Hospitalists Out-Earn Rheum, Endo and ID?

[laserbeam]

To be fair most hospitalists earn near the median and are content doing so, however if needed they can add 50-100k to that bottom line quite easily provided they are willing to work more.

Agree with this. It is hard to count on successful private practice, endo or rheum - that has some luck component inside. The abundance of hospitalist shifts now is more real, plus the flexibility of scheduling, flexibility of workflow.....

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[bronx43]

You're telling me that every rheumatologist can earn upwards of 300k and is only constrained by willingness to take more patients? Find that hard to believe. Whereas virtually any hospitalist - if he or she wanted to - can pick up shifts in critical access hospitals or LTACs or extra shifts at their existing practice.

That was my original point.

Yes, I'm telling you that basically every rheumatologist can earn 300k if they want to work for it. There is a huge shortage of rheumatologists, and every practice I'm talking to has a 4-6 month waiting period. We are in a relatively "saturated" market and our wait is 4 months. The reason why the averages are so low for rheumatology (and potentially endo) is that these specialties are largely women, who are either part time or don't want to crank out 25-30 pts a day. However, the demand is absolutely there. Honestly, most rheumatologists just want to have an easy work life balance and work 4 days a week and see 15 pts a day. Of all the recent grads from my program, none are working a full 5 day week...

However, the people that want to earn as much as possible can absolutely clean up.

 

[VA Hopeful Dr]

Yes, I'm telling you that basically every rheumatologist can earn 300k if they want to work for it. There is a huge shortage of rheumatologists, and every practice I'm talking to has a 4-6 month waiting period. We are in a relatively "saturated" market and our wait is 4 months. The reason why the averages are so low for rheumatology (and potentially endo) is that these specialties are largely women, who are either part time or don't want to crank out 25-30 pts a day. However, the demand is absolutely there. Honestly, most rheumatologists just want to have an easy work life balance and work 4 days a week and see 15 pts a day. Of all the recent grads from my program, none are working a full 5 day week...

However, the people that want to earn as much as possible can absolutely clean up.

Exactly. Other than being in insanely high demand, there is no difference between Rheumatology endocrinology and US basic Primary Care guys in terms of how we're paid and earning potential.

If you work 5 days a week and see 20 patients a day, 300K is fairly easy to manage.

That's the biggest difference between Hospital pay and Outpatient Clinic pay. Hospitalist, generally speaking, are paid hourly. The only way to earn more is to work more shifts and there are a finite number of days in the month. Clinic based practices you earn more by scheduling more patients, and while there is theoretically a ceiling to how many patients you can see in a day you'd be surprised how high that is.

 

[DiagnasaurusRex]

So right now most rheum and endo docs are women and/or are content with seeing 15 pts 4 days a week and that accounts for the purportedly low average salary? Maybe you guys are right and when y'all get out of fellowship you can manage to work twice as hard as the existing generation. I just haven't seen salary numbers like that thrown around by any practicing rheum and endocrine doc. For the prospective specialist thinking of entering fellowship it's important to note this distinction.

 

[CCM-MD]

So right now most rheum and endo docs are women and/or are content with seeing 15 pts 4 days a week and that accounts for the purportedly low average salary? Maybe you guys are right and when y'all get out of fellowship you can manage to work twice as hard as the existing generation. I just haven't seen salary numbers like that thrown around by any practicing rheum and endocrine doc. For the prospective specialist thinking of entering fellowship it's important to note this distinction.

People like to think they are the exception but forget they are part of the statistic. I'm sure there's some rheumatologists and endocrinologists making bank but most are making around the median. High demand does not usually translate to higher compensation in medicine. Insurance companies aren't going to pay more per patient because there's a higher demand. Work more = get paid more. The important question to answer for those looking for $ is whether you would rather see tons of fibromyalgia or uncontrolled diabetes or rather work a few extra hospitalist shifts to make that extra dough.

I'm biased, I prefer the ICU to outpatient. But we need everyone to like different specialties for things to work.

 

[ICmyFuture]

So right now most rheum and endo docs are women and/or are content with seeing 15 pts 4 days a week and that accounts for the purportedly low average salary? Maybe you guys are right and when y'all get out of fellowship you can manage to work twice as hard as the existing generation. I just haven't seen salary numbers like that thrown around by any practicing rheum and endocrine doc. For the prospective specialist thinking of entering fellowship it's important to note this distinction.

Before I started Endocrine Fellowship I assumed for the most part Endo pay was low due to limited procedures. I thought low 200s was probably where my earning potential would lie. However, this isn't really the case. Other Endos can comment but from what I have seen most Endocrinologists just don't see a lot of volume. Our hardest working doc sees around 16 patients a day; some only work around 0.5 FTE. I think this is why Medscape, MGMA etc show overall low income for endo. Most endo docs don't want to crank out patients- we like to spend time with our patients, formulate therapy plans and not feel rushed. However, like VA doc alluded to, if I saw 20 patients a day, 5 days a week- this could easily generate 300K.

