Private practice family medicine still possible?

[MrSunny1]

Still possible for FM doc to start a private practice after residency? I totaled up bills average around 200-220k per year with three employees. Estimating the average physician sees approximately 18 patients per day if the schedule is fully booked for 240 work days out of the year approximately 4320 visits per year. Average reimbursement for medicaid is less than 50$ per visit while medicare is less than 75$ so 50/50 practice would earn 62.5$ per visit or 270,000 per year working 9 hour days.

Of course it would probably take 2-3 years to get to the point of having this many patients but what if there werent enough patients to fill the schedule then gross income would quickly fall from 270,000 and not cover expenses leading the physician to pay out of pocket or get loans in order to continue to run the business.

Maybe there is something that I am missing but how is this possible and profitable?

---

Members don't see this ad.

 

[MrSunny1]

Here is a spreadsheet i created from average expenses and doing a little research please add if you can think of anything else or if something seems too high:

EHR 12,000
labor(coder, nurse, secretary, business admin) benefits and taxes 118,000
charge for lab tests 25,000
malpratice, workers comp, business 12000
medical supplies 9500
Rent, utilities, upkeep 25,000
medical supplies 9500
other 5000

216,000

 

[Taddy Mason]

1) Reimbursement depends on what the visit entails.
2) You're not accounting for insured patients or out of pocket patients.
3) Most FM docs, when their practice is full, see ~20-30 pts/day.
4) Not sure where you got your numbers, but Medicare reimbursement is (generally) better than Medicaid reimbursement.

 

[Sunshizzle]

it's pretty awesome you are interested in this. IMO, it wouldn't be possible to do a successful private practice by only seeing medicare/medicaid patients... you need to be able to see regular insurance patients to keep yourself afloat (medicare/medicaid rates are based on private insurance rates minus a certain %).

Also, reimbursement is moving towards rewarding quality of care... and if you have a lot of medicare/medicaid patients, many may fall into the "non-compliant" category (no fault of their own - are they going to pay for their prescriptions, or feed their family, buy TP, etc), which would make your reimbursement from the government even less than it normally would.

I think a safe labor cost estimate is salary+20% fringe benefits... so realistic salaries to get quality workers would have to be at least average (never skimp on your workers, but especially on your coder and office manager... they help make sure you get paid and they deal with all the BS. they are worth the investment)

In private practice you can also seek out training to be able to offer different "services" to help with overhead - like botox or cosmetics, cool sculpting, travel medicine, etc.

 

[deleted480308]

the real answer is to ditch medicare and insurance altogether. search "direct primary care" on the forums here and see how a number of posters here are doing it

 

[MrSunny1]

1) Reimbursement depends on what the visit entails.
2) You're not accounting for insured patients or out of pocket patients.
3) Most FM docs, when their practice is full, see ~20-30 pts/day.
4) Not sure where you got your numbers, but Medicare reimbursement is (generally) better than Medicaid reimbursement.

4) I gave averages for both if you read the post. Then averaged them at 50/50 to calculate the average patient visit reimbursement which was probably pretty generous vs what would actually be received and thats not factoring in any denials from insurance...

 

[MrSunny1]

the real answer is to ditch medicare and insurance altogether. search "direct primary care" on the forums here and see how a number of posters here are doing it

Thought about this as well but seems there is less and less people in the pool of "direct payers" and more and more under the umbrella of "medicare/medicaid" Im not certain but it seems it might be difficult to find enough patients willing to pay cash especially just entering the medical field.

 

[Taddy Mason]

4) I gave averages for both if you read the post. Then averaged them at 50/50 to calculate the average patient visit reimbursement which was probably pretty generous vs what would actually be received and thats not factoring in any denials from insurance...

Again, no idea where you got your averages, and average is very vague as it depends on what you're billing for which is dependent on your practice. My spouse does Medicare and Medicaid reimbursement, and I can assure you that your Medicaid number is off (for whatever a "visit" entails) in relation to your Medicare number - there's a reason many dentists and private practice physicians don't accept Medicaid patients.

