6 ms·

Wait till you find out how much it actually costs doctors/providers to render some of these services! Do you like 90% margins? Doctors sure do! :)

rr888 4y ago
Doctors and Surgeons in America are incredibly highly paid. People love hating insurance and drug companies but the cost of people is driving much of the price.
- haldujai 4y ago
  Disclaimer: I am a physician. Physician salaries represent a small fraction of overall healthcare costs. Nursing/allied health salaries make up the bulk of any hospital’s costs and are often bloated due to powerful unions physicians don’t have. For comparison, Canadian physicians are on average better compensated than American physicians. I practice radiology, a specialty often considered “overpaid” yet my compensation is only high because of the amount of advanced studies ordered in modern medicine. On a per study basis I get paid less and less every year yet scans are getting more and more complex (many studies on this). In addition the standard to which I am held to keeps rising and I spend a significant amount of time doing unpaid QA, following up on my reports to improve my ROC, and at least a few hours every week reading the latest publications in my sub specialty. The average diagnostic radiologist in the USA is grossing around 400k (no retirement fund, pension, and commonly no benefits). What is reasonable compensation in your opinion for someone who has finished 10+ years of post-undergrad training and accepts significant liability for every report (a radiologist at HMS missed a lung nodule on an X-ray and lost 16 million in court)?
  - rr888 4y ago
    My brother and his wife both are doctors in the UK. At 400k you earn about the same pay as 3 or 4 doctors there. https://www.bmj.com/careers/article/the-complete-guide-to-nhs-pay-for-doctors https://www.bmj.com/careers/article/the-complete-guide-to-nh.... To me that is a lot of money. I realize lots of tech wages are crazy high too, I dont understand that either.
throwaway12245 4y ago
So do lawyers.
- pishpash 4y ago
  Lawyers don't have the ability to kill you.
  - deleted 4y ago
    [deleted]
  - willcipriano 4y ago
    A prosecutor could have you killed.
  - jonmb 4y ago
    I get where you were coming from but corrupt lawyers landed my handicapped brother in an unlicensed group home where he was mistreated and soon died. Lawyers can absolutely kill you.
nojito 4y ago
Net margins != gross margins
kstrauser 4y ago
As the spouse of a doctor, this made me giggle. If her practice had 90% margins, my life would be a lot different than it is. Her actual net margin, as in what she brings home after paying all the bills, is closer to 15%.
- InefficientRed 4y ago
  A private practice owned by the MDs reporting relatively low net margins is meaningless without knowing what the MDs are taking out as income.
  - kstrauser 4y ago
    Her practice, as are most, is an S Corp. In other words, the net income is her take-home income. Put another way, the rent, employee pay, supplies, malpractice insurance, etc. etc. etc. add up to about 85% of her gross revenue. That 15% difference is how much she personally makes.
programmertote 4y ago
Spouse of a third year resident here. My wife has volunteered at several primary care (i.e. generic doctor) clinics in Manhattan and nearby area (Queens, Astoria, Brooklyn and even in Boundbrook, NJ). These are all owned by the doctors. She worked in all kinds of operations of a clinic from billing, sending prescription, taking patient history, etc. Back-of-the-napkin calculation based on my wife's experience -- if you are a primary care (generic) doctor in a highly populated area and you see ~40 patients a day and each patient pays $100/visit. $100 * 40 patients * 22 days per month of work * 12 months = $1056000 (about $1 million USD) We are using $100/patient/visit and that's being very conservative. Most of these doctors would encourage the staff/volunteers who do the billing to put as many relevant billing codes as possible in the system (e.g., if someone comes in with a cough, they'll try to bill for anything related to cough symptom although they already knew it's just for seasonal allergy). This is necessary also because a lot (not all) of the patients are on medicare/aid and the reimbursement from medicare/aid is not as good as the ones from the private insurance companies. The cost of the labor is mostly just one assistant or at most two for ~$20-$30/hour max. Not sure about the insurance cost (but we assume that it would cost ~$20-$30K/year for malpractice insurance?) and renting the clinic (some docs do own the clinic). All in all, we believe that having your own practice can net you a lot more than what you'd make by working as an attending/hospitalist at a hospital (on average, hospitalists make between $250K-$300K/year, which is still commendable). But if you live in a rural area, which tend to have smaller population density, then you are probably better off working for a hospital because as a hospitalist, you can make close or a little more than $300K/year as a general doctor. My wife knows a couple of doctors in Palmdale, CA, who work as hospitalists in two hospitals (6 days a week alternating between two hospitals; the days start at around 9am and ends around 3-4pm). They rake in ~$600K/year from salaries (not including bonuses). A friend of mine just completed his residency and got an offer from a hospital near Dyersburg (Tennessee) for $300K/year salary with $40K sign-on bonus. The specialists earn more of course: https://www.whitecoatinvestor.com/how-much-do-doctors-make/ https://www.whitecoatinvestor.com/how-much-do-doctors-make/. A cardiologist friend of mine told me that he got an offer from a hospital in Montana that pays $800K+/year. Just wanted to share what I know about how much the doctors can make in the United States.
- kstrauser 4y ago
JohnBjorge 4y ago
There's a child comment that is in disagreement with the margins you mentioned. I've seen the financials of a lot of practices and hundreds of contracts between payors and providers. The child comment by kstrauser is much more in alignment with my experience, and they also did a good job of noting all the various expenses that are overlooked. Sometimes there are services that do have 90% margin like you mention, but there are also sometimes services that have a negative (-90%) margin. I want to emphasize I'm talking about specific services/procedures, not the overall margin for the whole practice. A profit margin of 90% is unheard of. Perhaps you're thinking of hospital systems for example which will have certain departments that are operating at a loss and then other departments that are profitable. Then they offset each other.

