How low can salary go?

[baseballer]

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I feel that I should start with a disclaimer that this post is truly a sincere curiosity of mine and not an attempt to simply stir the pot. I decided to go into family medicine knowing full well that, generally speaking, the field does not offer the same compensation as other specialties. Of course, exceptions exist to every rule, and I'm sure that there are FPs who are able to achieve incomes higher than the average.

My concern mostly revolves around the ever-increasing presence of NPs and PAs. It is not my intent to propagate another NP/PA vs. MD debate as that issue has already been bantered about ad nauseum. However, I do believe that the ongoing "turf war" raises interesting questions from a financial standpoint.

I know that the NP leaders are fighting for equivalence in terms of autonomy/independent practice and, ostensibly, salary as well. It is my understanding that an NP can make ~100K in certain parts of the country, while the average salary for an FP is perhaps in the vicinity of 160-180K. I also read that CMS has actually been increasing primary care reimbursements of late and has pledged to continue to do so (at least for the next few years).

Assuming that NPs and PAs play a larger and larger role in healthcare, do you foresee FP salaries actually falling as a result? I would imagine that an MD will always make more than an NP given the discrepancy in qualifications/training, but is it possible that we will be making low-six figures when all is said and done? Thanks for your insight.

 

[dsoz]

If you only work part-time, or can't fill your schedule with patients, or don't understand how to bill correctly, your "salary" can drop.

You are asking like you are going to make a certain amount per year. I believe that is a misconception. Unless you work for a large hospital system, or you have a contract with a group, you will be making whatever you can bill insurance, and collect from private payers.

I asked a FP physician about this while shadowing. In his private practice group, they may offer a new physician a "salary" for the first year while he/she builds a client base. But by the second year, the new physician is expected to have a self supplying group of patients. The physician earns what he/she can bill for. Procedures provide more income, office visits are break-even, and medicare/medicaid patients are actually considered (mostly) lost income. Therefore the physician can set the number (percent) of medicare/medicaid patients that he/she is providing for.

The physician also sets the number of patients per hour, how long to make each office visit, etc. The more patients that can be packed into an hour, the more a physician makes. That is how the rules are set up, and so that is how they live.

I hope you get a better answer to your question. Mine kinda went off topic.

dsoz

 

[lowbudget]

The physician also sets the number of patients per hour, how long to make each office visit, etc. The more patients that can be packed into an hour, the more a physician makes. That is how the rules are set up, and so that is how they live.

I hope you get a better answer to your question. Mine kinda went off topic.

dsoz

Exactly. Everybody, whether you are a doctor, an engineer, a lawyer, or whatever needs to justify their salary at some point. NP's and PA's can be useful for a practice but their salary must be justified also. Personally, I think mid levels are a fad and reflects an extent of degree inflation. I think in doctor shortage areas they provide great service. But generally I think they are currently overpaid and everyone is just scrambling.

 

[deleted87716]

The OP doesn't understand how we're paid.

First off, practically no physicians are salaried, even those who are employed by large health systems. A salary is a set annual remuneration for a defined amount of work (e.g., you get $x/year paid in bimonthly installments in exchange for working 40 hours/week for 48 weeks/year). That's rarely how it works in medicine. With few exceptions, we're all paid based on productivity. There are endless formulas for determining how this is done (some based on revenue, some on RVUs), but the bottom line is that those who work harder and/or smarter tend to earn more than those who don't.

That being said, anytime I see anyone here using the word "salary," it pretty much guarantees that they don't know what they're talking about. Say "income" instead.

As has already been mentioned, some new physicians receive a true salary for a short time (typically 1-3 years) while they build their practice, after which they're paid based on productivity.

Mid-levels, OTOH, are almost exclusively paid based on salary, sometimes with a productivity bonus. Who decides their salary? Physicians, for the most part, because that's who employs them. A mid-level's salary is based on the prevailing market rates in a given area of the country for a given specialty, not by how much physicians in the same specialty are making. Granted, if physicians in a given specialty are having trouble making ends meet, they probably aren't going to be able to pay their mid-levels very well (if they can manage to find any to work for them in the first place), and physicians working in lucrative specialties will be able to afford to pay their mid-levels more than those in less-lucrative specialties. That's one reason why most mid-levels work in specialties, not primary care. They go where the money is. However, the OP seems to be under the impression that mid-level salaries have the ability to exert downward pressure on physician incomes, which simply isn't possible. If anything, it's the other way around.

I think the misconception arises from the idea that there's some all-controlling entity which artificially sets physician and mid-level "salaries" and is scheming somehow to bring them in line with one another. This is pure fantasy.

 

[christiandocj]

I actually am salaried. I'm a FP and I work in a Federally Qualified Health Center in Long Beach and, at least the FQHC's that I'm familiar with, are all salaried based on hours worked, rather than patients seen. How much you make really depends on your setting, rural vs urban, private vs federally funded, etc. Most FQHCs in the area that I work at, first year out of residency the salary is something like 130-140s. They don't pay nearly the same as bigger private organizations, but many who work there are there because of the mission of providing care to the underserved. Many of those clinics do offer loan-repayment as part of their compensation package so that offset's the difference a little bit. Hope that helps.