 

[MrSunny1]

From what I see the average pay for office visit with private insurance is 76$.. So not much more than what I calculated using medicare. Though that would be a significant difference in revenue if only medicare and private insurance patients were accepted.

 

[MrSunny1]

Again, no idea where you got your "averages", and average is very vague as it depends on what you're billing for which is dependent on your practice. My spouse does Medicare and Medicaid reimbursement, and I can assure you that your Medicaid number is off - there's a reason many dentists and private practice physicians don't accept Medicaid patients.

I got them from my states reimbursement schedule.

 

[MrSunny1]

I got them from my states reimbursement schedule.

W

Again, no idea where you got your "averages", and average is very vague as it depends on what you're billing for which is dependent on your practice. My spouse does Medicare and Medicaid reimbursement, and I can assure you that your Medicaid number is off - there's a reason many dentists and private practice physicians don't accept Medicaid patients.

So you are saying that the number 50$ per visit is inflated vs what you could actually expect to receive thats even worse. In that case only a much smaller percent of patients could be medicaid if the doors were going to stay open.

 

[deleted480308]

Thought about this as well but seems there is less and less people in the pool of "direct payers" and more and more under the umbrella of "medicare/medicaid" Im not certain but it seems it might be difficult to find enough patients willing to pay cash especially just entering the medical field.

I've never spoke to someone doing it who remotely considers going back to taking insurance so I'd like to encourage you to at least investigate before you give up on the notion

 

[MrSunny1]

Also I read that reimbursement rates have been trimmed closer to the medicaid rate for private insurance that is issued under the ACA so that all patients visit will be reimbursed at the medicaid rate. Not sure how this is in actuality but seems pretty detrimental to anyone who has a private practice.

 

[Taddy Mason]

...So you are saying that the number 50$ per visit is inflated vs what you could actually expect to receive...

It depends on what you are billing for...

Edit - I also suggest you do some research on how Medicaid, Medicare, and medical billing in general actually function (from legit sources).

 

[W19]

My cousin has a very profitable IM private practice in FL... He is the only attending running the practice.

 

[MrSunny1]

It depends on what you are billing for...

Edit - I also suggest you do some research on how Medicaid, Medicare, and medical billing in general actually function (from legit sources, not Internet forums, biased personal websites, or the first couple of hits on Google).

Not sure how much more "legit" it can get than my own states medicaid and Medicare fee schedule as stated above...

 

[MrSunny1]

My cousin has a very profitable IM private practice in FL... He is the only attending running the practice.

Thanks glad to hear.

 

[Taddy Mason]

Not sure how much more "legit" it can get than my own states medicaid and Medicare fee schedule as stated above...

Well you don't seem to understand those so...

And Medicare is a federal program, not state

 

[bashwell]

Medicaid, the bane of pediatricians. Medicaid is part of the reason why pediatricians make so little.

 

[group_theory]

Here is a spreadsheet i created from average expenses and doing a little research please add if you can think of anything else or if something seems too high:

EHR 12,000
labor(coder, nurse, secretary, business admin) benefits and taxes 118,000
charge for lab tests 25,000
malpratice, workers comp, business 12000
medical supplies 9500
Rent, utilities, upkeep 25,000
medical supplies 9500
other 5000

216,000

Are your expenses per year or per month?

Having an office nurse, an office manager/bus admin, and coder - for $118,000 - that's around $40k per person (if equally split, which you may not do) - that includes salary, benefits (401k, health, dental) - remember as an employer, you are responsible for half of their social security and medicare taxes. $40k/year (including benefits) means a very low salary with benefits, or below market salary with benefits

According to salary.com, the average office LPN nurse salary (median, $44.4k) and that doesn't include fringe benefits (plus you have to account for social security and medicare taxes that the employer pays, which is not considered benefits/compensation)
http://www1.salary.com/Licensed-Practical-Nurse-Outpatient-Clinic-Salary.html

Median salary for medical billers is $34.6k
http://swz.salary.com/SalaryWizard/Medical-Billing-Clerk-Salary-Details.aspx

Median salary for a medical office manager is $66.8k
http://swz.salary.com/SalaryWizard/Business-Office-Manager-Healthcare-Salary-Details.aspx

Good employees are worth their weight in gold.

