Re: my type of practice - can I increase my profits?

[Guest guest]

There are better brains on this listserv than me who are already doing

this (I'm in the process of making the leap to solo-solo... five weeks

from today) but my first thought relates to your hours in the office. I

remember a conversation with Gordon about four years ago (when I first

stepped to the edge but didn't make the leap) about first considering how

many hours you are willing to work because in the end the balance of work

hours and life hours is what this is all about. Then consider how many

patients you can see per hour (1?, 2?, 3?, 4?... more?). Then consider

what your average payment is... hopefully with the new found knowledge of

coding, etc, you are more aware of the potential there and may already

know your own numbers. Then with a little math you'll figure out your

gross office income. Then can consider what you can afford to pay for and

how much you can take home.

This seems simple, and of course my explanation doesn't cover the

subtleties. But really that first question is the all important one -- how

much time are you willing to work? Because honestly, for any of us, the

simplest way to make more money is to see more patients, and the simplest

way to see more patients is to work more hours. But often the " simplest

way " is not a " simple thing " to do because the ripple effect to all other

parts of life is significant.

Another way to increase income is to broaden your scope of practice.

Previously you did non-office based work so I'd guess you don't want to go

back to that. But do you do your own skin procedures? Other procedures?

Doing some procedures that you might otherwise refer out is relative

financially beneficial. Then there are other " outside the box " ideas but

I'll leave it there for now.

This basic thinking is still fresh in my mind as I'm making the leap. I

look forward to many wise thoughts from those on the list with more time

in the low overhead world of primary care.

And whatever happens, good luck!

Tim

> Over six years ago I stopped delivering babies and everything else that

> was not office based. Naturally, my income plummeted. Unfortunately,

> my overhead did not. My overall profit for the last six years has been

> less than that of a beginning teacher. I had been an ostrich with my

> head buried in the dirt, and rebelled at the concept of learning

> " business. " Only over the last two years, as a result of being on the

> AAFP practice management listserv, have I even opened a code book.

> Believe me, prior to that time, I didn't know the difference between an

> ICD9 code and a CPT code.

>

> I have become more knowledgeable in coding, but still am relatively

> ignorant on the subject, as well as most other things that conceivably

> might permit me to reduce my overhead. I have eliminated some staff,

> but that is my biggest overhead expense.

>

> I have a solo family medicine practice, own my own solo office, and have

> practiced solo for 23 years. I generally work from 9 - 1 MTTh, 11 - 1

> on Wednesdays, 9-12 on Fridays.

>

> I'm 57, have been married to the same man for 37 years. We have 3 sons,

> ages 14, 18, and 20 who work for me somewhat reluctantly mostly during

> school breaks. My 14 yo is a computer genius, having built his own

> computer. My husband is a computer whiz (several steps below a genius),

> and although I am more knowledgeable on computers than my medical peers

> of the same general age in my community, I definitely need to learn

> more.

>

> Would the group have an interest in guiding me through incremental steps

> with the goal of decreasing my overhead and increasing my gross?

>

> Shirley Pigott, MD

> DABFM, FAAFP

> , Texas serves about 130,000.

[Guest guest]

Wow Shirley!

Sounds like you are ready to make a major

change. I think you can get a lot

of help here. Your situation is

different from that of most others here in that (I believe) most folks on this

list started their low-overhead practices as new start ups that were “lite”

from the get-go. Either they

started that way straight out of residency, or (like me) they were in a more “traditional”

situation first, and found they didn’t find that to their liking, so they

left to start fresh. You have a lot

of stuff (like a building) that you are not going to leave behind to start

over, but I don’t think that has to mean you can’t make a big

transformation. Lots of businesses

reorganize and “reopen under new management”, so I think patients

will respond OK to seeing you do something like that.

For starters, I would like to know how

many patients you typically see during the hours that you posted? And how many staff (part-time &

full-time) do you have?

Annie,

PS- you should know that my income is no

more than a beginning teacher either, so I am still learning as I go along…..

my

type of practice - can I increase my profits?

Over six years ago I stopped delivering babies and

everything else that was not office based. Naturally, my income

plummeted. Unfortunately, my overhead did not. My overall profit

for the last six years has been less than that of a beginning teacher. I

had been an ostrich with my head buried in the dirt, and rebelled at the

concept of learning " business. " Only over the last two years,

as a result of being on the AAFP practice management listserv, have I even

opened a code book. Believe me, prior to that time, I didn't know the

difference between an ICD9 code and a CPT code.

I have become more knowledgeable in coding, but still am relatively ignorant on

the subject, as well as most other things that conceivably might permit me to

reduce my overhead. I have eliminated some staff, but that is my biggest

overhead expense.

I have a solo family medicine practice, own my own solo office, and have

practiced solo for 23 years. I generally work from 9 - 1 MTTh, 11 - 1 on

Wednesdays, 9-12 on Fridays.

I'm 57, have been married to the same man for 37 years. We have 3 sons, ages

14, 18, and 20 who work for me somewhat reluctantly mostly during school

breaks. My 14 yo is a computer genius, having built his own

computer. My husband is a computer whiz (several steps below a genius),

and although I am more knowledgeable on computers than my medical peers of the

same general age in my community, I definitely need to learn more.

Would the group have an interest in guiding me through incremental steps with

the goal of decreasing my overhead and increasing my gross?

Shirley Pigott, MD

DABFM, FAAFP

, Texas serves about 130,000.

[Guest guest]

Shirley,

Thought of adding any fee for service items? Offering Botox to patients

is a relatively easy way to adding to your bottom line. Little done

side, 100% mark up. It should not change your malpractice either.

Patients get very excited and are very happy. Given your longevity in

practice, they will trust you as well, as opposed to going to a

medispa.

rocky

--- Shirley wrote:

> Over six years ago I stopped delivering babies and everything else

> that was not office based. Naturally, my income plummeted.

> Unfortunately, my overhead did not. My overall profit for the last

> six years has been less than that of a beginning teacher. I had been

> an ostrich with my head buried in the dirt, and rebelled at the

> concept of learning " business. " Only over the last two years, as a

> result of being on the AAFP practice management listserv, have I even

> opened a code book. Believe me, prior to that time, I didn't know

> the difference between an ICD9 code and a CPT code.

