Doctors going bankrupt?

[rafman]

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Just read this article on Yahoo about doctors with small practices going broke due to medicare:

http://finance.yahoo.com/news/small-business-doctors-going-broke-101200127.html

 

[Prncssbuttercup]

Yeah, it's pretty sad. I think it is a combination of insurance, medicare, and cost increases. I wouldn't want to pin it solely on medicare, but it certainly isn't helping when you're barely scraping by. I think insurance companies have a hand in it as well, considering a surgery I had (so I saw the bill) was billed at ~5k, and Blue Cross paid them a total of ~$800. It's pretty ridiculous...

 

[NeuroDocDO]

The outlook for medicine looks pretty grim. 🙁

 

[Art3MiS]

That's pretty worrisome, is anyone else very worried about this?

 

[DocEspana]

I hold the radical position that anyone clearing 100k or more after every last cost and insurance can't honestly be on dire straights.

Sure physicians fail, just like any small business. Its due to poor business not the state of medicine. These guys would have also failed at any other small business venture they might have undertaken in all likelihood. Sure medical business is unique to some degree, its not unique enough for simple "that happens to many small businesses" to entirely explain why a few go bankrupt and are outliers.

Unless you're talking sgr, physicians arguing about income loss is sort of like tornado alley demanding extra federal disaster relief for 5 extra tornadoes than the mean. It's real. It does deserve attention, but when you're dealing with a number of tornados so far from the norm for anyone else (or pay so far from the norm) the relative insignificance is hard to totally ignore, despite the raw value impact.

 

[Futureofyourtv]

I just read this and was going to make a thread on it. You beat me to it. Unfortunately, yes there is some truth to it. However, I do strongly believe that a good chunk of this has to do with piss poor business skills. Lets face it you guys. BEING A GREAT DOCTOR DOES NOT EQUAL SUCESSFUL BUSINESSMAN😉
Like the piece mentioned, a private practice is like a small business. I think its time that med schools across the board start including business courses into their curriculum(if they are not doing so already). Or perhaps add to their pre-requisites a business course or two. If I am not mistaken, macro or microeconomics is a pre-req at most pharmacy schools?
I think we should all accept NOW that the days of luxury and uber-wealth as a doc are over(for most of us anyway). Any of u still pursuing medicine so u can be swimming in the benjamins are going to be disappointed. We are not going to be Dr. Oz, Dr. Drew, and Dr. Gupta's. Enjoy your work and accept ur salary. If your aim is wealth, maybe u should find something else to do. 😉

 

[futuredoc15]

But every single premed here knows that they are the student who will be at the top of the class, get 99+ percentile COMLEX and USMLE scores, get into the ultracompetitive plastic surgery residency, and live happily ever after taking cash only for their cosmetic services.
And every premed here knows that their loans are irrelevant since they will be making 7 figure salaries every year.

 

[JeetKuneDo]

I read this in the gas forum. Very unfortunate and depressing news.

 

[Futureofyourtv]

But every single premed here knows that they are the student who will be at the top of the class, get 99+ percentile COMLEX and USMLE scores, get into the ultracompetitive plastic surgery residency, and live happily ever after taking cash only for their cosmetic services.
And every premed here knows that their loans are irrelevant since they will be making 7 figure salaries every year.

🙄 And this is part of the problem for most premeds: completely delusional and naive. Life will not always work out the way u planned. Most of us WILL NOT end up in competitive and lucrative specialties. You better all get over it(I am saying this as a premed myself).
About the loans...I know a doc approaching his 50s and just now finished paying off his loans.
I said it before and will say it again: most of you us will not be Gupta's, Oz's, and Drew's. A lot of industries have taken a hit nowadays anyway. Medicine is not immune. I still stand by the statements I made in my previous comment🙂

 

[TexasPhysician]

The problem is with Medicare/insurance. Eventually physicians may band together and universally refuse to accept anything other than cash/credit card up front. Physicians provide a service like retailers, wholesalers, attorneys, etc. We are the only ones not paid the amount on the bill. It's sad really.

