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Mike,
I have no further comment on your post.
Just read both articles. It literally says against your statement.

You clearly misunderstood my point. Rural docs choose to work less and earn less (Work vs leisure, simple economics), but if given a position at a hospital or group practice, the salary is always higher than urban areas. Many young, mid age docs choose this higher salary and put in the hours. but many also choose to work 30hrs a week and enjoy comfortable living. With this in mind, Mid/Southwest region still tops earning over Northeast and CA.

Did you even look at the Median salary vs highest earning state income? Take a look at that number and rethink your position.
If you are talking about TOP 100 earners, yes they are all in major cities like NYC, LA, Boston, Chicago, etc. BUT GENERALLY, (talking average doctors) higher salaries are given in rural areas. You really don't have to be a doctor to figure this out. As someone had mentioned earlier, it's simple economics. Big cities draw more people in and thus less salary. Rural area needs incentive for docs to serve those areas. From what I remember, there are 1000 patients per 1 doc in nyc. In other rural areas, the ratio can be as high as 8000:1.

Pun said:   Mike,



If you are talking about TOP 100 earners, yes they are all in major cities like NYC, LA, Boston, Chicago, etc. BUT GENERALLY, (talking average doctors) higher salaries are given in rural areas. You really don't have to be a doctor to figure this out. As someone had mentioned earlier, it's simple economics. Big cities draw more people in and thus less salary. Rural area needs incentive for docs to serve those areas. From what I remember, there are 1000 patients per 1 doc in nyc. In other rural areas, the ratio can be as high as 8000:1.


I can't believe I have to simplify this that much for you to understand.

Read the bolded part. The statement of rural docs make more than big city docs is incorrect based on the bolded statement. Rural docs cannot make what the docs in the bolded statement make. What rural docs can do is on average make more than the average doc in LA or another big city.

So if the #10 highest paid doc makes $400,000 (or whatever number you want to use) then can a rural doc make the top 10? No, not even close. There is simply far too much business and money making opportunities in the big city along with higher reimbursement in the big cities.

SO in other words rural docs cannot make as much as the top big city docs, but they can make more than your average big city doc when you look at their average.

Next time I suggest you read what is written because way back when I specifically said I see the books on hundreds of practices so I know the top 10,20, or 50 money making practices/doctors. I specifically stated that most of those top earning practices/doctors (you know the ones in the top 10,20, or 50) are in big cities, thus proving rural docs cannot make as much as those specific docs. Now if you wanted to come in and say your average LA, Chicago, or NYC doc can't make what he could if went to a rural location that was in need of his specialty then you would be correct, but even then he isn't approaching what his peers make in those cities that are the top earners, or in other words his rural butt can't make what those specific big city docs can. So if you want to make the most money possible you need to be in a big city.

You then tried to disagree and post regional information which is completely irrelevant.

You wanna know why we collect over $20 million a year in fees? This is why. Basic things physicians don't grasp about business.

mikef07 said:   Pun said:   DrDubious said:   Pun said:   Many are linked with the Scientology groups.

Not that I'm doubting you, but I've never heard this and would like to learn more.

Got a link or reference?


Mike clearly has no clue. Many physicians have come forward on this thread with their input and he still argues.
Mike, do you get our monthly journals? At least once or twice a year, there are statistical data of state incomes based on over 30,000-40,000 offices. You have what...500? You call that a number that most physicians have ever worked with? I am sorry but, just within my network, I have over 700 practicing physicians all over the country. Although, I have no clue of what their numbers are, I'd take these statistical data based on medical journals over your lousy 500 books.

These management companies do MORE HARM than goods. There are many doctors who are incapable of running an office, but they are much better off by seeking help from their colleagues and mentors, instead of sinking $$$ on these companies. Personally, I have seen over two dozens of physicians who got burnt bad from these managements and had to close their doors.

Drdubious,
Try googling. Just to throw one out there, Ster1ing Healthcare Manangement. I am not saying (nor denying) that they are one of them (some groups will break the law to harass you, and for that reason I have replaced L with 1 on Ster1ing)


Keep your head in the sand. BTW there are not 30,000 to 40,000 Urology offices in the USA. In 2009 there were approximately 10,000 Urologists in the US. Our company works with over 1500 practices. I personally work with over 500. So I could look up billing amounts for any of the 1500. Second learn about statistics. If NYC has 100 physicians and the top 20 are higher than rural docs and the bottom 40 are way lower than rural docs, then to say that physicians are higher paid in rural areas over big city docs is just plain wrong. On average when taking into account the bottom 40 they may be. Your top paid physicians in America If you ranked them 1-100) are in big cities (and their suburbs) for the most part.

Furthermore a rural community might have two Urologists making $400K whereas a big city might have 40 making only $300K or less thus driving the average pay down, but there are also 10 or so making well over $500K. Third many physicians lie. All those journals do is ask physicians what they make. They also don't take into account physicians who are able to double dip because they own surgery centers, hospitals, various rolling lab facilities, etc. Those can only be supported in larger cities and their suburbs.

But yeah you know what you are talking about. I do this for a living and unlike your journals we actually see what is billed rather than a survey asking doctors what they make. BTW we get every journal related to our field. 700 practicing physicians? Great. Since I have relationships with well over 500 practices (A little hint. One practice has over 50 docs) my number far exceeds yours. Second you have viewed their billables exactly 0 times (other than your own practice) whereas I have seen pretty much everyone's that we work with. Finally I have no dog in this fight. We work with both rural and big city docs. I can tell you unequivocally the top practices are in big cities.