>

> I have become more knowledgeable in coding, but still am relatively

> ignorant on the subject, as well as most other things that

> conceivably might permit me to reduce my overhead. I have eliminated

> some staff, but that is my biggest overhead expense.

>

> I have a solo family medicine practice, own my own solo office, and

> have practiced solo for 23 years. I generally work from 9 - 1 MTTh,

> 11 - 1 on Wednesdays, 9-12 on Fridays.

>

> I'm 57, have been married to the same man for 37 years. We have 3

> sons, ages 14, 18, and 20 who work for me somewhat reluctantly mostly

> during school breaks. My 14 yo is a computer genius, having built

> his own computer. My husband is a computer whiz (several steps below

> a genius), and although I am more knowledgeable on computers than my

> medical peers of the same general age in my community, I definitely

> need to learn more.

>

> Would the group have an interest in guiding me through incremental

> steps with the goal of decreasing my overhead and increasing my

> gross?

>

> Shirley Pigott, MD

> DABFM, FAAFP

> , Texas serves about 130,000.

>

>

>

>

Rakesh Patel MD

Arizona Sun Family Medicine, P.C.

633 East Ray Road, #101

Gilbert, Arizona 85296

www.azsunfm.com

PLEASE NOTE: Email is not a secure form of communication. It should not be used

for urgent or sensitive messages. Email may be done securely through our web

portal. If you have a medical emergency go to an Emergency Room or call 911.

[Guest guest]

Shirley,

Thought of adding any fee for service items? Offering Botox to patients

is a relatively easy way to adding to your bottom line. Little done

side, 100% mark up. It should not change your malpractice either.

Patients get very excited and are very happy. Given your longevity in

practice, they will trust you as well, as opposed to going to a

medispa.

rocky

--- Shirley wrote:

> Over six years ago I stopped delivering babies and everything else

> that was not office based. Naturally, my income plummeted.

> Unfortunately, my overhead did not. My overall profit for the last

> six years has been less than that of a beginning teacher. I had been

> an ostrich with my head buried in the dirt, and rebelled at the

> concept of learning " business. " Only over the last two years, as a

> result of being on the AAFP practice management listserv, have I even

> opened a code book. Believe me, prior to that time, I didn't know

> the difference between an ICD9 code and a CPT code.

>

> I have become more knowledgeable in coding, but still am relatively

> ignorant on the subject, as well as most other things that

> conceivably might permit me to reduce my overhead. I have eliminated

> some staff, but that is my biggest overhead expense.

>

> I have a solo family medicine practice, own my own solo office, and

> have practiced solo for 23 years. I generally work from 9 - 1 MTTh,

> 11 - 1 on Wednesdays, 9-12 on Fridays.

>

> I'm 57, have been married to the same man for 37 years. We have 3

> sons, ages 14, 18, and 20 who work for me somewhat reluctantly mostly

> during school breaks. My 14 yo is a computer genius, having built

> his own computer. My husband is a computer whiz (several steps below

> a genius), and although I am more knowledgeable on computers than my

> medical peers of the same general age in my community, I definitely

> need to learn more.

>

> Would the group have an interest in guiding me through incremental

> steps with the goal of decreasing my overhead and increasing my

> gross?

>

> Shirley Pigott, MD

> DABFM, FAAFP

> , Texas serves about 130,000.

>

>

>

>

Rakesh Patel MD

Arizona Sun Family Medicine, P.C.

633 East Ray Road, #101

Gilbert, Arizona 85296

www.azsunfm.com

PLEASE NOTE: Email is not a secure form of communication. It should not be used

for urgent or sensitive messages. Email may be done securely through our web

portal. If you have a medical emergency go to an Emergency Room or call 911.

[Guest guest]

I find that very, very hard to believe that doing Botox treatments would not

raise your malpractice. I'm certain mine would go up exponentially if I

were to add that ( & tell the carrier which I think some choose not to do).

Re: my type of practice - can I increase my

profits?

Shirley,

Thought of adding any fee for service items? Offering Botox to patients

is a relatively easy way to adding to your bottom line. Little done

side, 100% mark up. It should not change your malpractice either.

Patients get very excited and are very happy. Given your longevity in

practice, they will trust you as well, as opposed to going to a

medispa.

rocky

--- Shirley wrote:

> Over six years ago I stopped delivering babies and everything else

> that was not office based. Naturally, my income plummeted.

> Unfortunately, my overhead did not. My overall profit for the last

> six years has been less than that of a beginning teacher. I had been

> an ostrich with my head buried in the dirt, and rebelled at the

> concept of learning " business. " Only over the last two years, as a

> result of being on the AAFP practice management listserv, have I even

> opened a code book. Believe me, prior to that time, I didn't know

> the difference between an ICD9 code and a CPT code.

>

> I have become more knowledgeable in coding, but still am relatively

> ignorant on the subject, as well as most other things that

> conceivably might permit me to reduce my overhead. I have eliminated

> some staff, but that is my biggest overhead expense.

>

> I have a solo family medicine practice, own my own solo office, and

> have practiced solo for 23 years. I generally work from 9 - 1 MTTh,

> 11 - 1 on Wednesdays, 9-12 on Fridays.

>

> I'm 57, have been married to the same man for 37 years. We have 3

> sons, ages 14, 18, and 20 who work for me somewhat reluctantly mostly

> during school breaks. My 14 yo is a computer genius, having built

> his own computer. My husband is a computer whiz (several steps below

> a genius), and although I am more knowledgeable on computers than my

> medical peers of the same general age in my community, I definitely

> need to learn more.

>

> Would the group have an interest in guiding me through incremental

> steps with the goal of decreasing my overhead and increasing my

> gross?

>

> Shirley Pigott, MD

> DABFM, FAAFP

> , Texas serves about 130,000.

>

>

>

>

Rakesh Patel MD

Arizona Sun Family Medicine, P.C.

633 East Ray Road, #101

Gilbert, Arizona 85296

www.azsunfm.com

PLEASE NOTE: Email is not a secure form of communication. It should not be

used for urgent or sensitive messages. Email may be done securely through

our web portal. If you have a medical emergency go to an Emergency Room or

call 911.