Also, some of the docs have wait times up to 9 months as well. My clinics get booked out >6 months- I have to double book a lot of follow ups.

 

[CCM-MD]

The whole thought process in this thread summarized: "the reason physicians in my chosen specialty earn less is because they don't work hard enough, I'm going to be able to see way more patients in a significantly less amount of time than them, and easily make way more $".

 

[Raryn]

Again the numbers just don't seem to add up. Where does the average come from? If you're already "booked out" do you see more patients in less time? If that were then shouldn't true virtually every rheum doc should be rolling in dough? From what I've seen that isn't the case. To be fair most hospitalists earn near the median and are content doing so, however if needed they can add 50-100k to that bottom line quite easily provided they are willing to work more.

Can a practicing endocrine or rheum doc chime in? I guess y'all will just have to wait and see once your in practice.

Rokshana is a practicing Endocrine attending.

But regardless, this is easy to answer with percentiles.

Per the last MGMA data, the median hospitalist makes a total compensation of $278,471. Now, that includes all the various production bonuses and whatnot. The median rheumatologist makes $255,560. So far so good. Except the 90th percentile hospitalist makes $410,441 and the 90th percentile rheumatologist makes $454,055. There's no percentiles above 90 in the data, but you can imagine that it could diverge even further.

Basically, the typical hospitalist makes more than the typical rheumatologist, but the possible upside if you hustle seems to be more for rheum. (But less for Endocrine )

 

[DiagnasaurusRex]

Before I started Endocrine Fellowship I assumed for the most part Endo pay was low due to limited procedures. I thought low 200s was probably where my earning potential would lie. However, this isn't really the case. Other Endos can comment but from what I have seen most Endocrinologists just don't see a lot of volume. Our hardest working doc sees around 16 patients a day; some only work around 0.5 FTE. I think this is why Medscape, MGMA etc show overall low income for endo. Most endo docs don't want to crank out patients- we like to spend time with our patients, formulate therapy plans and not feel rushed. However, like VA doc alluded to, if I saw 20 patients a day, 5 days a week- this could easily generate 300K.

Also, some of the docs have wait times up to 9 months as well. My clinics get booked out >6 months- I have to double book a lot of follow ups.

I see. Well that's good that patient care is more important than volume for you guys. 20 patients a clinic day is up there. For rheum they bill for injections so that def helps.

I just don't want people to get the impression that it's feasible for all such specialists to be able to make 300+ except in certain circumstances which would entail overbooking clinics, niche location and/or some luck.

 

[bronx43]

the demand for endocrinology is quite large and the supply is not as much ( a number of endo fellows stay research so the number going out into the clinical world not as many as you think). Sure the big cities (NYC, Boston, etc) are saturated, but that can be said for any specialty(hospitalist in those cities are not making bank), but even the mid sized city doesn't have as many Endocrinologist as are needed...most Endocrinologist are booking at least 2 and sometimes as much as 6 months out for new referrals.

I see. Well that's good that patient care is more important than volume for you guys. 20 patients a clinic day is up there. For rheum they bill for injections so that def helps.

I just don't want people to get the impression that it's feasible for all such specialists to be able to make 300+ except in certain circumstances which would entail overbooking clinics, niche location and/or some luck.

You don't need to overbook to see 20 pts a day. Not even close. Yes, you have to double book or overbook for 30-40, but not 20. And honestly, 20 pts is not bad AT ALL. I don't see fibromyalgia. One time consult, then back to PCP they go. You also don't have to be in a niche location. And luck? Well, I don't know what that even means.

The point I want to get across to anyone that cares is that ANY outpatient subspecialist can make 300+ due to the fact that the demand is there, and you are usually dealing with one problem. For instance, the average stable RA patient takes about 10 minutes including documentation.

Again, I think this thread was meant to be for someone that is contemplating fellowship but is also considering hospitalist. You can make good money doing both, and ultimately it comes down to what you think you enjoy doing. I did fellowship because I saw more opportunity for entrepreneurship and upside in specialties than I did in hospital medicine. However, another big reason is that I simply don't like the hospitalist gig. I have friends that do it and LOVE it, and they honestly live a better life than I can imagine. But to each his own.

 

[CCM-MD]

There's a reason why the median is where it is. It is an important thing to note that MGMA (although I believe it's the most reliable) usually reports higher numbers than most other compensation surveys. If it really is that easy to make 300s, that's where the median would be.

But I guess the people arguing on this thread are special and the surveys don't include special people who have a much easier time making more $ because they are special.

 

[ICmyFuture]

I see. Well that's good that patient care is more important than volume for you guys. 20 patients a clinic day is up there. For rheum they bill for injections so that def helps.

I just don't want people to get the impression that it's feasible for all such specialists to be able to make 300+ except in certain circumstances which would entail overbooking clinics, niche location and/or some luck.

