If one were to be thinking of leaving an employed psychiatrist gig for the wilds of PP: timeline?

[fiatslug]

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Background: I have a good job with a hospital system. I like (love) what I do, but the political life of enormo-hospital bureaucracy is lately leaving a bad taste. Plus they are starting to demand much more weekend coverage from us. Thinking/fantasizing about PP.

What would be a timeline for leaving a secure & steady (& good) paycheck to get a PP going? I'd be starting from scratch (unless I joined an existing small group, or set up shop with a colleague or two... also tempting...). I'd need to get paneled, I'd need a lawyer, I'd need insurance, an office, an EMR... my husband could probably learn/do the work of front & back office stuff. I am a cautious person by nature, and as the sole breadwinner, I need to have a steady income source quickly.

Any links/advice/first steps? Any benefit to starting a small group practice vs going solo? If I were to start the process now, when would be a reasonable time to hang out the shingle? Has anyone figured out what billing is the best outpatient practice plan? (For instance, they were initially encouraging us to do 90833s--16-37 min psychotherapy add-on--but now the push is for us to "not do any therapy" and just bill E&M, which I have to assume is purely about money...)

Thanks in advance!

 

[F0nzie]

I am biased because I only do cash-- which has its own set of issues. But just looking at where my time and money go into pp, paneling up would not be a good financial move. Worst case scenario, I would drop my rates down to $75 per visit and see 3 patients an hour before I even considered running an insurance based practice on my own (but honestly I would just close down my practice lol)

My advice is do cash 1 day a week and play around with it first. The question you should ask yourself is: do I want more free time and fill at a slower rate? or do I want to hustle and break my back to fill at a faster rate? If you are feeling insecure about an all cash model get on 1 panel (that should be plenty to keep you busy and maybe even a bit suicidal) then drop it when you fill.

But strictly speaking from a business/financial perspective IMO you're better off dealing with an organization's politics or joining a group pratice to share the overhead than dealing with insurance companies on your own-- unless your plan is to eventually become CEO of a group practice by starting a company from the ground up.

 

[happygilmore]

Seeing 3 patients an hour, do you write your notes at the end of the day or during the interview?

- Is insurance that difficult to deal with, I mean - are they denying payments on lots of patients? I understand it's a pain billing them but you also get a lot of patients that way.

 

[dl2dp2]

Depending on your geographical location, training background, social network, knowledge of how to run a business, etc., this could take anywhere between a few months to a few years (or even longer). I second Fonzie's thought to get started with 1 day a week if you can. If not (i.e. inpatient job), I would start with exploring mentorship relationships first. It's very possible that you net a higher salary and work less if you join a group than starting from scratch. There are instances where solo practice would very quickly and easily become much more desirable, but usually these circumstances are very obvious from the get-go--i.e. I would say that if a large number of recent graduates/faculty from your residency class also have a solo practice it's a sign that it's feasible and lucrative, and they should be your 1st go around for more information.

 

[fiatslug]

Good things to consider here. Happy, different insurance companies (from what I've heard from friends/colleagues in PP) can be wildly different to work with. BC/BS and Aetna seem (again according to others) to be relatively easy to work with: good reimbursement, not a lot of pprwork BS. Some are much more challenging, and many providers choose not to be on those panels. I'd like to have a much better sense of which insurance companies are good vs bad before paneling

It's hard, because this is a Good Job, and I love what I do. OTOH, they are suddenly requiring me (and others in our program) to work 13 Saturdays a year (paid at a half day rate for 5 hr work day, which works out to being not nearly enough to justify ruining 13 weekends) beginning next year. If it were just political toxicities at my job, I could duck & cover, but this other stuff really screws around with work/life balance...

Better to join an exisiting group or join forces with other disgruntled docs and form our own group? What's the favorite EMR out there for PP docs? Any VA docs here? (not that I even know if they have job openings locally)...

ETA: I write my notes in session with the pt present (or about 90% of it). I'm a fast & accurate typist and I face them with my keyboard on my lap, with my monitor also in my line of sight.

