IM docs making >500,000 a year?!?

[Nutoamerica]

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Hey,
I was just talking to one friend the other day and he told me his attending broke it down to him how much the attending was making a year, a shocking >500,000 a year!!! I mean this guy said the attending has no life just work and work everyday, and he covers a few nursing homes and hospices or something.
Really??? Is it possible for an IM doc with no specialty to make that much? what about having your own clinic and get privileges at hospitals and just do half clinic and procedures at hospitals?

 

[Saladin MD]

Hey,
I was just talking to one friend the other day and he told me his attending broke it down to him how much the attending was making a year, a shocking >500,000 a year!!! I mean this guy said the attending has no life just work and work everyday, and he covers a few nursing homes and hospices or something.
Really??? Is it possible for an IM doc with no specialty to make that much? what about having your own clinic and get privileges at hospitals and just do half clinic and procedures at hospitals?

I believe it is possible in any field, including Family Medicine. Obviously they are outliers.

 

[radslooking]

500K sounds tough to swallow unless he's in a rural area with some sweet side gigs. I wonder how good his patient care seeing that many patients is though.

 

[mercaptovizadeh]

Hey,
I was just talking to one friend the other day and he told me his attending broke it down to him how much the attending was making a year, a shocking >500,000 a year!!! I mean this guy said the attending has no life just work and work everyday, and he covers a few nursing homes and hospices or something.
Really??? Is it possible for an IM doc with no specialty to make that much? what about having your own clinic and get privileges at hospitals and just do half clinic and procedures at hospitals?

The key to making the most money is efficiency and hours put in. Then again, when you turn it into patient shop rather than patient care, it can get nasty. Read the "other fellowships" subforum to read about an oncologist who spends ~7 minutes per patient. I am sure that someone battling cancer and possibly fighting for his life is thrilled to spend 7 minutes per visit with the main doctor who is coordinating his care.

Dermatopathologists can make so much because they spend something like 1 minute per path slide.

 

[asmallchild]

The key to making the most money is efficiency and hours put in. Then again, when you turn it into patient shop rather than patient care, it can get nasty. Read the "other fellowships" subforum to read about an oncologist who spends ~7 minutes per patient. I am sure that someone battling cancer and possibly fighting for his life is thrilled to spend 7 minutes per visit with the main doctor who is coordinating his care.

Dermatopathologists can make so much because they spend something like 1 minute per path slide.

1 minute is rather generous. I've worked with dermatopathologists who move the slide off the microscope stage so quickly I get motion sickness. 😛

I do agree that kind of pace is probably inappropriate for certain fields. Even regular follow up vists at a heme/onc office should probably take more than 7 minutes.

 

[doc20]

and specially in those small rural areas IM docs can work in ER and get paid less but working like 80-100 hrs a week like a resident would easily pay around 400-500 k

 

[Nutoamerica]

thanks everyone for clearing up the doubt.

what's your opinions on hiring PAs? Can that help you to work more efficiently and at the same time provide enough time for patient care?

 

[jabreal00]

Is that salary possibly yes but that is definitely not the norm. One can do that if they are basically working 7 days a week and are a patient mill, spending time with a patient every 5-10 minutes. I would bet the care is substandard. Hospitalists can make up to $250K/yr. If they moonlight on those 7days they have off, then can approach $400K or more. The only problem is that they wouldn't have a life.

---------------- Listening to: Massive Attack - Protection via FoxyTunes

 

[Nutoamerica]

with all the numbers mentioned, are these numbers before tax and malpractice or after? Is it the take home that much?

 

[skypilot]

and specially in those small rural areas IM docs can work in ER and get paid less but working like 80-100 hrs a week like a resident would easily pay around 400-500 k

Find a job paying 100 per hour. They are out there. Work 80 hours a week. 80 hours times 50 weeks a year is 400k. Plus you get a two week vacation! 🙂

 

[bkpa2med]

$500k? That's the latest sign on bonuses, haven't heard? Salaries are for suckers -- work for yourself and have a business sense and you can easily make $250-300k. I don't really know about $500k. The only way I can see that is if he has a ton of docs in a group together where overhead is close to nothing.

