Best ways to make money outside of high paying specialties?

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What are some of the best ways to make money in medicine besides matching into the higher paying specialties? I'm guessing mostly private practice, cash-only type of gigs? I've heard psych docs can kill it doing that. FPs that do concierge or specialize in ADD tx? Medical marijuana? Just curious 😉
 
Poit said:
What are some of the best ways to make money in medicine besides matching into the higher paying specialties? I'm guessing mostly private practice, cash-only type of gigs? I've heard psych docs can kill it doing that. FPs that do concierge or specialize in ADD tx? Medical marijuana? Just curious 😉
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Concierge and cash only practices can make bank. So can direct primary care. Have heard FMs doing DPC who make around 400k. Going into aesthetics (botox, coolsculpting, other weight loss programs) can also bring in bank. People will pay to look pretty and make themselves feel better about their how their bodies look. Building a practice and employing other docs or NPs under you is another way. One of my psych attendings basically built up a psych hospital from an 8 bed clinic to ~60 beds. He has a contract with the state and a major med school's medical system and employs 3 psychiatrists under him to run the hospital, then he does his actual work as a psych consult at a hospital and contracts out with nursing homes and sees their residents once a month. Pretty sure he's pulling in 7 figures annually after talking to one of the psychiatrists he employs.

Other than that guy, you can make a ton if you're willing to be "morally flexible" with snake-oil treatments or just throw morals out the window altogether...
 
Poit said:
What are some of the best ways to make money in medicine besides matching into the higher paying specialties? I'm guessing mostly private practice, cash-only type of gigs? I've heard psych docs can kill it doing that. FPs that do concierge or specialize in ADD tx? Medical marijuana? Just curious 😉
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Its hard to give specific advice without at least knowing what profession you do go into. A few general rules though:

1) Rural is > urban. The weirdest thing about medicine is that your salary goes up, a lot, where the cost of living is lowest. For example a Pediatrician can usually make 300K/year (without employing anyone) covering nursery call and seeing clinic in a small town in flyover country, 210K/year for seeing clinic in a midsized city, and 120K/year for seeing clinic in the DC metro area.

2) Ownership > private practice employment > academic medicine. If you care about money either found a practice or join a partnership track.

3) This profession pays too well to play around at the edges of legality/morality. Don't take kickbacks. Don't do concierge. Don't sell weed or methadone or run a pain pill mill. Bill as much as you legally can but not more.
 
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Prison medicine


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Stagg737 said:
Concierge and cash only practices can make bank. So can direct primary care. Have heard FMs doing DPC who make around 400k. Going into aesthetics (botox, coolsculpting, other weight loss programs) can also bring in bank. People will pay to look pretty and make themselves feel better about their how their bodies look. Building a practice and employing other docs or NPs under you is another way. One of my psych attendings basically built up a psych hospital from an 8 bed clinic to ~60 beds. He has a contract with the state and a major med school's medical system and employs 3 psychiatrists under him to run the hospital, then he does his actual work as a psych consult at a hospital and contracts out with nursing homes and sees their residents once a month. Pretty sure he's pulling in 7 figures annually after talking to one of the psychiatrists he employs.

Other than that guy, you can make a ton if you're willing to be "morally flexible" with snake-oil treatments or just throw morals out the window altogether...
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This sounds shady as hell.
 
Poit said:
What are some of the best ways to make money in medicine besides matching into the higher paying specialties? I'm guessing mostly private practice, cash-only type of gigs? I've heard psych docs can kill it doing that. FPs that do concierge or specialize in ADD tx? Medical marijuana? Just curious 😉
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Do what this guy (HMS graduate) did:
Michael Crichton - Wikipedia
MichaelCrichton_2.jpg
 
Perrotfish said:
3) This profession pays too well to play around at the edges of legality/morality. Don't take kickbacks. Don't do concierge. Don't sell weed or methadone or run a pain pill mill. Bill as much as you legally can but not more.
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What's wrong with concierge medicine?


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Is there a reason why cash specialties/clinics make more money?
 