Yeah, I never tell med students or residents potentially interested in Endo that they can make 300+ easy. The only time you see that statement is on recruitment fliers.

The difference between seeing 10, 15, 20, 20+ patients usually comes down to time management and the efficiency of the doc and the practice. Some people are quite inefficient using EMR- seeing the patient, placing the note, the orders and the billings and they take 1-2 hours after patient contact finishing up, not to mention inbox; others can do most/all of that during the visit. So if you are efficient AND the practice/support staff is built to see patients- you can see more. The clinic I am at right now- I don't think you could see 20 patients a day without running behind and staying late.

 

[PlutoBoy]

So right now most rheum and endo docs are women and/or are content with seeing 15 pts 4 days a week and that accounts for the purportedly low average salary? Maybe you guys are right and when y'all get out of fellowship you can manage to work twice as hard as the existing generation. I just haven't seen salary numbers like that thrown around by any practicing rheum and endocrine doc. For the prospective specialist thinking of entering fellowship it's important to note this distinction.

If it helps, my wife is a rheumatologist. She makes $245,000 + RVUs working four days a week. Mid sized city.

 

[PlutoBoy]

You don't need to overbook to see 20 pts a day. Not even close. Yes, you have to double book or overbook for 30-40, but not 20. And honestly, 20 pts is not bad AT ALL. I don't see fibromyalgia. One time consult, then back to PCP they go. You also don't have to be in a niche location. And luck? Well, I don't know what that even means.

The point I want to get across to anyone that cares is that ANY outpatient subspecialist can make 300+ due to the fact that the demand is there, and you are usually dealing with one problem. For instance, the average stable RA patient takes about 10 minutes including documentation.

Again, I think this thread was meant to be for someone that is contemplating fellowship but is also considering hospitalist. You can make good money doing both, and ultimately it comes down to what you think you enjoy doing. I did fellowship because I saw more opportunity for entrepreneurship and upside in specialties than I did in hospital medicine. However, another big reason is that I simply don't like the hospitalist gig. I have friends that do it and LOVE it, and they honestly live a better life than I can imagine. But to each his own.

Well, I don't know if your average ID doc could make that amount of money even if they wanted to.

 

[PlutoBoy]

There's a reason why the median is where it is. It is an important thing to note that MGMA (although I believe it's the most reliable) usually reports higher numbers than most other compensation surveys. If it really is that easy to make 300s, that's where the median would be.

But I guess the people arguing on this thread are special and the surveys don't include special people who have a much easier time making more $ because they are special.

Thank you.

 

[CCM-MD]

If it helps, my wife is a rheumatologist. She makes $245,000 + RVUs working four days a week. Mid sized city.

But people on this thread are way more efficient and harder workers than your wife. They could easily hit 350k annually cuz they are special.

 

[DiagnasaurusRex]

But people on this thread are way more efficient and harder workers than your wife. They could easily hit 350k annually cuz they are special.

Not special, just exploiting readily available opportunities which vary by speciality and other constraints. We are discussing constraints unique to specialities not some sort of unfounded exceptionalism.

 

[ICmyFuture]

But people on this thread are way more efficient and harder workers than your wife. They could easily hit 350k annually cuz they are special.

I don't think anyone is suggesting that making 300K in any of those specialties is easy; I certainly don't want to come across that way. I can't stand that naivete of pre-meds, med students who think earning that much is attainable for most; its not- no matter that their friend's uncle is making 500k! I wholeheartedly believe that as you increase patient volume, patient care will suffer at some point.

However, if you are compensated based on wRVU then hitting median endocrine income is obtainable with around 14-15 patients daily; so if you were see a few more each day- then you could increase income. From my viewpoint, most endos do not want to increase patient load for a variety of reasons- hence the median income shown on these reports.

 

[DiagnasaurusRex]

There's a reason why the median is where it is. It is an important thing to note that MGMA (although I believe it's the most reliable) usually reports higher numbers than most other compensation surveys. If it really is that easy to make 300s, that's where the median would be.

But I guess the people arguing on this thread are special and the surveys don't include special people who have a much easier time making more $ because they are special.

For the record I made about 300 with bonuses. Worked 20 shifts a month a few months and got other bonuses for admit/swing shifts etc... although I worked a lot of weekends I still had plenty of time off. On months I wasn't working hard went on two trips to Hawaii, one to NYC, 2 trips to Houston and spent about 11 days on the mountain (live an hour from breckenridge - way better to ski weekdays vs weekend anyways). It does get tiring so this year I think I'll cut back. But the option remains. That's my point. It's all options.

 

[bronx43]

But people on this thread are way more efficient and harder workers than your wife. They could easily hit 350k annually cuz they are special.

Lol, wut? Can you read or do math?