 

[dragonfly99]

I guess there are outliers in any field, but 500k for a general IM doc sounds unrealistic. He must be running a patient mill, and yes, that has to be before taxes.

 

[bkpa2med]

I guess there are outliers in any field, but 500k for a general IM doc sounds unrealistic. He must be running a patient mill, and yes, that has to be before taxes.

Definitely.

 

[nlax30]

1 minute is rather generous. I've worked with dermatopathologists who move the slide off the microscope stage so quickly I get motion sickness. 😛

HAHA +1 on this.

Spent a little time with one looking at some slides from a med mission trip and even slowing down to point out things he didn't spend 1 min on a slide.

 

[Nutoamerica]

bkpa2med, the $250-300K you talked about, is that take home?

If it is, I definitely agree with you, cause one of the people I used to work with got an offer of a package that is worth $250 K a year fresh out of residency, which I am not surprised. I've also worked a FP 1st year med school, who takes home 300$, he worked 5 1/2 days a week, starts 7:45am and gets off 5:00pm, and he definitely does not make people having motion sickness!

 

[texashemonc]

Interesting discussion. I work in a suburb of big city and know many IM docs who make over 500K, some over 1M. The ones who do the best see the most inpatient consults, typically ID and cardiology. For some reason in private practice, those 2 specialties get consulted the most. Most ID docs do not even go into the room to examine the patient, they just write 2 line notes. So if you have 30 or 40 patients/day as inpatient consults and follow-ups and spend just 5 minutes a chart, even on medicare fees, that easily adds up. Plus many have little overhead from office rent and staff fees , although outpatient clinic is sometimes the way to go. For example, cardiologists make a ton on reading echos in the office- some up to $1000/exam on private insurance! And they ALWAYS end the interpretation with the "technically difficult due to body habitus" to protect themselves! Another way of abusing the system when you order echos every 3-4 months or stress tests yearly on asymptomatic patients. Could go on and on about this - just hope none of you all do this sort of thing in the future.

 

[bkpa2med]

bkpa2med, the $250-300K you talked about, is that take home?

If it is, I definitely agree with you, cause one of the people I used to work with got an offer of a package that is worth $250 K a year fresh out of residency, which I am not surprised. I've also worked a FP 1st year med school, who takes home 300$, he worked 5 1/2 days a week, starts 7:45am and gets off 5:00pm, and he definitely does not make people having motion sickness!

Well, it's not after taxes -- it's before. At the end after all expenses and whatnot are paid in the practice the physician who has a full schedule should make that.

 

[Nutoamerica]

texashemonc,
you mentioned two IM specialties, what about the IM hospitalist?

oh, and the two lines specialists write are usually very hard to read, lol...

 

[DrJosephKim]

Cash-only concierge practice in Beverly Hills?

 

[Nutoamerica]

haha, yeah, i got the idea mdjkim!

 

[efex101]

IM hospitalist offers are from a minimum of 190K start off salary with some offers 220K. Of course this will vary based on how many patients you will be seeing, location and other factors. Most are providing sign on bonuses, relocation expenses, loan repayement, CME allowance, some will have 2 weeks vacation others not, some with tail others not. I am seeing that the norm is 100$/hour for anywhere from 8-12 hour shifts.

 

[Captopril]

Salaries are for suckers -- work for yourself and have a business sense and you can easily make $250-300k. I don't really know about $500k. The only way I can see that is if he has a ton of docs in a group together where overhead is close to nothing.

Expand on this. I love medicine, but have always had the entrepreneur's fire in my belly...what could be better than combining the two?

