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Thread: Coveted Residency Specialities Loosing Their Lusture - Comments Welcomed!!

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    binojmatthew's Avatar
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    Coveted Residency Specialities Loosing Their Lusture - Comments Welcomed!!

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    University of California San Francisco - Fresno MEP (UCSF-Fresno)
    Psychiatry
    PGY-1, July 2013
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    Graduated AUC February 2013


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    drrich2 is offline Junior Member 519 points
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    Well, it mentions Radiology income in substantial decline but still double what a Family Physician makes. That alone wouldn't make a person want to jump to Family Practice!

    Radiology is getting hit by the telemedicine trend; some fields are vulnerable to off-site providers via video conferencing.

    Anesthesiology is getting hit by Nurse Anesthetists. Family Physicians see some competition from Nurse Practitioners. Granted, you may think adding Nurse Practioners to your practice adds an income stream, but if you've got a salaried position with a large organization, it's quite possible you'll be forced into a collaborative agreement effectively making you liable for their caseload without paying you much extra, if any.

    If you're a Psychiatrist, the specter of Psychologists getting prescriptive privileges and flooding the mental health market is concerning, especially since from what I've seen & heard, they're more prone to see themselves as equals, rather than the way an ARNP looks at an M.D.

    It's hard to say just what would be 'safe.' Especially amongst career paths open to people who aren't in the top 25% of their class, or aren't U.S. school grad.s.

    Richard.

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    Quote Originally Posted by drrich2 View Post
    Well, it mentions Radiology income in substantial decline but still double what a Family Physician makes. That alone wouldn't make a person want to jump to Family Practice!

    Radiology is getting hit by the telemedicine trend; some fields are vulnerable to off-site providers via video conferencing.

    Anesthesiology is getting hit by Nurse Anesthetists. Family Physicians see some competition from Nurse Practitioners. Granted, you may think adding Nurse Practioners to your practice adds an income stream, but if you've got a salaried position with a large organization, it's quite possible you'll be forced into a collaborative agreement effectively making you liable for their caseload without paying you much extra, if any.

    If you're a Psychiatrist, the specter of Psychologists getting prescriptive privileges and flooding the mental health market is concerning, especially since from what I've seen & heard, they're more prone to see themselves as equals, rather than the way an ARNP looks at an M.D.

    It's hard to say just what would be 'safe.' Especially amongst career paths open to people who aren't in the top 25% of their class, or aren't U.S. school grad.s.

    Richard.
    for those looking to be an entrepreneur, you can still live very comfortably well into orthopedic surgery range salaries while being in a primary care field. you just need to not take the easy way out by signing with a hospital or large group with no profit sharing. if you open your own place (of course you have deal with payroll, extra headaches, etc)....... primary care can still take care of your student loans and debt very easily.
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    axiomofchoice is offline Senior Member 6116 points
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    Not surprising at all. Anes and Rads are grossly overpaid and most easily replaceable. The only way to be safe in the near future is surgery.

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    AphtaLyfe is offline Senior Member 520 points
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    Quote Originally Posted by axiomofchoice View Post
    Not surprising at all. Anes and Rads are grossly overpaid and most easily replaceable. The only way to be safe in the near future is surgery.
    oh yeah, grossly overpaid. I can't wait to be grossly overpaid
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    drrich2 is offline Junior Member 519 points
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    for those looking to be an entrepreneur, you can still live very comfortably well into orthopedic surgery range salaries while being in a primary care field. you just need to not take the easy way out by signing with a hospital or large group with no profit sharing. if you open your own place (of course you have deal with payroll, extra headaches, etc)....... primary care can still take care of your student loans and debt very easily.
    I knew a Psychiatrist who also had an MBA & opened a private practice. While he was 'making it,' he also took on a great deal of extra debt starting out after residency (no small thing considering the debt burden medical students are finishing with these days), and there was a lot to the business end of things. For example, when the air conditioning unit on the building where he rented space messed up, he got part of the bill. And he learned phone lines in a business cost a LOT more than an extra line for your teen ager in a home.

    My point is, running a private practice can bring great burden and stress, and not everyone is cut out for it. It's not always substantially more lucrative, either.

    Let me share the view of the income issue from a Psychiatrist's perspective. You can probably make about as much money as you determine to make as a Physician, on these conditions:

    1.) You sacrifice a 'normal' life and can function as a work-a-holic with grossly excessive hours and aren't stressed by grossly excessive responsibility (e.g.: on call for 3 different hospitals & signed collaborative agreements with a few nurse practitioners).

    2.) You are adaptable and will take whatever work is available, and will moonlight outside your main job to rake in income from other sources. You can pick up still more money by taking 'working vacations' - doing locum tenens or other contract work elsewhere during your vacation breaks.

    3.) You're good at cutting through work fast. Be mindful 'too fast' can hurt people and get you sued.

    4.) You are willing to relocate to where there's high demand/opportunity.

