Not that far. You just have to be 45-60 min outside of a major metro. That’s the sweet spot for outpatient specialties. Farther out and you won’t have the population density. You want big enough of a market to draw from but one that’s far enough from major hospital systems that patients won’t want to drive (especially with gas prices).
Yes. Exactly. And preferably a locale where the payor mix is still good. One slight issue I’m noticing in semi rural Alabama is that a fair fraction of patients are on Medicaid and/or don’t even have the money to drive to a doctors appt. But 45 min out is about where it’s at. I’m about 45 min from 2 metros. Some of my best patients from a personality (and resources) standpoint are those who drive from the metros.
I mean yeah but on both sides the benefits of being a business owner are large and unlimited theoretically.
Obviously not talking about the subject matter, just more so comparing two clinic based specialties based on objective factors. PCPs probably see more patients but the visits can often be very easy, "DM doing well, htn doing well, refer to GI for colonoscopy" bill a 99214 and keep it pushing.
Are you even in med school yet? Do you have any clinical experience in medicine, oncology or GI...at all?
Support staff mostly. And the fact that patients have no interest in 6am or 10pm appointments for the most part. Oh...and the reality that this is not physically or emotionally sustainable in even the short term.
GI can make 1M without 120 hours a week. But if you haven’t even started fellowship yet then I wouldn’t go around assuming making that much money by the time you’re done. Things in healthcare (and the world) are changing rapidly. I would bet my entire net worth that healthcare will be entirely different within 5-10 years and what we discuss now will not apply.
Wrong.
To be honest, this sounds like a terrible “strategy”. Where I did residency, there was a hospitalist/GIM guy who apparently hated being a doctor and was trying to do this “FIRE” stuff as soon as possible-so he took every single spare moonlighting shift he could possibly sign up for, as well as working in an outpatient clinic. It wasn’t clear when he actually slept. Regardless, whether it was from apathy, sleep dep or actual mental illness stimulated from this insane strategy, he was a terrible clinician and his overall affect and mannerisms deteriorated dramatically during the time I was there to the point that the state PHP was called on him by his colleagues because they thought he may have had schizophrenia.
Scary thing is that some docs actually think this way out there. There was another hospitalist at my institution who worked something like 28 days out of each month because he had no family, apparently no hobbies or anything else to do in his life, and “didn’t know what else to do if he wasn’t at work”.
Do yourself and your potential future patients a favor and go to Wall Street.
That's so true. I've been lucky to be healthy so far to not need regular doctors visit but i'm nearing the age when some regular screening are recommended. If diagnosed with some serious illnesses,godforbid, I'd be more afraid to face jaded & 'FIRE 4 Life' doctors than the actual diagnosis.
If you don't want to face FIRE mindset doctors, then blame the government. They took away ownership and medical decision making from doctors and gave it on a silver platter to corporate entities, whose sole purpose is to make a profit. Most of us didn't go into medical school wanting FIRE, because that would be idiotic. Most of us see FIRE as a way out after observing the world around us, and the unfathomable decay of medicine year after year. If you get an actual serious illness, I would be more afraid of the cost-cutting hospital system in town or the deny-everything insurance company.
I'm afraid you stated the obvious. The ills of the medical industrial complex is very apparent to a premed college junior let alone to a practicing physician like myself.
You can still retire on time (FIR-on-time) with fair financial cushion without having to cut corners or wanting to work to the ground just to be able to retire early. The slow but steady wins the race. This also could help for burn-out.
I'm not oblivious to personal finance, retirement planning & saving. In fact, i intently follow multiple financial forums including the WCI forum where young and old high-net-worth physicians discuss various financial topics including retirement. To your surprise, the majority are often grateful for the profession and propelling them in nice financial path. And continue to practice despite having the nest egg to call it quits anytime.
