Doctor's office in tall building downtown?

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shangrila

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My question might seem a little odd, but I come from a family of architects, so I have always dreamed of working in a 30/40+ story building downtown in a large city. Unfortunately I recently realized that being a future doctor instead of lawyer/banker/businessperson, the chances of this happening is slim. Nonetheless, I know that psychiatrists and dermatologists can set up private practices in these places, but wouldn't their overhead, ie. overbearing rent, be 10 times their revenues? And are there other methods for doctors to work in a tall office building downtown? (not including working in hospitals like Northwestern's)

Obviously I don't mind working in a normal hospital because I chose this profession and I'm not going to choose a specialty purely based on this, but I just wanted to know if this particular childhood aspiration of mine can still come true.
 
Agreed this is one of the stranger posts. Having said that...there are a ton of dental offices in downtown chicago on the upper floors...with suites facing the lake or millennium park...they are very upscale and use their address as part of their selling point. They also service the tens of thousands of employees who work in those buildings...making scheduling patients not that difficult

I'm sure a physician could do just as well...especially the procedural based specialties.

Seems like you shouldn't be worrying about this for many years though.
 
I recognize that this sounds strange, but everyone's got their unique preferences, and this is what happens when you grow up in a family of architects. Northwestern Memorial Hospital is a good height, but could be a little taller... From what I know, there are no hospitals that are at least 30/40 stories.

How do medical practitioners afford to rent out space in a downtown Chicago office building that costs 10 times the rent of a community medical building when they would bill at similar rates at either location? Wouldn't their overhead exceed their revenue?
 
Mad Jack said:
I think you really need to get your priorities straight. This is quite possibly the dumbest career fetish I've ever heard of.
Click to expand...
trust me it is quite reasonable and well put compared to other's peoples drives in their careers.
I would think the first sentences of this thread would make a great letter for residency candidature.
 
shangrila said:
I recognize that this sounds strange, but everyone's got their unique preferences, and this is what happens when you grow up in a family of architects. Northwestern Memorial Hospital is a good height, but could be a little taller... From what I know, there are no hospitals that are at least 30/40 stories.

How do medical practitioners afford to rent out space in a downtown Chicago office building that costs 10 times the rent of a community medical building when they would bill at similar rates at either location? Wouldn't their overhead exceed their revenue?
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texas medical center could be your shangrila, but still, you could probably set a private office in a taller building.
 
you can always do md consulting for a very big company, if tall building are really your thing.
 
shangrila said:
I recognize that this sounds strange, but everyone's got their unique preferences, and this is what happens when you grow up in a family of architects. Northwestern Memorial Hospital is a good height, but could be a little taller... From what I know, there are no hospitals that are at least 30/40 stories.

How do medical practitioners afford to rent out space in a downtown Chicago office building that costs 10 times the rent of a community medical building when they would bill at similar rates at either location? Wouldn't their overhead exceed their revenue?
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They don't rent that space unless they hate money.

Does your family of architects have any experience with hospital architecture? There is a reason why huge multi level hospitals are logistically unfavorable.
 
Kahreek said:
you cant judge people's dreams.
Click to expand...

Yeah, I'm never really clear on where and when to judge. Thanks.

I dreamed up some really silly **** as a kid, glad to know I can announce pursuit of said silly **** on here and not be judged.
 
Mad Jack said:
I think you really need to get your priorities straight. This is quite possibly the dumbest career fetish I've ever heard of.
Click to expand...

OP made it pretty clear that this isn't something he isn't going to base his career goals around working in a high-rise. There's nothing dumb about having a "fetish" like this. It's no different than wanting to have a mansion or a super-sporty car.
 
bunionberry said:
OP made it pretty clear that this isn't something he isn't going to base his career goals around working in a high-rise. There's nothing dumb about having a "fetish" like this. It's no different than wanting to have a mansion or a super-sporty car.
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I'm not sure you're clear on the definition of "different".
 
bunionberry said:
OP made it pretty clear that this isn't something he isn't going to base his career goals around working in a high-rise. There's nothing dumb about having a "fetish" like this. It's no different than wanting to have a mansion or a super-sporty car.
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I think those things are childish too

But it's not like most doctors will ever have that much wealth to hoard. If they're driving a ridiculously expensive sportscar, 9 times out of 10 they're making horrible financial decisions for themselves.
 
