Is it possible to make over $200K in FM?

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Everywhere I look I see average salaries for family docs around $140K. However, many people have told me that with FM, the sky is the limit! If you tailor your practice the right way then you have the potential of making a lot of money. For example: performing laser hair removal and other cosmetic procedures, and maybe having more than one clinic.

I don't want to sound like I'm in this for the money. I'm not. Its just that I have over $300K in student debt. Yeah I could pursue a specialty that is better reimbursed, but I love family medicine. So, is it possible to make over $200K/yr? I don't want to live in a rural area either.

I spoke with a practicing FM doc who told me that he made $400K last year because he performs his own biopsies on his patients and he does some endscopies. And he practices in the suburb of a big city. Is this realistic for future family docs?
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Family Guy said:
Everywhere I look I see average salaries for family docs around $140K. However, many people have told me that with FM, the sky is the limit! If you tailor your practice the right way then you have the potential of making a lot of money. For example: performing laser hair removal and other cosmetic procedures, and maybe having more than one clinic.

I don't want to sound like I'm in this for the money. I'm not. Its just that I have over $300K in student debt. Yeah I could pursue a specialty that is better reimbursed, but I love family medicine. So, is it possible to make over $200K/yr? I don't want to live in a rural area either.

I spoke with a practicing FM doc who told me that he made $400K last year because he performs his own biopsies on his patients and he does some endscopies. And he practices in the suburb of a big city. Is this realistic for future family docs?
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This is interesting 500kAUD for a FP in Australia. This is equal to $456,400.00 USD If this was paid upfront with the opportunity to invest the money, could be a good deal. Thoughts?
 
While possible, keep in mind if the average is really $140k then $400k will be many standard deviations above the mean (unless he means $400k gross in which case removing overhead like malpractice insurance, paying office salaries, etc knocks that down to at most $200k, which is still above the mean) . Also keep in mind it means there are many people making less than $140k if that's an average. To reach higher income levels you probably need to start your own clinic (requires business skills, even more capital you'll need to loan, and a good bit of risk), it won't happen as an employee. And honestly, graduating with $300k in debt will you want to take on more loans to try and start up that lucrative practice with many cosmetic procedures or take the offer where you can count on making $150k? Setting up a clinic and buying computers, an EMR (say $10,000 minimum for both), an EKG machine or two (several hundred), an ultrasound (thousands) and X-ray machine ($20,000), microderm abrasion machine ($3,000-$20,000), endoscope ($6500), buying exam room tables, BP cuffs, setting up a waiting room, finding a place to buy or lease that isn't too expensive but has room to expand in the future, etc . . . not that you have to start out with all these things or necessarily even want an X-ray machine or EMR, but you can see where this is going. Then you have to hire staff, say a receptonist/scheduler, an RN, find someone to do your billing (and take 5% off the top), etc. Then you get to worry about providing benefits for yourself and your staff.

As an example of an employed job I saw a pretty standard FM job advertisement with a salary guarantee of $122k for two years. You needed to see 22 patients per day to generate that income. Pushing that to 30 patients per day could get you to $170k (again according to the ad). There were some additional benefits like health insurance, malpractice, and $401k matching. No start up costs, not responsible for paying for the receptionist, billing coder, etc, just come and work. And $170k with benefits can be a lot more than $200k without any benefits.

Some people start out with the guaranteed job (like the above) to pay back some of their loans with plans to open up their own practice after things get settled but most never end up doing this for two rweasons, 1) it can alienate the people you are working with now making it hard to practice in your current location (some even have non-compete clauses in the contracts), and you might not want to move to another location if you have kids in school, a house, etc. 2) It's hard giving up the guaranteed income.
 
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I'm starting to think that 200k is possible but not the "usual".

I'm sure there are many ways to do it but you probably would have to do OB. Also do as many procedures as possible; derm, colpo, etc. I would think this would be much harder to do in the suburbs/city than in a more rural area.

IMHO, it seems that Family doctors can only practice true Family Medicine in a rural setting; in doing so they are reimbursed more bc they have a larger scope of practice. I would love to be proven wrong on that though.
 
If you wanna make over $200k a year you just have to configure yourself to see 160 patients a week... so you figure it out.
 
