Peds salary question?

[jpl291]

I don't understand why pediatric salaries are so low. The pediatrician I did my rotations with never saw less than 40 patients a day when I was there. He said often during the winter 55. This was all while working 38-40 hours a week. So let's say hypothetically:
Some level 2/3
Low end reimbursement 75$ per visit and low end 40 patients per day.
75$ X 40 patients X 5 days X 48 weeks(-4 vacation)
800k a year he had two lpn's employed.. So even u payed 400k in salaries overhead malpractice and billing that leaves 400k. Where is all the money going to make the average salary 180k. It seems to me they should make more money than fam prac because it's difficult to see over 25 patients a day. I kno u throw in some labs and ekgs etc but...not 20 patients worth of billing? I plan on doing emergency medicine I'm Just asking out of curiosity. I was a finance major in undergrad... It just doesn't add up to me.

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[Blarry]

I don't understand why pediatric salaries are so low. The pediatrician I did my rotations with never saw less than 40 patients a day when I was there. He said often during the winter 55. This was all while working 38-40 hours a week. So let's say hypothetically:
Some level 2/3
Low end reimbursement 75$ per visit and low end 40 patients per day.
75$ X 40 patients X 5 days X 48 weeks(-4 vacation)
800k a year he had two lpn's employed. Where is all the money going to make the average salary 180k. It seems to me they should make more money than fam prac because it's difficult to see over 25 patients a day. I kno u throw in some labs and ekgs etc but...not 20 patients worth of billing? I plan on doing emergency medicine I'm Just asking out of curiosity.

I'm not knowledgeable in this but from what i have heard the problem is getting the insurance company to pay you for everyone you see. although i'm sure a lot more than that goes into how the pay is affected.

 

[yamaraja808]

I'm not knowledgeable in this but from what i have heard the problem is getting the insurance company to pay you for everyone you see. although i'm sure a lot more than that goes into how the pay is affected.

I agree with Blarry on this one. It is one of the major reasons why there is a doctor shortage in most rural areas (especially for PCPs).

 

[jpl291]

So an insurance company just refuses to reimburse a provider for a non elective required visit based on accepted pediatric recommendations. I guess they don't care if the kids don't get vaccinated or if they don't see there primary care provider for bronchitis which developes into pneumonia and a 10k hospital stay.

 

[DoctwoB]

I don't understand why pediatric salaries are so low. The pediatrician I did my rotations with never saw less than 40 patients a day when I was there. He said often during the winter 55. This was all while working 38-40 hours a week. So let's say hypothetically:
Some level 2/3
Low end reimbursement 75$ per visit and low end 40 patients per day.
75$ X 40 patients X 5 days X 48 weeks(-4 vacation)
800k a year he had two lpnl's employed.. So even u payed 400k in salaries overhead malpractice and biling that leaves 400k. Where is all the money going to make the average salary 180k. It seems to me they should make more money than fam prac because it's difficult to see over 25 patients a day. I kno u throw in some labs and ekgs etc but...not 20 patients worth of billing? I plan on doing emergency medicine I'm Just asking out of curiosity. I was a finance major in undergrad... It just doesn't add up to me.

Overhead usually runs over 50%, probably closer to 60%. The difference is largely that billings for pediatrics usually generate less money per patient. A major contributor to this is that a huge chunk of peds patients are one medicaid, which pays very poorly.

 

[yamaraja808]

So an insurance company just refuses to reimburse a provider for a non elective required visit based on accepted pediatric recommendations. I guess they don't care if the kids don't get vaccinated or if they don't see there primary care provider for bronchitis which developes into pneumonia and a 10k hospital stay.

There is truth to what you are saying. Insurance companies try to find ways to maximize profits. Why don't you pose this question to the physicians on the pediatrics threads. They maybe able to help you more.

 

[jpl291]

Overhead should definatley not be over half of 800k

70k 2 lpn includes ins
25 k malpractice for peds
50k billing
255 left for office per year..would never cost that much obviously.

 

[MedicineMike]

yeah it seems to me that something just isn't adding up. I agree with posting this in the Peds forum. I am interested to see the real answer to this...

