Are Hospitalists Looking at an EM-Style Glut

[Trousseau]

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So this year, myself and all my co-residents that wanted hospitalist jobs found them (except for one that is specific about location, he’s been at it for 7 months and got nothing), but we had a harder time of it than our buddies going into outpatient IM. I’ve seen the projections of a Hospitalist glut in the years to come:

https://aamc-black.global.ssl.fastly.net/production/media/filer_public/31/13/3113ee5c-a038-4c16-89af-294a69826650/2019_update_-_the_complexities_of_physician_supply_and_demand_-_projections_from_2017-2032.pdf

And I was thinking: do you think we’re looking at an EM-esque situation as the decade goes on? I prefer inpatient medicine, but I was thinking of switching to outpatient a few years later when my contract finishes if I can’t find a satisfactory new job.

 

[bronx43]

Hard to predict. But at my academic institution, they are starting to add midlevels to the hospitalist group... this would have been inconceivable a mere 3 years ago. My hospitalist buddy who also works for a large health system corroborates this trend at his shop.

Extrapolate what you wish from these early changes in the market. Any time you are nothing but a cog in the machine, you are extremely sensitive to market pressures. I would make the change to outpatient sooner rather than later if I were you. And if you can jump to a physician-owned group, all the better.

 

[Trousseau]

Hard to predict. But at my academic institution, they are starting to add midlevels to the hospitalist group... this would have been inconceivable a mere 3 years ago. My hospitalist buddy who also works for a large health system corroborates this trend at his shop.

Extrapolate what you wish from these early changes in the market. Any time you are nothing but a cog in the machine, you are extremely sensitive to market pressures. I would make the change to outpatient sooner rather than later if I were you. And if you can jump to a physician-owned group, all the better.

Heh, well I already bought a house, and in any case my current contract is pretty decent...probably best to ride it out for as long as I can. I think outpatient medicine in relatively undesirable locations (like where I’m going to) should be safe near-indefinitely...and if it ever isn’t, then medicine as a field is over anyways.

 

[bronx43]

Heh, well I already bought a house, and in any case my current contract is pretty decent...probably best to ride it out for as long as I can. I think outpatient medicine in relatively undesirable locations (like where I’m going to) should be safe near-indefinitely...and if it ever isn’t, then medicine as a field is over anyways.

Medicine is already over... most people just don't know it yet.

 

[IMGASMD]

Hard to predict. But at my academic institution, they are starting to add midlevels to the hospitalist group... this would have been inconceivable a mere 3 years ago. My hospitalist buddy who also works for a large health system corroborates this trend at his shop.

Extrapolate what you wish from these early changes in the market. Any time you are nothing but a cog in the machine, you are extremely sensitive to market pressures. I would make the change to outpatient sooner rather than later if I were you. And if you can jump to a physician-owned group, all the better.

One of my buddies is in private GI was telling me that in their area all the primary care IM is banding together to start their own medical group. They will be hiring their own GI and Cards.
When you own the patients, you have tremendous leverage.

 

[bronx43]

One of my buddies is in private GI was telling me that in their area all the primary care IM is banding together to start their own medical group. They will be hiring their own GI and Cards.
When you own the patients, you have tremendous leverage.

Exactly.

All the medical specialists at my institution are paid significantly less than what the PCPs get. The specialists all huff and puff, but admin brush us off like flies. When the PCPs want something... different conversation altogether.

 

[DrMetal]

I’ve seen the projections of a Hospitalist glut in the years to come:

It's already here. There's way too many of us, and mid-levels are all over the place.

Medicine is already over... most people just don't know it yet.

Unfortunately true. We've become a huge industrial juggernaut, no one wants to admit it.

One of my buddies is in private GI was telling me that in their area all the primary care IM is banding together to start their own medical group. They will be hiring their own GI and Cards.
When you own the patients, you have tremendous leverage.

Who's pay them? If you go this route, you gotta get the patients and convince them to pay cash or deal with their insurance companies. It's ultimately the same rat race. Maybe you have some more control, we'll see how it pans out.

