Is it possible for a FM doc to make 500K?

[VA Hopeful Dr]

I see no real advantage to same-day results for most of that stuff.

I get the same benefits (review labs with patient, no call-backs, etc.) from having routine labs drawn a few days in advance of appointments. I'm also not limited to labs that can be done in the office setting (e.g., LDL-p, etc.)

I like having a CBC... but otherwise I"m with you

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[DCFamilyMed]

The advantage is that you're not having to call patient x 2-3 days later. Sending out labs addresses the original question.


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[deleted87716]

I don't have to call them the way I do it, either.

 

[DCFamilyMed]

Has nothing to do with original question blue dog.
Are you explaining in detail every lab result to follow trends. The original question was making 500. My gross last year was over 2 million in solo practice so that is how a family physician can compete with the specialty fields. Data driven, numbers based, trend analysis, customized health care for each patient seeing 20 patients daily. Also, looking up results on a web portal is not the same as a face to face detailed evaluation by the physician.


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[deleted87716]

Has nothing to do with original question blue dog.

Not directly, but these threads tend to go off on a tangent now and then.

Are you explaining in detail every lab result to follow trends.

Of course.

My gross last year was over 2 million in solo practice

Irrelevant. If you want to tell us your take-home, that's what the original thread was asking.

 

[DCFamilyMed]

Take home last year 650 so not irrelevant and answers your question.


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[deleted87716]

Take home last year 650 so not irrelevant and answers your question.

Anfield rd's (the OP) question, you mean.

 

[DCFamilyMed]

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[MOHS_01]

Economics tells you that capital and overhead are not fixed in the long-term.

Working those hours indefinitely is a sure path to physical, psychological, emotional, or family ruin. It's insanity that leads to more insanity. Plus it builds inner resentment, and this can come out in terms of how other people, patients, colleagues, or staff get treated.

Not worth it. After a while, you'd no longer love what you do.

Costs come in two forms: highly variable and less variable. Everything varies, just some relationships are more linear than others.

 

[MOHS_01]

Has nothing to do with original question blue dog.
Are you explaining in detail every lab result to follow trends. The original question was making 500. My gross last year was over 2 million in solo practice so that is how a family physician can compete with the specialty fields. Data driven, numbers based, trend analysis, customized health care for each patient seeing 20 patients daily. Also, looking up results on a web portal is not the same as a face to face detailed evaluation by the physician.


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Now. That. Is. Impressive.

Let's do some math.

20 patients a day, 5 days a week, 50 weeks a year. That's $400 collected per visit -- and presumably not doing many overpaid procedures at that.

How do you rate on the United, Aetna, Athem, et al efficiency ratings? Has that penetrated your market yet?

 

[DCFamilyMed]

I take all insurances including Medicare except HMOs. I have met with medical directors with all three major health insurances and they like our model and almost zero hospitalization rate. High efficiency and top rated amongst insurance companies here. Insurance to insurance we have payments documented including trends on which insurances pay best and my manager is always on top of that. That ensures my knowledge of which insurances do well with our office.


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[tiotropium]

I take all insurances including Medicare except HMOs. I have met with medical directors with all three major health insurances and they like our model and almost zero hospitalization rate. High efficiency and top rated amongst insurance companies here. Insurance to insurance we have payments documented including trends on which insurances pay best and my manager is always on top of that. That ensures my knowledge of which insurances do well with our office.


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So can I work with you in 3 years when I graduate from my FM program?

 

[DCFamilyMed]

Sure... Do well in your residency and keep me in mind......


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[lowbudget]

Sure... Do well in your residency and keep me in mind......


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Ugh. I need to get out of employed setting.

So how did you start up your solo practice? How did you overcome some of your obstacles? Thoughts/pressure on joining ACO?

 

[DCFamilyMed]

Employed may appear easy to a new graduate but that "security blanket" in the end does not really allow the freedom of being the boss. I've worked in both settings and really prefer the private setting. No politics and committees dictating what I decide to do. My staff is exclusively loyal to me. I've posted in earlier posts about possible ways to run a solo practice. ACOs will probably turn out to be another HMO which I have not made a final decision yet and still thinking about. It will take new creativity and boldness to allow family medicine to thrive in the 21st century. Residency programs should prepare graduates not only to work at employed positions but really be open to models of practicing family medicine and running a small business. Although on fierce is starting to build and the new gimmick in my area, most patients nationwide cannot afford monthly fees with little value at the end.


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[drempl]

This is a serious question. Do you know of family medicine doctors who

1. Are 1-5 years after residency
2. Make at least 500K profit (NOT revenue).
3. Own and run their own practice


If so, please share some details. Type of practice, patient mix, procedures done, additional training etc. Thanks.

A very well run, full, solo Family Practice office can have a revenue of about 300K....assuming you take only 2 weeks vacation and work an average of 9h a day!
I have one for sale if you are interested !

 

[drempl]

Now. That. Is. Impressive.

Let's do some math.

20 patients a day, 5 days a week, 50 weeks a year. That's $400 collected per visit -- and presumably not doing many overpaid procedures at that.