 

[vin5cent0]

Are you comparing academia salary (180k/year) to private practice salary? I think most would agree that the typical salaries you see for each specialty isn't reflective of what you'd make if you ran your own practice.

 

[docB]

There are several reasons that peds docs make less. The previously mentioned overhead and Medicaid issues are true. They are also not getting anywhere near $75 per visit, they are more in the $25 to $45 range.

Peds visits usually pay less because most of the patients are less complex with fewer billable diagnoses. Compare the usual peds day full of well visits, vaccinations and viral illnesses to an adult PMD's day full of patients with COPD, diabetes, htn, heart disease, etc. I am not saying this is how it should be. I think seeing kids is tough and it should be reimbursed better but this is the current system.

 

[DoctwoB]

There are several reasons that peds docs make less. The previously mentioned overhead and Medicaid issues are true. They are also not getting anywhere near $75 per visit, they are more in the $25 to $45 range.

Peds visits usually pay less because most of the patients are less complex with fewer billable diagnoses. Compare the usual peds day full of well visits, vaccinations and viral illnesses to an adult PMD's day full of patients with COPD, diabetes, htn, heart disease, etc. I am not saying this is how it should be. I think seeing kids is tough and it should be reimbursed better but this is the current system.

Is there a salary discrepancy for peds EM as well?

 

[Freakfarm0]

I think this is why Pediatrics is one of the medical specialties that is more of a "calling" than other specialties.

That comment had nothing to do with reimbursements or insurance rates, but I thought I'd chime in.

 

[KidDr]

Is there a salary discrepancy for peds EM as well?

Yes. In most cases, PEM docs make significantly less than adult EM docs. In the city I'm in, starting salary for PEM is around $170k, whereas for adult EM it is easily $225k++. PEM also requires more training (3 year fellowship after peds residency or 2 year fellowship after EM residency) and your options for where to practice will be more limited after training (i.e. you're basically limited to bigger cities). Despite all that, it really is a great field! And it is still good money, all things considered.

 

[surftheiop]

I think this is why Pediatrics is one of the medical specialties that is more of a "calling" than other specialties.

That comment had nothing to do with reimbursements or insurance rates, but I thought I'd chime in.

this is true from what I've seen, pediatricians I've known don't seem to ever fall into the "just a job" category. They are highly interested in making sure kids are happy/healthy in all aspects of life and not just when they are at work. They tend to do tons of volunteer/activism stuff in the community, will step up and advocate for children whenever they see society looking them over, etc. A couple pediatricians I used to know would often collect outgrown clothes from neighborhood families to give to poor patient's families, etc. I know of 3 different non-profits in my town that were started by peds physicians. It seems they are the "save the world" premeds who never got jaded.

 

[NeuroChris]

peds are paid pretty well, peds surgeon ..even better

 

[oldbearprofessor]

I don't understand why pediatric salaries are so low. The pediatrician I did my rotations with never saw less than 40 patients a day when I was there. He said often during the winter 55. This was all while working 38-40 hours a week. So let's say hypothetically:
Some level 2/3
Low end reimbursement 75$ per visit and low end 40 patients per day.
75$ X 40 patients X 5 days X 48 weeks(-4 vacation)
800k a year he had two lpn's employed.. So even u payed 400k in salaries overhead malpractice and billing that leaves 400k. Where is all the money going to make the average salary 180k. It seems to me they should make more money than fam prac because it's difficult to see over 25 patients a day. I kno u throw in some labs and ekgs etc but...not 20 patients worth of billing? I plan on doing emergency medicine I'm Just asking out of curiosity. I was a finance major in undergrad... It just doesn't add up to me.

Okay, I don't do general pediatrics, but no one has really answered your question so I'll provide some info.

There are three components here:

1. Number of patients seen/week: Regardless of what the dude you were shadowing was doing, the AVERAGE for all pediatricians is about 25-26 patients/day. This increases with shorter visits during the winter, but rarely goes over 30 patients/day on the average except for a brief winter burst into the mid-30's for some pediatricians. This is well documented by the AAP. I can't explain the guy who does 40 at least, but this is a real outlier and not really what happens with pediatricians doing well-baby visits and well-child/adolescent care. You can't do these at a turnover of 12 minutes each even if you were popular enough to have that many patients, which few pediatricians are.