 

[heyjack70]

Good things to consider here. Happy, different insurance companies (from what I've heard from friends/colleagues in PP) can be wildly different to work with. BC/BS and Aetna seem (again according to others) to be relatively easy to work with: good reimbursement, not a lot of pprwork BS. Some are much more challenging, and many providers choose not to be on those panels. I'd like to have a much better sense of which insurance companies are good vs bad before paneling

It's hard, because this is a Good Job, and I love what I do. OTOH, they are suddenly requiring me (and others in our program) to work 13 Saturdays a year (paid at a half day rate for 5 hr work day, which works out to being not nearly enough to justify ruining 13 weekends) beginning next year. If it were just political toxicities at my job, I could duck & cover, but this other stuff really screws around with work/life balance...

Better to join an exisiting group or join forces with other disgruntled docs and form our own group? What's the favorite EMR out there for PP docs? Any VA docs here? (not that I even know if they have job openings locally)...

ETA: I write my notes in session with the pt present (or about 90% of it). I'm a fast & accurate typist and I face them with my keyboard on my lap, with my monitor also in my line of sight.

Do you believe that the psychiatrists could push back on this? This seems like a decision that has been dictated down from administration. Was there any negotiation prior to this change? If not, (and I caution that I don't have personal experience with this), I would be curious about older psychiatrist's opinions about creating a unified front against this change. Demanding you be paid for 2/3 of a day?

 

[fiatslug]

I should be more clear--they are paying us for the full 5 hrs, but after taxes, it works out to something like $250 after taxes. Which sucks, and none of us feel this is worth it, in terms of the weekend being effectively tanked.

There are budget cuts coming, and we are all a little fearful of what that might mean. We want to push back but... dicey. We'll see.

 

[F0nzie]

Practice Fusion for EMR. It's free. Best to cut your overhead as much as possible. I keep looking at $ amount of my expenses and think to myself how the heck did that happen.

 

[notdeadyet]

Practice Fusion for EMR. It's free. Best to cut your overhead as much as possible. I keep looking at $ amount of my expenses and think to myself how the heck did that happen.

Ethically dicey.

With Practice Fusion, you agree to allow them to take your patients charts (after scraping out unique identifiers) and sell the contents to advertisers like Big Pharma. This is very explicit in the terms of agreement. Dodgy...

 

[nitemagi]

Ethically dicey.

With Practice Fusion, you agree to allow them to take your patients charts (after scraping out unique identifiers) and sell the contents to advertisers like Big Pharma. This is very explicit in the terms of agreement. Dodgy...

If you're really paranoid about patient data, just do paper records. Your overhead involves trees, ink, and a filing cabinet.
I use PF, without issues, but am careful not to overdocument, as one wouldn't with therapy notes.

 

[notdeadyet]

If you're really paranoid about patient data, just do paper records. Your overhead involves trees, ink, and a filing cabinet.
I use PF, without issues, but am careful not to overdocument, as one wouldn't with therapy notes.

it's not an issue of paranoia. The company is very explicit about the fact that they will be selling the content of your patients records to companies.

I just can't think of the ethical gymnastics I would have to go through to be okay with selling my patients charts for the sake of a cheap EMR. It is a great business model for practice fusion, but I just can't consider it ethical as a clinician to support.

"your privacy to me is paramount, Ms. Doe, and it would take a subpoena for me to reveal any of the contents of your records. Except I will release those records to a third-party software company so that they can sell it to pharmaceutical companies so that they can better target market their non-generic medications... Sorry but I got a free EMR out of it…"

 

[fiatslug]

If you're really paranoid about patient data, just do paper records. Your overhead involves trees, ink, and a filing cabinet.
I use PF, without issues, but am careful not to overdocument, as one wouldn't with therapy notes.

I *definitely* overdocument.

Nitemagi, you've been in PP for awhile--are you seeing any change in revenue with the new coding? For better or worse?

Getting worried I won't be able to leave on my own terms. I hate how long it takes to get up & running in our field. Can you get paneled without a practice address? I really don't want top pay rent for a few months just for a mailbox.

