compensation/patient seeing factories

[rwk66]

Hi all,

I have a quick question - I'm getting ready to apply to MD/DO programs, interested in family med. A friend of mine <recent MD graduate> told me that it's really tough for primary care docs these days, as they have to become "patient seeing factories" because the compensation for primary care doc visits is so low. Have you found this to be the case?

Thanks and pardon my ignorance.

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[lowbudget]

Every specialty is the same way. I'm in Derm clinic now and these guys do 30 patients a day with many double bookings with procedures. In Pedi clinic my preceptor is one of the more senior docs so he sees less patients and moves a little slower, but his associates blaze through the day. Surgery and Gyn had its share of back to back cases in the OR and clinic was booked to the brim with procedures causing many delays. Psych was slower but patients ended up waiting months out before being seen.

I think it's just medicine in general. I'd rather have a busy practice and make money than a slow practice and go bankrupt.

 

[CambieMD]

Hi all,

I have a quick question - I'm getting ready to apply to MD/DO programs, interested in family med. A friend of mine <recent MD graduate> told me that it's really tough for primary care docs these days, as they have to become "patient seeing factories" because the compensation for primary care doc visits is so low. Have you found this to be the case?

Thanks and pardon my ignorance.

It is a little too early for you to be thinking about specialty choices.You should at least start med school first . You cannot accurately say what you are interested in because you haven't been exposed to anything as a med student.
However, your friend was correct in their assessment of primary care, today. I think that primary care is as bad as it can get right now. Things will hopefully get better in the future.

CambieMD

 

[raptor5]

It is a little too early for you to be thinking about specialty choices.You should at least start med school first . You cannot accurately say what you are interested in because you haven't been exposed to anything as a med student.

What's with the lecture on rwk66's career path. Do you routinely give this lecture to little kids who want to be the president, a firefighter, or police officer. Say to them "grow up first b/c you do not know enough about the world to really know what you want to do". Many people have visions about what they want to do and it is that vision that keeps them motivated.
Sorry FP isn't working for you.

 

[bmickelsen]

RWK66

Your question is a tough one because it can be answered in a lot of different ways.

First off yes, most FPs are patient seeing factories, but not all are.

If you go into FP and work for someone else then they will often force you to be a pt seeing factory, or if you open your own practice and your number one goal is financial gain then you will be a pt seeing factory.

However if you are willing to open your own practice or very very carefully choose who you work for, and if money isn't your greatest motivation then you can be a doctor who spends adequate time with their patients.

And I would recomend right now thinking about what you want to do, sure it may change during medical school, but the earlier you think about it the better.

Good Luck

 

[doc05]

if your real motivation is FP, then you should think about becoming a PA or FNP. very similar scope of care, less liability, much shorter training, good-excellent salary.

 

[rwk66]

Thanks all for the information. I've thought about going the PA route too. As of now I definately am interested in primary care, but it seems that most primary care docs are pretty stressed and fed up. It's sad that this is the case, as pc's are such an important part of the health system. Well, I need to do more research before I definately make a decision, but thanks again to all of you.

 

[PACtoDOC]

if your real motivation is FP, then you should think about becoming a PA or FNP. very similar scope of care, less liability, much shorter training, good-excellent salary.

Ask yourself this:

Would you be satisfied with such:
Your neighbor asking you, "How do you afford such a nice house as a medical assistant..do they pay that well to draw blood?"
Making 100K per year to work 5 full days busting your ass while your boss makes 300K because of you busting your ass into your old age?
Not knowing what the patient has wrong with them but thinking you do, and actually finding out later that you had no clue?....routinely!!
Not having a true social circle to fit into? Docs won't hang out with PA's routinely as close friends, and the nurses and MA's are also not in your arena. You are left to socialize with the drug reps!!!
Not having a real say on decisions in the practice, not being able to hire and fire at will, and the best on of all.............................................
Having your boss tell you that you were complained on to him because you refuse to write antibiotics for some kid with viral pharyngitis and a negative strep test!!!!

Life for some PA's is awesome because they have bosses that truly value them. But as a Doctor, you will never experience ANY of these things, and these things can often make life intolerable!!

 

[USFOptho]

Based on the drug reps I know, this would NOT be a bad thing.

Ask yourself this:


Not having a true social circle to fit into? Docs won't hang out with PA's routinely as close friends, and the nurses and MA's are also not in your arena. You are left to socialize with the drug reps!!!

 

[bigfrank]

if your real motivation is FP, then you should think about becoming a PA or FNP. very similar scope of care, less liability, much shorter training, good-excellent salary.

AWESOME logic.

 

[iatrosB]

Based on the drug reps I know, this would NOT be a bad thing.

