According to healthcaresalaryonline.com, the average salary for a FM physician is $168,550 and the highest reported is $226.950. However, I've heard about some family medicine doctors making over $300K, the highest I heard was $600K. So I was wondering how they did this? Apart from living in rural areas, how do some family medicine doctors make over 300k?
How do family medicine doctors make over 300K?
- Thread starter reree17
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Lots of NP/PAs, elective dermatology procedures (or really, any procedures that pay well), endoscopy, moonlighting, OB.
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Run a large fm/urgent care clinic. Utilize PA's. Find a niche and exploit it.
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deleted87716
Good payer mix, appropriate coding, careful billing and collection, overhead management, volume.
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I've heard of pretty incredible salaries for FPs in rural, somewhat unpopular places to practice. I'm sure they were also doing a lot of OB, ER shifts, procedures, etc. but I figured some part of that was just so that they could get a doctor in town.
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Build a practice, expand ridiculously over a brief period of time, mortgage everything, speculate fabulously on things like in-house CT/MRI, US, nuclear stress tests, train and be certified to do in-house endoscopy AND hire a bunch of PAs/NPs and open an urgent care center. Helps if you're in the south and your family name had brand-recognition and you've just described one of my (former) supervising physicians...who I would not be at all surprised to know made $1 mil/yr if not more. Surprised this guy has time to still see his own pts....
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Concierge medicine.
Insurance medicine / IMEs.
Botox.
etc.
Work smarter, not harder. OBS / ER work is a pretty brutal way to make a significant amount of money. Most docs do this sort of work for a combination of reasons. It is rarely for purely that of a financial one.
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I have spoken with employed physicians and heard from a recruiter of a group that this is no unheard of. They have a base then get quarterly bonuses based off RVU's. The docs in my hometown apparently draw about 200K in "salary", then bonus off that. They do ER call and some do OB, but I've also heard this isn't unheard of doing OP only.
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If in private practice, a good coder will make you or break you. Some of the best practice models I have seen has an employed coder who works on salary/commission model. This means that they get a small percentage bonus at the end of each fiscal year on collections. YMMV though. 
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deleted87716
IMO, a physician who learns to code properly will outperform a "professional coder" every time. Most of them are way too conservative.
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Not to mention the money you save from not having to hire one.
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I have not mastered this art yet
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When you consider we have to deal with a lot of non-medical issues, that's not enough. It's relative when you think about the 600K a year ER, cardio, and GI make. Oh...GI..they make a killing with those colonoscopies. hahaha
Blue Dog: So what is the best way to learn coding??
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As a hospitalist, I do my own billing after each encounter note. I have a iPhone app I got on sale for 10 dollars that pretty much lays out the documentation criteria for various coding levels. We get a pretty large percentage of "sick people" and I see quite a few more 99232 and 99233 hospital f/u and not many 99231. The question I have is how important is it to have a bell shaped billing curve in the environment of the gov't trying to recoup money due to increasing cost and declining revenues. That said if I have to spend 30 to 45 minutes on a pretty seriously ill patient in my mind that is a 99233. Either way it's not to tough to hit the criteria for coding at a certain code level. I try to do what I think is right in terms of billing but the idea of some gov't worker who makes a living trying to recoup money taking out a magnifying glass is a little disconcerting regardless.
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deleted87716
As long as your documentation supports your coding, you have nothing to worry about.
CMS has limited resources, and goes after extreme outliers (e.g., people who code all of their visits as 99215), not those whose bell curves merely lean to the right.
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deleted87716
I should point out that doing the opposite of the above is the road to ruin.
- Accept all payers (no matter how poorly they reimburse)
- Chronically under-code
- Sloppy billing, fail to correct/re-bill rejected claims, fail to collect co-pays at the time of service, fail to collect patient-allowable balances, write off bad debts without dismissing patients, etc.
- Overpay your staff, hire too many people, pay health insurance and other benefits blindly, overpay for your real estate, fail to keep an eye on expenses, advertise (usually a waste)
- See <20 patients in an 8-hr. day because you're "oh-so-methodical and spend time with your patients" (read: inefficient)
Sadly, the above describes the majority of primary care practices in this country.
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How many patients do you typically see in a day? Some of the jobs that I've looked at say that their providers usually see 24-28 pts. in a regular day.
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deleted87716
That's about right. I typically see 20-25 in an 8:15am-4:30pm day with a scheduled break for lunch from 12:45-1:45 (15-minute appointments for most, 30-min. for new patients and physicals - max of 5 of those per day). If my schedule is full, and they're all 15-min. appointments, I could see up to 30 (not counting any work-ins), but that starts to get a little painful.
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Are you able to get all of your charting done during that time or do you complete your charts after hours?
Reason I ask is that I work in an FP/resident clinic 1/2 day per week for my internship. I like to get a pt's chart done before going onto the next pt but I find myself falling behind schedule. Seems like most of my colleagues spend a few hrs everynight doing charts if they don't complete them in the room. Granted, I have a 1/2hr per pt, but it would seem impossible to do this if I had to see 4 pts an hour like the senior residents.
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And a follow-up question regarding charting, if you have EMR, does that slow you down or speed things up? I have seen some EMR applications that seem to take forever to document a simple office visit (multiple screens to access and it seems like a "zillion" clicks to complete the chart. I'm sure there must be some better ones).
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deleted87716
With rare exception, I complete each note as I see each patient.
It probably slows me down a little bit, but I was "charting as I go" when I was on paper, and continue to do so on EMR.
I've always used a three-step process to write my notes (this mainly applies to follow-up visits). The "pre-visit" is a minute or two spent looking through the chart, seeing why they're here today, reviewing my last note and any management changes that were made, reviewing any labs or studies done since that time, and roughing out a "skeletal" note based on normal history and exam findings for what I'm going to ask and do when I am in the room. This lays out my "game plan," so to speak. During the visit itself, the note gets fleshed out with specific history and exam findings, along with any issues or new problems raised by the patient. The "post-visit" takes a minute or two after I leave the exam room, and basically involves finishing up my note, pre-ordering labs and/or studies for the next visit, and ordering any referrals.
Works for me.
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as a 3rd year resident, i am often able to finish my charts with each patient. i usually have less than 1/2 hour of finishing work to do after a full clinic of 15 - 20 patients (patients every 15-30 minutes depending on what they are coming in for). i'd say the EMR makes me faster, but that is because i type fast and i can navigate through the EMR quickly. my speed is more based on the processing speed of our old computers / network vs. the speed of the EMR or my typing / thinking.
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Once you decide to set up on your own you will not have a `salary' concept to deal with other than what you decide to pay yourself. Salaried positions are proportional, to a large part, as to what you can bring into the practice that `hires' you.
Office procedures including but not limited to: Fx care, injections (arthrocentesis, trigger point), skin biopsies, removal of skin lesions, Incision and Drainage, wound care, and on and on. Learn about coding inside out and make sure you document ALL of your records with proper consent and operative notes. CPT, ICD codes are a must. Visit the offices of some docs who have hands-on practices.
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