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Primary Care

Em1

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    Wow, that sucks a lot. No wonder physicians try to move through pts as quickly as possible.

    I didn't see Tricare (what I'm currently on) on the list though.
     
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    lilnoelle

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      One thing I'm thinking about doing (other than working in a hospital, which would pay me a salary) is charging patients up front for their visit and then giving them the paperwork they need to file with their insurance company. Dentists do this and so do veternarians. I will be working in a rural area where often people aren't insured. I would charge a bit more than what a physician expects to get from an insurance company, but not near as much as what a person without insurance would have to pay. This way, those without insurance will get much cheaper healthcare. Its quite possible that this idea isn't going to work, but I have ~8 years to refine it or decide not to do it, so we'll see.
       

      kevster2001

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        noelleruckman said:
        One thing I'm thinking about doing (other than working in a hospital, which would pay me a salary) is charging patients up front for their visit and then giving them the paperwork they need to file with their insurance company. Dentists do this and so do veternarians. I will be working in a rural area where often people aren't insured. I would charge a bit more than what a physician expects to get from an insurance company, but not near as much as what a person without insurance would have to pay. This way, those without insurance will get much cheaper healthcare. Its quite possible that this idea isn't going to work, but I have ~8 years to refine it or decide not to do it, so we'll see.
        That's what some surgeons do, especially ones that get really good at a procedure. Cash upfront. Helps them make a whole lot more
         

        jojocola

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          noelleruckman said:
          One thing I'm thinking about doing (other than working in a hospital, which would pay me a salary) is charging patients up front for their visit and then giving them the paperwork they need to file with their insurance company. Dentists do this and so do veternarians. I will be working in a rural area where often people aren't insured. I would charge a bit more than what a physician expects to get from an insurance company, but not near as much as what a person without insurance would have to pay. This way, those without insurance will get much cheaper healthcare. Its quite possible that this idea isn't going to work, but I have ~8 years to refine it or decide not to do it, so we'll see.
          Your going to charge patients up front, then ask for their insurance card. Thats allowed? Insurance companies cover only so much, what if the patients do not want to pay the extra money that you have already charged them up front for? I don't know much about the whole process. :oops:
           

          kevster2001

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            jojocola said:
            Your going to charge patients up front, then ask for their insurance card. Thats allowed? Insurance companies cover only so much, what if the patients do not want to pay the extra money that you have already charged them up front for? I don't know much about the whole process. :oops:
            They pay you up front, you do the procedure and then you're out of the process. How much they can get insurance to reimburse is their business. If they get screwed well, thats their problem. That's the thinking of the pay up front idea.
             

            AmoryBlaine

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              jojocola said:
              I have always considered primary care as one of my top choices. But this scares me!
              http://home.austin.rr.com/austintxmd/Pages/income.html#Earn
              :confused:

              Some aspects of primary care are scary. I would suggest to you though that the model of Family Docs running their own clinics (+/- partners) is on its way out the door. I think much more likely is a move towards primary care docs working for hospitals or other management structures where the "overhead" is not really their problem. Physicians are moving towards being employees rather than business owners. This is already true of fields such as anesthesia, EM, hospitalists, etc. and it won't be the end of the world if your neighborhood FP or pediatrician works for the local hospital.
               

              Anastasis

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                AmoryBlaine said:
                Some aspects of primary care are scary. I would suggest to you though that the model of Family Docs running their own clinics (+/- partners) is on its way out the door. I think much more likely is a move towards primary care docs working for hospitals or other management structures where the "overhead" is not really their problem. Physicians are moving towards being employees rather than business owners. This is already true of fields such as anesthesia, EM, hospitalists, etc. and it won't be the end of the world if your neighborhood FP or pediatrician works for the local hospital.
                Personally I think I would prefer this model. I'm not so good at the business side of things and I would like to have as little to do with it as possible. Anyone else feel that way?
                 

                jojocola

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                  Anastasis said:
                  Personally I think I would prefer this model. I'm not so good at the business side of things and I would like to have as little to do with it as possible. Anyone else feel that way?
                  I would rather be in control and have somewhat a say in how things get done.
                   

                  kevster2001

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                    Anastasis said:
                    Personally I think I would prefer this model. I'm not so good at the business side of things and I would like to have as little to do with it as possible. Anyone else feel that way?
                    It depends. You are more or less forced to become a corporate stooge. They tell you how many tests you can order, how long you can spend with a patient. if their policies agree w/ you then you're set, if not then it wont be so fun.
                     