I can;t speak on any other company other than mine. In the end when they open their books up after we work with them they are more profitable and provide higher success rates to their patients at least according to their own books. If not they would leave us in a heartbeat. WE give them the ability to offer substantially more options for their patients. Again this is off topic and what we provide is irrelevant. What is relevant is that I get to see the books.

Specifically tell me where in rural America a Urologist is making more than $700K per year because I personally know of 20+ big city docs that are and since you claim that rural docs make more naming what city they are in should be no problem especially since you know over 700 practicing physicians in the US alone. Ironically I could tell you which rural docs do make that kind of money so we can see if you can name 5 or so. WIll wait for your answer as to what rural cities these guys are in.


I'm curious about what you said because I suspect I see a few holes in your logic and some clarity would help.

1. You have said at least as many times as I've had birthdays that you get to look at "books" then you seem to have changed to "billables". These are obviously two very different things. Is your view on compensation based on what is billed to insurance companies or what ends up in the Dr's hand at the end of the day? They could be extremely different numbers....

2. You have mentioned how great your business is several times and it's very diverse customer base (rural and big city, large and small) but then when the new urologist asks whether or not you're somebody to know, your response was an arrogant "if you're worth it, we'll find you". Doesn't that undermine everything you're saying? If you have a the keys to running a successful practice regardless of size and location, wouldn't that include a new practice? At least there, you wouldn't have to train the staff out of bad habits. Perhaps it's that single doctor practices just aren't worth you while, but how would we know that?

3. Wasn't the OP about the changes that come under Obamacare? I'm sure you know how it will effect your business better than I, but 5 years out, will there even be private insurance? At that point, will your business continue to be viable? If I was going into med school today, I would be far more concerned about 10 years out than I would be about current healthcare trends.

Mike,
Seriously, read again. If you still don't get it, read until you get it.

Pun said:   Mike,
Seriously, read again. If you still don't get it, read until you get it.


"If you are talking about TOP 100 earners, yes they are all in major cities like NYC, LA, Boston, Chicago, etc.
Read the bolded part. The statement of rural docs make more than big city docs is incorrect based on the bolded statement. Rural docs cannot make what the docs in the bolded statement make. What rural docs can do is on average make more than the average doc in LA or another big city."

If you need little help, just concentrate on this paragraph.

As I have said millions of times over and over again, Major cities have few outliers (like TOP 100 earners) but GENERALLY, Rural docs (average doctors) make more than urban ones (Unless they choose to work less). Higher salaries are offered IN GENERAL.

What you are saying is, take 100k (urban) vs 200k (rural) after residency because you have greater potential to be the top earner. Seriously?!? I am a successful practioner in Manhattan with near 7figure salary, but for me to aim for 8figure is like hitting a lotto. Most docs are better off taking the 200k vs 100k and growing from there. If you take the pay cut at 100k and stay in major cities, you'd end up like the rest of 99% docs with average income (which would be 100k difference per year vs rural). If one is certain of his/her success, I'd say take the income hit and aim for that 20mil/year practice...but like I said, you have better chance of hitting that mega million.

I am pretty sure you are on the same page as me (from your statement, "What rural docs can do is on average make more than the average doc in LA or another big city"), but you are SO FIXED on outliers and fail to see the general population which this thread is about.

double post

mikef07 said:   Pun said:   mikef07 said:   Pun said:   Urology or any other sub specialty group will do better in major cities and states, ABSOLUTELY!
People travel few hundred, thousands of miles to see these specialist who are affiliated with many famed hospitals.
But doctors in general is the opposite. Many families won't even go few extra blocks to see their regular physician.


Please explain this to me.

The average physician generalist makes a median of $173K in the US.

Based on what you have said it would lead us to believe that in the big cities that it would have to be less than the median or close to it (but below) because:

1) Less docs in rural areas so more would have to be below in big cities slightly because the rural docs would be above the median and there are fewer rural docs

However when I looked at the numbers for your larger cities in America this is what came up:

LA -$189K (above)
Chicago - $183K (above)
Dallas - $172K (at)
Houston $173K (At)
NY - $201K (above)
SF - $207K (above)
Boston - $191K (Above)
Miami - $169K (below) Well you got one right
Seattle (186K) above)

SO rural docs would have to make significantly less than big city counterparts for the median of US to be below all of those large cities otherwise all of the big city docs would be below the median. SO for the median in the US to be that much below there has to be a hell of a lot of rural docs that drag that median down. Please let me know if I missed any significant big cities. I also just checked Atlanta, DC, Phoenix and Vegas (all are at median except DC which is above). Approximately 10% of physicians are in the rural setting so pretty much what you are saying is statistically impossible except for a few outliers.

I will wait for an explanation as to where the generalists are located in the US that are making the median at 173K which is well below most big cities.


Mike,
I am not sure what data you are looking at but it can be biased based on the type of data pulled.
If it's Salary.com, you are obviously looking at the wrong number.
An Average 30-60yo Primary Care physicians? including salaried? Does it include semi-retiree?

Take a look a few of the links below:
Text
West is comparable to mid/southwest (although still lower) because of cities other than LA (including OC/Irvine, etc), San Diego.

Text
Northeast takes almost every category on Lowest income. Mid/Southwest takes almost every category on Highest income.

Take a look at the median income vs highest paid region income. If you don't know why the median income is higher than highest paid region income, you shouldn't be giving any advice in your urology billing/consulting group.

