Doctors going broke

<p>I think we all need to be concerned about this. While money shouldn't be the dominant motivation for a career in medicine, there's no denying that it is a factor in our best and brightest choosing the profession. In addition, if experienced docs feel it is no longer worth their while to be in practice, the overall quality of care will surely suffer. Small</a> Business: Doctors going broke - Jan. 5, 2012</p>

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"Many are too proud to admit that they are on the verge of bankruptcy," she said. "These physicians see no way out of the downward spiral of reimbursement, escalating costs of treating patients and insurance companies deciding when and how much they will pay them."

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<p>Yup, they can only push so far before it's not worth it. 3 docs where my wife works retried early mostly due to this and just being sick of all the BS and they could afford to. Younger guys working very hard to make a living--good living but not what they expected.</p>

<p>My doc must be doing something right. He drives an Audi R8 (100K+), just took a three week vacation with his wife to Scandinavia, lives in a million+ dollar home and sent his son to private elementary and high school and then Harvard, full pay. Nice guy, though, so I don't begrudge him. But I laugh every time his office charges me 50 cents for a copy of my lab report. Gotta pay the rent.</p>

<p>Yes. The Doctors of yesterday have made their money. Especially specialty surgeons and practitioners. But it's the new breed of family medicine and internal medicine that are suffering due to govt. regulations and the insurance companies. Lots of paperwork and red tape, a litigious society and the public that demands what they want based on Internet searches and not necessarily on good medicine. .</p>

<p>The insurance companies are doing quite well. As far as litigation goes, malpractice claims are down, but medical injuries are up. Rewards have been declining for years but insurance premiums don't reflect. Studies continually show that people who like their doctors don't sue them, even when they screw up so doctors can limit their liability by just being nicer people. They can limit their liability also by not screwing up so much.</p>

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The insurance companies are doing quite well. As far as litigation goes, malpractice claims are down, but medical injuries are up. Rewards have been declining for years but insurance premiums don't reflect. Studies continually show that people who like their doctors don't sue them, even when they screw up so doctors can limit their liability by just being nicer people. They can limit their liability also by not screwing up so much.

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<p>With lower reimbursement, that will only get worse. Hard to be both nice and perfect when they have to do more and more patient contacts and procedures to net the same or less income.</p>

<p>It does appear that if you want to find a new primary physician (internal or family practice), your choices are:</p>

<ul>
<li>Use one in a large multispecialty practice where the primary physicians share billing services with each other and the specialists.</li>
<li>Use a concierge practice that charges additional fees to compensate for the billing costs.</li>
<li>Use a physician who does not handle insurance billing (you pay, then do your own submission of paperwork to the insurance company who may not reimburse that much anyway since the physician is out of network and not contracted to charge within the insurance company's reimbursement limits).</li>
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<p>You are talking about the loss of private practice as health care is being restructured. The average pay od a primary care physician is 185K and a specialist 425K. That seems to me plenty of incentive to go to med school.</p>

<p>When I was home recovering from surgery with nothing but hours on the sofa to occupy me, I actually googled as many doctors as I could think of on our tax appraisal web site. I know, horrible, horrible, horrible, HORRIBLE. I had heard how bad docs have it and with hours and hours to spare each day, I just got overly curious. And I was on drugs...not in my right mind...in pain...bored and lonely...depressed and grumpy...(yikes). Anyway, not one of the docs I found on the property tax web site lived in a house of less than a million dollars in value (and in some neighborhoods, the tax value is far less than the actual market value). MANY of them are in houses valued at more than 2 or 3 million dollars. </p>

<p>Maybe I just don't know the right bankrupt doctors.</p>

<p>The co-pays of 10 bucks with the lousy reimbursement rates from health insurance,medicare,medicare will be the death of private practices that accept insuranc..i know of several docs who have started cash only practices and they are thriving</p>

<p>nrdsb4 - no reason at all to rationalize or feel guilty. It's public information :) How else is one supposed to know if his own house is appraised reasonably in comparison?</p>

<p>My D3 had foot surgery and we called back a few months later for some questions and couldn't find her excellent podiatrist. After some digging, we contacted him but he had closed his practice and moved to being part-time at two different clinics. He said it was to "simplify things" but it was clear that this was a euphemism. It's so sad, he's a great doc and came highly recommended but when the insurance companies control BOTH what piddling change they reimburse and what they demand in malpractice, well, it's clear where the money is going. </p>

<p>Our allergist also chose to move his practice to a management company so he wouldn't have to deal with insurance bs anymore. This was a doctor who you would call for a (non-emergency) appointment and be told that the next available time was about two months away! Very highly regarded and busy, and still found it hard to make ends meet (paying rent, office staff, nurses, etc. etc.). </p>

<p>I don't think for a minute that average physician income is 185K/425K. Not around here anyway. Maybe for older docs, or cosmetic surgeons, or some surgeons. My D's OB/Gyn practice recently sent her a postcard advertising that they now offer microdermabrasions and other cosmetic dermatology services. ??????? I asked them about it and they said it was just to make sure they had guaranteed income. Very sad.</p>

