Doctors & Sobriety

[SouthernSurgeon]

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In residency we have very clearly defined times when we are "off" and have no call responsibilities. We have other times where we are on home-call either as a primary or a backup/senior.

If I'm on primary call - nada.

If I'm on back-up call - I'd have a glass of wine or a beer with dinner. Or a beer during a football game, that sort of thing.

The old non-PC joke among surgery residents taking home call is that you can have one drink for every PGY-level on primary call (i.e. one drink if it's an intern, 2 if it's a second year, etc).

 

[mehc012]

Being in PP still means taking call. Someone has to be manning the office phones 24/7. You can't just turn them off at 5 pm.

Tell that to the Derm offices we can never get in touch with on nights/weekends. Some of their patients have weird things going on, and the ER docs know what it is and what the first steps are, but when the patient comes in on Saturday because the 2nd or 3rd round of treatment they are getting from their Derm is failing and now they have blistering patches all over their body, it would be nice if they would have someone actually on call to tell us what step 4 is.

 

[Winged Scapula]

Tell that to the Derm offices we can never get in touch with on nights/weekends. Some of their patients have weird things going on, and the ER docs know what it is and what the first steps are, but when the patient comes in on Saturday because the 2nd or 3rd round of treatment they are getting from their Derm is failing and now they have blistering patches all over their body, it would be nice if they would have someone actually on call to tell us what step 4 is.

Hmmm...I find that odd that they wouldn't have someone on call but perhaps that's specialty specific. Maybe @DermViser could shed some light. I admit never trying to get ahold of my dermatologist after hours. Even my malpractice provider requires that we have someone on call 24/7 and you're talking to someone who isn't required to take ED surgery call.

 

[DermViser]

No way I'd ever be non-sober as doctor on call or off. You already have enough demands placed upon you and enough responsibilities to keep track of without being cognitively impaired.

Spoken by the illustrious "holier than thou" premed on his/her soapbox. The same type who believe healthcare is a "right" and that physicians are "greedy" if they even think about how much they are reimbursed/compensated.

 

[DermViser]

You have it backwards. UG is the time with flexibility and relatively low stress. I wouldn't consider hitting that attending status as the "light at the end of the tunnel" for stress reduction.

Bingo. If you believe being an attending is the "light at the end of the tunnel", you're in for a world of hurt.

 

[DermViser]

Tell that to the Derm offices we can never get in touch with on nights/weekends. Some of their patients have weird things going on, and the ER docs know what it is and what the first steps are, but when the patient comes in on Saturday because the 2nd or 3rd round of treatment they are getting from their Derm is failing and now they have blistering patches all over their body, it would be nice if they would have someone actually on call to tell us what step 4 is.

Hmmm...I find that odd that they wouldn't have someone on call but perhaps that's specialty specific. Maybe @DermViser could shed some light. I admit never trying to get ahold of my dermatologist after hours. Even my malpractice provider requires that we have someone on call 24/7 and you're talking to someone who isn't required to take ED surgery call.

Even private practioners in Derm carry a pager for call. If it's a group practice, then it rotates among the MDs in the group. I do know that a lot of private practices in Derm will turf off recalcitrant cases that require systemic agents (which carry more malpractice risk) to academic medical centers (both from a monitoring and malpractice perspective).

The only thing I can imagine a Derm issue coming in to the ER is for a 1) Stevens-Johnson Syndrome - however this is a well known entity learned in Internal Medicine and is treated quite effectively - i.e. stop the medication, steroids, etc. it's even on their IM boards (so many times Derm isn't even called for this)

or 2) Adverse side effect of certain systemic medications which are used in other IM subspecialties and happen to be used for dermatologic purposes i.e. methotrexate, biologic agents, etc. which again the treatment in these cases is to stop the medication, supportive care, etc. That being said, many times the patient is admitted to the hospital (as they should be) to Internal Medicine, anyway with the offending med d/ced and supportive therapy started: wound care, fluids, etc.

The only reason I can think of as to why a Derm may not do call and do the usual 911 emergency thing on their voicemail is bc of being burned before by going to the ER from a malpractice standpoint, but this is definitely not limited to just Derm by any stretch of the imagination. Specialists in PP are known to just see the patient as a followup as an outpatient rather than go to the ER, due to unnecessary malpractice risk, having to bring in equipment to the ER, administrative hassle, etc.

