Any ballin’ FM attendings?

[VA Hopeful Dr]

Not here. 99213 vs. 99214: Three tips for spotting the difference

A single acute (probably self-limited) problem with no lab review, imaging, or follow up just doesn't pass the smell test for 99214, regardless of prescription drug management, IMO.

I see that differently. New problem no work up and RX management hit the level 4 MDM.

If I'm prescribing antibiotics I clearly don't think it's self limited.

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[deleted87716]

I see that differently. New problem no work up and RX management hit the level 4 MDM.

If I'm prescribing antibiotics I clearly don't think it's self limited.

Our EHR will give me a 99214 for something like that based on my ROS and PE, but I'll manually downcode it to a 99213. My bell curve already skews waaaaaaay to the right, so I need to bill some 99213's just to keep the auditors off my ass.

 

[Bacchus]

Our EHR will give me a 99214 for something like that based on my ROS and PE, but I'll manually downcode it to a 99213. My bell curve already skews waaaaaaay to the right, so I need to bill some 99213's just to keep the auditors off my ass.

Do you get those reports from insurers as well that you’re billing outside the average distribution for peers in your area? Lol.

 

[deleted87716]

Do you get those reports from insurers as well that you’re billing outside the average distribution for peers in your area? Lol.

Yep.

 

[deleted997790]

You suggest a level 2. If you were a doc that “fell under my review” (I’m the ‘lead’ at our office) I’d question your sanity. Please tell me you aren’t billing level 2s. Haha.

That would be akin to seeing you walk through the parking lot with a bad posture and I tell you to straighten up.

I’m billing 3’s. If you prescribe a medication that can’t be bought OTC, it’s a 3 (moderate). If u r taking care of 2+ chronic conditions, one requiring further management than refill (increase or decrease dose), plus follow up, etc then it’s a 4.

you should NOT be billing a 4 for a sinus infections esp since ~10 days is observation with symptomatic OTC tx and you can make an argument for an additional 10 days afterwards (I think this is the IDSA recommendations? Need to look it up again).

 

[deleted997790]

Making 500+ K by seeing 45 patients a day is impossible unless ur doing a high volume, low accuracy medicine (crappy care that’s dangerous to patients) OR ur doing urgent care stuff and billing inappropriately (99214 for a sinus infection).

 

[Keona]

1) Was testing done?
2) With a fever of 104 I’d argue unknown diagnosis with possible poor outcome leads to a 214 “seriousness.”
3) Were you paying out of pocket?

I always review my EOBs, but I never mind paying if there’s no concern. We all gotta eat.

As a resident I cared a lot more about the around $250 bill I had to pay. (It’s been over 3 years now so I can’t remember exact amount). If her normal pediatrician in the same health system had seen her it would have been billed a 99213 based on past experiences. That was the price after insurance (thankfully we have a much better insurance plan now!). The urgent care actually got in trouble for how many inappropriate 99214s they were doing. They tried to get all sinus infections and strep throats billed as those. And yes my kid’s fever I can see making it higher risk decision making.

 

[deleted997790]

As a resident I cared a lot more about the around $250 bill I had to pay. (It’s been over 3 years now so I can’t remember exact amount). If her normal pediatrician in the same health system had seen her it would have been billed a 99213 based on past experiences. That was the price after insurance (thankfully we have a much better insurance plan now!). The urgent care actually got in trouble for how many inappropriate 99214s they were doing. They tried to get all sinus infections and strep throats billed as those. And yes my kid’s fever I can see making it higher risk decision making.

No the fever shouldn’t make it a higher risk. You can have a fever with a cold, strep, etc - it’s part of the picture. Three plus years ago, I think we were still using centor scores which listed fever as one of the metrics for scoring. The fever is part of the strep at that age. It was just BAD medicine and u had to unfortunately pay for that. That wasnt a high complexity case, 99214 case. Anyone who thinks it was doesn’t understand basic basic basic basic acute primary care medicine. This should have been a 99213. You got ripped off by someone who was doing bad medicine.

