Independent contractor schedule and patient load

[psychtoobe]

I’m thinking about switching to pure independent contractor inpatient arrangement ie you do your own billing and get all your collections, and an optional medical director stipend if one chooses. My main reason for trying to leave employed position for this is the flexibility in schedule.
- Can anyone who does this enlighten me on what the daily schedule looks like? What’s the average time you typically leave work?
- what’s a reasonable # patient load for ~$20k/month after tax ?
- Do you have the hospital find after hour call coverage? Or you do it?

Thanks in advance!

---

Members don't see this ad.

 

[DMBandFan86]

This can be so variable based on your goals and how you are set up in the hospital you contact with.

Most independents are “on call” for admissions/patients all day. There isn’t a closing time, but since it’s post-acute you can do stuff the next day.

Some places would have an overnight call person, but that is mostly an employed model. Some places would have IM cover, but that is variable if you are set up that way.

What are you billing mostly? There is a large difference from level 2 to level 3 reimbursement. Are you spending over 50 min a day with patients or looking to see people quickly and have volume? How much time does it take you to see your patients? Most independents would carry 16+ patients per day (avg 2 discharges and 2 admissions). That’s usually an 8 hour day. But again there is so much variability and some could see that much is 2-4 hours and others it would take 16 hours.

 

[psychtoobe]

Thanks. I’ll have to think about those issues you raised. Are you independent contractor?

 

[j4pac]

PMR2008 usually provides his input on these topics but it is January, so he's probably too busy skiing in Val d'Isère with that hard earned inpatient loot

 

[RodofEbullience]

I’m thinking about switching to pure independent contractor inpatient arrangement ie you do your own billing and get all your collections, and an optional medical director stipend if one chooses. My main reason for trying to leave employed position for this is the flexibility in schedule.
- Can anyone who does this enlighten me on what the daily schedule looks like? What’s the average time you typically leave work?
- what’s a reasonable # patient load for ~$20k/month after tax ?
- Do you have the hospital find after hour call coverage? Or you do it?

Thanks in advance!

I worked with Encompass out of residency for almost 2 years. Midatlantic region, within 30 min to 1 hr of a major city so not totally in the sticks.

Daily schedule: show up at 830-9AM to start rounding a bit. Go to morning medical meeting to get (mostly outdated) nursing updates on patients at 930. Finish rounding. Write notes. Usually all this is done just before noon. If I wanted to, I could go home at this time, but I would typically stick around to prep orders/notes for new admissions and do work for upcoming discharges. Also seems like nurses prefer docs to stick around a bit especially if there are sick patients. If it's team conference day, then I go to that at around 1PM and it takes just about an hour. Again, all this is dependent on how efficient you are.

I would typically have 15-20 patients on my census. Average 3 of these patients are new admits every day. Made a good deal more than 20K/month.

Every hospital is different. Some have the IM consult services take call. At my hospital, PM&R was attending so we took calls for our own patients every day including getting called at night about random things. This was the one single huge negative. At the time I didn't hate it too much, especially just coming out of residency. But in hindsight it can get annoying. Every 3rd weekend, I would take call and cover all the patients in the hospital and go in to see new admits. This was where a lot of $ was made but again, kind of annoying in hindsight.

 

[PMR2008]

PMR2008 usually provides his input on these topics but it is January, so he's probably too busy skiing in Val d'Isère with that hard earned inpatient loot

I was on a long break but a warm destination lol.

 

[j4pac]

I was on a long break but a warm destination lol.

lol glad to see you still enjoying life, my man

 

[Issa_Mithras]

Also work IC doing community inpatient rehab. Luckily we have medicine as primary so we really get to just focus on rehab. No call outside of covering admissions/consults on the weekends, split between colleagues. Unicorn job.

I have colleagues who do the bare minimum, come in and round for 2-3 hrs and leave. Typically the older physiatrists. Communicate briefly with case managers and sign DME orders electronically. I understand you only get paid for seeing patients, but I still don’t feel comfortable with that.

A few of us are medical directors which comes with a nice stipend. Usually a few weekly admin meetings, liaison education, program oversight, and there’s pressure to have more face time around the hospital, which I like honestly.

