IMP success?

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I've always been a little lost in comparing what I make now to how it was when I was salaried. After all the salaried position paid 1/2 the FICA etc. And I am definately one who has sugar coating since I have no rent to pay. So are the numbers being reported here before or after taxes? Just so we are all on the same page. To: Sent: Friday, May 18, 2012 1:20 PM Subject: RE: HELP FORK IN THE ROAD

Sorry ,Not trying to sugar coat anything. Just trying to point out that the model in and of itself does not mean financial ruin. Though I do not make as much as many of my colleagues, I am definitely keeping my head above water and definitely above $100,000/year. I would agree that a lot of IMPs don’t make that much, but I believe that at least in this area, the model is working. From: [mailto: ] On Behalf Of magnetdoctor@...Sent: Friday, May 18, 2012 1:21 PMTo: Subject: Re: HELP FORK IN THE ROAD With all due respect , in previous surveys of the group, you are distinctly in the minority on this. Most do make under 90K. That is just a fact of IMP life in most places, many have struggled to make 60K. Let's not sugar coat anything here. CCoteTo: Sent: Friday, May 18, 2012 9:52:49 AMSubject: RE: HELP FORK IN THE ROAD le,Regarding point #3. Though my practice has been around a while (9 years) and is big for an IMP (1.25 FTE and see around 70 people/week), I easily make over $100,000. Last year, with the help of the MU funds, I broke the $150,000 level. I don’t charge any fees. I don’t do any second jobs. I know I have still not hit the “average†FP salary, but it is possible to use this model and still do pretty well. From: [mailto: ] On Behalf Of Dannielle HarwoodSent: Friday, May 18, 2012 8:35 AMTo: Subject: RE: HELP FORK IN THE ROAD ,A few thoughts from Northern California.....1. Many NP's/PA's here in town make more than $75 per hour. The ones working in the ER most certainly do. I think that price is too low unless it is also including a major

benefit package?? Call a locums company and see what you would make per hour taking Illinois locums jobs. 2. If you have ever considered moving to another part of the country this is a great time to look at that option. I have moved 2x in my career. Once from Baltimore to Denver and then from Denver to CA. We finally figured out that being closer to family was a big deal to us and then looked at cost of living vs salaries etc.Lucky for us most places need doctors. That said it is much easier to create niche practices in larger metropolitan areas. 3. I do not think the numbers add up for a single doctor to be in an IMP style practice unless a very low salery is acceptable. Yes, I know I am an IMP. I think.....and I am totally open for the

group to point out how wrong I am here......that for the most part the IMP doctors are either content with less than 90k year or they work a second job or they are a retainer or cash only practice. 4. I think the system is trying to squeeze solo doctors out...new regualtions are popping up all the time that are very difficult to comply with based on our size. Again, if doing a niche practice, cash etc in a larger area this may be survivable. 5. I also know that hospitals that are building new projects tend to run behind so you may have a little time to wait and see. 6. You are welcome in Northern CA any time! Blessings!DannielleSubject: Great article on medical abandonment issuesTo: ericacodes , Date: Wednesday, May 2, 2012, 3:41 PM Thought some of you might find this article informational. Hope it is informative for those on our list.Dr. BethMedico-legal: Unintentional and accidental abandonment Last week we looked at how to avoid a claim of abandonment of a patient when you are terminating that patient from your practice.However, it is still possible to be the

subject of an actionable abandonment claim by patients you specifically had no ongoing physician-patient relationship with and patients you discharged in full technical compliance with all formal requirements and even by patients you consider to be fully active in your practice.Let's look at those situations now. I. Failure to carry through on an accrued duty Last week, the necessity to engage in limited-scope work like physicals and screenings only under a disclaimer that no ongoing physician-patient relationship is thereby established was discussed. However, the critical word there is “ongoingâ€. Even within the scope of the limited care that you are providing, you still have the duties of a physician relative to what that examination reveals, even if it exceeds the intended purpose of the examination and is not part of your specialty. The law assumes that the examinee would expect to be told of any medically important issues the physician finds and that this imposes a duty of reasonable care on the physician to reveal any such to the examinee. Therefore, for example, if you notice a suspicious mole on the back of a patient you are performing a disability physical on, you are obligated to not just document it in the record with a recommendation for follow-up but to inform the patient that it is something they need to have attended to by their own

physician. Similarly, if you are doing an initial evaluation to decide if you will even accept the patient into your practice, as, for example, many plastic surgeons do, and you identify significant hypertension that was previously unknown, yo! u are obligated to both inform the patient and to offer to send the results to their primary care physician. You do not, however, have to order a biopsy or prescribe an anti-hypertensive or even make sure that the patient followed-up as you suggested. That would all be care associated with an ongoing relationship with the patient and it exceeds your duty. In other words, your duty was limited to dealing appropriately with what might accrue during the examination that you performed and that