 

[VA Hopeful Dr]

99214 isn't high complexity

No the fever shouldn’t make it a higher risk. You can have a fever with a cold, strep, etc - it’s part of the picture. Three plus years ago, I think we were still using centor scores which listed fever as one of the metrics for scoring. The fever is part of the strep at that age. It was just BAD medicine and u had to unfortunately pay for that. That wasnt a high complexity case, 99214 case. Anyone who thinks it was doesn’t understand basic basic basic basic acute primary care medicine. This should have been a 99213. You got ripped off by someone who was doing bad medicine.

 

[deleted997790]

99214 isn't high complexity

No, but it’s higher complexity (not in terms of MDM <— is this correct?) than a strep throat should be.

 

[VA Hopeful Dr]

No, but it’s higher complexity (not in terms of MDM <— is this correct?) than a strep throat should be.

Disagree

 

[door_to_balloon_knot]

I see that differently. New problem no work up and RX management hit the level 4 MDM.

If I'm prescribing antibiotics I clearly don't think it's self limited.

I agree with this because in the flip side, if it was a “self-limited” condition I wouldn’t prescribe anything and it’s essentially a worried-well.

 

[Bacchus]

Disagree

and you could argue not self limited, 1) RX and 2) Comps -- although those could be self-limiting if the patient goes into renal failure for example lol

 

[door_to_balloon_knot]

Disagree

I think you guys are getting the terms mixed up. “High” risk is different than the generic term of higher risk. New diagnosis without work up is a component of “moderate risk”

 

[door_to_balloon_knot]

I’m billing 3’s. If you prescribe a medication that can’t be bought OTC, it’s a 3 (moderate). If u r taking care of 2+ chronic conditions, one requiring further management than refill (increase or decrease dose), plus follow up, etc then it’s a 4.

you should NOT be billing a 4 for a sinus infections esp since ~10 days is observation with symptomatic OTC tx and you can make an argument for an additional 10 days afterwards (I think this is the IDSA recommendations? Need to look it up again).

My dude/ dudette, you are literally leaving money/ RVU points on the table for no good reason except because of how it “feels” not and objectively at the way it is calculated. Could you argue that a strep throat left untreated could lead to endocarditis or Rheumatic fever? Reasonably yes. I’m not sure how you are calculating your MDM between problem/data/risk but take a look here:

New office patients (99201-99205) - E/M Coding Education, EM evaluation and management coding, e&m documentation, 99214, 99213

 

[deleted997790]

My dude/ dudette, you are literally leaving money/ RVU points on the table for no good reason except because of how it “feels” not and objectively at the way it is calculated. Could you argue that a strep throat left untreated could lead to endocarditis or Rheumatic fever? Reasonably yes. I’m not sure how you are calculating your MDM between problem/data/risk but take a look here:

New office patients (99201-99205) - E/M Coding Education, EM evaluation and management coding, e&m documentation, 99214, 99213

I’m a dude. And yes, apparently this is why I’m not ballin

I’ve literally been billing 99213’s for these things based on it taking me 5 minutes (including the swab). I never actively think about a long term PSGN, sepsis, scarlet fever, endocarditis, myocarditis as complications because it’s engrained in my head and feels like “duh this can happen, let’s treat it”. I guess u guys r right, technically MDM supports 99214. Just feels strange my detailed MSK H&P with X-ray followed by diagnostic msk ultrasound with possible ultrasound guided injections Followed by a referral to PT and a 4-6 week follow up is equivalent coding to a strep throat (minus the additional billing codes for diagnostic US, etc).

 

[sloh]

I’m a dude. And yes, apparently this is why I’m not ballin

I’ve literally been billing 99213’s for these things based on it taking me 5 minutes (including the swab). I never actively think about a long term PSGN, sepsis, scarlet fever, endocarditis, myocarditis as complications because it’s engrained in my head and feels like “duh this can happen, let’s treat it”. I guess u guys r right, technically MDM supports 99214. Just feels strange my detailed MSK H&P with X-ray followed by diagnostic msk ultrasound with possible ultrasound guided injections Followed by a referral to PT and a 4-6 week follow up is equivalent coding to a strep throat (minus the additional billing codes for diagnostic US, etc).