<p>The docs I know who are the most comfortable financially personally are those who work for HMOs or group practices where someone else does the overhead and billing & malpractice. They have some colleagues who gross or net more but those with HMOs or group practices have far less stress. Those docs have been in practice for several decades and started working with NO debt.</p>

<p>My allergist is a dear -- she's one of the most caring & best allergists in the state. She barely can pay her staff and her MOM is helping put the allergist's D through med school because the allergist can't do it alone! The allergist is also supporting her adult S & his wife.</p>

<p>Even if docs live in million dollar homes, whose to say those homes aren't underwater or how much equity they have in those homes?</p>

<p>Called about a dozen docs today in VA, trying to find which ones were accepting new patients. Got 3 who were accepting new patients, one who is no longer going to be taking BCBS, 3 who are NOT taking new patients, and a lot of answering machines with NO person on the line. Suggested that S try to go to the practice that has two docs that were highly ranked and had a live person answer the phone, with BOTH accepting new patients.</p>

<p>Just like any business, there are successful doctors and there are some not doing so good.
Back in Jersey, my old allergist had three offices and when he entertained in his 23 room mansion, the Govenor of NJ was his guest. He had two carpenters and one gardener on staff ful time. OTOH, my md tenant who owed 500K in student loans, is still looking for a fellowship position anywhere in the USA.</p>

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In addition, if experienced docs feel it is no longer worth their while to be in practice, the overall quality of care will surely suffer.

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<p>Another myth to add to the fear mongering about a different healthcare system. Accounting for differences in cost of schooling, american doctors make tremendously more than doctors in Canada. Tremendously more take home pay after excluding the cost of student loans etc. </p>

<p>Yet you know what? We have just as much of a line up to get into med school in this country, our best and brightest flock into the profession, and there is no problem at all with either quality of care or medical research. </p>

<p>They'll get over it. Not to mention, if Americans adopted a more reasonable system, doctors wouldn't be all stressed out with tons of insurance paperwork and fighting with insurers. But hey this is the system the doctors pushed for so they got it! If they moved to Canada, they would have more time to just focus on <em>medicine</em> like our doctors do and not be constantly second guessed. People do not just leave a profession over money, they leave a profession because it is no longer fulfilling and because it is too aggravating.</p>

<p>Without knowing the exact details of someones financial situation, it can be hard to tell their income just by looking at their house. Some people have large inheritances, some have well paid spouses, some have invested wisely, and others are just in debt up to their eyeballs. Some doctors have hundreds of thousands of $$ in loans, some have zero.</p>

<p>I suspect that doctors salaries are highly variable, like people in other industries. My husbands good friend is an ER doc, married to another ER doc. They have no kids, work overtime, work in an upper income area where people actually pay their medical bills. They make ALOT of money. On the other hand, a husband of a family member who is an internal medicine specialist just sold his very nice house and downsized, because he realized that with medicare cuts, his salary was going down 40%. Wife doesn't work, no family money. It was a good decision on his part, but kind of sad to have to move from the neighborhood they loved, after all that time and effort he spent to that point in his career.</p>

<p>I don't think the money is going to be there for doctors soon to keep them from retiring, and encourage the best students to go to med school. I saw on the medical bill what my husbands surgeon got paid for his knee surgery, and thought it was pathetic. He was worth 5-10 times that amount, it was next to nothing.</p>

<p>My pulmonologist is one of the very best in the US by nearly every standard. I saw him for a visit that lasted 1.5 hours. Insurer gave him a pittance for the visit. The CT bill & interpretation was much higher. He is only able to spend the time because he is at a very large teaching hospital that gets a LOT of research grants, which help subsidize the place, plus gifts from wealthy grateful patients.</p>

<p>When the head of your state blue cross blue shield, makes $5 million a year by denying coverage to patients and reducing reimbursement to physicians, you don't have far to look for the main cause of physician income problems. National insurance company CEOs make multiples of that in salary. Insurance companies wield more power than physicians do in any individual negotiation and not one iota of their work helps patients.</p>

<p>Unfortunately, physicians most often choose the old, dying structure of the individual or 2-3 person practice. There are some larger practices, 100-300 physician practices, where they control their reimbursement because they have more equal bargaining ability. Physicians just have to get over this idea of being complete entrepeneurs and they'll be so much better off, in terms of revenue and also in terms of not having so much paperwork and administration themselves.</p>

<p>My SIL is a CPA that does the taxes for many doctors. She claims their average salary is about $100,000 but the partnership income they make from ownership of the various medical devices they own runs significantly higher.</p>

<p>Would be curious as what cars the doctors who went broke were driving. </p>

<p>What I see for most docs in our area is that the delta in income from before and now is not good, but in absolute numbers the profession doesn't seem to have a problem. There may be docs who made bad business decisions who are in trouble, or those who want to live the Elin Nordegren lifestyle that they could before, but can't now, or those who choose to live in one geographical region and don't want to relocate, who are feeling the pinch, but the average doc is financially still comfortably off compared to most.</p>

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She claims their average salary is about $100,000 but the partnership income they make from ownership of the various medical devices they own runs significantly higher.

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The average W-2 salary is meaningless when you also have S-Corp distributions and corp profits. Keeping the salary low avoids FICA.</p>