 

[zoomzoom123]

🙄 And this is part of the problem for most premeds: completely delusional and naive. Life will not always work out the way u planned. Most of us WILL NOT end up in competitive and lucrative specialties. You better all get over it(I am saying this as a premed myself).
About the loans...I know a doc approaching his 50s and just now finished paying off his loans.
I said it before and will say it again: most of you us will not be Gupta's, Oz's, and Drew's. A lot of industries have taken a hit nowadays anyway. Medicine is not immune. I still stand by the statements I made in my previous comment🙂

I think futuredoc15 would also agree with what you have to say. He was being sarcastic

 

[Futureofyourtv]

I think futuredoc15 would also agree with what you have to say. He was being sarcastic

🙂 I am aware he/she is being sarcastic, but sadly he/she is describing the mindset of real premeds. Trust me, I personally know a few of them. Delusional rugrats I tell you lol. "It won't happen to me. I'm smart and I went to an Ivy League school. If I aced Physics 1and 2 I know I'll get the highest score on my USMLE's. I'm gonna get that derm. Just watch me"
Does anyone know much about concierge medicine? I always saw it as a system that would benefit rich people, but perhaps I'm wrong. Any thoughts?

 

[Prncssbuttercup]

Crap, my whole plan all along has been to work in FP/IM and be underpaid and overworked so I can get the Fed to pay off my loans for me. Wth, I hope you don't think I'm the delusional premed (other than thinking the Fed will have money in 7yrs)

 

[JeetKuneDo]

Whenever I hear the term concierge medicine, I think of royal pains and the hamptons.

 

[Futureofyourtv]

Crap, my whole plan all along has been to work in FP/IM and be underpaid and overworked so I can get the Fed to pay off my loans for me. Wth, I hope you don't think I'm the delusional premed (other than thinking the Fed will have money in 7yrs)

😉 Lets hope u're not. I hope ur plan was to live out ur passion for medicine and save some lives.

 

[Futureofyourtv]

Whenever I hear the term concierge medicine, I think of royal pains and the hamptons.

Interesting. Well is concierge medicine a viable option for doctors? How will low-income earners afford it? These are my concerns.
I must say I am very suprised that this thread does not have many responses. This is a serious issue that will impact all of us, M.D. or D.O.😕

 

[docmayer]

absolutely ridiculous.

 

[Queenofspades]

Interesting. Well is concierge medicine a viable option for doctors? How will low-income earners afford it? These are my concerns.
I must say I am very suprised that this thread does not have many responses. This is a serious issue that will impact all of us, M.D. or D.O.😕

I've been thinking about this quite a lot. It seems like a good approach might be to have a mixed practice - be a member of a Concierge group and take on a manageable number (although depending on the practice and clients who knows what "manageable" might be) of Concierge clients and on the side/half-time maintain a regular practice (in a group ideally to my mind) as a mix would be ideal.

That's my current hypothesis but I'm wondering if anyone is doing this or experimenting with it...?

 

[notbobtrustme]

That article says more about the decline of private practice more than anything else.

 

[JESSFALLING]

But every single premed here knows that they are the student who will be at the top of the class, get 99+ percentile COMLEX and USMLE scores, get cash only for their cosmetic services.

Many psychiatry practices are run like this too, which is one reason I am interested in the field. Personally, I want to spend my day practicing medicine, not fiddling around with coding and billing and staff.

 

[Iliketoytles]

We all know business is going to play a huge part of what we do and how we do it in a few years. This may be ignorant to say, but the smart businessmen/women will be the ones who overcome the problems facing private practices... because they will be 10 steps ahead of the game.

 

[futuredoc911]

The only way to make a lot (this number is different for everyone) as a doctor in the future is to go into certain specialized surgery or certain specialized non surgical fields and to be top notch at it also. The trend is moving away from private practice however it would still be possible if you have a "unique" practice or take payment and then bill to the patient to give to their insurance for the patients reimbursement. Otherwise the trend is to be an employee of a hospital or a medical group where you are paid on a salary and they usually cover your malpractice insurance as well. A number of doctors are now doing this and making a great salary and the hospital pays all of the overhead costs for the doctors in the group. The downside is you are an employee and it is not your own business if that is what you want but that is going to only get tougher to do in the future.

In the end the doctors who are smart business men/women tend to be pretty successful. Unfortunately most doctors are not the most business and financial savvy people.