If you paid median wage, that alone is $146k. Add an additional $9k for their social security that you're responsible for, and $2k for medicare tax that you're responsible for, and that's $157k for employee expenses without any additional benefits. A rule of thumb is that benefits usually cost 30% of employee's salary (not exactly true) so let's assume you are a nice employer (or someone who wants to attract and RETAIN competent employees), employee benefits will cost you $44k (30% of $146k)
http://www.bankrate.com/finance/financial-literacy/the-value-of-employer-benefits.aspx

So labor cost would be closer to $201k



Malpractice Insurance, Workman Comp, Unemployment, and Business Insurance will certainly cost more than $1000/month (if the $12000 is your fiscal year budget). Obviously this is very dependent on where you practice - high litigation areas will have much higher premiums than lower litigation areas. Medical malpractice insurance may be as low as $12000 if you're in the right spot, in the right field, with the right claim history, but may be as high as $200,000. Business Insurance, 3rd party liability insurance, WC, unemployment insurance also varies in prices. But I think $12k for the whole thing is a low and unrealistic estimate

Your medical office rent is also dependent on where you practice, and how big your office is. Downtown Manhattan, SF, Austin, etc will be more expensive than middle of nowhere flyover state. Rent can vary between $9-$15 per square foot per year, to $25-$30 per square foot per year.

A 3500 square foot office, at $12/SF/year is around $42.5k

And I haven't even address cost of medical equipments, tests, as well as the time you and your employee have to spend (uncompensated from insurance company) for regulatory compliance (ie HIPPA security audits, PQRI, quality controls for your labs and medication samples, MOC maintenance for your boards, etc)

Remember, in private practice, you are also a small business owner. So you will need an accountant to help file your quarterly taxes. And your income is basically what you get paid minus all expenses. You get paid last.

/depending on the state, it may be months before you get paid for services billed (account receivable), depending on state budget, etc. When you start, it may be several months before you even get cash flow to pay your expenses (hence why a lot of business get start up loans), and you need a good office manager or accountant to keep track of those account receivables to make sure you get paid for your services

//remember, in addition to seeing patients, you will also need time to fill out paperwork (lots of paperwork) for your patients (FMLA, disability, pre-certifications, prior authorizations), answer phone calls from patients, as well as call them with results of tests, and also call insurance companies to appeal denials.

///you will also have to arrange coverage (call) for overnight and weekends and vacations.

////do it right, and you can make a lot of money (legitimately). However there are a lot of hurdles

 

[deleted480308]

Are your expenses per year or per month?

Having an office nurse, an office manager/bus admin, and coder - for $118,000 - that's around $40k per person (if equally split, which you may not do) - that includes salary, benefits (401k, health, dental) - remember as an employer, you are responsible for half of their social security and medicare taxes. $40k/year (including benefits) means a very low salary with benefits, or below market salary with benefits

According to salary.com, the average office LPN nurse salary (median, $44.4k) and that doesn't include fringe benefits (plus you have to account for social security and medicare taxes that the employer pays, which is not considered benefits/compensation)
http://www1.salary.com/Licensed-Practical-Nurse-Outpatient-Clinic-Salary.html

Median salary for medical billers is $34.6k
http://swz.salary.com/SalaryWizard/Medical-Billing-Clerk-Salary-Details.aspx

Median salary for a medical office manager is $66.8k
http://swz.salary.com/SalaryWizard/Business-Office-Manager-Healthcare-Salary-Details.aspx

Good employees are worth their weight in gold.

