Differences in salaries between different FM options?

[KeikoTanaka]

I’ve been looking in various job boards and obviously many people are looking for FM docs. It appears as if they all offers various practice options though such as optional OB, optional hospital coverage, etc.

My question is: what is the time commitment difference in all these options, and do they change your income? If you did all OB and all hospital coverage, would you make more than those who solely do outpatient? How do you make OB work really? If there’s OBGYNs, and you’re doing clinical hours and a patient is suddenly going into labor, do you leave your clinic to go assist?

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[cabinbuilder]

Your status says pre health. Aren't you jumping way ahead of the game? It all comes down to the negotiation of the contract.

 

[KeikoTanaka]

Your status says pre health. Aren't you jumping way ahead of the game? It all comes down to the negotiation of the contract.

I like to know what options exist, my status shouldn’t change the nature of the question. As I look towards research opportunities I want to know big picture what everything means and what the work is like with different options so I can gear research in that direction

 

[Hippocrates II]

I like to know what options exist, my status shouldn’t change the nature of the question. As I look towards research opportunities I want to know big picture what everything means and what the work is like with different options so I can gear research in that direction

I know it's frustrating to be told that you're putting the cart before the horse given your current place in life, but really, you're 7-8 years out minimum to be in a position affected by these things. No one knows what the market will be like then regarding salary. Case in point, one of the top threads on this FM forum is from 2008 and it's asking about whether or not 200k is possible... today, people are asking if 300k is possible. Times change, hopefully for the better, but TBD. Just focus on getting into school, doing well, and keeping your options open so that you can be dynamic and flexible as the market will tend to do the same.

 

[deleted87716]

Your income will likely be proportional to how much you work, although there are many other variables (e.g., region of the country, employer, compensation plan, payer mix, etc.) People who do hospital and OB generally work longer hours than those who do strictly outpatient, and usually make more money as a result, but that isn’t necessarily the case.

 

[AFMD]

More acute and more procedures = more income. You want money, there's probably easier jobs than medicine, but doing more procedures in more acute settings will get you more money in medicine. If you want minimal training, doing FM/IM and then strictly outpatient cosmetic procedures for cash could maximize your time (in terms of money earned). I'd only do it if you enjoyed it, otherwise you might make more juggling numbers on an excel spreadsheet for some financial company, and you could avoid medicine altogether.

 

[shigatox]

What are the base salaries like for family physicians in California? Working in an out-patient gig M-F 40-50 hours. Not San Fransisco or Los Angeles, but places like Sacramento, Riverside, San Bernandino, etc.

 

[deleted87716]

Base salary...? Why are you afraid to work?

 

[shigatox]

Base salary...? Why are you afraid to work?

No. What does that question have to do with fear from working?

 

[deleted87716]

No. What does that question have to do with fear from working?

You should be asking with the earning potential is, not the minimum.

 

[VA Hopeful Dr]

You should be asking with the earning potential is, not the minimum.

Bingo. When I was interviewing at my current job, they made a big point of telling me the RVUs at the end of the first year that the last eight doctors they hired were making.

Salary guarantee is all well and good, but it's only for one year not the next 30.

 

[shigatox]

Oh, now I see. Thanks for pointing this out. I am naive right now, and I am trying to learn about these things from the forum.

Let me rephrase the question; What is the earning potential for outpatient-only family physicians in California (Riverside, Sacramento, San Bernandino)? I must also add that I am looking at figures attainable by physicians right out of residency.

Thanks again!

 

[AFMD]

For those who are risk adverse, knowing the minimum has a lot of utility. What if the area is already saturated, and you don't ramp? What if there is some other unforeseen issue, or a health/family event, that causes you to not be able to get the numbers you need? These are probably unlikely, but those who are planners and worriers, there is some reassurance from knowing the base salary.

 

[septoplasty]

Oh, now I see. Thanks for pointing this out. I am naive right now, and I am trying to learn about these things from the forum.

Let me rephrase the question; What is the earning potential for outpatient-only family physicians in California (Riverside, Sacramento, San Bernandino)? I must also add that I am looking at figures attainable by physicians right out of residency.