Coming from PM&R, your last sentence rings true. It's pretty much impossible for private practice outpatient PM&R physicians to be "ballers" practicing good medicine with how care is reimbursed. This is also why despite liking outpatient MSK the most, I don't currently practice in that setting/subfield.

 

[VA Hopeful Dr]

I’m a dude. And yes, apparently this is why I’m not ballin

I’ve literally been billing 99213’s for these things based on it taking me 5 minutes (including the swab). I never actively think about a long term PSGN, sepsis, scarlet fever, endocarditis, myocarditis as complications because it’s engrained in my head and feels like “duh this can happen, let’s treat it”. I guess u guys r right, technically MDM supports 99214. Just feels strange my detailed MSK H&P with X-ray followed by diagnostic msk ultrasound with possible ultrasound guided injections Followed by a referral to PT and a 4-6 week follow up is equivalent coding to a strep throat (minus the additional billing codes for diagnostic US, etc).

It is strange, but that's American medical billing for you.

 

[deleted997790]

Coming from PM&R, your last sentence rings true. It's pretty much impossible for private practice outpatient PM&R physicians to be "ballers" practicing good medicine with how care is reimbursed. This is also why despite liking outpatient MSK the most, I don't currently practice in that setting/subfield.

That’s unfortunate to hear. This many years out of residency and I had no clue that this is why I didn’t see outpatient PM&R practices (I think amongst sports medicine, we all agree PM&R knows MSK better than any field with the exception of ortho). This whole billing system is just ridiculous.

 

[chocomorsel]

Kids are way cheaper than ex-wives.

Eight of them though?

 

[deleted87716]

Eight of them though?

I have friends with that many. They're not unusually high earners, either. They're doing fine.

My friends with multiple exes, OTOH, bitch about money all the time. Most of them are high earners.

Part of it's probably lifestyle-related, granted. The guys with big families tend to live within their means. The multiply-divorced guys don't.

 

[chocomorsel]

I have friends with that many. They're not unusually high earners, either. They're doing fine.

My friends with multiple exes, OTOH...

Well if they were high earners, would the ex still get more than the eight kids?
Gotta compare apples to apples.

 

[deleted87716]

Well if they were high earners, would the ex still get more than the eight kids?
Gotta compare apples to apples.

Dunno. The monetary stuff is anecdotal, to be sure, but there's nothing crazy about having a big family, assuming you can take care of them. You aren't obligated to buy every kid a car at 16, send them to private school, or pay their college tuition, nor should you sacrifice your retirement no matter how many kids you have.

 

[chocomorsel]

Dunno. Then monetary stuff is anecdotal, to be sure, but there's nothing crazy about having a big family, assuming you can take care of them. You aren't obligated to buy every kid a car at 16, send them to private school, or pay their college tuition, nor should you sacrifice your retirement no matter how many kids you have.

I am talking about what the judge is going to order you to pay for child support versus alimony. No one says you have to buy your wife extravagant crap either.
Ok. I think we both can agree that it highly unlikely for alimony to outweigh child support for eight children. Hell I don't think it should outweigh child support for even one child. I mean, who's more incapable of taking care of themselves. A grown woman/man or a child.

 

[deleted87716]

I am talking about what the judge is going to order you to pay for child support versus alimony. No one says you have to buy your wife extravagant crap either.
Ok. I think we both can agree that it highly unlikely for alimony to outweigh child support for eight children. Hell I don't think it should outweigh child support for even one child. I mean, who's more incapable of taking care of themselves. A grown woman/man or a child.

Now you’re talking about someone getting divorced who also has lots of kids. I was speaking to the original comparison of multiple kids vs. multiple exes.

 

[chocomorsel]

Now you’re talking about someone getting divorced who also has lots of kids. I was speaking to the original comparison of multiple kids vs. multiple exes.

Well then, clearly we are speaking two different languages. Since you addressed the poster who talked about eight kids and claimed they are cheaper than ex wives, I thought you were talking literally. The same scenario the he was talking of. If that man got divorced.
And to be a high income earner, get divorced and taken to the cleaners, be stupid enough to do it again, well that is on you. What is the upside of marriage in that situation? Why not just live in sin?