[Guest guest]

Be happy to help. Annie already asked about patient numbers, I'm wondering about staffing - how many, who does what. As you already know, you can carve away at this from both directions - increasing your gross or decreasing your overhead. When I compare notes with other doctors, it's my low overhead that has given me my salary.I'm wondering how big a panel/patient base you have now, also. Most of us have very small panels that we grew as part of this practice. I hear that you have good computer resources, and that is important, but there are two doctors here in town that run low-overhead practices on paper. I think that while it may be useful to plan on making the jump to EMR and e-billing, if you haven't already, the mere existence of technology will not be helpful without a fundamental change in thinking through what and how you do every day in your practice.  GuinnAlbuquerque Over six years ago I stopped delivering babies and everything else that was not office based.  Naturally, my income plummeted.  Unfortunately, my overhead did not.  My overall profit for the last six years has been less than that of a beginning teacher.  I had been an ostrich with my head buried in the dirt, and rebelled at the concept of learning "business."  Only over the last two years, as a result of being on the AAFP practice management listserv, have I even opened a code book.  Believe me, prior to that time, I didn't know the difference between an ICD9 code and a CPT code.I have become more knowledgeable in coding, but still am relatively ignorant on the subject, as well as most other things that conceivably might permit me to reduce my overhead.  I have eliminated some staff, but that is my biggest overhead expense.I have a solo family medicine practice, own my own solo office, and have practiced solo for 23 years.  I generally work from 9 - 1 MTTh, 11 - 1 on Wednesdays, 9-12 on Fridays.  I'm 57, have been married to the same man for 37 years. We have 3 sons, ages 14, 18, and 20 who work for me somewhat reluctantly mostly during school breaks.  My 14 yo is a computer genius, having built his own computer.  My husband is a computer whiz (several steps below a genius), and although I am more knowledgeable on computers than my medical peers of the same general age in my community, I definitely need to learn more.Would the group have an interest in guiding me through incremental steps with the goal of decreasing my overhead and increasing my gross?Shirley Pigott, MDDABFM, FAAFP, Texas serves about 130,000.

[Guest guest]

One of the simplest ways to make more money is to see a few more patients a day. While it is important to balance work and life. Sometimes making a small change in your patient volume can make a big change in your take home pay. Most of your expenses such as malpractice, rent and utilities are fixed. For most offices the variable expense per patient is very small. By seeing 1 additional patient per day and collecting $80/patient will increase your income by $20,000. Of course trying to lower your overhead is still very important especially if you are working part time. Larry LIndeman MDWow Shirley! Sounds like you are ready to make a major change.  I think you can get a lot of help here.  Your situation is different from that of most others here in that (I believe) most folks on this list started their low-overhead practices as new start ups that were “lite” from the get-go. Either they started that way straight out of residency, or  (like me) they were in a more “traditional” situation first, and found they didn’t find that to their liking, so they left to start fresh.  You have a lot of stuff (like a building) that you are not going to leave behind to start over, but I don’t think that has to mean you can’t make a big transformation.  Lots of businesses reorganize and “reopen under new management”, so I think patients will respond OK to seeing you do something like that. For starters, I would like to know how many patients you typically see during the hours that you posted?  And how many staff (part-time & full-time) do you have? Annie,PS- you should know that my income is no more than a beginning teacher either, so I am still learning as I go along…..  my type of practice - can I increase my profits? Over six years ago I stopped delivering babies and everything else that was not office based.  Naturally, my income plummeted.  Unfortunately, my overhead did not.  My overall profit for the last six years has been less than that of a beginning teacher.  I had been an ostrich with my head buried in the dirt, and rebelled at the concept of learning "business."  Only over the last two years, as a result of being on the AAFP practice management listserv, have I even opened a code book.  Believe me, prior to that time, I didn't know the difference between an ICD9 code and a CPT code.I have become more knowledgeable in coding, but still am relatively ignorant on the subject, as well as most other things that conceivably might permit me to reduce my overhead.  I have eliminated some staff, but that is my biggest overhead expense.I have a solo family medicine practice, own my own solo office, and have practiced solo for 23 years.  I generally work from 9 - 1 MTTh, 11 - 1 on Wednesdays, 9-12 on Fridays.  I'm 57, have been married to the same man for 37 years. We have 3 sons, ages 14, 18, and 20 who work for me somewhat reluctantly mostly during school breaks.  My 14 yo is a computer genius, having built his own computer.  My husband is a computer whiz (several steps below a genius), and although I am more knowledgeable on computers than my medical peers of the same general age in my community, I definitely need to learn more.Would the group have an interest in guiding me through incremental steps with the goal of decreasing my overhead and increasing my gross?Shirley Pigott, MDDABFM, FAAFP, Texas serves about 130,000. 

[Guest guest]

I filled an aesthetic form for my carrier upon my last renewal. I

included all procedures offered in our office (including fillers,

botox, and nonagressive peels). The increase in my policy was what I

normally see year to year. I have been told that since botox does not

have permenant effects, that rates are usually not affected. Just my

experience here in Arizona, i don't know how it is in other parts of

the country and other carriers.

rocky

--- Brock DO wrote:

> I find that very, very hard to believe that doing Botox treatments

> would not

> raise your malpractice. I'm certain mine would go up exponentially

> if I

> were to add that ( & tell the carrier which I think some choose not to

> do).

>

>

>

> Re: my type of practice - can I

> increase my

> profits?

>

> Shirley,

>

> Thought of adding any fee for service items? Offering Botox to

> patients

> is a relatively easy way to adding to your bottom line. Little done

> side, 100% mark up. It should not change your malpractice either.

> Patients get very excited and are very happy. Given your longevity in

> practice, they will trust you as well, as opposed to going to a

> medispa.

>

> rocky

>

> --- Shirley wrote:

>

> > Over six years ago I stopped delivering babies and everything else

> > that was not office based. Naturally, my income plummeted.

> > Unfortunately, my overhead did not. My overall profit for the last

> > six years has been less than that of a beginning teacher. I had

> been

> > an ostrich with my head buried in the dirt, and rebelled at the

> > concept of learning " business. " Only over the last two years, as a

> > result of being on the AAFP practice management listserv, have I

> even

> > opened a code book. Believe me, prior to that time, I didn't know

> > the difference between an ICD9 code and a CPT code.