Out of curiosity, how much does an FM doc make if they were to work at a VA?

I would imagine that salary is lower but benefits could be higher, thus pushing total reimbursement over 200k. Plus I would imagine that call is a minimum, plus weekends/holidays off. Anyone have any experience with this?
 
You can do it. Get a job with a $160k base salary, hopefully with minimal call. Then moonlight in the hospital once a week or so. That will push your salary up over $200 but of course not without a little extra work.
 
drwatson said:
Out of curiosity, how much does an FM doc make if they were to work at a VA?
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From what I've heard salaries are indeed lower but the jobs are super cush.
 
I've been out for a couple of years. I don't work that hard and I've made over 200K every year. That's not typical. I enjoy traveling and I have done mostly locums work, including some rural locations few people are willing to take. Most of my residency class started in the 150 to 170 range, not including benefits (the lowest was 120 in an academic center with EXCELLENT benefits). Some have decided to work part time, but the full timers who have a stake in the practice are all making over 200 a year. It all depends on what you want and what you are willing to sacrifice (hours, location, scope).
 
On the side-comment about non-compete clauses: Have recently had a few docs tell me to NEVER EVER sign a non-compete contract. EVER. Like, EVER. You never know what's going to come up even next week, and if you have a non-compete hex on you, you're essentially bound to that group or you have to move.

So as to not hijack the thread - yeah, the 200k is doable, but as mentioned, that's above the mean. Also, you have to distinguish between newbies and the 'timers. Most full-time FP's who've been at it a few years are up around 200 or better. Not too many do that for the first few years out of residency.

And don't underestimate the diversification concept. You'll start seeing better money once you can buy into a practice, for example. Lots of docs I know have other income generators associated with their practice too, like procedures, or merchandise...all that, if you're into it. Somewhere along the way to 200k+ you'll sell your soul in the form or ethics or time, but you can make the $$ if you really want it.

And to the OP: Dude, in the end, we're all in it for the money. Why does everybody need to qualify their money questions by saying they aren't in it for the money? It's a damn JOB. We go to work for money. Docs become docs for, yeah, a meaningful job...but also for a good life. Nobody WANTS to work 70 hours a week. NOBODY wants to go home to a dry-wall apartment, dig leftover SPAM out of a watery foam cooler, heat it up over the grill of your neighbor's car and call it dinner. You think the altruism of patient care would make a life like that worthwhile?

It's about the money. Or it should be. Anybody who doesn't do their jobs for money are doing a disservice to the rest of the doctors in the world who are desperately trying to beat the SPAM life. Insurance companies, the government, lawyers, lawyers, lawyers and a thousand others would be happy to have us work for free...or for them. And consider this: The banks who loaned us the $300k (yep, I'm right around there too..worsening every second)...you think it wasn't about the money for them? ANY altruism from them? ANY assistance so we could go do good and moral things? The fact that we even pretend that it isn't about the money is why everyone else is making such good money...we suck at business and they know it. It's about the money for them...it should be for us too.
 
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secretwave101 said:
And to the OP: Dude, in the end, we're all in it for the money. Why does everybody need to qualify their money questions by saying they aren't in it for the money? It's a damn JOB. We go to work for money. Docs become docs for, yeah, a meaningful job...but also for a good life. Nobody WANTS to work 70 hours a week. NOBODY wants to go home to a dry-wall apartment, dig leftover SPAM out of a watery foam cooler, heat it up over the grill of your neighbor's car and call it dinner. You think the altruism of patient care would make a life like that worthwhile?

It's about the money. Or it should be. Anybody who doesn't do their jobs for money are doing a disservice to the rest of the doctors in the world who are desperately trying to beat the SPAM life. Insurance companies, the government, lawyers, lawyers, lawyers and a thousand others would be happy to have us work for free...or for them. And consider this: The banks who loaned us the $300k (yep, I'm right around there too..worsening every second)...you think it wasn't about the money for them? ANY altruism from them? ANY assistance so we could go do good and moral things? The fact that we even pretend that it isn't about the money is why everyone else is making such good money...we suck at business and they know it. It's about the money for them...it should be for us too.
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Thank you! It's about time someone said it!
 
