what is a physician to do? time to re-visit.

[erichaj]

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there has been a long standing post on this site about the future of fp and earnings of fp doctors. In fact it was so debated that people started to call each other names on the net. These are doctors and future doctor. That amazes me, but this post is not about that.

I would like to talk about some of the future choices that an FP doctor may have. Before I do this, please remember I'm only making suggestions, I'm not preaching, nor am I putting anyone down. So, for those of you who want to make rude comments, don't. It is not needed. Your frustration is understood.

The average Family practice doctor starts at around 120,000 per year. This is usually in the form of a salary with production bonus. Most Fp's beat the 120000, and get the production portion. This puts them in the 135000 to 150000 range.

If you practice in east, you will have a hard time doing ob. and this could limit your income and practice population. If you practice out west. You can find many places where you can choose to do ob, thus increasing income and changing to a younger population of pts.

If you don't like ob, there are options like urgent care. Which are usually more lucrative than general out patient medicine. It could also be more fun. Also, no pager to carry, 12 hours shift with 3 day work weeks, etc.

So, what procedures can a family practitioner do?

Colonoscopy? it depends on where you live. this is not a great option due to the politics involved. but that's just my opinion.

joint injections? Yes, this is a great addition to your practice and can increase your bottom line significantly. insurance pays a great deal for injections. The training is readily available and with some work an fp physician can get very good at this.

Have you considered opening your own practice by yourself or with one or two partners? it's hard at first. but many doctors that I know that have done this are very happy. they say location is key.

Laser treatments, botox injections, collagen, bone density screening, skin biopsy, mole removals all are lucrative additions to a practice. If you own the practice, you keep the earnings.
Since these are additions to your current practice, it's all profit after costs.

I asked a questions on this website that went unanswered. I asked how much people felt a family doctor should make.

200000/year
250000/year
300000/year
350000/year
400000/year
or more. What do you think?

There were many people who were talking about greed and how money does not make you happy and then there were others who argued against this until they were ready to kill each other.

I would like to make a comment on that. this is only my opinion and I respect other peoples opinion on this topic.

I feel that money is important after 4 years of undergrad, 4 years of medical school and 3 years of residency. I feel that as family doctors we should not sell ourself cheaply to the insurance compnies. Just because we do not do procedures like the GI docs or the orthopedics docs, its does not mean that we are not needed. In fact studies show that in every country where there is a strong family medicine presence, the state of healthcare is significantly better overall.

I feel that our salaries have gone down because we have allowed it to go down. We have not stood our ground. We work as hard as other doctors and should get as much a other doctors.

The average specialist makes about 250000 per year. I don't think there would be a single fp on this site that would complain if they made average or higher than this.

Am I greedy? No, I simply compare my salary to other doctors, then to other jobs with the same or less number of years of education and training in the united states.

Yes, I know, there are doctors in africa making far less than us and doctors in england making 75 k per year. but they don't have 200000 dollar student loans to pay back. If the govt. pays my loans for me. Then the 150000 is not bad. I have no other costs.

Ok, I'll get off my soap box. but I really felt I had to make a comment on this topic.

Thank you for your time.

EH.

 

[dread]

If you are looking to make more money as an FP, there's always practicing what's known as "boutique medicine". You essentially function as a doctor for only the very wealthy; they pay you a flat fee and you agree to see them whenver they want for however long they want. Some even agree to be available 24 hrs a day by cell phone. You have a much smaller patient base, but they pay you an amount much larger then insurance companies would ever agree to reimburse so that you can serve their neuroticism about their health. I suspect that this is the way that american medicine is eventually headed with the government taking over many more of our health care services and physicians and patients who can afford it stepping outside of the socialistic system in order to obtain better care. We already kind of have that today with some physicians routinely refusing medicaid and medicare patients and only picking up patients whose insurance's reimburse well and hospitals being created for the sole purpose of providing "specialty" care which translates into well reimbursed care, but I think that trend will only continue and the tiers seperate even more with these new health care proposals being proposed in washington.

 

[lowbudget]

Ugh, who the hell wants to serve the rich and wealthy? Total pain in the @ss.

I imagine there will always be ways to make money, especially in FP. Markets change all the time, as does the environment and competition around you. These things always come in waves: FP in, FP out, Gas/Rad in, Gas/Rad out.

 

[dr.smurf]

does anyone know where you can find out how much an fp can charge for various office procedures? i guess im trying to see exactly how realistic and cost smart it would be to buy various equipment for the office if you were to go solo or start a small office. office equipment like ekg machine, hyfricator, etc. can be quite expensive.

 

[CambieMD]

I think that specialty hospitals and botique medicine are a counter balance to declining reimburesment and governmental regulations. I do not understand why some think that everyone should obtain the the same level of health care despite ability to pay. Botique medicine will continue to grow as long as the government keeps its nose out of it. Patients want an alternative to being rushed through. Those with the means should be able to purchase such services. A lawyer can charge whatever he/she wants to chagre you . They always collect 100%.
Some well established physicians in this area no longer take medicaid. That makes a lot of sense to me. Half of the time medicaid doesn't pay you . The market will dictate how businesses are run. Medicine is no different. A practice top heavy with medicaid patients will struggle to survive.