> >

> > I have become more knowledgeable in coding, but still am relatively

> > ignorant on the subject, as well as most other things that

> > conceivably might permit me to reduce my overhead. I have

> eliminated

> > some staff, but that is my biggest overhead expense.

> >

> > I have a solo family medicine practice, own my own solo office, and

> > have practiced solo for 23 years. I generally work from 9 - 1

> MTTh,

> > 11 - 1 on Wednesdays, 9-12 on Fridays.

> >

> > I'm 57, have been married to the same man for 37 years. We have 3

> > sons, ages 14, 18, and 20 who work for me somewhat reluctantly

> mostly

> > during school breaks. My 14 yo is a computer genius, having built

> > his own computer. My husband is a computer whiz (several steps

> below

> > a genius), and although I am more knowledgeable on computers than

> my

> > medical peers of the same general age in my community, I definitely

> > need to learn more.

> >

> > Would the group have an interest in guiding me through incremental

> > steps with the goal of decreasing my overhead and increasing my

> > gross?

> >

> > Shirley Pigott, MD

> > DABFM, FAAFP

> > , Texas serves about 130,000.

> >

> >

> >

> >

>

>

> Rakesh Patel MD

> Arizona Sun Family Medicine, P.C.

> 633 East Ray Road, #101

> Gilbert, Arizona 85296

>

> www.azsunfm.com

>

> PLEASE NOTE: Email is not a secure form of communication. It should

> not be

> used for urgent or sensitive messages. Email may be done securely

> through

> our web portal. If you have a medical emergency go to an Emergency

> Room or

> call 911.

>

>

>

>

>

[Guest guest]

Shirley: I would be happy to address issues to lower your overhead. If you are comfortable with the idea give me a call (815)786-6988. D. Egly, M.D. Doctors Egly & Associates, P.C. P.S. My wife works similar hours so I can help you compare numbers.Shirley wrote: Over six years ago I stopped delivering babies and everything else that was not office based. Naturally, my income plummeted. Unfortunately, my overhead did not. My overall profit for the last six years has been less than that of a beginning teacher. I had been an ostrich with my head buried in the dirt, and rebelled at the concept of learning "business." Only over the last two years, as a

result of being on the AAFP practice management listserv, have I even opened a code book. Believe me, prior to that time, I didn't know the difference between an ICD9 code and a CPT code.I have become more knowledgeable in coding, but still am relatively ignorant on the subject, as well as most other things that conceivably might permit me to reduce my overhead. I have eliminated some staff, but that is my biggest overhead expense.I have a solo family medicine practice, own my own solo office, and have practiced solo for 23 years. I generally work from 9 - 1 MTTh, 11 - 1 on Wednesdays, 9-12 on Fridays. I'm 57, have been married to the same man for 37 years. We have 3 sons, ages 14, 18, and 20 who work for me somewhat reluctantly mostly during school breaks. My 14 yo is a computer genius, having built his own computer. My husband is a computer whiz (several steps below a genius), and although I am more knowledgeable on

computers than my medical peers of the same general age in my community, I definitely need to learn more.Would the group have an interest in guiding me through incremental steps with the goal of decreasing my overhead and increasing my gross?Shirley Pigott, MDDABFM, FAAFP, Texas serves about 130,000.

Yahoo! Autos. Looking for a sweet ride? Get pricing, reviews, more on new and used cars.

[Guest guest]

Shirley, We are just south of you in Harlingen. I, unfortunately, started with way too much out of the box, and I have been attempting to cut down ever since. So, believe me, I feel your pain. It is a lot easier to set up low overhead then to undo the mess once the expenses kick in. If you at least are not swimming in debt as I am, you can sell things off and downsize. I would suggest starting by visualizing your ideal practice. Don't think solely in terms of income/expense (that is where debt has us trapped). Once you visualize this practice think of the minimum amount of tools that you require to make that possible. If you have extra bells and whistles already paid for that don't cost you extra staff to run, then great, keep them. The other things you have may require a sale. My rule of thumb, now, with new items that supposedly will bring in all this new revenue is don't believe it. They are always

trying to sell something with all the codes and amounts of reimbursement. Well, insurance companies may change what they will pay for from year to year. So, I do not buy anything I can't afford in case it no longer gets paid. Tell us more about your set up and major expenses and maybe we can suggest cuts. I probably could use that,too.Shirley wrote: Over six years ago I stopped delivering babies and everything else that was not office based. Naturally, my income plummeted. Unfortunately, my overhead did not. My overall profit for the last six years has been less than that of a beginning teacher. I had been an ostrich with my head buried in the dirt, and rebelled at the concept of learning "business." Only over the last

two years, as a result of being on the AAFP practice management listserv, have I even opened a code book. Believe me, prior to that time, I didn't know the difference between an ICD9 code and a CPT code.I have become more knowledgeable in coding, but still am relatively ignorant on the subject, as well as most other things that conceivably might permit me to reduce my overhead. I have eliminated some staff, but that is my biggest overhead expense.I have a solo family medicine practice, own my own solo office, and have practiced solo for 23 years. I generally work from 9 - 1 MTTh, 11 - 1 on Wednesdays, 9-12 on Fridays. I'm 57, have been married to the same man for 37 years. We have 3 sons, ages 14, 18, and 20 who work for me somewhat reluctantly mostly during school breaks. My 14 yo is a computer genius, having built his own computer. My husband is a computer whiz (several steps below a genius), and although I am more

knowledgeable on computers than my medical peers of the same general age in my community, I definitely need to learn more.Would the group have an interest in guiding me through incremental steps with the goal of decreasing my overhead and increasing my gross?Shirley Pigott, MDDABFM, FAAFP, Texas serves about 130,000.

