private practice, matching issues, midlevels, and more

[gutonc]

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i own a company that does house calls and i also am about to be part owner of an urgent care where i'll be working. is that enough?

Then why in the name of all that's holy would you want to do a residency (unless you're lying)?

Honestly, with your CV, what most programs are looking for is the quickest way to round-file your app. Do you have "a chance?" Sure. Just as I have a chance at winning MegaMillions and Powerball in the same week. You've already gone through multiple app seasons (3 or 4?) and even when you got a spot it was only post-Scramble. Your CV is obviously beyond redemption from the standpoint of getting a residency spot. And while your business success is good for you, from the standpoint of a PD it's actually a negative. If I were a PD looking at your CV with prior unfinished training, I would just assume that, as soon as things got hairy, you'd just bail since you already have a solid backup plan. You're an incredibly high flight risk.

So my honest advice is that you should just move on. You already have a successful medical career without completing residency. You're one of the lucky ones. Enjoy it.

 

[docu]

Then why in the name of all that's holy would you want to do a residency (unless you're lying)?

Honestly, with your CV, what most programs are looking for is the quickest way to round-file your app. Do you have "a chance?" Sure. Just as I have a chance at winning MegaMillions and Powerball in the same week. You've already gone through multiple app seasons (3 or 4?) and even when you got a spot it was only post-Scramble. Your CV is obviously beyond redemption from the standpoint of getting a residency spot. And while your business success is good for you, from the standpoint of a PD it's actually a negative. If I were a PD looking at your CV with prior unfinished training, I would just assume that, as soon as things got hairy, you'd just bail since you already have a solid backup plan. You're an incredibly high flight risk.

So my honest advice is that you should just move on. You already have a successful medical career without completing residency. You're one of the lucky ones. Enjoy it.

My backup plan isn't that solid just yet, since it is in its beginning phase, and im not making a whole lot of money right now. i would definitely bail from what im doing and go to residency, because my dream is to do inpatient, not outpatient. actually i'd hire a PA to cover me and let the business run itself.

should I convey this on my application, maybe my personal statement or is it still a no go? all i want is to be BE/BC. I don't care how hard i have to work to get it and i promise to stick to it. Then I will be happy.

 

[Buzz Me]

I don't care how hard i have to work to get it and i promise to stick to it.

The problem is, your past track record indicates that you had some academic/professional problems. Makes PDs not want to take a risk with you.

 

[docu]

anyone know how to get credentialed in as many insurances as possible as a GP who is not BE/BC? i am credentialed in medicare and possibly medicaid and blue cross blue shield, my biller said i can accept PPO's too, but what about other insurances?

 

[docu]

an elaborate scam, (as everyone already probably knows because it even seems scammish) called the american board of general practice uncovered..... http://www.abgpscam.com/abgp

 

[GOMERE]

And so is the rest of all the other boards. All scams. They make you renew your licenses every 2-5 yr because they want fees. They make you be a member for fees. All a scam. And what do they provide you? Nothing really.

 

[gutonc]

And so is the rest of all the other boards. All scams. They make you renew your licenses every 2-5 yr because they want fees. They make you be a member for fees. All a scam. And what do they provide you? Nothing really.

It is clear that you have no idea what you're talking about here.

 

[Smurfette]

Thread 1


Thread 2

 

[Smurfette]

And so is the rest of all the other boards. All scams.

Not true.

They make you renew your licenses every 2-5 yr because they want fees.

Licensing and board certification are completely different. Each state has it's own licensing requirements and timeframe for renewal. Board certification simply requires you to be licensed, but has a different set of requirements to maintaining certification. Many specialties (mine included) have a 10 year certification.

They make you be a member for fees. All a scam.

You have to pay to be board certified, yes. You do not have to pay annual dues. And it is not a scam.

And what do they provide you? Nothing really.

Incorrect. Try getting a job without being BC/BE. See where you can and cannot get hired, and where you can or cannot get privileges. It does make a difference, especially as a young physician with little experience.

Board certification has been discussed on SDN at length. If interested, just do a search. 🙂

 

[neurolddoc]

Start about 6-9 months at least before you want to start practicing. Some insurances take an inordinately long time to get you credentialed.

 

[docu]

I'm a gp that hasn't finished residency and I'm thinking of opening up a clinic--mostly medicare or bcbs. How much do they gross? Some people tell me i may be making half a million a year. is this true?

and how exactly does one achieve a salary of 500k? what type of procedures and tests does one do?

thanks.