 

[Futureofyourtv]

I've been thinking about this quite a lot. It seems like a good approach might be to have a mixed practice - be a member of a Concierge group and take on a manageable number (although depending on the practice and clients who knows what "manageable" might be) of Concierge clients and on the side/half-time maintain a regular practice (in a group ideally to my mind) as a mix would be ideal.

That's my current hypothesis but I'm wondering if anyone is doing this or experimenting with it...?

Some doctors are currently doing this apparently. Here is the website for the AAPP(American Academy of Private Physicians): http://www.aapp.org/
This is straight from their site:
"The American Academy of Private Physicians (AAPP) is the national association of physicians who provide “concierge medicine,” fee-for-service, and other forms of health care delivery characterized by a direct, financial relationship between private physicians and their patients. This movement will forever change American health care by restoring the doctor-patient relationship of times past – private doctors unencumbered by insurance company policies, provider-network constraints, and the misaligned incentives that have infected our health care system."
I'm still not convinced yet. I need to see some long-term docs who utilized concierge medicine successfully. Still seems like an experiment to me. Your idea on a mixed practice sounds reasonable. Does anyone on SD know of any docs who are doing this? One of u has to know someone😕

 

[Futureofyourtv]

We all know business is going to play a huge part of what we do and how we do it in a few years. This may be ignorant to say, but the smart businessmen/women will be the ones who overcome the problems facing private practices... because they will be 10 steps ahead of the game.

Sir or ma'am, I don't think this is ignorant at all. I would agree. The problem is it is not part of a doctor's training(why not?) unless you pursue an M.D./M.B.A. or you actively involve urself in business so u understand.
Do we really need to go into private practice anyway🙄

 

[jinobi]

Concierge medicine? Here's a successful model:

http://www.onemedical.com

 

[Corpsman Up]

The problem is with Medicare/insurance. Eventually physicians may band together and universally refuse to accept anything other than cash/credit card up front. Physicians provide a service like retailers, wholesalers, attorneys, etc. We are the only ones not paid the amount on the bill. It's sad really.

I really like the way you put this. I don't think it's fair for people to expect providers to sacrafice so much going through 11+ yrs of school/training and accumulate so much debt but still not be compensated for their services because they feel that they are entitled to low cost/no cost healthcare. So many people lobby for that but never bother to address the overwhelming debt a doctor accumulates to provide these services. Can a person really be expected to rack up 300k in loans and work for a much lower salary (or even go bankrupt) just out of a desire to "help" other people?

 

[Prncssbuttercup]

😉 Lets hope u're not. I hope ur plan was to live out ur passion for medicine and save some lives.

That's why I'd be willing to be over worked and underpaid 😉 I want to work where I'll do the most good, which is primary care. The fed potentially paying off my loans is just a cherry on top... 😉

I think it is a combination of insurance, medicare, and cost increases. I wouldn't want to pin it solely on medicare, but it certainly isn't helping when you're barely scraping by.

Dude copy/paste much??

 

[Dharma]

All reasons to avoid primary care like the plague. Especially when the average PCP will be competing with Noctors in the next 10-20 years.

 

[sylvanthus]

That's why I'd be willing to be over worked and underpaid 😉 I want to work where I'll do the most good, which is primary care. The fed potentially paying off my loans is just a cherry on top... 😉


Dude copy/paste much??

I call bull****, you have barely started, see how you feel after busting your ass for the next 7 years.

 

[sandstone]

I am a bit confused about why docs are going so broke, especially those who are not running a private practice. If I were to be FP doc with 300K in debt to pay off and making, say, $170,000/yr. If I were to live on $60,000/yr (which is double what I live on now, and I live decently well), and pay ~20,000/yr in malpractice insurance (this is just a guess based on some averages I found online), that leaves about $90,000/yr to go to loan payoff. Why can't I have my school loans payed off in five years? Do people try to buy a mansion and porsche as soon as they're done with residency and that's why they can't pay off loans or what? Please let me know if I'm missing something.
EDIT: I guess I didn't account for taxes, but even with taxes it seems like it wouldn't take more than 5-10 years to pay off loans and then live a nice doctor lifestyle.

