Strongly considering concierge

[FrustratedFamDoc]

Please spare me the ethical side of things. I love what I do and would do it for free. Traditional Primary care is getting gobbled up by corporate medicine and the trend will only continue.

I have been absorbed in to the machine. They’re buying up the entire town, which had previously been a fantastic smaller town medical community with specialists ready to see all patients regardless of insurance.

Im forced in to at least 3-5 new patients a day, on top of my already unmanageable census. My rvu is ridiculous, and I make more money than I thought I ever would, but that really doesn’t matter to me.

I’ve begged numerous times to stop with the new patients but it goes ignored. Taking on a mid level would only give them an outlet to dump even more new patients giving me 0 relief. The new patient slots take away from my patients needing an acute visit.

DPC doesn’t interest me. I want a small panel back again.

I’m ready to not feel like I suck because everything important in what I do is god awful behind and my patients still love me, surprisingly.

Not being cocky and I really have no ego, but I’m good at what I do but my current situation makes me awful at it.

I know concierge isn’t the panacea, but I can fade needy old people with the best of them. I actually oddly enjoy that aspect of what I do.

I’d love it for the altruistic ivory tower snobs to stay sane doing this for even 6 months.

I don’t want to work for another system, urgent care, DPC, telehealth or nursing home.

The physician owned conglomerate in town that represents every specialty you can think of, that would never sell, is in the process of selling out.

Owning the hospital gives quite a lot of leverage on procedural fields that need your facility. I only see the trend continuing. Money talks, especially when they can cut your hospital privileges and put you out of business.

Tell me where I’m wrong in moving to a part of the country where the weather is nice and old people who have plenty of money would gladly pay a retainer fee.

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[VA Hopeful Dr]

Why don't you want to do DPC?

 

[FrustratedFamDoc]

Why don't you want to do DPC?

I don’t wan’t more than a 500 patient panel. I want a completely solo office besides my receptionist and nurse.

I want the freedom to write whatever I want to write and never see a prior authorization ever again because they can cover it out of pocket. I want to never have to write Coumadin or awful 30 year old diabetes medicines that either crash sugar, give horrible diarrhea or make people fat and they have to lie about compliance.

I don’t want to have to game anything anymore. No negotiating for lab, medicine or imaging rates. No back and forth with Medicare. I write, it gets done, I see patient for follow up. pretty much like it’s ‘supposed’ to be.

I know all of what I typed can be picked apart and know I’m probably being naive on a lot of it.

I’m firmly a resident of fantasy island but the sand sure feels nice. You don’t hear about many concierge docs being burned out.

The systemic trend is not good. I see this as a last ditch trend to preserve my sanity and absolute joy in what I do.

Without some serious political leverage, it will be harder for corporate med to kill concierge. They’ll be able to punch more holes in DPC before concierge if the forced consolidation were to occur. National health care is still very popular politically, but that is a whole different topic.

 

[VA Hopeful Dr]

I think you are confused about DPC versus concierge.

In concierge you take insurance but have a yearly retainer type fee on top of it. You'll still have to deal with insurance companies in various ways whether billing or getting meds/tests approved.

DPC you take no insurance its purely the monthly/yearly fee and whatever other charges you have. You only deal with insurance if your patients need testing/meds that involve insurance.

 

[FrustratedFamDoc]

BIG THANKS for the clarification.

Yes, DPC 100% then.

 

[FamilymedMD]

I don’t wan’t more than a 500 patient panel. I want a completely solo office besides my receptionist and nurse.

I'm solo (currently) DPC with about 530 patients, one business manager/MA/phlebotomist and a part time MA so she can take vacations. We still do prior auths because most patients have insurance and the local hospital monopoly on won't schedule imaging unless the PCP does the PA. No other insurance issues which is why I didn't chose concierge. After eight years DPC is still simple, sane, sustainable.

I prefer small group practice so adding a doc or two but solo DPC is fine.