SunsFun said:
What's wrong with concierge medicine?


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Here's a simple explanation: Concierge medicine is where patients pay a "fixed" amount each year to see their doctor. In return, they often have access to their physician almost 24/7. The catch is that things that cost the doctor money (due to use of supplies, equipment, etc) are usually excluded from what's covered in the annual fee and patients have to pay for these charges separately.

Not everyone thinks concierge medicine is bad, just depends where your beliefs lie. I am against it and find it goes against my personal ethical code. One of the main arguments against it is the idea that conceriege medicine limits access to care for the poor and only makes it accessible to those at the top.

In my experience engaging in dialogue about this topic with faculty and peers, the conversation usually boils down to whether or not you believe health care is a right.
 
NEApplicant said:
Is there a reason why cash specialties/clinics make more money?
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Many, many reasons but here a few:
  • With cash specialties, you get the money right away instead of having to chase down insurance companies.
  • You don't have to deal with insurance companies who will often try to undercompensate you.
  • People who can pay cash may be more wealthy and can thus afford your services.
  • Getting money in a timely manner increases your cash flow and allows your practice to grow much quicker.
  • And a small little thing called tax evasion when a patient literally hands you a $100 bill for their child's well-child visit that goes straight into your pocket.
 
AcademicNeurosurgery said:
Here's a simple explanation: Concierge medicine is where patients pay a "fixed" amount each year to see their doctor. In return, they often have access to their physician almost 24/7. The catch is that things that cost the doctor money (due to use of supplies, equipment, etc) are usually excluded from what's covered in the annual fee and patients have to pay for these charges separately.

Not everyone thinks concierge medicine is bad, just depends where your beliefs lie. I am against it and find it goes against my personal ethical code. One of the main arguments against it is the idea that conceriege medicine limits access to care for the poor and only makes it accessible to those at the top.

In my experience engaging in dialogue about this topic with faculty and peers, the conversation usually boils down to whether or not you believe health care is a right.
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My approach is more practical as I actually worked with a family doc in my 3rd year who practiced it. He was able to spend more time and provide better more comprehensive care, IMO, to his other patients because concierge fees covered more of his overhead.

Whether or not you believe healthcare is a right doesn't justify putting concierge medicine in the same paragraph with blatantly illegal and unethical practices.


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SunsFun said:
What's wrong with concierge medicine?


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Click to expand...

Though there isn't a fixed/official definition of the term, 'Concierge' medicine usually refers to the practice of operating an extremely high priced, cash only practice for a very small number of clients, usually 25-50 total patients on your census. They pay a fixed, extremely high amount of money per year to have 24/7 access to a personal physician.

Its basically impossible to practice concierge medicine ethically. When people pay an extremely high amount for a personal physician they expect you to cater to their wants, not their needs. Think about Michael Jackson's doctor prescribing Propofol as a sleep aid for an extreme example. The ones I have seen were miles away from practicing evidence based medicine. When you have 25 high paying clients you don't give them lectures about diet and exercise, you give them whatever pills that they want and whatever diagnoses their lawyers deem that they need. Not that a concierge doctor would recognize a serious problem if he saw it, of course. Attendings still need to see a lot of patients or their skills rapidly degrade, and concierge doctor see the equivalent of less than 1/2 day of clinic per week.

This is contrast to 'direct primary care', or DPC. Again, there isn't a fixed/official definition of the term, but DPC usually refers to a more moderately priced, cash only practice for a census of 400-800 patients. Again, they pay a fixed, annual sum for access to your clinic and you agree to be their physician, but they're paying you significantly less (usually about as much as they pay for a cell phone bill) and you need each individual client much less. DPC usually involves longer than average appointments (30-40 minutes) and the patients have some after hours and weekend access to their physicians, but its overall a normal physician patient relationship where they come to your office, you give sound advice and indicated medications, and if the patient begins to make wildly unreasonable demands they part ways with the practice.
 
