Salary

[deleted87716]

how about walmart customers?

What does that have to do with anything? I don't consider the urgent care center across the street to be any real competition...why should I care about some nurse in a sore throat clinic next to the flip-flops and and batteries at the local mega-store?

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[cooldreams]

What does that have to do with anything? I don't consider the urgent care center across the street to be any real competition...why should I care about some nurse in a sore throat clinic next to the flip-flops and and batteries at the local mega-store?

are you serious? the name of the game in the usa is minimize costs and maximize profits. of EVERYONE in the game, walmart is the best. so when you say that you could care less about THE BEST in the game moving in on your turf, you MUST sit back and think twice about how you are viewing the world because it cannot possibly be a rational view. if you want to succeed where all the others that walmart ousted, you cannot continue doing the same routine.

why should you care about nurses with prescription privledges in a walmart with a 5 dollar copay that every insurance company will eat up? i guess i assumed you wanted to make a living as a primary care physician. i am sorry, i was mistaken.

further it is not just the midlevels, re-read the article. hospitals are getting fully involved here, and walmart is actually just the middleman.

its interesting that actually, nearly all the stuff they carry, they are just the middlemen. hospital services are just the newest product they are offering. this TOTALLY is inline with how they do their products.

 

[cooldreams]

maybe you think the tide of politics in giving prescription privledges is ebbing? maybe it was. but with the biggest retailer lobbying otherwise..... who knows....

 

[cooldreams]

have you ever worked at a walmart? they manage employees and operations down to the smallest detail. smile within 10 feet of any customer. the cost of each cardboard box is stamped on the side so nothing is wasted.

it is a monster. its not something you should ignore. i am on your side, but this is just something that is not going to go away.

 

[ajce9]

I agree with cooldreams that the wallmart machine is going to have a significant effect on the bottom line of many physicians.

20 to 30 % of Primary care is the coughs and colds. Just cut you salary by about 20 to 30% and there you are.

However, not everyone want to go to wallmart to get healthcare. Many don't go there now.

And, If wallmart gets more into real medicine. I mean real clinics in wallmart with patients that have chronic issues, then that sets them up for some serious litigation.

I can just see the attorneys mouths watering right now.

If you read the so called "future of family medicine" published by aafp you will get to the section that says that in the future the FM will be treating and managing more CHRONIC issues. YES, Patients are getting older and sicker.
baby boomer are coming.

So, I'm not sure how the FM doc. is going to see more volume to make more money or to keep their practice going if it takes more time to see each patient.

Medicare is cuting not increasing.

So, the real problem is not wallmart and its zigillion trillion quicki-med shops. the real problem is when will primary care get paid higher better wages.

If a specialist makes 2 to 3 x more than an FP per hour and the overhead is similar, there is a real problem there.

Bottom line is that specialist pay and primary care pay needs to meet somewhere in the middle. or at least 60/40.

I read yesterday on the aafp website that the aafp was at a conferance and stated that care was more efficient and outcomes better by fp than specialist and therefore more cost efficient. All is true.
You know what else is true? They have been telling the same people (that is anyone who will listen or won't) this information for years. I remember it when I was a resident.

NOTHING HAS CHANGED. OH, something has changed. Things got worse.

Lets hope they get better by the end of this decade.

 

[Red Beard]

further it is not just the midlevels, re-read the article. hospitals are getting fully involved here, and walmart is actually just the middleman.

I posted this in your other thread, but it fits here too.

Walmart is leasing space for these clinics, they have little to do with the business that operates there. A hospital running a satellite clinic has no greater ability to undercut private practice physicians income from withinin a Walmart than it would outside. If this was such an easy way to corner the market, we would have seen this years ago, with or without a major retailer offering to rent floorspace for it.

Walmart's angle is to get more shoppers through its door, they aren't getting into the business of medicine.

 

[deleted87716]

A hospital running a satellite clinic has no greater ability to undercut private practice physicians income from withinin a Walmart than it would outside...Walmart's angle is to get more shoppers through its door, they aren't getting into the business of medicine.

Exactly.

 

[sophiejane]

What does that have to do with anything? I don't consider the urgent care center across the street to be any real competition...why should I care about some nurse in a sore throat clinic next to the flip-flops and and batteries at the local mega-store?

you forgot to mention that the quickest way to get there is via aisle 15 between the chee-tos and the whoppers...

 

[iatrosB]

you forgot to mention that the quickest way to get there is via aisle 15 between the chee-tos and the whoppers...

I'm hungry

 

[racerx]

http://images.southparkstudios.com/media/video/809/wallmartisntrunbyanybody.mov
http://images.southparkstudios.com/media/sounds/809/YOUFOOLS.wav

 

[deleted87716]

20 to 30 % of Primary care is the coughs and colds.