2. Overhead: Again this is well-documented by the AAP and other organizations as averaging 50-60% for pediatricians. One of the reasons many have sold out to larger groups (such as the local children's hospital) is to try to get this down from 60-65% to about 50%. I cannot go through the details of why it's this high, but it is and there are many practice management sites that discuss it as well as the AAP itself.

3. Reimbursement/visit and non-reimbursed care: This is actually by far the most variable of the three. Mostly it's a bit above the $25-45 mentioned in another post but below the $75 you quoted. So much depends on the payer mix and type of patients seen. Winter volume is up but reimbursement per visit is down, etc. Non-paid visits are a huge problem in some areas.

so, if you assume 125 visits/week times 48 weeks at $60/visit = 360,000 intake and 55% overhead....well, you get the salary of a pediatrician.

 

[Law2Doc]

peds are paid pretty well, peds surgeon ..even better

Per a recent Medscape salary study pediatrics is currently THE lowest paid specialty, with a median income of $148k.

It has everything to do with insurance reimbursement and billing. As mentioned above, when you see the adult hypertensive obese diabetic COPDer, you are entering a lot of billing codes per office visit, and getting reimbursed a lot more than the typical kid who has a transient viral cough. So you aren't getting the same kind of per visit amount as you would per adult. You also tend to do fewer procedures (which are reimbursed better). And office visits tend to be longer because not only is it harder to draw out a useful history from a 4 year old, and not only does it take longer to do an exam when your patient is crying and wriggling, but parents tend to show up with tons of questions and you can't rush them out the way you might an adult. So you pay a big price to work with kids.

Peds surgery is less "pediatrics" and more "surgery", and they thus make incomes more in line with other surgeons, which makes sense because their training is twice as long and they tend to work twice the hours. Best not to lump things together along pediatric lines, but rather in line with the parent specialty. In other words peds neurology is a neurology subspecialty. Peds surgery is a surgery subspecialty. Peds ortho is an ortho subspecialty.

 

[DoctwoB]

peds are paid pretty well, peds surgeon ..even better

Unfortunately peds surgery is an extremely competitive fellowship following general surgery (taking from 7-9 years post med school).

 

[oldbearprofessor]

At $75 reimbursement per visit, I can really see pediatricians switching to a cash-only model and do fairly well based on those numbers you put forth...... In my opinion, $75-$90 is more than reasonable for a visit - I'd gladly pay that. I'm sure there'd be no problem finding patients to keep the practice busy.

There are a few such practices and they have been very public in advocating for it. Do a bit of Google searching and you'll find them as it's not my interest in promoting them here by linking to the group(s). The problem is that actually very few people are interested in this model and it's nearly impossible to find a practice where this will work in pediatrics. Medicaid is a huge portion of pediatrics and although there are definitely some "no medicaid" practices, for a new graduate, this would be nearly impossible to do.

Others know more than me about payor mixes and why concierge pediatrics is so rare.

 

[docB]

Adult concierge practices tend to cater to wealthy people with some health issues. What they are really selling is access. People with issues are willing to pay for access, those with out any issues generally aren't. There are fewer kids with health issues than adults so that's why a concierge model in peds is hard to keep going.

Tachyon mentioned that he thinks $75-90 is reasonable for an office visit. The vast majority of people don't.

DoctwoB asked if Peds EM is affected by this as well. I agree with KidDr that it is.

 

[Perrotfish]

Peds surgery is less "pediatrics" and more "surgery", and they thus make incomes more in line with other surgeons, which makes sense because their training is twice as long and they tend to work twice the hours. Best not to lump things together along pediatric lines, but rather in line with the parent specialty. In other words peds neurology is a neurology subspecialty. Peds surgery is a surgery subspecialty. Peds ortho is an ortho subspecialty.

Just a quick FYI, Peds Neuro is a Peds subspecialty as well. Like Peds EM and Peds Psych you can get there from two different residencies.

One of the nice things about going into Peds, vs. IM, is that you're still free to do pretty much anything outside of the OR.