$200K is easily attainable. I just signed a contract with a clinic in my hometown and the base salary is $200K. I also got a $40K signing bonus. It's a fairly rural area though. The city where I'll be working has a population of around 25,000 and it's 100 miles to the nearest city with 100K+ population. Two of the three docs in the clinic made $300K+ last year and the other made $250K.
 
I think it has been established that if you want to make $200k, or more, you can do so in a rural setting. The real 200k question, is can you do this in the burbs or in a city (ie. Chicago)?

Given the unending castration of the scope of Family Medicine (no OB, fewer inpatient services, etc) I think this is more the exception (making 200k in a suburb) than the rule.
 
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drwatson said:
I think it has been established that if you want to make $200k, or more, you can do so in a rural setting. The real 200k question, is can you do this in the burbs or in a city (ie. Chicago)?

Given the unending castration of the scope of Family Medicine (no OB, fewer inpatient services, etc) I think this is more the exception (making 200k in a suburb) than the rule.
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Yes you can. But you have to think about the quality of medicine you will provide. Would you be happier making $150,000 each year, but knowing that you are spending enough time with your patients and not putting in crazy hours? Or would you be happier with long days, compromising patient care, but making $200,000?

Also, residents from certain FP residencies are more highly sought out than from others. Those residents would be able to demand a higher salary.

P.S. About 5% of FPs currently practice OB. And that is because most of the other 95% choose not to do OB. If that is something you are interested in, find a residency that has a large OB volume or make sure to do an OB fellowship. Also, a larger number of FPs provide strictly inpatient or strictly outpatient Peds. This is a trend due to the higher salaries the HMOs are willing to pay. The world is really open to an FP, depending on what you're interested in
 
Making $250+ in FM certainly isn't impossible, but it's not likely to fall into your lap, and you aren't likely to start there. You'll need to work hard, work smart, or (more likely) some combination of the two. "Crazy hours" are not required, nor do you have to see a zillion patients a day. Also, you'll probably do better if you avoid salaried jobs and work on production.
 
drwatson said:
I think it has been established that if you want to make $200k, or more, you can do so in a rural setting.
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Plus it's a ton cheaper to live in rural areas. And as you have implied, in these areas you can get privileged much more easily in sections, endoscopy, and other procedures, all of which earn even more money. --T
 
Does anyone know whether the pay averages include the docs that only work part time? Maybe this is why they seem so low all of the time? :confused:
 
secretwave101 said:
On the side-comment about non-compete clauses: Have recently had a few docs tell me to NEVER EVER sign a non-compete contract. EVER. Like, EVER. You never know what's going to come up even next week, and if you have a non-compete hex on you, you're essentially bound to that group or you have to move.

.
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Or make the non-compete outlandish - you know, 40 miles and 40 years if you are in an urban setting (40 miles may not be outlandish in a rural setting). This would be considered unenforceable and unreasonable, especially if you add the phrase "all terms of contract are understood to be in good faith and fair dealing". Being unreasonable, it would be nullified.

If they do not specify damages it can also swing in your favor, or if you make the damages miniscule. But if no damages are stipulated in the non-compete clause its up to a judges discretion as to what the damages should be.

Some states seem much more generous. Wisconsin certainly seems more favorable - some places over large signing bonuses, and if you take obstetric call it seemed many recently offered 200K base.

Owning your own business can have many perks that help with income and taxes. owning a business can be a huge headache - having owned several of my own business' it helped me want to go into medicine just so I could be employed somewhere. You may delegate but ultimately everything from hiring and firing to refilling copier toner is your responsibility. I loved hiring, liked firing - hated managing everything else.I also enjoyed doing my marketing, that was alot of fun. However having a business that makes some serious dough can give you some serious money to move around, even though your honest stated income may be modest. I have employees from over a decade ago that still stay in touch with me, as we had good working relationships.

I loved giving Christmas bonuses - and I loved giving incentives to employees. Which of course were tax deductible since they were business expenses. They really appreciate it. Technically I was an employee too.
 
