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FP Salary in very rural areas...

Discussion in 'Family Medicine' started by bigfrank, Jul 13, 2002.

  1. bigfrank

    bigfrank SDN Donor

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    Hi, I am considering FP and am attending a medical school where RURAL FP is strongly pushed if not overtly encuraged.

    That said, I know that FPs in cities can only hope to top out at $150K.

    But my question is this: What is the long-term (in practice) salary of a FP in a very rural area? I am just curious. I know the cost of living is less, etc., but I was wondering if anyone has any information.

    Thanks.
     
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  3. Lee

    Lee Sleestack
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    Frank-

    Don't believe that FPs max out at $150. The average FP in my urban/suburban area does much better than that.

    Rural FPs do well too. There are many reasons for this, including fewer HMO contracts and Medicare often pays a higher rate in rural areas. If you have a large enough insured patient base, you can reasonably make $250 a year.

    But if you're after the $, consider a surgical subspecialty. Insurance payments are heavily skewed in favor of procedures.
     
  4. droliver

    Moderator Emeritus

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    Lee,

    you telling me that FP docs routinely make >200K in California? This would be hard for me as an outsider to believe as CA is cited as one of the most heavily HMO capitated markets in the country & you've seen stories for the last decade about physicians leaving the state b/c their salaries were so low. Unless a FP doctor either owns some kind of revenue-producing facility (which is more rare due to some gov't regulations limiting self-referral situations eg. labs,etc.) or does an unusually large # of procedural things (again not the norm), you're left with a salary derived from clinic visits and risky capitated contracts which is pretty spartan. Where's the revenue these guys get that you are speaking of come from?
     
  5. UHS2002

    UHS2002 Senior Member

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    I am a FP PGY1 in the midwest. Throughout med school I was under the impression that FPs made about 120's to 150's, with some rare enterpreneurial soul making more. As a matter of fact, I applied to FP residencies under that false impression. I was very surprised last week when one of my attendings told me that he used to NET about $200k/yr 3 years out of residency and he mentioned that several of his colleagues in the area, who were really into working "resident hours", are making closer to $300k.
    :clap:

    However, I will have a military commitment after residency, so no big bucks for me yet
    :rolleyes:
     
  6. Toadkiller Dog

    Toadkiller Dog Senior Member

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    First of all, very few docs, FP or otherwise, earn a "salary". They have "income", which means that the more patients you see, the more you make. "Salary" is a set amount of money paid to you by an employer, and it drives a lot of docs nuts to have it referred to that way.

    With that said, your income as an FP depends almost entirely on one thing: who is paying the bill . If it is private insurance, you will make 200+ working 8-5, 4 days a week. If it is largely Medicaid, Medicare (as many, but not all, rural and poor urban areas are), you will make much less. If it is the VA, or the IHS, you can expect to make 120 or so with none of the hassles of running a business or getting sued. That likely has some loan payback on top of it, if you are a new grad.

    Here are two cases I can illustrate, both from docs I know personally (on West coast):

    Doc #1 takes mostly private insurance, including a good portion of his income from capitated or other HMOs. Takes home over 200k, works 4 days a week, takes a 2 hour lunch, and only works 8-5 because he gave up his hospital privs (too much hassle). Oh, and it is a suburban-almost-rural type practice.

    Doc #2 has a rural practice, also works 4 days a week, but has slightly longer hours (7-6), because he has to make rounds at the hospital before and after work, which take about an hour each. Takes a 1 hour lunch. Patients are about 40% Medicaid/care, 50% private insurance, and (I'm guessing) about 10% deadbeats (poor folks who haven't had the gumption to file for Medicaid, and don't pay). Has been slowly seeing his take-home dwindle to about 100k as Medicaid pays about 50 cents on the dollar, and paperwork hassles have forced the practice to hire new grunts to deal with it. But, he still loves his work and is an excellent doc.

    Last year, this doc sold his practice to the local hospital, which happens to be a Medicaid sponsored hospital, which means that Medicaid will now pay 100% of the bill (instead of 50%, as above, I hope that made sense). So he became an employee of the hospital on "incentive" (different from "salary" in that the more you work the more you make). Rumor has it that he makes significantly more now, although I'm not sure what that is. I know he was pretty pissed about making only 100k, though.
     
