Reimbursement in endocrine

[prithvi123]

I've been looking through some of the threads on this forum re: endocrine average annual base salary which can range between 200-250k for typical outpatient only practices (4-5 days/week). I had a few additional questions regarding reimbursement in this field

1) For endos comfortable with incorporating official neck ultrasounds and thyroid biopsies into their actual practices, how much more on average can this add to annual salary? (realizing that there are RVU limitations and not all positions will offer these opportunities)

2) What opportunities are available for those interested in doing inpatient endo/diabetes consults alongside their outpatient practices? What is a typical weekly schedule distribution/timeline for those that do both inpatient +outpatient, and how much higher on average are their annual salaries (if at all)?

3) What are other ways that endocrinologists can augment their annual salaries? Is picking up moonlighting shifts as a hospitalist on off days something that is feasible/done among endos? I realize that increasing patient volume per day within outpatient endo practices is another option. I also realize that with true PP + the more rural the practice setting, the higher the salary (as a general rule)

I an AMG IM resident who is drawn to endo specifically as a field because I love the physiology and the pathology and the idea of becoming familiar with a narrower subset of conditions and procedures/tools. However, I do know that endocrine traditionally is on the lower end of subspecialty compensation. I'm willing to forgo the lifestyle benefits that draw many people to endocrine in the first place in order to secure a higher yearly salary ($300k+) for my personal financial goals and responsibilities in life, while also working in a field that I enjoy and am passionate about. I wanted to get a sense of what is out there/and what's possible within the field to make that happen. I apologize for all the salary/money oriented questions---but I'm at the point in my training where I've realized the importance of considering the practical implications of career decisions and figured some of you might be able to help. Thanks for your help in advance!

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[ICmyFuture]

I perform a number of FNABs and diagnostic US(typically stick with cancer surveillance patients). You could probably make just as much with level 4 office visits so its kind of a wash. I have my ECNU, so its something I am interested in doing. You could make more if you were PP submitting your own billing vs wRVU. You can also charge for reading CGMs, this happens during diabetic visits and is around another 0.7 wrvus in addition to the clinic charge.

The averages for endo are low but some of that is due to selection bias. Most of us in Endo are not trying to hustle and make >300. We chose this field because we like seeing pure medicine patients.

However, if you are employed make around 1.7 wRVus per patient,make 55$ per wRVU and work 36 to 40 hours a week you will make more than 250k.

 

[rokshana]

Agree with IC...endocrinologists generally pick the specialty because they like the subject and are ok with making “only” 200k...

But that being said...there are endos out there making 300-500k/year...they see 35-40 pts a day and don’t take vacation, but hey! if money is your driving force...

The last survey I saw on endocrine salaries actually has a male endocrinologist making almost 1 million a yr...and has been in that survey for 5 years I think...the highest paid female endocrinologist was almost 500k. Both are definitely outliers...

And to complete a fellowship, you have to become competent in U/S and FNAs among other things...whether you choose to continue to do so after fellowship, is a choice people make...as is seeing inpt consults.

For example, currently I do only inpt consults...Raryn does no inpt consults...

If money is what you are after, yes you can make it in endocrine, but you really have to work a lot...but better you go into something that makes a lot of money if that’s what is important to you.

 

[PikminOC]

I have an endo friend who supervises an np who says he does tobacco counseling on every patient. Isn't this overbilling and fraud?

Friend makes 350. Sees 15 patient a day. Supervises two np. Is medical and lab director. Does thyroid bx. $7000 cme, 6 weeks off. Works in undesirable place

 

[rokshana]

I have an endo friend who supervises an np who says he does tobacco counseling on every patient. Isn't this overbilling and fraud?

Friend makes 350. Sees 15 patient a day. Supervises two np. Is medical and lab director. Does thyroid bx. $7000 cme, 6 weeks off. Works in undesirable place

If he does tobacco counseling then why would that be fraud? Practically every pt type seen in an endocrine office would benefit from smoking cessation.

The question would be are 100%of his pt smoking? Those that don’t smoke or are never smokers don’t need it.

 

[PikminOC]

If he does tobacco counseling then why would that be fraud? Practically every pt type seen in an endocrine office would benefit from smoking cessation.

The question would be are 100%of his pt smoking? Those that don’t smoke or are never smokers don’t need it.

He is marking tobacco counseling for people who don't smoke...

 

[rokshana]

He is marking tobacco counseling for people who don't smoke...

Not sure how much counseling needs to be done with those pts!

 

[PikminOC]

Not sure how much counseling needs to be done with those pts!

I found out he doesn't bill for it. But it's a large hospital system so maybe the billers do?