Family Guy said:
and maybe having more than one clinic.
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Would you be working both clinics (then you have 2 sets of rent, 2 power bills, 2 sets of employees to manage etc - on just your work) or would you hire someone like a NP or PA to run it? If you are working both then what you have is 2 jobs. Its not truly a business until someone is working for you. Secretaries etc do not work for you - you work for them.... if you do not work they do not get paid because no money comes in. You are the one earning money - and then giving part of it to the secretary. Only employees that actually earn money (the patients or insurance companies pay for something THEY do) are really an asset - otherwise you are the only income earner in the office.

COnsider some off beat things : massage therapists, aestheticians, psychologists, acunpuncturists. Consider that more money is spent every year on alternative treatments, and mostly by cash. A massage therapist can pretty easily charge $60 per hour everywhere - if they do 6 per day and you split it, then you are getting about $1000 per week or another $40-50,000 per year with little expense and no time on your part. If you have 2 massage therapists sharing the same room and working two 6 hours shifts (one from 6-noon and one from noon until 7) then you could make about $70-100,000 per year for the price of one small room with nothing special in it (a massage table costs a few hundred bucks). Very low malpractice with massage.

Acupuncture is another one that makes pretty good cash - again roughly $60-90 per treatment. Needles are pennies. Very very low malpractice for the average acupuncturist with 1 mill/3 mill coverage - under $2 grand per year. Could make $40K or so a year from an acupuncturist using one room.

So a couple of massage therapists and an acupuncturist could bring in some decent additional income - maybe cover half your overhead. At least they are non-competitive assets (they actually earn money, not expect you to pay them out of your income). You can gain new patients from them and they from you. Symbiosis at its best.
 
Dakota said:
and X-ray machine ($20,000), .
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Bad business investment. A really good friend of mine in the Phoenix area is a very well known chiropractor. He had an x-ray unit. He was making bank, and hired a cost analyst who also did cost analysis for Wendy's. He wanted to know how much he was making on each of his services. His x-ray unit shocked him. He averages 5 new patients a day - chiropractors take x-rays in everyone practically. He was losing money on his x-ray unit. He could not believe it, he was charging hundreds for a Davis series of the neck. But the analyst showed he was losing money.

The x-ray unit required a big room (for the unit, for the buckey, for the processor) which could not be used for something else. He had to control the temperature in there. He had to have the chemicals changed each month. If something went wrong it was expensive ( a new tube alone is thousands). On the other hand he could take the unit out,partition the room up into several smaller rooms and put a massage therapist in each one who earned money all day with almost no cost to him. If you are not taking x-rays ALL day long you will lose big money on this. Massage is a good thing for him to add, since it is a service - it comes with little cost attached to it. Have you even priced rare earth film jackets? Calipers, lead shielding, hot lights, etc - pricey pricey pricey. Plus you can only count on collecting a portion of what you bill for x-ray to insurance etc. Massage therapists, acupuncturists almost never get stiffed - they collect well over 90% of what they bill. Its cash

Instead I would set up an office within a mile of an outpatient radiology center. EKG is a pretty good service - once the initial unit is purchased it has very little parts that endure alot of stress (unlike an x-ray which has a spinning tube that is beamed with electrons that heat it up super hot) - and the strips are just paper (pretty cheap). About the worst that can happen is the battery goes if it has one, but then you just need to remove the battery and plug it in. Spirometry is also a pretty good thing.
 
So is the consensus that a rural family medicine doc does well financially? I'm really excited about the idea of going back to the farm (grew up on one). If I do family medicine (I'm a second year student) then I'd definitely go rural. I have a HUGE amount of loans though, and have to figure out how to pay them off. How "rural" does a place have to be to make higher incomes? My "hometown" had 11K in it and was the largest town for 40 miles. The town I went to school at had 2K, and the town I lived in had 50 people. I'm assuming it would be best to set up in the 11K town, but there are certainly more docs in town, so maybe the money wouldn't be quite as good. My brother is a dentist in said town and does well ($250K a couple years out of school), but I think there are more FM docs there than there are dentists.
 
The average rural FP makes more than the average urban FP, but there are deviations from the mean. If the area is eligible for loan repayment, that can be a huge addition to your pay. It wouldn't be a bad idea to talk to the local hospital administration either.
 
