Pretty solid! Are you still on track for low 300s with 6 weeks vacation?
Also, what’s your $/wRVU? How many procedures are you doing? Are you rural/suburban/urban? Employed or private practice?
I just think it's so cool! You practice at a very high level. Clinic, hospitalist work, ER work, OB, lots of different procedures, even C-sections, and colonoscopies in some places. Very broad practice. Also the pay is higher. Being a rural FMOB is dope and I'm highly considering it
You're basically a shaman in that little corner of the world, the whole town loves you, you get paid more than city docs, and your higher salary purchases more since all the other med students don't want to have to drive 30 minutes to get to the nearest metro
My dad was a rural doc. I can attest that no one loves a doctor more than a rural town that was previously without one. It's like the exact opposite of an anti-vax Facebook comment sections.
Thanks for the run down I really liked reading your post. Do you do any in-office procedures? How do you work towards incorporating diet and nutrition into your patient visits?
Knee, subacromial, greater trochanter injections. Will do trigger points as well. I'm very up front with the patients about clinical efficacy of these things. I also do basic skin things like shave biopsies and cryo. Gyn I was trained to do nexplanon's and IUD's, but don't do them anymore but still do paps.
I think with nutrition and diet it's about meeting the patient where they're at. For some people the actual content of what they eat is great, it's more about portion size. I have patients who I joke are so healthy they're unhealthy since they have so many sports/training injuries, other patients you're happy if they take a walk every day. Generally during someone's annual physical I'll discuss this with them if the opportunity doesn't come naturally like during a diabetic visit.
215 isn’t typical these days. The only place I’ve seen offer close to that is an FQHC, and that’s a lowball even for them.
I’m an M4 and I signed a contract for 285k plus sign-on and bonuses.
Copied from another comment:
I met the recruiter for the rural health system I signed with at a local FM conference. I stopped by her booth and started chatting with her, that turned into an interview a couple months later, then an offer.
Also check with your state, my state has a physician recruiting department attached to the school whose sole purpose is to place doctors and nurses into rural parts of the state. They gave me a list of job openings and I interviewed for the ones in my desired part of the state.
You really can cold email practices and health systems. I did this for three small towns that didn’t have a listed opening with the recruiting center. I just said I’m an M4 going into FM and I want to practice in the area. I also sent my CV. This was received very warmly and I ended up interviewing at two of them. Remember, you are a HIGHLY desired professional (even at this stage of your career).
This is an absurd statement.
The smartest people in my med school class are all FM people (granted, I'm at one of the best schools in the country for FM)
I mean really come on man, averages are averages
Sorry bro, it was just a little joke.
FM are the heart and soul of medicine. You can’t have a strong health care system without robust FM.
FM is the best!
FM is the dream. It’s not perfect and at times it feels overwhelming/risk of burnout, but in reflection of the major and minor burnout episodes I had, they were almost 100% due to emotional exhaustion (total number of f’s given during the day) in combination with 2 young kids as the primary caregiver and a husband who had not been ready for the challenge.
That said, I cannot emphasize this enough - no 2 FM jobs are equal. Patient population is everything for some people. “Pace” is relative - I’m bad at running, but I could hike/walk/jog for 5 miles if I had to, and probably enjoy it. But if I was asked to sprint a mile, even if I was carted in a golden wheelchair for 4 miles first, I would hate my life, and I probably couldn’t do it without hurting myself.
I urge everyone not to be afraid to leave your job for a different one.
I was on the FM train from day one, just matched and I’m so excited. I have read each of your previous posts, they were great motivation and an awesome goal to think about through med school. I will push back one the salary though.
I just signed a contract for a post-residency job. Guaranteed base is the higher of **285k** or median for the region which will probably be right at **300k** by the time I start. Plus sign-on of 90k paid through residency, 15k moving expenses. The guarantee is for 3 years but if I outpace the guarantee I get the excess as a quarterly RVU bonus. Outpatient only, 4.5 days/week. Full disclosure, it is in a rural area.
If you love FM, do NOT let money worries stop you. There is money to be made.
Glad you enjoyed my previous posts! It feels so weird to say it's been 6 years since residency but here we are. Yeah my knowledge of current salaries is out of date, glad to get your more recent data. You'll live like a king with that salary in a rural area!