Rural doctors tend to work less, and earn less, although they have the opportunity to earn more. If one commits to working full time (apple to apple) compare to major city, the salary is significantly more. This relates to what BenH had said before. People earn less in NYC but they choose to earn less while working full hours. On the other hand, people in the rural work less while making similar amount of money due to lower cost of living. IMO, we shouldn't consider them in GENERAL physician's income because they work different number of hours. But every data groups them together.



AS I pointed out take the top 100 earning physicians and rank them according to pay. If you think the majority are in rural areas you are sadly mistaken. There are no cities listed in those links. Show me median income for SF?LA docs and then show me what rural areas beat them. Little hint too - For rural docs to make more than big city docs they have to make more than every big city doc or the statement is not true. Saying that rural docs earn less because they work less is hilarious. Either they make more or less. Period. Take amount at end of year and compare to other docs amount at end of year. More is more.


Uhh, no. Read between the lines a little here. No one is arguing what you think they're arguing, Mike. Yes, the highest earners are in the big cities because there are more patients and a few of the powerhouse practices will capture a disproportionate amount of the market share there. Yes, everyone understands that.

HOWEVER, it is a select few that are able to score a position in these practices. The majority of the big city docs are fighting for the left over scraps. Smaller city docs can capture a larger market share, and on AVERAGE, make more. Every doc here has told you that these smaller towns are giving them better offers. That's been the trend for decades now.

Pun said:   Pun said:   Mike,
Seriously, read again. If you still don't get it, read until you get it.


"If you are talking about TOP 100 earners, yes they are all in major cities like NYC, LA, Boston, Chicago, etc.
Read the bolded part. The statement of rural docs make more than big city docs is incorrect based on the bolded statement. Rural docs cannot make what the docs in the bolded statement make. What rural docs can do is on average make more than the average doc in LA or another big city."

If you need little help, just concentrate on this paragraph.

As I have said millions of times over and over again, Major cities have few outliers (like TOP 100 earners) but GENERALLY, Rural docs (average doctors) make more than urban ones (Unless they choose to work less). Higher salaries are offered IN GENERAL.

What you are saying is, take 100k (urban) vs 200k (rural) after residency because you have greater potential to be the top earner. Seriously?!? I am a successful practioner in Manhattan with near 7figure salary, but for me to aim for 8figure is like hitting a lotto. Most docs are better off taking the 200k vs 100k and growing from there. If you take the pay cut at 100k and stay in major cities, you'd end up like the rest of 99% docs with average income (which would be 100k difference per year vs rural). If one is certain of his/her success, I'd say take the income hit and aim for that 20mil/year practice...but like I said, you have better chance of hitting that mega million.

I am pretty sure you are on the same page as me (from your statement, "What rural docs can do is on average make more than the average doc in LA or another big city"), but you are SO FIXED on outliers and fail to see the general population which this thread is about.


You failed to read. Sorry. Outliers? No. I am fixed on who makes the MOST money which is what I have stated since I first posted about it. Big city docs make the MOST money. Count up all the $ of which physician makes the MOST and it isn't rural. Period. End of story. So if you are a physician that is looking to maximize earnings over your career the big city is where to do it. Oh and it shows how little you know since earning more than the average rural doc isn't like hitting the lotto. Not even close. Many many of my big city docs make well over what rural docs do. Here is some plain math for you. 10 big city docs making $400K or more and 12 more making $200K or less with what we can call an average of $350K. 2 rural docs can make $400K each so on average they are making more than the average of the 22 big city docs. However being 10 out of 22 making more is hardly like hitting the lotto. You keep reaching though. Oh and for the record you look even more foolish because if you are making close to 7 figures as you claim there is no rural doc making close to that so in other words. No rural doc can make as much as Pun the big city doc. This is why we will always be in business. Bad business analysis.

Many that we don't do business with make less also. ANy decent Urologist in the big city can make $500K if he focuses on doing so and runs a decent practice. Not many rural Urologists are making that. But again I only help run a $20 million dollar business where I see actual numbers coming in each and every day. Oh and yeah we probably don't run analysis to see where the $ are. Oh wait we do. Now red away jealous people.

mwa423 said:   

I'm curious about what you said because I suspect I see a few holes in your logic and some clarity would help.

1. You have said at least as many times as I've had birthdays that you get to look at "books" then you seem to have changed to "billables". These are obviously two very different things. Is your view on compensation based on what is billed to insurance companies or what ends up in the Dr's hand at the end of the day? They could be extremely different numbers....

2. You have mentioned how great your business is several times and it's very diverse customer base (rural and big city, large and small) but then when the new urologist asks whether or not you're somebody to know, your response was an arrogant "if you're worth it, we'll find you". Doesn't that undermine everything you're saying? If you have a the keys to running a successful practice regardless of size and location, wouldn't that include a new practice? At least there, you wouldn't have to train the staff out of bad habits. Perhaps it's that single doctor practices just aren't worth you while, but how would we know that?

3. Wasn't the OP about the changes that come under Obamacare? I'm sure you know how it will effect your business better than I, but 5 years out, will there even be private insurance? At that point, will your business continue to be viable? If I was going into med school today, I would be far more concerned about 10 years out than I would be about current healthcare trends.


Very fair questions.

Re #1) We see both. We see profit, expenses, and billables. And all 3 are very different numbers

Re #2) Didn't mean it in an arrogant way. 1) If he is a new doctor then it is not worth knowing us since we can't really get you bang for your buck until you reach a certain volume. 2) WE specialize in one very focused area. If he goes into women's health then it is worthless to know us. If he focuses on Prostate cancer then it is worthless to know us3) If he joins a practice as a new person he will likely have little to no influence so it is also not worth it to know us. If and when he hits a volume that makes sense for us to come in we will find him. Could we advise on a small low volume practice? Yes, but we don't since there is no money in it. There are single man practices that we work with that are well worth it and there are large group practices that are not worth it (although that is rare).