[Guest guest]

I must comment on this although I often just lurk and read these posts once every few wks. I added Botox to my Practice in a small previously rural community last February. I didn't think anyone in this community would pay for it, or that it could possibly make money, without raising my malpractice. Called my malpractice carrier The Doctors Company out of California. Who quoted me that since Botox, and Restylane ( wrinkle filler, lasts 6 -9 months) are not permanent, no increase in fees, as long as I am the one doing it, not a nurse or ma, or pa under my supervision. They wanted to see that I had taken a class, AAFP offers a very minimalist one with no pt, or Botox can help you with either a trainer at your office or a local CME with live models. Added the wrinkle filler about 1 mo after the Botox, because of pt demand. I see only about 4-5 Botox pt a month, some months none, about 1vial or 2 depending on how many units/areas each pt needs. Each vial(100units) is about $440, I charge only 10$ a unit, very low for this area, after trying to match or be just under other local doctors, non-plastics. I just couldn't do the math, 300/for first area, 7$ a unit each unit after, etc. It's just easier to multiply by 10, and still double what I pay for it.

So less than a yr, $10,000, and I do very little of this. I have found, pt love it, it is easier than many other procedures we do routinely, it's fun, a little arsty, and yes they pay cash. Sometimes a credit card. It now doesn't surprise me to see a pt plunck down $300-700 in cash for botox and or Restylane, but to complain about the co pay that has gone up to 20 dollars, after 10 yr.

After 6 months added a laser that I lease to buy. Cost more than my first house. Got a 3 mo lease deferral to start and prayed. Got the laser because the pt who get the botox and restylane, were asking about leg veins, hair removal, and sun spots, more permanent wrinkle reduction. First month, didn't have the lease to pay but did enough visits to pay it, no profit. Next 3 mo took in $20,000 gross. I pay my biller, who was an aesthetician in another life to run the laser, she wanted more hrs than I had. She gets paid same hrly rate, and a commission on the laser profits. So, although it is very costly in the overhead department, $3,000 for the lease, it seems so far to have been a good decision, we'll see if it holds. AT the onset, before the decision asked TDC what would do to my malpractice. Since it's a non-ablative laser/cosmetic, not for doing cataracts, etc. They told me based on number/ month, likley would cost about 10% of my total yrly fee. We had estimates would take about 14/month to make payment, so said 20. Did our training, supplied them with the certificates, and just got the final letter back saying that we aren't going to do enough for it to raise my malpractice.

As it is the estimate is way high, I do no where near 20/month. But could someday, and didn't want to have to keep sending stuff in. I really like offering the aesthetic procedures. I don't run the laser but could. As it turns out, you need to be very detail oriented, after every last hair, although I don't mind details, I found running the laser very tedious, and far prefer to pay someone else to do it. With these procedures I keep my hand skills, provide a service to people who were getting it anyway but driving 45 min to have it, and keep it so I don't have to see 30 people a day. AT first I really had a crisis of confidence, why did I go to medical school anyway if I could have just done this. The answer is I love alot of aspects of medicine, but I hate having to see more/do more, worry about the billing etc. My practice now looks pretty typical, 1.5 Ma's about 12-15 visits a day, in 1000 sq feet. But I would be seeing 25 a day, and still making less than when I was in the big group were it not for expanding my horizons.

Cote MD

Maple Valley Wa

Four Corners Family Medicine, (and Laser Aesthetics)

--------- Re: my type of practice - can I> increase my> profits?> > Shirley,> > Thought of adding any fee for service items? Offering Botox to> patients> is a relatively easy way to adding to your bottom line. Little done> side, 100% mark up. It should not change your malpractice either.> Patients get very excited and are very happy. Given your longevity in> practice, they will trust you as well, as opposed to going to a> medispa.> > rocky> > --- Shirley wrote:> > > Over six years ago I stopped delivering babies and everything else> > that was not office based. Naturally, my income plummeted. > > Unfortunately, my overhead did not. My overall profit for the last> > six years has been less than that of a beginning teacher. I had> been> > an ostrich with my head buried in the dirt, and rebelled at the> > concept of learning "business." Only over the last two years, as a> > result of being on the AAFP practice management listserv, have I> even> > opened a code book. Believe me, prior to that time, I didn't know> > the difference between an ICD9 code and a CPT code.> > > > I have become more knowledgeable in coding, but still am relatively> > ignorant on the subject, as well as most other things that> > conceivably might permit me to reduce my overhead. I have> eliminated> > some staff, but that is my biggest overhead expense.> > > > I have a solo family medicine practice, own my own solo office, and> > have practiced solo for 23 years. I generally work from 9 - 1> MTTh,> > 11 - 1 on Wednesdays, 9-12 on Fridays. > > > > I'm 57, have been married to the same man for 37 years. We have 3> > sons, ages 14, 18, and 20 who work for me somewhat reluctantly> mostly> > during school breaks. My 14 yo is a computer genius, having built> > his own computer. My husband is a computer whiz (several steps> below> > a genius), and although I am more knowledgeable on computers than> my> > medical peers of the same general age in my community, I definitely> > need to learn more.> > > > Would the group have an interest in guiding me through incremental> > steps with the goal of decreasing my overhead and increasing my> > gross?> > > > Shirley Pigott, MD> > DABFM, FAAFP> > , Texas serves about 130,000.> > > > > > > > > > > Rakesh Patel MD > Arizona Sun Family Medicine, P.C. > 633 East Ray Road, #101 > Gilbert, Arizona 85296 > > www.azsunfm.com > > PLEASE NOTE: Email is not a secure form of communication. It should> not be> used for urgent or sensitive messages. Email may be done securely> through> our web portal. If you have a medical emergency go to an Emergency> Room or> call 911.> > > > >

[Guest guest]

I must comment on this although I often just lurk and read these posts once every few wks. I added Botox to my Practice in a small previously rural community last February. I didn't think anyone in this community would pay for it, or that it could possibly make money, without raising my malpractice. Called my malpractice carrier The Doctors Company out of California. Who quoted me that since Botox, and Restylane ( wrinkle filler, lasts 6 -9 months) are not permanent, no increase in fees, as long as I am the one doing it, not a nurse or ma, or pa under my supervision. They wanted to see that I had taken a class, AAFP offers a very minimalist one with no pt, or Botox can help you with either a trainer at your office or a local CME with live models. Added the wrinkle filler about 1 mo after the Botox, because of pt demand. I see only about 4-5 Botox pt a month, some months none, about 1vial or 2 depending on how many units/areas each pt needs. Each vial(100units) is about $440, I charge only 10$ a unit, very low for this area, after trying to match or be just under other local doctors, non-plastics. I just couldn't do the math, 300/for first area, 7$ a unit each unit after, etc. It's just easier to multiply by 10, and still double what I pay for it.