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Perrotfish said:
Though there isn't a fixed/official definition of the term, 'Concierge' medicine usually refers to the practice of operating an extremely high priced, cash only practice for a very small number of clients, usually 25-50 total patients on your census. They pay a fixed, extremely high amount of money per year to have 24/7 access to a personal physician.

Its basically impossible to practice concierge medicine ethically. When people pay an extremely high amount for a personal physician they expect you to cater to their wants, not their needs. Think about Michael Jackson's doctor prescribing Propofol as a sleep aid for an extreme example. The ones I have seen were miles away from practicing evidence based medicine. When you have 25 high paying clients you don't give them lectures about diet and exercise, you give them whatever pills that they want and whatever diagnoses their lawyers deem that they need. Not that a concierge doctor would recognize a serious problem if he saw it, of course. Attendings still need to see a lot of patients or their skills rapidly degrade, and concierge doctor see the equivalent of less than 1/2 day of clinic per week.

This is contrast to 'direct primary care', or DPC. Again, there isn't a fixed/official definition of the term, but DPC usually refers to a more moderately priced, cash only practice for a census of 400-800 patients. Again, they pay a fixed, annual sum for access to your clinic and you agree to be their physician, but they're paying you significantly less (usually about as much as they pay for a cell phone bill) and you need each individual client much less. DPC usually involves longer than average appointments (30-40 minutes) and the patients have some after hours and weekend access to their physicians, but its overall a normal physician patient relationship where they come to your office, you give sound advice and indicated medications, and if the patient begins to make wildly unreasonable demands they part ways with the practice.
Click to expand...

The concierge physician I worked with ran a completely different practice from what you've described in your second paragraph.

I am not entirely sure how much personal exposure you have to concierge medicine and will not get into discussion absorb who is right, but I am sure you can acknowledge that your definition of concierge medicine hinges on a long list of additional assumptions that make it sound unethical.


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AcademicNeurosurgery said:
Here's a simple explanation: Concierge medicine is where patients pay a "fixed" amount each year to see their doctor. In return, they often have access to their physician almost 24/7. The catch is that things that cost the doctor money (due to use of supplies, equipment, etc) are usually excluded from what's covered in the annual fee and patients have to pay for these charges separately.

Not everyone thinks concierge medicine is bad, just depends where your beliefs lie. I am against it and find it goes against my personal ethical code. One of the main arguments against it is the idea that conceriege medicine limits access to care for the poor and only makes it accessible to those at the top.

In my experience engaging in dialogue about this topic with faculty and peers, the conversation usually boils down to whether or not you believe health care is a right.
Click to expand...
Lol this has nothing to do with whether you believe healthcare is a right. Just bc you're personally catering to the people who are willing to shell out big money for extra attention doesnt mean you don't believe everyone should have access to healthcare. If for some reason you advocated that all docs only do concierge style medicine, then you may have a problem.
 
flapjack3d said:
Lol this has nothing to do with whether you believe healthcare is a right. Just bc you're personally catering to the people who are willing to shell out big money for extra attention doesnt mean you don't believe everyone should have access to healthcare. If for some reason you advocated that all docs only do concierge style medicine, then you may have a problem.
Click to expand...

You just contradicted yourself...it has everything to do with whether you believe health care is a right. If everyone practiced concierge medicine, as you mentioned in your last line, then health care would no longer be a right and would only be something for people who can afford it.

Since not everyone practices concierge medicine, it's not a problem. The fact that you recognize it would be a problem if everyone did it shows that it is an unethical practice.
 
AcademicNeurosurgery said:
You just contradicted yourself...it has everything to do with whether you believe health care is a right. If everyone practiced concierge medicine, as you mentioned in your last line, then health care would no longer be a right and would only be something for people who can afford it.

Since not everyone practices concierge medicine, it's not a problem. The fact that you recognize it would be a problem if everyone did it shows that it is an unethical practice.
Click to expand...
But yeah not everyone does it, and no one is advocating that, and there is no way that concierge medicine will ever come close to causing some kind of physician shortage all on it's own lol
 
Mad Jack said:
It's really not all that shady, there used to be plenty of private psych hospitals that were established in the Northeast. If he's older, he's probably one of those guys. These days, it's not so easy though.
Click to expand...