 

[elwademd]

I guess there are outliers in any field, but 500k for a general IM doc sounds unrealistic. He must be running a patient mill, and yes, that has to be before taxes.

there are a number of hospitalists here in vegas making over 500k. driving bentley continental gt's, building 5000 square foot houses. but they also "see" 40-50 patients a day. and i use the term "see" very, very loosely.

with that said, you also have to determine what's important to you. is it the check you bring home at the end of the day/month/year... or do you have other priorities.

Expand on this. I love medicine, but have always had the entrepreneur's fire in my belly...what could be better than combining the two?

if you're willing to take call all the time (getting/admitting patients, after all, is what brings in/drives income), and work 50 weeks out of the year, you should be able to get 300k easily, in vegas at least.

there are a lot of different hospitalist and outpatient practices out there. you just need to see which of those opportunities aligns with your interests.

 

[elwademd]

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[elwademd]

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[elwademd]

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[Nutoamerica]

I hear people say about IM getting derm training, how does that work?
You just finish your 3 yr residency and work with a dermatologist as an over-qualified PA?

Also, can some of you sages tell me which programs of IM are more geared towards outpatient training, like to be able to open your own clinic...thanks in advance!

 

[asmallchild]

I hear people say about IM getting derm training, how does that work?
You just finish your 3 yr residency and work with a dermatologist as an over-qualified PA?

Also, can some of you sages tell me which programs of IM are more geared towards outpatient training, like to be able to open your own clinic...thanks in advance!

2 routes:

1) There are IM-derm combined degree programs.

2) I know a couple of people originally trained in IM, did a research fellowship for 1-2 years, and then moved on to a dermatology residency.

I'm not sure too many people would stomach working as an over-qualified PA after finishing an internal medicine residency. Especially if you are being paid like a PA and not an MD.

 

[dragonfly99]

2 routes:

1) There are IM-derm combined degree programs.

2) I know a couple of people originally trained in IM, did a research fellowship for 1-2 years, and then moved on to a dermatology residency.

I'm not sure too many people would stomach working as an over-qualified PA after finishing an internal medicine residency. Especially if you are being paid like a PA and not an MD.

There are fp docs and IM docs who pretty much set themselves up doing laser treatments, botox, etc. or running medical spas. There's nothing illegal about this, and there are places you can go to get trained to do these procedures, for a fee. There's nothing illegal about doing this, as long as you don't claim to be a board certified internist.

I believe there are unaccredited derm fellowships where you essentially do go to work for private practice dermatologists (probably kind of like a PA, etc.) and learn derm. I have seen very occasional advertisements in medical journals for these. These are not ACGME approved fellowships, so you wouldn't be able to become board certified in derm.

FYI, my dad goes to a doc for his psoriasis in the small midwestern town where they live, and my mom was telling me she doesn't think he's a real dermatologist. I'm thinking he's probably just an IM or fp doc doing his thing, who has figured out there is only 1 real derm in town and plenty of business, so why not get in on that market? I need to check and see if the doc is board certified...he's basically just giving my dad topical steroids, which I informed him that his regular internist can do

 

[dragonfly99]

As for the ? about residency to do if you want to set yourself up in private practice later...some of the better community programs are more private practice oriented. The best way to find out where these are is probably just word of mouth and then going on interviews.

There are some major university programs that are more friendly to going into practice, but most of them emphasize research and expect residents to try to go on for fellowship. I would not advertise that you don't plan to, if/when you interview at university programs. It shouldn't matter but it can. You can always ask the house staff, when you interview...I would stay away from asking the program director or chief residents, though.

 

[asmallchild]

I remember going on an interview at a prominent Boston program and one of my interviewers ironically noted that a couple of years ago, the most successful dermatology private practice in the area (and this is Boston, this isn't middleofnowherepodunk) wasn't run by a dermatologist, it was run by a guy trained in FP/IM who basically told his patients, "Derm was an interest of mine. So I studied it on my own."

He didn't deceive his patients, he never claimed to be board certified, he'd generally try to avoid any high liability cases, and of course, engaged in cosmetics.