I never said the FIRE mindset is working 120 hours a week. FIRE mindset is just that - trying to achieve FIRE. In fact, most people here are entirely against this approach, hence the response to said poster who proposed this. If you aren't oblivious to what is being stated here, then what you would know is that the vast majority of FIRE proponents are for being frugal and cutting costs in order to save up, as opposed to working themselves ragged or compromising patient care.
Need i explain more? Good luck with your FIRE aspiration.
Good luck with finding a young doc who doesn’t FIRE when/if you need medical care.
Could you please elaborate on why you say wrong?
But what is the MAXIMUM POSSIBLE to earn? How do I earn 75 million/year? WHICH FIELD? Is it possible to do a LHC and an endoscopy at the same time using one hand for each in the outpatient surgery center I own while prescribing chemo using telemedicine in the infusion center I own while only doing one fellowship? How much could I make if I did that?????!21
I'm not sure about chemo but I could probably send in Tamoxifen with my toes... you will just have to structure your schedule correctly!
Medicine (and the current bizarre state of the medical industrial complex) looks a lot different when you know you can walk away from it at any time. I agree that medicine is a really terrific thing to be able to practice, but I also see the (many) flaws in the current system. (Also keep in mind that many of these “big nest egg” doctors that are still working have already cut their hours back and/or slowed down their practice in other ways. Again, it all looks different when you’re working 2-3 days a week or something.) My solution to this has been to try to get that sense of “ownership” back by switching to private practice and thus being able to (as much as possible) try to practice things *my* way, on *my terms*, which I think is critically important to the happiness and wellness of any doctor nowadays.
I think her goal is pretty stupid, but what the hell - I’ll bite. If your goal is just to rack em, pack em, crack em and irresponsibly maximize your income by any possible means while practicing garbage quality medicine, then GI is probably the better choice. Hell, I’ve already encountered a number of GIs whose entire goal seems to be to shove scopes up butts and down throats to the sheer maximum extent possible, whether or not they forget every other cognitive aspect of their specialty in the process (I have had more than one of these GIs tell me something along the lines of “hepatology is that thing the NPs do while we go scope”.) If you truly don’t give a damn about what you’re doing aside from making enough $$$ to GTFO medicine at the earliest possible opportunity, at least you might do (slightly) less damage doing GI.
GI has become an embarrassment to medicine. Scope reimbursement is the poster child for what's wrong with health care reimbursement. Incentivizing highly trained cognitive clinicians (medicine specialists) to do only rote procedures that can realistically be done by a midlevel is just asinine on so many levels.
I've seen a new trend too where the Emtala gi resists coming in to egd actively bleeding cirrhotics outside of banker hours and instead trying to punt straight to a tips and avoid writing a consult note entirely. I feel like there must be some kind of research I am not aware of that espouses the better outcomes in Ugib when they don't undergo egd. I'm sure the fact that they are all uninsured or on government insurance has nothing to do with it of course.
Exactly!
And I think part of the “love” of scoping is the love of $$$. My understanding is that in the 1970s and 1980s (aka back before GI meant big bucks), it was not a highly desired specialty and was considered kind of gross - who wants to deal with poop all day? Then, of course, reimbursements went up and the specialty turned into the “prestigious” one that it is today.
Because there was no managed care!
www.city-journal.org
www.americanprogress.org
Oh, I know. And this is yet another reason why I’m utterly disgusted by the AMA and refuse to give it a single cent of my money.The reason it changed can be sourced back to a series of Harvard studies commissioned by Congress published in the 1980s that served as the (flawed) foundation of the RVU. It needed a lot of work by the time they used up all the funding money so it was up to the government to fix the shell of a system that Dr. Hsiao concocted. The republicans thought it was wrong for the government to dictate what doctors should get paid and surrendered that duty to the AMA which in turn invented the shady RUC although to be fair I think it was an easy political hot potato that nobody wanted to make it look like they were trying to cut funding to doctors.
You can really go down the rabbit hole if you want to understand how it got so messed up.