With any business there are only several ways you can compete : 1) quality of service (guys in tuxedo's) , 2) Volume, or 3) level of service (services which reimburse better). A car salesman can offer friendlier service, sell more cars, or sell more expensive cars which have higher profit margin (pardon my analogy, I am not a car salesman).

The first is a personality practice, the second two are procedural practices.

Another big feature of making money is profit - delivering a product with low overhead. Chiropractors (my favorite business model) typically have positive cash flows of $120-200K on business' that collect $180-250K. Working 30 hours per week. Chiropractic malpractice is around $1500 a year. Low risk. Medicare does not pay for their exams, x-rays, therapies etc - just simply $20-30 for poppin' their backs. Can you imagine taking that practice and getting paid for the exams, being able to do an occassional EKG, some trigger point injections, a light pain med prescription here and there?

Low overhead, doing conditions that are low risk (no surgery or OB of course), quick, services people will pay cash for. I know most here hate chiropractors, but if you are talking making money I think they are the model to look carefully at.

I myself want to do Indian Health services among other things - not high paying, but valuable service.
 
Dakota said:
While possible, keep in mind if the average is really $140k then $400k will be many standard deviations above the mean (unless he means $400k gross in which case removing overhead like malpractice insurance, paying office salaries, etc knocks that down to at most $200k, which is still above the mean) . Also keep in mind it means there are many people making less than $140k if that's an average.
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140k? Isn't that kind of low. I have personally met PA's that make very close to that number.
 
Family Guy said:
Everywhere I look I see average salaries for family docs around $140K. However, many people have told me that with FM, the sky is the limit! If you tailor your practice the right way then you have the potential of making a lot of money. For example: performing laser hair removal and other cosmetic procedures, and maybe having more than one clinic.

I don't want to sound like I'm in this for the money. I'm not. Its just that I have over $300K in student debt. Yeah I could pursue a specialty that is better reimbursed, but I love family medicine. So, is it possible to make over $200K/yr? I don't want to live in a rural area either.

I spoke with a practicing FM doc who told me that he made $400K last year because he performs his own biopsies on his patients and he does some endscopies. And he practices in the suburb of a big city. Is this realistic for future family docs?
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I will tell you how most of the docs I know do it or at least take jobs that promote 220-250/year.

I had a friend tell me today that he sees patients 35 hrs /wk and does 20 to 3o hours of paperwork per week. He makes over 200K.

His buddy does the same but is a specialist. He makes double that.

His other buddy is also a specialist and works about 50hrs /week. He makes double that.

The most recent survey that came out a couple of weeks ago states that 70% of family physicians would go into medicine again. But only 29% would choose Family Medicine again.

Now, lets talk accounting. If you have a 300K student loan that means your payments will come to at least 2000k/ month.

If you make 220000/year after taxes you get to keep roughly 160000k. That about 13300/month.

13300 -2000 = 11300 Now you have to take retirement (about 25%) out of that and a mortgage. So that should leave you with about 5000 for everything else is you have a 2000/month mortgage.

If you live like a resident for 5 years and pay your student loan off then you will have more money but the same lifestyle.

Or you can go into a specialty that makes double that and live better. If you can't get into a specialty such as that then the above example is mostly accurate.
 
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On track for 240k gross - just finished residency 6/2017. 36hr/wk, 8hr moonlighting everyother weekend/saturday.

Next year, with more outpt volumes combined with inpt and nursing homes (40k each in additional revenue) - will be over 300k.
 
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DoubleBogey said:
On track for 240k gross - just finished residency 6/2017. 36hr/wk, 8hr moonlighting everyother weekend/saturday.

Next year, with more outpt volumes combined with inpt and nursing homes (40k each in additional revenue) - will be over 300k.
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Which region of the country do you work?
 
DoubleBogey said:
On track for 240k gross - just finished residency 6/2017. 36hr/wk, 8hr moonlighting everyother weekend/saturday.

Next year, with more outpt volumes combined with inpt and nursing homes (40k each in additional revenue) - will be over 300k.
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So if I do 72 hrs a week....


What ya trying to tell me?

;)
 
QueenJames said:
So if I do 72 hrs a week....


What ya trying to tell me?