 

[Socrates25]

I'm a gp that hasn't finished residency and I'm thinking of opening up a clinic--mostly medicare or bcbs. How much do they gross? Some people tell me i may be making half a million a year. is this true?

and how exactly does one achieve a salary of 500k? what type of procedures and tests does one do?

thanks.

Sure you could gross 500k, but your costs are going to cut your actual profits down a lot, maybe 200k.

If you are gonna actually take home 500k, you'd better be prepared to do office hours from 8 AM to 8 PM every day.... and see 1 patient every 5 minutes.

 

[link2swim06]

Sure you could gross 500k, but your costs are going to cut your actual profits down a lot, maybe 200k.

If you are gonna actually take home 500k, you'd better be prepared to do office hours from 8 AM to 8 PM every day.... and see 1 patient every 5 minutes.

I think it depends on how "business" savy you are...reducing overhead will increase salary. I know of a physician who has no staff, no nurses, and pts schedule appointments online through some website. Imagine how much money is saved by not hiring/managing all of those people. Also that guys charges $200/pt/year fee to be part of his practice...needless to say he easily passes 500K and isn't seeing a patient every 5 minutes.

But I think average salary is closer to 200K for more of a traditional office setup for a gp?

 

[docB]

Sorry to quibble but this is a pet peeve of mine.

Salary means a fixed amount of money paid someone on a regular schedule for services.

If you plan to open a clinic, i.e. start a small business you will not get a salary*. You will have income. Or not. But not a salary unless you work for someone else. It is very unlikely you will get exactly the same amount every month and what you do get may not be on a regular schedule.

So few doctors are compensated based on a salary model that it is important for med students and resident to understand the difference.

(If you run your business as a corporation you can pay yourself a "salary" for bookkeeping and tax purposes. This is not really the same as a real salary.)

 

[pseudosquam]

OP: Go Concierge.

Our family physician (internist) is switching to a retainer model. Seems smart.

Imagine this - 75 per month per patient to be apart of your practice. You grow to around 3k patients in your community. Minimal staffing lands your overhead around 30-40%.

$75*12 months*3000 patients = $2,700,000 * 0.6 or 0.7 = $1.62 to $1.89 million take home 👍

That is what I call winning. Well okay - either figure is large - that is what I call bi-winning.

 

[michaelrack]

OP: Go Concierge.

Our family physician (internist) is switching to a retainer model. Seems smart.

Imagine this - 75 per month per patient to be apart of your practice. You grow to around 3k patients in your community. Minimal staffing lands your overhead around 30-40%.

$75*12 months*3000 patients = $2,700,000 * 0.6 or 0.7 = $1.62 to $1.89 million take home 👍

That is what I call winning. Well okay - either figure is large - that is what I call bi-winning.

3k is a higher patient panel than a physician in a regular practice has. I think it is typically 6oo patients in a typical concierge panel.

 

[Asp]

You probably have to have impeccable credentials (Harvard etc) to convince that many wealthy and healthy (healthy because otherwise you can't sustain a panel of 3000) patients to sign up for your concierge subscription. Like all businesses, to the winners go all the spoils. The average MD is not going to be able to set up such a nice practice.

 

[Law2Doc]

3k is a higher patient panel than a physician in a regular practice has. I think it is typically 6oo patients in a typical concierge panel.

I think even 600 is probably a lot if you are solo. You have to realize that in the concierge system, you are going to be giving access to all of these people 24-7. People are not going to pay above their insurance unless you are providing them round the clock access and response. With a big group in the hundreds, some percentage of them will be sick and injured at all times. And they won't hold off calling you like they might for a regular doctor visit, because they are paying a premium. Any resident who has cross covered 50 patients can tell you that you'll get a lot of stupid calls that will not allow you to get any sleep, and that's just 50 sick people (ie less than 10% of your customer base, more of whom will be sick during cold and flu season).

You also have to realize that concierge business is market driven. You need to find a wealthy area where there isn't much competitive business. Most neighborhoods cannot support two concierge businesses, because it's already a hard sell to get people to pay for that which their insurance already covers. And if you want 600 or thousands of people to shell out cash, you will have to find and market to them, which is a big financial and time expense not likely included in your original figure.

Basically the concierge business model can work for one or two doctors in a region if they are willing to give their entire lives over to the business, don't bite off more than they can chew, and are savvy marketers on top of being well liked doctors. For everyone else it sounds good on paper but is a quick sojourn into bankruptcy.

 

[docu]

I would love to do something like that, but most of the patients here are at poverty level on medicare/medicaid.

 

[J-Rad]

Moving to Practicing Physicians.

 

[michaelrack]

Moving to Practicing Physicians.

do the non-attendings who are interested in this topic have access to this forum?

