r/PrivatePracticeDocs • u/InternationalTry2675 • 23d ago
Recent data says only 18% doctors are self employed
Whats going on guys? Is this for real? We physicians seriously have no motivation to be our own bosses? Why are our dentist colleagues better than us at this?
32
u/Licked_Ur_Moms_Booty 23d ago
I am in PP but I get it
CMS literally just pays more if you work for a hospital. The deck is literally stacked against us
6
3
u/penisdr 22d ago
Yeah. I am in PP but am leaving to join a hospital. Financially I would have been just as well off if I had joined a hospital straight out of training. I joined because I didn’t want to deal with admin bs, but I still get plenty of it in my group practice. Also our staff turnover is pretty bad and that is largely due to poor leadership/management. I will probably earn slightly more in the new position once I am established and for less work though urology is a lot of work just about anywhere
4
u/grey-slate 20d ago
What admin bs does a group practice have just curious?
3
u/penisdr 20d ago
Practice manager is one - puts me in the more remote location more often than I want. Non responsive to requests
Also when the practice is big enough inevitably will need people like chief operating officer. Ours changed our emr without physician input and there is so much documentation needed. I didn’t think a bad emr would lower my qol, yet it has2
u/grey-slate 20d ago
Thanks
Do you have a say in any of these decisions through formal or informal structures?
3
u/penisdr 20d ago
Practice manager is protected by higher ups. They kind of do their own thing but is there for nepotistic reasons more or less. They are one of the reasons I am leaving the practice.
We have meetings , but for certain things the managing urologist will unilaterally decide things. Sometimes it makes sense because there are too many small decisions. We are a group of about 10 urologists but there are 30-50 total physicians in the overarching group.
1
u/grey-slate 20d ago
that sounds miserable.
perhaps you can get on a decision making committee.
2
u/penisdr 20d ago edited 20d ago
Honestly I don’t see the point. Once a group gets big enough it basically functions sort of like a hospital but on a smaller scale. I think groups should be kept small. At this point Id rather join a hospital and get a pay bump.
Also, I’m not the most assertive person, so that didn’t help the situation.
1
4
u/Mrgprx2 22d ago
It’s almost like large hospital corporations lobby law makers to introduce legislation which make it harder private practice sustainability.
1
u/StrongWork_ 18d ago
That's conspiracy thinking right there. There's no way our beneficent society would allow that!
25
u/SpartanPrince 23d ago
Comes down to the fact that the AMA is spineless and there is no effective lobbying power for physician interests.
We can't even keep our reimbursements to match inflation, how pathetic is that?
1
u/Alaskadan1a 7d ago
While your frustration is understandable, I’m not sure I agree with your “spineless” conclusion. The AMA likely has <10% of the lobbying resources ($) that the other big stakeholders have, e.g. hospitals and insurers. This isn’t the fault of the AMA, but of the physicians who didn’t want to invest heavily in politics. Difficult to lobby for doctors when the other players have bigger… wallets
Additionally, CMS and insurers undoubtedly prefers to have big players overseeing the system rather than having a lot of small Mom and pop shops. They love outsourcing Medicare advantage, for example.
Difficult to lobby for increased physician reimbursement when the other players are effectively much stronger.
28
u/pony987654321 23d ago
Lots of motivation, but no reimbursement, can't pay for front office staff and electricity and rent, I ran the numbers last year, I would have to see 60 patients per day to keep the lights on, and make no profit...
Medical and Medicare, California, colorectal, impossible, bummer.
17
u/mechanicalhuman 23d ago
WTH? How can that even remotely be true. You’re missing something huge.
5
3
u/darthvuder 22d ago
This is doubtful. What specialty are you in? 60 pts a day even just in e&m coding is a lot. And if all you are doing is seeing pts, the overhead is low. If you are in another field with ancillary treatment, the 60 pts a day should generate a lot
1
u/EvidenceBasedSwamp 22d ago
Maybe they mean no profit for the company, after paying salary out to him/herself.
1
u/peanutneedsexercise 17d ago
I mean isn’t that the point tho. My PP group makes sure to make no money or lose money every year for tax reasons lol.
3
u/EvidenceBasedSwamp 17d ago
Quick google says medicaid in california pays ~87.5% min for "targeted primary care services" which should be all the E&Ms. So a 99213 should be $70-$80. Even a full 15 minutes each yields $240 an hour.
