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Average salary for primary care outpatient (clinic)

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SGU1212

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Anyone have any suggestions about where to look to find average primary care clinic physician salaries? I realize the salaries vary vastly by location, experience, etc but I'm completely clueless when it comes to the current salary ranges.
 

ArcGurren

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Isn't this basically dependent on your patient volume/what you do in the clinic too?
 

Bostonredsox

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my continuity clinic attending told me its $10,000/annually per daily patient. so 10 patients per day is $100k. 15 is %150K. He said you need to see 15 to break even and close to 25 to have a good lifestyle.
 

DIce3

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Full-time internal medicine nearly everywhere starts usually 150 to 200K. Less in highly competitive markets and academia. After two or three years, private full-time internists make >200K and >350K for the highly motivated types.
 

mozdef

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Full-time internal medicine nearly everywhere starts usually 150 to 200K. Less in highly competitive markets and academia. After two or three years, private full-time internists make >200K and >350K for the highly motivated types.

What about for hospitalists?
 

Bostonredsox

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Southeast, full time. Closer you are to big. City NYC Boston, dc etc. the closer hospitalists are to 140-160k.
Community shops in less urban areas are almost all 200k+
 

VentdependenT

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Damn 140-200k for outpt 5d a week for a 9-5 gig? that aint bad. Here its a lot less.

For hospitalist I was offered 250k 7d on 7d off. 7a-7p. Nocturnist coverage at night.
 

Bostonredsox

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Damn 140-200k for outpt 5d a week for a 9-5 gig? that aint bad. Here its a lot less.

For hospitalist I was offered 250k 7d on 7d off. 7a-7p. Nocturnist coverage at night.

about the same that I was seeing. Less the closer you got to academia. The main differences were the expected CC responsibilities. I took the one I took because they will let me run the MICU until I can get to fellowship and then move on to bigger and better things.

Most outpt Im docs that are seeing atleast 20 pts/day are making over 175k for 5days/week 8-5 hours. But in that worls salary is dependent on group size and patient volume.
 

DCFamilyMed

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I make 400 seeing 23 patients a day with hours of 9-330pm. I have a high complexity CLIA COLA lab which helps with income.


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Bostonredsox

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I make 400 seeing 23 patients a day with hours of 9-330pm. I have a high complexity CLIA COLA lab which helps with income.


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23 patients in 6.5 hours is nearly 1 every 15 minutes. Assuming there are no new patients. With todays EMRs and checkboxes for smoking counseling and all the vaccinations and **** for meaningful use that sounds like a nightmare to me. I honestly dont feel like I can effectively see/eval/treat and discuss treatment goals in the way I want to for most patients and then document it all, in 15 minutes. I admit, I am slow in clinic. Just not my bag.
 

flipmd

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That's right. Not being a hater, but can't you see 15 patients a day and make 200K? And take better care of your patients too. I'm not being malicious, just wondering if it's possible. Is the 400K gross or net?
 

intcards

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That's right. Not being a hater, but can't you see 15 patients a day and make 200K? And take better care of your patients too. I'm not being malicious, just wondering if it's possible. Is the 400K gross or net?


So, you would rather see 8 less patients a day and make $200k less per year? 15 minutes per patient is pretty routine in practice.
 

flipmd

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So, you would rather see 8 less patients a day and make $200k less per year? 15 minutes per patient is pretty routine in practice.
I know it's routine.... but is it right? I know those 8 people are probably better off being seen for 15 minutes than not being able to get an appointment anywhere else for a lack of primary care docs. How about working from 8-6 with an hour break for lunch, and having more time for each patient, AND making 400K? Other people work more for less money. Again, I'm not digging on DCFM, just that the system seems broken. Either that or I'm just really not cut out for outpatient medicine.
 

michaelrack

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I know it's routine.... but is it right? I know those 8 people are probably better off being seen for 15 minutes than not being able to get an appointment anywhere else for a lack of primary care docs. How about working from 8-6 with an hour break for lunch, and having more time for each patient, AND making 400K? Other people work more for less money. Again, I'm not digging on DCFM, just that the system seems broken. Either that or I'm just really not cut out for outpatient medicine.

It is going to be very hard for you, personally, to make even 300 k seeing patients every 15 minutes from 8-6. It's not that easy to replicate what DCFM has done.
 

nope80

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what is a CLIA COLA lab?
 

VentdependenT

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That 400k dude is at least 2 standard deviations away from the mean.

10-15 min per patient is standard. Finish your charts at home. Welcome to medicine.
 

