Can't doctors controll their own schedule if in private practice?

[antispatula]

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I hear over and over again things like "omg don't become a _______ because they work like 65 hrs a week!"

If a physician in working in a private setting, can't they set up their own schedules, as long as they are ok with the inherent salary decrease that accompanies less hours?

Here's a simple example. The average family practice doctor works about 50 hours a week and gets on average about 175,000 a year. If he decides to work 40 hrs a week, which is a 20% decrease, he will then expect his salary to decrease 20% down to about 140,000 a year, right? Is it really that simple? Is lower salary the only reason some doctors don't work less, or are there other reasons?

Thanks!

 

[badasshairday]

Here's a simple example. The average family practice doctor works about 50 hours a week and gets on average about 175,000 a year. If he decides to work 40 hrs a week, which is a 20% decrease, he will then expect his salary to decrease 20% down to about 140,000 a year, right? Is it really that simple? Is lower salary the only reason some doctors don't work less, or are there other reasons?

Thanks!

Wrong. If a family doc has a take home income of 175K after practice overhead (office space rent, staff, billing) he is probably grossing 350K if we assume 50% is his fixed overhead cost (again; office space rent, staff, billing, electricity etc). His fixed cost is 175K before he is able to take home his own salary.

If he works 20% less and his gross decreasing to

350K x 0.80 = 280K

His fixed cost is still 175K. So now he takes home 280K - 175K = 105K

 

[tantacles]

Wrong. If a family doc has a take home income of 175K after practice overhead (office space rent, staff, billing) he is probably grossing 350K if we assume 50% is his fixed overhead cost (again; office space rent, staff, billing, electricity etc). His fixed cost is 175K before he is able to take home his own salary.

If he works 20% less and his gross decreasing to

350K x 0.80 = 280K

His fixed cost is still 175K. So now he takes home 280K - 175K = 105K

I think your post is inherently correct, but still supports the OP's initial point, namely that the practitioner is only working more so that he can make a higher income.

 

[Doctor Strange]

Work more hours, make more money, see more patients.

Sure, people would like to work less hours, but people want to make more money and see more patients even more. $30,000 dollars is a lot of money, and not to mention that cutting hours means possibly not having enough hours in the week to see patients in a timely manner.

 

[Winged Scapula]

For all intents and purposes, once I meet my overhead, I can work whatever schedule I like.

As a partner, I am not limited on vacation hours, sick leave, days/week that I work as an employee would be. However, there are practical concerns in that someone in PP has to be available to his patients and referring physicians and the call has to be covered. So while I could take 6 months off per year if I wished, my partners would not be happy about covering all the call and my patients and referring physicians would likewise not be pleased. That's one reason why groups are loathe to hire a part-time physician; if you're there only half the the time, your partners/employers are covering your patient phone calls and office visits the other half (as patients are inconsiderate and do not heed to your schedule when they have a problem). One of my partners sees a crazy number of patients; she always runs behind and spends most of her evenings and weekends doing charts. I refuse to do that, and she makes about 1/3 more than I do. We've each decided what works best for us.

So yes, in PP you can work more or less, within reason, but there will be fixed costs and you'll end up making less.

 

[link2swim06]

Wrong. If a family doc has a take home income of 175K after practice overhead (office space rent, staff, billing) he is probably grossing 350K if we assume 50% is his fixed overhead cost (again; office space rent, staff, billing, electricity etc). His fixed cost is 175K before he is able to take home his own salary.

If he works 20% less and his gross decreasing to

350K x 0.80 = 280K

His fixed cost is still 175K. So now he takes home 280K - 175K = 105K

Maybe but if you work part time do you really need a full staff? If you are interested in working part-time there are other practice models with significantly reduced overhead.

 

[Winged Scapula]

Maybe but if you work part time do you really need a full staff? If you are interested in working part-time there are other practice models with significantly reduced overhead.

you could certainly reduce overhead by only having staff available when you're in the office. However there are other costs which do not change: malpractice and disability insurance, EMR costs, etc.

 

[michaelrack]

you could certainly reduce overhead by only having staff available when you're in the office. However there are other costs which do not change: malpractice and disability insurance, EMR costs, etc.

Agree. Not all of overhead is fixed (as in the example given by badasshairday), so a 20% drop in hours is not going to result in a 40% drop in income (profits), but it is definitely going to be more than 20% (maybe 30% or so)

 

[link2swim06]

you could certainly reduce overhead by only having staff available when you're in the office. However there are other costs which do not change: malpractice and disability insurance, EMR costs, etc.

Right...I knew an IM guy who works part-time and got rid of all the office staff.

Scheduling is through a website scheduling system. Of course as you noted he still has to pay malpractice, disability, electric, rent, etc.

Then again he has a concierge practice....this might not be applicable to other practices.

 

[DrBowtie]

Seems like a referral based practice is less amenable to controllable hours in the setting of a competitive market.

If your wait times are twice as long as the next guy, you'll likely be losing referral streams.

 

[Winged Scapula]

Seems like a referral based practice is less amenable to controllable hours in the setting of a competitive market.

If your wait times are twice as long as the next guy, you'll likely be losing referral streams.

Yep.

It might be reasonable for routine types of visits but there are plenty of patients with seemingly urgent needs who will just call around and see who can see them first. PCPs do it as well; if you're only available half the time, you may get less than half the referrals as does the other guy who is available more often.