Ended up opening a chain of private practice clinics. So it can happen. (Whether or not it should happen is another debate altogether 😛)

There are fp docs and IM docs who pretty much set themselves up doing laser treatments, botox, etc. or running medical spas. There's nothing illegal about this, and there are places you can go to get trained to do these procedures, for a fee. There's nothing illegal about doing this, as long as you don't claim to be a board certified internist.

I believe there are unaccredited derm fellowships where you essentially do go to work for private practice dermatologists (probably kind of like a PA, etc.) and learn derm. I have seen very occasional advertisements in medical journals for these. These are not ACGME approved fellowships, so you wouldn't be able to become board certified in derm.

FYI, my dad goes to a doc for his psoriasis in the small midwestern town where they live, and my mom was telling me she doesn't think he's a real dermatologist. I'm thinking he's probably just an IM or fp doc doing his thing, who has figured out there is only 1 real derm in town and plenty of business, so why not get in on that market? I need to check and see if the doc is board certified...he's basically just giving my dad topical steroids, which I informed him that his regular internist can do

 

[Nutoamerica]

Thanks a lot guys for the very detailed answers!

 

[BobA]

I remember going on an interview at a prominent Boston program and one of my interviewers ironically noted that a couple of years ago, the most successful dermatology private practice in the area (and this is Boston, this isn't middleofnowherepodunk) wasn't run by a dermatologist, it was run by a guy trained in FP/IM who basically told his patients, "Derm was an interest of mine. So I studied it on my own."

He didn't deceive his patients, he never claimed to be board certified, he'd generally try to avoid any high liability cases, and of course, engaged in cosmetics.

Ended up opening a chain of private practice clinics. So it can happen. (Whether or not it should happen is another debate altogether 😛)

I think whether dermatologists actually deserve to make what they do might be more open to debate than whether an FP can do cosmetics, biopsy a mole, or prescribe topical steroids.

 

[dragonfly99]

 

[psychforme]

(Whether or not it should happen is another debate altogether 😛)

Yeah, it should happen a lot more.

 

[Clemson Doc]

Hey,
I was just talking to one friend the other day and he told me his attending broke it down to him how much the attending was making a year, a shocking >500,000 a year!!! I mean this guy said the attending has no life just work and work everyday, and he covers a few nursing homes and hospices or something.
Really??? Is it possible for an IM doc with no specialty to make that much? what about having your own clinic and get privileges at hospitals and just do half clinic and procedures at hospitals?

Someone else might have already corrected you, but if not, I will:

Internal Medicine is a specialty. General internists are specialists in adult medicine, and are qualified to identify and treat just about everything they see. Internal medicine is every bit as much a specialty as radiology, pediatrics, anesthesiology, etc.

With that said, a general internist can choose to subspecialize in something like cardiology, rheumatology, pulmonology, nephrology, allergy/immunology, gastroenterology, etc. if he or she so chooses.

It might have been an innocent mistake on your part, but thanks for letting me rant nonetheless.

 

[Nutoamerica]

lol
you know what I meant Clemson Doc

 

[nephappl]

Sure , in this rural area where I live I came to know somebody making more than that.
He used to round without stethoscope; his only examination tool I ever saw was a pen.
He was covering several nursing homes and a busy ofice, also does moonlighting in the local hospital for the hospitalist group and also was taking hospitalist shifts at another hospital two hours from here.
Of course was single and lost his license as he was acused of sexual abuse to several patients so most of his money is gone to lawyers.
Balance in life might be more important that money.
NA

 

[Nutoamerica]

To all the above sages who have shared their wisdoms and views of what a good doctor should do:

This thread is only my self amusement and I don't want to be a money monster that harms patients. It is a priviledge to practice medicine, and we all should honor it.

 

[bojack]

Hey,
I was just talking to one friend the other day and he told me his attending broke it down to him how much the attending was making a year, a shocking >500,000 a year!!! I mean this guy said the attending has no life just work and work everyday, and he covers a few nursing homes and hospices or something.
Really??? Is it possible for an IM doc with no specialty to make that much? what about having your own clinic and get privileges at hospitals and just do half clinic and procedures at hospitals?