WhippleWhileWeWork said:
I'm not sure you're clear on the definition of "different".
Click to expand...

Please elaborate then.

Kaputt said:
I think those things are childish too

But it's not like most doctors will ever have that much wealth to hoard. If they're driving a ridiculously expensive sportscar, 9 times out of 10 they're making horrible financial decisions for themselves.
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I don't know if that's entirely true. If you're single and have other investments it's not hard to imagine getting a fancy car and not being in financial trouble.
 
bunionberry said:
I don't know if that's entirely true. If you're single and have other investments it's not hard to imagine getting a fancy car and not being in financial trouble.
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Help me out, when, where, and how is the typical single doctor coming out of residency going to have "other investments"? Their education is their investment.

Let's say 5-10 years post residency= spouse, 2-3 kids, private schools, mortgage, extra circulars for kids, vacations, utilities, car/house/health/malpractice insurances, college funds, retirement account, oh and 200k-250k of debt still. Tell me more about all this freed up cash for other investments and super sporty fancy cars?
 
bunionberry said:
Please elaborate then.
Click to expand...

A desire to work in a high rise on a certain floor/s.
Buying and living in a Mansion.
Driving a fancy sports car.

You really want a dissertation on how one of these things is not like the others?
 
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Ok so back to the original topic... How are some medical practitioners able to afford to rent out space in a downtown office building that are primarily dominated by companies, financial and law firms? Wouldn't they bill the same amount as their counterpart working in a community private practice? And if so, how do these medical/dental practices stay financially afloat or be even more profitable with the expensive rent?
 
WhippleWhileWeWork said:
Help me out, when, where, and how is the typical single doctor coming out of residency going to have "other investments"? Their education is their investment.

Let's say 5-10 years post residency= spouse, 2-3 kids, private schools, mortgage, extra circulars for kids, vacations, utilities, car/house/health/malpractice insurances, college funds, retirement account, oh and 200k-250k of debt still. Tell me more about all this freed up cash for other investments and super sporty fancy cars?
Click to expand...
You're missing a large piece of the puzzle. Family wealth. Statistics say that med students tend to come from above average household incomes.
 
WhippleWhileWeWork said:
Help me out, when, where, and how is the typical single doctor coming out of residency going to have "other investments"? Their education is their investment.

Let's say 5-10 years post residency= spouse, 2-3 kids, private schools, mortgage, extra circulars for kids, vacations, utilities, car/house/health/malpractice insurances, college funds, retirement account, oh and 200k-250k of debt still. Tell me more about all this freed up cash for other investments and super sporty fancy cars?
Click to expand...

He did say single. Eliminate the spouse, 2-3 kids, schools, ECs, and college funds. That frees up a LOT of money for other investments and fancy cars.

Compounded by the possibility of not having medical school debt (per DrBowtie's reasoning above), or much less severe since you could pay it down a lot faster. We're not saying a brand-new attending is gonna be driving a ferrari, but 10 years down the line, I could still see a single attending without alimony or child support rocking a mansion and a nice weekend car.
 
evilbooyaa said:
He did say single. Eliminate the spouse, 2-3 kids, schools, ECs, and college funds. That frees up a LOT of money for other investments and fancy cars.

Compounded by the possibility of not having medical school debt (per DrBowtie's reasoning above), or much less severe since you could pay it down a lot faster. We're not saying a brand-new attending is gonna be driving a ferrari, but 10 years down the line, I could still see a single attending without alimony or child support rocking a mansion and a nice weekend car.
Click to expand...

I went with the cultural norms of around 35-40, most people are married with kids.
Yes, if you're 40, still single, been making attending salary for 10 years then buy whatever you want because you're probably miserable. (assuming you wanted to be married/have a family, of course)
 
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WhippleWhileWeWork said:
I went with the cultural norms of around 35-40, most people are married with kids.
Yes, if you're 40, still single, been making attending salary for 10 years then buy whatever you want because you're probably miserable.
Click to expand...

Different strokes for different folks. Why don't we ask @Winged Scapula if she's miserable? 😎
 
evilbooyaa said:
Different strokes for different folks. Why don't we ask @Winged Scapula if she's miserable? 😎
Click to expand...