Re #3) Urology is a practice that is heavy heavy Medicare. Most of our physician's business comes from Medicare. So if Private insurance went away it could help us possibly because there would be no more high paying private companies so these physicians would need to maximize $ per patient from a lower paying Medicare.



Oh and to the poster above who said the majority yeah 12 out of 22 is the majority, but 10 is hardly like hitting the lotto. Oh an prior to this you can go back and read I did this in the Orthopedic field and the Bariatric/General Surgery field and it was very similar.

mike,
I feel so sorry for your clients.
After so many attempts, you still fail to grasp the basic point.

misterspaghetti said:   mikef07 said:   Pun said:   mikef07 said:   Pun said:   Urology or any other sub specialty group will do better in major cities and states, ABSOLUTELY!
People travel few hundred, thousands of miles to see these specialist who are affiliated with many famed hospitals.
But doctors in general is the opposite. Many families won't even go few extra blocks to see their regular physician.


Please explain this to me.

The average physician generalist makes a median of $173K in the US.

Based on what you have said it would lead us to believe that in the big cities that it would have to be less than the median or close to it (but below) because:

1) Less docs in rural areas so more would have to be below in big cities slightly because the rural docs would be above the median and there are fewer rural docs

However when I looked at the numbers for your larger cities in America this is what came up:

LA -$189K (above)
Chicago - $183K (above)
Dallas - $172K (at)
Houston $173K (At)
NY - $201K (above)
SF - $207K (above)
Boston - $191K (Above)
Miami - $169K (below) Well you got one right
Seattle (186K) above)

SO rural docs would have to make significantly less than big city counterparts for the median of US to be below all of those large cities otherwise all of the big city docs would be below the median. SO for the median in the US to be that much below there has to be a hell of a lot of rural docs that drag that median down. Please let me know if I missed any significant big cities. I also just checked Atlanta, DC, Phoenix and Vegas (all are at median except DC which is above). Approximately 10% of physicians are in the rural setting so pretty much what you are saying is statistically impossible except for a few outliers.

I will wait for an explanation as to where the generalists are located in the US that are making the median at 173K which is well below most big cities.


Mike,
I am not sure what data you are looking at but it can be biased based on the type of data pulled.
If it's Salary.com, you are obviously looking at the wrong number.
An Average 30-60yo Primary Care physicians? including salaried? Does it include semi-retiree?

Take a look a few of the links below:
Text
West is comparable to mid/southwest (although still lower) because of cities other than LA (including OC/Irvine, etc), San Diego.

Text
Northeast takes almost every category on Lowest income. Mid/Southwest takes almost every category on Highest income.

Take a look at the median income vs highest paid region income. If you don't know why the median income is higher than highest paid region income, you shouldn't be giving any advice in your urology billing/consulting group.

Rural doctors tend to work less, and earn less, although they have the opportunity to earn more. If one commits to working full time (apple to apple) compare to major city, the salary is significantly more. This relates to what BenH had said before. People earn less in NYC but they choose to earn less while working full hours. On the other hand, people in the rural work less while making similar amount of money due to lower cost of living. IMO, we shouldn't consider them in GENERAL physician's income because they work different number of hours. But every data groups them together.



AS I pointed out take the top 100 earning physicians and rank them according to pay. If you think the majority are in rural areas you are sadly mistaken. There are no cities listed in those links. Show me median income for SF?LA docs and then show me what rural areas beat them. Little hint too - For rural docs to make more than big city docs they have to make more than every big city doc or the statement is not true. Saying that rural docs earn less because they work less is hilarious. Either they make more or less. Period. Take amount at end of year and compare to other docs amount at end of year. More is more.


Uhh, no. Read between the lines a little here. No one is arguing what you think they're arguing, Mike. Yes, the highest earners are in the big cities because there are more patients and a few of the powerhouse practices will capture a disproportionate amount of the market share there. Yes, everyone understands that.

HOWEVER, it is a select few that are able to score a position in these practices. The majority of the big city docs are fighting for the left over scraps. Smaller city docs can capture a larger market share, and on AVERAGE, make more. Every doc here has told you that these smaller towns are giving them better offers. That's been the trend for decades now.


I am out. Don't even try to make sense in him. I just feel HORRIBLE for his clients who are throwing their hard earned money away (you can red me for the latter statement...but couldn't resist).

Pun said:   Just to throw one out there, Ster1ing Healthcare Manangement. I am not saying (nor denying) that they are one of them (some groups will break the law to harass you, and for that reason I have replaced L with 1 on Ster1ing)

Since this is a public info, here is the link
Text


Wow, crazy stuff. Closest thing I had heard of was the Bhagwan drumming up work for gastroenterologists in Oregon.
Maybe I should take a look at these guys, as I have long suspected I have Body Thetan problems in my accounts receivable. Well, that's what I get for letting the Moonies do my billing.

I have no concept of the size of the field or the players in it; do these guys and fellow-travelers really play a dominant role?

Pun said:   misterspaghetti said:   mikef07 said:   Pun said:   mikef07 said:   Pun said:   Urology or any other sub specialty group will do better in major cities and states, ABSOLUTELY!
People travel few hundred, thousands of miles to see these specialist who are affiliated with many famed hospitals.
But doctors in general is the opposite. Many families won't even go few extra blocks to see their regular physician.


Please explain this to me.

The average physician generalist makes a median of $173K in the US.