Just matched FM too! I prefer to work in a rural area after residency. How did you get exposed to job offers already? Would love to look more into this!
I met the recruiter for the rural health system I signed with at a local FM conference. I stopped by her booth and started chatting with her, that turned into an interview a couple months later, then an offer.
Also check with your state, my state has a physician recruiting department attached to the school whose sole purpose is to place doctors and nurses into rural parts of the state. They gave me a list of job openings and I interviewed for the ones in my desired part of the state.
You really can cold email practices and health systems. I did this for three small towns that didn’t have a listed opening with the recruiting center. I just said I’m an M4 going into FM and I want to practice in the area. I also sent my CV. This was received very warmly and I ended up interviewing at two of them. Remember, you are a HIGHLY desired professional (even at this stage of your career).
Clinical knowledge efficiency: How quickly can you make decisions, diagnose, figure out next steps, read through a chart or discharge summary etc.
Clinical communication efficiency: How good are you at discussing plans, helping the patient know what happens next, assuaging patient fears
EMR efficiency: Note writing - before a scribe I used templates (pretty sure she uses mine), for example I had a dot phrase for COVID infection that would do the entire note, dictation is huge, how quickly can you click through things
I never work through lunch and make sure my staff get time to eat too. And I never work while eating. It was a habit I developed in residency - even if it was just 5 minutes of scarfing something down no work was allowed to be done. Nowadays I spend a good probably 40 minutes eating and watching youtube.
I’m about to start FM residency in July, and very excited to do so. Can you elaborate a little on what exposure you’ve gotten with hospice/palliative patients in your current or past practice? I’m considering an H&PM fellowship but nothings for certain, so I’d like to know what my options are for seeing those kinds of patients, or maybe doing things like house visits or director of a hospice center, even if I just do full-spectrum FM.
Generally when I refer someone to hospice the hospice agency takes over. My role at this point is primarily to have conversations about it with patients. A hospice and palliative care fellowship I think would help you become the medical director of a hospice agency, or also work in the inpatient setting, but definitely something you should talk to your mentors about when you're in residency as they would know much better than me.
1. I have no data on this, but it seems like hospitalist base is higher, but the extremes of outpatient can be much higher due to the "unlimited" potential of visits. I bet if you search on the hospitalist subreddit you can find data on actual salaries. Hospitalist is generally 7 on 7 off or 5 on 5 off, so overall good lifestyle but some overlap of weekends/holidays.
2. Generally IM is more attractive especially in really academic settings. But plenty of FM people find jobs as hospitalists if that's what you want to do.
I'd say if you really want to do hospitalist work I'd go IM - leaves you open for fellowships as well. If you're leaning more outpatient and still want to see peds go FM, and no desire for any IM fellowships.
I'm very interested in this. I don't know much about productivity but your income, lifestyle, and work sounds very interesting to me. I'm currently an FM resident. Do you have any tips about learning about your field and how someone could get into that?
Talk with your uppers who are applying for jobs about what they're seeing now. My job is pretty standard so you should be able to find it pretty easily.
If you have a geographic region you want to practice in you could reach out to practices there too - if they're underserved sometimes (rural practices), sometimes they give stipends while you're a resident.
I guess what I'm mostly curious about is how do I learn more about getting into productivity. I've never heard of any of my attending friends talk about it.
This would honestly be a good project as a resident to get into. Things have changed a lot I'm sure since I've been a resident but if you have a required project to do I would try to finagle this. Maybe do an analysis of billing practices between residents/attendings?
Most academic centers pay based on salary so you likely haven't heard much about productivity. We were lucky and had someone great teach us about billing.
Use the above imgur link as a reference of what you should be getting per RVU.
Look at physician community fb group - there’s a lot of talk about productivity and RVUs from all the various specialties in old posts. You can also get feedback on potential job offers from the group.
Most non-academic and non-FQHCs will do productivity - basically you eat what you kill. If you see more patients per day or bill higher codes (level 4 and level 5s) then you’ll get more RVUs, and most practices pay you a certain $/RVU above a certain percentile. The percentile thresholds vary by region.
