceiling around 500k?
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You can do it but you would have to have a very large number of doctors/NP/PA working under you and perhaps more than one location.
 
Dave Chester said:
Settings? Hours worked?
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I don't know their schedules exactly, but they work full-time (5-6 days/week) in the ambulatory setting, and also go to the hospital and nursing home. At least one of them serves as medical director for a nursing facility as well as a hospice program.
 
Signing papers and they also see some patients (not all). My cousin used to do that and they paid him a 3k/month stipend and he bill the patients he sees as well. Most were Medicaid patients, so reimbursement was not good. He told me the overall gig was not bad for 4-6 hrs/wk of his time, but he was getting tired about LPN calling him for any stupid stuff.
 
W19 said:
Signing papers and they also see some patients (not all). My cousin used to do that and they paid him a 3k/month stipend and he bill the patients he sees as well. Most were Medicaid patients, so reimbursement was not good. He told me the overall gig was not bad for 4-6 hrs/wk of his time, but he was getting tired about LPN calling him for any stupid stuff.
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3k/mo? That sounds like a better offer than what I've got.
My office manager told me about one where I'd get 1800/mo.
 
Blue Dog said:
I know a couple FPs who are making >$500K. Basically, they work their asses off.
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I find this quote funny, it implies you can "take it easy" and make >$200k.

I work 6 days a week, about 60 hours a week, and I make much, much less than 500k. Even if I chose to work 80 hrs a week, I still would make about $400k. Not only that, but working as I do now, I make more than at least 75% of my FM colleagues in the local geographical area.
 
styphon said:
I find this quote funny, it implies you can "take it easy" and make >$200k.

I work 6 days a week, about 60 hours a week, and I make much, much less than 500k. Even if I chose to work 80 hrs a week, I still would make about $400k. Not only that, but working as I do now, I make more than at least 75% of my FM colleagues in the local geographical area.
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It's really not about you working more. That can help but it's more about leverage. Make money off others work. Like any other business.
 
If Family physicians aren't happy with their income, why don't they just moonlight in the ED? Are most family physicians not comfortable with that type of work due to lack of preparation during residency or do you guys just hate the lifestyle shift work etc


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BlackDynamite said:
If Family physicians aren't happy with their income, why don't they just moonlight in the ED? Are most family physicians not comfortable with that type of work due to lack of preparation during residency or do you guys just hate the lifestyle shift work etc


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Fewer and fewer EDs are wanting family doctors that aren't already working in EDs. I'm only 3 years out of residency, but even if I wanted to (outside of either the boonies or fast-track) very few EDs would hire me.
 
BlackDynamite said:
If Family physicians aren't happy with their income, why don't they just moonlight in the ED? Are most family physicians not comfortable with that type of work due to lack of preparation during residency or do you guys just hate the lifestyle shift work etc
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I moonlight at urgent cares to supplement my income.
 
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