If you paid median wage, that alone is $146k. Add an additional $9k for their social security that you're responsible for, and $2k for medicare tax that you're responsible for, and that's $157k for employee expenses without any additional benefits. A rule of thumb is that benefits usually cost 30% of employee's salary (not exactly true) so let's assume you are a nice employer (or someone who wants to attract and RETAIN competent employees), employee benefits will cost you $44k (30% of $146k)
http://www.bankrate.com/finance/financial-literacy/the-value-of-employer-benefits.aspx

So labor cost would be closer to $201k



Malpractice Insurance, Workman Comp, Unemployment, and Business Insurance will certainly cost more than $1000/month (if the $12000 is your fiscal year budget). Obviously this is very dependent on where you practice - high litigation areas will have much higher premiums than lower litigation areas. Medical malpractice insurance may be as low as $12000 if you're in the right spot, in the right field, with the right claim history, but may be as high as $200,000. Business Insurance, 3rd party liability insurance, WC, unemployment insurance also varies in prices. But I think $12k for the whole thing is a low and unrealistic estimate

Your medical office rent is also dependent on where you practice, and how big your office is. Downtown Manhattan, SF, Austin, etc will be more expensive than middle of nowhere flyover state. Rent can vary between $9-$15 per square foot per year, to $25-$30 per square foot per year.

A 3500 square foot office, at $12/SF/year is around $42.5k

And I haven't even address cost of medical equipments, tests, as well as the time you and your employee have to spend (uncompensated from insurance company) for regulatory compliance (ie HIPPA security audits, PQRI, quality controls for your labs and medication samples, MOC maintenance for your boards, etc)

Remember, in private practice, you are also a small business owner. So you will need an accountant to help file your quarterly taxes. And your income is basically what you get paid minus all expenses. You get paid last.

/depending on the state, it may be months before you get paid for services billed (account receivable), depending on state budget, etc. When you start, it may be several months before you even get cash flow to pay your expenses (hence why a lot of business get start up loans), and you need a good office manager or accountant to keep track of those account receivables to make sure you get paid for your services

//remember, in addition to seeing patients, you will also need time to fill out paperwork (lots of paperwork) for your patients (FMLA, disability, pre-certifications, prior authorizations), answer phone calls from patients, as well as call them with results of tests, and also call insurance companies to appeal denials.

///you will also have to arrange coverage (call) for overnight and weekends and vacations.

////do it right, and you can make a lot of money (legitimately). However there are a lot of hurdles

aaaaaaaaaand this, OP, is why so many docs are going direct primary care.

Rent a little 2 room office and you don't even need staff. Just greet your patients at the door yourself and see 2-10 a day with a panel of 600ish. A fraction of the overhead and more time with your patients. For real, listen to the atlasmd podcast

 

[Mad Jack]

From what I see the average pay for office visit with private insurance is 76$.. So not much more than what I calculated using medicare. Though that would be a significant difference in revenue if only medicare and private insurance patients were accepted.

You're assuming no procedures, no charges for other services (EKGs, PFTs, CXRs, etc) that can net you higher payments.

 

[Mad Jack]

The ENT I work for did a Medicaid peds tonsillectomy and the reimbursement=$15.
Seriously...

That's not even worth your time, let alone the liability.

 

[Mad Jack]

+1. Also it seems to me that depending on your area and patient population, the ratio of level 1 visits to level, say, 3 or something might be significantly different.

A good example is vaccine administration- you can get $20 or so extra per vaccine if coded right. If you've got a 2,200 patient panel and half of them get vaccinated for the flu, that's an extra $22,000/year on its own. Here's a short list of extra money physicians throw away:

http://www.mdedge.com/jfponline/art...-billing-coding-tips-boost-your-reimbursement

 

[Mad Jack]

Another great procedure that I saw a lot of in outpatient was steroid joint injections- they take all of a few minutes and reimburse $119. Do one of those a day and you just earned an extra $31,000.

 

[Winged Scapula]

If someone wants to tag blue dog, he's doing it now and doing it successfully.

Although I'm not in family medicine I can tell you that group theory is right on with his comments. In addition I would ask where are you getting an electronic health record for $12,000? They typically run between 40 and $90,000. Do you have to purchase licenses for each user, all the hardware and software. We spent a great deal of time a few years ago investigating the cost of these.


Sent from my iPhone using SDN mobile

 

[xffan624]

aaaaaaaaaand this, OP, is why so many docs are going direct primary care.