 

[mehc012]

Even private practioners in Derm carry a pager for call. If it's a multispecialty pager, then it rotates among the MDs in the group. I do know that a lot of private practices in Derm will turf off recalcitrant cases that require systemic agents (which carry more malpractice risk) to academic medical centers (both from a monitoring and malpractice perspective),

The only thing I can imagine a Derm issue coming in to the ER is for a 1) Steven-Johnson's Syndrome - however this is a well known entity learned in Internal Medicine and is treated quite effectively - i.e. stop the medication, steroids, etc. it's even on their IM boards (so many times Derm isn't even called for this)

or 2) Adverse side effect of certain systemic medications which are used in other IM subspecialties and happen to be used for dermatologic purposes i.e. methotrexate, biologic agents, etc. which again the treatment in these cases is to stop the medication, supportive care, etc. That being said, many times the patient is admitted to the hospital (as they should be) to Internal Medicine, after

The only reason I can think of as to why a Derm may not answer a pager after hours and do the usual 911 emergency thing on their voicemail is bc of being burned before by going to the ER from a malpractice standpoint, but this is definitely not limited to just Derm by any means. ENT does this, Optho, does this, etc. Specialists in PP are known to just see the patient as a followup as outpatient due to unnecessary malpractice risk, having to bring in equipment to the ER, administrative hassle, etc.

We call consults fairly often for 'what should we send them home on, their current med isn't working/they're having a reaction.' It's not a "they're going to die" situation, but more of a "we need to change their medications, I can make something up with no idea of what you've already tried, or I can call you and you can look up what they've been on in the past and what worked".
That being said, we pretty much don't expect an answer from Derm, because the incidence of actual emergencies is pretty low. For what it's worth, their voicemail does have a button to push for the doc on call, but then you just leave a message and no one ever returns the call.
Optho we often 'consult' just to setup an appointment, because too many people fail to followup on serious eye issues and have trouble down the line...if we give them discharge instructions that say "Call the eye doctor on Monday morning to schedule an appt" they think "well, I went to the ED and they didn't do anything, so it's not that bad. If we say "You have an appointment at 9am on Monday" or "go directly to the eye doctor's office at this address when you leave this ED" they actually go and get the problem addressed.
ENT always shows up, that day, even for minor cases (they're also across the parking lot). They are pretty much my fav practice, and we keep an ENT cart around for whenever they show up.

 

[DermViser]

We call consults fairly often for 'what should we send them home on, their current med isn't working/they're having a reaction.' It's not a "they're going to die" situation, but more of a "we need to change their medications, I can make something up with no idea of what you've already tried, or I can call you and you can look up what they've been on in the past and what worked".
That being said, we pretty much don't expect an answer from Derm, because the incidence of actual emergencies is pretty low. For what it's worth, their voicemail does have a button to push for the doc on call, but then you just leave a message and no one ever returns the call.
Optho we often 'consult' just to setup an appointment, because too many people fail to followup on serious eye issues and have trouble down the line...if we give them discharge instructions that say "Call the eye doctor on Monday morning to schedule an appt" they think "well, I went to the ED and they didn't do anything, so it's not that bad. If we say "You have an appointment at 9am on Monday" or "go directly to the eye doctor's office at this address when you leave this ED" they actually go and get the problem addressed.
ENT always shows up, that day, even for minor cases (they're also across the parking lot). They are pretty much my fav practice, and we keep an ENT cart around for whenever they show up.

With respect to your derm situation, usually in the case in which the patients aren't in a "they're going to die" situation, PP Derms usually would rather have the patient follow up with us the next day, so that we can thoroughly evaluate the patient. They just tack them on to the schedule. I don't know of any PP Derm doc in our area who wouldn't see their patient the next day in the outpatient setting, esp. if there is the possibility that one of the medications we started may have caused their trip to the ER. I'm curious if maybe you work in a rural ER? I'm assuming you're talking about writing for topicals or short-term antibiotics, bc I don't know of any EM doctor (who cares about their malpractice) who will be writing for Methotrexate or other systemics.

 

[Winged Scapula]

Have you asked these PP dermatologists why they aren't answering the calls? It doesn't have to be confrontational but sometimes it's a simple technical problem (they aren't getting the messages), or a misunderstanding that you are expecting a call back.

I had a problem reaching a plastic surgeon once and after texting one of the partners found that they didn't realize their back line was malfunctioning.

 

[YoungestBrother]

I haven't seen it brought up yet, but what about docs in Washington and Colorado? Can you smoke a joint when you're off duty? I mean, the states are barely figuring out how to test for DUIs, I wonder what it would look like for hospitals testing employees. Maybe this isn't too much of an issue yet, but many states have decriminalized cannabis, and more states are going to legalize recreational cannabis in the next 5-10 years, and I'm sure lots of docs enjoy the occasional toke.