 

[Apollyon]

do the non-attendings who are interested in this topic have access to this forum?

They're not supposed to. That defeats the whole purpose of the forum. So many residents just do NOT have a clue, but think they know it all. What they need to is get their butts kicked in the real world a bit, which will add some wisdom and (hopefully) humility to their knowledge and hubris.

And, honestly, I don't know that there is much of a market on SDN for people who haven't finished residency and aren't trying to get back in, who want to open a practice. Someone finishing residency and looking to open a new practice is another room in the same house.

 

[Smurfette]

FWIW, I have reported the post as well as PM'd J-Rad. Threads should not be moved from public forums to private forums. If this thread belongs anywhere, it belongs in the FM forum.

Actually, the OP IS a member of this forum, as she is a practicing physician, and has posted threads in this forum previously.

However, as docu did not complete a residency, moving this thread to FP or IM did not seem appropriate either. She's not asking how to open her own FP or IM clinic, but how she, as a GP, should go about opening her own clinic. Perspectives from individuals, currently in practice, in varying fields may be helpful, which is why it was moved into this forum.

 

[J-Rad]

docu has self-identified as a non-resident and as someone who is in active practice (i.e. practicing physician, albeit not board eligible/certified) as a GP. We certainly have struggled as to where to place GP-related threads and decided that they would generally be placed in TIH (if more broadly applicable to healthcare-related issues) or into PP if that area seems more germane and the member has appropriate group membership.

 

[Apollyon]

As a sidelight, did this docu disclose their gender? I don't see it on their profile page. Or did SDN breach this user's privacy? I haven't looked at all of docu's posts to see which pronoun was used.

 

[docu]

i feel weird putting myself at attending status, but maybe i am, because when i sign 485's or other forms, i sign under the blank, "attending physician".

the people who are helping me set up the clinic have high hopes for me, so hopefully it will turn out okay. it would be nice to make all the money instead of earning a percentage of someone else's practice. but hopefully i will have that kind of patient volume.

 

[Apollyon]

I thought this was a closed forum, including viewing. Why does it say "3 guests viewing"? If I try to access the Chief Resident forum, for example, I get an error message that I am not authorized.

 

[shayebug]

hello. yes -the path to "board certification in general medicine" through the requirements of the"american board of general pratice" is fraudulent. don't spend thousands of dollars and years of time pursuing this phony board certificate. find the facts at aagpscam.com.

 

[docu]

i think this clinic will do well...if i can get 20 patients a day....we shall see i guess

 

[docu]

has anyone ever heard of this?

http://www.theleadingphysiciansoftheworld.com/

they called me and wanted me to pay to join and to get a welcome packet. i was like what the heck and joined for $34/month. but i can cancel anytime. she waived my main fee cuz i kept refusing to pay the high prices.

im not that excellent by any means, at least i think so. lol....

sounds like a scam...is it?

they said i could put it under awards in my cv.

 

[DeadCactus]

You can join DeadCactus's Physician Honor Roll for a one time payment of $25 so yea, I think you're getting scammed...

 

[J-Rad]

This doesn't really have anything to do with Residency. Moving.

And no, it does not look legit. Just because they said they'd cancel at anytime does not mean they actually will. And now they most likely have your credit card number. I'd check your statements.

I used to get mailings from this one: http://usplaques.bestdoctors.com/ when I was in residency (I must have been an awesome resident!). Pretty good deal. Only $250 for a plaque saying I was one of the best doctors in the country. I didn't do it.

 

[docu]

has anyone ever heard of a hospital that will allow a licensed non-BE doc to work there?

 

[docu]

I have a few questions:

Does anyone know: Will there be more spots available this year? and if so, about how many? what about in the near future?

For one, india is passing a law where the medical grads have to return to india after their residency. Will that affect program director decisions to hire them as residents?
Will that make more spots available for grabs to others? or is the system unlikely to change just to boost program stats?

Also, there has been talk of more residency spots in the future to offset the physician shortage. I have heard that 2,000 spots are being created (but not entirely sure), and also heard that a bill *might* be passed that creates 15,000 residency spots. How likely is this to become a reality?

 

[shopsteward]

India is passing a law where the medical grads have to return to india after their residency.

How is India proposing to enforce that law?

 

[ShyRem]

Nope.

 

[Winged Scapula]

How is India proposing to enforce that law?

By refusing to issue NORI letters (no requirement to return to India) which are required for residents looking for J1 visa waivers.

