money and FM

[cfdavid]

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So, I realize that averages in FM are low, compared to other specialties. Granted the 3 year residency is a nice advantage given opportunity cost of more lengthy specialties. But, that aside, I've always thought that FM COULD offer the ability to earn a pretty darn good living (I know there will be the barage of posters suggesting $150k is darn good. But, I'm talking much more than that).

While other specialties may make more, they're also more directly effected by changes in Medicare reimbursement. While FM is not immune to this, it seems there are a NUMEROUS avenues for an FM doc to AUGMENT his/her income with other services.

These services could include in-office bone scanning, colposcopy's, minor surgical procedures such as mole removal, joint injections, and then there is the whole realm of male hormone replacement therapy, non-surgical cosmetic procedures (growing in number), and even non-surgical/invasive hemorrhoid treatment?

Now, in my experience, the average FM doc does NOT do these things. But, do you really need to be a derm to do laser hair removal, or varicose vein injections? How about non-surgical methods of cellulite reduction?

How about putting together a partnership for an urgent care center?

So, of course the average reimbursement will be less in FM. But, for the entrepreneur, it seems there are a TON of options that can augment/supplement any given FM practice, while practicing responsible medicine, and not violating one's scope of capabilities.

Additionally, this doesn't mean that you need to make these supplemental services the majority of your practice. Perhaps this is just the Friday routine. Maybe it's 2 days per week, if you're willing to work 6 days.

I'm sure this has been discussed, but I'd be interested in hearing what your thoughts on this matter may be.

cf

Granted, this would all require a very organized practice

 

[billydoc]

CF, I'm not FP doc, and I can't tell you for sure. But things like colonoscopies as an FP (?) Even in a rural area there are some GI specialists. Will you invest in that equipment? What about the pathology? Who is going to interprit Your findings, and F/U with the pt? What about anesthesiology there, crush equipment etc. I you don't do it every day I think the cost of this equipment will kill Your practice. What about liability, if You find something....or G-D forbid miss something? Derm....along those line as well. Though I know as an FP minor derm stuff is done routinely. I guess You need to ask yourself would You go to an FP for all of those things You've mentioned, or You would rather go to a specialist, even if it means a longer wait, substantial driving time etc? There is Your answer. Also, I wonder how does insurance reimburse FP for a colonoscopy? Or for the derm stuf? I'm in no way saying that FP can't do those things. But in terms of getting enough of a pt base I think it's an uphill battle.

 

[cfdavid]

CF, I'm not FP doc, and I can't tell you for sure. But things like colonoscopies as an FP (?) Even in a rural area there are some GI specialists. Will you invest in that equipment? What about the pathology? Who is going to interprit Your findings, and F/U with the pt? What about anesthesiology there, crush equipment etc. I you don't do it every day I think the cost of this equipment will kill Your practice. What about liability, if You find something....or G-D forbid miss something? Derm....along those line as well. Though I know as an FP minor derm stuff is done routinely. I guess You need to ask yourself would You go to an FP for all of those things You've mentioned, or You would rather go to a specialist, even if it means a longer wait, substantial driving time etc? There is Your answer. Also, I wonder how does insurance reimburse FP for a colonoscopy? Or for the derm stuf? I'm in no way saying that FP can't do those things. But in terms of getting enough of a pt base I think it's an uphill battle.

A colposcopy is an inner vaginal assessment commonly done by FM.

http://familydoctor.org/online/famdocen/home/women/reproductive/gynecologic/082.html
As for the cosmetic stuff, I disagree. With the proper marketing (brochures or a running video in the waiting room), you have a captive audience for elective, non-surgical, procedures. I imagine getting asked about said services during a routine exam, or some other chief complaint. Like, "oh, I didn't know you guys did XYZ". "Yep, we do it right here in the office and can schedule you in for Friday."

 

[EdibleEgg]

Lots of FP's are doing colonoscopy. I don't know of any that do enough to have an outpatient endoscopy suite, but I know of several that do them in the hospital. You don't need an anesthesiologist. The biggest issue is hospital credentialing, and that is regional.

 

[billydoc]

A colposcopy is an inner vaginal assessment commonly done by FM.

http://familydoctor.org/online/famdocen/home/women/reproductive/gynecologic/082.html
As for the cosmetic stuff, I disagree. With the proper marketing (brochures or a running video in the waiting room), you have a captive audience for elective, non-surgical, procedures. I imagine getting asked about said services during a routine exam, or some other chief complaint. Like, "oh, I didn't know you guys did XYZ". "Yep, we do it right here in the office and can schedule you in for Friday."