Based on what you have said it would lead us to believe that in the big cities that it would have to be less than the median or close to it (but below) because:

1) Less docs in rural areas so more would have to be below in big cities slightly because the rural docs would be above the median and there are fewer rural docs

However when I looked at the numbers for your larger cities in America this is what came up:

LA -$189K (above)
Chicago - $183K (above)
Dallas - $172K (at)
Houston $173K (At)
NY - $201K (above)
SF - $207K (above)
Boston - $191K (Above)
Miami - $169K (below) Well you got one right
Seattle (186K) above)

SO rural docs would have to make significantly less than big city counterparts for the median of US to be below all of those large cities otherwise all of the big city docs would be below the median. SO for the median in the US to be that much below there has to be a hell of a lot of rural docs that drag that median down. Please let me know if I missed any significant big cities. I also just checked Atlanta, DC, Phoenix and Vegas (all are at median except DC which is above). Approximately 10% of physicians are in the rural setting so pretty much what you are saying is statistically impossible except for a few outliers.

I will wait for an explanation as to where the generalists are located in the US that are making the median at 173K which is well below most big cities.


Mike,
I am not sure what data you are looking at but it can be biased based on the type of data pulled.
If it's Salary.com, you are obviously looking at the wrong number.
An Average 30-60yo Primary Care physicians? including salaried? Does it include semi-retiree?

Take a look a few of the links below:
Text
West is comparable to mid/southwest (although still lower) because of cities other than LA (including OC/Irvine, etc), San Diego.

Text
Northeast takes almost every category on Lowest income. Mid/Southwest takes almost every category on Highest income.

Take a look at the median income vs highest paid region income. If you don't know why the median income is higher than highest paid region income, you shouldn't be giving any advice in your urology billing/consulting group.

Rural doctors tend to work less, and earn less, although they have the opportunity to earn more. If one commits to working full time (apple to apple) compare to major city, the salary is significantly more. This relates to what BenH had said before. People earn less in NYC but they choose to earn less while working full hours. On the other hand, people in the rural work less while making similar amount of money due to lower cost of living. IMO, we shouldn't consider them in GENERAL physician's income because they work different number of hours. But every data groups them together.



AS I pointed out take the top 100 earning physicians and rank them according to pay. If you think the majority are in rural areas you are sadly mistaken. There are no cities listed in those links. Show me median income for SF?LA docs and then show me what rural areas beat them. Little hint too - For rural docs to make more than big city docs they have to make more than every big city doc or the statement is not true. Saying that rural docs earn less because they work less is hilarious. Either they make more or less. Period. Take amount at end of year and compare to other docs amount at end of year. More is more.


Uhh, no. Read between the lines a little here. No one is arguing what you think they're arguing, Mike. Yes, the highest earners are in the big cities because there are more patients and a few of the powerhouse practices will capture a disproportionate amount of the market share there. Yes, everyone understands that.

HOWEVER, it is a select few that are able to score a position in these practices. The majority of the big city docs are fighting for the left over scraps. Smaller city docs can capture a larger market share, and on AVERAGE, make more. Every doc here has told you that these smaller towns are giving them better offers. That's been the trend for decades now.


I am out. Don't even try to make sense in him. I just feel HORRIBLE for his clients who are throwing their hard earned money away (you can red me for the latter statement...but couldn't resist).


No need to feel sorry for my clients. They love us for the most part. Our retention rate is in the high 90%. I feel sorry for your patients. If you can't understand basic concepts, nor can you read very well what does that mean for your patients? Lets hope you don't kill someone. The analytics say that we do our job very well. Higher profit, higher patient outcomes. Keep that head in the sand though.

As you said ironically if you want to make the most money as a physician as in be in the top 100, 200, 300 etc. your chances of doing so are in the big city.

The funny thing too is that you think these physicians (Urology in my case) are fighting over scraps in the big city. Not even close. SHows me what you know about the business side of medicine is minimal at best. Stick to what you do. I notice you never listed examples of specifically where a rural doc makes as much as you supposedly do in Manhattan. Figures. All talk.

Mike,

As I have stated earlier, I make close to 7 figures (take home) in nyc and I don't even come close to being TOP 10,000 physician. So to take the risk of being in the big city for Top 100 is just a dream for many. Many colleagues will persue that dream and have a huge financial setback in their career. Some (talking lotto odds) will make it but the odds are greatly against you.

Good luck, I hope you grasp the subject in the near future.

Pun said:   bigtimesaver3652 said:   Hey bud. Here is my advice as I am a physician. DON'T GO INTO PEDIATRICS!!!! They make like 80k per year, and you have to deal with psycotic parents who are worried about little Johnie's behavioral problems preventing him from going to harvard in the future. If you really like pediattrics, I would recommend doing anesthesia and then doing a fellowship in pediatric anesthesia. I work days now, no weekends or overnights at a pediatric hospital and make about 350k. If you want to work weekends and overnight call you can make 500k/year pretty easily. It is fun and the kids are fun.

232 is a great step 1 score. Don't worry about the passes in the 3rd year clerkships. It is all subjective anyway, if you are a hot female you will get better grades. Just make sure to not piss anyone off.


I also agree.
My sister went to Havard undergrad (Full scholarship), Havard Med & Peds. Now, She is struggling with her payment on a 4 y/o minivan. She has been out of the residency since 2001.

That's not what I wants to hear. I am not going to medicine in order to be rich, but I also don't want to have to worry about making basic ends meet. Not lookin to live lavishly, but struggling w car payments just seems not the deal I want. At the same time, peds seems to usually score on the higher end of job satisfaction ...