I kept pretty good records of patient numbers and collections this year. Obviously YMMV but my average collection is $75 for follow up (2/3 Level 2, 1/3 Level 1 or 3) and $175 per admit/consult. Run the math on whatever census you want to hold. How many weeks off you want. Subtract 5-7% for billing. Malpractice. You can optimize your taxes quite a bit with a knowledgeable accountant.

$20K/month after expenses, collections alone, is definitely doable with average census 10-15.

There’s also so much open to you as an IC in terms of side gigs, medical directorships, tech partnerships. Incredible autonomy. I can’t imagine switching to a salaried position.

 

[psychtoobe]

This can be so variable based on your goals and how you are set up in the hospital you contact with.

Most independents are “on call” for admissions/patients all day. There isn’t a closing time, but since it’s post-acute you can do stuff the next day.

Some places would have an overnight call person, but that is mostly an employed model. Some places would have IM cover, but that is variable if you are set up that way.

What are you billing mostly? There is a large difference from level 2 to level 3 reimbursement. Are you spending over 50 min a day with patients or looking to see people quickly and have volume? How much time does it take you to see your patients? Most independents would carry 16+ patients per day (avg 2 discharges and 2 admissions). That’s usually an 8 hour day. But again there is so much variability and some could see that much is 2-4 hours and others it would take 16 hours.

Thanks so much. This is very helpful.

 

[psychtoobe]

Also work IC doing community inpatient rehab. Luckily we have medicine as primary so we really get to just focus on rehab. No call outside of covering admissions/consults on the weekends, split between colleagues. Unicorn job.

I have colleagues who do the bare minimum, come in and round for 2-3 hrs and leave. Typically the older physiatrists. Communicate briefly with case managers and sign DME orders electronically. I understand you only get paid for seeing patients, but I still don’t feel comfortable with that.

A few of us are medical directors which comes with a nice stipend. Usually a few weekly admin meetings, liaison education, program oversight, and there’s pressure to have more face time around the hospital, which I like honestly.

I kept pretty good records of patient numbers and collections this year. Obviously YMMV but my average collection is $75 for follow up (2/3 Level 2, 1/3 Level 1 or 3) and $175 per admit/consult. Run the math on whatever census you want to hold. How many weeks off you want. Subtract 5-7% for billing. Malpractice. You can optimize your taxes quite a bit with a knowledgeable accountant.

$20K/month after expenses, collections alone, is definitely doable with average census 10-15.

There’s also so much open to you as an IC in terms of side gigs, medical directorships, tech partnerships. Incredible autonomy. I can’t imagine switching to a salaried position.

Wow! Great information. Very helpful. Thanks. Do you know how long it typically takes to start getting insurance collections? I heard it might be a while before it begins. Also, I’ve heard IC tax is higher than employed because one will have to pay the part that the employer typically pays if one were to be employed. What percentage of collections on average should I budget for income taxes?

 

[psychtoobe]

I worked with Encompass out of residency for almost 2 years. Midatlantic region, within 30 min to 1 hr of a major city so not totally in the sticks.

Daily schedule: show up at 830-9AM to start rounding a bit. Go to morning medical meeting to get (mostly outdated) nursing updates on patients at 930. Finish rounding. Write notes. Usually all this is done just before noon. If I wanted to, I could go home at this time, but I would typically stick around to prep orders/notes for new admissions and do work for upcoming discharges. Also seems like nurses prefer docs to stick around a bit especially if there are sick patients. If it's team conference day, then I go to that at around 1PM and it takes just about an hour. Again, all this is dependent on how efficient you are.

I would typically have 15-20 patients on my census. Average 3 of these patients are new admits every day. Made a good deal more than 20K/month.

Every hospital is different. Some have the IM consult services take call. At my hospital, PM&R was attending so we took calls for our own patients every day including getting called at night about random things. This was the one single huge negative. At the time I didn't hate it too much, especially just coming out of residency. But in hindsight it can get annoying. Every 3rd weekend, I would take call and cover all the patients in the hospital and go in to see new admits. This was where a lot of $ was made but again, kind of annoying in hindsight.