Not in my practice.

FM will be treating and managing more CHRONIC issues. YES, Patients are getting older and sicker.

Maybe I'm alone in thinking that this is a good thing, but...isn't managing sick patients kinda the thing we went to medical school for...? That's what separates us from the doctor-wannabees out there. If you're only adept at managing sore throats and runny noses, prepare to have your lunch eaten.

I'm not sure how the FM doc. is going to see more volume to make more money or to keep their practice going if it takes more time to see each patient.

I'm already doing it. Every patient in my practice gets the same-length appointment. I make more money on the really sick ones. Do the math.

 

[ajce9]

Not in my practice.



Maybe I'm alone in thinking that this is a good thing, but...isn't managing sick patients kinda the thing we went to medical school for...? That's what separates us from the doctor-wannabees out there. If you're only adept at managing sore throats and runny noses, prepare to have your lunch eaten.



I'm already doing it. Every patient in my practice gets the same-length appointment. I make more money on the really sick ones. Do the math.

1. I never suggested that docs only do sore throats. But during certain times in the season we do end up with lots of those. That all ads up to revenue.

2. I believe the aafp published a list once about the most common visitis to fps. some of them were not very complicated cases.

3. Kent you mentioned in one of your old posts something like money is not everything and quality of life is and that you make somewhere in the national average for FPs.

If this this true, the money part anyway that means that regardless of how many patients you see at this time or how much time you give them you don't make more. This means that as they cut medicare and private insurance rates you will make less. You can't deny simple economics.

A doctor can be the best coder in the world and still not be able to fight the overall cuts.

 

[deleted87716]

I never suggested that docs only do sore throats.

Regardless, in these "Wal-Mart is going to put FPs out of business!" threads, that's certainly the underlying implication.

I believe the aafp published a list once about the most common visitis to fps. some of them were not very complicated cases.

What can I say? I like a challenge.

Kent you mentioned in one of your old posts something like money is not everything and quality of life is and that you make somewhere in the national average for FPs.

Money most definitely is not everything, and quality of life is indeed important. I've never specifically mentioned my income (that would be tacky), but I have stated that the average FP in my group earns well in excess of the national average. Most of us work around 40 hours/week. As far as I know, we're all pretty happy with our quality of life. I know I am.

The people who tend to fear the future are usually having trouble dealing with the present.

 

[thedman888]

The people who tend to fear the future are usually having trouble dealing with the present.

 

[bkpa2med]

 

[SoCal Doc]

Hello Everyone,
I am new to this site. I currently practice FM for a large HMO in L.A. . I am 2 years out of residency.
I found it interesting that the article we are talking about states to increase income we need to see more patients, but it does not talk about the acuity of the the patients. Your income comes down to what you bill for.

If you see all uti's and colds all day long your level of service is going to be a 99212 maybe a 99213 if they have a couple different problems, but there is no way your practice can stay alive billing 99212's all day long.

When you are managing a sicker patient population and dealing with multiple chronic problems you are Definately going to be reimbursed higher. And you don't have to spend a long time on each problem. Just make sure the patient is stable on their BP anb cholesterol meds and you docuement that you will be reimbursed for it.

Sorry to make this long winded, it is just a little annoying to see people post comments without having first hand knowledge of how the system works.

Walmart will take away some of the less acute stuff you see, but that is not where the money is anyways. I do not see my 90 and 92 year old couple that comes in once every 2 weeks to update me on their long list of medical problems going to Walmart for their cough.

People are missing the whole concept of FM. You have relationship with your patients, they know you, they trust you. You know their history their likes and dislikes. If you have a good relationship with your patient they are going to want to see you for ALL of their medical problems.

We have an Urgent care in my office building that is owned by the group, but my patients still call me first to see if I can squeeze them into mu schedule even if I am completely booked, unfortunately I can not see everyone so I have to send some of my patients to the Urgent Care, but I know who is going to be a quick appointment and which patients like to talk forever because I know my patients.

If you have no personality and your patients hate you then yes your patients are going to go else where for their care.

But if you a prick to begin with than you are not going to be successful in anything you do.

Sorry about the long winded post, but I just wanted get people back in the proper frame of mind.

 

[sophiejane]

People are missing the whole concept of FM. You have relationship with your patients, they know you, they trust you. You know their history their likes and dislikes. If you have a good relationship with your patient they are going to want to see you for ALL of their medical problems.

Excellent post, SoCalDoc. Voices of experience like yours are always welcome here. Welcome to the FM forum!

 

[George85]

>>get people back in the proper frame of mind.
The proper frame of mind is to understand what's happening to primary care in this country.

I don't agree with your acuity vs volume argument. You need those uti's and cold to smooth out the day and catch up on the 25 minutes that some train wreck managed to suck out of you that's only a 99213 - yes, I know you can bill by time, but try billing 99214 and 5 at above the national rate and see how quickly you get audited.

