^^Precisely A pulmonologist colleague of H makes a modest income from his medical practice, but has a showcase house and travels frequently to Europe. His wifes father owns a multimillion-dollar business of which she and her brother receive annual upper 6 figure salaries/dividends. </p>
<p>A physician in town just donated $50K to our school district after selling a large parcel of land he purchased years ago that was rezoned from agri to commercial. Most people are unaware his money is primarily from investments not his medical practice.</p>
<p>An oncologist colleague of H has been using his vacation time doing locums and even with the extra income he says he is nearly bankrupt. When he and his partner started their onc practice in the late 80s reimbursement for chemo was based on AWP not acquisition cost and Medicare/Medicaid/3rd party-payers reimbursed for administration time and cost. Well that changed and what was once a thriving medical practice is now basically bankrupt. </p>
<p>Sadly, I think the average person looks at doctors life style/assets and assume the largesse is a result of the doctors earned income … chances are it is not.</p>
<p>We’re selling our private medical practice and the $180+ and the $400+ is based on MGMA data. We’ll get paid more with a group setting because it’s all about collections and reimbursement in which private practices don’t have a prayer of competing with larger practices (favorable reimbursement is based on numbers of patients cared for). Here’s another reference for physician salaries [Physician</a> Compensation Data - Cejka Search](<a href=“Cejka Search: Health Care Executive Recruiting Firm”>Cejka Search: Health Care Executive Recruiting Firm) </p>
<p>Yes, private physician practices are going broke but physicians are not.</p>
<p>I used to work for an international hospital company and unfortunately came across too many doctors who should have been real estate developers or Wall Street types than people who want to help the sick. To equate lower doctor compensation with lower levels of care is simply not correct. I’d rather have someone go into medicine despite the lack of money than the reverse.</p>
<p>A few other things I’d like to throw out there:</p>
<ol>
<li><p>The salary figures quoted above are median, so an equal number above and below. They are also decreasing rather than increasing. I suspect that many of those below are the younger docs. If you think about 7+ years forgoing income post-bac (I do realize residencies are paid, but not exactly well), average post residency indebtedness of $200K+, and 60-80+ hour work weeks, $185K is not really not that much…if they can even make that in the future.</p></li>
<li><p>In my community, the ob-gyns are now operating weight loss centers, ENTs, Derms and Ophthalmologists trying to gear their practices to mainly cosmetic procedures and internists and family practice docs also getting into cosmetics or setting cash up front walk in clinics. Basically, it has come down to PAs and Nurse Practitioners who actually provide most of the diagnosis and treatment of actual medical problems.</p></li>
<li><p>While there are economies of scale in multi-specialty groups, I worry about the fragmentation of care and how well the doctors will actually “know” the patients they are treating beyond their EHR.</p></li>
</ol>
<p>I am actually a NP who owns my own practice with a physician partner. We both signed contracts which allow us to make more money for the same work as we will get paid for the work we do (productivity) rather than wait for collections that are dwindling due to 1) poorer reimbursements found in private practice as insurance companies pay more for larger organizations that care for “more lives” and 2) poor collections from individuals who feel that other bills are more important than doctor (especially private practice) bills. </p>
<p>We have a very successful practice and are making money. We’re just getting out due to the trends in health care and looking at the writing on the wall. All the other private primary care practices in our area are losing money and we’re the last one standing. Neither one of us is leaving the profession. We’re just changing with the times.</p>
<p>MGMA numbers show that the average salary for a new family physician is $175K which requires a 2 year residency. That salary assumes no hospital work and is pretty much a 40-50 hour a week job. I can tell you 10 years ago the starting salary for a primary care physician was around 130K. I hire physicians for my practice, so I’m not just speculating. I can tell you that a private practice cannot support the $175K salary which is why private practice is no longer sustainable and they are going broke. </p>
<p>
</p>
<p>Yes, you can make a ton of money with such a “cash business” which is why it’s being done. It doesn’t mean doctors are going broke. They just want to make more money.</p>
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</p>
<p>Theoretically transition of care will be better but I also share such worries.</p>
<p>Yes, such cash businesses can be a way to maintain a private practice. I know family practices who have been able to maintain their practice by cutting out the “extra services” and charging form fees and setting up ultrasound services in the office. I guess it all depends on your definition of “adequate income.” Do we make the assumption that other business expansions are due to inadequate income? Or do we assume that the business owners just want to make more money? It’s all semantics I guess.</p>
<p>As others have said, you can’t tell what doctors are making based on salary info and certainly not based on a medical bill. </p>
<p>Many doctors have financial interests in the equipment and the hospitals. The amount they make on a particular procedure may seem minimal but they get a cut of everything that went into that procedure. The health care act is attempting to stop that inherent conflict of interest but we’ll see how well it works. </p>
<p>I discovered how incestuous it is after my father died and I researched his doctors’ financial interest in the hospital and other health care facilities. My mother commented that everyone she knew who left the hospital entered some sort of rehabilitative care - either in the hospital or in the local nursing home. Some clearly didn’t need it or benefit from it. I researched the filings for the non-profits and found the doctors had ownership interests in the hospital, the rehab units and the local nursing homes. Their income from those dwarfed what they made just by seeing patients. Of course there was a huge conflict of interest when these doctors sent every patient for rehab. Medicare doesn’t pay for nursing home care but it pays for rehab in the same building. What a racket - that medicare almost completely pays for.</p>
<p>I think the “problem” is not that physicians don’t have a reasonable expectation of earning a very good salary, but that many have an expectation of being filthy rich. That expectation leads to business adventures which have risk - as described in the article cited - and sometimes those risks don’t pay off. Sounds like folks like GTalum who make reasonable decisions are doing OK.</p>
<p>Not sure the point of your comparison here. It is extremely competitive to get into med school in the U.S. As you know, it is not at all difficult to get into law school, it is only hard to get into a good law school.</p>
<p>I think this other quote from your linked article is more telling:
</p>
<p>Is it possible that the problem here is that there are just too many law schools? (a topic for another thread).</p>
<p>Not seeing the connect here… Those Residents are making almost double my salary as a professional healthcare provider working fulltime. </p>
<p>Insurances and especially Medicare/Medicaid are destroying healthcare in the USA. One of the biggest problems is that we have Medicare/Medicaid who are paying what they feel like paying and setting the standard. And that means politicians are involved in the funding of healthcare. The system is BROKE! It needs fixing and it needs to start at the top. Private insurance companies are making money hand and foot while the actual providers are getting less and less. This isn’t just physicians, but specialty clinics such as physical therapy clinics, etc.</p>
<p>Are we comparing apples with oranges here?
