RE: Tipping doctors

May 17, 2007

Okay, I’ve been reading the various

post-gospel posts re: being tough to make a decent living strictly by

micropracticing but didn’t have a chance to reply until now. I didn’t

think that I would be able to make it as a solo doc just by minimizing my

overhead, so I have my concierge-style practice membership fee. I tell my

patients that I consider mine to be a patient-financed

medical practice, and embellish this by saying that the return on

their investment is the type of service they receive from me (same-day on-time

unhurried office visits, 24/7 cell phone coverage by me, etc.). I suppose

that we could look at my practice membership fee either as a mandatory tip or

as my way of saving my patients from having to go to the trouble of holding a benefit

for me.

Where low overhead helps is allowing me to

keep my annual fee much lower than most concierge medicine practices, in which

this fee is typically in the $1500-$2400 range (and sometimes is much higher

than that). I describe my hybrid model in The Office column on page 49 of

the May 1 issue of Family Practice News. I expect to receive it in the

mail any day now, but it’s available online at www.familypracticenews.com, and I

attached the pdf. In the article I give a shout out to Gordon, the IMP

movement, and the Practice Improvement website. You can also read about my

practice model and fees at my website www.martyschulmanmd.com

Marty

From: [mailto: ] On Behalf Of roxywible

Sent: Wednesday, May 16, 2007

10:29 PM

To:

Subject:

Tipping doctors

Is it legal to tip doctors? I do not see why not. Of

course, it is declared

income. I heard of a guy, oncologist I believe, in a smallish town who

was going out of business because he could not afford his malpractice

premiums. Well, his patients threw a benefit and raised the money

for his malpractice premium so he could stay and take care of them.

This would be in the realm of tips or donations. Get the public

on board. Be transparent with your patients. Who knows? they'll

throw a benefit for your malpractice. Are things getting weird

or what???

I think primary care docs who are feeling strapped for income

(like Kathy with the 40K salary) should (after lowering overhead

as much as possible) put a tip jar out with a sad story on it about

having to make her own clothes and eat out of date food.

This would drive home the primary care predicament to patients

in " dead zones " and be sure to call in the media as this would be a

great story!

You guys will never leave me alone about this story but I must

share. My husband and a friend of his have a thing (maybe an

addiction) for dumpster diving. We (USA) throw out tons of perfectly

good food, furniture, etc.. in dumpsters behind stores all

across the country. It is such a waste -environmentally and

also throwing away perfectly good food - that is just disturbing.

Well, my husband wanted me to go with him to Trader Joe's

(they throw tons of food away and are one of the few places

that doesn't lock their dumpsters) So you should have seen

me. I pulled out 100 cans of perfectly good smoked sardines

in olive oil from Portugal

(worth >$300). I called the company

the next day to make sure they were not recalled. NOPE!

perfectly good food. One leaked and nobody wanted to

clean the olive oil off the entire case so I did! I'm vegan so I do

not eat them but I gave them away. At the time we had a rental

so everyone that filled out an application got a few cans of

sardines. They thought we were pretty cool landlords.

Also bags of organic veggies, peanut butter, shampoo.

Here is the deal - if one item is damaged in a box they throw

the entire case out!!!

So...I told my husband to get a picture of me in the dumpster

with my stethoscope and white coat. The caption

should read physicians dumpster diving for dinner.

I think that would drive it home to the public.

I hope you guys are laughing and Kathy I am NOT suggesting

you start dumpster diving though it is certainly an eye

opening experience.

Now you all know the real secret to my success. I'm a scrounge.

(married to a scrounge with an addiction)

But seriously I do think we need to get the public in on our

plight as abused primary care physicians. They'll go to bat

for us too!

Pamela

May 17, 2007

Marty, As a long time "lurker" here, and admirer of the "micropractice model, but stuck in a macro-practice situation, I think you've hit the right balance. There is no shmae in expecting a decent income for all that we, as physcians, have done and continue to do for our patients. I've been trying to deliver quality medical care for over 25 years now (damn, I've become an old fart!), and as we all know, it's been harder and harder to do so. I started asking for a "voluntary administrative fee" 5 years ago (up to $225 for 2007), and it has been met with good patient understanding, although slight declining support over the past 2 years. Those who don't pay get the same level of care as those who do, but it allows me to spend more effective, quality time with my patients. Ira G. Warshaw, M.D.Marty