Thanks again!

I don't think the issue is with a number, but the question. There is too much variation in FM to give you a number. If someone gives you a number, that's probably BS.

As senior members posted out above, it varies with what you do. Outpatient only, doing urgent care, doing hospitalist work, doing ED work, doing OB, procedures, doing a combination of all (yes, FM docs do that) etc.

A poor example of this is published in something called "MGMA data". Which tells you 50%tile of FM docs (no idea what they are doing, as above), in the west coast (again, no idea where/what state/type of setting), are making <225k (2016 data). I don't have the latest available data. It costs a lot of money to get this data, and its kept hidden usually for some reason even if its a really ****ty way to quantify.

Anecdotally, I know FM docs who make over 400k. I also know FM docs who make a 1/4 of that.

 

[deleted87716]

Link ---> Compensation is up for family physicians

 

[TableMD]

Link ---> Compensation is up for family physicians

Finally...the time has come, I can get the toilet I deserve. Blue tooth, remote control, dual flush its all there for only 7K

KOHLER Numi Comfort Height One-Piece Elongated Dual-Flush Intelligent Toilet with Integrated Bidet and Premium Remote in White-K-3901-NPR-0 - The Home Depot

 

[deleted87716]

Finally...the time has come, I can get the toilet I deserve. Blue tooth, remote control, dual flush its all there for only 7K

KOHLER Numi Comfort Height One-Piece Elongated Dual-Flush Intelligent Toilet with Integrated Bidet and Premium Remote in White-K-3901-NPR-0 - The Home Depot

Meh. If you want a lot of stuff blown up your ass, work for a health system.

 

[WantToBeFamMed]

I find it hard to understand why anyone in Family Medicine would not want to go rural if they prioritize maximizing their income potential. Pretty much the less supply/competition there is of other people wanting to live and work there, the less replaceable and higher in demand you become. It's one of the few jobs where pretty much the farther you go towards a low cost-of-living location and lower overall median income location, the more money you can make, because there will be more you as one of few physicians in the town are allowed/expected to do to provide the healthcare for the community. Doing ER coverage on top of your usual clinic hours is the big one, you can bring in an extra $60,000-70,000/year easily by doing 48 hours of extra ER coverage per month. And these small towns of 2,000-5,000 people typically average only a patient every 2-4 hours (when you include the slower overnight hours). Then some rural family docs do up to triple those ER hours per month on top of their clinic hours, bringing in an extra $200,000 annually.

If you want to practice Family Medicine in a place somewhere like a Sacramento (I'm just assuming without having ever been there or explored the job market there), I'd count on probably making $160,000 without opportunity for inpatient, OB, or ER, unless you're trying to see like 30+ patients/day, then you probably could push yourself into the low-$200,000's. Cities that size have their own IM, OB/Gyn, and ER physicians for those other duties. Or, you could go somewhere like a small town, away from the city, in say Arizona or Utah (or most states in the country), and probably pull in $400,000 if you wanted to work your butt off (probably more like $300,000 for a typical 50 hr/wk average). Extra perk being that each of your dollars goes twice to triple as far or more when it comes to houses and land when you get to those other places.

So it all depends on your priorities. Do you want to live in a Californian city because it's where you know people and the weather is perfect and there's a ton to do, but struggle to keep up with the rest of the upper-middle class and find an affordable home big enough to raise a family in a nice neighborhood that has decent schools. Or do you want to make twice as much and be able to get a bigger nicer home for half the cost and have extra money to put towards retirement, college funds, travel, a pool, a home gym, or toys like a sports car, an RV, a boat, etc.

 

[deleted87716]

The biggest downside to going rural is, well...being rural (unless that's your thing). You don't have to go rural to make decent money. You just have to find the right job and be willing to work. I could make a lot more money if I wanted to work more, but there's more to life than work, and I'd probably get burned out quickly.

 

[VA Hopeful Dr]

The biggest downside to going rural is, well...being rural (unless that's your thing). You don't have to go rural to make decent money. You just have to find the right job and be willing to work. I could make a lot more money if I wanted to work more, but there's more to life than work, and I'd probably get burned out quickly.