Following a tangent, do you think there are specialties that have higher numbers of former/current potheads? I'm thinking EM, maybe ortho? Or anesthesiology lol.

 

[mehc012]

With respect to your derm situation, usually in the case in which the patients aren't in a "they're going to die" situation, PP Derms usually would rather have the patient follow up with us the next day, so that we can thoroughly evaluate the patient. They just tack them on to the schedule. I don't know of any PP Derm doc in our area who wouldn't see their patient the next day in the outpatient setting, esp. if there is the possibility that one of the medications we started may have caused their trip to the ER. I'm curious if maybe you work in a rural ER? I'm assuming you're talking about writing for topicals or short-term antibiotics, bc I don't know of any EM doctor (who cares about their malpractice) who will be writing for Methotrexate or other systemics.

The particular instance I'm thinking of involved a patient with, if I remember correctly, bullous pemphigoid, who was already on several meds from her Derm. She was developing large blisters all over and also stating that her meds were making her feel ill. It was a Friday evening, so she had no way of getting in contact with her Derm until Monday. She didn't exactly warrant admission, but the doc would have preferred to speak to the physician following her before altering any of the meds or adding topicals, since she wasn't the most informed patient and had some of her meds on her, but not all, and couldn't remember what she'd had before, etc. The point of the story being more that it would have been nice to get in touch with someone, but not life-or-death...which is fairly common for this particular ED, and that it's the only experience I've had where I simply could not get in touch with ANY on-call doc (and also the only time I've ever called for Derm).

We're not a rural ED, but we are in a small 'city' on the edge of a pretty rural area...so we're more like a mid-sized ED with a sizable rural patient population. There are multiple other hospitals in the area, many of which send us their higher-acuity patients, and some national-level hospitals within a reasonable ambulance transfer distance. If you drive in one direction from us, there are cities and towns and tourist areas. Go the other direction and it's all farms and seasonal work.

 

[mehc012]

Have you asked these PP dermatologists why they aren't answering the calls? It doesn't have to be confrontational but sometimes it's a simple technical problem (they aren't getting the messages), or a misunderstanding that you are expecting a call back.

I had a problem reaching a plastic surgeon once and after texting one of the partners found that they didn't realize their back line was malfunctioning.

Nah, it was a one-time thing and we weren't expecting their on-call doc to respond. I don't know what the standard is elsewhere, but here it seemed as if they were calling them because it'd be nice to get in contact, but without any real expectation that they should be available to call back. This is why I was wondering whether it's common for some specialties to not really have call.

We do continue up the food chain and clarify miscommunication for our commonly contacted specialties...for example, the general surgery call got all FUBARed last week and everyone's service kept forwarding us to the next practice, ad nauseum in a big loop. THAT got addressed in a hurry.

 

[mehc012]

I haven't seen it brought up yet, but what about docs in Washington and Colorado? Can you smoke a joint when you're off duty? I mean, the states are barely figuring out how to test for DUIs, I wonder what it would look like for hospitals testing employees. Maybe this isn't too much of an issue yet, but many states have decriminalized cannabis, and more states are going to legalize recreational cannabis in the next 5-10 years, and I'm sure lots of docs enjoy the occasional toke.

Following a tangent, do you think there are specialties that have higher numbers of former/current potheads? I'm thinking EM, maybe ortho? Or anesthesiology lol.

I've been wondering this as well...even where it is legal, though, companies can require drug tests for employment. I would figure that the medical admin community would be behind the general community in accepting marijuana use...aka don't expect any hospitals to be OK with a THC+ screen until well after the majority of states are.

 

[Winged Scapula]

Nah, it was a one-time thing and we weren't expecting their on-call doc to respond. I don't know what the standard is elsewhere, but here it seemed as if they were calling them because it'd be nice to get in contact, but without any real expectation that they should be available to call back. This is why I was wondering whether it's common for some specialties to not really have call.

We do continue up the food chain and clarify miscommunication for our commonly contacted specialties...for example, the general surgery call got all FUBARed last week and everyone's service kept forwarding us to the next practice, ad nauseum in a big loop. THAT got addressed in a hurry.

it's hard to know what the situation is then with that practice. Since it was a one off event, it could've been anything from a mechanical or technical problem with their answering service/machine, they forgot to get back to you, or simply didn't think you were expecting a call back.