rr888 4y ago

Doctors and Surgeons in America are incredibly highly paid. People love hating insurance and drug companies but the cost of people is driving much of the price.

haldujai 4y ago
Disclaimer: I am a physician. Physician salaries represent a small fraction of overall healthcare costs. Nursing/allied health salaries make up the bulk of any hospital’s costs and are often bloated due to powerful unions physicians don’t have. For comparison, Canadian physicians are on average better compensated than American physicians. I practice radiology, a specialty often considered “overpaid” yet my compensation is only high because of the amount of advanced studies ordered in modern medicine. On a per study basis I get paid less and less every year yet scans are getting more and more complex (many studies on this). In addition the standard to which I am held to keeps rising and I spend a significant amount of time doing unpaid QA, following up on my reports to improve my ROC, and at least a few hours every week reading the latest publications in my sub specialty. The average diagnostic radiologist in the USA is grossing around 400k (no retirement fund, pension, and commonly no benefits). What is reasonable compensation in your opinion for someone who has finished 10+ years of post-undergrad training and accepts significant liability for every report (a radiologist at HMS missed a lung nodule on an X-ray and lost 16 million in court)?
- rr888 4y ago
  My brother and his wife both are doctors in the UK. At 400k you earn about the same pay as 3 or 4 doctors there. https://www.bmj.com/careers/article/the-complete-guide-to-nhs-pay-for-doctors https://www.bmj.com/careers/article/the-complete-guide-to-nh.... To me that is a lot of money. I realize lots of tech wages are crazy high too, I dont understand that either.

throwaway12245 4y ago

So do lawyers.

pishpash 4y ago
Lawyers don't have the ability to kill you.
- deleted 4y ago
  [deleted]
- willcipriano 4y ago
  A prosecutor could have you killed.
- jonmb 4y ago
  I get where you were coming from but corrupt lawyers landed my handicapped brother in an unlicensed group home where he was mistreated and soon died. Lawyers can absolutely kill you.

nojito 4y ago

Net margins != gross margins

kstrauser 4y ago

As the spouse of a doctor, this made me giggle. If her practice had 90% margins, my life would be a lot different than it is. Her actual net margin, as in what she brings home after paying all the bills, is closer to 15%.

InefficientRed 4y ago
A private practice owned by the MDs reporting relatively low net margins is meaningless without knowing what the MDs are taking out as income.
- kstrauser 4y ago
  Her practice, as are most, is an S Corp. In other words, the net income is her take-home income. Put another way, the rent, employee pay, supplies, malpractice insurance, etc. etc. etc. add up to about 85% of her gross revenue. That 15% difference is how much she personally makes.

programmertote 4y ago

Spouse of a third year resident here. My wife has volunteered at several primary care (i.e. generic doctor) clinics in Manhattan and nearby area (Queens, Astoria, Brooklyn and even in Boundbrook, NJ). These are all owned by the doctors. She worked in all kinds of operations of a clinic from billing, sending prescription, taking patient history, etc. Back-of-the-napkin calculation based on my wife's experience -- if you are a primary care (generic) doctor in a highly populated area and you see ~40 patients a day and each patient pays $100/visit. $100 * 40 patients * 22 days per month of work * 12 months = $1056000 (about $1 million USD) We are using $100/patient/visit and that's being very conservative. Most of these doctors would encourage the staff/volunteers who do the billing to put as many relevant billing codes as possible in the system (e.g., if someone comes in with a cough, they'll try to bill for anything related to cough symptom although they already knew it's just for seasonal allergy). This is necessary also because a lot (not all) of the patients are on medicare/aid and the reimbursement from medicare/aid is not as good as the ones from the private insurance companies. The cost of the labor is mostly just one assistant or at most two for ~$20-$30/hour max. Not sure about the insurance cost (but we assume that it would cost ~$20-$30K/year for malpractice insurance?) and renting the clinic (some docs do own the clinic). All in all, we believe that having your own practice can net you a lot more than what you'd make by working as an attending/hospitalist at a hospital (on average, hospitalists make between $250K-$300K/year, which is still commendable). But if you live in a rural area, which tend to have smaller population density, then you are probably better off working for a hospital because as a hospitalist, you can make close or a little more than $300K/year as a general doctor. My wife knows a couple of doctors in Palmdale, CA, who work as hospitalists in two hospitals (6 days a week alternating between two hospitals; the days start at around 9am and ends around 3-4pm). They rake in ~$600K/year from salaries (not including bonuses). A friend of mine just completed his residency and got an offer from a hospital near Dyersburg (Tennessee) for $300K/year salary with $40K sign-on bonus. The specialists earn more of course: https://www.whitecoatinvestor.com/how-much-do-doctors-make/ https://www.whitecoatinvestor.com/how-much-do-doctors-make/. A cardiologist friend of mine told me that he got an offer from a hospital in Montana that pays $800K+/year. Just wanted to share what I know about how much the doctors can make in the United States.

kstrauser 4y ago

JohnBjorge 4y ago

There's a child comment that is in disagreement with the margins you mentioned. I've seen the financials of a lot of practices and hundreds of contracts between payors and providers. The child comment by kstrauser is much more in alignment with my experience, and they also did a good job of noting all the various expenses that are overlooked. Sometimes there are services that do have 90% margin like you mention, but there are also sometimes services that have a negative (-90%) margin. I want to emphasize I'm talking about specific services/procedures, not the overall margin for the whole practice. A profit margin of 90% is unheard of. Perhaps you're thinking of hospital systems for example which will have certain departments that are operating at a loss and then other departments that are profitable. Then they offset each other.