Isn't she divorced? In which case, that's not an apples to apples.

How many females are worried about med school + residency because of "not finding a husband", "not getting married", "too late to have kids" etc.
 
WhippleWhileWeWork said:
Isn't she divorced? In which case, that's not an apples to apples.

How many females are worried about med school + residency because of "not finding a husband", "not getting married", "too late to have kids" etc.
Click to expand...

Not that I know of. Of course, I don't claim to know her entire life story.

That being said, are you saying that being divorced is better (at least financially) than never being married? Don't stereotype her as being financially better-off after a (hypothetical?) divorce just because she's a woman. I mean, she's a breast surgeon.

There are many females in medical school that worry about exactly what you said. That being said, there are also quite a few that don't (at least initially) have any desire to go through all of that. There's a large grey zone here; it's not all black and white.

As to your post about your kids feeding goats and chickens.... I would say your thoughts on this matter are out of the norm for future physicians (at least in regards to their future kids). While I will try my hardest to not make them spoiled little brats, I'm going to (try to) give them a comfortable life.
 
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evilbooyaa said:
Don't be jelly. Your future kids will likely be 'rich' kids.
Click to expand...

My kids will be driving clunkers and working miserable service industry jobs, just like I did. My eventual income may make us "rich" but they'll be living like I earned 5 figures.

Watch, 20 years from now I'll find this post and weep about how I didn't follow this plan my kids are awful spoiled brats...
 
evilbooyaa said:
Not that I know of. Of course, I don't claim to know her entire life story.

That being said, are you saying that being divorced is better (at least financially) than never being married? Don't stereotype her as being financially better-off after a (hypothetical?) divorce just because she's a woman. I mean, she's a breast surgeon.
Click to expand...

What? No. I thought we were on the topic of "miserable" vs "not miserable". My point being, I'd imagine someone 40+ who's divorced and wanted to be divorced is in fact less miserable then if they were still married. I was not making any "stereotypes" about Madame Scapula.
evilbooyaa said:
There are many females in medical school that worry about exactly what you said. That being said, there are also quite a few that don't (at least initially) have any desire to go through all of that. There's a large grey zone here; it's not all black and white.
Click to expand...

Of course there's grey area, but I was trying to make a point, and they are much easier made through superlatives, exaggeration, and hyperbole.
 
shangrila said:
Ok so back to the original topic... How are some medical practitioners able to afford to rent out space in a downtown office building that are primarily dominated by companies, financial and law firms? Wouldn't they bill the same amount as their counterpart working in a community private practice? And if so, how do these medical/dental practices stay financially afloat or be even more profitable with the expensive rent?
Click to expand...
1) as long as your overhead < gross income, you will make money

2) if my current lease rate was 10x what it currently is, I would still make money but clearly a lot less

3) insurance reimbursements do vary around the country but yes, you are correct in that the guy in the expensive high rise will be reimbursed at the same rate for the same CPT/E&M codes as guy in a community practice in a smaller cheaper office *in general* (see 4)

4) if the guy in the high rise was able, he could negotiate higher reimbursements as a percentage of CMS rates than the guy in the cheaper office but he'd have to show the private payors that there's a reason why he's worth the higher percentage (eg, 120% of Medicare rates vs 100%)

5) most likely, the guy in the high rise reduces expenses elsewhere (fewer staff, equipment etc) and TAKES CASH. These high rollers you see in these expensive medical buildings are often plastic surgeons, dermatologists, dentists etc who can command high cash rates. Most other specialists are not going to be able to. Another option is to have a side business in the office which pays for the cost of the lease - a MedSpa for example

6) sublease the space
 
evilbooyaa said:
As to your post about your kids feeding goats and chickens.... I would say your thoughts on this matter are out of the norm for future physicians (at least in regards to their future kids). While I will try my hardest to not make them spoiled little brats, I'm going to (try to) give them a comfortable life.
Click to expand...

I didn't see this edit:
As you said, different strokes for different folks.
There are skill sets and a type of education that only rural life can provide, which myself having had growing up, I want for my own. They'll experience the monetary advantages of my career decisions in more covert ways, one being education opportunities in its many varied facets. This is the plan anyways.
 