Then again I think all of us experienced in residency some colleagues who simply could not or would not return all of their phone calls. So that could be the situation as well that this practice doesn't really expect after hours calls so doesn't check their messages and or doesn't return phone calls.

 

[mehc012]

it's hard to know what the situation is then with that practice. Since it was a one off event, it could've been anything from a mechanical or technical problem with their answering service/machine, they forgot to get back to you, or simply didn't think you were expecting a call back.

Then again I think all of us experienced in residency some colleagues who simply could not or would not return all of their phone calls. So that could be the situation as well that this practice doesn't really expect after hours calls so doesn't check their messages and or doesn't return phone calls.

Right...I wasn't concerned with the specific practice. It was more that the attitude of 'well, try to get in touch with their on-call doc, but it's the weekend' made me think that perhaps some specialties are not really expected to be on call. This happens to be the specific situation in which I first encountered that attitude, but it made me curious about the trends overall.

 

[WestCoastNative]

Such a depressing thread. Medicine is awesome, but damn, you gotta be committed to it 24/7? No coming home and having a few brews with your homies while watching a game?

 

[armybound]

Such a depressing thread. Medicine is awesome, but damn, you gotta be committed to it 24/7? No coming home and having a few brews with your homies while watching a game?

... when you're on call.

I got home from work today and had a beer. about to go have another. we have department-sponsored trips to a local bar every other Wednesday. the people who aren't on call will drink, those on call will not.

 

[WestCoastNative]

... when you're on call.

I got home from work today and had a beer. about to go have another. we have department-sponsored trips to a local bar every other Wednesday. the people who aren't on call will drink, those on call will not.

On average, how often are you on call?

 

[QAsPsych]

God, who let the bible club post here? Take a shot or two, straight edge kids.

The best part of this post is imagining it being said in Dr. Nick's voice.

 

[IgEdoc]

being an enophile, love my situation..
HMO practice, my specialty - 9 to 5, NO CALL EVER

 

[mrh125]

Spoken by the illustrious "holier than thou" premed on his/her soapbox. The same type who believe healthcare is a "right" and that physicians are "greedy" if they even think about how much they are reimbursed/compensated.

Nope, nope, and nope that generalization doesn't apply. I'm speaking from knowing my own limitations and not implying anything about anyone else's. When I have to study more than twice as much as anyone else in undergrad to get the grades I need I know that mild cognitive impairment won't bode well for me when I have responsibilities and I don't want to be liability if I am on call and not be able to keep track of a patient's needs. If alcohol doesn't affect you that way and it probably won't, more power to you I'm not going to preach and tell you how to live your own life either way.. I think healthcare is equally a privilege and that given all the years doctors spend in school, long hours, and their vital role in society they should be able to make enough to enjoy a quality life. I also know a little about how ****ty reimbursement can be from scribing for a few doctors and talking about them. Not to mention if doctors had lower salaries than do (less than a 100k) it would make the profession far less appealing. Given all the hoops we have to jump through and long hours we have to work, our pay should represent that.

 

[WestCoastNative]

What man? Kind of confusing the way you worded that. You're a wine lover and you love your situation right? What's an HMO practice? What specialty btw? And wtf is up with this new quoting bull****..

 

[IgEdoc]

What man? Kind of confusing the way you worded that. You're a wine lover and you love your situation right? What's an HMO practice? What specialty btw? And wtf is up with this new quoting bullcrap..

HMO is a health maintenance organization which you should know quite well if you lived in California, the biggest being Kaiser-Permanente
Since this tread is not necessarily about drinking, but more about sobriety (or any mind affecting drug for that matter) if you have call schedules, my point is that I am just in a nice position not to have any particular mandatory call as emergencies requiring my experitise is quite rare in Allergy and Immunlogy at my medical center and never needed to return to the hospital to see a patient. Most acute cases can be handled by the medical staff and my role would be more towards chronic outpatient management

 

[WestCoastNative]

HMO is a health maintenance organization which you should know quite well if you lived in Calif ornia, the biggest being Kaiser-Permanente
Since this tread is not necessarily about drinking, but more about sobriety (or any mind affecting drug for that matter) if you have call schedules, my point is that I am just in a nice position not to have any particular mandatory call as emergencies requiring my experitise is quite rare in Allergy and Immunlogy at my medical center and never needed to return to the hospital to see a patient. Most acute cases can be handled by the medical staff and my role would be more towards chronic outpatient management

Allergy and Immunology huh? In my early teens, I ended up suffering from a serious disease and was scheduled to an Immunologist due to a rash I devolved from the antibiotics. Random, but I think that the doctor had it pretty great. Oddly enough, I'm pretty sure that he works with Kaiser as well outside of his private practice since most of the practices around the area are connected to a Kaiser center there. How do you like it? Mind providing some insight on what a usual day is like?