So less than a yr, $10,000, and I do very little of this. I have found, pt love it, it is easier than many other procedures we do routinely, it's fun, a little arsty, and yes they pay cash. Sometimes a credit card. It now doesn't surprise me to see a pt plunck down $300-700 in cash for botox and or Restylane, but to complain about the co pay that has gone up to 20 dollars, after 10 yr.

After 6 months added a laser that I lease to buy. Cost more than my first house. Got a 3 mo lease deferral to start and prayed. Got the laser because the pt who get the botox and restylane, were asking about leg veins, hair removal, and sun spots, more permanent wrinkle reduction. First month, didn't have the lease to pay but did enough visits to pay it, no profit. Next 3 mo took in $20,000 gross. I pay my biller, who was an aesthetician in another life to run the laser, she wanted more hrs than I had. She gets paid same hrly rate, and a commission on the laser profits. So, although it is very costly in the overhead department, $3,000 for the lease, it seems so far to have been a good decision, we'll see if it holds. AT the onset, before the decision asked TDC what would do to my malpractice. Since it's a non-ablative laser/cosmetic, not for doing cataracts, etc. They told me based on number/ month, likley would cost about 10% of my total yrly fee. We had estimates would take about 14/month to make payment, so said 20. Did our training, supplied them with the certificates, and just got the final letter back saying that we aren't going to do enough for it to raise my malpractice.

As it is the estimate is way high, I do no where near 20/month. But could someday, and didn't want to have to keep sending stuff in. I really like offering the aesthetic procedures. I don't run the laser but could. As it turns out, you need to be very detail oriented, after every last hair, although I don't mind details, I found running the laser very tedious, and far prefer to pay someone else to do it. With these procedures I keep my hand skills, provide a service to people who were getting it anyway but driving 45 min to have it, and keep it so I don't have to see 30 people a day. AT first I really had a crisis of confidence, why did I go to medical school anyway if I could have just done this. The answer is I love alot of aspects of medicine, but I hate having to see more/do more, worry about the billing etc. My practice now looks pretty typical, 1.5 Ma's about 12-15 visits a day, in 1000 sq feet. But I would be seeing 25 a day, and still making less than when I was in the big group were it not for expanding my horizons.

Cote MD

Maple Valley Wa

Four Corners Family Medicine, (and Laser Aesthetics)

--------- Re: my type of practice - can I> increase my> profits?> > Shirley,> > Thought of adding any fee for service items? Offering Botox to> patients> is a relatively easy way to adding to your bottom line. Little done> side, 100% mark up. It should not change your malpractice either.> Patients get very excited and are very happy. Given your longevity in> practice, they will trust you as well, as opposed to going to a> medispa.> > rocky> > --- Shirley wrote:> > > Over six years ago I stopped delivering babies and everything else> > that was not office based. Naturally, my income plummeted. > > Unfortunately, my overhead did not. My overall profit for the last> > six years has been less than that of a beginning teacher. I had> been> > an ostrich with my head buried in the dirt, and rebelled at the> > concept of learning "business." Only over the last two years, as a> > result of being on the AAFP practice management listserv, have I> even> > opened a code book. Believe me, prior to that time, I didn't know> > the difference between an ICD9 code and a CPT code.> > > > I have become more knowledgeable in coding, but still am relatively> > ignorant on the subject, as well as most other things that> > conceivably might permit me to reduce my overhead. I have> eliminated> > some staff, but that is my biggest overhead expense.> > > > I have a solo family medicine practice, own my own solo office, and> > have practiced solo for 23 years. I generally work from 9 - 1> MTTh,> > 11 - 1 on Wednesdays, 9-12 on Fridays. > > > > I'm 57, have been married to the same man for 37 years. We have 3> > sons, ages 14, 18, and 20 who work for me somewhat reluctantly> mostly> > during school breaks. My 14 yo is a computer genius, having built> > his own computer. My husband is a computer whiz (several steps> below> > a genius), and although I am more knowledgeable on computers than> my> > medical peers of the same general age in my community, I definitely> > need to learn more.> > > > Would the group have an interest in guiding me through incremental> > steps with the goal of decreasing my overhead and increasing my> > gross?> > > > Shirley Pigott, MD> > DABFM, FAAFP> > , Texas serves about 130,000.> > > > > > > > > > > Rakesh Patel MD > Arizona Sun Family Medicine, P.C. > 633 East Ray Road, #101 > Gilbert, Arizona 85296 > > www.azsunfm.com > > PLEASE NOTE: Email is not a secure form of communication. It should> not be> used for urgent or sensitive messages. Email may be done securely> through> our web portal. If you have a medical emergency go to an Emergency> Room or> call 911.> > > > >

[Guest guest]

That is a good description of how aesthetics has have impacted our

office. Patients whine and complain about their $10 copay, but are

ready to plunk down $400.00 for botox or fillers.

For example I had a patient come in today, saw my NP for her WWE/PAP,

and oh by the way, can i get some botox. $600.00 later she was out the

door. I don't seem to mind the " oh by the ways " when they are like

that. We are looking to add the laser within the next 30 days.

rocky

--- magnetdoctor@... wrote:

> I must comment on this although I often just lurk and read these

> posts once every few wks. I added Botox to my Practice in a small

> previously rural community last February. I didn't think anyone in

> this community would pay for it, or that it could possibly make

> money, without raising my malpractice. Called my malpractice carrier

> The Doctors Company out of California. Who quoted me that since

> Botox, and Restylane ( wrinkle filler, lasts 6 -9 months) are not

> permanent, no increase in fees, as long as I am the one doing it, not

> a nurse or ma, or pa under my supervision. They wanted to see that I

> had taken a class,

> AAFP offers a very minimalist one with no pt, or Botox can help you

> with either a trainer at your office or a local CME with live models.

> Added the wrinkle filler about 1 mo after the Botox, because of pt

> demand. I see only about 4-5 Botox pt a month, some months none,

> about 1vial or 2 depending on how many units/areas each pt needs.