If Obama gets his way, you'll barely be able to add 5 physicians salaries together and come up with $500k/yr, unless they don't accept any form of insurance reimbursement as payment.

I don't know who in their right mind would consider going into medicine in these times. To put in all of the time and effort, take on massive amounts of educational debt, and end up making $100k. Not bad money, but when you factor in what we do/sacrifice for to be a physician......it doesn't really sit well. Who is going to pay my loans off? I probably won't be able to if this is all I will make.

If you don't believe this could happen, look at what physicians make in places like Canada and the UK. I saw a salary survey for cardiologists in Canada last week, and the made approx $110k/yr Canadian. Chew on that a little while.

 

[bojack]

To all the above sages who have shared their wisdoms and views of what a good doctor should do:

This thread is only my self amusement and I don't want to be a money monster that harms patients. It is a priviledge to practice medicine, and we all should honor it.

I don't think anyone has suggested that they want to be a money monster. I think that it is normal for people in any type of profession to discuss compensation and how it varies.

I probably would not consider going into private practice if you're not willing to consider the financial aspects of medicine.....you won't stay in business long. The days of "hanging your shingle," and just going in to see your patients without worrying about anything else have long since passed.

Academic medicine may afford you a little less fiscal accountability; however, even in academics, physicians are coming under more intense pressure to become more efficient and consider things like: hospital flow, coding appropriately to allow for the highest level of billing, reducing if not eliminating the ever popular "running tests for educational benefit.....the hospital doesn't usually get paid for these," etc.

If you think that you will not have to consider the "money" of medicine, then don't take my word for it. Talk to attendings at your or any insitituion about how all institutions, including the academic ones are striving to maximize revenue and minimize expenses. Just like individual physicians, they have to in order to survive.

 

[Nutoamerica]

thanks Bojack!

 

[Acherona]

If you don't believe this could happen, look at what physicians make in places like Canada and the UK. I saw a salary survey for cardiologists in Canada last week, and the made approx $110k/yr Canadian. Chew on that a little while.

um, no. Canadian cardiologists make as much if not more than American ones. Even family docs average 200K/yr and specialists 350K/yr.

 

[bobcomlex]

I know a hospitalist who earns this. Medical students have no clue about the real world and make judgements based on hearsay. I still hear stupid comments like "Oh you are in family practice or internal medicine, you could make 200K if you work hard" It depends on the hospitalist group and what type of structure they have with the hospital. In general, a hospitalist in my area usually has a base salary of 150-180K and with bonus and partnership, we are talking easily over 300K.

 

[bojack]

um, no. Canadian cardiologists make as much if not more than American ones. Even family docs average 200K/yr and specialists 350K/yr.

Provide more than anecdotal evidence if you're going to make a claim.

Here's where I got my info:
http://www.payscale.com/research/CA/Job=Physician_/_Doctor,_Cardiologist/Salary

 

[bojack]

um, no. Canadian cardiologists make as much if not more than American ones. Even family docs average 200K/yr and specialists 350K/yr.

Here is the link to the family doc's pay:

http://www.payscale.com/research/CA/Job=Family_Physician_/_Doctor/Salary

 

[bobcomlex]

Sure , in this rural area where I live I came to know somebody making more than that.
He used to round without stethoscope; his only examination tool I ever saw was a pen.
He was covering several nursing homes and a busy ofice, also does moonlighting in the local hospital for the hospitalist group and also was taking hospitalist shifts at another hospital two hours from here.
Of course was single and lost his license as he was acused of sexual abuse to several patients so most of his money is gone to lawyers.
Balance in life might be more important that money.
NA