He's probably early to mid-50's. Been practicing psych for 20+ years, been running the hospital for 16. Took over as the only psychiatrist there when it was basically an overflow unit for the state mental institution. Built it up over 10 years to be 50+ beds and hired on a bunch of psychiatrists. The got contracted to be a part of the large, "prestigious" (in this area) academic hospital. Now basically does consults in the morning at another hospital and sees nursing home patients a couple days/month while checking in and overseeing "his" hospital in the afternoon.

He puts in a lot of hours each week, but the guy also makes more than almost any other doctor I've met other than one ortho who almost exclusively did IME's for insurance companies.
 
flapjack3d said:
But yeah not everyone does it, and no one is advocating that, and there is no way that concierge medicine will ever come close to causing some kind of physician shortage all on it's own lol
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Just because something is not prevalent does not mean it is ethical. For example, consider this: it is unethical to lie on a job application in order to get a job. If everyone lied on their applications there would be no point in having applications in the first place. However, not everyone is lying on their job application so it doesn't really have a large impact. Nevertheless, it is still unethical for an individual to lie on their job application. If your moral compass is reliant on you being an "exception", it is illogical and by extension unethical.
 
flapjack3d said:
But yeah not everyone does it, and no one is advocating that, and there is no way that concierge medicine will ever come close to causing some kind of physician shortage all on it's own lol
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I agree. The point though is that you can't say it's unethical for everyone to do it but okay if only a few do it. That's like saying it's okay if only a few people steal from a store but not okay if everyone steals.
 
AcademicNeurosurgery said:
In my experience engaging in dialogue about this topic with faculty and peers, the conversation usually boils down to whether or not you believe health care is a right.
Click to expand...
Lol. "Unethical". It is nowhere near unethical for a person who spent 12+ years getting an education to see however few patients they desire, and for whatever cost they so please. If you do concierge medicine you can also do charity care for free here and there. Not everyone wants to be part of the corrupt ultra-consolidated government-hospital complex where the physician burn-out rate is >50%.
 
Just open up a pain practice in a rich area. Cash in on all the wealthy soccer moms with back pain and kids named Aiden.

-Live a resident lifestyle to cut costs and pay down loans quicker

-Invest what profits you can

If you have a morally casual attitude:

-offer "holistic" pain treatments at your practice like accupuncture, dry needling, cupping, etc... charged at a premium, cash only. (white moms love 'authentic' cultural healing)

Is it evidence based? No.

Will patients ask/pay for it? Yep.

You can reconcile this by telling yourself "at least they are coming to me, a medical doctor, for these services. Instead of some quack chiropractor"
 
flapjack3d said:
What's with all the strawmen? Being a doctor for rich people is not equivalent to stealing from a store or lying on a job application.
Click to expand...

No it's not, but the examples convey the point. It is a contradictory argument to say it's ethical to do something at an individual level but not universally.
 
AcademicNeurosurgery said:
You just contradicted yourself...it has everything to do with whether you believe health care is a right. If everyone practiced concierge medicine, as you mentioned in your last line, then health care would no longer be a right and would only be something for people who can afford it.

Since not everyone practices concierge medicine, it's not a problem. The fact that you recognize it would be a problem if everyone did it shows that it is an unethical practice.
Click to expand...

So are expensive chefs unethical? If everyone was an expensive chef then poor people could not get food!
 
AcademicNeurosurgery said:
You just contradicted yourself...it has everything to do with whether you believe health care is a right. If everyone practiced concierge medicine, as you mentioned in your last line, then health care would no longer be a right and would only be something for people who can afford it.

Since not everyone practices concierge medicine, it's not a problem. The fact that you recognize it would be a problem if everyone did it shows that it is an unethical practice.
Click to expand...
First off, he/she did not contradict themselves, you are simply treating Kantian ethics as if they are the only valid ethical system in the world. "If everyone did it shows that it is an unethical practice" is an application of Kantian ethics, more specifically the formula of universality/the categorical imperative, which certainly isn't the only valid view of ethics and morality that exists in the world.