Rent a little 2 room office and you don't even need staff. Just greet your patients at the door yourself and see 2-10 a day with a panel of 600ish. A fraction of the overhead and more time with your patients. For real, listen to the atlasmd podcast

I worked with a physician who transitioned to this model from her rather successful insurance based family medicine practice during my rotation there. It was pretty interesting to see. She lost a lot of her patients from her old practice but was much happier not having to deal with the insurance BS and to being able to offer her patients reduced costs on labs, meds, etc.. There was a definite lean period during the transition, but from all accounts the practice is starting to gain steam again and pick up new patients and some that she had initially lost.

 

[libertyyne]

If someone wants to tag blue dog, he's doing it now and doing it successfully.

Although I'm not in family medicine I can tell you that group theory is right on with his comments. In addition I would ask where are you getting an electronic health record for $12,000? They typically run between 40 and $90,000. Do you have to purchase licenses for each user, all the hardware and software. We spent a great deal of time a few years ago investigating the cost of these.


Sent from my iPhone using SDN mobile

There are open source EHRs available that would limit you to the cost of the hardware and maintenance.

 

[bashwell]

There are open source EHRs available that would limit you to the cost of the hardware and maintenance.

Open source doesn't necessarily mean free (as in "free beer"), right? But they're probably significantly reduced in price in comparison. Maybe some are indeed free too.

More importantly, any of the open source EHRs any good? I'm genuinely curious because I have no idea.

 

[libertyyne]

Open source doesn't necessarily mean free (as in "free beer"), right? But they're probably significantly reduced in price in comparison. Maybe some are indeed free too.

More importantly, any of the open source EHRs any good? I'm genuinely curious because I have no idea.

They are free and you can purchase additional functionality with some. But some of them are completely free . Open EMR , practice fusion and if you are a masochist VistA. I can't vouch for the quality or if any will meet specific needs. But it is worth an investigation. I suppose it's about as inconvenient as running Linux on your computer compared to windows. But can theoretically do the work you want.

 

[dpmd]

I use practice fusion and it seems really nicely tailored to primary care (which isn't awesome for me as a surgeon but seems to be getting the job done fine for me). Totally free aside from the computer or smartphone I use it on.

Private practice can work for whatever specialty with the right payer mix, patient population, and some element of luck just like any other business. But I can see why so many people are moving towards employment.

 

[Winged Scapula]

There are open source EHRs available that would limit you to the cost of the hardware and maintenance.

Oh yes I'm well aware of that as a matter of fact that's what we started with many years ago. It wasn't nearly as user-friendly, or customizable, and are used to spend my entire weekend getting my charts done because of all the data entry that was required.
However, I believe this is one of those times where you get what you pay for. We considered practice fusion but they did not support electronic faxes nor did they have a portal for patient use.

My post was not meant to suggest that there aren't free or relatively cheap EMR's but that I don't know anybody who's really happy with them when they've seen what the others can do.


Sent from my iPhone using SDN mobile

 

[dpmd]

Oh yes I'm well aware of that as a matter of fact that's what we started with many years ago. It wasn't nearly as user-friendly, or customizable, and are used to spend my entire weekend getting my charts done because of all the data entry that was required.
However, I believe this is one of those times where you get what you pay for. We considered practice fusion but they did not support electronic faxes nor did they have a portal for patient use.

My post was not meant to suggest that there aren't free or relatively cheap EMR's but that I don't know anybody who's really happy with them when they've seen what the others can do.


Sent from my iPhone using SDN mobile

Hmm. Practice fusion has a patient portal now. Maybe it is new. But I haven't looked at much else besides some cerner outpatient version. But I do so little office based stuff that even paper worked just fine but I got tired of the penalty

 

[cabergoline2]

My cousin has a very profitable IM private practice in FL... He is the only attending running the practice.

Must be in South Florida...Boca raton or some such place..

 

[W19]

Must be in South Florida...Boca raton or some such place..

Lol... Is there anything particular about south FL or Boca Raton that makes it easier for private practice to flourish? I know Boca Raton is an upper middle class town (or city), but there are many towns like Boca Raton across the country...

People who know him and people who have worked with him think he is an excellent physician; maybe that helps.

 

[Stagg737]

aaaaaaaaaand this, OP, is why so many docs are going direct primary care.