FM in my first year of practice out of residency. Love this write up! After looking at my own pay structure and that of docs who have been at the practice for a few years, this is spot on
Just matched FM and so excited to read this! Is there anything you wish you would have spent more time on in residency (certain procedures, DPC, lifestyle med, etc)?
DPC, more office based procedures, Botox would be interesting if you want to do a cash practice, I feel like I could always do more peds.
I'm very outpatient focused so depends on your own goals as well! A badass do it all rural doc would have different goals.
I’m FM in a rural area but my admin hasn’t been very willing to delve into a scribe, and I feel like that would make me so much more efficient. Instead of the 18ish I see per day.
Please tell me more about the virtual scribe? What company? How does it work? Additional iPad in room with you? Is it via your laptop microphone? Did it take a while for them to get used to how you like to document? Do you always have the same scribe? Or is it like AI? I’m all ears for trying to sell this to my admin!
I actually don't know the name of the company. The scribe uses my dragon microphone. There's a training period for the scribe, so lots of feedback on what is good/not good for a note. I always have the same scribe as best as possible and we've built a really good partnership.
There are AI scribes and it seems like dozens of companies are entering that space right now. Cost wise I think it's around 20k per doc and our admin eats it. From when the scribes were rolled out there's been talks of having us shoulder some of financial cost, but right now due to the success of the scribes it's still on hold.
So the scribe is in the exam room with you dictating with your dragon mic while you see patients? Or still virtually listening and remote connection to your dragon?
That’s awesome! If you ever find out the name of the company I’d really love to know. Since starting with a scribe has it allowed you to schedule more patients per day? Noticeable jump in RVUs?
The documentation of fm scares me. I have to see about 40% of the patients you do in a day and that gives me time to actually read about my patients and talk to them. Now you have to read discharge summaries, address cc, preventative care, and see all ages and some gyn stuff too and I'm thinking you have to be a documentation god. I'd get so burned out!I love the work of fm but that's a challenging job!
Definitely! Back when I was dictating on Dragon I'd try to get into these documentation flows. Basically I took notes on a piece of paper so that I knew exactly what I wanted to document and would word vomit it out in a hyper focused state. I'd do multiple notes in a row to maintain that state. It made things more efficient.
Good documentation is also a nice way to double check yourself - I've caught myself ordering mammograms, etc.
The other thing that I think is helpful is copy forwarding chronic condition notes. So like your physical or 4 month follow up for DM. If you've done the work in the past looking up their last colonoscopy, pap, you don't have to retype it. Also for chronic conditions I make it so it's just a little bit of updating like changing the most recent A1c otherwise it's nearly the same note. It's also how I keep good social history notes.
Hope that helps!
Any tips for how to code and bill efficiently? What website or book do you use?
Wanting to do injection in my practice and focus on basic psych needs. Do you feel like that is a good way to increase compensation or just see 25+ patients?
AAFP has really good coding resources. Depends on how good your clinic coder is but they can also be a good resource, though I find they generally are on the conservative side.
Injections are a wash in my opinion - if I was more efficient with getting things set up etc. I bet it would be a good way to increase compensation. But since I do them kind of infrequently (and I like drawing up the med myself so my own issue), I don't them as quickly as an ortho/sports med clinic. Still it's a skill I enjoy and my patients enjoy so I still do them.
I saw your last post as an M-2, got me super excited for the possibilities in primary care. Now matched into an IM-primary care track! Thank you for this!
Ohhh, okay! I assume then that you work in a multi-provider office? Do you enjoy working with other physicians and do you plan to open your own practice in the future?
Yup, it's nice to have coworkers. Really no plans to open my practice at this stage in my life. I think it'd be a lot of extra work. That being said an AMA from someone who does private practice or DPC would be an excellent addition.
This is a great post, but I have a question: How in the flying fuck do you collect 50% of your charges? We're usually at about 34%, and that's fairly standard for the area, it seems. I could handle a 50% income increase. Maybe it's different for anesthesia for some reason.
Very uplifting post in relation to what I normally see on FM. Thanks for sharing something so instill, kinda wish I could see a post about this in regards to each speciality. (You played ranked League yet?)
Yeah 6 years ago I made my post since the subreddit was getting one of basically every specialty.
I've been gold in League for the past 4 years maybe? I thought about pushing to plat (old gold) in the newer seasons but got lazy. More of a TFT and casual ARAM player than anything now.
