Daily reminder to do the bare minimum

Started by GonnaBeADoc2222
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I’m playing BG3 on my SteamDeck but may buy the PS5 version when it’s released just to enjoy on my OLED in 4K considering the XB version doesn’t come out until next year reportedly. At least it has cross save support. Either that or I’ll get the Mac version. The early access version played great on my MBP.

The last game I played at work was D4 during a slow night shift. I hooked up my XSS to the tv in our call room.

Otherwise, I’m pumped for Starfield. I can’t freaking wait to play that game. In the meantime, I’ve been playing Everspace 2 which is tons of fun and scratching my space flight itch. It reminds me of Forsaken and Descent from the good ol PC gaming days.

Another one I’m itching for is Armored Core 6 due out Friday. I’ve had that preordered for months.
 
GonnaBeADoc2222 said:
Hoping Starfield runs well on the Deck

Knowing the developer, there will be massive problems at release across all platforms
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I’ve been following some of the early access impressions on 4chan and Reddit/Twitter and somebody posted that they had played 15+ hours without a single bug so far which would be very unusual for Bethesda but also seems promising. I’m super curious as to how it runs on the deck. The game reportedly has cross save functionality so having a portable version of the game would be awesome though I intend to main on my XSX.
 
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I like the concept here but ill say I view my time as the most valuable asset I have. As such making the max money while practicing medicine as I please feels the best to me.

I would rather make 300/hr seeing 2pph than make 225/hr seeing 0.5pph (to use extreme examples). I also prefer 12 hour shifts to minimize my commute time.

A question for the do the bare minumum is how does the effort vs value of time come into play.

To use the example above if you could work 12 hour shifts making 300/hr and work 10 shifts a month isnt that much better than working 15 shifts a month for the 120 hours and making 225/hr?

Im just curious where the group finds itself with respect to shift length and effort vs $$
 
EctopicFetus said:
I like the concept here but ill say I view my time as the most valuable asset I have. As such making the max money while practicing medicine as I please feels the best to me.

I would rather make 300/hr seeing 2pph than make 225/hr seeing 0.5pph (to use extreme examples). I also prefer 12 hour shifts to minimize my commute time.

A question for the do the bare minumum is how does the effort vs value of time come into play.

To use the example above if you could work 12 hour shifts making 300/hr and work 10 shifts a month isnt that much better than working 15 shifts a month for the 120 hours and making 225/hr?

Im just curious where the group finds itself with respect to shift length and effort vs $$
Click to expand...

I'd rather make 75% of the pay to do 25% of the work as you described + lunch and coffee breaks + downtime to chill/day trade/asynchronous telemedicine + going home on time. It's a marathon, not a sprint.
 
EctopicFetus said:
I like the concept here but ill say I view my time as the most valuable asset I have. As such making the max money while practicing medicine as I please feels the best to me.

I would rather make 300/hr seeing 2pph than make 225/hr seeing 0.5pph (to use extreme examples). I also prefer 12 hour shifts to minimize my commute time.

A question for the do the bare minumum is how does the effort vs value of time come into play.

To use the example above if you could work 12 hour shifts making 300/hr and work 10 shifts a month isnt that much better than working 15 shifts a month for the 120 hours and making 225/hr?

Im just curious where the group finds itself with respect to shift length and effort vs $$
Click to expand...

Cool story, bro .


Daily reminder to do the bare minimum.


(This was in good ribbing. Your question is a good one and deserves an honest answer. But later.)
 
EctopicFetus said:
I like the concept here but ill say I view my time as the most valuable asset I have. As such making the max money while practicing medicine as I please feels the best to me.

I would rather make 300/hr seeing 2pph than make 225/hr seeing 0.5pph (to use extreme examples). I also prefer 12 hour shifts to minimize my commute time.

A question for the do the bare minumum is how does the effort vs value of time come into play.

To use the example above if you could work 12 hour shifts making 300/hr and work 10 shifts a month isnt that much better than working 15 shifts a month for the 120 hours and making 225/hr?

Im just curious where the group finds itself with respect to shift length and effort vs $$
Click to expand...
I would much rather (and do) work more shifts that are shorter length. In your example, you've got 12 12s. Assuming single coverage, that's 6 overnights a month, and those nights are also 12s, whereas 3 8s a day yields 5 overnights a month for 15 shifts, and those nights are only 8 hrs long (all assuming an even distribution).

Aside from the extra nights that come (generally) with longer shifts, I also can't hustle at work for 12 hours like I do for 8 or 9hrs. My pace would slow down so much around the 10 hr mark that adding the hours on would only serve to lower my average hourly rate for the shift.
 