 

[digitlnoize]

One of the best EMR options I've seen is simply a word document. PP doc had a form in word, and kept all of patient x's records in that one word document with multiple pages of forms. Label top of each form with visit date and visit number. Control-F anything you need, keep each patient in their own folder. Very organized, very cheap, and very simple. I thought it was pretty sweet.

 

[Fenster]

it's not an issue of paranoia. The company is very explicit about the fact that they will be selling the content of your patients records to companies.

I just can't think of the ethical gymnastics I would have to go through to be okay with selling my patients charts for the sake of a cheap EMR. It is a great business model for practice fusion, but I just can't consider it ethical as a clinician to support.

"your privacy to me is paramount, Ms. Doe, and it would take a subpoena for me to reveal any of the contents of your records. Except I will release those records to a third-party software company so that they can sell it to pharmaceutical companies so that they can better target market their non-generic medications... Sorry but I got a free EMR out of it…"

You know, most stuff that is "free" works the same way, especially Google. I don't really see the harm in leasing out "generalized" data if it is going to cut overhead significantly which may get passed on to the cash-paying patient eventually. In fact, I'd support it!

 

[notdeadyet]

I don't really see the harm in leasing out "generalized" data if it is going to cut overhead significantly which may get passed on to the cash-paying patient eventually. In fact, I'd support it!

I see your point. Though most cash only private practice models I know are set up to charge as much as the market will bear and cutting overhead doesn't really reduce patient cost as much as it increases profit margin. Voluntarily selling patient data to pharmaceutical companies to increase profit margin to me is not acceptable, but maybe I'm just old fashioned.

I just find it off-putting that we have built up patient-provider confidentiality to be this important principle, but are willing to chip away at it for the sake of discount on EMR. People gripe about the respect people have lost for physicians, but this is a pretty good example of why the field might be held in less regard than it once was (it's hard to dispute the image some folks have of physicians as being money hungry when they're leasing out patient data to the same third parties they gripe about). And I have also yet to hear of a practice that has adopted Practice Fusion to amend their privacy policy to let them know that their chart information is going to be released to third parties, which seems to be the ethical thing to do if your privacy policy currently states that the information contained is confidential.

 

[happygilmore]

I see your point. Though most cash only private practice models I know are set up to charge as much as the market will bear and cutting overhead doesn't really reduce patient cost as much as it increases profit margin. Voluntarily selling patient data to pharmaceutical companies to increase profit margin to me is not acceptable, but maybe I'm just old fashioned.

I just find it off-putting that we have built up patient-provider confidentiality to be this important principle, but are willing to chip away at it for the sake of discount on EMR. People gripe about the respect people have lost for physicians, but this is a pretty good example of why the field might be held in less regard than it once was (it's hard to dispute the image some folks have of physicians as being money hungry when they're leasing out patient data to the same third parties they gripe about). And I have also yet to hear of a practice that has adopted Practice Fusion to amend their privacy policy to let them know that their chart information is going to be released to third parties, which seems to be the ethical thing to do if your privacy policy currently states that the information contained is confidential.

You are old-fashioned. It's not a higher moral value to do what you're doing over what the other person is.

There is no harm done to a patient if a company gets marketing information on generalized data.

If you can be an innovative physician who educates your patients on what is healthy, they shouldn't be so easily deceived by the evil marketers.

Yes, Google does the same thing. Yes, Google is a good company. Welcome to the world of technology - where companies and governments mine consumer data to sell crap or gain an advantage.

There is no high horse in this scenario - there is just preference.

 

[notdeadyet]

Welcome to the world of technology - where companies and governments mine consumer data to sell crap or gain an advantage.

Very true. It's one of the challenges to wrestle with when we identify as physician-as-company.

But technology is only part of the problem. Pharma has been trying for years to get this sort of data long before EMRs and physicians have blocked it based on moral grounds. But when it's made easier to disclose that patient information, it's interesting to see those moral grounds shift quite a bit.

There is no harm done to a patient if a company gets marketing information on generalized data.