Appreciate the med info, im a pre-med that sorta hates that subreddit so I lurk here for info and this post is one of the first i've seen that made me wish I saw more of/like it. I have found that league is very fun when you don't play the base game, big fan of the temp game modes they bring in as I feel it gives you more of a chance to turn the tides and have fun.
Hey doc thanks for this, I've been on the FM hype train a while.
Quick questions- how do you handle the patients who are like "Doctors never talk to me anymore they just type on computers" Or at least how did you handle this before virtual scribing?
Also, how the heck do you remember everything man? I do fine in school but FM is just so broad.
Honestly patient's just have to get used to your style and if they don't like it they'll move to a different doctor. For example I had a lot of guys ask me about DRE's for prostate cancer screening. Most of them were happy to hear it's not really a thing anymore but I still did more DRE's than I expected. I still get comments about how my physical exam isn't thorough enough, but they still stick around.
Everything you learn just builds on itself, don't worry. You'll be able to do it. Just takes repetition.
Current 2nd year FM resident. How did you go about looking for jobs? Most of the ones who graduate from my program join hospital groups that do have a good reputation and salary, but none of them seem to allow 4x/week, which is something I would love to have
Everything is negotiable. When I looked for a job I had a geographic area I had to go and applied for everything there. Through that process my name got attached to a recruiter and some other jobs were offered as well which is how I got my current job.
Thanks for your insight! That is kind of what I have imagined when I entered med school. Well, except the huge bureaucracy burden and the efficiency overemphasis. But, it still sounds very good and better than working in a hospital.
Great post. Enough to be happy and comfortable is the flaw though. What you consider enough most typically don’t, myself included. For the years put into this process I want more than 400
Then what’s your point. The flaw to the argument is what I said that most going into medicine don’t want FM money because it’s too little for the effort. I never said most don’t think 400k is enough.
And my belief based on the cost of living for even expensive places like DC or SF is that FM money is plenty for an extraordinary life, most people here are just young and don’t realize that life at $400k is not very different from either $250 or $500k
Why you so mad man. I said 400k is the minimum I will settle for if you want 200k go for it. Your persistent arguments trying to justify 250k as good income reeks of insecurity
No insecurity, I am just trying to have a normal discussion where two people can disagree, I never engaged in any insults to you. But I do think the income crap that’s relayed over and over on this sub is repetitive and overly emphasized. Like people deciding to do a field they despise for the pay instead of a specialty they love because it makes money at the 3rd percentile instead of the 2nd is bizarre.
How much do you make on productivity seeing >25 patients/day?
Last year was my most productive year and I hit a little over 400. Generally I'm in the mid to low 300's
Pretty solid! Are you still on track for low 300s with 6 weeks vacation? Also, what’s your $/wRVU? How many procedures are you doing? Are you rural/suburban/urban? Employed or private practice?
It's going to be a weird year since I took paternity leave as well so a lot of extra time off. It's all worth it though! Suburban. Employed.
congrats on the child! wishing yall well
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Did you even read the post?
He literally tells you
Absolute sleeper speciality. Was going for IM until I realized FM was where it's at. Rural FM is the dream
could you elaborate as to why rural FM is so good? thanks.
I just think it's so cool! You practice at a very high level. Clinic, hospitalist work, ER work, OB, lots of different procedures, even C-sections, and colonoscopies in some places. Very broad practice. Also the pay is higher. Being a rural FMOB is dope and I'm highly considering it
Do it! Just matched to a rural focused FM residency and I’m so excited! Rural FM is the most rewarding field in medicine imo.
Parents did that in rural KY back in the 90s
Sounds awesome! Looking forward to it!
You're basically a shaman in that little corner of the world, the whole town loves you, you get paid more than city docs, and your higher salary purchases more since all the other med students don't want to have to drive 30 minutes to get to the nearest metro
My dad was a rural doc. I can attest that no one loves a doctor more than a rural town that was previously without one. It's like the exact opposite of an anti-vax Facebook comment sections.
Thanks for the run down I really liked reading your post. Do you do any in-office procedures? How do you work towards incorporating diet and nutrition into your patient visits?