First off, what is claimed on this thread is that you CAN make that much if you are willing to put in some work... meaning working 5 days a week, and seeing more than 15 patients per day, which is not that hard. Therefore, if you're making $245k + RVU on 4 days a week, it means you would make 300k +RVU on 5 days a week. And of all the jobs I've seen, the RVU threshold is usually 4000-4500, after which you hit your productivity bonus. The median comp per wRVU in the country for rheumatology is around 50-60. And honestly this is the MAIN number that matters when it comes to physician compensation. I rather take $245k with 4500 wRVU threshold than $400k with 8000 wRVU threshold.

Going by the MGMA data that I have from 2015, 300k is the 75th percentile in early career. If you define "special" or "exception to the rule" as 75th percentile, then you probably have a different definition from the rest of us.

 

[bronx43]

If it helps, my wife is a rheumatologist. She makes $245,000 + RVUs working four days a week. Mid sized city.

Yes, those are the standard offers. I was offered around those numbers with $57/wRVU and threshold of 4400 wRVU. I honestly have zero interest in what the "base salary" is, since that's all hogwash. The only important things are definition of wRVU, and compensation per wRVU. It's important to make sure it's BILLED wRVU and not COLLECTED wRVU.

 

[CCM-MD]

My apologies. Everyone reading this thread should assume they will make 75th percentile on the MGMA report when making deciding on their specialty. Ignore the medians, cuz if you're reading this you're obviously more hardworking and efficient than that.

 

[DiagnasaurusRex]

Could make*

 

[Raryn]

My apologies. Everyone reading this thread should assume they will make 75th percentile on the MGMA report when making deciding on their specialty. Ignore the medians, cuz if you're reading this you're obviously more hardworking and efficient than that.

Depends on the person and the circumstances.

If you're willing to hustle and willing to live in a medium sized city, you can make 75th percentile in pretty much any field. I promise you. Not you will, but you *can*.

If you want to live in NYC and work 4 day weeks, you'll struggle to make 10th percentile in just about every field.

 

[DubbiDoctor]

Exactly. Other than being in insanely high demand, there is no difference between Rheumatology endocrinology and US basic Primary Care guys in terms of how we're paid and earning potential.

If you work 5 days a week and see 20 patients a day, 300K is fairly easy to manage.

That's the biggest difference between Hospital pay and Outpatient Clinic pay. Hospitalist, generally speaking, are paid hourly. The only way to earn more is to work more shifts and there are a finite number of days in the month. Clinic based practices you earn more by scheduling more patients, and while there is theoretically a ceiling to how many patients you can see in a day you'd be surprised how high that is.

Is 300K really possible as a primary care physician (FM or IM outpatient)? The average salary for FM is only a bit above 200K, so I suppose you would have to work a packed schedule in an undeserved area. I just can't see 300k being sustainable, adjusted for inflation, with the influx of midlevels, who many patients use as their PCP. I live in an affluent area with lots of physicians, yet my own mother -- a physician herself -- sees a PA as her PCP. For subspeciality issues, patients seem more compelled to see a physician (given their 5+ years of residency + fellowship training), and will be willing to pay extra for it. And hospitals will always pay to retain trained physicians to treat sick in-patients, so hospital medicine is a safe job. I think it really comes down to what you like more. Unless you're an incredibly savvy entrepreneur, you probably won't be raking in 400k+ as one of the lower paid subspecialists, but you should make more than outpatient primary care and similar to hospitalists.

 

[bronx43]

My apologies. Everyone reading this thread should assume they will make 75th percentile on the MGMA report when making deciding on their specialty. Ignore the medians, cuz if you're reading this you're obviously more hardworking and efficient than that.

Ok, for those of you who are mathematically or logically impaired, here's how it breaks down.

Average rheumatology job: $240k / 4 days a week = $60k per day (a year)

Extrapolate that to days you wish to work per week. End of discussion.

 

[VA Hopeful Dr]

But people on this thread are way more efficient and harder workers than your wife. They could easily hit 350k annually cuz they are special.

You do realize that with that salary working 4 days a week, if you work 5 days a week and see the same number of patients/day you break 300,000, right?

 

[VA Hopeful Dr]

Is 300K really possible as a primary care physician (FM or IM outpatient)? The average salary for FM is only a bit above 200K, so I suppose you would have to work a packed schedule in an undeserved area. I just can't see 300k being sustainable, adjusted for inflation, with the influx of midlevels, who many patients use as their PCP. I live in an affluent area with lots of physicians, yet my own mother -- a physician herself -- sees a PA as her PCP. For subspeciality issues, patients seem more compelled to see a physician (given their 5+ years of residency + fellowship training), and will be willing to pay extra for it. And hospitals will always pay to retain trained physicians to treat sick in-patients, so hospital medicine is a safe job. I think it really comes down to what you like more. Unless you're an incredibly savvy entrepreneur, you probably won't be raking in 400k+ as one of the lower paid subspecialists, but you should make more than outpatient primary care and similar to hospitalists.