 

[deleted997790]

Well then, clearly we are speaking two different languages. Since you addressed the poster who talked about eight kids and claimed they are cheaper than ex wives, I thought you were talking literally. The same scenario the he was talking of. If that man got divorced.
And to be a high income earner, get divorced and taken to the cleaners, be stupid enough to do it again, well that is on you. What is the upside of marriage in that situation? Why not just live in sin?

*** grabs popcorn ***

 

[chocomorsel]

*** grabs popcorn ***

This must be a rather dull forum if this is all it takes for y'all to grab some popcorn.
You should come over to the anesthesia forum if you want to see some mudslinging. And I don't think the person I was addressing is in that repeatedly divorced situation. He/she was speaking of friends. But y'all would know better than me.

 

[deleted87716]

Well then, clearly we are speaking two different languages. Since you addressed the poster who talked about eight kids and claimed they are cheaper than ex wives, I thought you were talking literally. The same scenario the he was talking of. If that man got divorced.
And to be a high income earner, get divorced and taken to the cleaners, be stupid enough to do it again, well that is on you. What is the upside of marriage in that situation? Why not just live in sin?

I'm going to assume that's a rhetorical question.

 

[door_to_balloon_knot]

It is strange, but that's American medical billing for you.

 

[InvestingDoc]

This year is going to be close for me to cross the 500k threshold. Next year I certainly will unless something major happens. I'm busy....all....the....time.

I own a practice and the building space that I work out of which largely helps income numbers. I also now have 4 employed physicians /midlevel mix that is finally paying off for me.

I'm constantly on the phone, working on something for the business and it is a lot of work. I see about 16 patients a day and the rest of the day is admin time filled with meetings every 15 minutes to 30 minutes on average.

There is no free lunch. I can scale back and work less and make less but I've been focused on growth for my business. We have been growing pretty rapidly from not even existing 2 years ago to now having a 5 Physician / midlevel in total practice. I most likely will open 2 new locations if things keep going this way in the next 12 months.

So to OP...idk if this is what you wanted to hear but yeah you can make money doing outpatient....but you're going to work your ass off and sacrifice personal life.

 

[robellis]

This year is going to be close for me to cross the 500k threshold. Next year I certainly will unless something major happens. I'm busy....all....the....time.

I own a practice and the building space that I work out of which largely helps income numbers. I also now have 4 employed physicians /midlevel mix that is finally paying off for me.

I'm constantly on the phone, working on something for the business and it is a lot of work. I see about 16 patients a day and the rest of the day is admin time filled with meetings every 15 minutes to 30 minutes on average.

There is no free lunch. I can scale back and work less and make less but I've been focused on growth for my business. We have been growing pretty rapidly from not even existing 2 years ago to now having a 5 Physician / midlevel in total practice. I most likely will open 2 new locations if things keep going this way in the next 12 months.

So to OP...idk if this is what you wanted to hear but yeah you can make money doing outpatient....but you're going to work your ass off and sacrifice personal life.

In the optho forum, they work 35 hours per week and make 1.5 million per year as owners of the practice..bottom line is if you want to make money go into a procedural field..those guys are reimbursed wayyy more than us “cerebral” types...

 

[sloh]

In the optho forum, they work 35 hours per week and make 1.5 million per year as owners of the practice..bottom line is if you want to make money go into a procedural field..those guys are reimbursed wayyy more than us “cerebral” types...

It’s also important to note that they can see 60-80 patients per day. In my specialty PM&R, while it’s hard to break 220-250k with outpatient MSK clinic, 1099 SAR jobs routinely pay at least 350k/yr for 4 days of work/week, 4-6 hrs/day. Each patient encounter for 1099 SAR work is much shorter (both the actual encounter and documentation) compared to outpatient PM&R clinic. Therefore, the volume of patients is much higher. And we strictly see Medicare patients as well. My last monthly paycheck was 47k.

 

[InvestingDoc]

In the optho forum, they work 35 hours per week and make 1.5 million per year as owners of the practice..bottom line is if you want to make money go into a procedural field..those guys are reimbursed wayyy more than us “cerebral” types...

Any idea how much of that though goes to overhead and if that is gross profit for them vs gross income for their practice? My understanding is that for certain eye procedures, the machine fee is insanely high but I'll admit I have no idea if that is true?