 

[mdeast]

I hear over and over again things like "omg don't become a _______ because they work like 65 hrs a week!"

If a physician in working in a private setting, can't they set up their own schedules, as long as they are ok with the inherent salary decrease that accompanies less hours?

Here's a simple example. The average family practice doctor works about 50 hours a week and gets on average about 175,000 a year. If he decides to work 40 hrs a week, which is a 20% decrease, he will then expect his salary to decrease 20% down to about 140,000 a year, right? Is it really that simple? Is lower salary the only reason some doctors don't work less, or are there other reasons?

Thanks!

A lot of primary care docs are moving from private practice to larger organizations anyway. FP's at Kaiser work 40 hrs/week and get paid $140k, normal office hours. There's definitely a cohort of physicians who have worked in PP and disdain joining a larger organization for the independence and (quite possibly) tradition. But, to be honest, I've seen both PP and the Kaiser model. I'd much rather work in a practice that handles most of the overhead and nitty-gritty of billing so I can just concentrate on seeing patients and being a good physician.

 

[gike]

The funny thing about patients is they're not too patient...

I guess you may have already heard that one.

Here's another one, It's alright if my doctor wants to take a vacation as long as it's not when I'm sick.

Hey, but the money is alright, eh?
_____________________________________________
You never know until you try, good advice, except with poison, of course.
My Stuff

 

[Law2Doc]

Seems like a referral based practice is less amenable to controllable hours in the setting of a competitive market.

If your wait times are twice as long as the next guy, you'll likely be losing referral streams.

Yeah, I think the problem with "setting your own hours" is more complicated than the OP is hoping. (1) there is fixed overhead before you can take anything home, so you have to meet this threshold plus whatever salary you need right off the top. That's probably already a lot of hours. (2) patients in most specialties demand a certain level of service. If they can never get an appointment with you, or a return phone call, or see you without a long wait, because you are already booked for the X hours a week you are working, most will find someone else. (3) same with referral sources -- if you aren't making your referral clinicians and their patients happy, they will find someone else. (4) each year reimbursements get cut such that you have to spend a few more hours a week to earn exactly what you did the year before. That's just the nature of the industry. (5) to the extent you are hoping to someday retire and get out of the rat race, many will work harder while they are younger so they can actually bank something.

 

[happygilmore]

Psych can set almost any schedule.

 

[badasshairday]

(4) each year reimbursements get cut such that you have to spend a few more hours a week to earn exactly what you did the year before. That's just the nature of the industry.

The most twisted part of this profession.....

 

[Sardinia]

The most twisted part of this profession.....

Not even factoring the rise in real estate tax and fixed interest increase in overhead costs. If you take over another contract for someone else and you are nearing termination of lease with no extension offered on future rent schedule payout, then expect to see a hike in pricing. Some of the rent schedules I've seen for clients in New York are pretty disgusting.

 

[michaelrack]

If you take over another contract for someone else and you are nearing termination of lease with no extension offered on future rent schedule payout, then expect to see a hike in pricing..

that really needs to be part of the negotiation if you are buying out another practice; arrangements with the landlord need to be made.

 

[GangaMaster]

Even the famous Dr. Ben Carson needs to be relied on by his patients and his practice.

 

[Kahreek]

most people who work private still have bosses,

 

[Mac or Miller]

This is highly dependent on where you are working, what type of practice you are joining, and what your specialty is.

If you are taking a job someplace where supply of your services is high and demand is moderate, then the practice you join or buy into is going to fix your salary to start out, look at what kind of revenue you can bring to the practice, and decide to make you a partner or not after that based on your ability to generate revenue.

So if you finish, have 3 kids, and want to work less, you may do better as a paid associate than attempting a partner-track job.

If you are out in the middle of nowhere, fund your own start-up costs, and run the business yourself, then yeah, you eat what you kill.

Most urban practices don't give jobs like Burger King makes hamburgers, though, and chances are decent that you may even have to enter into a non-compete clause when you join a practice. In some states, that means that if you don't like your job, too bad, you have to pay them to let you practice somewhere within a given geographic radius.

As said above, these days, you will still probably have a boss. His name may be Obama if trends continue.

 

[Donald Juan]

The funny thing about patients is they're not too patient...

I guess you may have already heard that one.

Here's another one, It's alright if my doctor wants to take a vacation as long as it's not when I'm sick.

Hey, but the money is alright, eh?
_____________________________________________
You never know until you try, good advice, except with poison, of course.
My Stuff

And the scary thing about physicians is they call what they do "practice."

 

[AdamAustin]

Being doctor doesn't refer to all about making money, Just check out who are in real need of your service & your time. After checking these if you can spare good time for yourself then you shouldn't be worried about how much loss you made.

 

[Winged Scapula]

most people who work private still have bosses,

Only if they're employees. Many practices are all partners with no "boss".

 

[yehhhboiii]

Only if they're employees. Many practices are all partners with no "boss".

not for long apparently

 

[touchpause13]

Psych can set almost any schedule.

Private practice psychiatrists can make bank. Overhead costs are super low.

 

[CarlosDanger]

(4) each year reimbursements get cut

How exactly does this work, are you talking about medicare/medicaid, or private insurance...or both? Medicare reimbursements have been pretty stable for the recent past as I understand it, although they aren't growing either which isn't great.