 

[Law2Doc]

...
Also, there has been talk of more residency spots in the future to offset the physician shortage. I have heard that 2,000 spots are being created (but not entirely sure), and also heard that a bill *might* be passed that creates 15,000 residency spots. How likely is this to become a reality?

um, the current political opinion is that healthcare costs are too high, so it's very unlikely a bill that proposed spending so many millions to subsidize doctors is going to pass. Residency slots have been pretty stagnant and there's no reason to expect more than minimal changes.

 

[docu]

um, the current political opinion is that healthcare costs are too high, so it's very unlikely a bill that proposed spending so many millions to subsidize doctors is going to pass. Residency slots have been pretty stagnant and there's no reason to expect more than minimal changes.

wouldn't the affordable healthcare act offset these high costs? if there is a huge shortage of doctors as seen now and in the near future, how else are we going to get more doctors?

 

[docu]

i really dont see why a NP or PA is allowed in a hospital and licensed non BE docs arent. thats just blasphemous.

 

[NotAProgDirector]

The problem, I think, is that the world of medicine has evolved and the terminology has not.

It used to be that physicians trained for 1 year, then could get a license and go out and practice. Or, they could continue their training for additional years and become board certified as internists or specialists. BC internists were mainly academics.

But now, medicine has become more complex. Or society has demanded better trained phsycians -- either because they want docs with more experience, or because of medmal issues, or a million other reasons. So, BC has become the new "license". States have not changed their laws, mainly because doing so would be really complicated and not worth it. Hospitals and insurers have basically trumped state laws by demanding more strict training limits. And, this is not completely unreasonable -- if 1 year of internship was enough to learn medicine in 1960, it certainly can't be that way today.

However, you are correct that this creates some friction between physician training / licensing /.credentialing, and that for other providers (NP/PA). The difference is that NP/PA's have some limits, theoretically, on what they can do unsupervised. True, NP's can, in some states, practice completely independently -- although usually only in the outpatient arena (although I don't think the law demands this, I have not yet met an NP who practices inpatient medicine unsupervised).

In an ideal world, it would be reasonable for medical boards to have different levels of licensing -- i.e. perhaps BC internists could do "anything", but non BC internists could do only outpatient care, or would need supervision from a BC internist (whatever that means). But, changing any of this is hard and unlikely to happen.

Getting back to your original question, why don't you do moonlighting jobs? Many of my residents moonlight. They have a license, but are not BC. They can find night shifts in ED's, covering weekends at nursing homes, etc. They aren't glamorous jobs, and don't have benefits, but they do pay reaonably well. Finding jobs like this is not easy -- they often aren't listed in newspapers, journals, or web sites. You need to call places and see if there are open shifts, and what you need to fill them.

 

[ShyRem]

Depending on the state you can do this. I think some states require you at least complete an intern year. Not 12 months, mind you, but a documented complete intern year.

 

[NotAProgDirector]

You've asked a question that has no answer. Or too many answers. Depending on how you look at it. Much like asking "what's the value of Facebook's stock going to be next year?"

In general, the number of residency slots has grown slowly each year since 1997, when the total funding for residency spots was capped. There are lots of reasons -- duty hour limitations, opening of new hospitals / programs, perceived shortages of physicians, etc.

But, that's only half of the equation. The number of US medical students is also increasing. Allopathic schools specifically were told (by the AAMC) to increase enrollment by 15%. Several new US allo schools have opened or are in the process of opening. And, DO schools have grown in size like crazy (complicated issue, but the DO schools are overseen by COCA, which has no teeth and little control of it's members. Hence, they are growing like crazy, likely to increase tuition revenues). So, if the growth of US grads outpaces residency slot growth, then there's actually a net loss of positions for non-US grads.

The 2000 spots I believe were in the ACA, specifically for new primary care only training programs. Honestly, I don't know of any being created (although perhaps they are being created in the FP world, of which I would not be aware). The 15K slots was a suggestion / bill that had no chance of going anywhere in Congress.

Which brings us to the really interesting question -- the "doctor shortage". Is there a doctor shortage? It's an interesting question, and depends on what you see as the role of physicians. However, many argue that the doc shortage is due to the impending retirement of the baby boomers. If you believe that and train a bunch of new docs, what happens when the baby boomers all die? Then we'll have a physician oversupply.

I predict that, in the near future, Medicare residency funding will get trimmed. It's possible that it could take a hit if the sequestration thingie happens -- Medicare is cut by 2% only in payments to providers, if I remember correctly. Who knows if "residency payments" are included in payments to providers, and whether they will be cut by 2%, or more than 2%. Certainly if politicians are trying to keep people "happy" during cuts, cutting residency funding will be much more palatable than cutting physician funding in general.