Agreed. There are guys in my group who are seeing 30-40 patients per day. I've seen the figures, they are making insane money. But, that sounds like an awful day. I'm shooting for roughly 24/day (3 an hour is very doable) which will give me a very comfortable living without making me dread going in to work.

 

[deleted87716]

Agreed. There are guys in my group who are seeing 30-40 patients per day. I've seen the figures, they are making insane money. But, that sounds like an awful day. I'm shooting for roughly 24/day (3 an hour is very doable) which will give me a very comfortable living without making me dread going in to work.

There's one guy in my group who makes over half a mil. He works like a maniac, though. Full-time in the office (30+ patients/day), plus hospital, plus multiple medical directorships. No, thanks.

 

[VA Hopeful Dr]

There's one guy in my group who makes over half a mil. He works like a maniac, though. Full-time in the office (30+ patients/day), plus hospital, plus multiple medical directorships. No, thanks.

We have one guy that got pissed off that the NP they hired to handle some of the same day patient load was seeing his patients so now he gets ALL of his patients every day no matter what. He's seeing 40+/day. Granted he's on schedule to earn 35,000+ for May, but that's absolutely not worth it.

 

[QueenJames]

We have one guy that got pissed off that the NP they hired to handle some of the same day patient load was seeing his patients so now he gets ALL of his patients every day no matter what. He's seeing 40+/day. Granted he's on schedule to earn 35,000+ for May, but that's absolutely not worth it.

Goddamn NPs.

I'd feel the same way.

I don't want no frickin' pretend doc messing with my RVUs and billing insurances with my patients.

HOW DO WE STOP THEM!

 

[VA Hopeful Dr]

Goddamn NPs.

I'd feel the same way.

I don't want no frickin' pretend doc messing with my RVUs and billing insurances with my patients.

HOW DO WE STOP THEM!

If you can't accommodate your own patients (and seeing 40+ in an 8 hour day isn't providing good care), then you need to reduce your panel size.

 

[QueenJames]

If you can't accommodate your own patients (and seeing 40+ in an 8 hour day isn't providing good care), then you need to reduce your panel size.

But what iffff....


you CAN...??

 

[VA Hopeful Dr]

But what iffff....


you CAN...??

I've worked at that pace before, and no you can't do a good job in that time. Its just not possible. You can do enough to make sure there's no real harm done, but that's about it.

 

[FrustratedFamDoc]

I'm averaging 20-25 a day typically, and anything over 25 can get pretty punishing. I'm still actively accepting new patients (you're either growing or shrinking in this business) but it's a pinch to get them in.

 

[deleted87716]

If you can't accommodate your own patients (and seeing 40+ in an 8 hour day isn't providing good care), then you need to reduce your panel size.

I tend to agree. Seeing 40+ patients in an 8-hour day amounts to one patient every 10-12 minutes. This may not sound like a big difference between one every 15 minutes (which is what I do), but it's actually huge. You'll probably end up running behind, which I hate doing. Plus, you're going to have essentially no time to chart, much less answer phone messages and take care of all of the other stuff that comes in while you're seeing the patients. All of that's likely going to have to be taken care of during lunch or at the end of the day. The people I know who do that kind of volume inevitably either work late or spend 2-3 hours charting at home every night. No, thanks.

I know one guy (now retired) who had a setup with several MAs working concurrently where the MA would room the patient, get vitals, and do the CC/HPI/ROS. The doc would swoop in after that, do a quick PE and A&P, and move on to the next patient. He routinely saw 40-50 patients/day. He thought he provided good care, and I'm sure he made good money (although he had fairly high overhead with all the extra staff). However, patients either loved it or hated it. I inherited a few of the latter over the years.

 

[VA Hopeful Dr]

I tend to agree. Seeing 40+ patients in an 8-hour day amounts to one patient every 10-12 minutes. This may not sound like a big difference between one every 15 minutes (which is what I do), but it's actually huge. You'll probably end up running behind, which I hate doing. Plus, you're going to have essentially no time to chart, much less answer phone messages and take care of all of the other stuff that comes in while you're seeing the patients. All of that's likely going to have to be taken care of during lunch or at the end of the day. The people I know who do that kind of volume inevitably either work late or spend 2-3 hours charting at home every night. No, thanks.