 

[deleted87716]

I actually am salaried. I'm a FP and I work in a Federally Qualified Health Center

Yes, and most other Federal employees (e.g., the military, VA, etc.) are also salaried. To the OP's question, however, It's worth noting that your salary isn't based on what they're paying the mid-levels in your organization.

 

[baseballer]

Thanks for everyone's clarification. Again, my question was sincere, albeit naive. Appreciate the replies.

 

[deleted6669]

looking at it from the pa side of the equation-
some places are very desirable to live in (say san luis obispo california for example).
if they can pay a doc a lower salary to work there they are unlikely to use pa/np folks in that same area at similar salaries.
there are places that are not desirable to live in that will pay a pa 125k+ because no doc will work there for that money. then there are places that pay docs 125k because everyone wants to be there and they can afford to be cheap because if you won't work for 125k some other fp doc will. other places just pay everyone crap rates because they can get away with it.
a practice near me was recently offering fp boarded docs 90k/yr + 25 k loan replacement and they had a waiting list for folks to fill that job. the same place pays a pa 70K + the loan repayment, both very under nl market rates because folks want to live/work there.

 

[deleted87716]

looking at it from the pa side of the equation-
some places are very desirable to live in (say san luis obispo california for example).
if they can pay a doc a lower salary to work there they are unlikely to use pa/np folks in that same area at similar salaries.
there are places that are not desirable to live in that will pay a pa 125k+ because no doc will work there for that money. then there are places that pay docs 125k because everyone wants to be there and they can afford to be cheap because if you won't work for 125k some other fp doc will. other places just pay everyone crap rates because they can get away with it.
a practice near me was recently offering fp boarded docs 90k/yr + 25 k loan replacement and they had a waiting list for folks to fill that job. the same place pays a pa 70K + the loan repayment, both very under nl market rates because folks want to live/work there.

 

[MJB]

other places just pay everyone crap rates because they can get away with it.
a practice near me was recently offering fp boarded docs 90k/yr + 25 k loan replacement and they had a waiting list for folks to fill that job. the same place pays a pa 70K + the loan repayment, both very under nl market rates because folks want to live/work there.

I think I've seen those people...when you look up "stupid" in the dictionary, there's a picture of them.

 

[MedicineDoc]

In the current market you should aim for at least 250,000 and be insulted by anything less than 200,000. There are mechanics, police and plumbers making 100,000.

 

[deleted87716]

In the current market you should aim for at least 250,000 and be insulted by anything less than 200,000.

Starting? No way.

I'm sure there are jobs out there paying that, but there's undoubtedly a reason.

 

[cabinbuilder]

In the current market you should aim for at least 250,000 and be insulted by anything less than 200,000. There are mechanics, police and plumbers making 100,000.

Very rare. The going rate currently is 180-220 with a few exceptions. And those places with super high salaries are horrendous to work at with insane workload and/or are in the middle of nowhere.

 

[badasshairday]

Starting? No way.

I'm sure there are jobs out there paying that, but there's undoubtedly a reason.

probably location, Alaska.

 

[BrakngLyv]

Very rare. The going rate currently is 180-220 with a few exceptions. And those places are horrendous to work at with insane workload and/or are in the middle of nowhere.

Do I understand you correctly that the 180-220 gigs are difficult work environments?

 

[Zback]

Do I understand you correctly that the 180-220 gigs are difficult work environments?

The way I took it was 180-220 is the average. Anything above that will most likely be a place that is less desirable.

 

[MedicineDoc]

I know I'm not having any trouble getting up around there doing locums.

 

[deleted87716]

The way I took it was 180-220 is the average. Anything above that will most likely be a place that is less desirable.

I know I'm not having any trouble getting up around there doing locums.

There ya' go.

 

[BrakngLyv]

Got it! Thanks!

 

[MedicineDoc]

There ya' go.

Actually if I can keep the jobs coming its going to be closer to 300.

 

[cabinbuilder]

Do I understand you correctly that the 180-220 gigs are difficult work environments?

NO. The difficult work environments are the very high salaries.. The average lovely place to work is 180-220

 

[cabinbuilder]

probably location, Alaska.

NO, starting in Alaska is 220. The highest salary I worked for was in Nevada.

 

[brats800]

NO. The difficult work environments are the very high salaries.. The average lovely place to work is 180-220

I agree with CB but, as has been mentioned before, this is location / region dependent. The docs I knew in Chicago loved where they lived: right off of Michigan Ave, in sight of the lake, able to walk to everything. Salary? Less than 180. Docs in my area who are busy with a full patient panel? Maybe slightly above that range.

 

[andwhat]

180 is quite solid near Chicago and Michigan Ave I'd take that in a heartbeat