limited duty was fulfilled in full when you alerted the patient and activated an appropriate follow-up system. More is not required, but less is abandonment. II. Constructive abandonment (i) This can occur when the termination process looks perfect on paper but, in the real world, the patient is actually left high and dry. Whether the patient can get another physician, either within the time frame you specified or at all, must be realistic or you will be deemed to have constrictively abandoned the patient. For example, if you have specialized skills not otherwise available in your area, or you practice ! in an isolated rural town

where traveling to another physician is impossible for your patient, or even if you are the only practitioner in your area who accepts Medicaid or Medicare and your patient is otherwise completely unable to pay for treatment, then your responsibilities as the discharging physician are higher than usual in terms of making sure that your patient can actually get alternative treatment, beginning with allotting more than the usual time for the patient to get a new physician. However, if no matter how ample the transition period you offer is there simply are no practical alternatives to you, you may not be able to terminate the patient without facing an abandonment claim. In that case, you should contact your state medical board for instructions on how to proceed. (ii) Constructive abandonment can also

occur when the patient is still part of your practice but is actually not getting needed care. This can happen in several ways: a. Failure to initiate treatment that was warranted This is more of a technical aspect of pleading in a medical malpractice case. The premise is that the patient is internally abandoned within the active doctor-patient relationship because the ! care that was needed never began, leaving them as though they actually had no access to the treatment at all. Abandonment is alleged separately from medical negligence, but from your point of view in terms

of defending the two issues are inextricable on a practical basis. b. Refusal to assist the patient in accessing appropriate support Physicians who refuse to fill out forms for such matters as legitimate disability claims or to get the patient an appropriate medical device or to keep a patient’s medically-required utilities on, or who will do so only for a significant fee that the patient cannot pay, can be held to have abandoned their patients. Of course, a physician is not expected to be a kowtowing hand-puppet to an overly demanding patient or to an outright scammer to avoid being charged with abandonment. Constructive abandonment would only apply when the treatment or the assistance really were warranted

but were unilaterally denied by the physician without good cause.c. Refusal to see the patient.This most commonly occurs when the patient has a very large outstanding bill that they are refusing to address and the doctor tells them that they will not be scheduled for further appointments until that is dealt with. This acts as constructive abandonment because the patient thereby loses substantive access to the doctor while the bill remains unpaid.Such a situation should instead be dealt with by the! formal discharge of the patient from the practice, followed by all appropriate collection procedures. The potential for falling into constructive abandonment in such “self help†situations is an important reminder of two points:- There is no such thing as de facto termination by conduct. Even if the patient actually sues the doctor, that does not, in and of itself, end the

physician-patient relationship. Therefore, any approach to a troublesome patient that begins with the idea that “Well, since the patient did (fill in thing that drives you bonkers) it means that I am no longer bound by my duties as a doctor†should be immediately avoided.- The law views the physician-patient relationship as one in which thepatient, as the one needing expert services for their health, is in the dependent role. It is therefore protective of the patient. This means that any doctor who finds themselves in opposition to a troublesome patient should make sure to use only clearly sanctioned methods, such as formal discharge, that actually afford the doctor considerable protection. d. Another situation in which constructive abandonment can come into play is with regard to coverage. Because you are responsible for providing an adequate alternative to your patients when you are unavailable for an extended period, if you do not do so, thereby leaving the patient functionally uncovered, it can give rise to an abandonment claim. This could occur if you use a covering doctor who is not reasonably equivalent to you & nb! sp;(e.g.; not from the same specialty or a closely allied one, such as internal medicine and cardiology covering for each other, or is barely out of training when you are very experienced) and so cannot provide a comparable level of expertise. It can also occur if you continue to use an answering service even after it habitually proves unreliable at getting messages from the patient to the covering doctor accurately and promptly.

Since in both of those situations the patient really has no meaningful access to appropriate care through the coverage system their doctor has put in place, there is a predicate for an abandonment claim. III. Inadvertent abandonment(i) Coverage can be an issue in this regard as well when it is completelyabsent. This is not the situation where the doctor deliberately puts no coverage in place and simply leaves a voice message telling patients to call 911 or to go to ER. That is overtly inadequate.Instead, this occurs when there is a proper call schedule in place but the covering doctor becomes unavailable and no replacement is provided. In that situation, to the extent that the doctor needing coverage could have reasonably - that would be

something like taking the call yourself instead of going to a planned party, not coming back from your vacation in China - prevented the problem, they can be deemed to have abandoned their patients. (ii) Abandonment can also occur at your office level if your staff refuses to let a patient with a real problem talk to you or schedules a necessary appointment too far in the future or i! f your staff merely files away the chart of a patient who actually needs to do some important follow-up. You need to have set office policies in place - preferably in writing, since you may have to prove them - to avert these problems.In summary: The laws governing medical abandonment are predicated on the more dependent status of the patient in the relationship with the physician. Therefore, when terminating a patient or when dealing with a patient actively, it is essential to fulfill your duty to make sure that your

patient will not be left without appropriate care.