I know one guy (now retired) who had a setup with several MAs working concurrently where the MA would room the patient, get vitals, and do the CC/HPI/ROS. The doc would swoop in after that, do a quick PE and A&P, and move on to the next patient. He routinely saw 40-50 patients/day. He thought he provided good care, and I'm sure he made good money (although he had fairly high overhead with all the extra staff). However, patients either loved it or hated it. I inherited a few of the latter over the years.

I saw about that rate when I did full time urgent care. It was barely manageable then since it was mostly single issue, simple problems. No way I could have done it with typical family medicine patients

 

[betamale]

I tend to agree... However, patients either loved it or hated it. I inherited a few of the latter over the years.

Well they hate you even if you do well or not or if you talk for <5 or >20 mins. 40+/day tells me many ppl liked him/her enough to keep coming in...must be nice to have the ability to provide that many visits/day. Kudos to his office staff for being accommodating. Biggest danger to me is having pts with a possible urgent issue being undertiaged and made to wait for available appts. Obviously, urgent stuff can be addressed fairly quickly if pts can get in and the MA can prevent the patient from abusing the system by limiting complaintsto 1-2/encounter and if they can DC the pt as well to prevent those last minute complaints.

 

[VA Hopeful Dr]

Well they hate you even if you do well or not or if you talk for <5 or >20 mins. 40+/day tells me many ppl liked him/her enough to keep coming in...must be nice to have the ability to provide that many visits/day. Kudos to his office staff for being accommodating. Biggest danger to me is having pts with a possible urgent issue being undertiaged and made to wait for available appts. Obviously, urgent stuff can be addressed fairly quickly if pts can get in and the MA can prevent the patient from abusing the system by limiting complaintsto 1-2/encounter and if they can DC the pt as well to prevent those last minute complaints.

Or it means you're a Candyman for whatever the patients want

 

[septoplasty]

Or it means you're a Candyman for whatever the patients want

This is usually the UC though, because they're always convinced they have bacterial sinusitis after 2 days of runny nose & coughing.

 

[TableMD]

Such a big difference between an acute with someone you know/hopefully trusts you vs a new acute. The people that I know are usually happy to just know what I think.

Anyways I cap out at 22/day.

That 40/day thing sounds like a nightmare.

 

[Bacchus]

Anyone else having changes in wRVU rate? This year I was 43.XX and next year I’m down to 42.57. Is this common?

 

[Ericslv]

Oh, now I see. Thanks for pointing this out. I am naive right now, and I am trying to learn about these things from the forum.

Let me rephrase the question; What is the earning potential for outpatient-only family physicians in California (Riverside, Sacramento, San Bernandino)? I must also add that I am looking at figures attainable by physicians right out of residency.

Thanks again!

Most family physicians make between 200-250. Some make more if they do ER or OB. With more money comes more work and time away from other things. Procedures pay more. There are not many high paying procedures in Family medicine. I think that answers your question. If that is not enough for you OR you don't want to do all those years of school, debt and missing out on life, then consider another profession. If you don't mind the years, debt, missing out on life and now the major possible changes to medicine then go into it and TRY to go into a specialty that pays more. However, you may end up in a lower paying specialty because you may not have the board scores or just the luck of the draw. So make sure medicine is right for you. And no, it's like it's on TV. You get to try to solve peoples problems all day. Many times there is no solution. Sometimes patients are upset. They get to take it out on you. And you have to do it over and over again. Understand what you are getting into.

 

[BorntobeDO?]

Meh. If you want a lot of stuff blown up your ass, work for a health system.