CambieMD

 

[mlbshop]

The thing with family practice (fp) is just like marketing. It is not advertised as much therefore not many people know what it consist of. I being one of them once upon a time. If it werent for my rotations through a family practice hospital i too may believe that fp is nothing more that the kleenex holder and shipper off to someone else. See that used to be the case many years ago when you did one year and then off to something else. General practitioners only did the year and then went into practice, now fp is a specialty on its own, albeit not as well know or glorified as the others. In school the train your mind that you have to pick a specialty, but if you realize they prepare to to be a general practitioner in the begining.
Look at television, they have shows for er, im and surgery but no one really sees all he work an fp has to do, in reality you have to know a bit about everything and everyone. I am not knocking specialist we need them but fp are need just the same.
Think about it, if fp made just as much would you choose it?

 

[bustbones26]

You point out the frustration that FP's do much training but are yet the lowest paid docs. But this is not because they are FP's, this is because of risk involved.

Let me give you an example. I worked with a surgeon that did a fellowship in advanced laparoscopy and did many gastric bypass procedures lap. But in order to do these, he had to fish out 70K extra on his malpractice for doing such a procedure.

So on paper, maybe he makes more than an FP, but his malpractice coverage vs. and FP is astronomical.

Think about this, 70K just to coverage doing gastric bypasses, that's not including the coverage for everything else he does too. His malpractice alone is probably the cost of an FP salary.

 

[erichaj]

although it is true that a surgeon may have an increased risk, that is not the only reason why they make more money.
The AMA puts out a book every year that has codes like ICD-9 and cpt codes. These dictate how much we get payed by insurance. medicare sets a general pay scale for these codes and most insurance companies either match or exceed these rates.

Most of these codes are procedure based. This is because you can actually see somthing being done. A clinical Dx is not a visible entitiy. Therefore you can't see the mental work needed to dx someone and it is hard to say this dx is worth this much. This is the main reason why specialist get payed what they get.

If the salary was based solely on risk, then joint injections which are simple procedures would not be getting 150 to 500 per injection. The risk is low. the liability is low. the pay is high.

that is just one example of this type of pay scale.


A NOTE ON BOUTIQUE MEDICINE:

I feel this is not for everyone, but it is a solid alternative to the traditional medical practice. It is not easy to start a boutique practice. You have to be able to find at least 100 pt's willing to give you up-front 2000 to 3000 dollars. Next, you have to be on call 24/7 unless you get a partner with you. Then you need more pt's to pay the partner as well. Every kind of practice has it's headaches. Choose your poison.

 

[bustbones26]

I agree, codes do dictate how much money you make. Yes, you are right, you make money by doing these procedures and getting the reimbursement from them.

But now, let me share the really bad news with you. My wife is an FP resident in a program with 16 ppl. NONE of them want to do procedures, they find excuses not to do things! This was frustrating to my wife because on several occassions, there was things she wanted to do and attendings just did them behind her back, lumbar punctures, intubation, etc, assuming she was "just one of those FP residents and she wouldn't want to do it anyways"

Truth is, an FP can do anything he/she pleases. Can an FP do joint injections, colpos, flex sigs, minor derm sx, deliver a baby etc etc etc. Yes!! Some even do a fellowshipsand do C-sections, tubal ligations, and vasectomies. Unfortunately, most FP offices don't do this stuff, and the ones that do are usually residency based offices that are seeing a bulk of medicare and medical assitance patients and the only reason the office thrives is because of the grant money given to them for each resident they have on staff.

So if all you want to do is outpatient primary care follow up visits, then you're not going to make any money, you will be at the bottom of the ladder.

Unfortunately, this is how many primary care practices are now, they contract hospitalist to manage their patients while in the hospital while they see patients in the office all day.

So don't gripe about FP's not making money, they have the potential to do it! There is plenty of opportunity for an FP to do some of those low risk/highly reimbursed procedures you talk about. All an FP has to do is prick a good residency program where there is opportunity for them to do some of these procedures and get comfoprtable doing them.

Another point to make here is that FP's make plenty of money to live a more than comfortable lifestyle. So why gripe about it?

I suppose I think of it this way. How many medical specialties are there? Of all of those specialties, somebody has to be a the bottom of the list for lowest average salary, right?

But that is lowest AVERAGE salary. You want more money, work for it, it can be done!! No FP has to settle for the average salary. Most do anyways.

Bottom line, want to be an DP, want to make more money, it can be done, the ball is all in your courtthough if youwant this to be the case.

 

[deleted6669]

if I'm not mistaken outpt. general peds is at the bottom of the salary scale, not fp.....talk about no procedures

 

[dr.smurf]

why would an fp not want to round on his/her pts?? how much money can you bill the pt/insurance for rounding in the hospital? is it per day...per round?

if you can swing by the hospital on the way to the clinic for an hour to round then whats the big deal? it would certainly make continuity more complete. you may actually lose pts if they feel dumped on while they are in the hospital. i wouldnt want to be cared for by some internal medicine hospitalist who doesnt know crap about me and who is just running around writing standard orders and cranking out referrals.

any thoughts?? thanks..