Yes.

Let's do the math. In my area, PCPs are getting $40/wRVU. Average wRVU per patient most places with EMR is now 1.4.

300k/$40/wRVU gets you 7500 wRVU/year to hit 300k. At 1.4 wRVU /patient encounter you're at 5357 patient encounters per year. Assume a 46 work week year and you're at 117 patients/week. With a 5 day week, that's 23.5 patients/day. In residency I was seeing 12 patients/half day and that was with having to check out to attendings. So 24 in a day, assuming all of your patients aren't super sick is very doable.

 

[rokshana]

Again the numbers just don't seem to add up. Where does the average come from? If you're already "booked out" do you see more patients in less time? If that were then shouldn't true virtually every rheum doc should be rolling in dough? From what I've seen that isn't the case. To be fair most hospitalists earn near the median and are content doing so, however if needed they can add 50-100k to that bottom line quite easily provided they are willing to work more.

Can a practicing endocrine or rheum doc chime in? I guess y'all will just have to wait and see once your in practice.

uh...a practicing endocrine doc did just chime in...what? did you think i was pulling information out of my ass?

you think being a hospitalist is the best thing since sliced bread...well that's great. I'm happy for you...having been both a hospitalist and now an endocrinologist, i have some experience in both.

 

[DubbiDoctor]

Yes.

Let's do the math. In my area, PCPs are getting $40/wRVU. Average wRVU per patient most places with EMR is now 1.4.

300k/$40/wRVU gets you 7500 wRVU/year to hit 300k. At 1.4 wRVU /patient encounter you're at 5357 patient encounters per year. Assume a 46 work week year and you're at 117 patients/week. With a 5 day week, that's 23.5 patients/day. In residency I was seeing 12 patients/half day and that was with having to check out to attendings. So 24 in a day, assuming all of your patients aren't super sick is very doable.

Obviously, you can't predict the future, but do you think that that level of income will be sustainable with the continued influx of midlevels into primary care, acting as PCPs?

 

[VA Hopeful Dr]

Obviously, you can't predict the future, but do you think that that level of income will be sustainable with the continued influx of midlevels into primary care, acting as PCPs?

Why would it? Most PCP pay is independent of midlevels.

Besides, most places aren't increasing their mid-level numbers. I'm working for my 4th hospital system and none of them are putting more than 1 mid-level per office.

Truthfully, the specialist offices are the ones getting more mid-levels, not primary care.

 

[DiagnasaurusRex]

uh...a practicing endocrine doc did just chime in...what? did you think i was pulling information out of my ass?

you think being a hospitalist is the best thing since sliced bread...well that's great. I'm happy for you...having been both a hospitalist and now an endocrinologist, i have some experience in both.

Struck I nerve there didn't I? I don't recall you saying you were a practicing endocrine doc. Wasn't acusing you of pulling info out of your ass. Just getting information. Thanks for chiming in.

 

[Raryn]

Yes.

Let's do the math. In my area, PCPs are getting $40/wRVU. Average wRVU per patient most places with EMR is now 1.4.

300k/$40/wRVU gets you 7500 wRVU/year to hit 300k. At 1.4 wRVU /patient encounter you're at 5357 patient encounters per year. Assume a 46 work week year and you're at 117 patients/week. With a 5 day week, that's 23.5 patients/day. In residency I was seeing 12 patients/half day and that was with having to check out to attendings. So 24 in a day, assuming all of your patients aren't super sick is very doable.

The MGMA data is sometimes a little funny, but I will point out the median $ of total compensation/wRVU for an outpatient only internist is actually $52.33. So you can increase all those quoted incomes #s from this post by ~25%. Though again, that is total compensation divided by total RVU, so it isn't just the strict productivity pay but includes things like profit sharing/retirement plans/CME money. Unlike what some claim on this website though, it does NOT include any sort of benefits.

Average of 1.4 wRVU/visit passes my gut check as well, since a 99214 is ~1.5 wRVU and is likely the majority of the visits, but I don't actually have any data on that personally.

Per the same MGMA data, the median $/wRVU for Endocrinology is $53.65, and for Rheum is $55.37. So if the Rheumatologist in a median market sees 20 patients a day, gets 1.4 RVU/patient, works 4.5 days a week (very reasonable) for 46 weeks a year (6 weeks of vacation is plenty)... that's $320k/year. Make it 5 full days a week and only 4 weeks of vacation and you're at $372k. And that's at the median $/wRVU for Rheum. It's going to be more in private practice in a suburb somewhere (potentially significantly more). Substantially less in urban academics of course.

 

[VA Hopeful Dr]

The MGMA data is sometimes a little funny, but I will point out the median $ of total compensation/wRVU for an outpatient only internist is actually $52.33. So you can increase all those quoted incomes #s from this post by ~25%. Though again, that is total compensation divided by total RVU, so it isn't just the strict productivity pay but includes things like profit sharing/retirement plans/CME money. Unlike what some claim on this website though, it does NOT include any sort of benefits.

