Vacations in private practice

[MD13]

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[Visionary]

How do vacations work for private practice MDs? Assuming you're in a group, is there typically an arrangement where you will just go on vacation whenever you want and have the other docs cover your call (and vice versa)?

Seems like it might be more involved than that---is it reasonable to expect to take vacation whenever you want?

That's exactly right, but there's a little more to it. Sure you can take whatever time off you want, whenever you want...assuming call is covered (potentially more of an issue, if in solo practice). You need to realize, though, that your overhead (payroll, rent, utilities, etc.) does not go on vacation with you. Whenever you are out of the office, you aren't generating revenue. Not that you shouldn't take vacations, but you shouldn't go crazy with them either. I've heard of docs who take a week off per month. If you're okay with making less money, that's fine. In private practice, it's really up to you. After all, you're the boss. 😎

 

[anatomyaddict]

That's exactly right, but there's a little more to it. Sure you can take whatever time off you want, whenever you want...assuming call is covered (potentially more of an issue, if in solo practice). You need to realize, though, that your overhead (payroll, rent, utilities, etc.) does not go on vacation with you. Whenever you are out of the office, you aren't generating revenue. Not that you shouldn't take vacations, but you shouldn't go crazy with them either. I've heard of docs who take a week off per month. If you're okay with making less money, that's fine. In private practice, it's really up to you. After all, you're the boss. 😎

thanks for the info...

so how much vacation time is actually feasible if you want to make a good living? say as a retina specialist, you want to bring home around 300k a year... how much vacation do you think is feasible to take?
I know a lot of this depends on the practice model. the reason I ask this is that I am very interested in international work but do not want an academic career...so I am looking for the best way to balance this and private practice. I understand that life will be harder with the new medicare cut and the ACO model that seems to be coming up so really want your honest opinion!

 

[Visionary]

thanks for the info...

so how much vacation time is actually feasible if you want to make a good living? say as a retina specialist, you want to bring home around 300k a year... how much vacation do you think is feasible to take?
I know a lot of this depends on the practice model. the reason I ask this is that I am very interested in international work but do not want an academic career...so I am looking for the best way to balance this and private practice. I understand that life will be harder with the new medicare cut and the ACO model that seems to be coming up so really want your honest opinion!

As you said, there are really too many variables to give you a solid answer. Keep in mind that the Medicare cut and ACO deal are not set in stone. Health care reimbursement on the whole does not appear to have a good future, though. Suffice it to say, if you want to do international/mission work, you can definitely do so in ophthalmology. I know many in private practice that do mission work. They devote maybe 2-3 weeks per year. More opportunities exist for anterior segment (e.g., cataracts) than retina. You will just have to strike a balance that fits you. It will be more feasible once you are established, either on your own or as a partner in a group. Early on, you need to focus on building your practice.

 

[MstaKing10]

As you stated, a lot depends on where you are in your career and the practice model. Certainly the first few years out, you will likely only want to take a 2-3 weeks so as to maximize time to build your practice. Later in your career, 6-10 weeks isn't unreasonable (as I have seen many of my attendings in private practice do). Different practices will structure their vacation differently. The bigger the practice the more likely you are to get more vacation days vs solo practitioners. Reimbursement will have an impact but despite that I think you will still have a choice as to how much time to take off, particularly later in your career.

 

[johnbl]

25 yrs in private practice...high volume cataract practice..took 16 days for a great safari in africa a month ago. i squeashed in xtra cases before i left and on return...not easy..but it is what is necessary to keep the $$ coming in. problem is medicare and the "central planners" are trying to drive doctors out of private practice and into working for hospitals and insurance companies...unfortunately latest info shows this trend accelerating..

 

[johnbl]

ophthalmology as much as we doctors complain is still a great subspecialty..can have a family ,,,a life and time for other interests..less stress than other specialties

 

[Wedgebuster]

As you said, there are really too many variables to give you a solid answer. Keep in mind that the Medicare cut and ACO deal are not set in stone. Health care reimbursement on the whole does not appear to have a good future, though. Suffice it to say, if you want to do international/mission work, you can definitely do so in ophthalmology. I know many in private practice that do mission work. They devote maybe 2-3 weeks per year. More opportunities exist for anterior segment (e.g., cataracts) than retina. You will just have to strike a balance that fits you. It will be more feasible once you are established, either on your own or as a partner in a group. Early on, you need to focus on building your practice.