The Crux of Medicare Reform
Reformers have expended considerable effort to change the way Medicare buys health care for millions of Americans, finding a wide range of support across the political spectrum. But Medicare’s current structure may doom these reforms. Some primary-care doctors fear that the skewed incentives in...
What Every Physician Should Know About the RUC
A small group of physicians has a big say in what you get paid.www.aafp.org
Rethinking the RUC
For more than two decades, Medicare has relied far too heavily on recommendations submitted by the American Medical Association’s Relative Value Scale Update Committee.
The AMA makes more than half their annual take charging for CPT code updates that the RUC assigns values to that are essentially de-facto accepted by CMS. Their meetings are confidential and quite secretive and the voting process is never publicized so you dont get to see how bad the surgical fields are reaming the others. The RUC is heavily distorted to subspecialty care, having equal representation between ENT, a specialty with with under 10k active providers in the USA and pediatrics with >50k practicing providers (not counting FM). It is basically impossible to fix because the government created a system where there was a fixed amount for doctors to divide up and the surgical fields have huge voting power in the RUC over the cognitive fields. They would have to essentially vote themselves a pay cut to give a raise to the PCPs, fat chance of that ever happening.
Thank you this makes sense.
Because based on your posts you don't seem to care what kind of medicine you practice, you just want to make a bunch of money by whatever means.
The reason it changed can be sourced back to a series of Harvard studies commissioned by Congress published in the 1980s that served as the (flawed) foundation of the RVU. It needed a lot of work by the time they used up all the funding money so it was up to the government to fix the shell of a system that Dr. Hsiao concocted. The republicans thought it was wrong for the government to dictate what doctors should get paid and surrendered that duty to the AMA which in turn invented the shady RUC although to be fair I think it was an easy political hot potato that nobody wanted to make it look like they were trying to cut funding to doctors.
You can really go down the rabbit hole if you want to understand how it got so messed up.
The Crux of Medicare Reform
Reformers have expended considerable effort to change the way Medicare buys health care for millions of Americans, finding a wide range of support across the political spectrum. But Medicare’s current structure may doom these reforms. Some primary-care doctors fear that the skewed incentives in...
What Every Physician Should Know About the RUC
A small group of physicians has a big say in what you get paid.
Rethinking the RUC
For more than two decades, Medicare has relied far too heavily on recommendations submitted by the American Medical Association’s Relative Value Scale Update Committee.
The AMA makes more than half their annual take charging for CPT code updates that the RUC assigns values to that are essentially de-facto accepted by CMS. Their meetings are confidential and quite secretive and the voting process is never publicized so you dont get to see how bad the surgical fields are reaming the others. The RUC is heavily distorted to subspecialty care, having equal representation between ENT, a specialty with with under 10k active providers in the USA and pediatrics with >50k practicing providers (not counting FM). It is basically impossible to fix because the government created a system where there was a fixed amount for doctors to divide up and the surgical fields have huge voting power in the RUC over the cognitive fields. They would have to essentially vote themselves a pay cut to give a raise to the PCPs, fat chance of that ever happening.
The AMA
No we're not. I'm an FP (so not a subspecialist at all) and haven't "made my money" to any significant degree.
That's how lots of us FPs end up here. I enjoyed every single rotation 3rd year.
Maximizing income is fine - within the realm of practicing responsible, good medicine that helps patients and doesn’t hurt yourself. I promise you that running a clinic 110 hours a week doesn’t achieve either of these goals. You will be miserable, you will practice terrible medicine, and everyone from your patients to your colleagues to yourself will know it.
Ik a GI doc where I work that doesn't see patients in clinic. It's either the NP or a resident if he has one. He scopes then goes home 1-2, and I'm assuming he clears 500k easily. Practicing poorly/unethically, GI is a great lifestyle and money specialty.
My friend told me his group's GI does the same. No clinic. Scope only.
This is really horrible practice. his practice should be reported and suspended
