Most efficient specialties in medicine

Discussion in 'Medical Students - MD' started by WiseOne, Aug 5, 2018.

  1. WiseOne

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    What specialties do you think spend the most time on activities that are actually billable (% time spent on billable activities)?

    When I think about it, it seems like radiology and EM would be close to the top. And more diagnostic/cognitive specialties would be on the bottom, like neuro.
     
  2. W19

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    EM because they make the most $$$ per hour...
     
  3. FindersFee5

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    Radiology, Derm, EM
     
  4. Rads4lyfe

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  5. Crayola227

    Crayola227 The Oncoming Storm
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    it's fairly easy, it's the more procedural specialties, or the ones that spend less time face to face with patients

    patients = money drain, oddly enough
     
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  6. Dr. Doctor MD

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    Talking to patients = Money drain
    Cutting, poking, sticking scopes in orifices, and injecting patients = Cash cow

    What a funny world we live in
     
  7. CherryRedDracul

    CherryRedDracul The Sunlight Burns
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    Radiology definitely. Do a gig that it's purely diagnostic, and all your efforts are focused on billable work.
     
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  8. Lnsean

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    Don't make yourself a commodity...it will bite back
     
  9. Goro

    Faculty Verified Expert 7+ Year Member

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    OMM
     
  10. QueenJames

    QueenJames Account on Hold
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    Ortho by FAR.

    Knee arthoscopes get more than $600 for a 15 minute procedure.

    Imagine cranking out 4 of those in an hour... that's more than $2000... in ONE HOUR.

    Shoulders reimburse at >$1500.

    LOL

    These guys are BANKING $$$$$$$$$.

    REALLY wish I could go back to undergrad and kick butt and end up at a MD place and gun for ortho if I could do it all over again.

    Maybe in my next life.

    :)
     
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  11. Tenk

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    EM can easily get $250-300/hr+ and the only limit to how much you want to work is your body and your sanity. It is most certainly one of the highest paying specialties so long as you don’t work in the big coast cities or in Hawaii.
     
    #11 Tenk, Aug 6, 2018
    Last edited: Aug 6, 2018
  12. Mad Jack

    Mad Jack Critically Caring
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    There is more to it than that. Room turnover, follow-up, initial patient evaluations, etc etc. Every day isn't mostly OR time. Furthermore there are many ortho procedures that are likely to take serious cuts in the future as studies continue to show their ineffectiveness
     
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  13. W19

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    Are ED jobs in hospitals located in upper-middle-class suburbia as crazy as the ones in big city trauma centers? Why can't ED docs work 50 hrs/wk on these jobs and make a boatload of cash? Where I attended med school, the hospital ED is a small one (probably 22 adults bed and 8 peds), and things weren't as bad as the big trauma center I am working now.
     
  14. irJanus

    irJanus Falling into a burning ring of fire
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    Crazy is relative... But it's a good point
    Number of patients (x acuity) / number of docs at a time
    (To overly simplify it).
    I work in both environments... My community shop is about 55k/yr vs our main site (72k adult/30k peds) and I'm arguably busier at the community site.
     
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  15. Crayola227

    Crayola227 The Oncoming Storm
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    In EM too it makes a difference what you want to be busy with.

    On my community rotation we were busy with emergent URI and constipation. In the inner city there was a lot more trauma.

    People that belong in a PCP office in your ED, vs victims of trauma one after another, can represent different kinds of busy and different drain on the EM soul. At the same time, how well each type of practice was shouldered also seemed to depend on the individual EM provider's temperament.

    Universally it seems that providers don't relish being busy with non-emergencies in their ER, so a "slow" community setting can still leave a lot to be desired and feel more onerous than a "busier" one with a lot of trauma. That truism aside, even the most enthusiastic EM docs that get their "wish" to be busy with real medical emergencies, get drained.

    What I find true is that most EM providers are in a catch 22. They tend to like a fast pace and high acuity that burns most people out right away. They in turn are burnt out by things that are too slow and boring, or essentially low acuity ambulatory medicine, which is not what the practice setting is designed for nor are they really trained for. They are then burnt out over time by the high acuity medicine they find stimulating, because they're human.

    I've known some that did their training and then went to the community for the slower pace. You have to survive the faster pace of training no matter what. That's a special breed of human. Because most people that are content to do what is essentially overglorified PCP'ing under way worse conditions, are usually better suited to some sort of outpt training and practice over going into EM. Not that it doesn't happen.

    I've seen EM docs in your described setting. It seems a little fish out of water for them. They don't seem overworked but it seems like they lack a sense of fulfillment, feeling like what they do matters. Or they do feel overworked because there's a sense that a lot of what they are doing isn't really supposed to be their job if they're busy.

    Did you ever want to take a 30 patient 8 hour clinic day of an FM provider, but instead do it during a community gastroenteritis epidemic, and instead see 50 who are not your patients, you have little history on, over a 12 hour graveyard shift, all of whom likely have limited income and no insurance and no PCP? With higher liability and some high acuity stuff mixed in? Sounds like a dream.