DIce3

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A take home W2 income of 400K is doable for a busy general internist. I personally am no longer interested in working this hard. I can say (looks around making sure I can not be identified) that 400K is very doable. How?

4 patients per hour.. 10 hours per day..48 weeks per year

ok so.. to really oversimplify.. 99214 is average charge ( weighing out 99213 and a 99204/5)...
(my practice is essentially sick geriatrics. Yes, plenty of 99211,212,213.. but a 212 takes less than 5 minutes, etc)

$100 gross/pt x 4 pts/hr x 10 hours/day x 5 days/wk x 48 wks/year = $960,000 gross
I can keep my practice overhead slightly under 50% usually
This does not account for any ancillary services.

OK, but... while this is doable.. for me, 40 patients in the office is torture and not worth it. So not worth the income...
 
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F0nzie

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$100 gross/pt x 4 pts/hr x 10 hours/day x 5 days/wk x 48 wks/year = $960,000 gross
I can keep my practice overhead slightly under 50% usually
This does not account for any ancillary services.

Are you assuming a collection rate of 100% and that every 15 minute slot will be filled 100% of the time?
 

DIce3

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To answer,

My experience has been a pretty high collection rate. Medicare/Tricare is 100% unless the secondary has a co pay or does not pay the annual deductible. There is a pretty small fall out as we collect up front if we know there is a secondary copay or annual deductible requirement. Of course, commercial insurance has more fall-out but again tend to get a high rate of collection on patients that return to the office. The missing collections are on the patients that come once and don't return.

One or two patients miss every day on my schedule but there are usually a good bit of work ins so that I tend to stay overbooked. This is a negative on my stress level not a plus because of increased income. I am chronically behind. I have cut way back on what I see just cause life is too short. The internists I work with tend to never have a free second in the office.

Solid American general internists can make more than one would ever need (we are talking private practice where you have control (1-3 docs) or substantial partnership controlling interest). There is no real salary range but rather, work harder and make more. Life is not worth working hard enough to take home 7 figures/yr as an internist (these exist and I know a few). This would not be true likely as a banker, with bankers hours. Overhead is relatively fixed so that the last patients seen in the day generate about 95% net revenue as opposed to the first 9 to 10 patients seen (who result in paying overhead).
 

Extracts

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A take home W2 income of 400K is doable for a busy general internist. I personally am no longer interested in working this hard. I can say (looks around making sure I can not be identified) that 400K is very doable. How?

4 patients per hour.. 10 hours per day..48 weeks per year

ok so.. to really oversimplify.. 99214 is average charge ( weighing out 99213 and a 99204/5)...
(my practice is essentially sick geriatrics. Yes, plenty of 99211,212,213.. but a 212 takes less than 5 minutes, etc)

$100 gross/pt x 4 pts/hr x 10 hours/day x 5 days/wk x 48 wks/year = $960,000 gross
I can keep my practice overhead slightly under 50% usually
This does not account for any ancillary services.

OK, but... while this is doable.. for me, 40 patients in the office is torture and not worth it. So not worth the income...
I know a similar busy outpatient internist who easily makes around 300-400k. Practice is established and doesn't accept medicare/Medicaid. Great EMR and set up. Notes are easily done. MAs take the HPI, he revises it as necessary and finishes the A&P. No weekends. He usually see's 30 patients a day. Probably works around 40-50 hours a week.

The practice made more money last year due to new pay for performance measures (things you should be doing anyway as a physician). Also some insurances now pay $2 per patient per month and he has a panel of 2000-3000.
 

MrSunny1

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Are you assuming a collection rate of 100% and that every 15 minute slot will be filled 100% of the time?

Must be in dream land I saw my grandmothers medicare payments they were at 42% and medicaid is farrrr less. I've never even heard of 100% pay unless you are requesting cash only but I doubt anyone would have 40pts a day every single slot filled with cash pay customers. Its also getting to be more frowned upon to refuse medicaid/medicare I mean what kind of sick person would refuse to help people?
 

Silent Cool

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Right, so, can anyone chime in with REAL #s for a realistic out. pt. primary care gig?

thanxIA
 

infarct

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Must be in dream land I saw my grandmothers medicare payments they were at 42% and medicaid is farrrr less. I've never even heard of 100% pay unless you are requesting cash only but I doubt anyone would have 40pts a day every single slot filled with cash pay customers. Its also getting to be more frowned upon to refuse medicaid/medicare I mean what kind of sick person would refuse to help people?

in the real world...a lot of people.
 

wAyRadikull

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Buddy of mine got a pretty decent gig with 6 outpatient physicians who also round on their own patients in the hospital during the weekday. Community hospital with resident coverage. 180 to start until you build a patient base. Most partners (3-5 years in practice) are making 250-300. Call is Q6 during the weekdays and every 6th weekend call where you round on the inpatients and roll out. Otherwise hours are 9-5 primarily. This is on the east coast.
 

nope80

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bump. any other thoughts?
 