Average of 1.4 wRVU/visit passes my gut check as well, since a 99214 is ~1.5 wRVU and is likely the majority of the visits, but I don't actually have any data on that personally.

Per the same MGMA data, the median $/wRVU for Endocrinology is $53.65, and for Rheum is $55.37. So if the Rheumatologist in a median market sees 20 patients a day, gets 1.4 RVU/patient, works 4.5 days a week (very reasonable) for 46 weeks a year (6 weeks of vacation is plenty)... that's $320k/year. Make it 5 full days a week and only 4 weeks of vacation and you're at $372k. And that's at the median $/wRVU for Rheum. It's going to be more in private practice in a suburb somewhere (potentially significantly more). Substantially less in urban academics of course.

MGMA is tricky though, so I was using hard numbers that I've seen in signed contracts. My wife is an internist and is getting the same $40 per wRVU that I am as a family doctor. Even if we just increase the reimbursement rate by $5 to account for specialty training, 300000 per year is still not that hard to attain

 

[Gastrapathy]

MGMA is heavily weighted to large group practices.

 

[rokshana]

I see. Well that's good that patient care is more important than volume for you guys. 20 patients a clinic day is up there. For rheum they bill for injections so that def helps.

I just don't want people to get the impression that it's feasible for all such specialists to be able to make 300+ except in certain circumstances which would entail overbooking clinics, niche location and/or some luck.

How about you let those of us actually practicing in the field tell you want is probable and possible... I don't think anyone here is saying making upper 300s and 400s is really that probable as an endo or rheum...but making upwards to 400K as a hospitalist is also not that probable...working 20- 12 hour days as a Hospitalist is EXHAUSTING (been there, done that at a busy urban hospital in Philly) unless you are at some small, low acuity place in BFE
I essentially work a Hospitalist's schedule...2-2 1/2 weeks of clinic and then I'm off, depending on new or established pts see 8-16 pts/day...and I make easily what I had as a Hospitalist and enjoy it more ( frankly felt like a well paid intern as a Hospitalist)...I do work in BFE but guess what ? They pay me enough that I can live in my home state and travel when I'm off !

 

[DiagnasaurusRex]

How about you let those of us actually practicing in the field tell you want is probable and possible...
I essentially work a Hospitalist's schedule...2-2 1/2 weeks of clinic and then I'm off, depedind on new or established pts see 8-16 pts...and I make easily what I had as a Hospitalist and enjoy it more ( frankly felt like a well paid intern as a Hospitalist)...I do work in bed but guess what ? They pai me enough that I can live in my home state and travel when I'm off !

Well I was actually waiting for that but initially I just got "you couldn't be more wrong."

Thanks for clarifying, I didn't mean to overspeculate regarding your field, just trying to get the facts.

 

[rokshana]

Struck I nerve there didn't I? I don't recall you saying you were a practicing endocrine doc. Wasn't acusing you of pulling info out of your ass. Just getting information. Thanks for chiming in.

i don't have to tell people that...most people here know that (though WS did have to change my status from fellow to physician since i forgot to do that).

 

[Successor12]

i don't have to tell people that...most people here know that (though WS did have to change my status from fellow to physician since i forgot to do that).

I am curious about your clinic schedule? So you see patients in clinic for two weeks then your off the next two weeks or did I get that wrong?

 

[rokshana]

I am curious about your clinic schedule? So you see patients in clinic for two weeks then your off the next two weeks or did I get that wrong?

Yep! I'll do anywhere from 12-15 days in a row(excluding weekends) and then go home. It's all outpt so no call. I have remote access so any task I can take care of from anywhere...and my staff knows they can call me anytime if something needs attention on less than 24 hours.

 

[Successor12]

You mind sharing if you are still able to make your money with this schedule? Also how common is it to find such schedules in the outpatient world?

 

[Raryn]

Just wanted to provide a real life example to the above discussion. I interviewed at a job yesterday with a multispecialty group in a large, metropolitan area.

M-F, 4.5 days of clinic/week. No weekends or inpatient coverage, ever.
Typically ~19 patients scheduled per day, but usually see ~14-15 given current show rates.
If you see those 15 patients x 4.5 days/week x 46 weeks a year (yes, everyone takes 6 weeks of vacation), you meet (surpass) all productivity expectations and make roughly the MGMA median for endocrinology. Make a bit (~10% after sign on bonus taken into account) less the first year for a salary guarantee, but that's normal.

These are the kind of jobs that make the median. I may go for it, may take less pay for an academic schedule. Still not sure. Regardless, definitely a much better lifestyle than as a hospitalist, no nights or weekends, more vacation than I'd know what to do with. My cofellow on the other hand decided to go for $$$. She's going to a smaller market, a busier group, and starting out roughly the same as the job I described above.. but the median person in her group after 3-4 years makes close to $400k. She didn't have to look that hard to get that job. They aren't that uncommon out there if you're geographically flexible.

