This would be funny if you weren't trying to spread you unrealistic nonsense to med students and residents who might be tempted to believe this silliness.
That's rigth.. remind them that they are worthless and will never make it.. just because you didn't.
Overhead includes Rent/Mortgage, front desk staff, MA/RN, PT salaries, equiptment (EMG, C-arm, RF machine, pain table), transcription service, billing service (or the salaries of those who perform these functions for you in house). If you seriously envision all of those services costing $80k/yr, you are in for a rude awakening.
I gave you my first year overhead. I didn't have but one staff member and used the x-ray of the occ med doc besided me. As you see, my last few years, my overhead was always over $200K a year.
As for getting paid the next day, clearly you don't live in the real world. A well run practice has an average AR of between 30 - 45 days. Linda van Horn, a physician billing and coding expert who lectures at the AAPM&R, ISIS, and ASIPP billing and coding workshops suggests that a well-run pain practice should have an overhead of between 38-42%. Ortho practices run in the high 40s.
Real world? I billed insurance every single day.. MYSELF.. not some billing company. I know how long it takes to get paid. You are the one out of touch and need to update something if you are waiting 30-45 days to get paid. Even Medicare paid within 15 days.. and this was over a year ago. Wow.. you are saying overhead should be around 40%.. then why were you quoting 50% earlier? I said it would be around 40%, if you read what I wrote.
What expenses does a group incur to bring a doc onboard? Your salary until you break even, malpractice insurance, benefits, the cost of your support staff, capital expenditure for equiptment you might need (EMG, c-arm, RF-machine, pain table) - between $300 and 450k.
Salary is only an expense if you don't have patients. They should have patients lined up the day you arrive. As for equipment, this would only be to a start up group that just starting adding PMR. EMG is cheap, I got a few in storage I'd give away. c-arm would be the only expense and it can be leased for $600 a month. They don't have to pay malpractice upfront.. it is in payments..
As for your friend, that really made me laugh. OK, lets start with the notion that at 2M/yr, he makes twice as much as pain guys in the 75th percentile of MGMA. So he makes more than all but 1% of his colleagues. But he isn't raping the system - nah! And better still, 90% of what he does is injections. That is the very definition of a block jock. A reputable pain doc seems the patient to determine what needs to be done, does the procedure, and then brings the patient back in follow-up before doing something else. At MOST that is 3 days a week. 4 1/2 days a week procedures, 1/2 day a week f/u? Slimeball. (I know, he is your friend, so to you he is just better at it than ANYONE else in the country, but in th real world, not so much)
Block Jock, maybe.. but he is helping more people than you are I bet. And making a good living doing it. His wife is also a board cert anesthesiologist, she stays home with the kids.
Oh yes, your population was 80% private insurance, yet you treated them till they reched
MMI, a term reserved for WC. Chiros employing PCPs is an illegal arrangement if ever looked at carefully by the authorities, btw, as the billing for your services was done under THEIR provider numbers - but I'm sure you know that many of your fellow chiros have been prosecuted under the RICO statues for "billing correctly", as you so comically put it. For everyone else reading this - In most states, chiros can't own medical practices, so what they typically do is hire IMGs under whom they bill, and then take the vast majority of the profits out of the corporation as a "management fee". This scheme has been tested in the courts, and a number of high profile chiros have gone to jail as a result. PMRMD2B, you should be glad you were under the radar in your small town, and got out when you did.
You are right.. MMI is MAINLY used for WC, but not exclusively. I used this one.. to show that I only treat until they are as good as I could get them, two.. because I did impairment ratings, so it was common for me to use this term.
I didn't bill for my services under the MD, what I was saying was it was easier to get paid under them.. meaning under their number for their services. In my state, it is perfectly legal for a chiro to employ a MD, in fact, a nurse could.. anyone could .. Must hurt some people's pride to know their equal counterpart worked for a lowly chiro. I never had to be under a radar, I had good attornies that made sure I did everything legal. Second of all.. they would not get charged under RICO.. thye would get charged under STARK laws. For every insult you give to the business of chiro.. there are 100 MDs that have done way worse. There are more MDs in some states than chiros in the entire country. BUt.. yeah.. CHIROS are wrecking the system.. look at yourself pal.
By your numbers you were pulling down 700k per year. You have not spoken about anything OTHER than money this entire thread, but you are going into medicine to be altruistic, and serve the greater good? Apparently you can take the snake oil salesman out of the field of chiropractic, but at the end of the day, you remain a snake oil salesman. You are clearly in it for the money, and no amount of impressive retorts like "you are ******ed" or "that is the dumbest thing I have ever heard said" changes that fact.
If I were talk about ALL Of my income, I would include other businesses that my wife and I owned as well. I ONLY spoke of income I personally made as a chiropractor, not other ventures. The money made from the chiro office was very little compared to my wife's income and our other businesses. Her grandfather started what is now a fortune 500 company. You probably use the company's products on a daily basis and don't know it. Like I said, we are very blessed and I don't have to be in the "business" of medicine anymore. I can do it because I love it and want to help people. Are you willing to do it for free? Give me a year in a free clinic and I will pay off your student loan debt..
I don't need to be a business man, been there, done that. You can bash chiro all you want.. I don't care.. I am going to be a PMR physician.. right beside you.. then you will have to talk down to me about the way my hair looks or my shoes. Medicine has bad in it as well.. chiropractic came along around the same time MDs where still bleeding people to make them better.. and giving them mercury. This isn't a pissing contest.. you can talk about chiro all you want.. it doesn't bother me.. I am not one anymore. I think your feelings are hurt because I made more money than you.. and I wasn't a "real" doctor. Get over yourself.
But don't take my word for it:
Chiropractic: A Critical Evaluation
J Pain Symptom Manage. 2008 Feb 13 [Epub ahead of print]
Ernst E.
Chiropractic was defined by D.D. Palmer as "a science of healing without drugs". About 60,000 chiropractors currently practice in North America, and, worldwide, billions are spent each year for their services. This article attempts to critically evaluate chiropractic. The specific topics include the history of chiropractic; the internal conflicts within the profession; the concepts of chiropractic, particularly those of subluxation and spinal manipulation; chiropractic practice and research; and the efficacy, safety, and cost of chiropractic.
A narrative review of selected articles from the published chiropractic literature was performed. For the assessment of efficacy, safety, and cost, the evaluation relied on previously published systematic reviews.
Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today. Currently, there are two types of chiropractors: those religiously adhering to the gospel of its founding fathers and those open to change. T
he core concepts of chiropractic, subluxation, and spinal manipulation, are not based on sound science. Back and neck pain are the domains of chiropractic but many chiropractors treat conditions other than musculoskeletal problems.
Chiropractic spinal manipulation has not been shown to be effective for any medical condition. Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence.
Its cost-effectiveness has not been demonstrated beyond reasonable doubt. The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt.