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WhippleWhileWeWork said:
Isn't she divorced? In which case, that's not an apples to apples.
Click to expand...

Where did you get that idea? I've never been divorced. I'm confused about the turn this thread took.

Not every woman desires to be married and have children and is unhappy being single. I am far from miserable and make a **** ton of money not because I've gotten some divorce settlement but because I've worked hard for it.
 
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I don't get it, is sneering at poors any better from the 40th floor than it is from the 5th floor?
 
WhippleWhileWeWork said:
I went with the cultural norms of around 35-40, most people are married with kids.
Yes, if you're 40, still single, been making attending salary for 10 years then buy whatever you want because you're probably miserable.
Click to expand...
I dunno, I think plenty of the married types I know are firmly in the misery camp. Being single can be pretty sweet, and certainly is not a definite sentence of misery. It really only sucks if you're bad at it.
 
Winged Scapula said:
I'm confused about the turn this thread took.

Not every woman desires to be married and have children and is unhappy being single. I am far from miserable and make a **** ton of money not because I've gotten some divorce settlement but because I've worked hard for it.
Click to expand...
I am too, I was making a broad sweeping statement based on cultural norms and anecdotes from friends and classmates of both sexes adding that the females were especially vocal about their concerns. Also, I said "probably" not "without exception" miserable and I certainly wasn't talking about anyone specific much less you and your happiness or financial prowess. I didn't bring your name up and only tried to point out that if you had been divorced then you would not make a good counter point as the person who did insert your name was going for.
 
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This whole thread =
tXK3Ffg.gif
 
Mad Jack said:
I dunno, I think plenty of the married types I know are firmly in the misery camp. Being single can be pretty sweet, and certainly is not a definite sentence of misery. It really only sucks if you're bad at it.
Click to expand...

Oh man, I didn't realize this was going to be so touchy. Tough crowd.

Edit: added a qualifier.
 
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Winged Scapula said:
1) as long as your overhead < gross income, you will make money

2) if my current lease rate was 10x what it currently is, I would still make money but clearly a lot less

3) insurance reimbursements do vary around the country but yes, you are correct in that the guy in the expensive high rise will be reimbursed at the same rate for the same CPT/E&M codes as guy in a community practice in a smaller cheaper office *in general* (see 4)

4) if the guy in the high rise was able, he could negotiate higher reimbursements as a percentage of CMS rates than the guy in the cheaper office but he'd have to show the private payors that there's a reason why he's worth the higher percentage (eg, 120% of Medicare rates vs 100%)

5) most likely, the guy in the high rise reduces expenses elsewhere (fewer staff, equipment etc) and TAKES CASH. These high rollers you see in these expensive medical buildings are often plastic surgeons, dermatologists, dentists etc who can command high cash rates. Most other specialists are not going to be able to. Another option is to have a side business in the office which pays for the cost of the lease - a MedSpa for example

6) sublease the space
Click to expand...

Thanks so much Winged Scapula to provide the answers that I was really looking for on this thread.

Could you (or anyone) just clarify the concept of "taking cash payments" (I'm guessing that means only accepting either paper money or checks instead of health insurances)? Does this generate more revenue for the clinic?

And also, am I correct to assume that private practices set up in high real estate cost areas like Beverly Hills and Park Ave NYC are generally less profitable than community practices? Why do I hear that as a plastic surgeon in Beverly Hills or psychiatrist on Park Ave NYC, you'll easily make tons of money (at least not go bankrupt)?
 
A slick office space in proximity to other slick office spaces can be a specific business strategy targeting, as WS indicated, clients who seek certain types of services and aren't afraid to pay for it.

It'll never happen but if somebody wants to offer me a corner office with a view of the NYC skyline I'll take it and the rest of you of could blow me if you think it's in poor taste.

A great work space can make a great impact on your creativity and have a positive effect on your patients. For those of us who will be in urban areas, being up in the air is not a ridiculous notion.
 
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shangrila said:
Thanks so much Winged Scapula to provide the answers that I was really looking for on this thread.

Could you (or anyone) just clarify the concept of "taking cash payments" (I'm guessing that means only accepting either paper money or checks instead of health insurances)? Does this generate more revenue for the clinic?