Crazy if they are raking in 1.5M gross per year. Medscape says average is Medscape Ophthalmologist Compensation Report 2020 like 390k a year so 1.5M would be way way above that. I guess it can happen but wow, good for them if that is the case.

 

[robellis]

Any idea how much of that though goes to overhead and if that is gross profit for them vs gross income for their practice? My understanding is that for certain eye procedures, the machine fee is insanely high but I'll admit I have no idea if that is true?

Crazy if they are raking in 1.5M gross per year. Medscape says average is Medscape Ophthalmologist Compensation Report 2020 like 390k a year so 1.5M would be way way above that. I guess it can happen but wow, good for them if that is the case.

1.5 million net income as in taxable income, I know it’s pretty crazy what these guys are making lol their procedure takes like 10 minutes or something so they can line up 30 per day and rake in the money..they also laugh about the number you quoted and say the salary surveys are absurdly low..god bless em

 

[InvestingDoc]

1.5 million net income as in taxable income, I know it’s pretty crazy what these guys are making lol their procedure takes like 10 minutes or something so they can line up 30 per day and rake in the money..they also laugh about the number you quoted and say the salary surveys are absurdly low..god bless em

Love it, definitely not going to hate on someone for making hay while the sun shines.

 

[MedicineZ0Z]

At my academic center in the south we bill sinus infections as 4s always if faculty briefly steps their head in to say hi.

 

[door_to_balloon_knot]

This year is going to be close for me to cross the 500k threshold. Next year I certainly will unless something major happens. I'm busy....all....the....time.

I own a practice and the building space that I work out of which largely helps income numbers. I also now have 4 employed physicians /midlevel mix that is finally paying off for me.

I'm constantly on the phone, working on something for the business and it is a lot of work. I see about 16 patients a day and the rest of the day is admin time filled with meetings every 15 minutes to 30 minutes on average.

There is no free lunch. I can scale back and work less and make less but I've been focused on growth for my business. We have been growing pretty rapidly from not even existing 2 years ago to now having a 5 Physician / midlevel in total practice. I most likely will open 2 new locations if things keep going this way in the next 12 months.

So to OP...idk if this is what you wanted to hear but yeah you can make money doing outpatient....but you're going to work your ass off and sacrifice personal life.

I can definitely appreciate the amount of work that goes into reaching that level of income. Without seeming deaf to the cautionary tone in your post, how did you get started? If it’s so busy, why not consider selling or finding a successor and/or backing off? Sorry if that comes off naive.

EDIT: I found your site and previous posts. Will be reading up on all of those . Seeing what you went through in the beginning, definitely rooting for you to be successful.

 

[InvestingDoc]

I can definitely appreciate the amount of work that goes into reaching that level of income. Without seeming deaf to the cautionary tone in your post, how did you get started? If it’s so busy, why not consider selling or finding a successor and/or backing off? Sorry if that comes off naive.

EDIT: I found your site and previous posts. Will be reading up on all of those . Seeing what you went through in the beginning, definitely rooting for you to be successful.

You may have already found the answer but I'll still address the question.

I got started by subleasing from a surgeon. I wanted to be my own boss after getting arguably screwed over with my previous gig and take control over my future. There was a meeting where I was told with my previous employer that they could literally post my job and have 20 people interested in days if they wanted to. They also loved hiring new grads because the new grads had no idea how bad the contracts were against them. A part of me didn't believe it, but now that I own my own practice I see how true it is. Now that I submit payments to insurance companies, I see how much money they took from me. We are talking hundreds of thousands a year for their profit. I posted a job posting for a physician and within a week had 30 job applications from physicians who wanted to come work for me.

I also like running a business so it was a win-win for what I was looking for. If you work for someone else, they take a lot of the headache of running a business off your plate but remember that they make the decisions for the company....not you. For many people that is okay. For me, I wanted to make the decisions.

Everyone told me don't do it. No one is doing primary care anymore. Everyone also told me that Medicare would be such a pain in the ass and take forever to pay. Basically, everything I was told ended up being completely wrong.

It started out slow then snowballed and continues to snowball.

