Category: medicine

Do Doctors Need To Have A Business Degree?

One skill that is not emphasized and rarely even mentioned in our medical training is that medical practice is still a business. What this means is that even if you practice good medicine, you may still not earn enough to pay the rent if you are unable to manage your finances. How are you expected to run a medical business when you spent the last decade of your life learning how to practice medicine?

You could stay at a university. Universities often pay you a flat salary with a production bonus. You don’t have to worry about paying your staff.  Or you just join a medical practice and hope for the best.  Sadly, that is how the majority of us end up.

[showads ad=responsive]

It doesn’t have to be this way. We can learn about the business of medicine. One recommendation that I have heard is that doctors should obtain a business degree to help them with their medical business. Is that really a good idea?

A Business Degree Can Strengthen Your Medical Practice.

Sure, a Masters in Business Administration (MBA) will give you credibility. I have one colleague who obtained his MBA the same time as his Bachelor’s Degree in college, while another obtained his MBA during medical school. It certainly sounds more impressive to have an MD, MBA after your name. In general, the rigors of formally learning about business and finance will provide you with fundamental knowledge to run your practice. This will translate into greater profits for the rest of your medical career. If your practice is small enough, you may not even need a practice manager if you can run the books yourself. Even if you have a crew of business associates running the practice, you are more equipped to deal with issues if you have the background.

You can either take time off from your medical education to obtain an MBA, or you could even obtain an executive MBA while still practicing medicine. It all depends on how motivated you are and how well you can multitask.

A Business Degree Can Delay Your Earnings.

Most respectable business degrees require a two-year commitment. That means two extra years of potentially expensive tuition and delayed peak earnings from the practice of medicine. Even an executive MBA will require additional time off on weekends and evenings away from your family.

What if a business degree isn’t even applicable to your medical practice? That can certainly be the case. One of the most valuable aspects of business school is that you are given an intensive environment to network with your future colleagues. This can translate into future business deals. That doesn’t seem like what you’d actually need as a physician. Having friends who run Fortune 500 companies does not necessarily help you negotiate with Medicare to reimburse your for your services.

Likewise, even if you are better equipped to run your medical practice, you may not necessarily have the time to do it if you intend to be a full-time clinician. Your business manager, chief operating officer, or finance officer will still have to run the business.

Do you Want to Run A Hospital?

What a business degree does do is give you a title of credibility to enter the administrative side of medicine. If you wanted to join the administrative staff of your hospital or become Chief Medical Officer, an MBA will definitively improve your chances of being voted in. Does it matter where you obtain that business degree? Unlikely. I have seen plenty of hospital administrators will online business degrees or executive MBA’s. Skeptics might even say that the material you learn in business school is somewhat related only peripherally to the role of a hospital administrator.

What this also means is that you become an administrator, you will unlikely continue practicing medicine on a full-time basis. In this case, would you have needed to go through residency? Maybe not.

Do you have or plan to obtain an MBA?

View Results

Loading ... Loading ...
Do you want to get the latest Smart Money MD posts in you inbox?
Get the FREE Smart Money MD Financial Cheatsheet for signing up!

Grow your value in order to advance your career

One of the tenants of becoming a successful doctor is the three A’s. These are fundamental steps into order to prosper. However, to develop your career further, you have to grow your value. What this means is that in order to be marketable in your profession, you have to have a skill to offer. This essentially means that you need to figure out what your job description is and fully maximize your ability to fulfill that niche. Do it better than anyone else around who might be vying for that position and you become a superstar.

How can I grow my value?

As a doctor, you need to practice good, ethical medicine. Take care of your patients (as much as they let you). That is the foundation to build upon.

Identify your role models. Children learn from their parents and caretakers. Professionals learn from their seniors and others who have taken the same footsteps. There is never going to be a single ideal role model. Someone who can help you develop your clinical or research skills is not likely going to teach you how to run a medical practice. Likewise, a role model for a particular skill may even be someone from a competing practice who is willing to show you the ropes.

[showads ad=responsive]

Your accomplishments must be made known. It does not matter if you are the best diagnostician in the world if no one knows who you are. Many good deeds go unnoticed all of the time. You don’t have to boast your successes, but they must be publicized to promote your value. If you made a diagnosis or cure that others missed, casually introduce the topic in conversion with your coworkers or managers. In order for you to move the chain, your peers have to respect your clinical, managerial, and leadership abilities. Make a case for everything you excel in.

