why would anyone with a brain go into Primary Care?

[Trollest]

So, i have been contemplating Family practice or primary care for a while, but after shadowing a solo DO today, at her family practice. I don't see how it;s a viable choice, i mean we went over the financial side of the equation, she stated having trouble making ends meet. Thus will be switching to a direct primary care model, under-which no insurance company will be involved!! At the end of the day, i couldn't help it but connect the dot between dying podiatry practice and family care. I mean she had no more than 10 patients today, and most of them came for refill. Plus, some of them told her flat out, that they will be switching to another doctor.

In a real world, INSURANCE, CODERS, AND RETURNS, is primary care even worth it? And is anyone doing anything about improving it? As i am seriously interested in both primary care and General surgery.

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[DoctorCakes]

If we are talking about anecdotal stories... my family doc in rural area drives a lambo and has a house on the lake. There are many factors for salary. Another family friend of mine does two weeks off and two weeks on and makes 200k in a big city in the Midwest. If you like primary care you can work your butt off and adjust location to make decent bucks.

 

[cliquesh]

Hah, this isn't the place to post this. Try the family medicine sub-forum. I have a few friends in family medicine. They work for a midsized hospital system in a major city. They make like $180k to $210k, which I think is more than plenty. People say it's hard to be in private practice now. Don't know if that's true. There is an attending family med physician who posts here sometimes. Her name is cabinbuilder. I believe she does locums and makes close to $300k.

 

[Grannywang]

I work in a primary care clinic and we are doing more than fine. The doctors that are partners make money hand over fist because we are moving away from fee for service model and have switched to an ACO. Although I would agree that small primary practices with only one or two doctors will probably die off soon.

 

[Trollest]

I work in a primary care clinic and we are doing more than fine. The doctors that are partners make money hand over fist because we are moving away from fee for service model and have switched to an ACO. Although I would agree that small primary practices with only one or two doctors will probably die off soon.

And she is doing it alone as well. Only doctor in the practice, what's funny is that she has been doing this for 15 years, and cant stay afloat. Those are not good stats.

 

[Trollest]

Thread can be closed, i am going to repost in Family care Subsection

 

[Mr. D.O.five]

I'd definitely go primary care IM, but only so I can do a fellowship and specialize.

 

[Ho0v-man]

In FM, you can make about as much or as little as you want. You can ***** yourself out as a rural hospitalist, cover some shifts at an ER, or an urgent care. If you're willing to put in some hours, you can make some serious bank. This is especially true if you're willing to go to a rural area.

So you can work like crazy and make mad stacks...until you don't want to anymore. Then you can go for that Monday-Thursday with a half day on Friday outpatient job. Theres a lot of malleability to how much you can make and what kind of lifestyle you can lead. Compare that to a surgeon who of course will make more on average, but will likely never have the same control over his/her hours.

Then you factor in the phenomenal job market. The more you specialize, the more limited you become geographically. FM docs might get dozens of job offers per week. Most could get a new job by the end of this sentence because of demand. Would you rather be a subspecialist in a city you've never heard of a thousand miles away from home or a primary care physician essentially anywhere in the country you want to live?

 

[RTC19]

Money isn't everything and the long-term patient relationships just through the nature of FM can be very rewarding for people. Patients grow attached to you and those relationships are priceless. Additionally, some folks like being the person who does preventative care with folks to prevent them from needing that CABG in the first place!

The variety is great too if that floats your boat which sounds like it might be the case if you are between FM and GS.

From a more pragmatic standpoint, the job market is the best in medicine (as the person above noted), the lifestyle is good (outpatient only-40 hours a week and lots of time to spend with family/friends/other interests), and the money isn't bad at all. I would wonder if maybe the physician you shadowed had special financial issues like buying too expensive of a house or having alimony/child support payments if she is struggling to make ends meet. With average loans, you shouldn't have issues paying those student loans back so long as you are smart with your money those critical first few years out of residency. (I am sure you have heard of it already, but I would highly recommend The White Coat Investor.)

 

[Blunt Dissection]

There's a family practice doc I know whose practice brings in $2.4mil/year. After paying the NPs/PAs, auxiliary staff, and other overhead expensives, he still nets $1.2mil. Business savvy plays a large role in money making - regardless of specialty.

 

[Goro]

So, i have been contemplating Family practice or primary care for a while, but after shadowing a solo DO today, at her family practice. I don't see how it;s a viable choice, i mean we went over the financial side of the equation, she stated having trouble making ends meet. Thus will be switching to a direct primary care model, under-which no insurance company will be involved!! At the end of the day, i couldn't help it but connect the dot between dying podiatry practice and family care. I mean she had no more than 10 patients today, and most of them came for refill. Plus, some of them told her flat out, that they will be switching to another doctor.

