Millionaire Family Practicioners

[LateBl00meR]

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I just wanted to share with everyone that I shadowed a family practice today where 5 D.O.'s each made around $500K+ a year. It seems like everyone wants to specialize nowdays yet a general practicioner has the most flexibility to become an entrepreneur by having multiple procedures and additional testing. Next year they are also adding laser hair removal and botox both of which can be administered by the nurses on staff.

Just a message to those money savvy pre-meds who are scared of D.O. and/or family practice.

 

[CardioPlus]

reallyyy, exactly what procedures were they doing?

 

[dozitgetchahi]

reallyyy, exactly what procedures were they doing?

A lot of times GPs make some extra money by having an x-ray or CT scanner on site.

 

[BabyKangaroo]

First of all, a general, or more aptly named in the States, "Medical" practitioner is someone who goes through four years of medical school, but is licensed to practice in the U.S. without going through any kind of residency. They only are required to go through a one-year internship. I am pretty sure those have been pretty much phased out, leaving the older folks left. A general/medical practitioner is NOT a family medicine/pediatric/internal medicine doctor. Secondly, that information seems to be very misleading. Here on SDN, people usually make it a habit to provide some sort of evidence and/or reason to their posts, especially if it involves statistics such as yours. For instance, it would be interesting to know what state they work in, what services they provide, how many patients they have etc. and if they are truly providing good care to their patients and not disregarding them for a few extra bucks.

 

[JaggerPlate]

I just wanted to share with everyone that I shadowed a family practice today where 5 D.O.'s each made around $500K+ a year. It seems like everyone wants to specialize nowdays yet a general practicioner has the most flexibility to become an entrepreneur by having multiple procedures and additional testing. Next year they are also adding laser hair removal and botox both of which can be administered by the nurses on staff.

Just a message to those money savvy pre-meds who are scared of D.O. and/or family practice.

Going DO means same $ as MD. You specialty determines that, not your degree. With that said ... there are always ways to make money and practice smart, but as far as FP guys make 500k a year, I'd say your buddies are the exception that make the rule. Most FP guys do as many high paying procedures as they can, but it can only go so far, and it seems like there is a specific doc for any type of procedure you can dream up ... and they'll take this from the FP (ie derm, obgyn, plastics etc). Also, as far as the botox and laser ... unless they are rural, it won't help a lot. People will go to the derms and PRS guys, and it takes more than buying botox and a laser to properly execute cosmetic procedures.

 

[slick27]

I always kind of worry when I hear some doctors making that much money. To me when I hear this, I assume they are providing to many procedures to their patients that are not necessary. Therefore, padding their wallet and forgeting about the patient's needs. But, I could be worng. Just my thought about it.

 

[JaggerPlate]

I always kind of worry when I hear some doctors making that much money. To me when I hear this, I assume they are providing to many procedures to their patients that are not necessary. Therefore, padding their wallet and forgeting about the patient's needs. But, I could be worng. Just my thought about it.

That's making a huge assumption. Being paid well (which you better believe doctors deserve) and providing quality care are not mutually exclusive.

 

[dozitgetchahi]

That's making a huge assumption. Being paid well (which you better believe doctors deserve) and providing quality care are not mutually exclusive.

Yeah it's an interesting duality...i.e. would you rather choose the doc driving a Jag because he's getting paid well ergo he knows what he's doing, or would you rather choose the doc driving a Civic because he's more humble and less ostentatious?

BTW I'm doing some research on physician compensation for my senior thesis, which is on the topic of health care cost containment. Several well-regarded studies have indicated that when docs have their own private sets of medical equipment they tend to order more tests and procedures than docs that don't...and many of these additional orders occur in borderline or questionable situations.

 

[MossPoh]

Well yea, you have to pay that machine off somehow. Maximizing the ROI.

 

[pado13]

These figures are true if a family doc is willing to move outside the big city. I am a pa in fam med now, I work in a midwest town of 30k people, and my supervising physician said he does not know a family doc in town who makes less than 250k. He said salaries range from 250-500k+. This all depends how much someone wants to work. I know my supervising docs make 300k and 500k respectively.

I am matriculating to med school this fall and know that I am not willing to put in the type of time required to make that kind of money, but it is possible if money is your ultimate goal.

 

[LateBl00meR]

Hey everyone, yes they have X-ray and CT scanners, etc. and train residents and med students from a couple of different schools. They've pretty much tried to make it so patients will not have to go anywhere else unless it is to see a certain specialist. They also have specialists (i.e. urologists) come to them once a month. As for geographics, its in a rural area and combined they see about 30,000 patients a year. The doc I shadowed though still seemed to know everyone by name.