 

[bronx43]

Who's pay them? If you go this route, you gotta get the patients and convince them to pay cash or deal with their insurance companies. It's ultimately the same rat race. Maybe you have some more control, we'll see how it pans out.

Depending on the desirability of the location, they can make a play on geographic arbitrage. Young docs would give up quite a bit of income to live in a major metro, and most major metros are completely saturated. I'm in a growing tier 2/3 city, and you can see whichever specialist you want the same week (same day derm appointment, no joke). Suffice to say, not many job openings.

If the PCPs have a strong enough group, they can certainly hire their own GI doc, divert all scopes to him/her while paying lower than what the private practice docs are making across the street. The insurers fall in line, because of their primary care market dominance. They can then use the revenue from the endoscopy suite to lower everyone's overhead/increase profit. The volume would be there, because they control it. Elective specialists are beholden to their primary care feeders, whether they like it or not.

 

[Trousseau]

It's already here. There's way too many of us, and mid-levels are all over the place.

Hmm, I didn’t expect that. But I wonder why we didn’t hear IM PGY3s giving the horror stories that our friends in EM had. Our class did have to take jobs in less desirable locations (maybe this is a bit protective against the glut), but I heard EM guys could hardly find anything at all...

 

[bronx43]

Hmm, I didn’t expect that. But I wonder why we didn’t hear IM PGY3s giving the horror stories that our friends in EM had. Our class did have to take jobs in less desirable locations (maybe this is a bit protective against the glut), but I heard EM guys could hardly find anything at all...

Why? The same reason why EM grads 3 years ago didn't tell these horror stories. They simply noticed that there were fewer job postings, and they weren't bombarded as much with recruiter emails. Then the floor fell out.

It's like that Hemingway novel. "How did you go bankrupt?" "Two ways. Gradually, then suddenly."

 

[DrMetal]

Depending on the desirability of the location, they can make a play on geographic arbitrage. Young docs would give up quite a bit of income to live in a major metro, and most major metros are completely saturated. I'm in a growing tier 2/3 city, and you can see whichever specialist you want the same week (same day derm appointment, no joke). Suffice to say, not many job openings.

If the PCPs have a strong enough group, they can certainly hire their own GI doc, divert all scopes to him/her while paying lower than what the private practice docs are making across the street. The insurers fall in line, because of their primary care market dominance. They can then use the revenue from the endoscopy suite to lower everyone's overhead/increase profit. The volume would be there, because they control it. Elective specialists are beholden to their primary care feeders, whether they like it or not.

I'm intrigued by the concept, but the skeptic in me wants to say "I'll believe it when I see it." That is, small physician groups competing against the big juggernaut healthcare systems seems like a losing fight. I want the little guy to win, but in the same way that I buy my office products from 'Staples' and not the mom-and-pop office supply store, I think patients will still gravitate towards the larger enterprises (and maybe they'll be forced to).

We're a bunch of doctors trying to predict and thwart economic/business trends. That's dicey, I think.

 

[Mad Jack]

Why? The same reason why EM grads 3 years ago didn't tell these horror stories. They simply noticed that there were fewer job postings, and they weren't bombarded as much with recruiter emails. Then the floor fell out.

It's like that Hemingway novel. "How did you go bankrupt?" "Two ways. Gradually, then suddenly."

For now at least there are jobs, it's just getting tougher to get one in a desirable city

 

[Trousseau]

For now at least there are jobs, it's just getting tougher to get one in a desirable city

In EM or IM?

My experience and what I’ve heard from colleagues is that in IM there is nothing in desirable cities unless you have connections (I didn’t). Even then, the money for those jobs wasn’t good.

 

[Mad Jack]

In EM or IM?

My experience and what I’ve heard from colleagues is that in IM there is nothing in desirable cities unless you have connections (I didn’t). Even then, the money for those jobs wasn’t good.

IM. And you're saying what I was saying- it's tough to get jobs in a desirable city. They are there, but the pay is low and you need credentials or connections

 

[DrMetal]

In EM or IM?

My experience and what I’ve heard from colleagues is that in IM there is nothing in desirable cities unless you have connections (I didn’t). Even then, the money for those jobs wasn’t good.

