Are there certain procedures FM docs can become proficient in to increase billing?

[von Matterhorn]

I'm struggling a bit between gas and FM. Obviously not very related, but I enjoyed both of them and could see myself working in either position. I lean towards FM as it's always the kind of work I envisioned for myself, but I liked gas well enough and I'm starting to let the money aspect affect me more than I'd like.

I live in a relatively high COL area that my family is tied to, and with over 400k in student loans ahead of me, it's becoming hard to ignore the prospect of earning a substantial amount more in gas vs. FM. I've done a fair amount of research and jobs in my area seem to hover around 230-250k for FM, and gas seems to be more like 350-500k depending on PP or not.

My question is, is it feasible/practical for a FM doc to become proficient in things like various derm/endo/what have you techniques that allow for the doc to internalize some of these procedures rather than referring out? I would really like to earn ~350+ as that significantly bumps up the QOL potential for my family, but I don't want to work 80 hours a week to accomplish that. Thoughts?

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[cabinbuilder]

With that much student loan I would do anesthesia. You can make over 300K in FM but those folks work every day, never take vacation, and moonlight in ER/UC on the weekends. I work 2 jobs currently to try to approach the 300K mark.

 

[FrustratedFamDoc]

Second what CB said. As far as procedures go, cryo pays me the best for the time and training required to be proficient in it. Patients love not having to see a dermatologist for this relatively simple procedure. Some fam docs in my area do well on Synvisc injections. I do all the basic biopsies, injections, I&D, etc that other fam docs do, but there's not enough sustained volume for it to make a significant difference.

In FM, there is unfortunately no 'trick' to making $300k. It's just hard work. In the traditional model (which the majority of us do, unfortunately), you make more by moving more butts in and out of your office.

 

[FamilymedMD]

Learn some office procedures valued by patients and that you enjoy (office ortho including splinting or even casting, injections, derm procedures, laceration repair, cryo, gyn procedures, ultrasound, reading Holters/monitors, etc) and then join or start a Direct Primary Care practice.

Those procedures are highly valued by high deductible and cash patients because they pay a fortune out of pocket to get them from consultants and so that adds a lot of value to a monthly membership at your DPC.

Several DPC docs working together in a group can add xray, another thing that is usually horribly overpriced at the local hospital.

 

[FrustratedFamDoc]

Just went over my last year's financials and was again reminded how important payor mix is.

I actually saw about 40 fewer patients in Quarter 4 compared to Quarter 1 of last year but generated over 10K more in revenue, despite seeing fewer patients. Difference? My private insurance population has really grown over the last year and my average fee per pt increased a little over $10 with the better payor mix. I worked less hard and got more in return.

 

[WisNeuro]

I'm interested in this discussion secondhand. My wife is a FM MD who just finished residency and is starting a new job. First year is salary and then it shifts to productivity based. She's never really paid attention to reimbursement issues, so I was curious about that. Additionally, do you guys see the MACRA stuff impacting this in any meaningful way?

 

[VA Hopeful Dr]

I'm interested in this discussion secondhand. My wife is a FM MD who just finished residency and is starting a new job. First year is salary and then it shifts to productivity based. She's never really paid attention to reimbursement issues, so I was curious about that. Additionally, do you guys see the MACRA stuff impacting this in any meaningful way?

Procedures are a nice break from the routine and while they do pay well, most of us don't do enough of them to make a huge impact on money.

It all depends on how she's paid. If she's straight production then MACRA might be a part of her bonus structure. If its not, then no worries.

 

[Ericslv]

I'm struggling a bit between gas and FM. Obviously not very related, but I enjoyed both of them and could see myself working in either position. I lean towards FM as it's always the kind of work I envisioned for myself, but I liked gas well enough and I'm starting to let the money aspect affect me more than I'd like.

I live in a relatively high COL area that my family is tied to, and with over 400k in student loans ahead of me, it's becoming hard to ignore the prospect of earning a substantial amount more in gas vs. FM. I've done a fair amount of research and jobs in my area seem to hover around 230-250k for FM, and gas seems to be more like 350-500k depending on PP or not.