Let me ask you this: As a private practice doc, you get a visit from a Pfizer rep who says, "I'll give you a check for $20,000 if you'll just blank out identifying patient information and photocopy your patient records and give them to me." Would you accept that offer? Any doc I know would tell them to get lost. They have been saying no to this for YEARS.

But when it's for the sake of free EMR, and since the physician is not actually copying the records and turning them over, they're willing to functionally do the same thing. It's an easier compromise to patient confidentiality because the disclosure is more passive. You sign away the rights, but you don't have to photocopy, you don't HAVE to think about it. A lot more physicians are comfortable with this. It's somehow less distasteful an idea.

I don't see the ethics all that different between the two scenarios, it's just that the technology makes it easier to do and it doesn't feel as skeevy. But it's functionally the same thing.

Anyway, to each their own on the decision to use Practice Fusion. I would just be more reassured if folks seemed to consider the implications of allowing third parties to their patient records, if folks didn't accept it so readily because it saves them a buck and they can do it passively. This is a massive shift in the view of patient data and patient-physician confidentiality. I'd feel better if folks gave it more thought than many do.

 

[fiatslug]

OK, back on topic --anyone know if you can panel without a practice address?

 

[nitemagi]

I *definitely* overdocument.

Nitemagi, you've been in PP for awhile--are you seeing any change in revenue with the new coding? For better or worse?

Getting worried I won't be able to leave on my own terms. I hate how long it takes to get up & running in our field. Can you get paneled without a practice address? I really don't want top pay rent for a few months just for a mailbox.

I'm cash pay and do superbills. The only issues I've seen is that some are not honoring billing for multiple codes in a visit (E&M plus psychotherapy). Annoying.

 

[Shikima]

OK, back on topic --anyone know if you can panel without a practice address?

I don't believe you can.

 

[F0nzie]

Get a Virtual Office they're cheap. You basically pay around $50-100 per month for a physical address and a mailbox in an office building. You can also rent offices by the hour ($10-20/hr). As you get busier you can share an office with another mh provider or get your own office.This is how I transitioned into pp. The key is to keep your expenses low so you can bail out without significant financial losses.

 

[whopper]

PP has it's ups and downs. I've decided for myself to not even consider it until the Obamacare issues are been worked out cause I don't know how it will affect office based practice.

Personally for me, I'd do a combo of private practice and another job that locked in retirement benefits if I did it again. A plan I considered and might or might not do is work for the state, and PP, and when I reach the time required for half your salary for the rest of your life (25 years in most states), fold the private practice and just work for the state because they based the pension on 1/2 the salary from the last year if not few years. Just work overtime on the last few years.

 

[happygilmore]

Very true. It's one of the challenges to wrestle with when we identify as physician-as-company.

But technology is only part of the problem. Pharma has been trying for years to get this sort of data long before EMRs and physicians have blocked it based on moral grounds. But when it's made easier to disclose that patient information, it's interesting to see those moral grounds shift quite a bit.

Let me ask you this: As a private practice doc, you get a visit from a Pfizer rep who says, "I'll give you a check for $20,000 if you'll just blank out identifying patient information and photocopy your patient records and give them to me." Would you accept that offer? Any doc I know would tell them to get lost. They have been saying no to this for YEARS.

But when it's for the sake of free EMR, and since the physician is not actually copying the records and turning them over, they're willing to functionally do the same thing. It's an easier compromise to patient confidentiality because the disclosure is more passive. You sign away the rights, but you don't have to photocopy, you don't HAVE to think about it. A lot more physicians are comfortable with this. It's somehow less distasteful an idea.

I don't see the ethics all that different between the two scenarios, it's just that the technology makes it easier to do and it doesn't feel as skeevy. But it's functionally the same thing.

Anyway, to each their own on the decision to use Practice Fusion. I would just be more reassured if folks seemed to consider the implications of allowing third parties to their patient records, if folks didn't accept it so readily because it saves them a buck and they can do it passively. This is a massive shift in the view of patient data and patient-physician confidentiality. I'd feel better if folks gave it more thought than many do.

Once it's on a computer, it's no longer personal information. The NSA taught us that.