I think Internal Medicine is still somewhat safe. There will always be a need for adult physicians, especially in primary care.

The reason why EM got hit so hard, is b/c they demanded a lot of money (they were making $300/hr), so the system became more inclined to circumnavigate around them . . .and (quite frankly), their job isn't that hard (treating all the garden variety crap that comes in, can be easily done by a mid level). Grant it, those who work in Level 1s and do lots of procedures, they're worth their weight, but most EDs are not that, and even the Level 1s have a ton of garden variety crap that a midlevel could easily handle.

Historically, EM was never a specialty. Or another way of looking at it, there's 'emergency' medicine in every specialty. The ERs used to be staffed by general internits/surgeons/anes etc . . .everybody covered the ER for 1-2 weeks out of the year. It probably should've stayed that way. Now it looks like its reverting back.

 

[blue.jay]

Cannot compare hospitalist to EM because..

1. EM physician salary is about 3-5 times higher than NP/PA in ED. It makes sense to hire more midlevels to take on low acuity stuff and have 1-2 MD for real emergencies like cardiac arrest, trauma, or very ill patients.
2. Mid-levels mostly don't know real medicine but can at least determine if someone needs to be admitted or not. They pan order labs and imaging and give a reason for hospitalist to admit the patient. This is hoping that they have competent physicians and consultants who can figure out the pathology and manage complex issues. I don't see hospitals going the route of ED midlevel admitting to hospitalist midlevel who ****s up and send the patient to ICU under ICU midlevel.
Not saying this is not happening (currently I see this in my community site of a big name academic institution) but hospitals save more costs hiring midlevels for ED, ICU and anesthesia roles where the pay gap is higher.

Most hospitalist get 200-250k to see 14-18 patients. Most midlevels I have worked with round on 6-8 patients during the day and admitted 2-4 patients at night. They carry 50% of the workload of an average hospitalist for 50% pay. Unless midlevels carry liability and same census as MD/DO for 100k I don't see their use in general IM.

Bonus 3. There is always primary care backup.. but I know most of us have had bad experiences in residency that some IM grads would say they would be rather jobless than do PCP work. It is hard and less gratifying. I think even NP/PAs have figured out that primary care is a dump (and their fight to expand scopre) they are flocking to inpatient settings, ED, derm, psych, subspecialities for a better lifestyle and low stress.

 

[DrMetal]

Cannot compare hospitalist to EM because..

1. EM physician salary is about 3-5 times higher than NP/PA in ED. It makes sense to hire more midlevels to take on low acuity stuff and have 1-2 MD for real emergencies like cardiac arrest, trauma, or very ill patients.
2. Mid-levels mostly don't know real medicine but can at least determine if someone needs to be admitted or not.

Yup, pretty much, that's what's driving this.

It's a lot harder to manage a patient for 3-5 days and figure out what to do with him/her. Having said, NPs are encroaching on our world too.

All of medicine is becoming a dump.

 

[blue.jay]

Yup, pretty much, that's what's driving this.

It's a lot harder to manage a patient for 3-5 days and figure out what to do with him/her. Having said, NPs are encroaching on our world too.

All of medicine is becoming a dump.

I know but I will happily do the job of our midlevels. Getting 100k with benefits to round on 6-8 patients 8am-4pm (flexible scheduleing) with 2 week PTO; without liability and job security. Plus less debt, less rigorous schools and their national organization fighting for them. These midlevels started making $$$ when they were 24-26 so if they invest wisely they can easily come out ahead.

While our organizations invent bogus thrombsis fellowship, hospitalist fellowship, nutrition fellowship, alternative medicine fellowship, academic pediatric fellowship so they can abuse us more.

Like you said, this profession is doomed. There is no satisfaction monetary or otherwise after going through years of grueling training.

 

[DrMetal]

I know but I will happily do the job of our midlevels. Getting 100k with benefits to round on 6-8 patients 8am-4pm (flexible scheduleing) with 2 week PTO; without liability and job security. Plus less debt, less rigorous schools and their national organization fighting for them. These midlevels started making $$$ when they were 24-26 so if they invest wisely they can easily come out ahead.