 

[sinombre]

ehh, for me undergrad was hellishly hard and time-devouring. I had like no down time and was severely fizzled by my last quarter.

You're in for a real treat when you start med school.

It's all relative though. Undergrad was difficult for me at the time, but it's comical how much more free time I had then. Medical school is difficult for me now, but I'm sure working 80 hours every week will give me new perspective on the rigors of medical school.

 

[mrh125]

You're in for a real treat when you start med school.

No kidding, I have ADD and adversity is nothing new to me. Tell me something I don't know. I'm ready to face the challenge of medical school with full force.

 

[IgEdoc]

Being a combined Internal Medicine and Pediatrics board specialty, we do get an autonomy status as a distinct department and not as a subspecialty of either. The work can be intellectually challenging as many cases felt to be allergic turn out to be quite different. The patients are most appreciative as relief of their symptoms and improved quality of life is very feasible. We are strictly outpatient with absolutely no impatient service needed of us (we removed that area of practice years ago). So if you want a life outside Medicine, this is a 9 to 5 job with evenings and weekends off with no obligations or call. Oh, yes the pay is also very good 🙂

 

[sinombre]

No kidding, I have ADD and adversity is nothing new to me. Tell me something I don't know. I'm ready to face the challenge of medical school with full force.

Great attitude to have! You will adapt and get through it.

(also I added more on to the post you quoted)

 

[WestCoastNative]

Being a combined Internal Medicine and Pediatrics board specialty, we do get an autonomy status as a distinct department and not as a subspecialty of either. The work can be intellectually challenging as many cases felt to be allergic turn out to be quite different. The patients are most appreciative as relief of their symptoms and improved quality of life is very feasible. We are strictly outpatient with absolutely no impatient service needed of us (we removed that area of practice years ago). So if you want a life outside Medicine, this is a 9 to 5 job with evenings and weekends off with no obligations or call. Oh, yes the pay is also very good 🙂

Thanks for the information my friend 🙂You make it sound very appealing and enticing. I'll do some further research and keep an open mind if I hopefully make it into medical school.

 

[mrh125]

Great attitude to have! You will adapt and get through it.

(also I added more on to the post you quoted)

Good to know and I agree with what you said. When I studied for the MCAT and went back to undergraduate materials I realized how far I've come. Subjects I really struggled with including genetics, biochemistry, and cell biology were much easier the second time around and I was actually able to teach myself physiology on my own. Even if what we do tests every fiber of our being at the time we do it, by rising to the difficult challenges and not letting drag us down we will eventually see how simple it becomes when our work is complete. 🙂

 

[mehc012]

You're in for a real treat when you start med school.

It's all relative though. Undergrad was difficult for me at the time, but it's comical how much more free time I had then. Medical school is difficult for me now, but I'm sure working 80 hours every week will give me new perspective on the rigors of medical school.

I do far worse when I have free time. I honestly believe that the majority of my issue in undergrad was that I had too much free time and no idea how to handle myself when procrastination was an option...once you start relaxing it's hard to stop. I am a creature of momentum!
Now I'm 4x busier and 12x more organized and relaxed.

 

[Perrotfish]

On average, how often are you on call?

This depends on how you practice. Some possible attending scenarios:

1) A lot of doctors see exclusively outpatient clinic with set hours and don't cover any hospitals. Many family practice, psych, and Pediactric clinics are set up that way, as are many HMOs and many kinds of subspecialist (there is no such thing as a developmental Pediatrics emergency). No call ever, when you're off you're off. If your patients have a problem at night they go to the ED.

2) Many kinds of physicians do shiftwork and their only 'call' is backup. That includes ICU attendings, hospitalists, inpatient psych, and ER doctors. Backup means that, on a few of their off days each month, they need to stay sober and nearby in case someone else gets sick. Since one backup can cover at least half a dozen working doctors its really not that many days (though individual group policies may vary) Other than that they're never called in. On the days they're neither on call nor backup they're off and can do whatever.