Direct Primary Care Alliance - DPC Education

dpcalliance.org

 

[Sushirolls]

I'm psych.
Read my thread here:

Private Practice in Progress

Building a private practice, N of 1. Enjoy. Month zero: Grand plan was to use money from inpatient gig where independent contractor doing own billings to expedite insurance paneling, so all I had to do was switch over the practice address once opened. Long story short, not a quality place I...

forums.studentdoctor.net

You will find numerous things to help you out.
I was in one larger metro, and moved rural. Both locations are backed up and takes months to get in with an FM/IM.
I'm optimistic you can re-locate where you want.

 

[Prehealth1011]

I'm solo (currently) DPC with about 530 patients, one business manager/MA/phlebotomist and a part time MA so she can take vacations. We still do prior auths because most patients have insurance and the local hospital monopoly on won't schedule imaging unless the PCP does the PA. No other insurance issues which is why I didn't chose concierge. After eight years DPC is still simple, sane, sustainable.

I prefer small group practice so adding a doc or two but solo DPC is fine.

Direct Primary Care Alliance - DPC Education

dpcalliance.org

How often are you on call?

 

[bronx43]

I’ve begged numerous times to stop with the new patients but it goes ignored. Taking on a mid level would only give them an outlet to dump even more new patients giving me 0 relief. The new patient slots take away from my patients needing an acute visit.

Bingo. I honestly have no idea why any employed doc in an outpatient clinical specialty would ever take on a midlevel.

Brb spending double the time seeing a complex new patient for 2.6 wRVUs, while I give up the stable, established patient needing a refill and lab check to a midlevel so they can get 1.92 wRVUs. Midlevels only add work onto employed docs.

If you owned your own clinic or are a proceduralist needing someone in clinic to funnel patients to your suite/OR, then ok whatever. I get it.
But employed? Nah, bro. My employer has already asked me multiple times about a midlevel, and I say no chance.

 

[VenusinFurs]

I'm mainly just upset you preemptively had to tell people not to criticize you for wanting to do this. Doctors are part of the reason things are becoming like they are becoming for us, because of stupid bootlicker brainwashing.

 

[FamilymedMD]

How often are you on call?

I'm solo for now so I'm on call unless I'm on vacation. Was worried about that when I started 8 years ago but this is better than any call group I've had. I know the patients well and they respect me and my time off. Hoping to add docs for more flexibility but this works.

 

[FrustratedFamDoc]

I'm mainly just upset you preemptively had to tell people not to criticize you for wanting to do this. Doctors are part of the reason things are becoming like they are becoming for us, because of stupid bootlicker brainwashing.

I didn’t want to hear a peep out of the pre-med/med student altruists who haven’t breathed a breath of corporate med employment.

I make an ass ton of $$. My forced volume allows that to happen, but I can not practice up to my standard of medicine, and no amount of system efficiency will change that.

24 patients scheduled in a day where 4 - 6 are new. I already know how that day is going to go, and so do they, but they really don’t care. Hopefully the day will go perfect so I can get out by 6:30. I know the longer I stay, the worse it will become. I’m so exceedingly grateful that I STILL love what I do.

In a way, the ass ton of $$ is buying my integrity, and I’m not down with that. I’m glad I have a very understanding wife, I’m sure not all docs (sorry, meant providers) do. Looks like more Sunday morning notes, task replies and signing off on labs with “sorry for the late reply.”

I’m not fresh out and my white coat hasn’t been worn in over a decade. I know what ‘before all this ish’ looks and felt like.

I internally deeply struggle, though. I’m so incredibly blessed. The guilt is so powerful.

Cost of living is almost completely irrelevant to most established docs in general. Groceries, gas, power, modest mortgage? Whatever.

Have I worked my ass off to be where I am? Um, yes. Do I have any license to say a peep about what I call a difficult job? Nope. I know first hand what it’s like to have 12 on a stroke floor, doing q2 turns and a full linen change on another at 2:45 am for $8.50 an hour. Or Walmart. Or washing dishes. Bussing tables. Selling lawnmowers.

So complaining? No. Knowing that I deserve better, yes.

 

[TableMD]

you are not complaining

you deserve better