;)
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You’ll hit those hours routinely every week making $10/hr once you start residency - what I’m tryin to tell ya is there’s light at the end of the tunnel
 
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DoubleBogey said:
You’ll hit those hours routinely every week making $10/hr once you start residency - what I’m tryin to tell ya is there’s light at the end of the tunnel
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hahaha

I see what you did there ;)

But in all seriousness, Do you feel that FM offers a variety of ways to supplement your income like other specialties like EM or IM where you can "pick up" extra shifts and stuff for a set amount?

Is there additional paid call that you can take? Or does that depend on your contract?

Appreciate your input!
 
QueenJames said:
Do you feel that FM offers a variety of ways to supplement your income like other specialties like EM or IM where you can "pick up" extra shifts and stuff for a set amount?
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Sure. You can work as much (or as little) as you want.
 
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QueenJames said:
hahaha

I see what you did there ;)

But in all seriousness, Do you feel that FM offers a variety of ways to supplement your income like other specialties like EM or IM where you can "pick up" extra shifts and stuff for a set amount?

Is there additional paid call that you can take? Or does that depend on your contract?

Appreciate your input!
Click to expand...
When you say FM, are you implying outpt only?

I am IM trained and work both inpt and outpt. Depends on the setup you work in, as my current employer offers outpt moonlighting, which helps supplement income. The inpt and nursing home stuff is just extra. You can work as much as you want and is really dependent on the healthcare setting you’re in - if you do inpt you can pickup extra shifts, nursing homes are whatever you want to make it.

The more you work the more potential you have to make more money.

The 3 contracts I looked at when I was coming out of residency all offered 200-220k for outpt only, for what it’s worth. In the end, I like to work, and it took me 11 years (undergrad, medical school and residency) to start working in a field I enjoy, so now I finally get to work what I enjoy doing.
 
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DoubleBogey said:
When you say FM, are you implying outpt only?

I am IM trained and work both inpt and outpt. Depends on the setup you work in, as my current employer offers outpt moonlighting, which helps supplement income. The inpt and nursing home stuff is just extra. You can work as much as you want and is really dependent on the healthcare setting you’re in - if you do inpt you can pickup extra shifts, nursing homes are whatever you want to make it.

The more you work the more potential you have to make more money.

The 3 contracts I looked at when I was coming out of residency all offered 200-220k for outpt only, for what it’s worth. In the end, I like to work, and it took me 11 years (undergrad, medical school and residency) to start working in a field I enjoy, so now I finally get to work what I enjoy doing.
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I actually wasn't aware of "inpatient" FM. I figure it similar to hospitalist in IM? Please correct me if wrong.
 
FM and IM can do Hospitalist Medicine - not exclusive to one or the other
 
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QueenJames said:
hahaha

I see what you did there ;)

But in all seriousness, Do you feel that FM offers a variety of ways to supplement your income like other specialties like EM or IM where you can "pick up" extra shifts and stuff for a set amount?

Is there additional paid call that you can take? Or does that depend on your contract?

Appreciate your input!
Click to expand...


Your first few years out of residency are the best years to do extra work. You are used to doing it as a resident and now you will actually earn the pay for the extra hours plus the base pay as an attending. You'll pay more taxes if you don't plan it right. You can pay off those loans fast if you plan it right. Here are just some options for an FM doctor.

Urgent care shifts
Inpatient shifts
Outpatient shifts
Nursing homes
Longer clinic hours to fit in more patients
Rural clinic shift. Some pay more in rural ERs and most are level 4
Any combination of the above.
 
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Ericslv said:
Your first few years out of residency are the best years to do extra work. You are used to doing it as a resident and now you will actually earn the pay for the extra hours plus the base pay as an attending. You'll pay more taxes if you don't plan it right. You can pay off those loans fast if you plan it right. Here are just some options for an FM doctor.

Urgent care shifts
Inpatient shifts
Outpatient shifts
Nursing homes
Longer clinic hours to fit in more patients
Rural clinic shift. Some pay more in rural ERs and most are level 4
Any combination of the above.
Click to expand...
Plus the farther you are out for residency the less likely you are to want to pick up extra shifts of any kind.

My first year out I was doing three to four Urgent Care shifts a month in addition to a full-time job. Now I work full days a week and the idea of doing anything more than that makes me cringe
 
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