Rent a little 2 room office and you don't even need staff. Just greet your patients at the door yourself and see 2-10 a day with a panel of 600ish. A fraction of the overhead and more time with your patients. For real, listen to the atlasmd podcast

These guys are legit and are proof that if you understand the business side of medicine you can vastly improve your lifestyle and income without sacrificing patient care (and actually provide far cheaper care for your patients). One of their docs came and talked about the practice at our school one time and their set-up was pretty impressive. They're also out of Wichita, KS, so while location does matter in terms of a feasible DPC practice, it's certainly very possible to do in mid to small cities or suburbs of major metro areas.

I worked with a physician who transitioned to this model from her rather successful insurance based family medicine practice during my rotation there. It was pretty interesting to see. She lost a lot of her patients from her old practice but was much happier not having to deal with the insurance BS and to being able to offer her patients reduced costs on labs, meds, etc.. There was a definite lean period during the transition, but from all accounts the practice is starting to gain steam again and pick up new patients and some that she had initially lost.

The few primary guys I've talked to that have experience with DPC have said that establishing the practice and building the patient pool is the biggest hurdle of it. I mean, this is an issue for anyone trying to start up a private practice, but I've been told it's especially difficult because insurance and Medicaid/care is so ingrained in the U.S. that dropping insurance scares a lot of people. Plus it's even harder if you are fresh out of residency and haven't established yourself in the community yet.

 

[cabergoline2]

Lol... Is there anything particular about south FL or Boca Raton that makes it easier for private practice to flourish? I know Boca Raton is an upper middle class town (or city), but there are many towns like Boca Raton across the country...

People who know him and people who have worked with him think he is an excellent physician; maybe that helps.

lots of snowbirds who spend summer in north and winter in south and need doctors at both places.. I ll not be terribly surprised if your cousin is a GI who also practices concierge IM...That is an awefully common practice model there...

 

[W19]

lots of snowbirds who spend summer in north and winter in south and need doctors at both places.. I ll not be terribly surprised if your cousin is a GI who also practices concierge IM...That is an awefully common practice model there...

He is just an IM doc and he does not practice concierge med. His practice is lean and efficient though. A couple of office staffs and spouse is the office manager. I am just baffled when I see people here say that it's hard to thrive in private practice as a PCP when I know someone who is making >350k/year working ~50 hrs/wk. The only thing is that he does not pay rent because he owns the place outright (no mortgage).

 

[Winged Scapula]

Hmm. Practice fusion has a patient portal now. Maybe it is new. But I haven't looked at much else besides some cerner outpatient version. But I do so little office based stuff that even paper worked just fine but I got tired of the penalty

Yeah clearly depends on your workflow and needs. We looked at practice fusion, next GEN, all scripts epic etc. we settled on E clinical works and although it's not perfect it's very customizable and I no longer spend my entire weekend doing charts.

When we first looked at practice fusion it was many years ago and they definitely did not have a portal or the fax capability at It was pretty bare-bones.


Sent from my iPhone using SDN mobile

 

[MrSunny1]

12,000 that figure was just the annual cost base on 3-7% of gross billing which is what most of them charge. But I'm not sure if that includes initial setup and maintenance.

 

[MrSunny1]

So I think a Medicaid only practice would be impossible operating in the red every year. Medicare/Medicaid very lean might make ends meet. But really seems would need a max of 20 - 30% Medicare/Medicaid and the rest private insurance in order to get anwhere near the averages that are posted all over the internet for private practice. Then the next step would be to try and assess demand for physician in different areas to see if it would even be feasible to open a practice. No patients = quick bankruptcy.

 

[neoevolution]

aaaaaaaaaand this, OP, is why so many docs are going direct primary care.

Rent a little 2 room office and you don't even need staff. Just greet your patients at the door yourself and see 2-10 a day with a panel of 600ish. A fraction of the overhead and more time with your patients. For real, listen to the atlasmd podcast

Are there any private practice groups that employ this model, or do you need to start your own? I feel like vacation or illness would be a lot harder to manage without having partners, and there's the issue of having the start-up capital as well

 

[neoevolution]

Open source doesn't necessarily mean free (as in "free beer"), right? But they're probably significantly reduced in price in comparison. Maybe some are indeed free too.

