Thank you for saying ortho can even make up to $1.5 million.
Derm is still doing very well with procedures after procedures. Ophthal can still make a lot via volume. They are getting very efficient.
Anesthesia can still make very high salary. I have seen it. The movement toward making the whole group/department out of network and start sticking the insurance company and the patients with out-of-network bill amounts. And balance bill like crazy, while refusing to give in and offer any rate reduction/negotiation with patients who have high deductible plan. The Anesthesia group I had the misfortune of having been involved with, went one step further. I got my surgeon's EOB's and hospital EOB's first 3 weeks of the procedure. Done. They did the surgery and provided the service, and they are in-network so let's get paid. The anethesia's EOB did not arrive until 2.5 months later. That was fishy....why? Because Anesthesia wants all the other claims from the hospital and surgeon get cleared and ANY deductibles are met. Then they will swoop in and take all the fat insurance checks.
As an hypothetical example, Mr. Jones, has a high deductible plans and it is $5000 per calendar year. Because it is high, the out of network and in network deductibles are combined. Mr Jones gets admitted through ER and received emergency surgery. The gas guy and the trauma surgeon are involved. Right after the surgery, the trauma surgeon and the hospital submit their bills right away so Mr. Jones finally hits the deductibles (that $5000 deductibles are met but just not sure if surgeon or the hospital will need to go after the patient for that $5000). Then the gas guy comes in from the side and bang, submit the bill 2.5 months later after all the deductibles have already been made.
In this example, for the procedure involved, say, the gas guy's in-network rate would have been $1200 while the patient is responsible for 10% co-insurance = $120. But now the whole gas group opt'ed out of all insurance plan about 3 months ago so they are now out of network. They can then charge $7000 (insane amount but they don't care. They just want to charge an insane amount just to see how much of the charge ends up "sticking", i.e. considered usual customary). And when the EOB comes back, it says, $4200 is the usual customary and for out of network, co-insurance is 40% and the plan pays 60% so 0.6 x $4200 = $2520. Bang. instead of getting paid a meager $1200 after being locked into an in-network rate, they are now paid twice the amount of their old rate. Then the gas guy gets greedy and come after the patient and balance bill him/her for the missing $1680 to make up the usual customary rate of $4200. You can now forget about reaching anyone from the gas group's front desk person. Instead, they don't have an office and they don't have a desk. The only person you can call is on your collection letter, this 1800 guy on the other side of the coast. And that 1800 person just repeats the same mantra over and over again, as though you will just pay because they keep repeating it.
Now coming after someone for that missing $1680 which is pt's responsibility is totally legal. If you honor the usual customary rate of $4200 that the insurance calculated the benefits based on, then you do need to make reasonable attempt to collect the remaining $1680.
But that is a lot of money nevertheless.
Yes, I just showed you the current and future of many gas groups and their way to make $1 million without becoming a pain guy.