While our organizations invent bogus thrombsis fellowship, hospitalist fellowship, nutrition fellowship, alternative medicine fellowship, academic pediatric fellowship so they can abuse us more.

Like you said, this profession is doomed. There is no satisfaction monetary or otherwise after going through years of grueling training.

Yeah, pretty much. I had a friend who actually offered to take the PA rate at a hospital (b/c he really wanted to work there), they wouldn't allow it.

 

[emergentmd]

10 Yrs ago when I did hospital EM, they could not find enough Hospitalist to staff. I would hear stories of overworked docs and having difficulty hiring anyone for a top 10 US metro City. I was actually surprised b/c most specialists had a hard time breaking into the market.

Fast forward 3 yrs ago when I left, they had a flood of new hospitalists. Now when I call to do a transfer, I do not recognize any doc.

The Flood is here for hospitalists.

 

[Mad Jack]

Cannot compare hospitalist to EM because..

1. EM physician salary is about 3-5 times higher than NP/PA in ED. It makes sense to hire more midlevels to take on low acuity stuff and have 1-2 MD for real emergencies like cardiac arrest, trauma, or very ill patients.
2. Mid-levels mostly don't know real medicine but can at least determine if someone needs to be admitted or not. They pan order labs and imaging and give a reason for hospitalist to admit the patient. This is hoping that they have competent physicians and consultants who can figure out the pathology and manage complex issues. I don't see hospitals going the route of ED midlevel admitting to hospitalist midlevel who ****s up and send the patient to ICU under ICU midlevel.
Not saying this is not happening (currently I see this in my community site of a big name academic institution) but hospitals save more costs hiring midlevels for ED, ICU and anesthesia roles where the pay gap is higher.

Most hospitalist get 200-250k to see 14-18 patients. Most midlevels I have worked with round on 6-8 patients during the day and admitted 2-4 patients at night. They carry 50% of the workload of an average hospitalist for 50% pay. Unless midlevels carry liability and same census as MD/DO for 100k I don't see their use in general IM.

Bonus 3. There is always primary care backup.. but I know most of us have had bad experiences in residency that some IM grads would say they would be rather jobless than do PCP work. It is hard and less gratifying. I think even NP/PAs have figured out that primary care is a dump (and their fight to expand scopre) they are flocking to inpatient settings, ED, derm, psych, subspecialities for a better lifestyle and low stress.

Physicians also are way more productive, so the pay evens out much more

 

[chessknt]

ITT:

 

[bronx43]

Cannot compare hospitalist to EM because..

1. EM physician salary is about 3-5 times higher than NP/PA in ED. It makes sense to hire more midlevels to take on low acuity stuff and have 1-2 MD for real emergencies like cardiac arrest, trauma, or very ill patients.
2. Mid-levels mostly don't know real medicine but can at least determine if someone needs to be admitted or not. They pan order labs and imaging and give a reason for hospitalist to admit the patient. This is hoping that they have competent physicians and consultants who can figure out the pathology and manage complex issues. I don't see hospitals going the route of ED midlevel admitting to hospitalist midlevel who ****s up and send the patient to ICU under ICU midlevel.
Not saying this is not happening (currently I see this in my community site of a big name academic institution) but hospitals save more costs hiring midlevels for ED, ICU and anesthesia roles where the pay gap is higher.

Most hospitalist get 200-250k to see 14-18 patients. Most midlevels I have worked with round on 6-8 patients during the day and admitted 2-4 patients at night. They carry 50% of the workload of an average hospitalist for 50% pay. Unless midlevels carry liability and same census as MD/DO for 100k I don't see their use in general IM.

Bonus 3. There is always primary care backup.. but I know most of us have had bad experiences in residency that some IM grads would say they would be rather jobless than do PCP work. It is hard and less gratifying. I think even NP/PAs have figured out that primary care is a dump (and their fight to expand scopre) they are flocking to inpatient settings, ED, derm, psych, subspecialities for a better lifestyle and low stress.