There are headaches to owing your own practice and I could sell out (I've already been offered buy outs twice now). However, its not life changing money and to me the question comes up....then what? I go work for them for a few years or for someone else down the road?

Nah, I'd rather see how big I can make this rather than taking a million or two to sell out what I currently have. I complain sometimes about all the work but the truth is, I love it. I love learning something new. Learning how to run a company, how to grow a company, how to not only practice good medicine but also run a great business that provides for peoples paychecks and lives.

I was so excited when we had our first payment from insurance. I'll never forget that $2.97 check for venipunture. The milestones are a bit addicting. The first $100 dollar day. The first $500 day. The first $1000 day. Now, most days are $10,000 income days. It still is weird when I open my business account and see daily deposits over $10,000. Each milestone still feels surreal that I've built it from the ground up when everyone else told me no one is doing this anymore in major cities.

As biggie says....mo money, mo problems. Running a business is me putting out fires every day in between seeing patients but I wouldn't have it any other way for the time being. It surely is not for everyone since it is essentially two full time jobs. Business owner and physician.

Happy thanksgiving!

 

[Sardonix]

You may have already found the answer but I'll still address the question.

I got started by subleasing from a surgeon. I wanted to be my own boss after getting arguably screwed over with my previous gig and take control over my future. There was a meeting where I was told with my previous employer that they could literally post my job and have 20 people interested in days if they wanted to. They also loved hiring new grads because the new grads had no idea how bad the contracts were against them. A part of me didn't believe it, but now that I own my own practice I see how true it is. Now that I submit payments to insurance companies, I see how much money they took from me. We are talking hundreds of thousands a year for their profit. I posted a job posting for a physician and within a week had 30 job applications from physicians who wanted to come work for me.

I also like running a business so it was a win-win for what I was looking for. If you work for someone else, they take a lot of the headache of running a business off your plate but remember that they make the decisions for the company....not you. For many people that is okay. For me, I wanted to make the decisions.

Everyone told me don't do it. No one is doing primary care anymore. Everyone also told me that Medicare would be such a pain in the ass and take forever to pay. Basically, everything I was told ended up being completely wrong.

It started out slow then snowballed and continues to snowball.

There are headaches to owing your own practice and I could sell out (I've already been offered buy outs twice now). However, its not life changing money and to me the question comes up....then what? I go work for them for a few years or for someone else down the road?

Nah, I'd rather see how big I can make this rather than taking a million or two to sell out what I currently have. I complain sometimes about all the work but the truth is, I love it. I love learning something new. Learning how to run a company, how to grow a company, how to not only practice good medicine but also run a great business that provides for peoples paychecks and lives.

I was so excited when we had our first payment from insurance. I'll never forget that $2.97 check for venipunture. The milestones are a bit addicting. The first $100 dollar day. The first $500 day. The first $1000 day. Now, most days are $10,000 income days. It still is weird when I open my business account and see daily deposits over $10,000. Each milestone still feels surreal that I've built it from the ground up when everyone else told me no one is doing this anymore in major cities.

As biggie says....mo money, mo problems. Running a business is me putting out fires every day in between seeing patients but I wouldn't have it any other way for the time being. It surely is not for everyone since it is essentially two full time jobs. Business owner and physician.

Happy thanksgiving!

If Hallmark movies have taught me anything, it's that you're one family holiday/unrealistically-mild life changing event from realizing something is missing from your life and that you've ignored the importance of friendship/Christmas etc.

But seriously, it's amazing all that you've accomplished!

 

[deleted997790]

If Hallmark movies have taught me anything, it's that you're one family holiday/unrealistically-mild life changing event from realizing something is missing from your life and that you've ignored the importance of friendship/Christmas etc.

But seriously, it's amazing all that you've accomplished!

His family won’t notice when they’re driving around in brand-new cars without fear of losing the house because they can’t pay the mortgage lol hallmark movies leave that out.

 

[goldsummer]

its all about your perspective... in residency I felt like I was ballin with 60k. Now I feel rich as an attending (making way less than 500k). But I'm frugal and growing up I was used to not being able to afford anything above necessities, my parents' cars breaking down every month, etc.
Now, being able to go do whatever I want or get most whatever I want is a very cool feeling.