 

[BenZq]

.

 

[notbobtrustme]

All reasons to avoid primary care like the plague. Especially when the average PCP will be competing with Noctors in the next 10-20 years.

yea, this combined with decreasing medicare/medicaid reimbursements for office visits practically means that primary care is dead to physicians.

 

[pancakesyrup]

I've never met any actual physicians who say primary care is doomed for doctors.

It seems like typical SDN gloom and doom trolling here.

 

[DocEspana]

I've never met any actual physicians who say primary care is doomed for doctors.

It seems like typical SDN gloom and doom trolling here.

👍 👍 👍 👍 👍 👍 👍

for the love of all that is good and holy listen to this man 👍

 

[DubVille]

I am a bit confused about why docs are going so broke, especially those who are not running a private practice. If I were to be FP doc with 300K in debt to pay off and making, say, $170,000/yr. If I were to live on $60,000/yr (which is double what I live on now, and I live decently well), and pay ~20,000/yr in malpractice insurance (this is just a guess based on some averages I found online), that leaves about $90,000/yr to go to loan payoff. Why can't I have my school loans payed off in five years? Do people try to buy a mansion and porsche as soon as they're done with residency and that's why they can't pay off loans or what? Please let me know if I'm missing something.
EDIT: I guess I didn't account for taxes, but even with taxes it seems like it wouldn't take more than 5-10 years to pay off loans and then live a nice doctor lifestyle.

Well the IRS may not appreciate that.... nevermind, I didn't see your edit.

Still if you are willing to live like a resident for 5-10 years after training, you will be on the cusp of 40 by the time you will have the money to take regular vacations, start a family, buy a house, save for retirement, etc. I think about it all the time because I am terrified! I have hated everything in 3rd year except FM and outpatient IM..... but I still have some time!

 

[Iliketoytles]

Sir or ma'am, I don't think this is ignorant at all. I would agree. The problem is it is not part of a doctor's training(why not?) unless you pursue an M.D./M.B.A. or you actively involve urself in business so u understand.
Do we really need to go into private practice anyway🙄

Only males like turtles. 😎

You're right about business not really being a part of medical training... but I'm sure you agree that there's probably no time for such classes. Wouldn't be a bad idea for an elective though... but might as well dual degree with an MBA.

One doesn't have to have a business degree to understand how it works though. And you might be right, why go into private practice? I've always learned that it's better to work for yourself than under someone else. Sure working in a hospital will give you perks... cover your malpractice, etc... but there's something uncomfortable about your career resting in the hands of administration, who may not be aware of how hard you work and how much you love what you do. If you understand business and establish a solid practice, independent practice is much more secure and in my opinion, there may be a better quality of patient care.

 

[Prncssbuttercup]

I call bull****, you have barely started, see how you feel after busting your ass for the next 7 years.

Idk, for ****s and giggles I did some searching on physician recruitment sites today. I wasn't so depressed seeing jobs in the areas I'm willing to work that pay 225k (for family practice) with 200k in loan repayment (time commitment not specified), and up to 20k in relocation assistance. I am not really worried about the whole primary care thing, and considering I have two friends doing it, who both are making that much, I'm even LESS worried about it. Since you don't know me, or anything about me, you're calling BS on the wrong person.

 

[Panda247]

I know this is a little off topic... but this is one of the reasons why im seriously considering the HSPS... because I know that if everything in this country goes down the drain, the military will be one of the last things standing(currently having the biggest budget I believe? correct me if im wrong please). I'd rather have the security of big brother watching me than the insecurity of making it on my own.

 

[TheRadiologist]

I have been in private practice for two decades and know hundreds of physicians. I only know of one physician that financially failed. He was a surgeon who did not take any managed care patients as a matter of principle. I suspect that those going bankrupt were in special situations like an Oncologist who bought a chemo drug at a high price and is not able to get enough payment to recoup his cost because cutbacks in payment. The Oncologists doing this made boatloads of money all these years when they could buy chemo drugs cheap and sell them to patients at inflated prices. They will not be able make profits off the drugs as easily in the future, so they will have to adapt to the market. If they just made the patient pay for the drug, they will not loose any money, but they will not make any money either. After going bankrupt, these oncologists may have to settle for an annual income of 350-400K in the future instead of the 500-700K they were making before the cutbacks for drug payments. None of these guys going bankrupt is going be on food stamps very soon.