    Some of you now in the pipeline to become Physicians may think 'Yeah, I'm hungry, I've got the fire!' But I'm telling you, if you're going to live a wretched, miserable life, what good does it do you? Might do lots of good for the ex-wife who divorced you & scored major alimony & child support, but what good does it do you?

    Make no mistake; I like money. But it's a means, not an end.

    Richard.

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    Quote Originally Posted by drrich2 View Post
    I knew a Psychiatrist who also had an MBA & opened a private practice. While he was 'making it,' he also took on a great deal of extra debt starting out after residency (no small thing considering the debt burden medical students are finishing with these days), and there was a lot to the business end of things. For example, when the air conditioning unit on the building where he rented space messed up, he got part of the bill. And he learned phone lines in a business cost a LOT more than an extra line for your teen ager in a home.

    My point is, running a private practice can bring great burden and stress, and not everyone is cut out for it. It's not always substantially more lucrative, either.

    Let me share the view of the income issue from a Psychiatrist's perspective. You can probably make about as much money as you determine to make as a Physician, on these conditions:

    1.) You sacrifice a 'normal' life and can function as a work-a-holic with grossly excessive hours and aren't stressed by grossly excessive responsibility (e.g.: on call for 3 different hospitals & signed collaborative agreements with a few nurse practitioners).

    2.) You are adaptable and will take whatever work is available, and will moonlight outside your main job to rake in income from other sources. You can pick up still more money by taking 'working vacations' - doing locum tenens or other contract work elsewhere during your vacation breaks.

    3.) You're good at cutting through work fast. Be mindful 'too fast' can hurt people and get you sued.

    4.) You are willing to relocate to where there's high demand/opportunity.

    Some of you now in the pipeline to become Physicians may think 'Yeah, I'm hungry, I've got the fire!' But I'm telling you, if you're going to live a wretched, miserable life, what good does it do you? Might do lots of good for the ex-wife who divorced you & scored major alimony & child support, but what good does it do you?

    Make no mistake; I like money. But it's a means, not an end.

    Richard.
    i agree up to a point. obviously, im speaking with experience from an internist's perspective and not a psychiatrist's.

    owning your own business is a headache. it can be a very large headache at that. however, it also depends on how you run it because at the end of the day, it is a business too. there are a lot of revenue streams that you can do in a primary care office......but that is where you need to be an entrepreneur. botox, laser lipo, etc. can do that, but you need to be willing to put up money for advertising.

    you can get swallowed by owning your own practice....... but you can avoid getting swallowed by making smart decisions. if you go overboard you very well could end up in that burnt out lifestyle...... but im here to say that doesnt always turn out that way. if it is done correctly, you can work an easy schedule stress free and be compensated very well....... but its not for everyone. most people will take the easy way out and just sign a contract with a predetermined set of tasks and compensation.
    Last edited by Scott1981; 03-29-2013 at 07:25 PM.
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    cms
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    Quote Originally Posted by Scott1981 View Post
    for those looking to be an entrepreneur, you can still live very comfortably well into orthopedic surgery range salaries while being in a primary care field. you just need to not take the easy way out by signing with a hospital or large group with no profit sharing. if you open your own place (of course you have deal with payroll, extra headaches, etc)....... primary care can still take care of your student loans and debt very easily.
    But read up on the Ocare related changes to payments. Its forcing some consolidation of practices due to reductions in payments to smaller practices not in underserved areas. That being said this is absolutely true. My brother-in-law (AUC grad) makes $300K+ a year in FP working <40 hrs a week and 6 weeks of vacation. He did it by making the practice an efficient machine and by leveraging his practice. He built extra large and has the competing lab/radiology suites in his rented space. He also houses many of the specialty doctors who roll in to town 1-2 a week (its a small town). Gotta think outside the box.

    And oh yeah, 89% of the national average for cost of living. Lives like a king.....
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    Quote Originally Posted by cms View Post
    But read up on the Ocare related changes to payments. Its forcing some consolidation of practices due to reductions in payments to smaller practices not in underserved areas. That being said this is absolutely true. My brother-in-law (AUC grad) makes $300K+ a year in FP working <40 hrs a week and 6 weeks of vacation. He did it by making the practice an efficient machine and by leveraging his practice. He built extra large and has the competing lab/radiology suites in his rented space. He also houses many of the specialty doctors who roll in to town 1-2 a week (its a small town). Gotta think outside the box.

    And oh yeah, 89% of the national average for cost of living. Lives like a king.....
    i always follow all the changes. however, there was some good changes too. reimbursements increased highly for followup office visits after hospitalizations.....since those visits do take quite a bit of time. i think its all part of the governments plan to avoid re-hospitalizations, witch is a great thing. they are encouraging quick followup care.

    overall, if it ever gets bad enough (not seeing it anytime soon), ill just close shop and go concierge .
    Last edited by Scott1981; 04-07-2013 at 08:35 PM.
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