3) Many IM and Peds Subspecialits are frequently on call, but are rarely called in. Think endocrinology, Peds pulmonology, derm, etc. Some IM and Peds docs also cover local hospitals, holding the phone for nighttime questions from the nurses. For them call means holding a phone and taking questions from the other docs, nurses, and patients, but only very rarely coming in for patients that can't wait until morning. These are the professions where drinking gets tricky: most of the subspecialists at my hospital work clinic 5 days a week, but hold the call phone 24/7 for at least 15 days a month. Some are solo and hold it all the time, which is practical if your phone doesn't ring that often. Overall the lifestyle is good, but when the phone rings you have to be ready to answer competently and occasionally come in. If you want to have a beer at night its probably fine but if you're the kind of person who routinely wants to have a six pack you're picking the wrong job. On the plus side, since their work is primarily clinic and clinic patients can be rescheduled in an emergency, they often don't need a formal backup system.

4) There are a subset of mostly procedural specialties, that are not only on call a lot, but seem to frequently be called in on call. Think OBs, Gen Surg, Gastroenteroly, Cards, Heme-onc, etc. For them call means not just answering questions, but also getting called in to perform procedures and see patients. Also, since their patients can't be rescheduled, they generally need a backup system in addition to the call system. That's a lot of days you need to stay sober and a lot of nights where you work all night. I think you would be nuts to sign up for a job like that, but to each his own.

 

[WestCoastNative]

My view of doctors was mostly outpatient clinic with set hours. Is it rare to set up your career like that? Is the pay worse? What are the pros and cons in general??

 

[TheWeeIceMan]

My view of doctors was mostly outpatient clinic with set hours. Is it rare to set up your career like that? Is the pay worse? What are the pros and cons in general??

Choose the right specialty and you should have the opportunity to make that schedule happen. In general, you probably won't be making as much as you could if you go for that setup.

 

[Perrotfish]

My view of doctors was mostly outpatient clinic with set hours. Is it rare to set up your career like that? Is the pay worse? What are the pros and cons in general??

Its not rare. The pay depends on what kind of clinic you run. Outpatient cosmetic dermatology: amazing. Outpatient family practice: 150-250K/year depending on your business model. Outpatient Pediatrics Genetics: 100-180K/year.

Pros:

1) Regular hours
2) Relatively low risk, malpractice can happen anywhere but it happens more often in an ED, on a floor, in OR, or in an ICU
3) A lasting relationship with your patients. On the ward you mostly see patient's once, for a week, and the patients you get outpatient practices can establish relationships with you that lasts for years
4) Own your life. In the hospital everyone is their own separate chain of command: the subspecialits you consult, the nurses, the RTs, etc. There are committees to deal with true patient care issues, but if there's an interpersonal conflict it basically never gets solved, because there's no common boss to solve it. On the other hand clinics are often doctor run, which does cut down on the amount of drama.
5) You're helping. Statistically clinics, especially primary care clinics, are shown to significantly improve the health of a community, and the fees you charge likely won't bankrupt anyone.

Cons:
1) Clinic is boring. A lot of the fun is figuring out what a complicated patient has and how to fix them. Subspecialists manage patients with known diagnoses. Generalists diagnoses patients who, 95% oft the time, don't have anything interesting wrong with them in the first place
2) Clinic feels like an assembly line. See a patient, fix a patient, document a patient, 20 minutes. If they're the interesting patient it sucks because it still stalls the line and now all of your subsequent patients get seen late and they start their appointments pissed. Its a grind.
3) Low margins means a relatively ugly atmosphere. In the hospital you're basically playing with monopoly money: the beds are five figures a day and the tests are five figures a pop. It bankrupts your patients and our government but for you it means there are a lot of little extras: ambiance, offices, etc. A financially clinic, though, runs on relatively modest fee for appointments, which means to stay profitable they need to keep costs low.
4) While there are exceptions yes, it usually does pay less.

 

[WestCoastNative]

I see. Are there outpatient orthopedic surgery clinics where all you do is scheduled surgeries on joints, knees, shoulders, etc.. ? Would it be realistic to make 250k a year as an employee/owner at such a clinic? I know that these questions are way to hypothetical and may sound stupid, I'm just letting my curiosity get the best of me. Thanks for the replies everyone.

 

[Boolean]

I see. Are there outpatient orthopedic surgery clinics where all you do is scheduled surgeries on joints, knees, shoulders, etc.. ? Would it be realistic to make 250k a year as an employee/owner at such a clinic? I know that these questions are way to hypothetical and may sound stupid, I'm just letting my curiosity get the best of me. Thanks for the replies everyone.

Shadowing someone who does this. Unsure of their income, but it is decent (I assume upwards of 225k)