That's uncommon

Just look at the averages I posted a link to earlier and it will be clear that most don't have that problem

None of my pediatric colleagues are the richest people I know but none are also struggling to get by.

dhodson said:   That's uncommon

Just look at the averages I posted a link to earlier and it will be clear that most don't have that problem

None of my pediatric colleagues are the richest people I know but none are also struggling to get by.


Yes, I totally agree.
Just like few outliers who make 8 figures. There are going to be some who make barely enough.
Most Pediatricians love what they do, no matter how little they make.
My sister still loves what she does and wouldn't trade for anything in the world. IMO, she spends way too much time with each patient (45mins initial visit) in order to make comfortable living. She also resides in Boston, and the cost of living doesn't help with 2 kids.

If you break it down:
Student Loans, Mortgage, Kids, Car, etc in major city, one would need minimum $200k HHI.

Pun said:   Mike,

As I have stated earlier, I make close to 7 figures (take home) in nyc and I don't even come close to being TOP 10,000 physician. So to take the risk of being in the big city for Top 100 is just a dream for many. Many colleagues will persue that dream and have a huge financial setback in their career. Some (talking lotto odds) will make it but the odds are greatly against you.

Good luck, I hope you grasp the subject in the near future.


How do you not get this? It doesn't matter if it is top 100, top 10,000 or top 20,000. If you want to fall into any one of those you better be in the big city.

Based on what you have said and tax rates that put your income at around $2M. If $2M doesn't put you in the top 10,000, but puts you in the top 20,000 and someone wants to be in the top 20,000 then they are better off being in the big city. Not going to happen in a rural setting. Or at least the odds of that happening is lotto odds like. If what you say is true and $2M does not put you close to the top 10,000 then $500,000 is anything but lotto like odds. That would have to put you in top 50,000? 70,000?

linkin06 said:   sigh can any doctors out there give me advice? i'm a third year med student. school itself is not a pleasant experience. i got a 232 on step 1, but 3rd year grades are not going well... just passing. i was thinking of going into peds, but person above said he wouldn't recommend primary care in retrospect? i feel like i may like peds because 1.) helping cute kids who are sick without illnesses they control 2.) being able to be an advocate for kids who often may not have one
I like Peds, but primary care can be tough. I'm still in my primary care residency and it definitely has many downs. I am on call again tomorrow on our own inpatient service and will probably be hitting 90 hours this week. The paperwork is also non-stop and you're expected to do much of it on your own time. The sheer volume of new research, guidelines, and knowledge that you need to pick up and keep up with (in your own time, too, obviously) is staggering. But, as long as you like the specialty you choose, the ups are enough to bring you back up again and drive you to keep going. For Peds specifically, remember that you're treating the (anxious-and-about-to-have-a-nervous-breakdown-because-it's-my-first-baby-and-she's-crying-what-do-I-do-what-do-I-do-what-do-I-do) parents as much as you are the kids (if not more so). Dealing with the kids is generally fine, even accounting for the flailers and the criers. Dealing with parents can potentially be much more stressful.

Primary care is the wrong field for anyone that wants to practice medicine as just a job. Treat your clerkship years as though you are interviewing each specialty for a month. You want to make sure to choose a specialty (and residency program) that aligns with your personality. The culture also varies between and within each specialty. Pick something you love that has a culture you can work with and you'll be fine.

SUCKISSTAPLES said:   linkin06 said:   sigh can any doctors out there give me advice? i'm a third year med student. school itself is not a pleasant experience. i got a 232 on step 1, but 3rd year grades are not going well... just passing. i was thinking of going into peds, but person above said he wouldn't recommend primary care in retrospect? i feel like i may like peds because 1.) helping cute kids who are sick without illnesses they control 2.) being able to be an advocate for kids who often may not have one
OT but just wondering - how can you see sick kids all day without catching their illness too? Are dr superhuman a d immune to all these sick kids , or do they miss half the year working because the dr themselves are ill?

I'd rather work on people with injuries than contagious disease. Then again , I'd rather just work with a book, pen and computer and not deal with anyone in person

You DO get sick. VERY sick, sometimes. But, the culture in pretty much every residency program in the country is that you deal with it and come in to see patients, regardless. Taking a sick day off is akin to showing up to an interview in shorts and a t-shirt. It's strongly frowned upon because seeing patients is not something that can be put off until later without any consequence.

There was a recently published study where they surveyed residents on things like how often they went in to work sick, how many times they thought they got a patient sick, and how many times they thought other residents got a patient sick. Summary: we do get sick and patients do catch stuff from us. Yes, it sucks for everyone affected (patients and residents/MDs in general).

bigtimesaver3652 said:   ...Don't worry about the passes in the 3rd year clerkships. It is all subjective anyway, if you are a hot female you will get better grades. Just make sure to not piss anyone off.
I disagree about the importance of passing (it is important), but the rest of what I quoted is pretty dead on.

Kanosh said:   Anesthesia. Interesting. You don't see many TV doctor shows about anesthesiologists - there's not the excitement of an ER doctor or a surgeon. Dare I say that for most people this speciality might be a bit boring? Important, yes, and vitally so for those going under. I imagine it takes a very specific personality type to do well as an anesthesiologist. What attracted you to the field?

I'm not an anesthesiologist, but they can have quite a bit of excitement. Ever been in a hospital when they call a Code Blue? A Code Blue is called whenever a patient is found unresponsive or not breathing (or someone accidentally hits the code blue button). Yup, anesthesiologists have to go to those and can be key in stabilizing patients. Some intubations can be really tricky. Think along the lines of sticking a straw down someone's throat if that someone is 5'9", 450lbs, and not breathing. Not enough "excitement" for you? Too boring?

