Tag: physician

Is a degree from a prestigious medical school advantageous for doctors?

Some of us are overachievers. Some of us are overachieving doctors. What if you’re in-between? Let’s say that you’re an overachiever, and you want to become a doctor.

Should you go all the way up top and get that medical degree from a top private institution? Does it even matter? With tuition costs skyrocketing, you can easily spend $60,000 annually on tuition alone for each year in medical school. Add another $10-$15k in room and board, and you will be about a quarter million in the hole by the time you get out. In contrast, medical school tuition in 2016 for UT Houston for in-state resident is only about $20,000 annually. That’s a big difference.

These are considerations that are rarely taught or even discussed. If you are planning to go to medical school, it does pay to consider the consequences thoroughly before you proceed.

Does a prestigious degree help get you a better job?

It depends. It depends on where you plan to work. In clinical medicine, you can either work at an academic institution or in the private sector. Many job situations in the academic world require teaching, research, or involvement in administration. If I were a departmental chair looking to bring on a clinician-researcher, I’d want someone who not only can practice medicine well, but also has strong writing skills, coherent presentation abilities, and innovative characteristics. If two candidates had similar track records with similar recommendations and charisma, I might lean towards going for the gal with the Ivy-league degree, especially if I am running an Ivy-League department.

If I needed a doctor in the private sector, the institution that granted the degree is unlikely going to matter much at all. Yale? Great. Wayne State? That’s okay with me. You just need to be ethical, hard-working, and reasonable to deal with. For all other qualities, the verification process in each state and governing medical board can do the rest.

Do doctors from prestigious institutions make more money?

It depends again. To understand this question, you should understand how doctors make money to see whether an Ivy-League degree will translate to higher dollars. This is also contingent upon how you are using your medical degree, whether you are practicing medicine, performing administrative work, or consulting. Remember, you don’t have to be a doctor to get rich. Or you shouldn’t become a doctor if your main goal is to become rich.

If we are considering doctor worth from revenue alone obtained through clinical practice, insurance companies make no distinction between where you obtained your degree. U.S. grad, international grad, it doesn’t matter. As long as you pass your boards (sometimes you don’t even have to do that!), you’re golden. From clinical practice alone, you’re not going to make more money having gone to a top college or medical school. Period.

Now having that special degree CAN get you more business, depending on which part of the country you practice medicine. This is particularly true (and sometimes annoyingly so) in the New England area. Patients in New Caanan Connecticut do (in general) care where you obtained your degree. They may or may not even be highly educated, but the high concentration of Ivies in that region predisposes this behavior. Unless you have significant street cred and have been working in the area for a long time, your patient may doctor shop your degree.


Okay, I sank $200,000+ into an Ivy-league medical degree, what am I going to get in return?

Many of us, under the guidance of family, friends, or schooling, end up enrolling in well-known [read: expensive] private universities and medical schools.

DESPITE the equivocal conclusion by Smart Money MD.

Don’t fret. You’re not totally screwed. If you have a good inheritance coming your way or an alternative means to fund the process, you’re actually in great shape.

If the above doesn’t apply to you, don’t fret either!

Step 1. Pat yourself on the back.

Congratulations. It is not easy getting in. It is SIGNIFICANTLY more difficult to get in medical school than law school, business school, or college. Kudos to you.

This is a fact. By numbers alone. There are simply fewer number of available positions in medical school. The Class of 2018 Stanford Graduate School of Business has 417 new students. Last I checked, the Stanford medical school had fewer than 90 students per class. I think the acceptance rate in the medical school was about 2-3%, while the business school acceptance rate was 6%. If you compare these numbers to that of an average public medical school and public business school, you’ll see that the class sizes will be larger and the acceptance rate will also be higher.

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Step 2. You’ve got a lifetime of prestige attributed to your name.

Yup, your mother can brag about her daughter at every holiday party. Your distant relatives will direct their children to you for advice. Your alma mater will also hit you up for donations every single year. You can volunteer with your local alumni group and have “exclusive parties”.

You have a lifetime of memories and connections to potentially successful friends and colleagues.