Be firm but reasonable. This goes for job promotions, equipment needs, staffing needs. Everything. You must keep a level head in negotiation. People tend to ignore crazy people even if they are right. If you are getting paid at the 10th percentile of your specialty’s salary range and you are doing 90th percentile work, you need to gather enough data to present to your case. Collect your RVUs, staff utilization, expenses, and show that you are being undervalued. If you are the more qualified surgeon in the state but have inadequate nursing staff, make your case. Perhaps you need to show that most doctors in your specialty require a certain number and skill of staff, and that you could make more money if you have better staff.

You must have a goal.

Growing your value is ultimately useless if you have no finish line. You won’t really know what you are working for if you don’t have a goal in mind. Whether the goal is to achieve a certain annual income or giving yourself enough time to exercise every day, have your sights set on something.  After that, map out your plan to increase your self worth to achieve that goal.

To recap:

  1. Choose a goal. Short-term and long-term.
  2. Map out the qualities and achievements that you need to accomplish to reach that goal.
  3. Start growing your value. Make yourself a desired commodity.
  4. Work hard to get there. Hustle.

 

What have you done to grow your value?

Why Doctors Are Underpaid

https://flic.kr/p/hE6uGNSociety often portrays medical doctors as elite professionals who drive fancy cars, live in nice homes, and vacation in exotic locales. We are highly educated folks who work hard and have the luxury of a high paycheck.

The converse is true. Yes, most doctors have higher earning power than most of general society but we also paid the price in time. By the time we do achieve earning potential, we get hit by unreasonable regulations, denied by insurance companies, and short changed by decreasing reimbursements. As a profession, we are being short changed by our society. Why? Here are the top reasons:

Most Doctors Don’t Even Know How Much They Are Worth.

Most of us don’t understand billing, RVU generation, or the claims collections process. How we are paid is quite a convoluted process, but it’s certainly easier to figure out than even the fundamentals of diabetic ketoacidosis. Imagine how much hospitals actually take out of your salary or how much overhead your practice has and you start realizing that perhaps you should be commanding a higher income.

We Are Grossly Underpaid During Training.

During residency and fellowship, we go above are expected duties to deliver high quality medical care at the expense of our sanity. After our shifts finish, we prepare for presentations, study our field, and organize for the next day. Yes, we are still training, but getting a $40,000-$60,000 salary is absurd. Most physician’s assistants and nurses command a much higher rate than that.

Once we leave the sacred grounds of a university hospital, our income increases by a three to four fold. That is a serious salary hike for doing the same amount of work we did in residency. We are joyous that we even survived the lost decade in our lives and are happy to get a “good” salary.

The problem with this sudden jump in salary is that the transition distorts our perception of what our incomes should be. Sure, it’s great to go from $50,000 a year to $200,000 a year. It would be shameful if you actually should be getting $350,000 instead of $200,000.

[showads ad=responsive]

Discussion About Income Is Taboo.

Money is important but we don’t talk about it. Companies like the one that publicizes how much each employee makes is unheard of. Even my closest medical colleagues are apprehensive when we discuss physician incomes. I typically get answers like, “I am paid great,” or “I make really good money now.” Bullshit. These statements are meaningless without quantification. The problem with income is that we’ve associated a number toward self worth.  Perhaps it is a sense of humility that we don’t talk about money. I certainly can’t help you if you tell me that you are making really good money but actually aren’t.

We Actually Think That We Are Being Compensated Fairly. 

This would be an ideal situation. We actually are earning our worth and there is no need to fight the good fight. Most people I know actually aren’t getting paid enough but have no idea. Imagine this, all throughout your training, you aimed for your best.

As long as you think that you are doing fine at your current earning potential, you will not have a desire to earn more.

Ultimately, We Do What Is Necessary In Order To Be Happy.

Likewise, it makes no difference if you make $1 million a year but are unhappy. I would say the goal is to strike a balance. If your realize that your dream is to live off the grid practicing rural medicine in Botswana, by all mean do it.

Just make sure that you’ve paid off your student loans first.