Valid points, but I think where midlevels can really encroach upon hospital medicine is in the obs unit, or babysitting surgical patients. Those are low hanging fruit, which generates revenue and ease the census of hospitalists. Now, the hospitalists are burdened with only complex patients without commensurate increase in compensation.

 

[Trousseau]

Bonus 3. There is always primary care backup.. but I know most of us have had bad experiences in residency that some IM grads would say they would be rather jobless than do PCP work. It is hard and less gratifying. I think even NP/PAs have figured out that primary care is a dump (and their fight to expand scopre) they are flocking to inpatient settings, ED, derm, psych, subspecialities for a better lifestyle and low stress.

Yeah I had a fairly bad experience in continuity clinic...I've heard this is par for the course in IM residencies, though FP residencies take it more seriously than our PDs do. That said I got a good exposure to complex outpatient cases and wouldn't mind doing outpatient medicine as a career should I have to.

What about fellowships, I wonder. Not Cards or GI (which I'll never be competitive for), but the ones like Nephro, ID, Endo? I hated my Endo rotations but had a good time on Nephro and ID...

 

[Splenda88]

Exactly.

All the medical specialists at my institution are paid significantly less than what the PCPs get. The specialists all huff and puff, but admin brush us off like flies. When the PCPs want something... different conversation altogether.

Where is that?

 

[Splenda88]

I was able to find job where I ultimately want to end up, but the pay compared to where I am going now is huge. I am talking about 100k difference. I will do for a few years (3-5 years) and then try to open my own practice where I want to end up. That is the plan right now.

 

[Splenda88]

Why? The same reason why EM grads 3 years ago didn't tell these horror stories. They simply noticed that there were fewer job postings, and they weren't bombarded as much with recruiter emails. Then the floor fell out.

It's like that Hemingway novel. "How did you go bankrupt?" "Two ways. Gradually, then suddenly."

Lol. You are more gloomy than I am.

I guess I should dedicated my next 10 yrs to be FAT FI instead of FI

 

[bronx43]

Lol. You are more gloomy than I am.

I guess I should dedicated my next 10 yrs to be FAT FI instead of FI

What was it they said about recessions and depressions? A recession is when your neighbor loses his job. A depression is when you lose yours.

This is what we are witnessing here. For many, it's not that gloomy. Heck, I still have a job. I still make 6 figures, and can live an upper middle class lifestyle. So, maybe it's a mild recession for me, given my income isn't on the same trajectory that it could have been several years ago due to belt tightening by employers and increasing saturation of providers in the area.

For young EM docs and upcoming EM grads, it's looking more and more like a depression. I know for a fact that there is no EM job within 1 hour of my tier2/3 city. For someone who took out debt and endured 7 years of s***, it doesn't get much worse professionally.

The overarching trend that I see is one that is NOT in our favor. I certainly hope I'm wrong, but I think all of us need to be stacking that cash/btc/tsla/gold/whatever in preparation, because it's always prudent to hope for the best but plan for the worst.

 

[wamcp]

I think Internal Medicine is still somewhat safe. There will always be a need for adult physicians, especially in primary care.

The reason why EM got hit so hard, is b/c they demanded a lot of money (they were making $300/hr), so the system became more inclined to circumnavigate around them . . .and (quite frankly), their job isn't that hard (treating all the garden variety crap that comes in, can be easily done by a mid level). Grant it, those who work in Level 1s and do lots of procedures, they're worth their weight, but most EDs are not that, and even the Level 1s have a ton of garden variety crap that a midlevel could easily handle.

Historically, EM was never a specialty. Or another way of looking at it, there's 'emergency' medicine in every specialty. The ERs used to be staffed by general internits/surgeons/anes etc . . .everybody covered the ER for 1-2 weeks out of the year. It probably should've stayed that way. Now it looks like its reverting back.