Thanks for the many useful information here. Also, I need to watch out to make sure there’s little to no calls because that’s one the reasons for wanting IC.

 

[Issa_Mithras]

Wow! Great information. Very helpful. Thanks. Do you know how long it typically takes to start getting insurance collections? I heard it might be a while before it begins. Also, I’ve heard IC tax is higher than employed because one will have to pay the part that the employer typically pays if one were to be employed. What percentage of collections on average should I budget for income taxes?

Credentialing can be a major PITA. It varies by insurer and billing company but to give you an idea… I started gathering all the needed info (malpractice, LLC formation, etc) in April of my PGY-4 year, started seeing patients in July, and didn’t get my first payment from Medicare until October (albeit a very large deposit). After that, there were ups and downs, but it does start to settle out and become somewhat predictable.

Lots of ways to be savvy with taxes. Get a good accountant. I save about 30-35% of my collections for taxes, but after all the tricks, paid way less.

 

[Iamnew2]

I paid a fortune in taxes, still reeling from the taxes paid. Sigh. How do you only pay 30-35%?

 

[Issa_Mithras]

I paid a fortune in taxes, still reeling from the taxes paid. Sigh. How do you only pay 30-35%?

Probably less than that. Obviously the more you make the higher the tax but…

Maxing out Solo 401K
HSA
Tax-loss harvesting
S-Corp election, various tax deductions
lots of qualified business expenses
pass-through entity tax election (varies by state)

How to Reduce Taxable Income for High Earners [20 Ways] | White Coat Investor

Looking for ways to legally lower your taxes? Check out these 20 strategies to lower your tax bill.

www.whitecoatinvestor.com

 

[Iamnew2]

Probably less than that. Obviously the more you make the higher the tax but…

Maxing out Solo 401K
HSA
Tax-loss harvesting
S-Corp election, various tax deductions
lots of qualified business expenses
pass-through entity tax election (varies by state)

How to Reduce Taxable Income for High Earners [20 Ways] | White Coat Investor

Looking for ways to legally lower your taxes? Check out these 20 strategies to lower your tax bill.

www.whitecoatinvestor.com

I maxed out my solo 401k also, and per what my accountant told me, there is a limit in terms of qualified business expenses. I am not sure what a pass through entity tax election is though.

 

[psychtoobe]

Credentialing can be a major PITA. It varies by insurer and billing company but to give you an idea… I started gathering all the needed info (malpractice, LLC formation, etc) in April of my PGY-4 year, started seeing patients in July, and didn’t get my first payment from Medicare until October (albeit a very large deposit). After that, there were ups and downs, but it does start to settle out and become somewhat predictable.

Lots of ways to be savvy with taxes. Get a good accountant. I save about 30-35% of my collections for taxes, but after all the tricks, paid way less.

Thanks for the info. Very helpful! Better to overestimate taxes than underestimate.

 

[psychtoobe]

How much should one budget for malpractice insurance premium ? I thank God that I’ve never had a claim or named in a lawsuit but never had to pay for my personal insurace. But I read an article recently that it malpractice insurance has gone up for all specialties due to higher payouts by insurance for “mega claims”.

 

[RangerBob]

How much should one budget for malpractice insurance premium ? I thank God that I’ve never had a claim or named in a lawsuit but never had to pay for my personal insurace. But I read an article recently that it malpractice insurance has gone up for all specialties due to higher payouts by insurance for “mega claims”.

It depends on the state you're in, but I've yet to hear anyone tell me they pay an unreasonable amount.

My colleagues and I pay around $4k/year here in CA for inpatient rehab medmal, which is actually a physician-friendly malpractice environment, so I would expect most areas to cost a bit more than us (esp FL).

Shop around for the best rate you can get.

 

[psychtoobe]

It depends on the state you're in, but I've yet to hear anyone tell me they pay an unreasonable amount.

My colleagues and I pay around $4k/year here in CA for inpatient rehab medmal, which is actually a physician-friendly malpractice environment, so I would expect most areas to cost a bit more than us (esp FL).

Shop around for the best rate you can get.

Thank you!