How do you rate on the United, Aetna, Athem, et al efficiency ratings? Has that penetrated your market yet?

Correction: 25 patients per day for a full practice!

 

[Aces]

Yes... FM Physicians can make upwards of $300,000 very regularly if they are aggressive enough.

I know a number of FM physicians who do a combination of outpatient/inpatient and/or ER/Urgent Care who make at least $300,000 with 1-2 days off per week.

If you have a good business model and are willing to work hard to make it happen, you will make as much as you want to.

 

[addy]

Yes... FM Physicians can make upwards of $300,000 very regularly if they are aggressive enough.

I know a number of FM physicians who do a combination of outpatient/inpatient and/or ER/Urgent Care who make at least $300,000 with 1-2 days off per week.

If you have a good business model and are willing to work hard to make it happen, you will make as much as you want to.

Does that mean you take only people with good insurance?

 

[Leo Aquarius]

Set up a private practice where patients pay out of pocket and 300K won't be a problem.... like psychiatrists do.

add to that some botox, some hair transplantation, some trick of the hand waving, and maybe you can get to 500K. To me time is more valuable than money as I work to live not live to work.

 

[septoplasty]

Does that mean you take only people with good insurance?

Lol.

This.

 

[Kratos79]

In Canada, it is very possible to make 500k and above. I graduated med school in the US, came to Canada for residency, and stayed after. Some docs I know here bill easily over 500k gross, with some rare docs billing a million (all government plans). As for me, I grossed 60k last month, due to an additional non clinical contract I had, but I usually gross about 35-40k a month before overhead (usually about 25-30%). Ironically, even though we have socialized health care here (but we do not work for the government, unlike the VA or NHS) I feel that docs here have more freedom to practice and not be bogged down by insurance companies telling you what you can and cannot do. As for money, all this extra money I have gets invested and I hope to retire before I'm 40. Or at least be completely financially independent.

 

[deleted87716]

I usually gross about 35-40k a month before overhead (usually about 25-30%).

Canada's not a cheap place to live, tax-wise (somebody's gotta pay for that "free" healthcare.)

Gross billings and overhead are irrelevant. What matters is how much you take home.

 

[Kratos79]

True. But I don't have health insurance costs as its paid through my taxes. I also am incorporated so my tax rate is 14%. Take home pay my first year in practice after taxes was 50k in my personal account and 350k in my corporation. Could never make that in the US. Paid off my student loans in one year, have a 1.5 million dollar house and living the good life five years after residency with a goal to be mortgage free in 4 years. Sorry but you could never do that as a family doc in the US.

 

[deleted87716]

living the good life five years after residency ... Sorry but you could never do that as a family doc in the US.

Sure you can. Been there, done that.

Mortgage-free...? Why bother? There's certainly no tax advantage to it. Real estate is kind of a crappy investment these days. Put that money elsewhere.

 

[step2cspass]

True. But I don't have health insurance costs as its paid through my taxes. I also am incorporated so my tax rate is 14%. Take home pay my first year in practice after taxes was 50k in my personal account and 350k in my corporation. Could never make that in the US. Paid off my student loans in one year, have a 1.5 million dollar house and living the good life five years after residency with a goal to be mortgage free in 4 years. Sorry but you could never do that as a family doc in the US.

Sorry to tell you, but take a look at this article:

http://news.nationalpost.com/2011/0...ramatically-less-than-u-s-counterparts-study/

IF YOU WANT TO TALK ABOUT AVERAGES, THEN MAKE A CASE, DON'T TALK ABOUT A MINORITY OF PEOPLE. AND DON'T SAY 'SORRY YOU COULD NEVER DO THAT AS A FAMILY DOC IN THE US' BECAUSE IF YOU WANT TO TALK OUTLIERS; LOOK AT THE GUY WHO MADE 650K IN DC.........

Docs in Canada make less than the USA; not to mention you are living in Canada where the cost of goods/cost of living is MUCH higher. And not to mention the weather.....

 

[ioh]

I've been away from the forums for some time, and a little disappointed by a thread that's both focused on money and argumentative. Hopefully we can raise the caliber of discussion.

With regard to the OP's question, the answer is simple: anything is possible if you put your mind to it. The better question is why do you ask?

As to how to make 500K in FM, there are generally speaking two ways to do it. One is to become a business owner, that way your earnings are compounded by employee work and/or ancillary services (eg. Labs, x-rays, etc). Alternatively, some jobs can offer that type of income though you'd likely be relocating and working a lot with limited time for life outside of work.

But seriously, think about why you asked, because there are many ways for bright individuals to make money.

 

[deleted87716]

I've been away from the forums for some time, and a little disappointed by a thread that's both focused on money and argumentative.

This is SDN.

 

[Esquire]

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[step2cspass]

What's not to like about Canadian single payer and non-existent malpractice? Some Canada FM numbers:

Excellent opportunity for a Family Physician to join an established practice located in Windsor, Ontario just across from the US border. Very competitive split of 80/20, monthly guarantee and moving allowance provided. First year income potential $300K-$350K, then >$400K in subsequent years.