[poll id=”9″]
The Daily Life of An Emergency Room Physician

The Daily Life of An Emergency Room Physician

daily life emergency medicine doctorAmbulance sirens. Gunshot wounds. Broken bones and bloodied faces accompanied by security guards. That’s the sensational portrayal of the life in the emergency room. For those of us who are either aspiring to become an emergency room physician or are practicing emergency room medicine, you’d better pray that not every one of your shifts will be as action-packed as what we see on television.

The truth is that most emergency room physicians aren’t exposed to a constant barrage of high acuity illnesses. If you are, then you must either love it or are insane. Either way, I hope that you are compensated appropriately.

The Daily Clinical Aspects of Emergency Medicine Are Repetitive.

Just like most careers and jobs, emergency medicine medical practice typically consists of a standard routine. Most full-time ER doctors work in shifts ranging from 6 to 12 hours long. On average, a full-time ER job may include 10 twelve-hour shift per month. I have a friend working 8 twelve hour shifts a month and is still considered full-time! As you a can see, one of the perks of this field is that you do have the opportunity to work fewer hours than most other doctors.

Essentially the duties of an ER physician during that shift is to take care of the patients that roll into the ER and create a disposition for them: treatment and discharge, consultation with specialists, or admission to the hospital. If you can get everyone accounted for, you are done. Depending on the acuity of the clientele, you might have broken bones that need to be splinted, pneumonias, COPD exacerbations, trauma, heart attacks, or strokes—you do have to retain a breadth of knowledge as an ER physician and to identify what conditions need immediate attention. Some ER’s are going to be busier than others—an ER doctor might see anywhere from one to four+ patients an hour. Multiply that by a twelve-hour shift, and you’ve got some hurting.

The Income of An Emergency Room Physician is Good.

ER physicians can make good money. Income is something we don’t often discuss openly, but you can easily find an entry-level position that commands at least $250,000. More often, I see ER docs in the $300,000+ range on a normal schedule. If you like to add on extra shifts, you can go even higher. This is not bad for a typical three or four year residency. You get the most bang for the buck in terms of indentured servitude during residency. In fact, an ER doc’s income/work time is probably one of the highest in medicine.

[showads ad=responsive]

Emergency Medicine is High Stress.

There is no free lunch unfortunately. A high income in anything rarely comes easily.   Whether you are working at a Level 1 Trauma Center or a sleepy urgent care facility, you still have to be relatively vigilant during your shift. While it is unfair to say that a family practitioner has a less stressful job than an urgent care emergency physician, it is most definitely true in most cases. An otherwise well-appearing emergency room patient complaining of some difficulty breathing may actually have a collapsed lung. It is commonly said that an hour’s worth of work in an emergency room is equivalent to that of approximately 1.5 hours of outpatient medicine. Combine the intensity with unpredictable hours during shifts, and you get a relatively stressful job. Perhaps that is why ER docs command serious coin.

Emergency Medicine Is Not For Everyone.

In any career, you have to make a balance among income, stress, and time. Emergency medicine has a unique compromise with income and stress. Many ER physicians tend to have many hobbies outside of medicine; I’m not sure if the specialty lends itself to doing so or that it attracts those who already have extracurricular activities.

With high intensity during the work hours, there often is a higher burn-out rate among ER physicians. However, options do exist to work in lower acuity settings.

 

Would you consider becoming an emergency doctor?

View Results

Loading ... Loading ...
The Daily Life of A Dermatologist

The Daily Life of A Dermatologist

Dermatologists are busyThe television perception of doctors is often skewed toward drama, sex, and a rockstar lifestyle. Take Grey’s Anatomy, Mistresses (plastic surgeon character), Scrubs, or Dr. 90201. Even reality medicine shows like NY Med or Boston Med portray a more sensational view of a doctor’s life. Our lives are both exciting and boring at the same time. Exciting in that most specialties involve troubleshooting symptoms and boring in that there is quite a bit of repetition.

To help the general layperson get a broad sense of an average doctor’s routine, I will detail the daily life of a dermatologist. Note: I am not a Dermatologist, but have spent considerable time working with them and have colleagues in the field.