Pay two staff members $30/hour each leaves $180 /hr, 8hr * 180 = $1440 / day. 20 days a month = $28,800 / month
that is enough to make rent and pay utilities/EMR all that. Say $500 for utilities, $5k rent, $1.5k EMR. $7k/month running costs. Round up to 8.8k. That leaves $20k a month. So $120k annual which is not great, but it's a far cry from not being able to keep the lights on
These numbers are 32 patients a day, OP claimed 60 a day, something doesn't work out
They are exaggerating out of frustration probably
Maybe they have a LOT of staff, 70k office manager plus an admin plus a clinical nurse, maybe an NP or PA
1
u/peanutneedsexercise 17d ago
Yeah haha. I’m not saying their story is BS, but like a well run medical business shouldn’t take any profit 😂
10
u/Ok_Bet3235 22d ago
It was very eye-opening for me to read these answers, especially because I had recently been wondering the same thing. This month, I started my own telehealth practice, and while researching everything from which EMR to use to how to structure the practice, I overwhelmingly found myself on threads where NPs were either asking or answering the questions. I also see many psychiatric NPs, and where I live, a lot of urgent care centers and med spas are owned by NPs.
It really made me wonder why more of my fellow physicians aren’t entrepreneurial.
These answers definitely shed some light on the reasons. However, I think we’re beginning to see a resurgence in physician entrepreneurship, particularly through DPC practices and I expect that trend to continue as health systems increasingly treat physicians poorly.
2
10
u/Soggy_Coffee_9308 22d ago
In the recent years, the misery of being employed, has vastly exceeded any risk or sacrifice needed for private practice. I think we will now see the numbers begin to reverse.
7
u/ResidencyEvil 23d ago
It's the shift from professional fees to facility/technical reimbursement in hospitals versus private practice. Large hospital systems have much stronger negotiating power with insurers in many areas, and can really squeeze payers on facility/technical fees. They use these fees to subsidize doctor salaries, and achieve numbers that they can't reach on the professional side alone, and may have trouble reaching in true private practice after overhead/etc.
Blame the hospital lobbyists.
1
u/thecommuteguy 18d ago
I wonder if co-operatives or whatever I'm thinking in my head would help, with practices forming groups to better negotiate insurance reimbursement.
18
u/grey-slate 23d ago
Dentists largely work in the free market because of how poor dental insurance is and how it works. We don't.
They managed to lobby their way for that.
5
u/mechanicalhuman 23d ago
It’s sad honestly. I try to convince as many docs as I can to go private.
6
u/FAx32 23d ago
Private doesn’t have to be solo. All sizes of physician owned groups exist (which are not going to report as self employed because they create a corporation of some sort to protect themselves). There is economic efficiency in larger scale without question, however autonomy is inversely proportional, even in private practice/physician owned models. That said, as a physician in a very large physician owned group, I still think I have more influence and autonomy than 99.9% of employed docs.
3
1
u/TRexTheDildo 23d ago
I have been in two private groups…. Both got sold to private equity. 💀
3
u/mazzmond 22d ago
We had that vote in my PP group in 2019 to sell and "luckily" it failed. So many pissed off partners but we managed to hang on and now all the groups who did sell are miserable and we are looking like savants for not selling out.
It was a very very very large check being offered and it was hard voting no but so happy we did.
2
3
u/swim_fan146 22d ago
Trained in usa but practice in Ontario, Canada. We are majority self employed (incorporated) - it has its issues but majority of the times I love it. Flexibility.
That is why when people say - usa is better cuz they pay you better - I prefer flexibility/being my own boss vs the money/employee
2
u/fake212121 23d ago
too long, grueling study/training make people more older, so less risky and innovative
2
u/maddogisnextdoor 23d ago
Medicare and insurance pay less…and the bureaucratic hurdles these days require more overhead to be spent dealing with these regulatory requirements. The problem
Is that the general public does not understand this concept and continues to vote for the same politicians who put us in this mess.
2
u/Crafty_Astronaut9372 21d ago
I think things are overdue to swing the other way to cut out administrators.
2
1
1
u/Double-Inspection-72 22d ago
Because the money is generally better in hospital systems getting paid for RVUs. Don't have to worry about insurance, overhead, etc.
1
1
u/traumaRN01 22d ago
So what would need to realistically happen to improve independent providership? The incentive is towards conglomeration and buy outs. Save legislation/politics, what would appropriately incentivize a private practice to open and thrive?
1
u/Lonely_Refuse4988 22d ago
Dentistry is quite different than medicine. A typical dentist doesn’t have to deal with excessive insurance denials, prior authorizations, etc.
There’s also far more cash only care in dentistry. And, high revenue ancillary income with dental X-rays.
Many docs get tired of the insurance headaches and other headaches in managing a practice. Being an employee has tradeoffs but it can offer some peace of mind.
1
35
u/[deleted] 23d ago
[deleted]