I'll second that! Hello

 

[FMbound]

Ask yourself this:

Would you be satisfied with such:
Your neighbor asking you, "How do you afford such a nice house as a medical assistant..do they pay that well to draw blood?"
Making 100K per year to work 5 full days busting your ass while your boss makes 300K because of you busting your ass into your old age?
Not knowing what the patient has wrong with them but thinking you do, and actually finding out later that you had no clue?....routinely!!
Not having a true social circle to fit into? Docs won't hang out with PA's routinely as close friends, and the nurses and MA's are also not in your arena. You are left to socialize with the drug reps!!!
Not having a real say on decisions in the practice, not being able to hire and fire at will, and the best on of all.............................................
Having your boss tell you that you were complained on to him because you refuse to write antibiotics for some kid with viral pharyngitis and a negative strep test!!!!

Life for some PA's is awesome because they have bosses that truly value them. But as a Doctor, you will never experience ANY of these things, and these things can often make life intolerable!!

Are you already practicing medicine? If not, you need to get rid of the chip before you start residency.

 

[raptor5]

Are you already practicing medicine? If not, you need to get rid of the chip before you start residency.

I would think his screen name would say it all. I guess it should read PA-C to Doctor.

 

[iatrosB]

I would think his screen name would say it all. I guess it should read PA-C to Doctor.

It stands for Physician Assitant Captain (previous military) to Doctor. He has a lot of experience working as a PA and from what I gather, he was quite happy working as one but wanted to step up to be "the boss". He doesn't have a chip, he just trying to show that is isn't all peaches as a PA and that it is not a better route to take if you value autonomy and respect.

 

[raptor5]

It stands for Physician Assitant Captain (previous military) to Doctor.

Your kidding I hope. That would suggest that all the PAs at a local hospital by me were all former military captain's. I was under the impression that PA-C stood for Certified Physician Assistant according to the NCPPA.

 

[CambieMD]

if your real motivation is FP, then you should think about becoming a PA or FNP. very similar scope of care, less liability, much shorter training, good-excellent salary.

That's not a bad idea. I would choose PA over FNP. They seem to have more latitude.

CambieMD

 

[iatrosB]

Your kidding I hope. That would suggest that all the PAs at a local hospital by me were all former military captain's. I was under the impression that PA-C stood for Certified Physician Assistant according to the NCPPA.

No, you're right, it does stand for that. I thought his user name stood for captain though, maybe not. Your proposal sounds more reasonable.

 

[iatrosB]

That's not a bad idea. I would choose PA over FNP. They seem to have more latitude.

CambieMD

How about posting an example? I know you are disinchanted with FP, so please post concrete examples of why. It would help to get all of the good and bad aspects of the specialty out there.

 

[FMbound]

The preceptor for my neurology rotation would see 60-70 patients per day in his office. I kid you not. He had a pretty slick set up. The medical assistant (or medical student) would complete the H&P and validate the medication list and print prescriptions for the neurologist to sign. He used a computer system so you could complete all this in 15 minutes tops. He then came in did a cursory exam and sent the patient on their way.

He was also hooked up with a local hospital who would refer all accident victims with blunt head trauma or closed head injury to him.

I asked the guy how many patients were in his practice, but he didn't know. I also asked him about revenues and he just grinned.

I would say he was bringing in at a minimum $500k if not more since he also did EMGs, sleep studies, bubble doppler (for PFO), EEGs, and a couple of other things.

So I would imagine if money motivates you to work hard in FP, you could do well if you also do procedures.

 

[FMbound]

FMBound,

I can say these things because I AM A PA!! I am only trying to prepare someone to make a decision that they could regret the rest of their life. Please do some research before you start throwing out accusations. In 13 months you can add physician as well to my title. That will then give me the right to say whatever I feel about BOTH professions, even if I am just playing devil's advocate. My reply stands! It makes a lot of sense for someone that has been practicing medicine for 7 years, wouldn't you think? Guess you are feeling a bit embarrassed now huh? Well you are forgiven, as I know you probably did not know I was speaking from experience. Had you thought I was just a premed or med student with comments like that, I could understand your being pissed. But you were incorrect in your assumption, so lets just leave it at that.

Sorry dude. I am neither embarrassed or pissed. What I say still stands. You need to get rid of the attitude. There are enough asses in medicine without another one being added to the mix.

 

[PACtoDOC]

Sorry dude. I am neither embarrassed or pissed. What I say still stands. You need to get rid of the attitude. There are enough asses in medicine without another one being added to the mix.

Listen dude. You have about as much experience in medicine as the average 4th year, which is not much. You have no idea what it is like to be a PA, nor is it really your concern. My comments that you jumped all over were rhetorical comments from a seasoned veteran in the field, meant to give an inexperienced OP some clarity. You completely misunderstood the issue and decided that my post was somehow a "chip on the shoulder". My post was reality to the hilt, which you would know nothing about. I think you should stay in the EM forum where we all know you really want to be anyway. Good luck!