BoardingDoc said:
I would much rather (and do) work more shifts that are shorter length. In your example, you've got 12 12s. Assuming single coverage, that's 6 overnights a month, and those nights are also 12s, whereas 3 8s a day yields 5 overnights a month for 15 shifts, and those nights are only 8 hrs long (all assuming an even distribution).

Aside from the extra nights that come (generally) with longer shifts, I also can't hustle at work for 12 hours like I do for 8 or 9hrs. My pace would slow down so much around the 10 hr mark that adding the hours on would only serve to lower my average hourly rate for the shift.
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OK. I guess im a big fan of 12s but my group doesnt have them.. I’ll try to make it more of an apples to apples comparison.

I’ll restate my question as such would you rather work all 8s and job one see 2 pph and make 300/hr or job b see 1 pph but make 200/hr. The $/unit of work is higher for the lower paying job.

To make 300k in job 1 I have to work 1000 hours a year but I have to work 1500 hours a year in job B to earn the same.

My opinion is clear and skewed as I would frankly rather see 3pph and make 350/hr if it were sustainable than either of the above examples. For the sake of my example i am aware how i would be getting paid less and less per unit of work.

In reality in most true RVU based systems you should frankly be earning more per patient (which is how my sdg works). Every shift I have a fixed cost I cover. We operate as effectively an independent business unit. My scribe cost is fixed, one could argue my med mal cost is fixed and assuming a flat $/pt my fixed costs become a smaller and smaller % of my expense.

Again, I would be curious how the others on here see things. In my opinion part of doing the bare minimum is being at work as little as possible. Maybe my hospitals aren’t that nice but I dont find my time there terribly relaxing regardless of the number of patients I see. The beds suck, the food is average at best, the TVs small etc. I guess I would much rather be home.

Easiest to sprint to the FI line in my mind. As a parent maximizing my time with my kids matters. Whatever your financial goals are I think it is easiest for me to hit my desired income in the fewest hours possible. For those mentioning its a marathon i dont think im terribly special but ive been an attending for 10+ years. My first job out of residency we did a mix of 8,9,12s and I worked like a b*tch. I averaged 160 hours a month or so. Seeing 2pph. I tried to avoid the shorter shifts. Now I see more than 2pph, shifts are 8s and I average 100 hours a month clinically. My only complaint is I wish I could do 8 12s and not 12 8s.
 
RustedFox said:
Cool story, bro .


Daily reminder to do the bare minimum.


(This was in good ribbing. Your question is a good one and deserves an honest answer. But later.)
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Lol.. i know you mean no harm. real question (the tl;dr) of my long post above is is it better to work harder on shift to earn more and therefore be at work less or have an easier job (fewer pph) but have to be there for more hours to earn the same.

Caveat I would say is if you have a side hustle and the volume is so low you can double dip that changes the equation but for the sake of discussion keep it simple and pure. See options A and B above.
 
Mount Asclepius said:
Nope. I work as hard as possible whenever I work. Opposite of the path of trying to stick it to someone because of a bad job situation.
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LOL.

Lets work out the math in the example @EctopicFetus presented, assuming 1500 hrs / year:

1) $225/HR for 0.5 pph: 338k, 750 patients; $450/patient

2) $300/HR for 2 pph: 450k; 3,000 patients; $150/patient

Option 1 has less patients, more money per patient, less stress, less work, less documenting, less liability.

The choice is abundantly clear.
 
GonnaBeADoc2222 said:
LOL.

Lets work out the math in the example @EctopicFetus presented, assuming 1500 hrs / year:

1) $225/HR for 0.5 pph: 338k, 750 patients; $450/patient

2) $300/HR for 2 pph: 450k; 3,000 patients; $150/patient

Option 1 has less patients, more money per patient, less stress, less work, less documenting, less liability.

The choice is abundantly clear.
Click to expand...

Option 1 has more money per patient but less money per unit of time.
 
GonnaBeADoc2222 said:
LOL.

Lets work out the math in the example @EctopicFetus presented, assuming 1500 hrs / year:

1) $225/HR for 0.5 pph: 338k, 750 patients; $450/patient

2) $300/HR for 2 pph: 450k; 3,000 patients; $150/patient

Option 1 has less patients, more money per patient, less stress, less work, less documenting, less liability.

The choice is abundantly clear.
Click to expand...
I guess it’s all a matter of how long your employer wants to lose money on you for option 1.
 
GonnaBeADoc2222 said:
LOL.