 

[door_to_balloon_knot]

its all about your perspective... in residency I felt like I was ballin with 60k. Now I feel rich as an attending (making way less than 500k). But I'm frugal and growing up I was used to not being able to afford anything above necessities, my parents' cars breaking down every month, etc.
Now, being able to go do whatever I want or get most whatever I want is a very cool feeling.

Completely understand this perspective. That said, the ability to be debt-less and have FU money where you are not trapped with any particular job situation is another level of freedom akin to doing whatever you want... except it truly is whatever you want

 

[Splenda88]

@VA Hopeful Dr


What would be a fair wage in Columbia SC (W2)? Hospitalist vs. Nocturnist.

Can you name some neighborhoods with good public schools (Columbia + Suburbs)? For some reason, I am assuming you live in Columbia.

 

[VA Hopeful Dr]

@VA Hopeful Dr


What would be a fair wage in Columbia SC (W2)? Hospitalist vs. Nocturnist.

Can you name some neighborhoods with good public schools (Columbia + Suburbs)? For some reason, I am assuming you live in Columbia.

We used to, we moved 3 years ago.

When my wife left her hospitalist job 3 years ago, 12 12 hour shifts per month was paying about 240k before quality bonuses. Not sure what the nocturnist differential is but the guy at her hospital who had that job had a stroke at 42 so I'm not sure I'd recommend that.

The other hospital in town pays by RVU and their census runs 25ish patients per day, so really good money but their shifts suck.

The best schools are in the Ballentine and Chapin area. Parts of Lexington have good ones too.

 

[Splenda88]

We used to, we moved 3 years ago.

When my wife left her hospitalist job 3 years ago, 12 12 hour shifts per month was paying about 240k before quality bonuses. Not sure what the nocturnist differential is but the guy at her hospital who had that job had a stroke at 42 so I'm not sure I'd recommend that.

The other hospital in town pays by RVU and their census runs 25ish patients per day, so really good money but their shifts suck.

The best schools are in the Ballentine and Chapin area. Parts of Lexington have good ones too.

25 patients census! No way... I won't do anything above 16 patients.

 

[Reboa]

We used to, we moved 3 years ago.

When my wife left her hospitalist job 3 years ago, 12 12 hour shifts per month was paying about 240k before quality bonuses. Not sure what the nocturnist differential is but the guy at her hospital who had that job had a stroke at 42 so I'm not sure I'd recommend that.

The other hospital in town pays by RVU and their census runs 25ish patients per day, so really good money but their shifts suck.

The best schools are in the Ballentine and Chapin area. Parts of Lexington have good ones too.

Who knows maybe that hospitalist was messing around with Dr. Halstead’s magic powder because 12 night shifts a month doesn’t sound too bad. Is the 12 12s model common I’ve only ran into the 7 on 7 off model in my lazy google searches

 

[VA Hopeful Dr]

Who knows maybe that hospitalist was messing around with Dr. Halstead’s magic powder because 12 night shifts a month doesn’t sound too bad. Is the 12 12s model common I’ve only ran into the 7 on 7 off model in my lazy google searches

This hospitalist group was really big on retention and they thought that fewer shifts and not requiring 7 days in a row kept people working there longer. You could work more (many did) or work 7 in a row, but it wasn't required. After our kids were born, my wife told them she didn't want to work more than 5 days in a row and she didn't.

As for the nocturnist's stroke, there's a pretty large amount of evidence that night shift workers have a significantly higher risk of CV disease than day shift workers.

 

[cabinbuilder]

Kids are way cheaper than ex-wives.

Or ex-husbands. My ex was awarded 8 years of alimony: 5k/month for 3 yrs, 3.5K/month for 3 yrs, 2.5K/month for 2 yrs. Got 2 vehicles paid for. It was cheaper paying for my son's college.

 

[VA Hopeful Dr]

Or ex-husbands. My ex was awarded 8 years of alimony: 5k/month for 3 yrs, 3.5K/month for 3 yrs, 2.5K/month for 2 yrs. Got 2 vehicles paid for. It was cheaper paying for my son's college.

Jesus. That started out at half my starting salary. My mortgage plus my kid's private school is decently below that.