In a real world, INSURANCE, CODERS, AND RETURNS, is primary care even worth it? And is anyone doing anything about improving it? As i am seriously interested in both primary care and General surgery.

Because in the real world, people know that PC is not the 7th Circle of Hell pre-meds think it is. And more doctors nowadays are working for HMOs, etc.
My PC colleagues are dring pretty nice cars themselves, including a Corvette, and several Lexi.

 

[Mr. D.O.five]

In FM, you can make about as much or as little as you want. You can ***** yourself out as a rural hospitalist, cover some shifts at an ER, or an urgent care. If you're willing to put in some hours, you can make some serious bank. This is especially true if you're willing to go to a rural area.

So you can work like crazy and make mad stacks...until you don't want to anymore. Then you can go for that Monday-Thursday with a half day on Friday outpatient job. Theres a lot of malleability to how much you can make and what kind of lifestyle you can lead. Compare that to a surgeon who of course will make more on average, but will likely never have the same control over his/her hours.

Then you factor in the phenomenal job market. The more you specialize, the more limited you become geographically. FM docs might get dozens of job offers per week. Most could get a new job by the end of this sentence because of demand. Would you rather be a subspecialist in a city you've never heard of a thousand miles away from home or a primary care physician essentially anywhere in the country you want to live?

IMO, this is pretty important to me. Then again, I haven't started med school yet haha

 

[Trollest]

IMO, this is pretty important to me. Then again, I haven't started med school yet haha

Same here, i think the doctor i shadowed was being overly dramatic, but cant blame her as well, we saw no more than 6 patients. We are going to talk about it more on Friday, as i am shadowing her again on friday.

 

[Ho0v-man]

Same here, i think the doctor i shadowed was being overly dramatic, but cant blame her as well, we saw no more than 6 patients. We are going to talk about it more on Friday, as i am shadowing her again on friday.

No wonder she can't make ends meet. That's like 90 minutes of work or less for most docs.

 

[Grannywang]

Same here, i think the doctor i shadowed was being overly dramatic, but cant blame her as well, we saw no more than 6 patients. We are going to talk about it more on Friday, as i am shadowing her again on friday.

yeesh, it sounds like she's not good at the business side of it. Not sure how she puts food on the table if she doesn't average at least 10 a day...

 

[Trollest]

yeesh, it sounds like she's not good at the business side of it. Not sure how she puts food on the table if she doesn't average at least 10 a day...

It's all about location dude. Was thinking of PCP in rural area, maybe we will get more coverage but the area she is in is very competitive. 3 major hospitals in a 5 mile radius, bunch of Family practices around as well. So yeah, the business side of it is what's hurting, so she decided to change to a cash for service model.

 

[angeloflogic]

OP, I think your view of primary care and podiatry is very limited. It might be just that specific practice that is having issues. I'm on the west coast and most of the DO family med docs I know see 15-20 plus patients a day, and are booked out 1 month in advance. The podiatry clinic I see has three physicians and each sees around 20 per day. Success will vary with each clinic and is very location dependent.

 

[Blunt Dissection]

It's all about location dude. Was thinking of PCP in rural area, maybe we will get more coverage but the area she is in is very competitive. 3 major hospitals in a 5 mile radius, bunch of Family practices around as well. So yeah, the business side of it is what's hurting, so she decided to change to a cash for service model.

This issue actually isn't completely unheard of nowadays in large congested areas, but usually it is an issue for those that are just starting their practice. I would have expected though that after 15 years, she should have a patient base. Seeing only 9 patients a day after 15 years in practice sounds like she's either having a hard time keeping patients, or she has a problem with scheduling. Even new midlevels in congested cities will find a steady patient base because people don't want to wait a month to see a provider.

 

[Grannywang]

Primary care is no longer a single player game and this is a prime example of that. One doctor cannot do everything with the advent of EHR. She should have looked for other doctors to combine her practice because a fee for service model will not succeed especially if she plans on only keeping 1% of her patients, that's 10 patients...

 

[pseud0]

She's alone in a private practice...that's different than just being a primary care doc, she's also the primary shareholder in a business. When you work for an HMO/at a managed clinic/big hospital you dont deal with that. You get a salary and go home. She has to manage the financials

lesson is don't have a solo family care practice in 2017. How many of those do you see these days?