 

[JaggerPlate]

Yeah it's an interesting duality...i.e. would you rather choose the doc driving a Jag because he's getting paid well ergo he knows what he's doing, or would you rather choose the doc driving a Civic because he's more humble and less ostentatious?

BTW I'm doing some research on physician compensation for my senior thesis, which is on the topic of health care cost containment. Several well-regarded studies have indicated that when docs have their own private sets of medical equipment they tend to order more tests and procedures than docs that don't...and many of these additional orders occur in borderline or questionable situations.

The Jag. Jag = happy doctor, = thriving practice, = me not crammed into some dump with 90 other people and their crying babies in a waiting room, only to see a doc 45 minutes later for 100 seconds. My PCP drove a beautiful 911 Turbo when I was a youngling ...


Maybe that's just me though.

 

[JaggerPlate]

Hey everyone, yes they have X-ray and CT scanners, etc. and train residents and med students from a couple of different schools. They've pretty much tried to make it so patients will not have to go anywhere else unless it is to see a certain specialist. They also have specialists (i.e. urologists) come to them once a month. As for geographics, its in a rural area and combined they see about 30,000 patients a year. The doc I shadowed though still seemed to know everyone by name.

Yup. Rural + smart biz. This model wouldn't survive in a city. Good for them though.

 

[High Rolla]

I am from Canada and the family doctor I shadowed for DO school makes 120k after overhead (very high) and sees around 4-5 patients per hour, working 9-7. He does not have any special equipment like Xrays and CT scanners and is strictly outpatient. His practice is located in downtown Toronto, a city of 3 million plus people and he's been practicing there for roughly 10 years.

 

[punkiedad]

The doc I shadowed gave me a printout from a magazine called something like medical finance or something. It showed the different ranges for each specialty, including family practice. His purpose was to show me that GPs can make in the 500k range. Although I wasn't really focused on this, it was interesting.

From what I gather, it is not just about the procedures you can do, but that is 'low hanging fruit', it is about how good you are at coding......from what I hear itis all about the coding to get the insureance companies to reimburse.

BTW, in addition to coding, many of the DOs don't routinely practice OMM, and therefore leave $$ on the table........

Either way, he said he was running a practice in the 95% of the earning range. We live in a metro area of 300K people with a city population of 100k people with a lot of docs to chose from. Don't know how many patients he sees, but I do know he does blood draws but does not have any lab or diagnostics on site, but is considering it.

 

[JaggerPlate]

The doc I shadowed gave me a printout from a magazine called something like medical finance or something. It showed the different ranges for each specialty, including family practice. His purpose was to show me that GPs can make in the 500k range. Although I wasn't really focused on this, it was interesting.

From what I gather, it is not just about the procedures you can do, but that is 'low hanging fruit', it is about how good you are at coding......from what I hear itis all about the coding to get the insureance companies to reimburse.

BTW, in addition to coding, many of the DOs don't routinely practice OMM, and therefore leave $$ on the table........

Either way, he said he was running a practice in the 95% of the earning range. We live in a metro area of 300K people with a city population of 100k people with a lot of docs to chose from. Don't know how many patients he sees, but I do know he does blood draws but does not have any lab or diagnostics on site, but is considering it.

OMM is bank in my opinion. Here's the thing about it ... it's basically no risk. A DO I shadowed was telling me that he had a buddy at Western who did a fellowship in it during school (you stay an extra year) and that this guy did met a doc who was FP but started doing OMM in the LA area. Long story short, the guy had a big list of celeb clients, charges hundreds an hour - all cash - etc, and the fellow from Western practices with him now. However, the key to making $ in medicine, is keeping that god damn overhead low. The genius of OMM ... any DO with enough effort should be versed in it ... is that it takes a table to do correctly. No expensive lasers, or botox seminars, or anything like that ... just a table. Even if you aren't rolling in the patients ... what do you have to loose??

Also, I've heard the same thing about billing. Most docs could make 20% or so more if they were really on top of billing correctly (just floating around SDN, I can't source this).

 

[Chocolate Bear]

many of the DOs don't routinely practice OMM, and therefore leave $$ on the table........

