Practice model and satisfaction

[lejeunesage]

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1. What's your practice model and niche?
2. How many hours do you work?
3. Do you feel well compensated?

 

[RangerBob]

Independent contractor/sole-proprietor. Inpatient-acute. I’m the attending/admitting physician, not a consultant. No clinic. Occasional consults.

Hours I work depends on whether I have a partner. When I do, it varies from 4-12hrs/day. Call is every other week (ouch), but I could probably finish most days 2-4hrs quicker if I were really efficient and didn’t chat with any therapists, RNs, etc, but it makes the job more enjoyable.

I feel compensated fine (probably better than most). I just want more time off. I’m working on it! I have a great team so there’s not much to complain about at my job other than the hours. With a bit of work I think we’ll get them to the right place.

 

[lejeunesage]

Nice! That's what I do, too. How many patients do you carry on average?

 

[RangerBob]

Nice! That's what I do, too. How many patients do you carry on average?

It depends on whether I have a partner. Lowest I've ever been was about 6. Highest was about 22-24.

What do you and your partners typically average?

 

[lejeunesage]

Currently, I average 12. When my partner is out, I see about 20.
Ideally, I'd see 15 a day. I'm working on that.

 

[PMR2008]

I have discussed this before so apologize for repeating.
Subacute consultant/regenerative medicine(pain fellowship trained)/med legal
1 to 1 1/2 day clinic a week (non narcotic+regen self pay procedures) - lots of sports and some spine
1/2 day med legal - case reviews, expert witness, life care planning
1/2 admin/business - consultant, advisory board, investor and have a business
2 1/2 to 3 days - subacute consults. Co manage short term rehab patients. Primary takes call. Average 25-30 patients a day managing post op or post hospital rehab. 95% of what I do as a consultant is MSK/Neuro. Cover many facilities with the help of PA's.

9-6 daily. Clinic day usually the longest. Seems like a lot of things to cram into a week but I have plenty of help. Scribe/PA's/staff etc.
Feel very well compensated. I am independent which helps a lot. 4-6 weeks of vacation a week. It has taken me years but I feel that I have the ideal practice for my personality and professional goals.
Long term plan is to do less clinical and more med legal and admin. A lot of times it is better compensated than injections or patient visits.

1. What's your practice model and niche?
2. How many hours do you work?
3. Do you feel well compensated?

 

[lejeunesage]

I do 100% inpatient rehab. On top of that, I have light administrative duties with a Program Directorship, that pays about $2K/month.

No clinic. No consults.

The hours are unbeatable. I work less than 40 hours a week. I start whenever I want, with the only stipulations that my PAPEs be written within 24 hours of admission. So, if a patient is admitted on Wednesday at 4PM, my PAPE needs to be in my Thursday at the same time.

I also have team conferences on Wednesday morning. Other than that, I almost never start before 9:30 at the earliest. On most days, I work a maximum of 6-7 hours, depending on my census.

I work as an independent contractor. That means no benefits from work. I keep all my collections minus the 7% cut that I pay my billing company.

Let's run through a conservative estimate of what you can make.

Let's say you average 15 patients, with one discharge and one admission per day. And you round on all your patients 22 days per month.

Let's say that you bill 99223, for all your admissions and 99232, and 99239 for all your discharges.

Currently, those would be about $200, $70, and $100 respectively.

So, on an average day, you'd bill $200 (H&P) + $100 (discharge) + 13 X $70 (progress notes).

That's $1,210 a day. If you work 22 days a month, that's $26,620 in billings.

Medicare pays you 80% of that. The patient's secondary insurance, or the patient themselves if they don't have a secondary insurance, is responsible for the rest.

Let's be extremely conservative. Let's assume that none of your patients ever have a secondary insurance, and all of them are going to decide not to pay the 20% they're responsible for. You'll still collect 80% of $26,620, which is $21,296. Your Billing company will leave you with 93% of that, which is $19.8K

Of course, you'll have to pay taxes on that at the end of the year. But that's what you're looking at on a very conservative estimate if you carry a census of 15 patients and generally bill level 2s.

Hour for hour, this is one of the best jobs you can do. Malpractice is really low compared to other fields. For my first year, I paid a bit under $1K. It rises a bit year by year until you pay about $5-6K per year.

I can't imagine a much better deal than this, especially if you can land a directorship or associate directorship on top of your collections.

 

[Gauss]

I can't imagine a much better deal than this, especially if you can land a directorship or associate directorship on top of your collections.

1st off good for you, you're happy, enjoy it
2nd there's always someone out there who has or had a better job, makes more, is 'happier', and loves to brag about it and rub it in your face. As you age, your reference set becomes larger.
Heed the advice Albert Brooks offered William Hurt in the 1988 movie Broadcast News. Mr. Hurt's character asks, "What do you do when your real life exceeds your dreams?" Mr. Brooks's answer: "Keep it to yourself."

 

[lejeunesage]

As you age, your reference set becomes larger.

Fair enough!
I'm sure some of you guys who've been in practice for much longer have seen lots and lots of practice models, and things that you'd consider a better deal than straight IPR.

I'm posting this for a few reasons:
1. This isn't social media. Maybe 3 people on this site know who I am in real life. We're all physicians. I don't think my income potential falls outside the norm.
2. This is a much, much, much better deal than I ever thought possible in med school, or even as a senior resident. I kind of stumbled into it.
3. There is too much opacity about financial issues in medicine. It was in my fourth year of residency that someone on this site was kind enough to share some clear information about billing. None of the physicians I trained with in med school or residency ever did this for me. I knew a bit about billing levels, but I had no idea what that translated into, income-wise.
4. I want students and residents coming here and reading this to have a very clear and accurate picture of their earning potential, so that they don't have to rely solely on surveys, as I once did.

Also, I've been meaning to ask you. Where did you find this quote?

"Hi guys, I have no interest in PM&R what so ever, but I did hear that they have a great lifestyle. But do you guys make big bucks? I mean hell, if you have a great lifestyle and don't make big bucks, maybe I should look into radiology as an alternative, I hear they make huge dollars. I mean, I am about as interested in PM&R or rads about as much as sticking a hot poker through my eye, but damn, I just want a cushy lifestyle and big bucks"

 

[j4pac]

I appreciate hearing people who have had success stories within the field because I think that the ones with negative experiences tend to make most of the noise on anonymous forums. I think that students should hear both the good and bad.

 

[Gauss]

I appreciate hearing people who have had success stories within the field because I think that the ones with negative experiences tend to make most of the noise on anonymous forums. I think that students should hear both the good and bad.

anonymous forums are rife with exaggeration both positive and negative, however things can be said here that cannot be said on a listserve, phyzforum, or in real life where your identity is exposed.

 

[Gauss]

Also, I've been meaning to ask you. Where did you find this quote?

"Hi guys, I have no interest in PM&R what so ever, but I did hear that they have a great lifestyle. But do you guys make big bucks? I mean hell, if you have a great lifestyle and don't make big bucks, maybe I should look into radiology as an alternative, I hear they make huge dollars. I mean, I am about as interested in PM&R or rads about as much as sticking a hot poker through my eye, but damn, I just want a cushy lifestyle and big bucks"

This was sarcasm written by another doc on the forum who at the time was a student exploring PM&R but I think eventually went into neurology. At the time (maybe 15 years ago?) there were a ton of threads debating which field had the highest income to work ratio. This was not an unusual frame of mind at the time as grueling abuses were endured (this was pre ACGME work week restrictions)

 

[nvrsumr]

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