O.K my bad. I misread "colposcopy". Thank You for enlightening me on what it is...lol . BTW I've heard of FP doing colonoscopies as well. I was just curious of the practical aspect. Again, from what I understand GYN are considered to be a primary care providers for woomen's health, and usually don't need a referral even with most crappy HMO plans. But I live in NY. I just can't immagine FP doing all these things here or in any big city. I do know some FPs here do some minor cosmetic stuff, integrative medicine etc. But the competition is stiff. BTW, many of these things are not regulated, not covered by the insurance, and are not exclussive to the scope of practice. Chiropractors, NPs even beauty parlors want a piece of this action. I'm not saying it can't be done. But it's a tough sell, esp in today's economy.
Anyway, best of luck to You 😀

 

[Abducens]

O.K my bad. I misread "colposcopy". Thank You for enlightening me on what it is...lol . BTW I've heard of FP doing colonoscopies as well. I was just curious of the practical aspect. Again, from what I understand GYN are considered to be a primary care providers for woomen's health, and usually don't need a referral even with most crappy HMO plans. But I live in NY. I just can't immagine FP doing all these things here or in any big city. I do know some FPs here do some minor cosmetic stuff, integrative medicine etc. But the competition is stiff. BTW, many of these things are not regulated, not covered by the insurance, and are not exclussive to the scope of practice. Chiropractors, NPs even beauty parlors want a piece of this action. I'm not saying it can't be done. But it's a tough sell, esp in today's economy.
Anyway, best of luck to You 😀

My brother is a family doc in the southeast. He has his own clinic with one NP. Works about 4-5 shifts per month in the ED and also performs about 5-6 colonoscopies per month. So yeah, a FP can easily do colonoscopies, etc if there is a need in the area. The closest GI doc is about 30-40 miles, and many people refuse to make that drive if they can get it done in there home town. Of course all path gets sent out and if they have GI CA then they are referred out, but he takes care of the initial screening. Another FP in the area performs colposcopy and cardiac stress testing.

 

[cfdavid]

Guys, my main point is that FPs have a captive audience. They're in the perfect position to offer extended services (again, not overstepping one's training) to their traditional care.

When laproscopy came out, surgeons took courses to familiarize themselves with this newer technology. When cardiologists began doing interventions, there were no fellowships. In addition, device manufactureres would (and still do) offer training/certification of their own.

So, there's NO reason that FM should shy away from new, non-surgical, technologies that are constantly being developed. Some of these "generalists" are doing completely non-surgical cosmetic procedures, while others are doing these as a means of augmenting their income.

The life of an FM need NOT be limited to a $150k salary (and if you check out Merrit Hawkens, one of the leading physician recruiting firms, you'll see that compensation is moving well beyond that these days).

Here are a few examples of what people are willing to pay for. These are just examples, as I've not investigated safety or efficacy, as any responsible physician would do prior to embracing any technology. But, suffice it to say, you don't need to be a dermatologist to "treat" these conditions (because they're not diseases....)

http://www.fraxel.com/

http://www.ultroid.com/shop/pages.php?pageid=1

http://www.velashape.com/started/starting-velashape#TO

http://www.mesotherapy.com/

http://www.alluremedicalspa.com/varicose-spider-veins.aspx

The list goes on. And you don't need to be a plastic surgeon or dermatologist to do this stuff. It's overkill, although I know those specialties are also doing these procedures.

What I'm saying is that if you're a competent FM or IM, you can offer these procedures to significantly increase the profitibility of your practice. And FM/IM (outpatient) is in the best position to capitalize on this since they have the long standing relationships with their patients, and a captive audience as their patients sit in the waiting room watching company promotional videos (on the procedures) or reading a pamphlet that you have laid out. Kind of like "Did you know Dr. X also provides non-invasive, in-office, procedures for hemorrhoid treatment". OR, "At Family Medicine XYZ, we offer the convenience of having non-surgical cosmetic procedures performed right here in our office, under the care of Dr. XYZ".

Again, this doesn't have to become 100% of one's practice, but it could be 1 or 2 days a week, where you book patients for said procedures. The other days, you see patients in the traditional way. Maybe one of the partners in your practice is designated the procedure dude/dudette. The device companies offer the training, he/she is gone for a few days now and then (or the device reps do in-office training for some of the simpler stuff), and that's what they do to augment practice income.

To some, this won't be what you want to do. For others that are smart, this can be a goldmine, and you can still do the traditional stuff.