Socrates25

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Right, so, can anyone chime in with REAL #s for a realistic out. pt. primary care gig?

thanxIA

OK so I'm peds and cant comment directly on IM billing but I think the numbers posted above are doable, even for peds, IF you set up in the right part of town.

$100 per patient seems low to me. Peds is the lowest paying/reimbursement of all specialties and I still make quite a bit more than $100 average. Last month my average billing was somewhere around $180 per patient. It varies from month to month, ranging from $140 to over $200. The average number of patients per day varies quite a bit in pediatrics because there is a ton of seasonal variation. In winter I push 30+ per day, some days in the summer there are only 14-15 patients.

If you take Medicare/Medicaid then you wont see anywhere near these levels of reimbursement, because your practice will fill up so fast with M&M that you wont be able to fit in private insurance patients unless you have a strict quota on how many M&M patients you accept.

If you set up shop in a good area with no M&M you'll tend to get pretty good private insurance reimbursement rates which should make higher incomes (300+) possible, although it is quite a bit of work.
 
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circulus vitios

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Is there an analogue to private practice groups for inpatient services? Would that just be like...a physician group that is contracted by local hospitals? Do these exist and is it possible to make good money -- more than one could make as a hospital employee -- by being a part of, or starting, an inpatient group?
 

nope80

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OK so I'm peds and cant comment directly on IM billing but I think the numbers posted above are doable, even for peds, IF you set up in the right part of town.

$100 per patient seems low to me. Peds is the lowest paying/reimbursement of all specialties and I still make quite a bit more than $100 average. Last month my average billing was somewhere around $180 per patient. It varies from month to month, ranging from $140 to over $200. The average number of patients per day varies quite a bit in pediatrics because there is a ton of seasonal variation. In winter I push 30+ per day, some days in the summer there are only 14-15 patients.

If you take Medicare/Medicaid then you wont see anywhere near these levels of reimbursement, because your practice will fill up so fast with M&M that you wont be able to fit in private insurance patients unless you have a strict quota on how many M&M patients you accept.

If you set up shop in a good area with no M&M you'll tend to get pretty good private insurance reimbursement rates which should make higher incomes (300+) possible, although it is quite a bit of work.


If you calculate this out, based on these numbers, primary care providers should be able to make a nice salary. I wonder why this never pans out or at least you never hear of it...
 

Textbookversion

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If you calculate this out, based on these numbers, primary care providers should be able to make a nice salary. I wonder why this never pans out or at least you never hear of it...

The same reason you don't hear about all the other business savvy specialists pulling 2-3 million. They are smart enough not to broadcast it.

Reality is no one in medicine has to take low pay. But it takes some initiative and luck to make the big bucks.

The people who are really cleaning up in GIM are those that are running the $50/mo/pt type pseudo-concierge practice. Hire a couple other internists to work for you, run with a pt panel of 1k each = $$$$ and you don't have to do the 15 minutes/pt wankery that sounds miserable to me.

But again it makes NO SENSE to broadcast this IRL. Plead poverty, hire some other suckers @ 175k and stash all the profits for yourself.
 
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nope80

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How easy is it to recruit patients in this new model, as mentioned above? Also how long does it take to build up panel of patients, lets say 1000? In this model, pts can make appts/same day appts etc whenever they want?
 

flipmd

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How easy is it to recruit patients in this new model, as mentioned above? Also how long does it take to build up panel of patients, lets say 1000? In this model, pts can make appts/same day appts etc whenever they want?

And there is the rub. Just because it's possible, doesn't mean it's easy or prevalent. How does one even begin to start a concierge practice. The only way I can think of is if you start off traditional with your own practice and slowly build up a patient base and gradually shift to concierge.

In NYC, I have an aunt who does concierge Peds. She works for a company though where she gets her "referrals" / "calls" (not sure if employee or independent contractor), and makes much less than the quotes here.
 

Silent Cool

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And there is the rub. Just because it's possible, doesn't mean it's easy or prevalent. How does one even begin to start a concierge practice. The only way I can think of is if you start off traditional with your own practice and slowly build up a patient base and gradually shift to concierge.