 

[AD04]

I have been in private practice for two decades and know hundreds of physicians. I only know of one physician that financially failed. He was a surgeon who did not take any managed care patients as a matter of principle. I suspect that those going bankrupt were in special situations like an Oncologist who bought a chemo drug at a high price and is not able to get enough payment to recoup his cost because cutbacks in payment. The Oncologists doing this made boatloads of money all these years when they could buy chemo drugs cheap and sell them to patients at inflated prices. They will not be able make profits off the drugs as easily in the future, so they will have to adapt to the market. If they just made the patient pay for the drug, they will not loose any money, but they will not make any money either. After going bankrupt, these oncologists may have to settle for an annual income of 350-400K in the future instead of the 500-700K they were making before the cutbacks for drug payments. None of these guys going bankrupt is going be on food stamps very soon.

Do you know of a primary care doctor in private practice with at least 50% medicare patients? Are they doing ok too?

 

[MrNovember]

All reasons to avoid primary care like the plague. Especially when the average PCP will be competing with Noctors in the next 10-20 years.

This part concerns me, not just for the sake of primary care but for the sake of healthcare in general in this country. I work in a pharmacy and I am concerned that massive numbers of prescriptions are written by nurses/PAs. More times than I could count these prescriptions have been written INCORRECTLY. These 'Noctors'... who knows how much medical training they've had yet they are writing prescriptions.

 

[DocEspana]

Do you know of a primary care doctor in private practice with at least 50% medicare patients? Are they doing ok too?

I know of 4 (two different clinics) who deal with >66% medicare patients, confirmed, and over 75% likely. They're doing damn well. I rotate under one of them and he is doing damn well. He's in a poor area of queens and nassau county NY doing FM for the dregs of society and hes rolling in the dough. The fact that this guy is sharp as hell, and his partner and the other two with thier office are very similar people, likely has to do with thier success.

 

[DuxburyPembroke]

I know of 4 (two different clinics) who deal with >66% medicare patients, confirmed, and over 75% likely. They're doing damn well. I rotate under one of them and he is doing damn well. He's in a poor area of queens and nassau county NY doing FM for the dregs of society and hes rolling in the dough. The fact that this guy is sharp as hell, and his partner and the other two with thier office are very similar people, likely has to do with thier success.

Are their practices attached to larger institutions? I know one PCP whose (largely medicare and medicaid) private practice lost money every year until he sold it to the area hospital conglomerate. He still practices in the same office, with mostly the same staff, but now the practice pays a much lower price for labwork and gets much higher remuneration for services. He hates that his practice is now a franchise, but he gets to practice in much the same way without having to worry so much - and he got to keep his medicaid patients in the practice. His family is happier, too. I wonder if part of health reform should include making prices be the same for every customer.

 

[docnotsopc]

Apparently "they" were saying doctors were going to go bankrupt 20 years ago too....... so I dont know. I dont believe it personally, although i know tons of my classmates have no money sense so I can see them digging themselves a hole of debt beyond tuition loans

 

[FrkyBgStok]

I shadowed a doc who said the reason the old doctors are pissed is because they aren't making the same money they were and there is nothing they can do about it.

I want to think this will level out. If medicare and insurance (and whatever else) screw the doctors more, at some point they will start saying, "eff you, I am not doing that." Enough doctors will fall in line, not because they are greedy, but because they can't afford to. Patients will start to get shafted and get pissed because the doctors aren't providing care. Doctors will push the blame and before long, both doctors and patients will be against the companies that refuse to provide care. These companies will either adapt or get washed ou by the companies that will. in time, things will balance.

At least that is what I hope, and I start med school in aug so I have no idea what I am talking about either.

 

[DocEspana]

Are their practices attached to larger institutions? I know one PCP whose (largely medicare and medicaid) private practice lost money every year until he sold it to the area hospital conglomerate. He still practices in the same office, with mostly the same staff, but now the practice pays a much lower price for labwork and gets much higher remuneration for services. He hates that his practice is now a franchise, but he gets to practice in much the same way without having to worry so much - and he got to keep his medicaid patients in the practice. His family is happier, too. I wonder if part of health reform should include making prices be the same for every customer.

