Any ideas/suggestions/enlightenment you could shed on various structural options would be greatly appreciated.
S-
I'm only an M0, but I do work in a US hospital and know a little about different practice structures, so here's my $0.02, for what it's work. Anyone with more understanding of this, please correct me.
In the US, most docs are either private practice or work for academic institutions. If you work in academics, you are employed by a university and receive a salary, however contracts are set up differently among institutions and among specialities. Some docs only receive their salary, while others have a large component that is based on how many private patients they see, surgeries they do, research grants they get, etc. Other docs barely see patients at all, and spend most of their time in their labs. If you go the academic route, you probably start out after residency (or fellowship if you do one) making something in the range of $100k/yr, with potential of $200-$300k after 10+ yrs as an attending, depending on a variety of factors, including specialty, contract structure, institution, research funding, side consulting gigs, etc. That said, there are attendings at my hospital that have been around for a while that still make only in the range of $150k/yr, and work very hard. But academics is very exciting IMO, which helps to make up for the lower salaries. The most interesting cases and treatments are in academic settings.
The other route is private practice, which is where the majority of US docs end up. Decades ago, many docs hung a shingle and worked solo, seeing patients in their office and admitting them in the local hospital when necessary. You are reimbursed by billing the insurance that your patients have, or sometimes by cash payments. In this scenario, you are not salaried. You eat what you kill, and are responsible for all overhead costs (which are SUBSTANTIAL - insurance, office space, support staff, technology, etc.). Also, when your patient is hospitalized, you round on them and take your own call. Partly as a way to share overhead and partly as a way to increase revenues (like through surgery centers or MRIs), the trend for the past few decades has been for doctors to work together in groups, sometimes single specialty and sometimes multi-specialty. In private practice, salaries run the gamut, from a your family doc barely making $100k to your spine surgeon pulling in $750k. Obviously, co-ownership in surgery centers or imaging technology increases income potential. Note that these are NOT salaries. Business skills really matter in private practice, as payer mix (i.e. if you have a lot of medicaid patients), the amount and type of procedures you do, the # of patients you see, your overhead costs, etc. will make or break you.
There are combinations of these two scenarios and other types of docs that don't really fit either model (ie hospitalists and some ER docs), but this is the general US set-up.
I know very little about OB/Gyn, but many are private practice in the US and they often seem to work in groups, at least in areas with large populations. As I'm sure you've heard, malpractice is very very high which has squeezed incomes, but people will keep having babies and hopefully the specialty is on the upswing. The trend is also towards female docs for your bread and butter pregnancies, and in certain areas male OB/Gyns are having trouble. The most exciting, high risk cases will go to the academic hospitals. An interesting field, which I know very little about, is fertility (there is probably a fancier name for this out there). Some fertility docs can basically run a cash practice, like a plastic surgeon or some dermatologists. Fertility also seems very interesting and rewarding. For anyone interested in OB/Gyn and also wants $$$ and lifestyle, I'd suggest exploring this route. Otherwise, if you want a comfortable salary and lifestyle, OB/Gyn may not be for you. Although the trend is towards scheduled C-sections, particularly in wealthy areas, the majority of babies are still not born from 9-5, M-F.
Old_boy out.