                    Anastasis

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                      jojocola said:
                      I would rather be in control and have somewhat a say in how things get done.
                      I don't think the model he described would remove any of the doctor's authority on how the patient is treated (anymore than the HMOs have already) just the authority on the business side. That's what I don't care about.
                       
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                      kaat44

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                        It seems like that website has a definite agenda--I mean, you can find plenty of info explaining why doctors are overpaid. Most doctors I know are at least middle class if not wealthy. I just want enough money to pay the bills and it seems like doctors have that, so why worry so much?

                        Also, just to let you know, the doctors I work with make more money in a day than I make in a month (~$1200). Right now that sounds great!
                         

                        jojocola

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                          kevster2001 said:
                          It depends. You are more or less forced to become a corporate stooge. They tell you how many tests you can order, how long you can spend with a patient. if their policies agree w/ you then you're set, if not then it wont be so fun.
                          Kev brings up a good point. Spending time with a patient is very very important. According to the website, the average time spent from an office visit is about 10 minutes. This website is from 1999. I have read several MD blogs that, assuming the comments are from real MDs(why wouldn't they be), their average time spent with a patient is roughly 7 minutes.

                          7 minutes is nothing.
                           

                          jojocola

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                            kevster2001 said:
                            They pay you up front, you do the procedure and then you're out of the process. How much they can get insurance to reimburse is their business. If they get screwed well, thats their problem. That's the thinking of the pay up front idea.
                            btw this idea sounds :thumbup:
                             

                            mchou

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                              medanthgirl said:
                              check this out

                              http://www.newsobserver.com/145/story/445602.html


                              Duke University is getting rid of their Family Medicine residency. wow. that's bad. i wonder how many other places will follow suit.

                              i think that sucks on their part. :thumbdown:

                              From the article, it sounds like that residency program was pretty unpopular as well. Their remedy doesn't seem any better however. I think it's unwise for hospitals to do such a thing anyway since residency slots bring in plenty of money for the hospitals.
                               

                              LizzyM

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                                BrettBatchelor said:
                                At $40 per 10 minutes visit X 5 visits per hour and 10 minutes for doing misc. stuff they are pulling in $200 an hour.

                                From which they pay rent or morgage on the building, utilities, malpractice insurance, staff salaries (or wages), uniforms & linens, costs associated supplies and equipment, maybe advertising (listing in the yellow pages), cost of continuing medical education, memberships in professional organizations. Gross is far less important than net.

                                The business end of medicine is getting more complex and confusing. There are "preferred provider networks" where in exchange for agreeing to a negotiated lower fee, a provider has a steady stream of patients directed to him. This usually means accepting whatever the insurance pays and patients can not be required to make up the difference - they pay only the deductable and co-pay specified by the insurance company. Patients have incentives to go to "preferred providers" so opening up an office that requires cash up front with the patient doing the paperwork to get reimbursement from insurance works, perhaps, in some specialties (plastics) and in some affluent areas (orthopedics in Aspen) but it can otherwise be very limiting.

                                Along the way, you should have a good med school course in health care financing and residency programs often offer educational programs about the business end of entering a practice.

                                :luck:
                                 
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                                DrBowtie

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                                  LizzyM said:
                                  From which they pay rent or morgage on the building, utilities, malpractice insurance, staff salaries (or wages), uniforms & linens, costs associated supplies and equipment, maybe advertising (listing in the yellow pages), cost of continuing medical education, memberships in professional organizations. Gross is far less important than net.

                                  The business end of medicine is getting more complex and confusing. There are "preferred provider networks" where in exchange for agreeing to a negotiated lower fee, a provider has a steady stream of patients directed to him. This usually means accepting whatever the insurance pays and patients can not be required to make up the difference - they pay only the deductable and co-pay specified by the insurance company. Patients have incentives to go to "preferred providers" so opening up an office that requires cash up front with the patient doing the paperwork to get reimbursement from insurance works, perhaps, in some specialties (plastics) and in some affluent areas (orthopedics in Aspen) but it can otherwise be very limiting.

                                  Along the way, you should have a good med school course in health care financing and residency programs often offer educational programs about the business end of entering a practice.

                                  :luck:
                                  I'm not saying that's a lot or even enough for them but the reason why the general public isn't outraged is b/c that is a lot more money than most of them make.
                                   

                                  AmoryBlaine

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                                    kevster2001 said:
                                    It depends. You are more or less forced to become a corporate stooge. They tell you how many tests you can order, how long you can spend with a patient. if their policies agree w/ you then you're set, if not then it wont be so fun.