 

[brucecanbeatyou]

OMM is bank in my opinion. Here's the thing about it ... it's basically no risk. A DO I shadowed was telling me that he had a buddy at Western who did a fellowship in it during school (you stay an extra year) and that this guy did met a doc who was FP but started doing OMM in the LA area. Long story short, the guy had a big list of celeb clients, charges hundreds an hour - all cash - etc, and the fellow from Western practices with him now. However, the key to making $ in medicine, is keeping that god damn overhead low. The genius of OMM ... any DO with enough effort should be versed in it ... is that it takes a table to do correctly. No expensive lasers, or botox seminars, or anything like that ... just a table. Even if you aren't rolling in the patients ... what do you have to loose??

Word. Here's your snaps 'n cracks, give me the cash! Seriously, I'm way excited about this.

 

[JenHeart]

We have a family friend who has a cash only clinic. He is making about $500k a year. He let's the patients deal with the insurance companies to collect.. he gets the cash up front. Seems to be working out for him.

 

[JaggerPlate]

We have a family friend who has a cash only clinic. He is making about $500k a year. He let's the patients deal with the insurance companies to collect.. he gets the cash up front. Seems to be working out for him.

Nice.

 

[DrYoda]

BTW, in addition to coding, many of the DOs don't routinely practice OMM, and therefore leave $$ on the table........

OMM is bank in my opinion.

Joking or serious biznus? (sorry I know nothing about OMM).

Also, I've heard the same thing about billing. Most docs could make 20% or so more if they were really on top of billing correctly (just floating around SDN, I can't source this).

Can't give a percentage, but I've been told by a good source that poor billing causes many physicians to lose out on "lots".

 

[jazzgurl7]

I worked in a doctor's office for quite a while and managed to find him $80,000 that he was owed in past billing that was never checked in on from claims that were denied for careless errors on the biller's behalf.

 

[TexasTriathlete]

I am from Canada and the family doctor I shadowed for DO school makes 120k after overhead (very high) and sees around 4-5 patients per hour, working 9-7. He does not have any special equipment like Xrays and CT scanners and is strictly outpatient. His practice is located in downtown Toronto, a city of 3 million plus people and he's been practicing there for roughly 10 years.

There is a reason why we have tons of Canadian transplants working in the ER where I used to work. In Texas, which is nowhere near Canada, last time I looked at a map.

 

[scpod]

Yup. Rural + smart biz. This model wouldn't survive in a city. Good for them though.

But, don't make it sound like you have to be in the middle of nowhere to do this. I know a couple of docs who have this type of practice 25 miles from Orlando. Yes, the little towns are small, but they are very near a pretty good sized city with anything you want. Smart doctors find ways to pay the bills because, like I've said before, medicine is a business.

 

[JaggerPlate]

But, don't make it sound like you have to be in the middle of nowhere to do this. I know a couple of docs who have this type of practice 25 miles from Orlando. Yes, the little towns are small, but they are very near a pretty good sized city with anything you want. Smart doctors find ways to pay the bills because, like I've said before, medicine is a business.

A good FP office in a big city with smart billing and a thriving practice ... no doubt. An FP who is going to make millions doing laser procedures and botox in cosmetic doc saturated Fl ... nope, seriously won't happen.

 

[punkiedad]

OMM is bank in my opinion. Here's the thing about it ... it's basically no risk. A DO I shadowed was telling me that he had a buddy at Western who did a fellowship in it during school (you stay an extra year) and that this guy did met a doc who was FP but started doing OMM in the LA area. Long story short, the guy had a big list of celeb clients, charges hundreds an hour - all cash - etc, and the fellow from Western practices with him now. However, the key to making $ in medicine, is keeping that god damn overhead low. The genius of OMM ... any DO with enough effort should be versed in it ... is that it takes a table to do correctly. No expensive lasers, or botox seminars, or anything like that ... just a table. Even if you aren't rolling in the patients ... what do you have to loose??

Also, I've heard the same thing about billing. Most docs could make 20% or so more if they were really on top of billing correctly (just floating around SDN, I can't source this).

good call on your reply....I forot to mention the same DO I shadowed also versed me in the overhead piece. There is a great model that dictates the overhead piece.

They say to do everything in twos Meaning, you can have two docs in the practice, but when you add the third, you have to upsize support headcount disproportionately to the size of the practice and thus adds negative marginal dollars. So, the correct number to have in a practice is either 2, 4, etc..... Don't know if this is exactly true, but as my friend says "If there is an angle, I'll find it."

BTW, he says there are plenty of classes and seminars for this type of stuff....

 

[binko]

The genius of OMM ... any DO with enough effort should be versed in it ... is that it takes a table to do correctly. No expensive lasers, or botox seminars, or anything like that ... just a table. Even if you aren't rolling in the patients ... what do you have to loose??

When IKEA comes out with an OMM table, I'll be really excited about this.