  7. Whisker Barrel Cortex

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    There is a wide variety of income for FP docs. They do a lot better in areas with less HMO penetration. They make a lot more money if they work more hours and see more patients. One of the private FP docs that my classmate rotated with made 300K but worked his but off. He was in a suburban area in the midwest. Many FPs in southern california are employees of HMOs (like Kaiser) and make 80-120K.

    Veterans Affairs physician salaries are much lower than 120K unfortunately. Here is a link that shows many physicians making 60-80K: http://www.press-citizen.com/salaries2001/va.htm
     
  8. Mindy

    Mindy Senior Member

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    WBC:

    I am confused by your reference. Where does it state they are FPs? Do you know any of these folks? Are they part-time or full-time? Since these are "base" salaries (per FAQ) do they have bonuses? How much are their benefits worth, particularly since government bennies are often very significant?

    Thanks for the reference, of course, but I am not sure if this is truly an accurate representation. I am not sure what this website actually is either (though admittedly I didn't take much time to find out!)

    Mindy
     
  9. Whisker Barrel Cortex

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    I don't know all the details of the VA salary system and don't specifically know if these are FPs. I just posted that to show that VA doctors, no matter what the specialty are generally paid much less than anywhere else.
     
  10. Toadkiller Dog

    Toadkiller Dog Senior Member

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    Concerning the VA (and the IHS), here is what I have learned first hand:

    1. I asked a VA administrator point blank how much the docs there make and how many hours they work (he was a very nice guy or I would not have been so forward). His reply: "40 hours a week, and we start our docs at about 110." This was in a western US state.

    2. I have had two close friends work for the IHS (Indian Health Service, like the VA but for native indians). This was in Alaska, so the pay was probably more than the rest of the US, but the FP started at "about 125", and the NP was "about 62".

    And, as Forrest Gump said, that's all I have to say about that.
     
  11. Stuck in Ohio

    Stuck in Ohio Junior Member

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    So does anyone know which suburban/urban areas are of the country are most heavily HMO penetrated and which are least? Anyone know particularly about the east coast cities located DC and northward?
     
  12. RPW

    RPW

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    Wow!!

    Some of those salaries are really low. My FP doc cleared 1.5 million last year and you haven't seen rual until you see where he works.

    He also does rounds and the some ER moonlighting at the local hospital. About 20 years ago he did some ob but I think some of the babies he delivered died because of bad parential care which he couldn't take so he doesn't do that any more. Basically he is superman. Oh and he is a DO.


    Any ways I was talking to him about going into medicine. He told me that he really wouldn't advise going back into medicine. He also told me that medicine would be socialized by the time I was able to get through undergrad,medschool,residency,ect.;but if that was what I wanted to do he would help me out all he could including and job and some loan repayment.

    Sorry for rambling just thought I would tell you about this awsome doc.
     
  13. PACtoDOC

    PACtoDOC 1K Member

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    When I was still practicing full time FM last year, my average reimbursement was about 50 bucks per patient give or take. So if I saw 30 per day, then I billed about an average of 120 K per quarter. We averaged about 70 collections, putting my annual collections at about 336. In busier years, or when I wanted to make more, I might collect 400K for my patients. If I had been working alone without any other PA's or physicians, then my overhead would have eaten about half of this and I would have made about 170-200 per year HAD I BEEN THE DOC. Instead, as the PA, I was lucky to see a 6 figure year, usually making about 85K or so. Guess who made the difference?? The FP who was already making himself about 150K just with his own work. So when you add the 100K I made for him and the other 100K that our other PA made for him, his salary approached 350K easy. With 3 providers instead of 1 under the same roof, the overhead only increases about 25% overall. This is where FP docs make big money, but it is not without some problems. Patients tend to like the midlevels more because they are a little kinder, more patient-centered, and you find yourself loosing your patients to the PA and NP's. Then when they leave, and they generally do after an average of 3 years, they often take the patients with them. And more patients can mean more headaches because the patients are still all officially yours on paper as the doc. I know other rural FP's who make 500K pretty easily seeing about 50 patients a day. I also know an FP in a rural setting who makes over 1,000,000 per year, but he works about 12 hours per day, takes no lunch, and literally sees 90 plus people per day. The 120K rumor is mostly for new grads and federal service. And no VA doc makes below 100K!!! VA PA's make in the 70-80 range. I know because I have many friends in VA's all across the country. The adds are generally 10 years behind.
     