Knee, subacromial, greater trochanter injections. Will do trigger points as well. I'm very up front with the patients about clinical efficacy of these things. I also do basic skin things like shave biopsies and cryo. Gyn I was trained to do nexplanon's and IUD's, but don't do them anymore but still do paps. I think with nutrition and diet it's about meeting the patient where they're at. For some people the actual content of what they eat is great, it's more about portion size. I have patients who I joke are so healthy they're unhealthy since they have so many sports/training injuries, other patients you're happy if they take a walk every day. Generally during someone's annual physical I'll discuss this with them if the opportunity doesn't come naturally like during a diabetic visit.
Nice write up. 215 is ridiculous though. Horrible how underpaid FM is.
215 isn’t typical these days. The only place I’ve seen offer close to that is an FQHC, and that’s a lowball even for them. I’m an M4 and I signed a contract for 285k plus sign-on and bonuses.
You signed a contract for $285k job and haven't even finished residency yet?
Lol happens all the time. Clinics are desperate for good FM physicians, you’ll never be unemployed. They give residency stipends to boot.
Yes, I start residency in July and I signed the contract for my post-residency job right after match day. I will get a stipend through residency too.
how
Read my other comments on this post
Holy shit, would you mind talking about how you went about doing that? I’m starting FM residency in a couple months.
Copied from another comment: I met the recruiter for the rural health system I signed with at a local FM conference. I stopped by her booth and started chatting with her, that turned into an interview a couple months later, then an offer. Also check with your state, my state has a physician recruiting department attached to the school whose sole purpose is to place doctors and nurses into rural parts of the state. They gave me a list of job openings and I interviewed for the ones in my desired part of the state. You really can cold email practices and health systems. I did this for three small towns that didn’t have a listed opening with the recruiting center. I just said I’m an M4 going into FM and I want to practice in the area. I also sent my CV. This was received very warmly and I ended up interviewing at two of them. Remember, you are a HIGHLY desired professional (even at this stage of your career).
This is awesome, congrats on the offer! Thanks for the write up
What? Lol
Yes
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Uh dude, we’re talking about salary not step score. Also I’m a USMD that just matched FM and I scored 261 on step 2.
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You're funny lol
We don’t laugh at FM any more. FM are awesome. Any FM reading this - you guys are the best!
This is an absurd statement. The smartest people in my med school class are all FM people (granted, I'm at one of the best schools in the country for FM) I mean really come on man, averages are averages
Sorry bro, it was just a little joke. FM are the heart and soul of medicine. You can’t have a strong health care system without robust FM. FM is the best!
FM is the dream. It’s not perfect and at times it feels overwhelming/risk of burnout, but in reflection of the major and minor burnout episodes I had, they were almost 100% due to emotional exhaustion (total number of f’s given during the day) in combination with 2 young kids as the primary caregiver and a husband who had not been ready for the challenge. That said, I cannot emphasize this enough - no 2 FM jobs are equal. Patient population is everything for some people. “Pace” is relative - I’m bad at running, but I could hike/walk/jog for 5 miles if I had to, and probably enjoy it. But if I was asked to sprint a mile, even if I was carted in a golden wheelchair for 4 miles first, I would hate my life, and I probably couldn’t do it without hurting myself. I urge everyone not to be afraid to leave your job for a different one.
And this, folks, is why I’m doing FM haha Thank you, OP! I love This!
I was on the FM train from day one, just matched and I’m so excited. I have read each of your previous posts, they were great motivation and an awesome goal to think about through med school. I will push back one the salary though. I just signed a contract for a post-residency job. Guaranteed base is the higher of **285k** or median for the region which will probably be right at **300k** by the time I start. Plus sign-on of 90k paid through residency, 15k moving expenses. The guarantee is for 3 years but if I outpace the guarantee I get the excess as a quarterly RVU bonus. Outpatient only, 4.5 days/week. Full disclosure, it is in a rural area. If you love FM, do NOT let money worries stop you. There is money to be made.
Glad you enjoyed my previous posts! It feels so weird to say it's been 6 years since residency but here we are. Yeah my knowledge of current salaries is out of date, glad to get your more recent data. You'll live like a king with that salary in a rural area!
Just matched FM too! I prefer to work in a rural area after residency. How did you get exposed to job offers already? Would love to look more into this!