More importantly, any of the open source EHRs any good? I'm genuinely curious because I have no idea.

Wiki says the entire VA system uses VistA and it's open source and free. No idea if it's any good, but I suspect private EMR wouldn't be such a huge market if VistA could compete for free at the same level

 

[hello1234!]

Yeah clearly depends on your workflow and needs. We looked at practice fusion, next GEN, all scripts epic etc. we settled on E clinical works and although it's not perfect it's very customizable and I no longer spend my entire weekend doing charts.

When we first looked at practice fusion it was many years ago and they definitely did not have a portal or the fax capability at It was pretty bare-bones.


Sent from my iPhone using SDN mobile

You're lucky u didn't choose NexGen, NexGen is horrible

 

[deleted480308]

Are there any private practice groups that employ this model, or do you need to start your own? I feel like vacation or illness would be a lot harder to manage without having partners, and there's the issue of having the start-up capital as well

a lot of solo docs and groups all over the country

 

[VA Hopeful Dr]

a lot of solo docs and groups all over the country

 

[Winged Scapula]

Are there any private practice groups that employ this model, or do you need to start your own? I feel like vacation or illness would be a lot harder to manage without having partners, and there's the issue of having the start-up capital as well

It can certainly be done. I have friends doing solo practice but it is admittedly difficult without a good system for vacation. Doctors don't get sick so we don't have to worry about illness LOL

Finally it is not unheard of to have a hospital system fund your start up capital as part of an agreement to provide services. When my partner started our practice she did exactly that: presented to her skills and the fact that there was an unmet need in the community and she got a big fat check from a local hospital which enabled her to purchase the office equipment, furniture etc. Pate\four given over a few years so don't count that option out either.


Sent from my iPhone using SDN mobile

 

[tymont12]

Lol... Is there anything particular about south FL or Boca Raton that makes it easier for private practice to flourish? I know Boca Raton is an upper middle class town (or city), but there are many towns like Boca Raton across the country...

People who know him and people who have worked with him think he is an excellent physician; maybe that helps.

South Florida is known for having pockets of very wealthy residents. People with money from the Northeast go there to retire. I know a concierge doc there who has a panel of ~600 patients, fully bills their insurance, along with charging an annual membership fee of $1,800. therefore, he already grosses $1,000,000/yr before ever billing an insurance company. I'm not sure how normal his panel size or annual fee is. He also has a large office staff so it's not just a solo practice. This guy's a go-getter though, he still takes call every 3rd night and goes to the hospital regularly. He works for his patients but you can tell he loves it.

I know other concierge docs who have said that the money is about the same, but that they never have to work past 5pm and don't work weekends anymore. However, they all had at least 10 years practice and huge patient panels before doing this. I'm not sure how feasible this practice model would be in most of the country.

 

[VA Hopeful Dr]

Are there any private practice groups that employ this model, or do you need to start your own? I feel like vacation or illness would be a lot harder to manage without having partners, and there's the issue of having the start-up capital as well

http://iamdirectcare.com/direct-careers/

 

[Bearcat74]

Still possible for FM doc to start a private practice after residency? I totaled up bills average around 200-220k per year with three employees. Estimating the average physician sees approximately 18 patients per day if the schedule is fully booked for 240 work days out of the year approximately 4320 visits per year. Average reimbursement for medicare is less than 50$ per visit while medicaid is less than 75$ so 50/50 practice would earn 62.5$ per visit or 270,000 per year working 9 hour days.

Of course it would probably take 2-3 years to get to the point of having this many patients but what if there werent enough patients to fill the schedule then gross income would quickly fall from 270,000 and not cover expenses leading the physician to pay out of pocket or get loans in order to continue to run the business.

Maybe there is something that I am missing but how is this possible and profitable?

Medicare may only pay $50, but there is a 20% co-payment the pt is required to pay on the full amount of the visit. So if the Doc has a $150 visit fee (and medicare only reimburses $50 from that), he/she will also collect $30 in co-payment from the full $150, making that visit really be worth $80.

Medicaid does not pay $75. Probably more like $45 per visit.