If the government decides to allow Practice Fusion to mine all kinds of data to sell crap to people - well, that's their choice. I don't have the time or energy to stop the government/pharma machine from doing what they want to do. We would need a physicians union that isn't corrupt to do such a thing - and the government won't let physicians form a union.

Unfortunately, I don't have the power as a single physician to stop corrupt people from doing what they will do. There's no proof that any computer data is safe - so blaming Practice Fusion or other EMRs is not my line of thought. The government sets the regulations. I don't believe my patients would be harmed in any way by someone accessing generalized data on habits, tendencies, etc.

Btw, you guys must be highly irate about the NSA spying. I don't like it at all but I seem to be a little more liberal on these policies than others.

 

[happygilmore]

PP has it's ups and downs. I've decided for myself to not even consider it until the Obamacare issues are been worked out cause I don't know how it will affect office based practice.

Personally for me, I'd do a combo of private practice and another job that locked in retirement benefits if I did it again. A plan I considered and might or might not do is work for the state, and PP, and when I reach the time required for half your salary for the rest of your life (25 years in most states), fold the private practice and just work for the state because they based the pension on 1/2 the salary from the last year if not few years. Just work overtime on the last few years.

The problem with pensions are they are promised funds from a risky entity. Call some people and Detroit and ask them about their pensions.

 

[notdeadyet]

Btw, you guys must be highly irate about the NSA spying. I don't like it at all but I seem to be a little more liberal on these policies than others.

Nah, to be honest, it doesn't bother me all that much. I'm actually a lot more copacetic about my government's intelligence wing reading my emails than I am with my doctor whoring out my confidential health information to turn a buck.

It's a trust thing: I probably trusted that doctor. The NSA? Not so much...

 

[happygilmore]

Nah, to be honest, it doesn't bother me all that much. I'm actually a lot more copacetic about my government's intelligence wing reading my emails than I am with my doctor whoring out my confidential health information to turn a buck.

It's a trust thing: I probably trusted that doctor. The NSA? Not so much...

Fair enough. I guess my lack of scruples comes from not being able to see a patient being directly harmed from generalized data (i.e. not attaching their names, addresses, etc.). Essentially case studies or physicians telling stories are in the same vein - generalized data to learn from. Whoring out? I understand pharma wants to make $ - just like all the medical students I go to school with. It's kind of interesting how none of the top students are going into the lowest paying fields - almost like they are whoring themselves out to plastics, orthopedics, dermatology, etc. Of course I don't think that - I understand they just want to make a $ like the pharma guys do.

 

[whopper]

The problem with pensions are they are promised funds from a risky entity. Call some people and Detroit and ask them about their pensions.

Absolutely. I know some docs that believe expecting a pension from the state is too risky. But here is my counter-argument.

When observing this risk historically, no states or the US as far as I know has ever refused to pay a pension it owed. (Anyone here know of an exception, post it). I do know, however, of specific towns and cities that have not been able to honor a pension because it went bankrupt, and Detroit is an example of this. It's not bankrupt yet as far as I know but they're pursuing going this route.

I think it's a safe assumption to believe that a state or federal job will still honor it's pensions. Look at it this way. If a state or the fed couldn't honor a pension, then in the big picture, you probably have bigger things to worry about, such as having a food supply, assault rifle, water decontamination device and a secret bunker established, cause the government at that point would have to be bankrupt or close to it. There would be no confidence in government and the value of the currency would likely be almost worthless. At that point I would've been in some post-apocalyptic scenario, with an eye patch, leather jacket, have a cobra tattoo on my belly and telling people to call me "Snake" while I lit a cigarette, and they'll tell me, "I heard you were dead." and I wouldn't be giving a damn if I got a pension or not.



But a realistic scenario for many is one could be fired from a job and be close to the pension milestone date and then not be able to cash that pension in. E.g. city/state works on several levels.

For doctors, however, that is a relatively small risk. Doctors from state institutions are rarely fired, even if those doctors are terrible. Anyone who worked for a state institution could likely attest to that unless that doctor is naive and thinks all of his colleagues are highly skilled, or that doctor happens to be in that one-in-a-million situation where he's in a state facility where the majority of the docs happen to be good. I have not yet seen that happen. I've seen good docs in state institutions but they are the rare exception and unfortunately not close to the norm.