  14. LeslieKay

    LeslieKay Member

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    Who are these docs that are seeing 90 patients a day? Even for a 12 hour day, that seems crazy. How can you really care for that many patients a day and do a half-way decent job? Are they doing it because it is so rural that there is no one else to see the patients, or are they just that greedy?
     
  15. PACtoDOC

    PACtoDOC 1K Member

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    This guy I know who sees nearly a hundred a day in my mind does not give quality care. From my experience, you can provide quality care only to about 30 per day. When I pushed 50 per day, I began to feel like I was leaving something out, and often times I would have to cut people to one complaint. Now don't get me wrong, there are ways to see 50 a day and do a good job, but you have to have the right patients. If you have been seeing the same patients for years and they are coming in during flu season in droves for the same problem, and if you have dictation, you really can go fast. But overall, if you want to enjoy the time with your patients, get to know them, learn from them, and KEEP THEM, then 35 max per day is the way to go. In fact, I plan to cap at 30 and hire a PA once I start exceeding that. I don't need to make 300K per year to be happy. Its unbelievable how nice you can live off 90K per year, so 150 for me is even better if I can make it. There is more to life than money.
     
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  17. Marilane

    Marilane New Member

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    I can't believe that so many people are complaining about making $120-150K. Isn't the work supposed to be about helping people? What about all that BS you said in your admissions interviews? What happened to that? I think that 80K is more than comfy to live on even if your partner doesn't work.

    And I am astounded that a doc would work a 12hr day. Do people get money hungry in this profession or what? I know that $ is a very real concern, and I'm not arguing that, but common, we're talking six digits here..

    Anyway, I come from a social work background working with youth in the area of healthy sexuality/aids/std prevention. I'd have been happy with 40K a yr. The executive director of our agency only made 35K a year...

    Think about our priviledge in this world. As people with university degree we represent only 4% of the world population... It is important to not forget how it is we have what we have and how much of this is not available to so many others in this world.

    I would be so happy to have a job I felt gave me the power to make a difference, to use my power in collaborative ways, and to be living in a comfortable life. I would be so happy for this... That's why I want to be a doctor.
     
  18. copacetic

    copacetic Copacetic Was Here!

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    i'd be happy with 40K too...if i didn't have 300k in student loan debt.
     
  19. iatrosB

    iatrosB trying not to kill anyone

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    Dude, this thread is almost 6 years old!! :laugh:
     
  20. medicinesux

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    would love to hear from this Marilane character today. I am sure she is ecstatic making her 80-100K now.:smuggrin:
     
  21. Dr McSteamy

    Dr McSteamy sh*tting in your backyard

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    and big frank is probably in one of the ROAD residencies by now.

    with his scores, why would he even remotely think about FP
     
  22. EdibleEgg

    EdibleEgg Member

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    "Why would he even remotely think about FP"


    -there are tons of reasons to choose Family Medicine
     
  23. medicienne

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    lol @ the cynicism :laugh:.

    Well I am an IMG from a country where almost everyone applies to Internal Medicine and become GI doctors:laugh:

    I still chose FM because I realized that it was the right fit for me, based on my rotations and experiences here.
     
  24. DrJosephKim

    DrJosephKim Advisor
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    Remember that private practice medicine is a business. Some PCPs make a tremendous amount and work very hard, while others may want to live a more balanced life and make less. Your income is dependent on how many patients you see and what procedures you perform.

    Being a salaried physician is entirely different because your income isn't necessarily dependent on how many patients you are seeing.

    Also, many places have a bonus structure. Plus, health plans may offer financial incentives (such as P4P) that can really raise salary. So, there are so many different factors that influence one's income.
     

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