I would also like to add the increased competition to get into medical school these days. 20 years ago you only needed a 3.5 and like a 60th percentile MCAT score when now there's non ivy league schools whose average incoming class is a 3.8+ 515+. Like any job if you are more selective with who you hire the ones you do expect to be compensated for it.
Med schools admission departments aren't hiring you and employers, Insurance companies, Medicare and Medicaid couldn't care less about how selective of a med school admission process you went through. If you feel that you can't do family medicine because you won such a selective lottery, you probably wouldn't be happy with it anyway.
I just ran the numbers for my (currently solo) DPC. I could do this if I had one or two partner(s) to split some of the overhead so, yes, that's realistic.
How often are you on call?
I was talking about the selectiveness of getting into medical school not family medicine. Someone who goes through that much competition should reasonably expect to be compensated for it. They do have to care about it or they would dramatically drop rates instead of chipping. They know if they pay below what a physician thinks they are worth that they won't take that insurance or find a new job.
I think I understood your point correctly based on this. Again, if you expect a higher competition because you won that competition, that's fine, maybe family medicine isn't for you. Just don't delude yourself that employers or payers think you deserve more pay because of that.
I'm interested in FM due to the shortage and being able to help a broad range of patients with a broad range of issues. I disagree with your stance that one shouldn't do FM if they think they deserve higher pay based on higher competition to get into medical school. Everyone wants to be paid more for doing harder work, and if a low paying job isn't filled, they will either have to raise the pay or go out of business. Physicians hold the power in clinical businesses, if you have no doctors you have no clinic. Going to the hospital, urgent care, clinic that pays more or hanging your own shingle and rejecting low ball offers is the best thing to do.
Right but I think what he's saying is that just because you got into medical school doesn't mean you deserve higher pay.
End of the day,
Lots more grade inflation nowadays. And many more prep classes etc. It was always selective and the board exams are the great equalizer. When people get in, some will have to do primary care.
My school prided itself on grade deflation so that's not always the case. While it has always been selective this past 10 years it has become extremely more so. The average MD student 15 years ago is the average DO student today in terms of average gpa and MCAT.
It makes sense economically to ask for more pay based on supply and demand, is it this way because some doctors are willing to work for peanuts?
It's not just about the scores. Don't forget the older docs didn't have access to things like sdn and all the resources that are available now. But hey if it makes you feel superior that's fine too. And lots of physicians have massive loans so they will take the reimbursement. And now midlevels are nipping at their heels too.
Agree completely. In my 20+ years, insurers, Medicare and Medicaid have only paid this lip service.
Its complicated. If you're limited for some reason (geography being the main one), there's not much you can do. Our main area of power is the fact that we can leave and get another job. If you can't leave, your bargaining power is very limited.
Its getting better. Meeting quality measures = more money. Having complicated patients (higher HCC scores) = more money. Medicare Wellness visits/TCMs pay very well and are pretty easy to do. The CPT changes are designed with us in mind.
You still had to have the resources to succeed or nobody would have made it. I don't feel superior the higher requirements are due to competition and not to have better doctors. I'm just saying in a capitalistic market more competition is something that usually results in a demand for more pay. I would love to get reimbursement for my loans when I'm done but if I can get a job that pays more after without a significant increase in responsibilities compared to the one that paid off my loans I'll take the higher paying job after.
That's the aspect I love about family medicine. It's flexible so you have avenues to go if they try to lowball you and the shortage means you're helping people no matter where you go. I wouldn't consider geography a limitation as much as a choice. You don't have to move super far from family, even 30 min out of alot of major cities turns rural.
Pls update us when you get your job with salary and benefits.
Harder to get in with all the Caribbean and for profit do schools?
Wow, it sounds like you work hard and are very well-compensated for it. What region do you work in? Rural? And are you 1099 on those jobs?
Not everyone can work that much but there are people out there who can do it. One of my co-workers work 24-25 hospital medicine shifts per month. 18 shifts is the max for me.
Go on..
PM me if you're interested in more details
This is inspiring. Would love to hear more about the Suboxone gig though! That’s an aspect I know nothing about . How does the pay/income come it?
It’s about $50 a patient. You’re limited to 275 pts a month if you max out your waver. Visits can be as short as 3-5 minutes though if you’re trying to do a good job and not just become a pill mill then they will be longer. A lot of it is encouraging the patient that they can do it and using motivational interviewing to get them to want to make a change for themselves and come off suboxone.
Wait, you're convincing them to come off of Suboxone? Why exactly are you doing that? Are these people that have been on it for years and you're talking about stepping it down? Because otherwise, unless it's their goal, it doesn't seem like that would be good for them.
This has always been something I've wondered about. At one point do you say "OK it's time to finish weaning off"? I'm not saying every patient has to come off Suboxone after 8 months but something just seems off about the same low dose of Suboxone for 10 years.
I treat in a harm reduction model. My goal is not no medications, but if a patient is interested in reduction I support them, but I do it slow. I've seen people go from 16 to 8 in <2 mos then they disappear for months because they relapsed and almost died (those are the ones with better outcomes). I don't do that. I do 2 mg reduction with stability for a few months discussing craving and mood symptoms. As far as when to start reduction, it's up to them, but after a prolonged period of stability (usually 6-12 mos stable on the same dose with no relapses) I offer it if they're interested, but I make it clear it's not a requirement. Basically I treat it the same way I would treat an SSRI. Relapses during reduction mean longer term maintenance and more caution with reduction in the future.
Why does it seem off?
I don’t want it on my conscience that I am only their new drug dealer. People who take htn and other meds are not “addicted” in the same way suboxone patients are because they need this to feel normal. And now they are in a way forced to come to you or some one else for the rest of their life for this medicine. I am over generalizing here but I hope you get what I’m trying to say.
What setting(s) do you practice in (outpatient, inpatient, ER)? What general region do you work in? About how many hours per week do you put in between your 3 jobs?
If I'm being completely honest, probably part of it is that it's a long term opioid.
Meanwhile people are being prescribed methadone and buprenoprhine indefinitely by shady providers.
Wait what? Please expand upon this. I assume all 3 jobs are inpatient, and you're double dipping a significant portion of the time.
I too would also like to hear more for the breakdown of this.
You're working 100 hours/week average?She’s a Doctor. He Was a Limo Driver. They Pitched a $30 Million Arms Deal. (Published 2022)
New brokers are cashing in as the Biden administration quietly encourages private weapons sales to Ukraine. Oversight is scant in these shadows.www.nytimes.com
you can do this.
I work in EM locums only 2.5 FTE/month. i bought a couple of rental houses. I day trade. single, youngish, frugal.
I know we've already talked about this, and I'm sure you may have seen articles like this before, but here's a newer one detailing risk factors that increase the likelihood of OD for patients tapering buprenorphine. Nothing ground breaking, but it's helpful for counseling patients regarding risks of tapering in a not so slow or well planned way.
jamanetwork.com
84 hr/wk at the most. My shifts are 12 hrs. Not uncommon that I work 10-14 days straight. It sucks, but I chose to do it. I do have long commutes and occasional flights which can add up to 6-12 hrs of driving/week. The day trading also takes some time (research, trading...)