 

[FMbound]

I think you should stay in the EM forum where we all know you really want to be anyway. Good luck!

You got that right!

 

[iatrosB]

You guys are going to get another thread closed!

 

[FMbound]

You guys are going to get another thread closed!

You're right. I'll stop.

 

[PACtoDOC]

You're right. I'll stop.

You really don't have to stop, I think all the fascists are in Washington this week trying to pretend they are for limited government and states rights, except when it comes to medical practice where being a fascist now qualifies one to do limited but major surgeries on capitol hill!! So I don't think there are any left here to pose their judgement on others

 

[bigfrank]

Hey BigFrank, you bailing on the FP gig my friend, or are you still considering it? I can just tell from all your posts that you would make a great FP.

Hey there again. YES, I'm still strongly considering FP, but I'm also still strongly considering radiology. I'm going to do a rotation ("get my itch scratched") and see what I think. If I love Rads, I'll apply for Rads. If I have any hesitation about the field, I'll go FP and never look back........

Good luck to you!

 

[jetproppilot]

GEEEEZ!
Man, this is better than a soap opera!
All kidding aside, heres my two cents (like you really wanted it, but I'm on call, bored, so here goes...)
I humbly agree with PAC.
Everything PAC looks accurate to me. The heart surgeons I work with have 2 PAs who get to work when I do (0615), round, come to surgery all day, then round again. Usual time to go home for them, about 9pm. They do all the scut, receive criticism for things that go wrong, and very little positive feedback.
From what I've witnessed, I concur with PAC's social dilemma.
I don't think PAC has a chip. Sounds like all true stuff to me.
Congrats on your MD in advance, PAC.
I think ya'll should shake hands and fuggetaboutit.

FMBound,

I can say these things because I AM A PA!! I am only trying to prepare someone to make a decision that they could regret the rest of their life. Please do some research before you start throwing out accusations. In 13 months you can add physician as well to my title. That will then give me the right to say whatever I feel about BOTH professions, even if I am just playing devil's advocate. My reply stands! It makes a lot of sense for someone that has been practicing medicine for 7 years, wouldn't you think? Guess you are feeling a bit embarrassed now huh? Well you are forgiven, as I know you probably did not know I was speaking from experience. Had you thought I was just a premed or med student with comments like that, I could understand your being pissed. But you were incorrect in your assumption, so lets just leave it at that.

Oh, and one more thing FMbound. Please do not come on here with your 11 total posts ranting like some experienced physician when you are only interested in FM because you couldn't get into your desired specialty. Going to a top program is more about avoiding ending up with people who use FM as a "backup" than about really wanting to be at a top program for me. Just last week you were on here crying about how you thought FM was boring and only saw sinus infections, but now you are some expert in judging how someone with about 10,000 more patient encounters than you in FM has the right to speak his mind about HIS profession.

Anyone who wants some entertainment value, just look back at FMbound's 11 total posts and see his/her bashing of FM yet somehow this person will be one of our future partners! Scary if you asked me.

 

[PACtoDOC]

GEEEEZ!
Man, this is better than a soap opera!
All kidding aside, heres my two cents (like you really wanted it, but I'm on call, bored, so here goes...)
I humbly agree with PAC.
Everything PAC looks accurate to me. The heart surgeons I work with have 2 PAs who get to work when I do (0615), round, come to surgery all day, then round again. Usual time to go home for them, about 9pm. They do all the scut, receive criticism for things that go wrong, and very little positive feedback.
From what I've witnessed, I concur with PAC's social dilemma.
I don't think PAC has a chip. Sounds like all true stuff to me.
Congrats on your MD in advance, PAC.
I think ya'll should shake hands and fuggetaboutit.

Sounds good to me!! But my degree will be a proud DO. You know, the first two words in DOctor 13 months and counting!!

 

[jetproppilot]

Correction...congrats on the DO, dude, and good luck. You have a bright future ahead of you.

Sounds good to me!! But my degree will be a proud DO. You know, the first two words in DOctor 13 months and counting!!

 

[CambieMD]

How about posting an example? I know you are disinchanted with FP, so please post concrete examples of why. It would help to get all of the good and bad aspects of the specialty out there.

I do not want to seem like I am knocking FP. You can view my previous posts to get a sense of why I left FP. All I will say is that primary care is at the epi-center of the American healthcare crisis. Good luck as you decide what to do with your life.

CambieMD

 

[iatrosB]

I do not want to seem like I am knocking FP. You can view my previous posts to get a sense of why I left FP. All I will say is that primary care is at the epi-center of the American healthcare crisis. Good luck as you decide what to do with your life.

CambieMD

Thanks