My reply to any post by mikef07 regarding MD reimbursement: yes, we understand that you probably "have access to" urologist financial info. But, most MDs are not (and do not want to be) urologists and not every specialty is so procedure-focused (which is where the money is).

I know most of my urologist friends who went to the city ended up making less than those who went to the boonies (private insurers pay less in the cities.)

3 of my buddies in the rural east coast made 4 millions, 2 million, and 1.5 million respectively a few years back.
That is certainly NOT the norm.

JacksonX said:   I know most of my urologist friends who went to the city ended up making less than those who went to the boonies (private insurers pay less in the cities.)

3 of my buddies in the rural east coast made 4 millions, 2 million, and 1.5 million respectively a few years back.
That is certainly NOT the norm.


Private insurers pay less in the city? Huh? That is simply not true. I definitely see this every day. I can tell you for a fact that private insurers pay more in SF/LA and OC than in rural areas of CA. Dallas and Houston pay the most in TX. NYC definitely pays more than in the middle of nowhere. What you say is not supported by Medicare data, analytics that we receive and run as well as insurance payments out to physicians that are from United Healthcare, BLue Shields/Blue Cross, Medicare, Aetna, and a few others.

Reimbursement has been (to date) biggest in LA, SF, NYC, and Boston.

4 million doesn't touch what some of the guys from Premier make. Those guys would be the first to tell you they couldn't come close to making what they do in rural parts of the East Coast. Not to mention I simply don't believe what you say since I can run procedure payments out and see what rural areas support that.

Bur hey this is FWF where people always seem to just make crap up and never support what they say and never give examples.

mikef07 said:   JacksonX said:   I know most of my urologist friends who went to the city ended up making less than those who went to the boonies (private insurers pay less in the cities.)

3 of my buddies in the rural east coast made 4 millions, 2 million, and 1.5 million respectively a few years back.
That is certainly NOT the norm.


Private insurers pay less in the city? Huh? That is simply not true. I definitely see this every day. I can tell you for a fact that private insurers pay more in SF/LA and OC than in rural areas of CA. Dallas and Houston pay the most in TX. NYC definitely pays more than in the middle of nowhere. What you say is not supported by Medicare data, analytics that we receive and run as well as insurance payments out to physicians that are from United Healthcare, BLue Shields/Blue Cross, Medicare, Aetna, and a few others.

Reimbursement has been (to date) biggest in LA, SF, NYC, and Boston.

4 million doesn't touch what some of the guys from Premier make


I can tell you that my friends in NYC and the surrounding vicinity actually take LESS from BC/BS than medicare (about 80-90%) because of increased competition; similar in Philadelphia.
Whereas there are people in the "boonies" who get around 1.5x medicare and higher because the insurers are desperate to find providers. (No providers = out of network, which is very expensive for insurers)

JacksonX said:   mikef07 said:   JacksonX said:   I know most of my urologist friends who went to the city ended up making less than those who went to the boonies (private insurers pay less in the cities.)

3 of my buddies in the rural east coast made 4 millions, 2 million, and 1.5 million respectively a few years back.
That is certainly NOT the norm.


Private insurers pay less in the city? Huh? That is simply not true. I definitely see this every day. I can tell you for a fact that private insurers pay more in SF/LA and OC than in rural areas of CA. Dallas and Houston pay the most in TX. NYC definitely pays more than in the middle of nowhere. What you say is not supported by Medicare data, analytics that we receive and run as well as insurance payments out to physicians that are from United Healthcare, BLue Shields/Blue Cross, Medicare, Aetna, and a few others.

Reimbursement has been (to date) biggest in LA, SF, NYC, and Boston.

4 million doesn't touch what some of the guys from Premier make


I can tell you that my friends in NYC and the surrounding vicinity actually take LESS from BC/BS than medicare (about 80-90%) because of increased competition; similar in Philadelphia.
Whereas there are people in the "boonies" who get around 1.5x medicare and higher because the insurers are desperate to find providers. (No providers = out of network, which is very expensive for insurers)


Well I can tell you that not 99% of the time we get our clients Medicare + X% (at least Medicare at a minimum). Ironically the only situation where on a case by case basis where payments have come up short is BC/BS (handful of times in the past 6 years), but that is not the norm so to say private insurers pay less in the city is highly misleading.

Do you not understand I have data upon data from insurers on who gets paid what, where they are, who prescribes the most alpha blockers, what procedures they do (by cpt code)? This is what we do.

Oh and we work with significant numbers of doctors in NYC and based on our actual revenue and the actual analytics what you are saying is simply false. Not to say that it has never happened, but private insurers in NYC pay as well as anywhere in the country and most of the time significantly more.

What you have said is why so many practices use us. They simply are willing to take less from BC/BS when they don't have to. Since none of ours are taking 80-90% of Medicare and since we work in NYC that means your friends are taking less than their peers right down the street and those peers have more business than they can handle.

i havent been following this closely enough to know what exactly is the continued argument (and im not sure it has any relevance to the OP or any of the folks who were asking serious questions) but most physicians get better than medicare rates from private insurance. Typically the only thing lower than medicare is medicaid. There are exceptions but its not the norm. Many insurances base what they are going to do upon what happens with medicare rates. Its kind of like they allow medicare to do their work for them especially when it comes to trying to reduce compensation for a procedure or office visit. They can just point to whatever evidence medicare uses as justification.

bytem3 said:   
Kanosh said:   Anesthesia. Interesting. You don't see many TV doctor shows about anesthesiologists - there's not the excitement of an ER doctor or a surgeon. Dare I say that for most people this speciality might be a bit boring? Important, yes, and vitally so for those going under. I imagine it takes a very specific personality type to do well as an anesthesiologist. What attracted you to the field?