To be honest though, demanding 300/hr to work EM seeing 2+ pt/hr is very reasonable. You need to pay me >500/hr to be an EM doc. There’s good reasons why we all chose IM over EM

 

[chessknt]

To be honest though, demanding 300/hr to work EM seeing 2+ pt/hr is very reasonable. You need to pay me >500/hr to be an EM doc. There’s good reasons why we all chose IM over EM

It isn’t though because the hospital can actively lose money under that model. Same goes for Anyone in the hospital that isn’t billing anywhere near their pay and is employed by the hospital—you are marked as a cost and will be reviewed by consultants who will recommend ways to get you to do more or get rid of you for as long as you remain in that column.

 

[Splenda88]

Lol

 

[tylerb1800]

Where is that?

It is not hard to find a good paying PCP job. I think people see the starting salary and think that is what they will make each year of their career. The take home pay really increases when you take into account productivity bonuses and value-based payments from the medicare advantage plans. I will easily make over 100k more than my base this year being out of residency now for more than 2 years. Many of the PCPs where I work are making more than the specialist with the exception of procedural specialist. Administration has incentive to keep the PCPs happy since every referral within the clinic keeps more money for the clinic plus the specialist have an almost guaranteed referral base without having to work for it.

 

[Prehealth1011]

It is not hard to find a good paying PCP job. I think people see the starting salary and think that is what they will make each year of their career. The take home pay really increases when you take into account productivity bonuses and value-based payments from the medicare advantage plans. I will easily make over 100k more than my base this year being out of residency now for more than 2 years. Many of the PCPs where I work are making more than the specialist with the exception of procedural specialist. Administration has incentive to keep the PCPs happy since every referral within the clinic keeps more money for the clinic plus the specialist have an almost guaranteed referral base without having to work for it.

Is your base in the low 200s?

 

[tylerb1800]

Base low 200s plus value-base payments and wRVU bonus. I am in clinic 4.5 days/week. Full control over my schedule. The IM PCPs in my group are all consistently taking home >300. Cannot speak to the FM PCPs in my practice. Our top earners are in the low 500s. The easiest way to make >450 is by becoming partner in a physician owned practice where you can take home part of the ancillary collections. There are still jobs out there like that. Unfortunately not in my small city though. I get emails from recruiters every week or two for physician-owned practices with job opportunities with partner track

 

[emergentmd]

In all jobs, you are a widget if you do not own the business rightfully so. Owners main goal is to make $$$ and if they can find a similar widget for less $$$ it would be fiduciary malpractice to not get the cheaper widget. Thus, if you are making 500K and I can hire 3 APC widgets for 300K, then that is 200K in the owner's pocket. If you are making 500K, and I can hire a new attending for 400K, then that is 100K in the owner's pocket.

All businesses should look for ways to increase profit and truthfully is the main reason they exist. I learned this when I was a widget. I was probably one of the most productive, least complaining widget but it is not hard to find a cheaper widget to accomplish the same job.

 

[Splenda88]

I wonder how much money one needs to open as small outpatient PC clinic. Is it > 200k to start?

 

[chessknt]

In all jobs, you are a widget if you do not own the business rightfully so. Owners main goal is to make $$$ and if they can find a similar widget for less $$$ it would be fiduciary malpractice to not get the cheaper widget. Thus, if you are making 500K and I can hire 3 APC widgets for 300K, then that is 200K in the owner's pocket. If you are making 500K, and I can hire a new attending for 400K, then that is 100K in the owner's pocket.

All businesses should look for ways to increase profit and truthfully is the main reason they exist. I learned this when I was a widget. I was probably one of the most productive, least complaining widget but it is not hard to find a cheaper widget to accomplish the same job.

This is an incredible argument for government run healthcare

 

[Redpancreas]

I wonder how much money one needs to open as small outpatient PC clinic. Is it > 200k to start?

It's probably more than that. If I wanted to start an IM Primary Care Private Practice this is what I am guessing I would pay them so that everyone's compensated fairly.

Yearly costs:
Rent Space + Utilities: 50K
Medical Equipment: 10K
2 Multipurpose RNs: 160K
Medical Secretary: 70K
Intake Specialist: 50K
2 Partners: 600K

 

[sloh]

It's probably more than that. If I wanted to start an IM Primary Care Private Practice this is what I am guessing I would pay them so that everyone's compensated fairly.