Lets work out the math in the example @EctopicFetus presented, assuming 1500 hrs / year:

1) $225/HR for 0.5 pph: 338k, 750 patients; $450/patient

2) $300/HR for 2 pph: 450k; 3,000 patients; $150/patient

Option 1 has less patients, more money per patient, less stress, less work, less documenting, less liability.

The choice is abundantly clear.
Click to expand...
JacobMcCandles said:
I guess it’s all a matter of how long your employer wants to lose money on you for option 1.
Click to expand...
It’s all just degrees of what it out there. You can find outlying 1 pph sites near me for 180-200/hr.

The purpose of my examples is to weigh the difficulty of time at work with the actual hours at work. I dont mind working quite hard but i want to be at work for as short a time as Possible.

The second examples i made was more akin to 1pph for 200/hr or 300/hr for 2pph or 3 pph for 400/ hr.

Personally as long as it is safe im taking the 3pph for 400/hr.
 
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JacobMcCandles said:
I guess it’s all a matter of how long your employer wants to lose money on you for option 1.
Click to expand...
They just lost nearly all the docs at my place and are paying me extra to fill some upcoming shifts. Those seem like great shifts for me to do the bare minimum. I see myself at little risk of being let go. They have no warm bodies. But really, I haven't been seeing very many patients on recent shifts, but the ones I've been seeing are sick as hell and time-consuming.
 
EctopicFetus said:
It’s all just degrees of what it out there. You can find outlying 1 pph sites near me for 180-200/hr.

The purpose of my examples is to weigh the difficulty of time at work with the actual hours at work. I dont mind working quite hard but i want to be at work for as short a time as Possible.

The second examples i made was more akin to 1pph for 200/hr or 300/hr for 2pph or 3 pph for 400/ hr.

Personally as long as it is safe im taking the 3pph for 400/hr.
Click to expand...

I'll totally do 3pph for 400 sign me up.
 
Mount Asclepius said:
More math.

Average 1,500 hours/year.

Job 1: 2 pph at $300/hour = $450K/year for 3,000 patients at $150/patient

Job 2: 1.5 pph at $225/hour = $337.5K for 2,250 patients at $150/patient

Difference of $112.5K/year ($450K - $337.5K) for 750 more patients.

Extra income marginally taxed at 24-32%, but perhaps an effective tax rate of closer to 24% married filed jointly.

$112.5K x 76% = $85.5K extra post-tax income for post-tax investing.

Place all in S&P500 for 20 years with a conservative, inflation adjusted rate of return at 7% results in an extra $3.5M with compounded growth.

View attachment 376257

750 patients extra for 20 years results in 15K more patients seen during that time for an extra $3.5M. Equates to $233/patient ($3.5M/15K patients).

I think we'd all take $233/patient as $150/patient after overhead is the gold standard. Very few places collect >$200/patient.

You essentially get to retire 5 years sooner and have a lot more in post-tax investment accounts at that time. Over those next 5 years from age 50-55 you have a better passive income stream and the gap further widens.

View attachment 376261

You end up with close to an extra $5M assuming you don't withdraw from this amount and live off of your traditional retirement that you would have otherwise had in your portfolio. All for just working a little harder and seeing 0.5 pph more.

Retiring 5 years sooner saves you from seeing an additional 11,250 patients (2,250 patients/year x 5 years) during that timeframe. 60,000 patients (3K patients/year x 20 years) versus 56,250 patients (2,250 patients/year x 25 years). 3,750 extra patients over 25 years for $5M.

I'll take job 1. Daily reminder to do the bare maximum.
Click to expand...

You spent way too much time on this.
 
Also if you have a DB plan you could defer those taxes and that number is much bigger. I think if you are hourly it’s not wrong to do the bare minimum. If you have some RVU portion if it is big enough it makes sense. If the RVU portion is too small which is often the case then you have to weigh it.

For RVUs it’s often something stupid like some flat rate and $8/rvu.. that makes the docs stupid to work hard for that especially if it is wRVUs. Then that extra patient is only worth like $30.. thats nonsense money for the work Imo.
 
Mount Asclepius said:
More math.

Average 1,500 hours/year.

Job 1: 2 pph at $300/hour = $450K/year for 3,000 patients at $150/patient

Job 2: 1.5 pph at $225/hour = $337.5K for 2,250 patients at $150/patient

Difference of $112.5K/year ($450K - $337.5K) for 750 more patients.

Extra income marginally taxed at 24-32%, but perhaps an effective tax rate of closer to 24% married filed jointly.

$112.5K x 76% = $85.5K extra post-tax income for post-tax investing.

Place all in S&P500 for 20 years with a conservative, inflation adjusted rate of return at 7% results in an extra $3.5M with compounded growth.