I'm not an anesthesiologist, but they can have quite a bit of excitement. Ever been in a hospital when they call a Code Blue? A Code Blue is called whenever a patient is found unresponsive or not breathing (or someone accidentally hits the code blue button). Yup, anesthesiologists have to go to those and can be key in stabilizing patients. Some intubations can be really tricky. Think along the lines of sticking a straw down someone's throat if that someone is 5'9", 450lbs, and not breathing. Not enough "excitement" for you? Too boring?

I'll take your word -- sounds like a lot more excitement than my typical work day

I've always been curious about those doctors who operate on the fringes. For example, doctors who prescribe marijuana to patients where state law allows that, or medical practices that focus on, say, erectile dysfunction such as the Boston Medical Group.

What's the medical community consensus on these places? Outright scams? The final refuge of second-tier physicians? Or is focusing on one very specific yet semi-embarrassing problem a clever way to earn a fortune as a physician?

i dont specialize in any of that but i think it varies.

For the dysfunction, i imagine its a mixed bag of folks. Since its obviously important to a decent number of patients, it would make sense that some physicians would be attracted to helping people with this problem just like any othe problem. I also imagine there are some who just see it as an easy cash cow where there is little hard work to be done for the reimbursement. The ones where they sort of just sign a prescription without any real questions or work up are the ones i would guess fall towards the lower 2nd tier as you put it. I imagine they however are the cheapest if you like burger king type medicine where you just tell the doctor what you want and they make it for you right away regardless of putting any thought into the issue.

Im not in a state that allows marijuana and if i was, i wouldnt prescribe it. Im not seeing it as a necessary tool for most physicians. There typically appears to be already approved options and the potential for a slippery slope seems too great but again not my field.

I agree with the main point of the article. Physicians are not as well off as many think and we have to work very hard for the income that we earn. However, the author exaggerates the indebtedness of medical graduates. The average allopathic graduates owes $162,000, according to the AAMC, not $300,000.

When I left medical school, I had a debt load of less than $90,000. I've paid most of it off within 3 years. I currently have about 10k @ 2.1% interest, which I am paying off slowly. I have another 23k @ 5.0%, but it is in deferment because I am in advanced training (residency or fellowship). I paid off all the high interest loans already (@6.8%).

I was lucky enough to attend a medical school with excellent financial aid. There are still a handful of medical schools that have graduates owing less than 100k. Secondly, I went to a state school for undergrad and lived at home during that time. I also lived very frugally during residency. I moved back home after medical school and stayed there for 3 years. I currently live on my own now (had to move out before 30). Even with paying off my loans, I was able to contribute to my retirement fund.

However, the future for physicians is certainly not as bright as it used to be. Many fields in medicine being targeted for reimbursement cuts. The specialty I am in is being hit particularly hard with reimbursement cuts. Income is declining. The job market is tight right now and I pray that it recovers by the time I finish. I'd rather have a lower paying job than no job.

Guys, you clearly have never been in an argument with Mike07 before. He doesn't understand words like "generally" and he will beat an anecdotal example into the ground without ever acknowledging that his case might not be reflective of the whole industry. Case in point - info from 500 urologists is suddenly indicative of the entire salary profile of the US medical industry.

BTW, ask him whether or not his wife or his kids would get the last bagel in the house, that's always fun.

JTausTX said:   Guys, you clearly have never been in an argument with Mike07 before. He doesn't understand words like "generally" and he will beat an anecdotal example into the ground without ever acknowledging that his case might not be reflective of the whole industry. Case in point - info from 500 urologists is suddenly indicative of the entire salary profile of the US medical industry.

BTW, ask him whether or not his wife or his kids would get the last bagel in the house, that's always fun.


Wow. Can't read either. 500 urologists does not equal 500 practices. Second I have data on thousands of other types of docs as well, but since we don't do business with those specialties we simply don't use the data. Amazing I can give specific examples of actual cities and no one else can. Move along troll. Also I wasn't using an anecdotal example, but thousands of them. Then again I am paid hundreds of thousand of dollars for my opinion and have exact data points in this matter and well you aren't. Since our company specifically gets paid a % of revenue that physicians receive it is pretty easy to see where those $ come from and they come from big cities for the most part except for a few outlier rural areas. Keep that head in the sand. I'll have to let our company know they have a few internet posters say our business doesn't actually come from where it does.

Oh and the kids would get the last one.

Oh and the name is mikef07. Get the name right troll.

dhodson said:   i havent been following this closely enough to know what exactly is the continued argument (and im not sure it has any relevance to the OP or any of the folks who were asking serious questions) but most physicians get better than medicare rates from private insurance. Typically the only thing lower than medicare is medicaid. There are exceptions but its not the norm. Many insurances base what they are going to do upon what happens with medicare rates. Its kind of like they allow medicare to do their work for them especially when it comes to trying to reduce compensation for a procedure or office visit. They can just point to whatever evidence medicare uses as justification.

This is my experience as well, but then again I only have hundreds of thousands of payments over the years so it likely will be called anecdotal by some troll.


Nice to see salary.com supports what I say. We will have to let them know it is anecdotal according to FWF experts.

arent the last bagels always a day old and a little hard. i try and pawn them off on my kids.



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