                                    nah.

                                    Evidence based medicine and insurance companies are going to tell what what/how many tests you can order and the bottom line is going to tell you how long you can spend with a patient.

                                    I think it's awesome that lots of people on the pre-med forums are concerned about stuff like this and want to change it (kudos to all of you :thumbup: :thumbup: ). But no one goes into Primary Care saying "I want to spend 5 minutes with each patient and get them out the door as soon as possible." There are forces out there that are larger than you, if you are trying to maintain your own practice you will work a good part of the day just to pay your bills before you even take anything home (pre-tax).

                                    Time spent in the exam room is a balancing act. I know someone who is practicing pediatrics in a setting where access to MDs is very limited. She has to balance a desire to be thorough and address all concerns against the fact that if she doesn't see the patient in the next room, they ain't gonna be seen!

                                    Another side note for you folks interested in Primary Care, and I am not an expert so take my words with a grain of salt: I think "Boutique medicine" is really going to take off at some point in the future. For those of you that don't know, this is where an MD charges each patient a set amount of money per year for essentially unlimited access to that MD's services. Think about it, if you have a decent income as a parent it might very well be worth it to just drop $1000 up front per year and be able to get your kid into his Pedi the next day. I think this is a workable practice model, especially if there is a wide range in the level of "boutique" offered (i.e. a family with less money might pay less to be in a larger boutique with comparatively limited access to the MD). And if your conscience is guitly because you only have 300 patients @ $1000 apiece (don't rip the numbers, I just made them up), work in a free clinic one afternoon a week.
                                     

                                    Beau Geste

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                                      My mom is an FP with 4 other partners and 2 PAs in a rural town of about 8000. They also have a clinic the next town over with a population of about 3000. The physician's salaries are, on average $140K. They require payment up front and take insurance as well. Basically, those with insurance have a copay, and are charged whatever insurance doesn't pay. Those without insurance can either pay up front or pay 10% (for bills over $150) and then have payments set up.They have a great bill collector for those who don't pay.

                                      There is a major state prison, a hospital, and a major factory in the town, so many people carry insurance through those. Less than 5% require collections. They have a great business going on, but I think the key is having 5 physicians and 2 PAs on staff to make more money. The clinic started with just 2 physicians about 25 years ago and was not as prosperous. Then my mom came on and soon after another MD. Then it started taking off.

                                      Being a smaller town, they bought the land and built the building, so they don't pay rent. Each physician and PA has a nurse to assist, and there is other staff for front desk, billing, patient care, phlebotomy, lab, etc. I think they employ an additional 25-30 people between the 2 clinics.

                                      There is only one other physician in town to compete with, and the service radius includes about 50,000 people (there are many smaller towns within 25 miles that don't have a permanent physician office).

                                      Personally, I think they need to add allied health to their clinic (OT, PT, ST) because the closest providers for these services are 30 miles away.
                                       

                                      LizzyM

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                                        megboo said:
                                        My mom is an FP ...The physician's salaries are, on average $140K.

                                        Point being that the salaries work out to $70/hr for a 40 hr week, not $200/hr. (of course, what FP works a 40 hour week :rolleyes: so it works out to even less on an hourly basis but its a living, a good living by US standards.)
                                         

                                        Dr.Andrews

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                                          Alot of people forget that family docs also have to pay their secretary, which is like another $30k you have to remember. However, family docs don't have at as bad as dentists!

                                          Just imagine a dentist's start-up costs! :eek:
                                           

                                          Beau Geste

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                                            LizzyM said:
                                            Point being that the salaries work out to $70/hr for a 40 hr week, not $200/hr. (of course, what FP works a 40 hour week :rolleyes: so it works out to even less on an hourly basis but its a living, a good living by US standards.)

                                            With so many partners, my mom has a 4-day work week and takes call every 5th week and weekend.

                                            But, my mom is also lucky that she has a government contract with the local prison that pays her $80K for 10-15 hours a week. So she really works 5.5 days a week making $220K with benefits from both the clinic and the government.

                                            There *are* opportunities to make more, but you have to be willing to look for them and relocate. It's not like other specialty fields, but the job is rewarding.
                                             

                                            skypilot

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                                              mam4993 said:
                                              Is ob/gyn considered primary care? Google provided me with conflictiing opinions.

                                              ObGyn is considered primary care for loan repayment and for other criteria but of course ObGyns can also do surgery.

                                              I guess the way to think of it is that the ObGyn is the primary physician for the pregnant woman, and for non pregnant women with gynecological concerns.
                                               
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