Clinical Lifesyle

The average workday of a Dermatologist is not easy by any stretch of the imagination, but it is also a very manageable day. A typical day runs about 8-10 hours including some amount of time to use the restroom and eat lunch (10 minutes – 1 hour). Most of the workday for a clinician dermatologist involves patient care. An average Dermatology office will have its doctor see about 40-50 patients a day, although I have seen numbers up to 100 a day! What this means is that you haul ass, as a Dermatologist! Minimal chit-chatting, and a lot of spot diagnoses and treatments. Our reimbursements have dwindled over the years, and many offices are often forces to pile on our patients. Nonetheless, the brief time the Dermatologist spends with her patients is quite sufficient for accurate diagnosis.

Rinse and repeat for each of the days the doctor is in clinic. Some Dermatologists may have certain half days dedicated to biopsies or particular skin treatments in order to operate more efficiently. Most doctors will also have administrative duties like business meetings that often add on 5-10 hours a month to the work schedule.

There’s no loitering around. On an average 20-day month, a Dermatologist seeing 50 patients per day will see 1000 people!

Academic Lifestyle

An academic Dermatologist will have more dedicated time to research, teaching, administration, or writing. Many university-based doctors will have perhaps two half-day clinics of patient care with perhaps two days a week of research time. One day of the week may even be dedicated to administrative duties. Revenue generated by the academic Dermatologist is minimal and likely insufficient to even cover the doctor’s salary. Income thus comes from donations (appointed chairs), state/governmental funding, and grants to perform research. The perks of academic medicine include the fact that you can be removed from the financial considerations of medical practice. You involve yourself with interesting technology and are given the opportunity to work with thought leaders (and become one) of your field. You can’t really put a price on fame. And what you do daily really shouldn’t be boring. You can immerse yourself in the cutting edge of medicine. Most academic physicians I know bring their paper-writing home and spend a lot of their free time on their careers. Not necessarily a bad thing to do, but it really shows that you love your career.

One of the downsides of the academic lifestyle is that you are removed from many of the practical matters of medical practice (read: finances). Most doctors I know in academia are quite ignorant of finances and actually think that their one-day a week clinic actually covers their salary. There is no free lunch. You really aren’t generating your worth in cold, hard, cash but rather intrinsically through your research, teaching, and innovations to the field.

Dermatologists Are Busy 

You can basically substitute in any medical specialty in the sentence above (except for maybe rehab medicine—j/k). Dermatologists are no different. The clinician routine is quite repetitive. Imagine spending your entire 20’s training to see thousands of patients a month for your entire career! It is not an easy task. Maybe that’s why we often seen doctors with those fancy cars, homes, and yachts….

Do you have any comments to add regarding the lifestyle of a Dermatologist? Sound out below!

Those of you who are interested about the life of a Moh’s surgeon, see our post on this specialty.

[showads ad=responsive]

Step by Step Rules To Become A Successful Doctor

Hard WorkBeing a successful doctor isn’t hard, but it also takes effort. And when I say it’s not hard, I mean that it’s easier than what we all went through to become a doctor (testing, rotations, testing, long nights, and more testing). That being said, we aren’t necessarily blessed with the ability to become successful nor are we even taught how to become successful. I’ve collated a few key pointers that my mentors have recommended throughout the years.

The Three A’s

The fundamentals of building your reputation are the three A’s: Affability, Availability, and Ability. No matter how stressed out we are with our lives, practices, and patients, we have to be nice. Remember, we are a service industry. With quality performance measures and ratings, affability is even more critical. Word of mouth still drives our referrals, so we have to present ourselves accordingly. In order to generate business, we have to be available. People do not like to wait, and if they do have to wait several weeks in order to see a doctor, they might as well see someone else. This translates to same-day emergency walk-ins, or same week appointments. The only way you can capture reimbursement revenue is to see the patient AND treat them well. Make sure that the referring doctor is kept in the loop regarding the treatment. Lastly, you have to know what you’re doing. This is the “ability”. Keep in touch with the latest changes and innovations in your field, especially if you are a clinic-based physician. Patients are savvy and are capable of discovering the newest fads, whether or not they are based on science. Treat people well, get your patients into the clinic promptly, and know what you’re doing. That’s it. You don’t have to accomplish all of them the second you open up shop, but strive to improve throughout your career.