If you are a strict adherent of Kantian ethics, the following must be true: It is always unethical to lie. What if you lived in a society where petty theft was punishable by death? Is it unethical to lie about someone stealing $5 in order to save their life? Based on Kant's categorical imperative, he would say that it is. If you believe in your original statement, that "if everyone did it it shows that it is an unethical practice," it follows that you, like Kant, would say that lying in this instance is unethical, as lying is always unethical.

I think we can both agree that that is ridiculous and the context of a situation certainly should play a role in the morality of a decision, suggesting that Kantian ethics are, to a degree, flawed as a complete system of ethical reasoning.

Long story short: the only way for what you claim to be true is if Kantian ethics are the only valid ethical principles, which is not only close-minded but arrogant.
 
UGA Non Trad said:
So providing goods/services that only the more well off can afford is unethical? I didn't know Rolls-Royce, Rolex, and printer ink retailers were so morally corrupt...
Click to expand...
Solid dig at those bastards who set the prices at staples. I shouldn't have to pledge the life of my first-born child to get ink!
 
aprilfools said:
First off, he/she did not contradict themselves, you are simply treating Kantian ethics as if they are the only valid ethical system in the world. "If everyone did it shows that it is an unethical practice" is an application of Kantian ethics, more specifically the formula of universality/the categorical imperative, which certainly isn't the only valid view of ethics and morality that exists in the world.

If you are a strict adherent of Kantian ethics, the following must be true: It is always unethical to lie. What if you lived in a society where petty theft was punishable by death? Is it unethical to lie about someone stealing $5 in order to save their life? Based on Kant's categorical imperative, he would say that it is. If you believe in your original statement, that "if everyone did it it shows that it is an unethical practice," it follows that you, like Kant, would say that lying in this instance is unethical, as lying is always unethical.

I think we can both agree that that is ridiculous and the context of a situation certainly should play a role in the morality of a decision, suggesting that Kantian ethics are, to a degree, flawed as a complete system of ethical reasoning.

Long story short: the only way for what you claim to be true is if Kantian ethics are the only valid ethical principles, which is not only close-minded but arrogant.
Click to expand...
Definitely agree; context matters. Kantian ethics are not the only valid ethical principals and there should be consideration given to individual cases. However, I do think Kant's formula of universalizability has worth and makes some intuitive sense.
flapjack3d said:
Lol this has nothing to do with whether you believe healthcare is a right. Just bc you're personally catering to the people who are willing to shell out big money for extra attention doesnt mean you don't believe everyone should have access to healthcare. If for some reason you advocated that all docs only do concierge style medicine, then you may have a problem.
Click to expand...
The claim I was originally responding to (that concierge medicine has "nothing to do with whether you believe healthcare is a right") is flawed in suggesting that there are no further underlying ethical questions (for example, healthcare as a right) to consider. If you recognize that there would be a problem if all physicians practiced concierge medicine, then there is probably need for deeper ethical consideration if you yourself are doing so.
sliceofbread136 said:
So are expensive chefs unethical? If everyone was an expensive chef then poor people could not get food!
Click to expand...
Is access to food something that a person is entitled to, IE is it a right? So similar considerations apply for healthcare.
 
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UGA Non Trad said:
So providing goods/services that only the more well off can afford is unethical? I didn't know Rolls-Royce, Rolex, and printer ink retailers were so morally corrupt...
Click to expand...

I think the point that people are trying to get at is that because many people see healthcare as a "right", it's unethical to charge an amount that most people other than the 1% can afford. If so, I get where they're coming from, even if I completely disagree.

sliceofbread136 said:
So are expensive chefs unethical? If everyone was an expensive chef then poor people could not get food!
Click to expand...

I think a more apt metaphor would be an expensive farmer that sells their crops at an exuberant price which only a select few could afford. Having a chef (or eating at a restaurant) is a luxury, having food is a necessity.
 