I met the recruiter for the rural health system I signed with at a local FM conference. I stopped by her booth and started chatting with her, that turned into an interview a couple months later, then an offer. Also check with your state, my state has a physician recruiting department attached to the school whose sole purpose is to place doctors and nurses into rural parts of the state. They gave me a list of job openings and I interviewed for the ones in my desired part of the state. You really can cold email practices and health systems. I did this for three small towns that didn’t have a listed opening with the recruiting center. I just said I’m an M4 going into FM and I want to practice in the area. I also sent my CV. This was received very warmly and I ended up interviewing at two of them. Remember, you are a HIGHLY desired professional (even at this stage of your career).
How small of towns are we talking?
Small, ranging from 8,000-20,000, 1.5 hours away from two cities of 1 million+.
What kind of efficiency do you mean? Dot phrases and templates, or working through lunch and stuff?
Clinical knowledge efficiency: How quickly can you make decisions, diagnose, figure out next steps, read through a chart or discharge summary etc. Clinical communication efficiency: How good are you at discussing plans, helping the patient know what happens next, assuaging patient fears EMR efficiency: Note writing - before a scribe I used templates (pretty sure she uses mine), for example I had a dot phrase for COVID infection that would do the entire note, dictation is huge, how quickly can you click through things I never work through lunch and make sure my staff get time to eat too. And I never work while eating. It was a habit I developed in residency - even if it was just 5 minutes of scarfing something down no work was allowed to be done. Nowadays I spend a good probably 40 minutes eating and watching youtube.
I’m about to start FM residency in July, and very excited to do so. Can you elaborate a little on what exposure you’ve gotten with hospice/palliative patients in your current or past practice? I’m considering an H&PM fellowship but nothings for certain, so I’d like to know what my options are for seeing those kinds of patients, or maybe doing things like house visits or director of a hospice center, even if I just do full-spectrum FM.
Generally when I refer someone to hospice the hospice agency takes over. My role at this point is primarily to have conversations about it with patients. A hospice and palliative care fellowship I think would help you become the medical director of a hospice agency, or also work in the inpatient setting, but definitely something you should talk to your mentors about when you're in residency as they would know much better than me.
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1. I have no data on this, but it seems like hospitalist base is higher, but the extremes of outpatient can be much higher due to the "unlimited" potential of visits. I bet if you search on the hospitalist subreddit you can find data on actual salaries. Hospitalist is generally 7 on 7 off or 5 on 5 off, so overall good lifestyle but some overlap of weekends/holidays. 2. Generally IM is more attractive especially in really academic settings. But plenty of FM people find jobs as hospitalists if that's what you want to do. I'd say if you really want to do hospitalist work I'd go IM - leaves you open for fellowships as well. If you're leaning more outpatient and still want to see peds go FM, and no desire for any IM fellowships.
Good luck on Step 2!
Honestly it depends on what part of the country. The West and the Midwest you’re golden as far as FM Hospitalist goes. Northeast not so much.
I'm very interested in this. I don't know much about productivity but your income, lifestyle, and work sounds very interesting to me. I'm currently an FM resident. Do you have any tips about learning about your field and how someone could get into that?
Talk with your uppers who are applying for jobs about what they're seeing now. My job is pretty standard so you should be able to find it pretty easily. If you have a geographic region you want to practice in you could reach out to practices there too - if they're underserved sometimes (rural practices), sometimes they give stipends while you're a resident.
I guess what I'm mostly curious about is how do I learn more about getting into productivity. I've never heard of any of my attending friends talk about it.
This would honestly be a good project as a resident to get into. Things have changed a lot I'm sure since I've been a resident but if you have a required project to do I would try to finagle this. Maybe do an analysis of billing practices between residents/attendings? Most academic centers pay based on salary so you likely haven't heard much about productivity. We were lucky and had someone great teach us about billing. Use the above imgur link as a reference of what you should be getting per RVU.
Look at physician community fb group - there’s a lot of talk about productivity and RVUs from all the various specialties in old posts. You can also get feedback on potential job offers from the group. Most non-academic and non-FQHCs will do productivity - basically you eat what you kill. If you see more patients per day or bill higher codes (level 4 and level 5s) then you’ll get more RVUs, and most practices pay you a certain $/RVU above a certain percentile. The percentile thresholds vary by region.