> Each vial(100units) is about $440, I charge only 10$ a unit, very low

> for this area, after trying to match or be just under other local

> doctors, non-plastics. I just couldn't do the math, 300/for first

> area, 7$ a unit each unit after, etc. It's just easier to multiply

> by 10, and still double what I pay for it.

> So less than a yr, $10,000, and I do very little of this. I have

> found, pt love it, it is easier than many other procedures we do

> routinely, it's fun, a little arsty, and yes they pay cash.

> Sometimes a credit card. It now doesn't surprise me to see a pt

> plunck down $300-700 in cash for botox and or Restylane, but to

> complain about the co pay that has gone up to 20 dollars, after 10

> yr.

> After 6 months added a laser that I lease to buy. Cost more than my

> first house. Got a 3 mo lease deferral to start and prayed. Got the

> laser because the pt who get the botox and restylane, were asking

> about leg veins, hair removal, and sun spots, more permanent wrinkle

> reduction. First month, didn't have the lease to pay but did enough

> visits to pay it, no profit. Next 3 mo took in $20,000 gross. I pay

> my biller, who was an aesthetician in another life to run the laser,

> she wanted more hrs than I had. She gets paid same hrly rate, and a

> commission on the laser profits. So, although it is very costly in

> the overhead department, $3,000 for the lease, it seems so far to

> have been a good decision, we'll see if it holds. AT the onset,

> before the decision asked TDC what would do to my malpractice. Since

> it's a non-ablative laser/cosmetic, not for doing cataracts, etc.

> They told me based on number/ month, likley would cost about 10% of

> my total yrly fee. We had estimates would take about 14/month to

> make payment, so said 20. Did our training, supplied them with the

> certificates, and just got the final letter back saying that we

> aren't going to do enough for it to raise my malpractice.

> As it is the estimate is way high, I do no where near 20/month. But

> could someday, and didn't want to have to keep sending stuff in. I

> really like offering the aesthetic procedures. I don't run the laser

> but could. As it turns out, you need to be very detail oriented,

> after every last hair, although I don't mind details, I found running

> the laser very tedious, and far prefer to pay someone else to do it.

> With these procedures I keep my hand skills, provide a service to

> people who were getting it anyway but driving 45 min to have it, and

> keep it so I don't have to see 30 people a day. AT first I really

> had a crisis of confidence, why did I go to medical school anyway if

> I could have just done this. The answer is I love alot of aspects of

> medicine, but I hate having to see more/do more, worry about the

> billing etc. My practice now looks pretty typical, 1.5 Ma's about

> 12-15 visits a day, in 1000 sq feet. But I would be seeing 25 a day,

> and still making less than when I was in the big group were it not

> for expanding my horizons.

> Cote MD

> Maple Valley Wa

> Four Corners Family Medicine, (and Laser Aesthetics)

>

>

> --------- Re: my type of practice - can I

> > increase my

> > profits?

> >

> > Shirley,

> >

> > Thought of adding any fee for service items? Offering Botox to

> > patients

> > is a relatively easy way to adding to your bottom line. Little done

> > side, 100% mark up. It should not change your malpractice either.

> > Patients get very excited and are very happy. Given your longevity

> in

> > practice, they will trust you as well, as opposed to going to a

> > medispa.

> >

> > rocky

> >

> > --- Shirley wrote:

> >

> > > Over six years ago I stopped delivering babies and everything

> else

> > > that was not office based. Naturally, my income plummeted.

> > > Unfortunately, my overhead did not. My overall profit for the

> last

> > > six years has been less than that of a beginning teacher. I had

> > been

> > > an ostrich with my head buried in the dirt, and rebelled at the

> > > concept of learning " business. " Only over the last two years, as

> a

> > > result of being on the AAFP practice management listserv, have I

> > even

> > > opened a code book. Believe me, prior to that time, I didn't

> know

> > > the difference between an ICD9 code and a CPT code.

> > >

> > > I have become more knowledgeable in coding, but still am

> relatively

> > > ignorant on the subject, as well as most other things that

> > > conceivably might permit me to reduce my overhead. I have

> > eliminated

> > > some staff, but that is my biggest overhead expense.

> > >

> > > I have a solo family medicine practice, own my own solo office,

> and

> > > have practiced solo for 23 years. I generally work from 9 - 1

> > MTTh,

> > > 11 - 1 on Wednesdays, 9-12 on Fridays.

> > >

> > > I'm 57, have been married to the same man for 37 years. We have 3

> > > sons, ages 14, 18, and 20 who work for me somewhat reluctantly

> > mostly

> > > during school breaks. My 14 yo is a computer genius, having

> built

> > > his own computer. My husband is a computer whiz (several steps

> > below

> > > a genius), and although I am more knowledgeable on computers than

> > my

> > > medical peers of the same general age in my community, I

> definitely

> > > need to learn more.

> > >

> > > Would the group have an interest in guiding me through

> incremental

> > > steps with the goal of decreasing my overhead and increasing my

> > > gross?

> > >

> > > Shirley Pigott, MD

> > > DABFM, FAAFP

> > > , Texas serves about 130,000.

> > >

> > >

> > >

> > >

> >

> >

> > Rakesh Patel MD

> > Arizona Sun Family Medicine, P.C.

> > 633 East Ray Road, #101

> > Gilbert, Arizona 85296

> >

> > www.azsunfm.com

> >

> > PLEASE NOTE: Email is not a secure form of communication. It should

> > not be

> > used for urgent or sensitive messages. Email may be done securely

> > through

> > our web portal. If you have a medical emergency go to an Emergency

> > Room or

> > call 911.

> >

> >

> >

> >

> >

[Guest guest]

That is a good description of how aesthetics has have impacted our

office. Patients whine and complain about their $10 copay, but are

ready to plunk down $400.00 for botox or fillers.

For example I had a patient come in today, saw my NP for her WWE/PAP,

and oh by the way, can i get some botox. $600.00 later she was out the

door. I don't seem to mind the " oh by the ways " when they are like

that. We are looking to add the laser within the next 30 days.

rocky

--- magnetdoctor@... wrote:

> I must comment on this although I often just lurk and read these

> posts once every few wks. I added Botox to my Practice in a small

> previously rural community last February. I didn't think anyone in

> this community would pay for it, or that it could possibly make

> money, without raising my malpractice. Called my malpractice carrier

> The Doctors Company out of California. Who quoted me that since

> Botox, and Restylane ( wrinkle filler, lasts 6 -9 months) are not

> permanent, no increase in fees, as long as I am the one doing it, not

> a nurse or ma, or pa under my supervision. They wanted to see that I

> had taken a class,

> AAFP offers a very minimalist one with no pt, or Botox can help you

> with either a trainer at your office or a local CME with live models.