 

[LebronManning]

Sure- if you're looking at these surveys, I don't expect the outpatient subspecialties to make the same or more than hospital medicine. When I was an academic hospitalist, I was making more than almost all the specialists with the exception of GI and cards.

The difference is the POTENTIAL. If you're entrepreneurial and know how to maximize volume and/or ancillary revenue streams, then you will out-earn hospital medicine by multiples. As a hospitalist, you're limited in how much you will make by your employer. You simply do not have the control to be able to expand your reach, and you will not be able to scale your services. You're simply a nameless cog in the machine. No one knew your name before going to the hospital, they barely know your name when they're in the hospital, and they will forget your name once they leave.

On the other hand, when you are in control of your own practice, you have MANY different avenues to make money and your patients will be coming FOR YOU. My friend who is a rheumatologist on the east coast owns a relatively large practice and he essentially has a monopoly in his region. He easily pulls $1.5-2 mil a year with the clinical volume and vast ancillary services that he offers. He's obviously the exception to the rule, but these opportunities are really only possible in the specialties.

Can't an IM only trained physician also be entrepreneurial? How does it make sense to specialize for the sole purpose of outpatient practice? PCPs are more in demand than any other type of physician and are also booked out. Can't a "hospitalist" always open up a primary care practice and see 35 patients a day and make similar pay? What's the difference in reimbursement for a primary care vs rheum visit? Furthermore, the IM guy can continue to work week on/week off and work his OP practice the other 2 weeks with another partner to manage it while one is being a hospitalist.

Also, you can get certified in various things such as addiction medicine or aesthetic medicine and offer other ancillary services at your practice just like any specialist would.

I'm curious to why outpatient practice can be so much more lucrative as an endocrinologist or rheum or some non cards/GI specialist. In financial terms, you also have to consider the 300k per year one forfeits by doing those fellowships vs being a hospitalist and also building up a practice on the side.

 

[gutonc]

Can't an IM only trained physician also be entrepreneurial? How does it make sense to specialize for the sole purpose of outpatient practice? PCPs are more in demand than any other type of physician and are also booked out. Can't a "hospitalist" always open up a primary care practice and see 35 patients a day and make similar pay? What's the difference in reimbursement for a primary care vs rheum visit? Furthermore, the IM guy can continue to work week on/week off and work his OP practice the other 2 weeks with another partner to manage it while one is being a hospitalist.

Also, you can get certified in various things such as addiction medicine or aesthetic medicine and offer other ancillary services at your practice just like any specialist would.

I'm curious to why outpatient practice can be so much more lucrative as an endocrinologist or rheum or some non cards/GI specialist. In financial terms, you also have to consider the 300k per year one forfeits by doing those fellowships vs being a hospitalist and also building up a practice on the side.

Because it's not always all about the Benjamins.

Can a hospitalist (who is already working 60-80h/week on his weeks on) also work 2 weeks as a PCP seeing 4-5 patients an hour 5 days a week and double his pay? Of course. But all that cheddar will be useless to him when he puts a bullet in his head.

Alternatively, he could do a fellowship, give up $100-150K for 2-3 years (but moonlight and make half of that back) and then make the kind of money the dude in the first scenario makes working 1 job, 3-4 days a week in clinic with no nights or weekends and minimal call. That's the choice I made.

 

[PlutoBoy]

Can't an IM only trained physician also be entrepreneurial? How does it make sense to specialize for the sole purpose of outpatient practice? PCPs are more in demand than any other type of physician and are also booked out. Can't a "hospitalist" always open up a primary care practice and see 35 patients a day and make similar pay? What's the difference in reimbursement for a primary care vs rheum visit? Furthermore, the IM guy can continue to work week on/week off and work his OP practice the other 2 weeks with another partner to manage it while one is being a hospitalist.

Also, you can get certified in various things such as addiction medicine or aesthetic medicine and offer other ancillary services at your practice just like any specialist would.

I'm curious to why outpatient practice can be so much more lucrative as an endocrinologist or rheum or some non cards/GI specialist. In financial terms, you also have to consider the 300k per year one forfeits by doing those fellowships vs being a hospitalist and also building up a practice on the side.

35 pts a day? Right...

 

[LebronManning]

Because it's not always all about the Benjamins.

Can a hospitalist (who is already working 60-80h/week on his weeks on) also work 2 weeks as a PCP seeing 4-5 patients an hour 5 days a week and double his pay? Of course. But all that cheddar will be useless to him when he puts a bullet in his head.

Alternatively, he could do a fellowship, give up $100-150K for 2-3 years (but moonlight and make half of that back) and then make the kind of money the dude in the first scenario makes working 1 job, 3-4 days a week in clinic with no nights or weekends and minimal call. That's the choice I made.