The problem, IMHO, for working for the state is not the risk of not getting a pension, but the loss of passion and enthusiasm that'll likely happen in being in a situation where none to few of your colleagues challenge your intellectual and professional skills, working harder offers no financial rewards, and constantly seeing your colleagues do poor to mediocre work while patients suffer and the only thing you can do about it is not do poor work yourself. Efforts to improve quality outside of your own practice are often met with disdain or ambivalence. It slowly eats at your soul, and you can't leave it cause you need to stay at that job for 25 freaking years!

At least if you do private practice on the side you have something you can escape from the daily drudgery of state work.

 

[notdeadyet]

When observing this risk historically, no states or the US as far as I know has ever refused to pay a pension it owed. (Anyone here know of an exception, post it). I do know, however, of specific towns and cities that have not been able to honor a pension because it went bankrupt, and Detroit is an example of this. It's not bankrupt yet as far as I know but they're pursuing going this route.

Agree, but you need to look at trending.

If you go back 40 years, union pensions were not deferred due to company financial struggles. Now it's commonplace (look airline pilots, as one example).

If you go back 20 years, city pensions were safe and cities did not go into bankrupt proceedings and negotiate cutting city pensions. Now it's happening too.

I don't know of any state pensions currently in jeopardy, but there are already movements in place to curtail state pension money owed due to financial struggles of states. This is happening with the state workers pensions in California.

When you are looking at a pension 30 years down the road, I would look for trends, and the trend right now is that state pensions are much less safe an entity than they were 30 years back. And unless you're predicting massive changes and brighter financial futures (which I'm not), I think considering state pensions to be safe to be a very optimistic viewpoint given the direction we've shown to be heading over the past 40 years.

 

[Shikima]

PP has it's ups and downs. I've decided for myself to not even consider it until the Obamacare issues are been worked out cause I don't know how it will affect office based practice.

Personally for me, I'd do a combo of private practice and another job that locked in retirement benefits if I did it again. A plan I considered and might or might not do is work for the state, and PP, and when I reach the time required for half your salary for the rest of your life (25 years in most states), fold the private practice and just work for the state because they based the pension on 1/2 the salary from the last year if not few years. Just work overtime on the last few years.

I'm in the same boat now. The hardest part with all of this has been the patience in waiting.

 

[whopper]

I don't know of any state pensions currently in jeopardy, but there are already movements in place to curtail state pension money owed due to financial struggles of states. This is happening with the state workers pensions in California.

When I put my post above, it's rhetoric was to propose an argument as if in a debate.

Your own post, counter to mine, has merit.

While states and the Fed as far as I know never reneged on a pension, never before has the US also had such a high amount of debt, and the fact that the population doesn't seem very concerned about it is troubling. During the 90s, when Perot ran for president, he showed several charts showing that the US was on the road to bankruptcy unless things drastically changed. This freaked people out and balanced budgets became a higher priority.

It's worse now than it was back then, yet people aren't freaking out.

This is certainly a sign that a government pension, that could've been seen as very safe is not on firm ground.

As Bill Maher said, whatever happens to the US, it happens in California first, saying that the California government had major budget problems, this'll happen to the US. Wow, it came true. He said this when Schwarzenegger was the governor experiencing the troubles that happened about 5 years ago.

IMHO, pensions will still exist but the government may add further stipulations or increase the amount of time it takes to get similar benefits that exist today. The big debate there will be if such requirements are changed, do existing employees enjoy grandfather clauses? I could see someone being real ticked off having put in 24.9 years and then being told they now need to put in 30.

As evidenced by government institutions in dire straits, when they cut, they'll more likely even cut things that could affect national security before they refuse pensions.

IMHO, reneging on a pension could possibly be illegal (unless the state/fed declares bankruptcy, though I'm not a legal expert in this area), and would be on the order of refusing to pay a bond-holder that is owed money by that government entity because it's promised money.