 

[Socrates25]

i really dont see why a NP or PA is allowed in a hospital and licensed non BE docs arent. thats just blasphemous.

Hospitals arent comparing MDs against NPs, they want everybody to have a piece of paper behind their name and title that says "certified" regardless if the certification is trash or not.

Hospitals get sued frequently if someone on their staff ****s up and it turns out they arent "board certified." It also invites media and public pressure on their facility and credentialing process.

If we made up a new job called "magic witch doctor" and started putting them in hospitals, it's only a matter of time before hospitals start demanding that all "magic witch doctors" are "board certified" by some sham "accreditation" organization, even if it's completely dubious and an obvious sham. They do the same bull**** with naturopaths, chiropractors, acupuncturists, and the rest of the charlatans. Its a stupid exercise at putting up a front to stave off inquiries by malpractice lawyers, media, and government organizations.

You can imagine (RIP) Mike Wallace on 60 minutes doing a sensational show and getting outraged that none of Podunk Hospitals' 30 doctors are board certified. Thats the kind of BS the hospitals are responding to. Even if the certification is an absolute joke, it's the necessary golden ticket to get admission.

 

[Socrates25]

i really dont see why a NP or PA is allowed in a hospital and licensed non BE docs arent. thats just blasphemous.

The real blasphemy is that there are bridge programs for PA to MD, but yet there is no reciprocal bridge for non-BE/non-licensed/non-BC MD to PA.

the PAs on these forums make all kinds of ridiculous excuses as to why there's a double standard at work here, but it is obvious that its the same kind of of protectionist racket dribble that they accuse us of using to limit their scope of practice.

 

[Socrates25]

I'm a GP and have a license and I've been looking for job opportunities (besides home care). I haven't been able to find much on craigslist or simplyhired.com or even googling it. I read somewhere that one can work in a rural ED non BE/BC, but where exactly do you find such jobs?

Any help would be much appreciated.

Thanks.

These are the places where you can work:

1. Most rural places -- they're so desperate to find people they cant be picky.

2. Indian Health Services

3. Some VA locations, depending on how "desirable" the location is (e.g. Los Angeles, forget about it)

4. Urgent care clinics

 

[Postictal Raiden]

Just wondering, wouldn't it be better if the government offers to pay for students' medical education, and in return, students agree to do residency with no pay?

I'm sure the situation if much more complex than that (due to variation in medical school costs and residency length), but I think this is a "fair" solution for both, medical students and the community.

 

[InterimChair]

why can't medicare to reimburse residents directly during the residency years?

 

[Law2Doc]

Just wondering, wouldn't it be better if the government offers to pay for students' medical education, and in return, students agree to do residency with no pay?

I'm sure the situation if much more complex than that (due to variation in medical school costs and residency length), but I think this is a "fair" solution for both, medical students and the community.

Simplistic approaches to complex problems are not a good mix. First, indentured servitude (aka slavery) is illegal in this country. And obligating yourself to work for 3-7 years for free after you are awarded a degree is pretty close to that definition. Second, if the government starts subsidizing the education of one profession, why shouldn't lawyers, teachers, etc get free education too? And it's not like student loans are small potatos to the lending industry, so basically the government would be hitting a segment if the US economy hard. And finally, it's a hard sell to the public to subsidize sending rich kids to professional schools to graduate and earn high incomes, while Johnny can't read. Basically this is a huge political can of worms, with the group you want to benefit already deemed too benefitted by society as is, and your "fair" solution is far more complex and unfair to too many parties than you give it credit. Government focuses on what sounds good to the public first, helps big industry and banking second, and "greedy rich doctor wannabes" last. To do otherwise is political suicide.

 

[Law2Doc]

i really dont see why a NP or PA is allowed in a hospital and licensed non BE docs arent. thats just blasphemous.

First, blasphemous doesn't mean what you seem to think it means.
Second, the real issue is lability. Under the law, you get held to a higher standard with a higher degree. Meaning as an MD, you are going to be held to the same standard of care of the typical physician working in whatever field you work in. So if you moonlight in an ED, as a licensed physician, you are going to expected to meet the level of the average ED physician, not someone who is a GP with one year of experience. An NP or PA gets held to the standard of care expected of someone with that lesser level of education, so it's a much lower standard, even if the task is the same. So the risk to that individual, the hospital and the medmal carrier is lower. That's why non BE physicians are a problem -- they simply don't have the training commensurate to the level of liability and legal expectations they incur. So it's simply better to have someone with average training and knowledge for an NP working at a hospital than it is to have a doctor with below average training, even if their training is better than an NP.