Good point, but the first guy in your scenario works an average of 70 hours 2 week, and 50 hours the rest of his 2 weeks. So he makes 500k/yr working an average of 60 hours per week, I doubt that would make anyone kill themselves. Furthermore the goal of this would be to stop the hospitalist gig by 45 and by that time have a successful practice built up where you employ other physicians but also see 25 patients per day and keep up the income. I think people exaggerate the nature of hospitalist work. Sure it’s not like anything outpatient or even some specialists in patient, but it’s nowhere near surgical lifestyles. The pay per hour is worth it. My father is a hospitalist for the last 15 years at a major community hospital with academic affiliation with a census of 22+ 7on/7off and says it’s literally cake once you have experience and a good relationship with colleagues. For the record, I’m not saying it’s cake before anyone starts about that...perhaps after 15 years as a hospitalist it is.

I guess what I’m more curious about is the pay differential specialists receive for the same # of patients vs a IM PCP. Obviously proceduralists will net more, but how about the other IM sub specialties?

 

[rokshana]

Good point, but the first guy in your scenario works an average of 70 hours 2 week, and 50 hours the rest of his 2 weeks. So he makes 500k/yr working an average of 60 hours per week, I doubt that would make anyone kill themselves. Furthermore the goal of this would be to stop the hospitalist gig by 45 and by that time have a successful practice built up where you employ other physicians but also see 25 patients per day and keep up the income. I think people exaggerate the nature of hospitalist work. Sure it’s not like anything outpatient or even some specialists in patient, but it’s nowhere near surgical lifestyles. The pay per hour is worth it. My father is a hospitalist for the last 15 years at a major community hospital with academic affiliation with a census of 22+ 7on/7off and says it’s literally cake once you have experience and a good relationship with colleagues. For the record, I’m not saying it’s cake before anyone starts about that...perhaps after 15 years as a hospitalist it is.

I guess what I’m more curious about is the pay differential specialists receive for the same # of patients vs a IM PCP. Obviously proceduralists will net more, but how about the other IM sub specialties?

what are you a basic science med student? have you even been near a pt or a hospital?
or even talked to your Dad? Ask him if his job is "cake"...better yet ask your DAD if your scenario is remotely feasible?
and i am assuming you have no relationship or SO....or kids.With that schedule, you never will.

 

[LebronManning]

what are you a basic science med student? have you even been near a pt or a hospital?
or even talked to your Dad? Ask him if his job is "cake"...better yet ask your DAD if your scenario is remotely feasible?
and i am assuming you have no relationship or SO....or kids.With that schedule, you never will.

Is there a reason you have an inability to participate on these forums without being hostile?

To answer your question, yes I’ve been near a patient, I scribed for 2 years ER and in patient. Is the scenario remotely feasible? Lol it’s directly from my father. He has a well established outpatient practice and works as a hospitalist. He sees his kids after work, hasn’t been at work after 7 PM any time in the last 10 years. During his outpatient weeks he’s home by 4:30. Lol. And you said ask him if his job his cake...that’s literally who told me so. Even with that, I wrote that I don’t believe it to be cake.

My dad does do that schedule, is happy, happily married for 28 years with 3 kids and coach of my little sisters soccer team. And makes a cool 600-700k per year depending on business. He has 3 other MDs and 1 PA employed at the outpatient practice. According to you he must be some sort of unicorn. That’s also false because I know of other family friend physicians who are doing similar. Kindly, I’d suggest not implying other people aren’t capable of doing things if you don’t believe yourself to be.

Finally, I’m here to get information and participate in discussion, not be yelled at by miss rokshana. You must have some great gig to where you can spend your days trying to demolish pre med and med students arguments and failing at it. Learn to disagree without being disrespectful.

 

[rokshana]

Finally, I’m here to get information and participate in discussion, not be yelled at by miss rokshana. You must have some great gig to where you can spend your days trying to demolish pre med and med students arguments and failing at it. Learn to disagree without being disrespectful.

That would be DR. Rokshana to you, honey.
did you stay in a Holiday Inn too?

and now i remember you...its ok, if you actually practice, it will be in Australia and not the US.

and pre meds don't belong in the resident threads...kindly go back to the pre med forums until you actually have some real rationale for asking questions here.

:troll: can't believe i got sucked in

 

[LebronManning]

That would be DR. Rokshana to you, honey.
did you stay in a Holiday Inn too?

and now i remember you...its ok, if you actually practice, it will be in Australia and not the US.

and pre meds don't belong in the resident threads...kindly go back to the pre med forums until you actually have some real rationale for asking questions here.

:troll: can't believe i got sucked in

Yeah just like you're practicing in Grenada lol. And learn the definition of a troll. Its someone who gets on forums just to degrade other people for their own enjoyment, like you here. Added nothing except something that was proven 100% false. Not someone who is actually curious about the said topic.