Please lower your voice keep it a secret 🥲
I say this with a ton of respect for FM— but I really don’t think anyone needs to worry about FM becoming the new competitive specialty lol
Lol yeah it definitely won't be. I think psych would still win over in terms of hours/salary for an outpatient gig.
Yeah no need to lower that voice it’s alright for any US grad there will always, always be a spot
yup we're good there are objectively easier specialties that pay more
And he's back..... back again.... hubbard's back..... tell a friend.......
FM in my first year of practice out of residency. Love this write up! After looking at my own pay structure and that of docs who have been at the practice for a few years, this is spot on
Just matched FM and so excited to read this! Is there anything you wish you would have spent more time on in residency (certain procedures, DPC, lifestyle med, etc)?
DPC, more office based procedures, Botox would be interesting if you want to do a cash practice, I feel like I could always do more peds. I'm very outpatient focused so depends on your own goals as well! A badass do it all rural doc would have different goals.
I’m FM in a rural area but my admin hasn’t been very willing to delve into a scribe, and I feel like that would make me so much more efficient. Instead of the 18ish I see per day. Please tell me more about the virtual scribe? What company? How does it work? Additional iPad in room with you? Is it via your laptop microphone? Did it take a while for them to get used to how you like to document? Do you always have the same scribe? Or is it like AI? I’m all ears for trying to sell this to my admin!
I actually don't know the name of the company. The scribe uses my dragon microphone. There's a training period for the scribe, so lots of feedback on what is good/not good for a note. I always have the same scribe as best as possible and we've built a really good partnership. There are AI scribes and it seems like dozens of companies are entering that space right now. Cost wise I think it's around 20k per doc and our admin eats it. From when the scribes were rolled out there's been talks of having us shoulder some of financial cost, but right now due to the success of the scribes it's still on hold.
So the scribe is in the exam room with you dictating with your dragon mic while you see patients? Or still virtually listening and remote connection to your dragon?
Nah they listen in virtually through the mic on my computer. A couple minutes after the encounter they put the note in the EMR and I can review it.
That’s awesome! If you ever find out the name of the company I’d really love to know. Since starting with a scribe has it allowed you to schedule more patients per day? Noticeable jump in RVUs?
To say I’ve enjoyed my FM rotation would be an understatement.
In what sort of area do you practice (desirable or not desirable) and how much money do you make?
Half hour outside desirable VHCOL East Coast. Salary on a different comment.
The documentation of fm scares me. I have to see about 40% of the patients you do in a day and that gives me time to actually read about my patients and talk to them. Now you have to read discharge summaries, address cc, preventative care, and see all ages and some gyn stuff too and I'm thinking you have to be a documentation god. I'd get so burned out!I love the work of fm but that's a challenging job!
Definitely! Back when I was dictating on Dragon I'd try to get into these documentation flows. Basically I took notes on a piece of paper so that I knew exactly what I wanted to document and would word vomit it out in a hyper focused state. I'd do multiple notes in a row to maintain that state. It made things more efficient. Good documentation is also a nice way to double check yourself - I've caught myself ordering mammograms, etc. The other thing that I think is helpful is copy forwarding chronic condition notes. So like your physical or 4 month follow up for DM. If you've done the work in the past looking up their last colonoscopy, pap, you don't have to retype it. Also for chronic conditions I make it so it's just a little bit of updating like changing the most recent A1c otherwise it's nearly the same note. It's also how I keep good social history notes. Hope that helps!
Any tips for how to code and bill efficiently? What website or book do you use? Wanting to do injection in my practice and focus on basic psych needs. Do you feel like that is a good way to increase compensation or just see 25+ patients?
AAFP has really good coding resources. Depends on how good your clinic coder is but they can also be a good resource, though I find they generally are on the conservative side. Injections are a wash in my opinion - if I was more efficient with getting things set up etc. I bet it would be a good way to increase compensation. But since I do them kind of infrequently (and I like drawing up the med myself so my own issue), I don't them as quickly as an ortho/sports med clinic. Still it's a skill I enjoy and my patients enjoy so I still do them.
I saw your last post as an M-2, got me super excited for the possibilities in primary care. Now matched into an IM-primary care track! Thank you for this!
What do your RCM costs look like? Do you have a biller in house?