> Added the wrinkle filler about 1 mo after the Botox, because of pt

> demand. I see only about 4-5 Botox pt a month, some months none,

> about 1vial or 2 depending on how many units/areas each pt needs.

> Each vial(100units) is about $440, I charge only 10$ a unit, very low

> for this area, after trying to match or be just under other local

> doctors, non-plastics. I just couldn't do the math, 300/for first

> area, 7$ a unit each unit after, etc. It's just easier to multiply

> by 10, and still double what I pay for it.

> So less than a yr, $10,000, and I do very little of this. I have

> found, pt love it, it is easier than many other procedures we do

> routinely, it's fun, a little arsty, and yes they pay cash.

> Sometimes a credit card. It now doesn't surprise me to see a pt

> plunck down $300-700 in cash for botox and or Restylane, but to

> complain about the co pay that has gone up to 20 dollars, after 10

> yr.

> After 6 months added a laser that I lease to buy. Cost more than my

> first house. Got a 3 mo lease deferral to start and prayed. Got the

> laser because the pt who get the botox and restylane, were asking

> about leg veins, hair removal, and sun spots, more permanent wrinkle

> reduction. First month, didn't have the lease to pay but did enough

> visits to pay it, no profit. Next 3 mo took in $20,000 gross. I pay

> my biller, who was an aesthetician in another life to run the laser,

> she wanted more hrs than I had. She gets paid same hrly rate, and a

> commission on the laser profits. So, although it is very costly in

> the overhead department, $3,000 for the lease, it seems so far to

> have been a good decision, we'll see if it holds. AT the onset,

> before the decision asked TDC what would do to my malpractice. Since

> it's a non-ablative laser/cosmetic, not for doing cataracts, etc.

> They told me based on number/ month, likley would cost about 10% of

> my total yrly fee. We had estimates would take about 14/month to

> make payment, so said 20. Did our training, supplied them with the

> certificates, and just got the final letter back saying that we

> aren't going to do enough for it to raise my malpractice.

> As it is the estimate is way high, I do no where near 20/month. But

> could someday, and didn't want to have to keep sending stuff in. I

> really like offering the aesthetic procedures. I don't run the laser

> but could. As it turns out, you need to be very detail oriented,

> after every last hair, although I don't mind details, I found running

> the laser very tedious, and far prefer to pay someone else to do it.

> With these procedures I keep my hand skills, provide a service to

> people who were getting it anyway but driving 45 min to have it, and

> keep it so I don't have to see 30 people a day. AT first I really

> had a crisis of confidence, why did I go to medical school anyway if

> I could have just done this. The answer is I love alot of aspects of

> medicine, but I hate having to see more/do more, worry about the

> billing etc. My practice now looks pretty typical, 1.5 Ma's about

> 12-15 visits a day, in 1000 sq feet. But I would be seeing 25 a day,

> and still making less than when I was in the big group were it not

> for expanding my horizons.

> Cote MD

> Maple Valley Wa

> Four Corners Family Medicine, (and Laser Aesthetics)

>

>

> --------- Re: my type of practice - can I

> > increase my

> > profits?

> >

> > Shirley,

> >

> > Thought of adding any fee for service items? Offering Botox to

> > patients

> > is a relatively easy way to adding to your bottom line. Little done

> > side, 100% mark up. It should not change your malpractice either.

> > Patients get very excited and are very happy. Given your longevity

> in

> > practice, they will trust you as well, as opposed to going to a

> > medispa.

> >

> > rocky

> >

> > --- Shirley wrote:

> >

> > > Over six years ago I stopped delivering babies and everything

> else

> > > that was not office based. Naturally, my income plummeted.

> > > Unfortunately, my overhead did not. My overall profit for the

> last

> > > six years has been less than that of a beginning teacher. I had

> > been

> > > an ostrich with my head buried in the dirt, and rebelled at the

> > > concept of learning " business. " Only over the last two years, as

> a

> > > result of being on the AAFP practice management listserv, have I

> > even

> > > opened a code book. Believe me, prior to that time, I didn't

> know

> > > the difference between an ICD9 code and a CPT code.

> > >

> > > I have become more knowledgeable in coding, but still am

> relatively

> > > ignorant on the subject, as well as most other things that

> > > conceivably might permit me to reduce my overhead. I have

> > eliminated

> > > some staff, but that is my biggest overhead expense.

> > >

> > > I have a solo family medicine practice, own my own solo office,

> and

> > > have practiced solo for 23 years. I generally work from 9 - 1

> > MTTh,

> > > 11 - 1 on Wednesdays, 9-12 on Fridays.

> > >

> > > I'm 57, have been married to the same man for 37 years. We have 3

> > > sons, ages 14, 18, and 20 who work for me somewhat reluctantly

> > mostly

> > > during school breaks. My 14 yo is a computer genius, having

> built

> > > his own computer. My husband is a computer whiz (several steps

> > below

> > > a genius), and although I am more knowledgeable on computers than

> > my

> > > medical peers of the same general age in my community, I

> definitely

> > > need to learn more.

> > >

> > > Would the group have an interest in guiding me through

> incremental

> > > steps with the goal of decreasing my overhead and increasing my

> > > gross?

> > >

> > > Shirley Pigott, MD

> > > DABFM, FAAFP

> > > , Texas serves about 130,000.

> > >

> > >

> > >

> > >

> >

> >

> > Rakesh Patel MD

> > Arizona Sun Family Medicine, P.C.

> > 633 East Ray Road, #101

> > Gilbert, Arizona 85296

> >

> > www.azsunfm.com

> >

> > PLEASE NOTE: Email is not a secure form of communication. It should

> > not be

> > used for urgent or sensitive messages. Email may be done securely

> > through

> > our web portal. If you have a medical emergency go to an Emergency

> > Room or

> > call 911.

> >

> >

> >

> >

> >