More About Money

From the comments (posted by a headhunter physician recruiter):

Most physicians who complain about money fall into two categories. The first don't see enough patients and aren't efficient with their schedules. The second live in poverty-stricken areas (either inner cities or remote, rural areas.) There are hundreds of thousands of doctors who do extremely well. What do they do differently than you do?

Here's what some of the hundreds of thousands of doctors who do extremely well do differently than I do:

• They're not practicing in areas dominated by one or two giant insurers who offer take-it-or-leave-it contracts paying sub-Medicare rates.
  
• They're specialists who order and perform lots of procedures, often without regard to their clinical utility.
• They spend five minutes with a patient and charge for a level III or IV visit using an EMR to generate reams of meaningless documentation.
• They bring patients back for return visits to review all tests regardless of the results, producing visits like, "The MRI was negative; you don't need surgery on your knee; just keep going to physical therapy" (and then see above.)
• They use consult codes exclusively, even for follow-up visits and when patients self-refer, when they should be using Evaluation/Management codes (which don't pay nearly as much.)
  
• Their malpractice premiums are less than 40% of their net pay.
• They're practicing "concierge medicine," charging $2,000 per patient a year to do exacty the same things I do for non-negotiable "negotiated" insurance rates.

As for "most physicians who complain about money" falling into two categories:

I have open access and see all patients the day they call, if they wish. Physicals are accomodated within the week. August was great because of this; the phones have been slower this month, so we sit. Don't go talking about marketing to get "more people in the door" because:

1. There's no money for it,
2. I'm seeing 1-2 new patients a day on average, because
3. Word of mouth -- as you know, the best marketing there is -- is going great guns thanks to my patients.

It's not volume; it's revenue per encounter, which in primary care isn't nearly as elastic as you seem to think. Surely you're not suggesting I perform unnecessary procedures or recommend extra immunizations just for the money, all the while justifying it with "creative coding"? As for impoverished inner city and rural areas, are you implying that people who live there don't deserve medical care since they can't pay for it? Or that doctors who take on the challenges of practicing in those areas shouldn't expect to make much of a living?

You are oversimplifying and blaming the victim.

I will not let you pin this one on me.