We are seeing a Family Physician for a community hospital with a full nursing team in Atlantic Canada.
Pay will be $400K per year.

An opportunity exists to engage in a diverse and high quality, well established, 3 physician Family Medicine Practice within the City of Regina.
- Income is FFS with annual income $300,000+

Family doc to cover for a maternity leave. Alternative Payment Plans providing gurantee min salary of $260,000/yr. Located in New Glasgow Nova Scotia

If you are a US Board certified Family Physician, or have simply completed your US post-graduate FP/GP training and hold an active state license, you are eligible for an independent Canadian license - NOW! 10 Reasons to Come to Atlantic Canada: 1. Average annual income of $250,000 US and Starting Bonus of up to $50,000 US. 2. Canada has the lowest tax rate of the G8 countries, including the USA. 3. Incorporated physicians can access 17% corporate income tax rate, and deduct operating expenses from taxable income.

again; stop spewing nonsense about a country where doctors make less......you people equate gross collections to income.......

http://www.cbsnews.com/8301-505144_162-57474364/canadas-favorite-tax-haven-the-u.s.a/

 

[Kratos79]

Say what you want. I make a lot more here than my specialist colleagues down south as a FP. And I'm talking about net income. And I work less than them. And I pay less taxes as I'm incorporated. A 14% rate.
Money is invested, with compounded dividends, and I'm set to retire at 40 with my million dollar home and student loans all paid off. Sorry but I've experienced both Canada and the US and as a family doc, it's just way more financially lucrative up here.
As an example, this weekend, worked 8 hours on Saturday, gross billings 2200, net pay after overhead before taxes 1540. On Sunday, 6 hours in clinic, gross billings 1600, net pay 1120. Worked 3 hours on a medicolegal report, net pay 1500 bucks. Total for two days 4260 bucks. That's 250 bucks an hour net for a typical weekend for a typical doctor. I make more certain months doing other things as well with the freed up time I have. Made 60k NET last month with all the extra contracts and teaching I had which also apply to this month and going forward.
I am a typical doctor up here. Average salary reports are never accurate as they include a lot of docs who are semi retired or working part time (like my friend who is a mother who works a day a week). If you want the money you can make it up here provided you are willing to work hard.
As for goods being more expensive up here. It hardly matters if you are making so much money. I can stomach paying a buck more for a gallon of milk than in the US, or 30 bucks more to fill up my BMW. Or since I live 20 minutes to the border I can do my shopping in the US which I sometimes do.

 

[step2cspass]

again......take a look at the articles........and a corporate rate of 14%? that's fine and dandy.........however that's for your corporation........if you want to use it for personal use........you have to pay more taxes...........

it's great that you are doing well; but you have to compare apples to apples.........your one example can be compared to other examples in the us as well...........there are people in areas in the us where they come out of residency making 250k - 350k........what exactly are you doing for the money and where do you live?

and the overall tax rate for high-income earners in the canada is > than the us.......

i personally have friends in the ontario-toronto area...........and their take home is more in the ballpark of 150-175k working 40-45 hours...........so again; use averages other than the norm to discuss things.........

people don't talk about the guy who has a rent-ceiling priced apartment in nyc who pays $800 a month..........the average rents in nyc for a 1-bedroom is close to $3000...........

speak in averages not exceptions........

 

[deleted87716]

worked 8 hours on Saturday...On Sunday, 6 hours in clinic...Worked 3 hours on a medicolegal report...

Getting paid extra for working weekends and doing stuff outside of clinical medicine isn't a Canada-only phenomenon.

Personally, I don't want to do that, so I don't. I have no doubt I could make a lot more money if I did. There's more to life than money, however.

 

[step2cspass]

plus the biggest thing is that the canadian dollar has historically been 1.3 for every 1 dollar us.........

which means, 200k US =260k canadian.....

again, comparing apples to apples is difficult......canadians dont earn in us dollars

 

[step2cspass]

due to the recent economy however; canadians think that the cad=usd......which it has recently; but historically; the parity was not there.....so it's going to take some time for salaries/purchasing power will return to normal levels.....

 

[Afsplace]

Hi DCFamily Med

Can I ask you what you think of the following link I posted in another thread (I noted DC family Med and am interested in washington DC areas )

" I'd appreciate any advice here, I'm an Irish trained family physician. ECFMG certified and ready to apply for a residency, but I was hoping to just do PGY 2 and PGY 3, I only need 2 years of ACGME training to be licensed as already board certified for family med in USA (reciprocal arrangement).

All the PGY 2 openings for 2013 say I need PGY 1 training except for 1 of them which is now filled.

Does anyone know if it is possible to do deals though? Are programs willing to take people who would work for free ? Would they create an extra residency post if I would work for free or even pay the residency ?

Is it acceptable to ring program directors and speak with them about this ?

Pleaseeee help , I really need to get to US by july 2013 and commence PGY 2 "