In NYC, I have an aunt who does concierge Peds. She works for a company though where she gets her "referrals" / "calls" (not sure if employee or independent contractor), and makes much less than the quotes here.

+1. Would someone comment on this?
 

xenotype

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And there is the rub. Just because it's possible, doesn't mean it's easy or prevalent. How does one even begin to start a concierge practice. The only way I can think of is if you start off traditional with your own practice and slowly build up a patient base and gradually shift to concierge.

In NYC, I have an aunt who does concierge Peds. She works for a company though where she gets her "referrals" / "calls" (not sure if employee or independent contractor), and makes much less than the quotes here.

1) Work urgent care/hospitalist/ED shifts (if rural) for income while building panel
2) Advertise intelligently and keep practice overhead extremely low
3) Profit

Protip: Don't let some national company skim off of your profit. They usually only bet on practices they think will fill quickly anyways.

Concierge is going to be huge in the future. 40-50% of primary care gross revenue today in the traditional practice goes just to bill insurance. That is ridiculously inefficient and begs for competition. Most patients will pay for better care if they can afford it, and a lot of people are going to be stuck with NPs.
 
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michaelrack

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. 40-50% of primary care gross revenue today in the traditional practice goes just to bill insurance. That is ridiculously inefficient and begs for competition. .

While many primary care practices have total overhead of that amount, it isn't all for billing insurance. Even a cash pay/concierge practice is going to have an overhead of at least 20% (probably a little more). You still need someone to check patients in, etc. Also don't forget rent for the office.
 

xenotype

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While many primary care practices have total overhead of that amount, it isn't all for billing insurance. Even a cash pay/concierge practice is going to have an overhead of at least 20% (probably a little more). You still need someone to check patients in, etc. Also don't forget rent for the office.

Overhead of 20-35% is perfectly reasonable for concierge. I said 40-50% of gross revenue is billing insurance, but there is still that 20-35% on top of that in a traditional practice too (rent, medical assistant, utilities, supplies). So a traditional practice may collect $800,000 in gross revenue per physician, but take home and benefits are only $250,000 or so. That makes a true overhead of around 70%. The vast majority of that is billing insurance. The traditional system isn't going to be able to compete with the direct/concierge wave that is coming because it is just more expensive for crappy service.
 

nope80

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So how much is one realistically billing per patient and how much reimbursement are they getting back from insurance per patient?
 

xenotype

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My guess would be a little over 100$ a visit on average with 30 patients a day. Only about 30$ of that will be profit. A low collection rate will quickly eat into the profits, while taking private insurance patients only with good negotiated rates in a large group practice will of course raise that number. The patient gets screwed because in the end they pay all of that 100$ and then some through copays, premiums, and taxes.
 

nope80

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My guess would be a little over 100$ a visit on average with 30 patients a day. Only about 30$ of that will be profit. A low collection rate will quickly eat into the profits, while taking private insurance patients only with good negotiated rates in a large group practice will of course raise that number. The patient gets screwed because in the end they pay all of that 100$ and then some through copays, premiums, and taxes.

Is it against any insurance rules to charge an up front fee to patients coming for a visit (an administrative fee for example) and then bill for actual services separately? I see that some doctors are starting to charge a monthly fee to belong to their practice - im assuming this fee is just to belong to the practice and then every time they come the insurance is charged. Thats a little different than what I was suggesting - creating a per visit copay to cover all the enormous business overhead.

Also, how hard is it to go into private practice right out of residency, with lets say another partner, from a financial perspective?
 

xenotype

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Is it against any insurance rules to charge an up front fee to patients coming for a visit (an administrative fee for example) and then bill for actual services separately? I see that some doctors are starting to charge a monthly fee to belong to their practice - im assuming this fee is just to belong to the practice and then every time they come the insurance is charged. Thats a little different than what I was suggesting - creating a per visit copay to cover all the enormous business overhead.

Also, how hard is it to go into private practice right out of residency, with lets say another partner, from a financial perspective?

Such a fee would be classified as a copay, which would be absolutely not allowed if you accept medicare and your insurance contracts would almost certainly disallow it as well. Monthly fees however are perfectly allowed, though you must provide a service like 24 hour cell/email access for them. I don't think most patients will like this because they are essentially being charged twice. You can get away with it in a wealthy area provided people really like you. The better way to do it is to charge a monthly fee and not take any insurance, eliminating the overhead for billing and giving patients more value.