 

[JaggerPlate]

When IKEA comes out with an OMM table, I'll be really excited about this.

Hahaha ... I wouldn't let my dog lay on something made by IKEA, let alone a patient. That **** is cheap.

 

[JaggerPlate]

Joking or serious biznus? (sorry I know nothing about OMM).

Serious. It's one of those great health secrets that spreads quickly, very low saturation of market, hundreds per hour in cash, etc. I'm not saying it's a get rich quick scheme ... I've just seen/heard of numerous cases where docs doing OMM cash based practices make what the high paid specialists make. Another thing too is that I'm sure it may take a while to build a good practice, but if you're doing it on the side with your practice ... it's not going to affect you. Eventually you could switch over (the doc I knew of did this).

 

[scpod]

A good FP office in a big city with smart billing and a thriving practice ... no doubt. An FP who is going to make millions doing laser procedures and botox in cosmetic doc saturated Fl ... nope, seriously won't happen.

Just so you know, at a major resort hotel in Orlando once a month is a weekend-long course on laser hair and lesion removal that's very well attended. The same people presented at the ACOFP convenion teo years ago. The then president of the AOA, who is an FP, had it done on him during the student/resident luncheon. ACOFP is encouraging FPs to begn dong procedures like this to make more money. The machines are beng leased or bought outright every month. FL is not yet saturated with it. One of the docs I rotated with in famly practice does more procedures in his office than anyone I've ever seen and he just sent his NP to school for laser/botox. There's stll a lot of bucks to be made becasue the "saturation" s only in the big cites-- not in the outlying areas. And since no pont in Florida is more than 65 miles from the ocean, people want to look good. I know; I live here.

 

[JaggerPlate]

Just so you know, at a major resort hotel in Orlando once a month is a weekend-long course on laser hair and lesion removal that's very well attended. The same people presented at the ACOFP convenion teo years ago. The then president of the AOA, who is an FP, had it done on him during the student/resident luncheon. ACOFP is encouraging FPs to begn dong procedures like this to make more money. The machines are beng leased or bought outright every month. FL is not yet saturated with it. One of the docs I rotated with in famly practice does more procedures in his office than anyone I've ever seen and he just sent his NP to school for laser/botox. There's stll a lot of bucks to be made becasue the "saturation" s only in the big cites-- not in the outlying areas. And since no pont in Florida is more than 65 miles from the ocean, people want to look good. I know; I live here.

I'm not trying to argue with you here, but go to the derm and PRS boards if you want professional opinions. They all agree that the weekend courses are BS, and using lasers and fillers without proper training is dangerous. I heard one story where a derm had a patient come in with damage from a laser bc the FP doing work on her turned it up way too high instead of doing multiple sessions. I wouldn't be surprised of a board certified derm guy just isn't doing the stuff in the area you are in. I also think it's stupid that FP governing bodies are encouraging FPs to do botox and laser procedures. This isn't what they went into residency for, and is not something that can be learned in a 4 hour seminar at the holiday inn conference room. Why not start doing dentistry out of the office too after going to a few dent school lectures?? That makes money. Smart people will always seek out the best care, which means cosmetic procedures from derm/PRS. Too much risk as an FP, and it's sad they need to resort to that to make money.

 

[MossPoh]

A lot of the stuff isn't ridiculously hard. Just like everything in life, you have to know you're limits. A dermatologist may cite a situation where a family practice doc messed it up, but I can guarantee that there have been derms and PRS people that have screwed up procedures too. Know your limits and send them to someone else if it is outside of your ability. Many of the dermatologists also have reasons to be defensive and complain since they lose out on money by others learning procedures. Even OMM can be dangerous if done wrong, yet there are people that go to seminars for that. People start doing new procedures and techniques after weekend or week long seminars all the time in multiple specialities. This isn't limited to one area.

 

[JaggerPlate]

A lot of the stuff isn't ridiculously hard. Just like everything in life, you have to know you're limits. A dermatologist may cite a situation where a family practice doc messed it up, but I can guarantee that there have been derms and PRS people that have screwed up procedures too.

Agreed. A lot of the derms admit their residency didn't cover a lot of the cosmetic stuff. Everyone screws up ... but if I were to get anything done, you'd bet I'd go to a board certified derm/PRS, and most people who do research do the same.

Also, about it not being hard ... maybe not technically hard to do, but it's all very easy to do with ****ty results. Go look at people doing hair transplants without experience, laser procedures not knowing what they are doing etc. Can these docs easily figure out how to do these ... yes, it's not neurosurgery. Is there a huge gradient in quality, yes. Doing something =/= doing something well.