Yearly costs:
Rent Space + Utilities: 50K
Medical Equipment: 10K
2 Multipurpose RNs: 160K
Medical Secretary: 70K
Intake Specialist: 50K
2 Partners: 600K

What do you think your own gross income would be?

 

[Redpancreas]

What do you think your own gross income would be?

I would collect 50-100K for the first couple years. Then I suppose hopefully meet my partners salaries at 350K? Any additional profits after that I would add to my salary though. This is a complete guess. I guess if it fails what we don't earn comes out of my paycheck first which is the risk.

 

[Splenda88]

It's probably more than that. If I wanted to start an IM Primary Care Private Practice this is what I am guessing I would pay them so that everyone's compensated fairly.

Yearly costs:
Rent Space + Utilities: 50K
Medical Equipment: 10K
2 Multipurpose RNs: 160K
Medical Secretary: 70K
Intake Specialist: 50K
2 Partners: 600K

Will only use 1 RN (my spouse) and no partner for the first 1-2 yrs. Will not get a salary for a 1 yr. Therefore, I think it's doable with 250-300k.

 

[Redpancreas]

Will only use 1 RN (my spouse) and no partner for the first 1-2 yrs. Will not get a salary for a 1 yr. Therefore, I think it's doable with 250-300k.

OMG, you're gonna bring your wife into this! I guess that may work but if it doesn't then both of you are in this mess together.

 

[Redpancreas]

Will only use 1 RN (my spouse) and no partner for the first 1-2 yrs. Will not get a salary for a 1 yr. Therefore, I think it's doable with 250-300k.

I am interested in a subspecialty of IM but I won't be done for another 6 or so years. Is your practice going to be multidisciplinary and have openings for IM subspecialists?

 

[cards67]

I wonder how much money one needs to open as small outpatient PC clinic. Is it > 200k to start?

Maybe even less. Probably don't really need to hire anyone off the bat. Just some office space (or even just rent a single exam room), supplies and computer/emr to start.

 

[Redpancreas]

Maybe even less. Probably don't really need to hire anyone off the bat. Just some office space (or even just rent a single exam room), supplies and computer/emr to start.

Yeah I completely forgot about all that intellectual property!

 

[Splenda88]

I am interested in a subspecialty of IM but I won't be done for another 6 or so years. Is your practice going to be multidisciplinary and have openings for IM subspecialists?

If it's growing after 3 yrs, I will definitely add subspecialties.

 

[tylerb1800]

Will only use 1 RN (my spouse) and no partner for the first 1-2 yrs. Will not get a salary for a 1 yr. Therefore, I think it's doable with 250-300k.

What is hard with a solo practice is insurance negotiation for payment. You have no leverage as a solo practitioner to negotiate rates with the private and medicare advantage insurers. If you are serious about opening a solo practice, I would try to find out if there is a IPA in your area that you can join. This would allow for the best reimbursement. Even though I am employed by a big hospital system, I am still part of an IPA for medicare advantage reimbursement.

 

[Splenda88]

What is hard with a solo practice is insurance negotiation for payment. You have no leverage as a solo practitioner to negotiate rates with the private and medicare advantage insurers. If you are serious about opening a solo practice, I would try to find out if there is a IPA in your area that you can join. This would allow for the best reimbursement. Even though I am employed by a big hospital system, I am still part of an IPA for medicare advantage reimbursement.

What does IPA stand for?

 

[sunshinefl]

What does IPA stand for?

Independent Physician Associations (IPAs)

Read the AAFP's guiding principles for establishing independent physicians associations definition and the benefits to business.

www.aafp.org

 

[emergentmd]

This is an incredible argument for government run healthcare

Maybe and will continue to be so until healthcare is truly nonprofit. For profit has one goal and its to make $$$. Even the nonprofit hospitals are in it to make money and don't let them tell you otherwise.

Like every business, a few bad years and you can be out of business so for small groups they need to make profit, pay off debt, and be able to ride out the lean years. There are always lean years and the successful practices prepares by maximizing profit to weather it.