As for right out of residency, I think the best idea is to do shift work at urgent care/hospitalist/ED while you build the practice. Those are fairly lucrative, in high demand, and should work great for an income for 2-3 years while you fill a panel. Because it is shift work, you can take fewer shifts as you get more patients in your practice. Small business loans would take care of initial overhead and advertising, and you could write off a lot of your expenses as business related to lower your taxes.
 

nope80

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Such a fee would be classified as a copay, which would be absolutely not allowed if you accept medicare and your insurance contracts would almost certainly disallow it as well. Monthly fees however are perfectly allowed, though you must provide a service like 24 hour cell/email access for them. I don't think most patients will like this because they are essentially being charged twice. You can get away with it in a wealthy area provided people really like you. The better way to do it is to charge a monthly fee and not take any insurance, eliminating the overhead for billing and giving patients more value.

As for right out of residency, I think the best idea is to do shift work at urgent care/hospitalist/ED while you build the practice. Those are fairly lucrative, in high demand, and should work great for an income for 2-3 years while you fill a panel. Because it is shift work, you can take fewer shifts as you get more patients in your practice. Small business loans would take care of initial overhead and advertising, and you could write off a lot of your expenses as business related to lower your taxes.

So if you have a monthly charge to have access to email, easy appointments, etc. how do you bill for the actual appointment? just through the regular insurance?

If you don't accept any insurance, you could then charge a copay but then it would be more like a paying for your entire visit, not just a copay.

It doesn't seem entirely fair that you can't charge a copay while billing insurance. those two things should not be contradictory given the large overhead doctors face.

In terms of doing shift work, I'm assuming this would also help in recruiting patients.
 

xenotype

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So if you have a monthly charge to have access to email, easy appointments, etc. how do you bill for the actual appointment? just through the regular insurance?

If you don't accept any insurance, you could then charge a copay but then it would be more like a paying for your entire visit, not just a copay.

It doesn't seem entirely fair that you can't charge a copay while billing insurance. those two things should not be contradictory given the large overhead doctors face.

In terms of doing shift work, I'm assuming this would also help in recruiting patients.

Charge a high enough monthly fee that you don't need to bill for every visit, allow unlimited visits. The monthly fee should ideally be all inclusive for services you provide. Some math for you: 80$ pp/pm X 12m X 500p = $480k/yr gross. Take off $150k for office/MA/taxes, $50k bennies for you = $280k take home. You'd probably work no more than 35-40 hr/wk with that many patients. Have a partner for vaca time. Everyone should be doing this. $350k for cards or critical care at 60hr/wk or 40hr/wk direct primary care. Have to be crazy not to take this deal. I'm probably actually going to do fam med so I can offer family plans to fill the panel faster and offer office procedures that IM residencies usually don't teach you how to do, but there is no reason you can't get in on the ground floor in this with a good IM residency.
 

bronx43

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Charge a high enough monthly fee that you don't need to bill for every visit, allow unlimited visits. The monthly fee should ideally be all inclusive for services you provide. Some math for you: 80$ pp/pm X 12m X 500p = $480k/yr gross. Take off $150k for office/MA/taxes, $50k bennies for you = $280k take home. You'd probably work no more than 35-40 hr/wk with that many patients. Have a partner for vaca time. Everyone should be doing this. $350k for cards or critical care at 60hr/wk or 40hr/wk direct primary care. Have to be crazy not to take this deal. I'm probably actually going to do fam med so I can offer family plans to fill the panel faster and offer office procedures that IM residencies usually don't teach you how to do, but there is no reason you can't get in on the ground floor in this with a good IM residency.

What does 50k bennies for you mean in the context of 280k take home?

Good plan, though. You should look at mostly unopposed FM programs. Large university programs are complete crap for FM due to the fact that you'll be treated like the redheaded stepchild.
 

xenotype

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What does 50k bennies for you mean in the context of 280k take home?

Good plan, though. You should look at mostly unopposed FM programs. Large university programs are complete crap for FM due to the fact that you'll be treated like the redheaded stepchild.

The same benefits you would get in an employed position, namely health insurance, malpractice, max 401k contrib, other things that aren't part of take home pay. And yes I think unopposed is the best way to go, but there are FM programs that have their own services in a lot of places that manage to create an unopposed-like experience. I am still considering IM but I don't think the outpatient training is good enough to offer the most value for the $. Things like joint injections and managing derm problems suddenly become very important when patients have high deductible plans and want as much care in that monthly fee as possible without getting hit with a 200$+ bill for a referral. I think it'll make primary care more complex and less dumbed down than it is today since referrals will never be done just out of convenience.
 
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