I'm not denying what you say is true but there is an assumption that anyone who earsn 500K in IM or Family Medicine are physicians who provide poor service. There are physicians who are more efficient than others. There are just as many physicians who are inefficient and like to chat. There is a difference between being friendly, and examining your patients and spending 45 minutes discussing Barrack Obama with your patient. Unfortunately, the doctors that tend to be chatty often confuse that with providing good service. In my personal experience, the primary care physicians who are earning the stated averages are the ones who see less than 20 pts a day because they spend extraneous amounts of time chatting with pts even when the patient has no questions and doing no procedures or tests in their office. I'm basing this on personal experience. For example. they will schedule 45 min blocks for follow-ups visits. Again, it's about using judgement. Not all patients require a set amount of time; some will require more and others will require less. I've learned that success in medicine has as much to do with common sense and business sense as medicine. Unfortunately many intelligent physicians are absolutely clueless in regards to the business side of medicine.

The FP and IM docs that have been financially successful are ones who are extremely personable yet efficient. They see about 30 pts per day. They hire PA's or NP's to see another 10-20 pts. They have ultrasound techs and other techs who come once a week to do certain tests. They have EMR to eliminate paperwork and speed up charting. They do many procedures themselves like suturing, removing warts or skin tags, doing injections. They impose financial penalties for patients who fail to show up to appointments without advance notice which lowers missed appointments. They reduce overheard by leasing offices in locations that are visible but reasonable in terms of the lease. Again, I could list so many more reasons but many PCP's are just clueless and don't think outside the box or do the bare minimum.

I feel like the IM physicians who specialize do so for the prestige and the opportunity to perform certain procedures (Cardiology and stent placement) as opposed to just making more money. You can make money doing general internal medicine.

 

[radslooking]

I'm not denying what you say is true but there is an assumption that anyone who earsn 500K in IM or Family Medicine are physicians who provide poor service. There are physicians who are more efficient than others. There are just as many physicians who are inefficient and like to chat. There is a difference between being friendly, and examining your patients and spending 45 minutes discussing Barrack Obama with your patient. Unfortunately, the doctors that tend to be chatty often confuse that with providing good service. In my personal experience, the primary care physicians who are earning the stated averages are the ones who see less than 20 pts a day because they spend extraneous amounts of time chatting with pts even when the patient has no questions and doing no procedures or tests in their office. I'm basing this on personal experience. For example. they will schedule 45 min blocks for follow-ups visits. Again, it's about using judgement. Not all patients require a set amount of time; some will require more and others will require less. I've learned that success in medicine has as much to do with common sense and business sense as medicine. Unfortunately many intelligent physicians are absolutely clueless in regards to the business side of medicine.

i dont' know anyone who schedules 45 minutes for return visits. there may be 45 minute intervals b/w patients occasionally, but that doesn't mean they are scheduling them for 45 minutes routinely. I know lots of people and I don't know ANYONE who does that. If you are earning 500,000 a year an IM or FM you must have a very unique practice or you are necessarily providing poor service.

 

[Acherona]

Here is the link to the family doc's pay:

http://www.payscale.com/research/CA/Job=Family_Physician_/_Doctor/Salary

That seems like a schlocky website. Their numbers are based on 131 respondents!

Here are some better sources from Canadian sites:

References cardiologist average pay at 687K
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20061004/ont_doctors_061004?s_name=&no_ads=

Quebec Family docs make 195K, which is 45% less than other provinces
http://www.cbc.ca/health/story/2007/11/20/qc-gps1120.html?ref=rss

"The average gross annual income for a specialist in Quebec is $233 000 — $100 000 less than the national average."
http://www.cmaj.ca/cgi/content/full/175/8/861

 

[CuriousKat]

500K is impossible to make from professional fees seeing patients alone. Ancillary income is key (but 500K is still highly unlikely). Some income boosters:

-multispecialty practice (allows you to siphon off some of the specialists' income in return for sending referrals)
-imaging: buy PET/CT, MRI, etc and collect the fee for the procedure
-lab
-"wellness"/weight loss program that is fee-for-service
-medical directorships of nursing homes