What factors should we consider to compare or to set salaries? How many patients do you see a day while working full time as compared to the resident physicians? And how many hours do the resident physicians work per week? Do you have 24 hour shifts,with hardly any sleep? Do they have over-time pay like the paramedics, fire fighters and police officers? Are the consequences of your decisions as important as the physicians?
Should we consider the number of years of education and training while maintaining high level of achievements, competitiveness of the profession, hours worked, having the knowledge, expertise and skill set to make decisions involving life and death matters and providing better quality of life for the patients. What value do you place on that?</p>
<p>When I go to an urgent care facility, they give us choices to whether to be seen by nurse practitioners and physician assistants or physicians. I have some medical knowledge so depending on the seriousness of my illness, I choose the level of care which is more appropriate. However, most of the patients will choose to see a medical doctor…even if they have to wait 2 or more hours longer.</p>
<p>Is Residency considered part of “school” or not?</p>
<p>I’m not upset that they make more or anything like that. I just don’t think somebody should say that they make “no money” when they actually make a significant amount compared to other professions while they are considered “students” still. </p>
<p>Look if a physician desires to make $200k+, I don’t begrudge them for that. They have a hard job and a lot of bills to pay. If they can get that money, good for them. </p>
<p>I just think it’s laughable when somebody making less than $75k/year is “not making good money” and it’s not just in healthcare that it is like that…</p>
<p>"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>"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>Just bookmarking, but want to remember these…</p>
<p>"The average W-2 salary is meaningless when you also have S-Corp distributions and corp profits. Keeping the salary low avoids FICA. "</p>
<p>I don’t even know what half of that MEANS!..</p>
<p>W2-they own the practice and it operates as a corporation. They are employees of the corp. and receive a W2 for their earnings. Self-employment tax-FICA- (~15%) is paid on the self-employment earnings, but not on the net earnings of the corporation. The corp net earnings are also included on the shareholder’s tax return, but they are not subject to FICA.</p>
<p>It is in the dr’s best financial interest to keep his earnings artificially low and have the corp. make a higher net income. A Sub-S corp (typical set up for smaller corp) is not double taxed like a regular corp. The shareholders can withdraw earnings without paying additional tax. The Internal Revenue Code states that a “reasonable salary” must be paid, but they do not define it further. So…Sub S corp employees take a lower salary and take more compensation out as dividends.</p>
<p>As a medical resident, they work long hours and have already finished four years of medical school and earned an MD degree. Typically, their school debt is not yet paid back, but continues to accrue interest during this period. In comparison, dental hygienists with a community college degree and a four day work week earn at least that much in most areas of the country.</p>
<p>^ The way I remember residency is, can you come up for air long enough to even THINK about money? How much have things changed in twenty years? I’ve heard there are unions, and limits to hours worked…what???</p>
<p>With regard to </p>
<p>"W2-they own the practice and it operates as a corporation. They are employees of the corp. and receive a W2 for their earnings. Self-employment tax-FICA- (~15%) is paid on the self-employment earnings, but not on the net earnings of the corporation. The corp net earnings are also included on the shareholder’s tax return, but they are not subject to FICA.</p>
<p>It is in the dr’s best financial interest to keep his earnings artificially low and have the corp. make a higher net income. A Sub-S corp (typical set up for smaller corp) is not double taxed like a regular corp. The shareholders can withdraw earnings without paying additional tax. The Internal Revenue Code states that a “reasonable salary” must be paid, but they do not define it further. So…Sub S corp employees take a lower salary and take more compensation out as dividends. "</p>
<p>In addition to private practice, I have been employed by the military, a huge HMO, a variety of places as an “independent contractor”, including county mental health. First in “psychiatry”, then “mental health”, then “behavioral medicine”, as the politics change. </p>
<p>Each has taught me the value of thinking about who the “customer” is. That is, who pays the bills? This is KEY!. </p>
<p>What I have noticed on CC, as opposed to other forums I frequent, is support for the “spectrum” diagnosis in “mental health”. This could be huge.</p>
<p>Audiophile, I was responding to this statement (which I believe hops_scout was responding to as well):
I think if you asked most people if they thought that a guaranteed $50K job for three or four years after going to 4 years of post-graduate school followed by an income of $185K a year was “not that much” they’d disagree. Even factoring in the $200K of indebtedness.</p>
<p>I know this is CC where all the kids think that they’re going to go into IB and make seven figures right out of MBA school, or $160K right out of law school, but in fact $50K/yr is a good starting salary and $185K/yr. is in the top 5% of American incomes.</p>