    More patients = more notes even if they're short. The setting being in the ER even if you get a lot of low acuity, the setting alone makes the malpractice liability even for stubbed toes just ridiculous so your medicolegal responsibility is still high, out of proportion with the care actually being rendered at that point. ED notewriting presents a special challenge when it comes to efficiency, saying enough/not too much for proper and necessary CYA.

    Even in well to do surburbia the EM practice demographic skews to those with challenging socioeconomic determinants of health you can't do shyte about, namely the non or underinsured.

    TLDR
    EM is NOT a good way to try to wring money out of a 50 hr work work, even in surburbia, because it will be little of what there is to love about EM and a lot of what there is to hate about outpt medicine.
     
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  16. BigRedBeta

    BigRedBeta Why am I in a handbasket?
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    There are variable definitions of efficiency. Billable time is only one measure - the work you're actually doing matters too, as does what people are willing to pay you for that time.

    As a pediatric intensivist I bill critical care time on the majority of my patients. But the structure of billable time varies significantly based on my patients age as patients under the age of 6 have critical care codes that represent bundled payments.

    For example, I can bill Neonatal Intensive Care Initial Hospital Day (99468) for babies <29 days which is worth 18.46 RVU. Doesn't matter if it's a 34 week preemie who needs a 1/2 LPM of O2 or a 24 weeker that undergoes significant resuscitation in the delivery room, intubation, and umbilical line placement, the neonatologist is going to make the same 18.46 RVUs. Likewise, the subsequent Neonatal Intensive Care days generate 7.99 RVUs and so the baby that gets terribly sick with NEC at day of life #14, may require a ton of time but pays the same as they did the day prior when they were "well". With my older kids, 29 days to 24 months initial critical care bundle is 99471 and worth 15.98, but for ages 2-5 (99475) it's 11.25 RVU for that first day. For kids over 6, they bill the same as adults so it's unbundled and it become 4.5 RVU per hour of critical care time exclusive of procedures.

    My efficiency to generate billing is directly tied to the age of my patient and it makes the most sense for me to admit a bunch of 6 month olds with bronchiolitis who are on high flow nasal cannula, but who ultimately aren't that "sick". I'm not bound to spend a certain amount of time with them and I'll get paid even if I only spend 15 minutes with each one.

    Likewise, in terms of actual income, RVU's are only part of the metric - the types of patients you see matter too, which is why people get uptight about payer mix. Private insurance pays more per RVU, so obviously you want to have a bunch of patients with good insurance because it makes your time more efficient.
     
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  17. cubsrule4e

    cubsrule4e The Company Misery Loves
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    If you want to break it down even further, i can get $650 for a basic cataract surgery (not counting all the upgrade options with laser and premium lenses) in 4-6 minutes, and do 6 in an hour, and operate for 4 hours. That should get ophtho into the qualifying range lol. Im thinking knee scopes would get more than 600 though, no?
     
  18. atomi

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    Urologist can do vasectomy in office for 15 minutes and get paid $1000 cash.
     
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  19. QueenJames

    QueenJames Account on Hold
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    Of course.
    But the ortho attendings I was talking to during surgery are killing it.
    But in terms of right now..?

    Absolutely murdering it.

    Their lifestyle is amazing too.
    my bad doc.

    Totally forgot about the optho homies. Y'all are killing it.

    And tbh the exact figure I was told was ~$700 for the knees.

    Goals. (Won't happen for me in primary care but I can live vicariously through y'all ballers.)
     
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  20. mehc012

    mehc012 Big Damn Hero
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    The only problem is that I would shoot myself after the first hour, and medical bills are $$$, yo.
     
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  21. cubsrule4e

    cubsrule4e The Company Misery Loves
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    Shoot yourself?? Yeah, i guess ophtho aint for everybody
     
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  22. Peach Newport

    Peach Newport board certified in jewish dermatology
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    This

    OMM gets a bad rap but have you seen those billing numbers? They’re Bonkers.
     
  23. Goro

    Faculty Verified Expert 7+ Year Member

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    One can practice anywhere in the world as long as you have an OMM table. Only Psychiatry can say something similar.

    A decent OMM jock can make as much as any dermatologist in the right urban or suburban area.
     
  24. RNthenDoc

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    Efficient?

    Sell something. Be a sellout. Brand some vitamins and supplements and make millions off of the woo crowd.

    If $$$ earned with least effort is the goal, surgery will not be the route!
     
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  25. Osminog

    Osminog Future Doctopus

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    Dr. Rusilko, is that you? ;)
     
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  26. OP
    OP
    WiseOne

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    The definition of efficient is somewhat vague, I don't exactly mean $/hour. Moreso just not spending your time doing BS activities that you shouldn't need to be doing. Radiology is I think a good example of an efficient specialty because there is no real distance between them and their work, and the accomplishment of their work is (for the most part) dependent only on themselves. In IM or many other specialties, you have to check if the nurse carried out your order, get consultants to agree with you on a plan, etc etc basically BS stuff that you would rather not spend your time doing but is something that comes with the specialty.
     

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