I don't know, this description doesn't sound like my hospital employee experience: "I knew from the moment I saw the cinematography in this commercial it was destine to impress. The moment I sat on this masterpiece ( toilet doesn't do it justice) I knew I was in for a treat. I live in florida but the heated seat seemed to ease my bowels better than the most potent laxative on the market. I saw down and played Mozart and waited for the magic to happen. As my bowls moved with the rhythm of the music my feet felt at peace with the warmers. Once it was completed the soothing jets finished me off with a clean feel that made me want to shout from the highest mountain top! MUST TRY THIS TOILET."

I think a hospital is more apropro to getting an administrators bowels loosened upon you than helping you go.

 

[BorntobeDO?]

If you can't accommodate your own patients (and seeing 40+ in an 8 hour day isn't providing good care), then you need to reduce your panel size.

I don't know about reducing my size due to an inability to accommodate. Seems like it should be the other way around.

 

[VA Hopeful Dr]

I don't know about reducing my size due to an inability to accommodate. Seems like it should be the other way around.

Huh?

 

[BorntobeDO?]

Huh?

I think you thought too hard on that one. Accommadation can always be made for increased size. Just got to give it some time to adjust

 

[VA Hopeful Dr]

I think you thought too hard on that one. Accommadation can always be made for increased size. Just got to give it some time to adjust

So you have a panel of 3000 patients. Acute visits can't be seen sooner than one week, chronic follow ups 1 month. You already work 5 days per week, 15 minute appointment slots.

So what's your plan other than reducing panel size so that all of your patients can be seen in a timely manner.

 

[BorntobeDO?]

So you have a panel of 3000 patients. Acute visits can't be seen sooner than one week, chronic follow ups 1 month. You already work 5 days per week, 15 minute appointment slots.

So what's your plan other than reducing panel size so that all of your patients can be seen in a timely manner.

A. The post was a joke, one that I thought was fairly obvious (unless your Asperger's and don't understand that sort of thing, in which case I apologize).

B. Since you are asking I think the only way to break the barrier is to reduce the paperwork. This means putting as much of the scut on office staff as possible. Full ROS done by nurses with checkboxes etc. If you wanted to take it to the next level you have a PA/NP do a full SOAP, and you come in and proofcheck/adjust the A/P.

Obviously some patients, especially older, will not be happy with a setup as above. You would lose them, but with such a large panel it wouldn't be a big deal IMO. Depending on reimbursement (I would assume a capitation model for a large panel), you would have people in the panel who basically came to see you maybe once every couple years before insurance was changed or lost. You would be selecting for the healthier, working age end of the spectrum.

I would expect high turnover, but this is common in the younger populations whose insurance is constantly changing. Thats what I would imagine someone is doing with a panel like that.

 

[VA Hopeful Dr]

A. The post was a joke, one that I thought was fairly obvious (unless your Asperger's and don't understand that sort of thing, in which case I apologize).

B. Since you are asking I think the only way to break the barrier is to reduce the paperwork. This means putting as much of the scut on office staff as possible. Full ROS done by nurses with checkboxes etc. If you wanted to take it to the next level you have a PA/NP do a full SOAP, and you come in and proofcheck/adjust the A/P.

Obviously some patients, especially older, will not be happy with a setup as above. You would lose them, but with such a large panel it wouldn't be a big deal IMO. Depending on reimbursement (I would assume a capitation model for a large panel), you would have people in the panel who basically came to see you maybe once every couple years before insurance was changed or lost. You would be selecting for the healthier, working age end of the spectrum.

I would expect high turnover, but this is common in the younger populations whose insurance is constantly changing. Thats what I would imagine someone is doing with a panel like that.

I guess I just don't expect to see penis jokes in this part of the forum for some weird reason..

 

[BorntobeDO?]

I guess I just don't expect to see penis jokes in this part of the forum for some weird reason..

So you have a joke about a 7k toilet, and the hospital crapping on us, but the penis joke just doesn't fit in? Its been a long week hasn't it? The internet is for fun, no one should take it too seriously.

 

[VA Hopeful Dr]

So you have a joke about a 7k toilet, and the hospital crapping on us, but the penis joke just doesn't fit in? Its been a long week hasn't it? The internet is for fun, no one should take it too seriously.

Ha, I didn't even see the post with the toilet. This all makes more sense now.