 

[lowbudget]

Well, it works in too many ways for me to understand but...

For some doctors, the time it takes to go to the hospital takes time away from patients in the clinic. And you're right, if it's merely a swing-by in the morning, then it potentially is not an issue assuming the patient does ok, there's no traffic, and you get to clinic on time before getting behind schedule. But if your patient is so sick (enough to be in the hospital), they might need more of your time other than a morning/afternoon round. And if they crap out during the day or night, you gotta go see them, which potentially takes away from your patients in clinic (either because you gotta ditch them to save this dude's life, or you're so tired the next day from Nursing calling q2 hours vitals).

Second thing is pertains to doctor-privilege-insurance. If you see people in the hospital, you have to have privileges in that hospital AND the patient's insurance has to approve of it. If you have privileges in hospital A and insurance says No, Hospital B, your patient is hosed. So what happens is many docs will have privileges in different hospitals to cover at least 1 hospital that's on the list of the the insurance plan that they signed on to. But if you have more than 1 patient in the hospital, it sometimes can mean driving around from hospital to hospital seeing patients.

What it comes down to is economics productivity vs. quality patient care. One advantage in punting to a hospitalist is that they're always at the hospital in case patient craps out. Plus, hospitalists tend to specialize in inpatient medicine and may keep up with that a little better. At the same time, doing only outpatient medicine means your lifestyle is a little better, despite sacrificing a really interesting part of medicine. What some FP's do then is they manage some patients in the hospital and punt other patients who are going to be really complicated/involved in the hospital to hospitalists... So again, the beauty of FP: it's flexible/optional. (But then again, you can argue that because you know this patient really well and you as an FP admitted him, you don't need to spend so much time working him/her up... thereby making you more efficient just by the fact that there's continuity of care).

So it really depends patient-by-patient, how much training you have, how comfortable you are with staying current, how much money you want to make, etc. It would really suck if you got stuck in clinic/traffic when someone craps out on the floor... that more than anything else will hit your bottom line and confidence really hard.

As far as how docs are paid in the hospital, I don't know off the top of my head but it depends on insurance plans. I want to say they pay per diagnosis but I forget if this is for the doctor or for the hospital (DRGs).

 

[bustbones26]

Well one thing to consider, and I know this from personal experience. If you see an FP that contracts hospitalist to see you if you are ever admitted to the hospital. They tell you this right up front, so that is your chance to leave their practice. If you are OK with seeing hospitalist, you sign a form stating that you understand that you will be taken care of by a hospitalist while in the hospital.

Some may not like this, but they are informed of it immediately, it is not a supise to them if they are ever admitted to the hospital.

And why do FP's do it? One observation to make. The BIG FP offices do it, not the little rinky dinky soloist. The "BIG" FP offices are what I like to call "medical factories". They have like 15-20 thousand patients as part of their practice, see patients in 15 min appointments all day long, in and out, and even though you can't get an enourmous reimbursement from just seeing a patient, they see so many patients in one day that they make profit, and unfortunately, do not have time to swing by the hospital and see patients. That is where either FP residents or hospitalist come into the picture.

The solo FP, the person that has a little tiny office and maybe 5000 patients has time.

 

[erichaj]

1. The procedures you talk about can be learned after residency.

2. An office with 5000 active pts is not a little office.

3. Where I work, even the smaller offices may choose to use a Hospitalist.

EH.

 

[Avrelian]

If the govt. pays my loans for me. Then the 150000 is not bad. I have no other costs.

This is the funniest thing I've read today

 

[iatrosB]

This is the funniest thing I've read today

You had to dig for this thread!😱

 

[lateness]

there has been a long standing post on this site about the future of fp and earnings of fp doctors. In fact it was so debated that people started to call each other names on the net. These are doctors and future doctor. That amazes me, but this post is not about that.

I would like to talk about some of the future choices that an FP doctor may have. Before I do this, please remember I'm only making suggestions, I'm not preaching, nor am I putting anyone down. So, for those of you who want to make rude comments, don't. It is not needed. Your frustration is understood.

The average Family practice doctor starts at around 120,000 per year. This is usually in the form of a salary with production bonus. Most Fp's beat the 120000, and get the production portion. This puts them in the 135000 to 150000 range.


THe average FM does not start at 120 a year, i have never heard that. it's weird bc i just recently heard from several of my friends who are finishing their resideny, and 4 of them, took job offers, some out west and on in midwest, starting at 180 and up to 200, starting.. i don't know what u are talking about.. but also remember I met FPs or FMs at several different cities and states, and some of them do everything, and some do nothing.
alot of times taht is dependent upon where they trained, whether is was opposed or not and how eager they were to learn among several other factors..

 

[bkpa2med]

Mind you the initial post was about 2 years ago so the low end of the salaries could of been 120k compared to let's say $160k.

 

[deleted87716]

This thread was obviously revived after nearly two years as part of a dispute between Avrelian and erichaj.

Closing.