My question is, is it feasible/practical for a FM doc to become proficient in things like various derm/endo/what have you techniques that allow for the doc to internalize some of these procedures rather than referring out? I would really like to earn ~350+ as that significantly bumps up the QOL potential for my family, but I don't want to work 80 hours a week to accomplish that. Thoughts?

400K in debt. I would do Anesthesiology especially since you liked it. You will get out of debt and make 350 much easier. You will have more call and early hour work. But it pays and if you save right you can even retire earlier.

www.physicianonfire.com

FM docs can do many office procedures but the ones that pay well are usually cosmetic and require you to go into further debt to buy equipment, train and market yourself. Even then you can fail. So you will need to learn business skills.

You won't work 80 hrs a week and anesthesiology but you won't work a 9-5 either. To make 350K in FM you will be working hard.

 

[jm192]

Cryo is quick and simple.

Punch and shave biopsies.
Splinting.
Stitches.

 

[von Matterhorn]

I hate for money to determine what specialty I go into, but this thread has been very informative. Thanks all. If I could go back and time and choose the cheaper school, I would do just that.

 

[ddjamb]

I hate for money to determine what specialty I go into, but this thread has been very informative. Thanks all. If I could go back and time and choose the cheaper school, I would do just that.

not sure it is a wise idea...

 

[cabinbuilder]

If you are a DO and like OMT. That can add a significant amount of extra $$ to your bank.

 

[CountryMed]

If you are a DO and like OMT. That can add a significant amount of extra $$ to your bank.

OMM is one of most profitable procedures in primary care, due to low investment, low to moderate time, and good reimbursement .

 

[geauxg8rs]

I'm struggling a bit between gas and FM. Obviously not very related, but I enjoyed both of them and could see myself working in either position. I lean towards FM as it's always the kind of work I envisioned for myself, but I liked gas well enough and I'm starting to let the money aspect affect me more than I'd like.

I live in a relatively high COL area that my family is tied to, and with over 400k in student loans ahead of me, it's becoming hard to ignore the prospect of earning a substantial amount more in gas vs. FM. I've done a fair amount of research and jobs in my area seem to hover around 230-250k for FM, and gas seems to be more like 350-500k depending on PP or not.

My question is, is it feasible/practical for a FM doc to become proficient in things like various derm/endo/what have you techniques that allow for the doc to internalize some of these procedures rather than referring out? I would really like to earn ~350+ as that significantly bumps up the QOL potential for my family, but I don't want to work 80 hours a week to accomplish that. Thoughts?

Why not just do pain?
You can do clinic hours and do a mix of clinic time and procedures. Might be the compromise you are seeking.

I went into gas because I liked the immediate changes seen in the or. I also thought I disliked clinic. It turns out I disliked third year and intern year clinic. Once I did pain roatations in ca2 and 3 I was happier.

 

[pre med 2014]

If you are a DO and like OMT. That can add a significant amount of extra $$ to your bank.

pretty sure MDs have always been able to get OMT certified.

 

[cabinbuilder]

pretty sure MDs have always been able to get OMT certified.

this is true. I have a friend who is an MD and she when to Michigan to take the OMM course. She billed for some OMT as well.

 

[verren]

pretty sure MDs have always been able to get OMT certified.

I didn't know this! That's so exciting to me, I've always loved the idea of OMT for those chronic pain/MSK issues. Does it go through AAFP or a different organization?

 

[SpartanWolverine]

OMM is one of most profitable procedures in primary care, due to low investment, low to moderate time, and good reimbursement .

Please correct me if I'm wrong, but I thought that OMT visits were generally reimbursed pretty poorly for the time. Is it much different to do it as an procedure for an associated complaint (as opposed to a visit for the sole purpose of OMT?)?

 

[cabinbuilder]

Please correct me if I'm wrong, but I thought that OMT visits were generally reimbursed pretty poorly for the time. Is it much different to do it as an procedure for an associated complaint (as opposed to a visit for the sole purpose of OMT?)?

Depends on the technique. If you are proficient at HVLA, you can do the whole back in 5 minutes.

 

[Bacchus]

OMM is one of most profitable procedures in primary care, due to low investment, low to moderate time, and good reimbursement .

Meh. I could just as easily do a shave biopsy or knee injection and get paid more.