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Business of ENT
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Boy does that depend on the location of your practice.
In my area, which is fairly well-to-do, I want Medicare/Medicaid to be less than 20%. Some people even opt out of it. Some are opting out of insurance altogether. There is an ENT in Dallas who does nothing but snoring/OSA surgery. He accepts no insurance. He will bill insurance on behalf of the patient who has paid him, but he won't pursue payment for the patient beyond that.
I know in my previous town, the private docs were around 30% and happy to keep it there. Large metro areas that serve a poorer population in general may be even higher.
In my area, which is fairly well-to-do, I want Medicare/Medicaid to be less than 20%. Some people even opt out of it. Some are opting out of insurance altogether. There is an ENT in Dallas who does nothing but snoring/OSA surgery. He accepts no insurance. He will bill insurance on behalf of the patient who has paid him, but he won't pursue payment for the patient beyond that.
I know in my previous town, the private docs were around 30% and happy to keep it there. Large metro areas that serve a poorer population in general may be even higher.
As far as surgical specialists, would you say ENTs are in lesser or greater than supply than orthos, urologists or plastics?
Super-desirable locations aside (SoCal, NYC), is there enough of an unfilled demand in general urban or suburban locations to be able to be picky about what you want to do/who you want to see and still fill a practice?
Super-desirable locations aside (SoCal, NYC), is there enough of an unfilled demand in general urban or suburban locations to be able to be picky about what you want to do/who you want to see and still fill a practice?
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Again, that really depends on location. Denver and Salt Lake City for example are super-saturated with ENT's. In fact, the going rate for a first year ENT to be hired in Boulder is a ridiculous $140k. That's just disgusting given the cost of living there.
Overall, ENT is one of the most regulated specialties in medicine owing to very good oversight by our Academy/Board. When I was looking for jobs a couple of years ago, a headhunter told me that at any given time there are between 1500 and 2000 jobs available for an ENT the vast majority of which are not adverstised.
If you just calculate the numbers on your own, here's what you get. You need 1 ENT for every 35k people. There are 300,000,000 people in the US give or take. There are somewhere around 6,300 ENT's. Do the math and the US has a need for 8,571. Thus we need something like 2,200 ENT's or so.
That seems like a favorable job market to me.
Would agree that a reasonable mix is less than 30 % Medicare/caid. But if you are just starting out in a desirable and pretty urban area and you want to get busy quickly, you may have to run much higher % than that.
You're right. I think the first 10 patients I had were Medicaid and then the 11th one was Medicare.
The primary care docs will send you the less "desirable" insurances first and see what kind of feedback those patients give about you. Then, if you treat those patients well, the primary docs will start sending you the ones with better payers. At least that's the way I was told it worked in my area and it turned out to be accurate.
In my first year of private practice, I am denying no one even if I have to write-off the visit--simply because I do not want to turn away any patient from a referring physician. Once I'm as busy as I want to be I too will probably opt out of Medicaid. Currently I'm the only one in our area accepting it, so if I don't opt out (or at least limit the number of patients I see monthly) I could end up hurting my bottom line because I'll end up seeing every single one.