 

[814965]

0/10 **** troll attempt

 

[Trollest]

Primary care is no longer a single player game and this is a prime example of that. One doctor cannot do everything with the advent of EHR. She should have looked for other doctors to combine her practice because a fee for service model will not succeed especially if she plans on only keeping 1% of her patients, that's 10 patients...

even worse, think of how the OBAMA care mandate is going to affect her unless congress decide to patch it. You are require to have insurance, and most her patients (10+ years patients) have issue paying insurance and her fee as well. But i like the feedback i got from this thread, a feel a lot more confident going into FM or Med-school, just need to look into the business side a bit more. Because i dont think any group will be willing to work in the rural area. The way i see it, it's solo or nothing in those rural towns.

 

[Trollest]

She's alone in a private practice...that's different than just being a primary care doc, she's also the primary shareholder in a business. When you work for an HMO/at a managed clinic/big hospital you dont deal with that. You get a salary and go home. She has to manage the financials

lesson is don't have a solo family care practice in 2017. How many of those do you see these days?

So, you think the outcome would be the same for solo FM in rural areas?

@phantomyinyang That's because you are assuming i am a troll.

 

[814965]

.

 

[Grannywang]

even worse, think of how the OBAMA care mandate is going to affect her unless congress decide to patch it. You are require to have insurance, and most her patients (10+ years patients) have issue paying insurance and her fee as well. But i like the feedback i got from this thread, a feel a lot more confident going into FM or Med-school, just need to look into the business side a bit more. Because i dont think any group will be willing to work in the rural area. The way i see it, it's solo or nothing in those rural towns.

Another reason why a cash service won't work. Her patients will be paying twice for the same service. It only works for dermatologists because the cash side is all cosmetic.

 

[DoctorDOWell]

you think average_patient_01 has the wherewithal to find the best specialist they need or that all insurances reimburse patients for directly seeking specialists before being referred through their primary care provider?

sweety, join the real world and recognize that-- while google is a good start for laypeople to research their symptoms what they think they require in the way of healthcare-- they most likely won't be sent to your office without having seen the gatekeeper that is a primary care provider...

and god I wish there wasn't anonymity to this forum, so I could know 100% know who not to send my future patients to see. as though specialists are **burrrrp** gods or something. that's ridiculous morty

 

[Blunt Dissection]

you think average_patient_01 has the wherewithal to find the best specialist they need or that all insurances reimburse patients for directly seeking specialists before being referred through their primary care provider?

sweety, join the real world and recognize that-- while google is a good start for laypeople to research their symptoms what they think they require in the way of healthcare-- they most likely won't be sent to your office without having seen the gatekeeper that is a primary care provider...

and god I wish there wasn't anonymity to this forum, so I could know 100% know who not to send my future patients to see. as though specialists are **burrrrp** gods or something. that's ridiculous morty

Most specialist I know will refuse to see a patient or provide care beyond an initial consultation without a primary care provider established to begin with because ultimately, if there is no primary care provider involved, there is no plan for management. The only real exception I've seen to this are Cardiologist and Oncologist due to the nature of their treatments, other providers usually have to discuss with the cardiologist or oncologist before starting/stopping meds and they become the PCP for the patient until treated or expired.

 

[Coltuna]

Because in the real world, people know that PC is not the 7th Circle of Hell pre-meds think it is. And more doctors nowadays are working for HMOs, etc.
My PC colleagues are dring pretty nice cars themselves, including a Corvette, and several Lexi.

Goro, you're back! How was your time off?

 

[Goro]

Goro, you're back! How was your time off?

 

[Dr.SFla]

Because in the real world, people know that PC is not the 7th Circle of Hell pre-meds think it is. And more doctors nowadays are working for HMOs, etc.
My PC colleagues are dring pretty nice cars themselves, including a Corvette, and several Lexi.

Goro? is that really you? are you back? OMG!!! I'm so happy you're back. WE (the SDN family) have missed you!!!!!!!

 

[GypsyHummus]

Then you factor in the phenomenal job market. The more you specialize, the more limited you become geographically. FM docs might get dozens of job offers per week. Most could get a new job by the end of this sentence because of demand. Would you rather be a subspecialist in a city you've never heard of a thousand miles away from home or a primary care physician essentially anywhere in the country you want to live?

This is so huge. I look at physician recruiter sites, and majority of the jobs on there are for general internal medicine docs or Family medicine, not for specialists.

With FM, you can travel the world and still make a great living.

 

[Goro]

Goro? is that really you? are you back? OMG!!! I'm so happy you're back. WE (the SDN family) have missed you!!!!!!!

 

[Dr.SFla]

Welcome back, Sir!!!