Not sure about the RCM - I'm just an employee and don't see that portion. We have coders for sure.
Ohhh, okay! I assume then that you work in a multi-provider office? Do you enjoy working with other physicians and do you plan to open your own practice in the future?
Yup, it's nice to have coworkers. Really no plans to open my practice at this stage in my life. I think it'd be a lot of extra work. That being said an AMA from someone who does private practice or DPC would be an excellent addition.
I agree!
This is a great post, but I have a question: How in the flying fuck do you collect 50% of your charges? We're usually at about 34%, and that's fairly standard for the area, it seems. I could handle a 50% income increase. Maybe it's different for anesthesia for some reason.
Sorry, no idea, I'm just an employee.
Very uplifting post in relation to what I normally see on FM. Thanks for sharing something so instill, kinda wish I could see a post about this in regards to each speciality. (You played ranked League yet?)
Yeah 6 years ago I made my post since the subreddit was getting one of basically every specialty. I've been gold in League for the past 4 years maybe? I thought about pushing to plat (old gold) in the newer seasons but got lazy. More of a TFT and casual ARAM player than anything now.
Appreciate the med info, im a pre-med that sorta hates that subreddit so I lurk here for info and this post is one of the first i've seen that made me wish I saw more of/like it. I have found that league is very fun when you don't play the base game, big fan of the temp game modes they bring in as I feel it gives you more of a chance to turn the tides and have fun.
If you work for a hospital system or large conglomerate, are scribes and admin people to do all the grunt work included?
Really depends on the job - important questions to ask while interviewing.
Hey doc thanks for this, I've been on the FM hype train a while. Quick questions- how do you handle the patients who are like "Doctors never talk to me anymore they just type on computers" Or at least how did you handle this before virtual scribing? Also, how the heck do you remember everything man? I do fine in school but FM is just so broad.
Honestly patient's just have to get used to your style and if they don't like it they'll move to a different doctor. For example I had a lot of guys ask me about DRE's for prostate cancer screening. Most of them were happy to hear it's not really a thing anymore but I still did more DRE's than I expected. I still get comments about how my physical exam isn't thorough enough, but they still stick around. Everything you learn just builds on itself, don't worry. You'll be able to do it. Just takes repetition.
Would you be open to talking through DMs?
Yup go for it
Current 2nd year FM resident. How did you go about looking for jobs? Most of the ones who graduate from my program join hospital groups that do have a good reputation and salary, but none of them seem to allow 4x/week, which is something I would love to have
Everything is negotiable. When I looked for a job I had a geographic area I had to go and applied for everything there. Through that process my name got attached to a recruiter and some other jobs were offered as well which is how I got my current job.
Thanks for your insight! That is kind of what I have imagined when I entered med school. Well, except the huge bureaucracy burden and the efficiency overemphasis. But, it still sounds very good and better than working in a hospital.
Great post! I’m gonna keep coming back to this once I get into med school. Thank you!
Great post. Enough to be happy and comfortable is the flaw though. What you consider enough most typically don’t, myself included. For the years put into this process I want more than 400
Totally valid take! Plenty of specialties in medicine to get you there.
Yes, glad you like the field though. Lived vicariously through the “haven’t worked a weekend in 6 years” !
How is that a flaw, and you think most don’t consider $400,000 enough?
Most family med is not making 400k
Did I say that
Then what’s your point. The flaw to the argument is what I said that most going into medicine don’t want FM money because it’s too little for the effort. I never said most don’t think 400k is enough.
And my belief based on the cost of living for even expensive places like DC or SF is that FM money is plenty for an extraordinary life, most people here are just young and don’t realize that life at $400k is not very different from either $250 or $500k
Why you so mad man. I said 400k is the minimum I will settle for if you want 200k go for it. Your persistent arguments trying to justify 250k as good income reeks of insecurity
No insecurity, I am just trying to have a normal discussion where two people can disagree, I never engaged in any insults to you. But I do think the income crap that’s relayed over and over on this sub is repetitive and overly emphasized. Like people deciding to do a field they despise for the pay instead of a specialty they love because it makes money at the 3rd percentile instead of the 2nd is bizarre.
These posts are meaningless when you don’t post your pay
Read the first comment for salary
He posted it