 

[Raryn]

I've been looking through some of the threads on this forum re: endocrine average annual base salary which can range between 200-250k for typical outpatient only practices (4-5 days/week). I had a few additional questions regarding reimbursement in this field

1) For endos comfortable with incorporating official neck ultrasounds and thyroid biopsies into their actual practices, how much more on average can this add to annual salary? (realizing that there are RVU limitations and not all positions will offer these opportunities)

2) What opportunities are available for those interested in doing inpatient endo/diabetes consults alongside their outpatient practices? What is a typical weekly schedule distribution/timeline for those that do both inpatient +outpatient, and how much higher on average are their annual salaries (if at all)?

3) What are other ways that endocrinologists can augment their annual salaries? Is picking up moonlighting shifts as a hospitalist on off days something that is feasible/done among endos? I realize that increasing patient volume per day within outpatient endo practices is another option. I also realize that with true PP + the more rural the practice setting, the higher the salary (as a general rule)

I an AMG IM resident who is drawn to endo specifically as a field because I love the physiology and the pathology and the idea of becoming familiar with a narrower subset of conditions and procedures/tools. However, I do know that endocrine traditionally is on the lower end of subspecialty compensation. I'm willing to forgo the lifestyle benefits that draw many people to endocrine in the first place in order to secure a higher yearly salary ($300k+) for my personal financial goals and responsibilities in life, while also working in a field that I enjoy and am passionate about. I wanted to get a sense of what is out there/and what's possible within the field to make that happen. I apologize for all the salary/money oriented questions---but I'm at the point in my training where I've realized the importance of considering the practical implications of career decisions and figured some of you might be able to help. Thanks for your help in advance!

Ultrasound and biopsies take up enough time that they don't really increase your income - you can easily do an extra followup visit during that slot and get paid more (that is, a typical followup visit reimburses more than a biopsy).

I do outpatient only, but plenty of people do some inpatient work as well. It depends on the size of your group - it can be anywhere from you going to the hospital before/after clinic to having dedicated one week on service each month, or anything else. Typically you get paid more if you're busier - but hospital consults are a pretty inefficient way to make money unless you do a ton of them. You, again, would be better off just seeing more clinic patients each day

You can always make more money by working more hours - either in your own clinic or in the hospital. Hospitalist moonlighting is also an option - I did it as a fellow and briefly considered it when I was starting out as an attending since my clinic was slow, then realized the reason I went into endocrine is my love of sleeping in my own bed at night and never followed up.

Median endocrinologist outside of academics makes $250k or so, slightly less the first couple years in practice. You can pretty typically hit $300k if you're outside a big city and actually work a full 40+ hours a week - might just need to build your practice for a year or two first.

 

[tenacious11]

If only outpatient endo with no inpatient consults and no FNAC/Thyroid biopsies, how many patients in a 8 hour day(new+ follow up) would be expected to be seen , would it be 40 mts/20 mts and what compensation would be fair if looking for a employed position for a 36 or 40 hours/week?

 

[Raryn]

If only outpatient endo with no inpatient consults and no FNAC/Thyroid biopsies, how many patients in a 8 hour day(new+ follow up) would be expected to be seen , would it be 40 mts/20 mts and what compensation would be fair if looking for a employed position for a 36 or 40 hours/week?

This is going to be incredibly variable based on location, practice type, etc but for a first order approximation - if you have 20 patients scheduled in a mature practice, it's probably ~16 f/u and ~4 new per day, which is exactly 8 hours at a 40/20 appointment type. If you assume billings using the typical endocrine distribution (at E/M Utilization Benchmarking Tool – E/M Calculator – AAPC ), assume a 15% no show rate, and multiply it out with what RVUs are currently worth in 2020, you'll get an average of 28 wRVU a day.

If you then work 4.5 days/week with that (36 patient facing hours a week) and you take 4 weeks of vacation, that is 6048 wRVU a year - quite a bit above the national endocrine average. Median endocrinologist in private practice makes about $50/wrvu total compensation, so that would come out to roughly $300k.

Lot of assumptions in that math though.

 

[tenacious11]

Thank you, so this model is probably for endos couple of years in practice most likely in a private practice setting.

 

[Raryn]

Thank you, so this model is probably for endos couple of years in practice most likely in a private practice setting.

Yes. A reasonably mature private practice, probably not in a super saturated city (that is, pay will be less in NYC, SF, two or three others) that sees probably a majority of commercially insured patients (rather than say, medicaid)

If you're a few hours out from the city, like in rural TX or something, it will be more. If you're busier, it will be more. If you're in academics, it will be less. Etc.

 

[tenacious11]

Thank you.