View attachment 376257

750 patients extra for 20 years results in 15K more patients seen during that time for an extra $3.5M. Equates to $233/patient ($3.5M/15K patients).

I think we'd all take $233/patient as $150/patient after overhead is the gold standard. Very few places collect >$200/patient.

You essentially get to retire 5 years sooner and have a lot more in post-tax investment accounts at that time. Over those next 5 years from age 50-55 you have a better passive income stream and the gap further widens.

View attachment 376261

You end up with close to an extra $5M assuming you don't withdraw from this amount and live off of your traditional retirement that you would have otherwise had in your portfolio. All for just working a little harder and seeing 0.5 pph more.

Retiring 5 years sooner saves you from seeing an additional 11,250 patients (2,250 patients/year x 5 years) during that timeframe. 60,000 patients (3K patients/year x 20 years) versus 56,250 patients (2,250 patients/year x 25 years). 3,750 extra patients over 25 years for $5M.

I'll take job 1. Daily reminder to do the bare maximum.
Click to expand...
We collect more than $200/pt at our worst payer mix site. Where are your numbers from?
 
The older you get, the wiser you become, the more wealth you accumulate. Time start to be more important than Money. Time can buy you money but money can not buy you time. Money>>>>Time when I was a teenager, as time passed, this has flipped where Time>>>>>>Money.

10 yrs ago, I was happy with 250hr working in an efficient community ER. 5 yrs ago doing Locums, I would not step into a shift unless they offered me 500/hr. Now, I would not go back to those locums site even if they offered me 1k/hr. If they offered me 2k/hr, I may do it if I had a cleared personal schedule.
 
TooMuchResearch said:
We collect more than $200/pt at our worst payer mix site. Where are your numbers from?
Click to expand...
I know the data for collections from 6 different EDs in my state, all in very different areas with different demographics. None of them exceed 200/patient on average. I suppose it's possible that my state is simply poorer than yours or that yours is much better insured, but I don't see how your collections is exceeding 200/patient unless your billing is conspicuously high (e.g. adhering to the CMG mentality that every ED visit should be a lvl 5 or CC)
 
BoardingDoc said:
I know the data for collections from 6 different EDs in my state, all in very different areas with different demographics. None of them exceed 200/patient on average. I suppose it's possible that my state is simply poorer than yours or that yours is much better insured, but I don't see how your collections is exceeding 200/patient unless your billing is conspicuously high (e.g. adhering to the CMG mentality that every ED visit should be a lvl 5 or CC)
Click to expand...
$200/pt across all sites is crazy impressive. Agree that it sounds too good to be true. Keep in mind app had $165. Usacs also. Envision likely a bit higher pre nsa.

Groups can have exceptional contracts, minimal self pay etc.

Medicaid expansion also a factor but I think average for sdgs pre covid /nsa was like 130/135. That’s data from multiple rcm companies.
 
I agree with working more for more per hour...for now. Once I hit a good CoastFI number, I'll probably go to a local but rural hospital that sees 4-5 patients per day and pays around $160/hr, with a longer contract/more hours would probably go up to 180/hr. Working on getting locums shifts there currently. If you don't factor in the 6-8 hours of sleep that people pretty routinely get there that I'd be sleeping at home anyway, that rate goes up 20-30% for pretty minimal work. Work one 48 hour shift two times a month and have enough to live off of and still increase savings a bit, and have 12 days off between shifts making it easy to see the kids a lot and travel more. Yes I make close to $300/hr right now, but I'm already pretty burned out just a couple years out of residency, and I'm not going to be able to keep this up forever. I'm keeping at it due to the increased time value of money saved early on but that will diminish more as I keep getting older.
 
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EctopicFetus said:
OK. I guess im a big fan of 12s but my group doesnt have them.. I’ll try to make it more of an apples to apples comparison.

I’ll restate my question as such would you rather work all 8s and job one see 2 pph and make 300/hr or job b see 1 pph but make 200/hr. The $/unit of work is higher for the lower paying job.

To make 300k in job 1 I have to work 1000 hours a year but I have to work 1500 hours a year in job B to earn the same.

My opinion is clear and skewed as I would frankly rather see 3pph and make 350/hr if it were sustainable than either of the above examples. For the sake of my example i am aware how i would be getting paid less and less per unit of work.

In reality in most true RVU based systems you should frankly be earning more per patient (which is how my sdg works). Every shift I have a fixed cost I cover. We operate as effectively an independent business unit. My scribe cost is fixed, one could argue my med mal cost is fixed and assuming a flat $/pt my fixed costs become a smaller and smaller % of my expense.