Hustle and Work Hard

Money doesn’t grow on trees. Your insurance claims aren’t going to mail themselves. Likewise, physician reimbursements have become so disgustingly low that we no longer are able to hang your shingles and watch the money roll in. Work on the three A’s. If you are in a private group setting, find ways to build your referral network. Meet other doctors and make it known that you deliver good care. If you are a university-based physician, continue to do good work. You have to make it known in the medical and pharmaceutical community that you are a thought leader in your field. Carve out a niche for yourself. That is how you develop your alternative revenue streams through lectureships and invited speaker roles.

If you are in an HMO setting, you are screwed. Okay, I’m joking (almost). Your income level is capped and even though you might receive a productivity bonus, the formulas tend to be subjective (because the administration profits from your hard work). The only practical approach is to work hard and take care of your patients. Meet your RVU requirements and get the hell out of the clinic/hospital when you finish your work. Don’t spend unnecessary time in the office when you could be home playing with your kids.

Keep Improving

Write down a list of your strengths and weaknesses. Figure out how each one plays a role in your work life. Make it known (subtly) at work what your strengths are. Figure out what you can do to turn your weaknesses into strengths or at least improve your skills in the process.

Think about making a one, five, and even ten year plan. It’s good to set some goals. Do you want to be a multi-millionaire? Can it actually be done given your salary and expenses? Do you want to retire early? Do you want to be the next Dr. Oz?

What other strategies have you used to become successful?

[showads ad=responsive]

Should You Join An HMO Practice?

Plenty of my friends from medical training have gone the way of the HMO (health maintenance organization), particular those who are working in California (read: KPMG). HMO’s were formed as a way to streamline healthcare costs whereby the healthcare system and the insurer are either the same organization or a closely knit partnership. It is sort of a top-down one stop approach to healthcare (a la Super Walmart). Presumably all specialists are available within the organization to consult and provide efficient healthcare.

Sounds like an ideal system, right? You really have to know what you’re getting yourself into.

HMOs provide a platform to jump start your career

After you become a newly anointed physician, patients still don’t know that you exist. In order to build your patient population you have to establish relationships with referring doctors and your presence in the community. However, in HMO’s the referral network has already been established. The patient volume seen by HMO doctors during their first year of employment are as high as those doctors who have been working for a decade in a metropolitan city!  This immediate volume is beneficial in that it provides a platform for instant experience. Not only that, many treatment protocols are typically in place to treat certain diseases. These “flowcharts” help ease your daily routine of medical practice.

Because you’re instantaneously busy in an HMO practice, you are generating revenue for the practice. They can afford to pay a decent salary. Since these entities are generally well-established, they also will likely have good pension, retirement plans, medical and dental insurance coverage (in their network!).

Despite advantages, practicing at an HMO isn’t a panacea

HMO practice isn’t suited for everyone. Because so many protocols are in place, it may feel like you’re practicing cookie-cutter medicine. If you need to offer treatment that is off-protocol, you might be out of luck. Then again, if you are in the private world, the patient’s insurance company may not cover off-protocol/non-standard treatments anyway.

The generous salary and benefits in HMO practices often translates into more rigidity in the daily schedule. If you need to take a Friday afternoon off for errands, you might have to use a vacation day. Need extra time off? It’s not a easy as shutting down the office for a day. Everything has to be run through the administration. The doctor, while she may be a shareholder of HMO, still functions as an employee in the system. In a way, you really aren’t the owner or controller of your medical career.

In light of a decent salary, you probably could make a whole lot more money if you saw a similar volume of patients and worked for yourself. There is no free lunch in the world, and if you are paid handsomely that means you are unlikely sitting around blogging during work hours.

Only You Will Know If You Are Suited For an HMO

HMO practices definitely offer a stable job for doctors at the expense of control of your schedule. As a summary, the pros and cons are as follows:

[vc_column width=’1/2′]

[vc_row]Pros of an HMO Practice[/vc_row]

[vc_row]Instant patient volume[/vc_row]

[vc_row]Well-established practice patterns and protocols[/vc_row]

[vc_row]Good benefits[/vc_row]

[vc_row]Less pressure to distinguish yourself[/vc_row]

[/vc_column]

[vc_column width=’1/2′]

[vc_row]Cons of an HMO Practice[/vc_row]

[vc_row]Less flexibility to innovate[/vc_row]

[vc_row]Less flexibility on scheduling[/vc_row]

[vc_row]Career success dependent upon system[/vc_row]

[/vc_column]

 

What are your opinions on HMO practices?

[showads ad=responsive]