Visionary,
New resident here. I think I might be interested in retina but foreign mission work is one of the main reasons I became interested in ophthalmology. Is it feasible to continue to do cataracts 1-2 weeks a year on foreign mission trips if you are a retina specialist? If not, is it feasible to continue to do a few cataracts each month to keep up my skills or will that tick off my referring comprehensivists?

 

[touchadream]

25 yrs in private practice...high volume cataract practice..took 16 days for a great safari in africa a month ago. i squeashed in xtra cases before i left and on return...not easy..but it is what is necessary to keep the $$ coming in. problem is medicare and the "central planners" are trying to drive doctors out of private practice and into working for hospitals and insurance companies...unfortunately latest info shows this trend accelerating..

Indeed, the problem is identified above. The government (medicare) and insurance companies and hospitals, I would add, are all trying to get doctors to work on salary. Why would that be? Because there is profit in doing so. Hospitals make money on doctors when they they pay them salaries, whereas doctors make more when they work for themselves. Since doctors are the least organized of the groups, they are the most vulnerable to this kind of pressure, hence the trend of buying up practices. Young doctors should take heed of this advice and think hard about keeping control of their practice/decision making as long as they can. Unless you believe that medicare or an insurance company or hospital executive will do a better job making decisions than you will. Healthcare executives salaries exceed those of almost all doctors. Its hard to believe that this kind of consolidation can be good for patient care, and provide meaningful cost control, but unless the medical professions gets up and gets involved in the dicussion with the decisionmakers, its coming.

 

[Visionary]

Visionary,
New resident here. I think I might be interested in retina but foreign mission work is one of the main reasons I became interested in ophthalmology. Is it feasible to continue to do cataracts 1-2 weeks a year on foreign mission trips if you are a retina specialist? If not, is it feasible to continue to do a few cataracts each month to keep up my skills or will that tick off my referring comprehensivists?

It's not impossible, but definitely not the best approach. As a retina specialist, you rely on comprehensive ophthalmologists for referrals. If you're doing cataracts (enough to be proficient, that is), you will have to be in competition with your referral base. No easy way around it. The problem with retina is that there aren't a lot of services you can provide on a short mission trip. Most of retina is emergent (RD, endophthalmitis) or chronic (AMD, diabetic retinopathy). That's why most mission work focuses on cataracts and correcting refractive error. Those issues can go untreated for a long time and still respond well. If you want to pursue fellowship training to enhance your mission work, I would recommend an anterior segment subspecialty, such as cornea, glaucoma, or even plastics. Many practice comprehensive with a subspecialty focus in those areas, in contrast to retina. You are more likely to keep up your cataract skills that way and will potentially acquire some other mission-worthy skills.

 

[TheLesPaul]

It's not impossible, but definitely not the best approach. As a retina specialist, you rely on comprehensive ophthalmologists for referrals. If you're doing cataracts (enough to be proficient, that is), you will have to be in competition with your referral base. No easy way around it. The problem with retina is that there aren't a lot of services you can provide on a short mission trip. Most of retina is emergent (RD, endophthalmitis) or chronic (AMD, diabetic retinopathy). That's why most mission work focuses on cataracts and correcting refractive error. Those issues can go untreated for a long time and still respond well. If you want to pursue fellowship training to enhance your mission work, I would recommend an anterior segment subspecialty, such as cornea, glaucoma, or even plastics. Many practice comprehensive with a subspecialty focus in those areas, in contrast to retina. You are more likely to keep up your cataract skills that way and will potentially acquire some other mission-worthy skills.

Great advice, thanks -- I'm sure a lot of us are thinking about our global health impact and I didn't realize how anterior segment subspecialties could add more to my international work.