And also, am I correct to assume that private practices set up in high real estate cost areas like Beverly Hills and Park Ave NYC are generally less profitable than community practices? Why do I hear that as a plastic surgeon in Beverly Hills or psychiatrist on Park Ave NYC, you'll easily make tons of money (at least not go bankrupt)?
Click to expand...
Cash means cash/credit cards/checks; that is, not billing insurance for your services but patients paying out of pocket.

These practices exist and they can be quite profitable. For example, although I take insurance, I will also see uninsured "cash pay" patients. I have a fee schedule for these patients but I can basically chart whatever I want. There are no allowable fees or limits; "whatever the market will bear". Patients are charged at the time of service and surgeries and other "big ticket" items are paid upfront, before service is rendered. So yes, it generates a fair bit of revenue especially if your practice is all cash as you then don't have to employ a medical biller so you've brought I more money and reduced your overhead.

I'm not sure why you think a BH or UES practice is less profitable or where you would have heard that. The overhead will be high but you will draw a certain clientele who wants expensive treatments and is willing to pay for them out of pocket. It's all in how you set up your practice and manage it. You can be very successful in a single floor community practice and you can fail to attract the rich and famous despite a 10065 zip code. If you set up shop in an area where there are potential patients with a lot of money, you will be more successful than if you try and do the same in an economically depressed community.

Finally, some people believe that you get what you pay for. If you charge a lot, patients may think its because you're worth it.
 
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shangrila said:
Thanks so much Winged Scapula to provide the answers that I was really looking for on this thread.

Could you (or anyone) just clarify the concept of "taking cash payments" (I'm guessing that means only accepting either paper money or checks instead of health insurances)? Does this generate more revenue for the clinic?

And also, am I correct to assume that private practices set up in high real estate cost areas like Beverly Hills and Park Ave NYC are generally less profitable than community practices? Why do I hear that as a plastic surgeon in Beverly Hills or psychiatrist on Park Ave NYC, you'll easily make tons of money (at least not go bankrupt)?
Click to expand...
I thought I'd give you a real life experience of cash pay.

The average CMS reimbursement for a mastectomy is about $700. I charge about twice that for cash pay and more if it's a technically more challenging (eg a nipple sparing procedure). I will make more than if I billed insurance and I've saved the medical biller fees (which are a percentage of the amount reimbursed by insurance). I will get that fee, paid in full, before the surgery. I might wait 30-90-120 days before seeing reimbursement from an insurance company.

Insurance will reduce payment for multiple procedures as if it's somehow less work. So while I might make $700 for a mastectomy, I will generally get 50% of that for the other breast (if anything at all) should we be doing a bilateral case. I do not discount multiple procedures for cash pay patients.

A friend of mine is a PP psychiatrist. She charges $350/hour and gets it. Doesnt take insurance. Mostly medical professionals and others with disposable income who want treatment but don't want it billed to insurance. She has very little overhead (doesn't eve have office staff); she does it all herself and does pretty well it appears.
 
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Winged Scapula said:
Insurance will reduce payment for procedures as if it's somehow less work. So while I might make $700 for a mastectomy, I will generally get 50% of that for the other breast (if anything at all) should we be doing a bilateral case. I do not discount multiple procedures for cash pay patients.
Click to expand...

I've heard rumors of some surgeons who won't do bilaterals for this reason (doing staged procedures instead)...which obviously is less desirable for the patient. Do you see this much in your region?
 
shangrila said:
My question might seem a little odd, but I come from a family of architects, so I have always dreamed of working in a 30/40+ story building downtown in a large city. Unfortunately I recently realized that being a future doctor instead of lawyer/banker/businessperson, the chances of this happening is slim. Nonetheless, I know that psychiatrists and dermatologists can set up private practices in these places, but wouldn't their overhead, ie. overbearing rent, be 10 times their revenues? And are there other methods for doctors to work in a tall office building downtown? (not including working in hospitals like Northwestern's)

Obviously I don't mind working in a normal hospital because I chose this profession and I'm not going to choose a specialty purely based on this, but I just wanted to know if this particular childhood aspiration of mine can still come true.
Click to expand...
Instead of obfuscating on tall downtown buildings (I hope this isn't a sexual double entendre), why not just come out and say you want to do a mostly outpatient specialty?

As an aside, you have weird childhood aspirations.
 
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