As an aside, I was recently watching CNBC and they interviewed a CEO of some "pharma" company. But, they were geared towards the pharmacology of "anti-aging", using research and RCT's to attempt to bring these products to market. The point was that demand is insatiable for such things. And FM docs are in a great position to embrace these technologies and innovations.

 

[Frijolero]

CF, I'm not FP doc, and I can't tell you for sure. But things like colonoscopies as an FP (?) Even in a rural area there are some GI specialists. Will you invest in that equipment? What about the pathology? Who is going to interprit Your findings, and F/U with the pt? What about anesthesiology there, crush equipment etc. I you don't do it every day I think the cost of this equipment will kill Your practice. What about liability, if You find something....or G-D forbid miss something? Derm....along those line as well. Though I know as an FP minor derm stuff is done routinely. I guess You need to ask yourself would You go to an FP for all of those things You've mentioned, or You would rather go to a specialist, even if it means a longer wait, substantial driving time etc? There is Your answer. Also, I wonder how does insurance reimburse FP for a colonoscopy? Or for the derm stuf? I'm in no way saying that FP can't do those things. But in terms of getting enough of a pt base I think it's an uphill battle.

As others have mentioned, many FPs do colonoscopies. No GI doc is an island, either; They have to rely on path to interpret specimens and occasionally GS to do something about them just like an FP does. As far as derm goes, obviously FPs aren't going to be doing complex flaps and mohs but are able to do most of the other stuff.

Who would I rather see for my derm/other minor procedure needs? Well, that's entirely dependent on the doc. I've seen a dexterous FP throw down some minor surgical work that was as good as if not better than the some of the dermatologists/plastics docs work. A lot of that stuff is so operator dependent that it really depends on who's behind the wheel. I'd much rather go to an FP who was really into minor surgeries than a dermatologist who wasn't.

OP, you're right, FPs have the potential to take things far beyond the traditional. That potential is part of why I chose the field. What you might find is that when you're actually in practice you're too busy taking care of real issues to try to pad your paycheck with cosmetic fluff (cellulite, laser hair, etc). One dermatologist I worked with sold his laser that he made bank from because using it meant he had less time to do things he considered more valuable to his patient population like mohs, flaps, psoriasis, etc. You also might find that the group who might come to you for that sort of thing can be rather difficult to satisfy.

 

[cfdavid]

As others have mentioned, many FPs do colonoscopies. No GI doc is an island, either; They have to rely on path to interpret specimens and occasionally GS to do something about them just like an FP does. As far as derm goes, obviously FPs aren't going to be doing complex flaps and mohs but are able to do most of the other stuff.

Who would I rather see for my derm/other minor procedure needs? Well, that's entirely dependent on the doc. I've seen a dexterous FP throw down some minor surgical work that was as good as if not better than the some of the dermatologists/plastics docs work. A lot of that stuff is so operator dependent that it really depends on who's behind the wheel. I'd much rather go to an FP who was really into minor surgeries than a dermatologist who wasn't.

OP, you're right, FPs have the potential to take things far beyond the traditional. That potential is part of why I chose the field. What you might find is that when you're actually in practice you're too busy taking care of real issues to try to pad your paycheck with cosmetic fluff (cellulite, laser hair, etc). One dermatologist I worked with sold his laser that he made bank from because using it meant he had less time to do things he considered more valuable to his patient population like mohs, flaps, psoriasis, etc. You also might find that the group who might come to you for that sort of thing can be rather difficult to satisfy.

Good point. I hear you on that. Frankly, I wouldn't JUST want to do cosmetic oriented procedures. If fact, maybe it's just a couple procedures that one could focus on, and not offer the full spectrum, which hopefully I've shown is quite large.

 

[Dr McSteamy]

i've seen a few FM's locally that make $$$$
i've seen one in my hometown that does exclusively cosmetics.

you don't have to be a derm. as long as you're good at the side jobs, you'll get good business by word of mouth. fraxel?- everyone's doing laser cosmetics these days. how hard can it be.
with all these MILFs trying to look 10 years younger, you're guaranteed to have customers

 

[cfdavid]

i've seen a few FM's locally that make $$$$
i've seen one in my hometown that does exclusively cosmetics.

you don't have to be a derm. as long as you're good at the side jobs, you'll get good business by word of mouth. fraxel?- everyone's doing laser cosmetics these days. how hard can it be.
with all these MILFs trying to look 10 years younger, you're guaranteed to have customers

Exactly. And the advantage in FM is that your patients are coming to you for long term care etc. It's the perfect venue to offer those additional services. They come in for XYZ ailment, notice the brochure (or in-office video), and then come back in a month for the procedure.

The key is being a competent practitioner, and building relationships with your patients.