No. just independent practices floating out there.

To comment on what someone else said: its true. Everyone complains because salaries are going down from what they used to be. Its fine, its fair, you're allowed to complain about that. But the impact is so distorted from reality. But, as i said before, its like complaining that there are 5 more (or less) tornados in tornado alley in a year. That handful of states gets between 50 (oklahoma) to 110 (North Texas) per year, while most states get 2-5. Saying texas got 5 less tornados this year is big in the sense that its a 100-250% decrease in the norm from what most states get. But its an insignificant 4% decrease by texas standards. Physicians complain about this stuff because it does seriously increase their work load and lower their income in an absolute sense. But it is rather insignificant when you relate it to what they are still earning. Its one of the reasons no physician ever talks openly about their earnings.... it ruins the mystique that they are trying to foster that everyone is making them poor. Its only correct if you look at how much they've lost without the context of what they are still earning, and if you only focus on the random outlier failures rather than the overwhelming majority who are affected only minorly.

This coming from a person who spends his free time fighting for physicians and their income. I want physicians to keep every cent as its a trend I dont support and could eventually lead to a very different income situation for phyicians. But any horror stories set in the present are gross and belligerent in their inaccuracy towards the actual situation for nearly everyone unless the physician was a bad businessman or some other extraneous factor played into it.

 

[Postictal Raiden]

No. just independent practices floating out there.

To comment on what someone else said: its true. Everyone complains because salaries are going down from what they used to be. Its fine, its fair, you're allowed to complain about that. But the impact is so distorted from reality. But, as i said before, its like complaining that there are 5 more (or less) tornados in tornado alley in a year. That handful of states gets between 50 (oklahoma) to 110 (North Texas) per year, while most states get 2-5. Saying texas got 5 less tornados this year is big in the sense that its a 100-250% decrease in the norm from what most states get. But its an insignificant 4% decrease by texas standards. Physicians complain about this stuff because it does seriously increase their work load and lower their income in an absolute sense. But it is rather insignificant when you relate it to what they are still earning. Its one of the reasons no physician ever talks openly about their earnings.... it ruins the mystique that they are trying to foster that everyone is making them poor. Its only correct if you look at how much they've lost without the context of what they are still earning, and if you only focus on the random outlier failures rather than the overwhelming majority who are affected only minorly.

This coming from a person who spends his free time fighting for physicians and their income. I want physicians to keep every cent as its a trend I dont support and could eventually lead to a very different income situation for phyicians. But any horror stories set in the present are gross and belligerent in their inaccuracy towards the actual situation for nearly everyone unless the physician was a bad businessman or some other extraneous factor played into it.

👍👍👍👍👍 I agree with everything you wrote.

 

[Dharma]

I've never met any actual physicians who say primary care is doomed for doctors.

It seems like typical SDN gloom and doom trolling here.

"Doom" is stretching it and I was certainly not making any claim about the field as a whole, but rather my own personal opinion towards the current climate, or rather potential climate change. Midlevels are infiltrating the field to some degree and there is a push for autonomy by the DNP's. That said, you can bet your @$$ that somewhere, someplace, and to some varying degree, primary care will be coming at a cheaper price, without the physician's involvement in the process. I understand that's a bit off-topic, but it is definitely something that concerns me, and that said, something I'd rather avoid, if at all possible. Just my stance. No trolling homie.

 

[TheRadiologist]

Do you know of a primary care doctor in private practice with at least 50% medicare patients? Are they doing ok too?

Most IM primary care practices are greater than 50% Medicare in my area.None of them are going broke. Some are doing a lot better than others. I know of one OB/GYN who had a practice with only public AID. He worked like a dog and did a massive volume of work, but cleared $ 800K+ after expenses.

 

[NurWollen]

I've never met any actual physicians who say primary care is doomed for doctors.

It seems like typical SDN gloom and doom trolling here.

So true!! So often I mention a current issue in healthcare/medical education that I read about on SDN to a physician or some other healthcare provider and they look at me funny.