And if that were to happen, like I said, a rifle and food supply would be a higher priority. Some of you could say that's ridiculous. Hey, take a look at Greece, but they're being bailed-out. No one will be able to bail-out the US, social security is on a fast track towards insolvency, and I'm realistically expecting another stock market crash unless someone balances the budget in the next few years.

 

[Shikima]

When I put my post above, it's rhetoric was to propose an argument as if in a debate.

And if that were to happen, like I said, a rifle and food supply would be a higher priority. Some of you could say that's ridiculous. Hey, take a look at Greece, but they're being bailed-out. No one will be able to bail-out the US, social security is on a fast track towards insolvency, and I'm realistically expecting another stock market crash unless someone balances the budget in the next few years.

Check. Already ahead of you!

 

[michaelrack]

I don't think the Feds will default on a pension. The Federal government can always print money (though it may become increasingly worthless as we loss our reserve currency/petrodollar status). I could imagine several states or territories (Puerto Rico) partially defaulting on pensions in the late 2020's in a non-apocalyptic scenario (rifles not necessary)

 

[whopper]

The gov could print more money, but we're then in the have a rifle and food scenario.

In post WWI Germany, with devalued currency, mother-daughter sex prostitution sex-duo teams started forming so they could make more money vs the usual solo prostitute, just for those mothers-daughters to get enough money for food.

As Jim Cramer said, there's always a bull market somewhere. The only good thing about this is if the US goes that way, there'll still be ways to profit. E.g. stick your money into gold, another country, move out, or have a walled property with a terminator and drone security system. The trick will be you'd have to have enough signs of it happening beforre it happens so you could invest accordingly.

But getting back to pension issue, if you decide to plant your behind into a government job for the pension, you're trapped there for 25 years. A lot can happen. I'd bet pensions will be safe despite that I'm not exactly sure about the economic status of America. The US still honored pensions as far as I'm aware even during the Great Depression. Again, anyone know of data that makes mine incorrect, left us know.

 

[PistolPete]

Very interesting discussion, something that I've been thinking about recently as I've been considering working for the state hospital system with 1-2 days of private practice on the side after graduation. Had no idea it was such a soul-sucking job.

On the flip side, what do you guys think about the solvency of Kaiser's pension, in contrast to that of the state? Seems like Kaiser is so huge that it also seems like a sure bet that it would pay out it's pensions in 25 years? Anyone here work for Kaiser who can give some input?

 

[Fenster]

On the flip side, what do you guys think about the solvency of Kaiser's pension, in contrast to that of the state? Seems like Kaiser is so huge that it also seems like a sure bet that it would pay out it's pensions in 25 years? Anyone here work for Kaiser who can give some input?

I work for Keyser Soze. That help?

(sorry for the inapposite jibber-jabber; couldn't resist)

 

[whopper]

Had no idea it was such a soul-sucking job.

I don't think it's soul sucking for the doctors working int it that don't give a damn. Either they're conning the system, not doing their end and maybe getting a bit of an anti-social pleasurable feeling (while their patients get screwed), or their souls are already gone.

Where I'm at, in Ohio, it's worse. They pay psychiatrists $150K. Pathetic. Ohio's not a poor state. No it's not California, NY or NJ, but even very poor states usually pay 180K/year. The only things that draws doctors in is they don't know how pathetically bad the pay is because they don't have a running idea of what decent pay is, and tell any new doc $150K a year with a smile on your face and most of them won't know it's bad. The other draw is that you don't have to do much in the job. I literally had nothing to do for 4-5 hours a day even though I did everything I could. (There are exceptions. They tend to stick the newer docs on the units where you really have to work but those are the exceptions).

The job only pays off (financially) IMHO if you marry that job with private practice because you can work for them minimum 20 hours-still get full-time benefits, build a pension, while making real money in private practice, and the PP will keep you intellectually alive and make good money. I've also considered a viable job for when I finally slow down significantly and need the time to spend 3 hours on an H&P.

When I left the state job, they offered me to come back and pay me $175K/year, but I'd have to do the full 40 hours a week. Nope. Only way I'm going back is if I do it with PP and for less than 40 hours a week or if I took an administrative position.