It certainly is possible, in private practice. After 1-3 years as an employee/associate you are generally allowed to buy into partnership (can have practice buy ins, joint venture (dialysis unit) buy ins, some combo of those, or no buy in). Majority of partners I know make well over 300k. In academics, if full time clinical more likely mid 200s after a few years, but tradeoff is lifestyle is generally much better.
In practice you make money seeing patients per standard E&M billing but have the capability to expand income by obtaining a medical directorship of a dialysis unit, these generally are close, even over six figures yearly. It has responsibility, but the additional income is generous. As practice grows, dialysis patients grow, and this reimburses better than time in clinic. In some cases your group may not only have medical directorship of units, but joint venture with dialysis corporations, meaning they generally take a minority shareholder position, allowing them to generate passive income if the unit is profitable (also exposes to risk on the downside as any company, but generally multiple units generate significant income).
So yes, a well run private practice can generate very high incomes. It is unfortunate starting incomes are low because this is what most residents see and hear, not what partners are making just a few years later.