Know your limits and send them to someone else if it is outside of your ability.

Good advice, but few FPs who are doing these procedures are likely to turn down cash because they feel like it's 'outside their limits.' This is where the problems come in ... $.

Many of the dermatologists also have reasons to be defensive and complain since they lose out on money by others learning procedures. Even OMM can be dangerous if done wrong, yet there are people that go to seminars for that. People start doing new procedures and techniques after weekend or week long seminars all the time in multiple specialities. This isn't limited to one area.

Everyone who legitamately goes through PRS or derm has something to complain about. Everyone who wanted to take the easy road or didn't have derm stats, or hell, didn't even go to med school, is stealing from these guys. Luckily, most of them know that these clowns screw up, and it creates good word of mouth and a steady stream of repair for their practices. One PRS doc on the boards says he gets a lot of business from some unqualified doc down the road who does the '15 minute' injectable nosejobs. Any FP who wants to do this too better make sure they can get a good stream of patients - and as I said ... I doubt it - because those lasers cost about 100k and need to be replaced, their malpractice is going to go way the hell up, and they are going to start dealing with PRS/derm lawsuits without the PRS/derm money.

If you want to do cosmetics ... do derm, ENT -> FP, or PRS. Or even g-surg + a cosmetic fellowship. Don't go into FP only to get sick of all the BS and make yourself a wanna be cosmetic surgeon. The world has enough of these guys and not enough FPs.

 

[scpod]

....Don't go into FP only to get sick of all the BS and make yourself a wanna be cosmetic surgeon. The world has enough of these guys and not enough FPs.

It's not just cosmetics. No specialist wants an FP doing anything except a history and physical because everything else they do takes money out of a specialists pocket. BUT, things like removing skin tags or growths really don't require a surgeon. I can't tell you how many skin growths we cut off during surgery rotations that could have easily come off in the office without the insurance company paying for a surgeon, a scrub nurse, a circulating nurse, and anesthesiologist and OR time to boot. Yet, we sat aside Friday mornings to do those things on one of my surgery rotations because FPs referred them. Then again, on my last rotation I was the one who cut or froze every skin lesion off, sutured them up, and sent the specimens to the lab-- in the office!

In another example, colonoscopies were done by FPs and surgeons long before they ever came up with GI specialists. Do you really think you need three years of an IM residency and 3 years of GI fellowship just to do colonoscopies? Do you really need a cardiologist to do ekg's and stress tests? No. You can do them in the office too. It all depends on your training and your comfort level.

Then there's another side of it. Patients love continuity of care and they love to go to one place and have it all done. They have a tendency to cancel referal appointments, but if you can have an echo tech come in one day a week at your office, they'll be glad to get that ultrasound done.

You also haven't seen what a hassle it is to get information from some of these specialists too. Time and tme again you send a patient to see someone and ask them to follow up with you afterwards. When they show up you can never find the labs, the imaging or even notes from the specialists. And, inevitably, the patients have no idea what the specialist told them. They are waiting for you to talk to them about it. As an FP, you will refer patients out from time to time, but you have to remember that ultimately YOU are their doctor. And remember, too, that you don't get paid for all the time it takes to track down this stuff, read it, and interpret it for your patients. The one who gets all the money in this is the specialist. You CAN have a consultation visit, but those usually end up with you gong over multiple other problems anyway.

So, the bottom line is... you follow the patient, diagnose a problem, refer them to the specialist for confirmation, spend time tracking down the info, explain the finding to the patient, and sit back and watch while the specialist makes more money off of the patient in one visit than you did in a whole year off of them. Who can really blame the FP who then tries to go out and make a little more money by doing a few procedures in his or her office?

 

[JaggerPlate]

Who can really blame the FP who then tries to go out and make a little more money by doing a few procedures in his or her office?

Not me. I'm 100000% for getting money and respect back into FP. However, I don't think it will happen, because as you said ... there is a specialist for everything now. My point though is that in this thrust to get some of that money back, there are other things the FP can do (like those you mentioned) to get some of that money back. AND, more importantly, this need for more income also creates a dangerous mindset where you will do things for money that you maybe shouldn't be doing, like laser stuff with only a weekend course. I just don't think anyone should go into FP with the intent of doing cosmetic stuff because a. I personally don't think it will pan out due to saturation, people seeing derm/prs guys for it, and the overhead/lawsuit risk b. You should go into FP knowing what the field is right now because you want to do primary care and really start to fight for better PC rights all around.