>>Your income comes down to what you bill for.
Again, billing at above the national rate is not smart.

>>And you don't have to spend a long time on each problem.
You may not have to, but what about when you need to? Cards can spend 30 mins going over HTN and cholesterol with a patient - I have 15 mins to cover that and their DM and all the other issues they have.

>>comments without having first hand knowledge of how the system works.
Actually, the system doesn't work - that's the point. And you won't see it getting fixed anytime soon. Specialists have much more clout than primary care and there's no way they want to see anything change.

>>If you have no personality/But if you a prick
Believe me, there are plenty of opportunities in medicine for people with poor social skills and questionable personalities. Quite often these people work in areas where patient contact is minimal to none (path, rads) or where contact is just for a short period (ortho, surg) before going back to their primary. I'm not saying that everyone in these areas are pricks, far from it - it's just that people like that can survive very well in certain area, but not in primary care. So once again, primary care has to deal with more crap by taking the brunt of patients bitching and moaning while being the low man on the totum pole. (not sure that's spelt right or even politically correct).

>>to begin with than you are not going to be successful in anything you do.
Tell that to ortho $480,000 (wefinddocs.com job4776) or anesthesia (job3712) $330 with 13 weeks off - can you believe that, 13 weeks.

 

[deleted87716]

You need those uti's and cold to smooth out the day and catch up on the 25 minutes that some train wreck managed to suck out of you that's only a 99213 - yes, I know you can bill by time, but try billing 99214 and 5 at above the national rate and see how quickly you get audited.

If you're undercoding out of fear of being audited, you need to learn how to code and document properly, as do most physicians. Your attitude is unfortunately typical.

billing at above the national rate is not smart.

Not knowing how to get paid for what you're doing doesn't seem real smart, either.

 

[Red Beard]

>>to begin with than you are not going to be successful in anything you do.
Tell that to ortho $480,000 (wefinddocs.com job4776) or anesthesia (job3712) $330 with 13 weeks off - can you believe that, 13 weeks.

Those are pretty amazing numbers, but I also see a lot of FM jobs posted on that same website that are offering guaranteed salaries in excess of $140k, loan repayment, 4 day work weeks, and full bene's including 4 weeks vacation plus 1-2 weeks CME, etc.

I'd take that over the hell of ortho residency + fellowship and the monotony and lack of continuity any day.

 

[Louisville04]

>>
>>If you have no personality/But if you a prick
Believe me, there are plenty of opportunities in medicine for people with poor social skills and questionable personalities. Quite often these people work in areas where patient contact is minimal to none (path, rads) or where contact is just for a short period (ortho, surg) before going back to their primary. I'm not saying that everyone in these areas are pricks, far from it - it's just that people like that can survive very well in certain area, but not in primary care. So once again, primary care has to deal with more crap by taking the brunt of patients bitching and moaning while being the low man on the totum pole. (not sure that's spelt right or even politically correct).

>>to begin with than you are not going to be successful in anything you do.
Tell that to ortho $480,000 (wefinddocs.com job4776) or anesthesia (job3712) $330 with 13 weeks off - can you believe that, 13 weeks.

Sorry but I don't believe you. If you have poor social skills and a questionable personality it will hurt you if you are in a referral based practice. I used to send my patients to a spine surgeon who is supposed to be very good. However, none of my patients liked him due to his bedside manner...he would walk into the room, look at the MRI and say you aren't a surgical candidate and walk out of the room....I now refer them to another surgeon.

Ortho and anesthesiology do have higher salaries than FM. However, I am sure there are some catches to those salaries you listed...just go to the gas net forum and you can read about how some anesthesiologists got hosed with their jobs.

 

[EvieG2017]

I can't believe that the NHS in the U.K is potentially being privatized under the Tory government. I know this is slightly off topic, but I can't help but bring this up. I'd love to know what others think of this, especially those based in the U.K. Could this be beneficial for our futures in terms of employment and pay rates? So far all I can see is the negatives. It's no secret that healthcare in the U.S is extremely expensive, choosing to privatize such services ostracizes the poor further. How can we expect our society to function properly and as the Tories propose in many of their policies, reduce the gap between the rich and poor when this will be the case?

In terms of our futures as healthcare professionals, could we see an increase in doctor/nurse other healthcare salaries across the U.K as a result of this privatization? My currently 'future salary' stands at a mere £22,100. After relentless hours of work, extortionate amounts of money spent on my degree is this really my future? A take home salary of

 

[smq123]

Necro-bump. If you would like to discuss current salaries, please start a new, updated thread. If you would like to discuss the situation with the UK and their NHS, please do so in the International forum.

Closing.