To bring it back to answering the OP/title of this thread:

Making a lot of money without yourself matching into a high paying specialty is easy:
Just marry someone who does match into a high paying specialty, and swallow your competitiveness about who makes more. 😉
 
Stagg737 said:
I think a more apt metaphor would be an expensive farmer that sells their crops at an exuberant price which only a select few could afford. Having a chef (or eating at a restaurant) is a luxury, having food is a necessity.
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No it would be growing a more expensive crop, just as it is an entirely different service. sure people have a right to food but if someone wants said specific crop then they have to pay the higher price. Is filling this niche in the food sector unethical?

You could also extend it to housing as well. Are luxury homes unethical? I'm just not seeing how any of these make logical sense.
 
As a doctor you will be well off and "rich" by most laypersons take.

However. You will also gain access (unless you were already loaded) to seeing the truly rich in our society and you will feel poor as **** in comparison. These people toss around $500,000 investments like spare change.

The only way to get truly wealthy as a physician is to make incredible investments that you probably will never make on your own or invent something by yourself.
 
Tenk said:
As a doctor you will be well off and "rich" by most laypersons take.

However. You will also gain access (unless you were already loaded) to seeing the truly rich in our society and you will feel poor as **** in comparison. These people toss around $500,000 investments like spare change.

The only way to get truly wealthy as a physician is to make incredible investments that you probably will never make on your own or invent something by yourself.
Click to expand...
Disagree. One of the best things about medicine is that, unless you seek it out, you are not in any way forced to interact with the hyper wealthy individuals and zip codes that make you feel poor. If you don't join a country club no one will make you.

Also unlike most white collar professions (lawyers, finance, and engineering) doctors don't need to see the 1 percenters at work either. Our patients definitely aren't rich, we mostly serve the middle class and the poor. Also unlike other white collar professions, doctors don't usually have to answer to their wealthier bosses and bosses bosses, we usually have relatively little interaction with hospital admin even if we're employed. You don't even need to move to a nice area to be a doctor. In medicine the highest incomes go along with the lowest home prices!

Finally if your definition of 'truely wealthy' isn't achievable by a physician, you need to lower your standards. It is very possible for a physician to generate 6 and even 7 figure investment accounts through nothing but hard work and good financial planning. When you have a 6 figure passive income you're wealthy, like it or not
 
AcademicNeurosurgery said:
Many, many reasons but here a few:
  • With cash specialties, you get the money right away instead of having to chase down insurance companies.
  • You don't have to deal with insurance companies who will often try to undercompensate you.
  • People who can pay cash may be more wealthy and can thus afford your services.
  • Getting money in a timely manner increases your cash flow and allows your practice to grow much quicker.
  • And a small little thing called tax evasion when a patient literally hands you a $100 bill for their child's well-child visit that goes straight into your pocket.
Click to expand...

What specialty allows one to maximally exploit all of these? totally serious.
 
masaraksh said:
What specialty allows one to maximally exploit all of these? totally serious.
Click to expand...

DaTruMD said:
Dermatology
Click to expand...
I'd actually put in a vote for plastic surgery edging out Derm in that aspect. They can do many of the things Derms do while also having an arsenal of breast and butt augmentations, etc to further diversify any such attempt.
 
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Perrotfish said:
When you have a 6 figure passive income you're wealthy, like it or not
Click to expand...

Physician compensation is usually never passive income. It is about as active income as can be, i.e. you work for your dollars and you are taxed with a heavy hammer. Passive income is income generated from other investments that flow. E.g. you rent out an apartment and every month a rent check comes in. The latter, passive income, is how you can truly be wealthy.
 
Tri723 said:
Physician compensation is usually never passive income. It is about as active income as can be, i.e. you work for your dollars and you are taxed with a heavy hammer. Passive income is income generated from other investments that flow. E.g. you rent out an apartment and every month a rent check comes in.
Click to expand...
@Perrotfish was referring to passive income based on investment accounts. 2 million in index funds @5% return provides 100K without touching the principle.
 
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