This is not a bad situation to be in.

Step 3. Clear your mind and get to work.

Get yourself back into the real world. Don’t let anything else cloud your judgment. You’re probably not even that smart. Your coworker at the hospital who came from Portugal probably is one the smartest gals in her country. She memorized Harrison’s twice to pass her country’s exams. Oh yea, she also repeated residency in the U.S. and passed all of her U.S. board exams…in English.

That’s right, her native tongue is Portuguese, and she learned Spanish as her secondary language. English was her third language.

Get yourself out of debt if you funded your education through loan sharks. If I dug myself out of debt, so can you. Save up your money. Figure out how much you are worth.

Figure out what makes you happy. Then work to get there. Easy peasy.

Would you spend extra to get a degree from a top medical school?

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(Photo courtesy of Flickr)

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The Daily life of a Moh’s surgeon

The Daily life of a Moh’s surgeon

daily life mohs surgeonMoh’s surgeons typically focus their careers on removal of cancers on the skin. They are dermatologists by training, but have completed a fellowship (often lasting one year) on microscopic removal of cancerous lesions. The Moh’s fellowship society tends to limit the number of trainees in their field for various reasons, so availability is scarce. Competition into the field is fierce, since there are already a limited number of dermatology spots and only a handful of Moh’s fellowship positions yearly.


Daily practice 

Full-time clinical Moh’s surgeons are either in the office or in the procedure room on most days. Clinical days are spent seeing referrals for skin lesion removals. Most of these referrals come from dermatologists or internists. I would say that a high number of referrals end up requiring surgery. The clinical volume of a Moh’s surgeon runs around 20+ patients a day. This is significantly less than what a general dermatologist will see.


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Surgery days (or half days) are spent removing skin lesions, waiting for histology to assess clean margins (if possible), and closing up the skin lesions. These procedures are tedious, but the RVUs generated are very high. Very busy Moh’s surgeons can have 8-10 procedures a day.

The overall lifestyle of this profession is relatively good. There are very few emergencies. Most of the procedures are planned. Many Moh’s surgeons can structure a 4-day workweek, simply because there are sometimes limited number of cases that need to be performed and revenue rate per procedure is very high. Some Moh’s surgeons starting out in their practice will also see general dermatological cases.

Income generation

Many starting salaries for Moh’s surgeons being around $300,000. I’ve seen salaries around $250,000 in highly competitive markets. A well-established Moh’s surgeon who also owns a histology department can earn serious amounts of money. I once met a Moh’s surgeon who worked 4 days a week and took 2 months of vacation per year tell me that she made approximately $1.5 million (pretax)!

The ability of a Moh’s surgeon to generate high income comes from multiple revenue sources. The professional fees for the surgery itself are relatively high given the complexity of the procedure. However, I would estimate that the revenue stream coming from a histology lab (charges insurance for analysis) would more than double the income of an efficient surgeon.



Sounds great being a Moh’s surgeon, right? The truth is that there are still stresses with the job. You are mostly dealing with cancer. There is limited room for mistakes given that clinical management will change depending on surgical outcome.

Would you want to be a Moh’s surgeon?


(Photo courtesy of Flickr)

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?

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Physician non-compete laws state by state

Courtesy FlickrWe’ve previously discussed how to determine how much you are worth as a physician and RVUs. You are presented with a contract with a restrictive covenant, or non-compete clause. A restrictive covenant clause often stipulates that if you leave the hospital that recruited you, you may be prohibited from practicing in a certain geography from the hospital for a period of time. Essentially it prevents you from competing with the employer for the same group of patients.
The enforceability of these clauses vary by state. You should check with a legal counsel who is familiar with your state’s laws before you consider signing any contracts. At last that I had checked, the following states deem non-competes to be not enforceable:
  • Alabama
  • Arizona (maybe)
  • California
  • Delaware
  • Illinois
  • Iowa (maybe)
  • Massachusetts
  • Montana
  • North Dakota
  • Tennessee (maybe)
  • Texas (maybe)

Questions or any other suggestions to add? Sound out below!


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