Again, I would be curious how the others on here see things. In my opinion part of doing the bare minimum is being at work as little as possible. Maybe my hospitals aren’t that nice but I dont find my time there terribly relaxing regardless of the number of patients I see. The beds suck, the food is average at best, the TVs small etc. I guess I would much rather be home.

Easiest to sprint to the FI line in my mind. As a parent maximizing my time with my kids matters. Whatever your financial goals are I think it is easiest for me to hit my desired income in the fewest hours possible. For those mentioning its a marathon i dont think im terribly special but ive been an attending for 10+ years. My first job out of residency we did a mix of 8,9,12s and I worked like a b*tch. I averaged 160 hours a month or so. Seeing 2pph. I tried to avoid the shorter shifts. Now I see more than 2pph, shifts are 8s and I average 100 hours a month clinically. My only complaint is I wish I could do 8 12s and not 12 8s.
Click to expand...
Yes agree with you, specifically as a function eat what you kill with significant "Fixed" cost (mal practice, lots of the benefits). Adding 1-2 patient per shift is "profit". I want my shifts to mostly be very busy, with just enough downtime to shove calories in my mouth.

Now, I have moonlit places where I am a fixed hourly person. My two favorite of those:
--Moderate sized, moderate acuity hospital-- well staffed w/ PA, MD. Run hard for the first 2-4hr, then slow up and have a snack and go easier the second half of the shift (grab more low acuity). Culture was HIGHLY encouraging of getting out on time. I felt like I did good work for them, but also wasn't sprinting and staying two hours late like my P&L gig (where, granted, I could make more $ if I did that)
--Little freestanding place. Totally didn't mind seeing 1/hr low acuity there. Once you hit a threshold of "i'm just here to hold the fort down" and bring a book, an iPad, a switch deck, and your income taxes to work on... I'm cool with that mode of work. However doing it 14x12hr every month would likely make me crazy. 1-2x/mo? lovely.
 
Mount Asclepius said:
Personal experience. Anyone please share if you have broader data on collections and are able to share.

I don’t think it’s common to average collecting >$200/patient after overhead. Some do, but you have to have a pretty decent payer mix.
Click to expand...
After overhead? That's different. I'd have to dig into the books a bit to know our actual overhead.
 
BoardingDoc said:
I know the data for collections from 6 different EDs in my state, all in very different areas with different demographics. None of them exceed 200/patient on average. I suppose it's possible that my state is simply poorer than yours or that yours is much better insured, but I don't see how your collections is exceeding 200/patient unless your billing is conspicuously high (e.g. adhering to the CMG mentality that every ED visit should be a lvl 5 or CC)
Click to expand...
We're not a CMG. I think our billing is fair. We use a major EM billing company. Our patient population is old and sick so we tend to be pretty level 5 heavy. Another of our EDs averages about 25% more per patient with a much better payer mix. Maybe it's state dependent, but I don't think we're outside the norm here.
 
TooMuchResearch said:
Our patient population is old and sick so we tend to be pretty level 5 heavy. Another of our EDs averages about 25% more per patient with a much better payer mix.
Click to expand...
If you're averaging above 200/patient, that means that your other site is pulling in ON AVERAGE over $250/patient? If true, that is utterly bananas. You must live in an area solely populated by young, well employed people with good insurance. Anyone on medicare/medicaid/self pay is going to bring that average down.

Old+sick as the explanation for this level of reimbursement doesn't track. Even if you bill ONLY lvl 5 charts for those sick old people, medicare pays 5.21 RVU for a 99285. That's $176.57 based on the current RVU conversion factor, which is below your low end 200/pt. Obviously, any patient who bills a lvl 3 or 4 brings the average down further.

Maybe your number is a pre NSA implementation? Or maybe I'm just missing something that changes the fundamental numbers.
 
TooMuchResearch said:
We're not a CMG. I think our billing is fair. We use a major EM billing company. Our patient population is old and sick so we tend to be pretty level 5 heavy. Another of our EDs averages about 25% more per patient with a much better payer mix. Maybe it's state dependent, but I don't think we're outside the norm here.
Click to expand...
Food for thought. A level 5 Medicare patient is paying ~$180 before med mal billing and coding and paying for your medical director/admin scheduler. Average your critical care+obs with level 4 and you end up in a similar spot. Hard to imagine your level 5/cc/obs is at 70% total. Level 4s pay about 130. Weighted averaged would be like 160 (at best).

In general Medicaid while very state dependent is 70% of that but way fewer level 5s.

Your commercial could be way high. That’s the only way to get to $200/chart. Lots of commercial or insanely great commercial contracts (or both).

I’m not doubting you. I worked at a site before where we collected 250/pt+.
 
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