Schulman wrote: Okay, I’ve been reading the various post-gospel posts re: being tough to make a decent living strictly by micropracticing but didn’t have a chance to reply until now. I didn’t think that I would be able to make it as a solo doc just by minimizing my overhead, so I have my concierge-style practice membership fee. I tell my

patients that I consider mine to be a patient-financed medical practice, and embellish this by saying that the return on their investment is the type of service they receive from me (same-day on-time unhurried office visits, 24/7 cell phone coverage by me, etc.). I suppose that we could look at my practice membership fee either as a mandatory tip or as my way of saving my patients from having to go to the trouble of holding a benefit for me. Where low overhead helps is allowing me to keep my annual fee much lower than most concierge medicine practices, in which this fee is typically in the $1500-$2400 range (and sometimes is much

higher than that). I describe my hybrid model in The Office column on page 49 of the May 1 issue of Family Practice News. I expect to receive it in the mail any day now, but it’s available online at www.familypracticenews.com, and I attached the pdf. In the article I give a shout out to Gordon, the IMP movement, and the Practice Improvement website. You can also read about my practice model and fees at my website www.martyschulmanmd.com Marty From: [mailto: ] On Behalf Of

roxywibleSent: Wednesday, May 16, 2007 10:29 PMTo: Subject: Tipping doctors Is it legal to tip doctors? I do not see why not. Of course, it is declaredincome. I heard of a guy, oncologist I believe, in a smallish town whowas going out of business because he could not afford his malpracticepremiums. Well, his patients threw a benefit and raised the moneyfor his malpractice premium so he could stay and take care of them.This would be in

the realm of tips or donations. Get the publicon board. Be transparent with your patients. Who knows? they'llthrow a benefit for your malpractice. Are things getting weird or what???I think primary care docs who are feeling strapped for income (like Kathy with the 40K salary) should (after lowering overhead as much as possible) put a tip jar out with a sad story on it about having to make her own clothes and eat out of date food. This would drive home the primary care predicament to patients in "dead zones" and be sure to call in the media as this would be a great story!You guys will never leave me alone about this story but I must share. My husband and a friend of his have a thing (maybe anaddiction) for dumpster diving. We (USA) throw out tons of perfectlygood food, furniture, etc.. in dumpsters behind stores allacross the country. It is such a waste -environmentally and also

throwing away perfectly good food - that is just disturbing.Well, my husband wanted me to go with him to Trader Joe's(they throw tons of food away and are one of the few placesthat doesn't lock their dumpsters) So you should have seenme. I pulled out 100 cans of perfectly good smoked sardinesin olive oil from Portugal (worth >$300). I called the companythe next day to make sure they were not recalled. NOPE!perfectly good food. One leaked and nobody wanted toclean the olive oil off the entire case so I did! I'm vegan so I donot eat them but I gave them away. At the time we had a rentalso everyone that filled out an application got a few cans ofsardines. They thought we were pretty cool landlords. Also bags of organic veggies, peanut butter, shampoo.Here is the deal - if one item is damaged in a box they throw the entire case out!!!So...I told my husband to get a picture of me in the

dumpsterwith my stethoscope and white coat. The captionshould read physicians dumpster diving for dinner. I think that would drive it home to the public.I hope you guys are laughing and Kathy I am NOT suggestingyou start dumpster diving though it is certainly an eye opening experience.Now you all know the real secret to my success. I'm a scrounge.(married to a scrounge with an addiction)But seriously I do think we need to get the public in on ourplight as abused primary care physicians. They'll go to batfor us too!Pamela Ira G. Warshaw, M.D.1216 U.S. Highway #1North Palm Beach, FL 33408(561)626-1000

June 11, 2007

I have been toying with all kinds of ideas

to increase my revenue (besides the obvious, start accepting insurance). I

was thinking whether it would be tacky to have a sign “Tips accepted”.

J I have had a few patients tell me I should charge more for

my visits (usually those who have never had such service before and have high

deductible so are aware of the costs). I never thought about replying “You

can give me a tip if you want.”

Just wanting some opinions on this…

maybe people would think it was a joke, but it might generate their question as

to why the sign is present.

Thanks

Ramona

Ramona G. Seidel, MD

www.baycrossingfamilymedicine.com

Your Bridge to Health

410 349-2250

polis, MD

From: [mailto: ] On Behalf Of Marty Schulman

Sent: Thursday, May 17, 2007 2:46

AM

To:

Subject: RE:

Tipping doctors

Okay, I’ve been reading the various post-gospel posts re:

being tough to make a decent living strictly by micropracticing but

didn’t have a chance to reply until now. I didn’t think that

I would be able to make it as a solo doc just by minimizing my overhead, so I

have my concierge-style practice membership fee. I tell my patients that

I consider mine to be a patient-financed

medical practice, and embellish this by saying that the return on

their investment is the type of service they receive from me (same-day on-time

unhurried office visits, 24/7 cell phone coverage by me, etc.). I suppose

that we could look at my practice membership fee either as a mandatory tip or

as my way of saving my patients from having to go to the trouble of holding a

benefit for me.

Where low overhead helps is allowing me to keep my annual fee much

lower than most concierge medicine practices, in which this fee is typically in

the $1500-$2400 range (and sometimes is much higher than that). I

describe my hybrid model in The Office column on page 49 of the May 1 issue of

Family Practice News. I expect to receive it in the mail any day now, but

it’s available online at www.familypracticenews.com,

and I attached the pdf. In the article I give a shout out to

Gordon, the IMP movement, and the Practice Improvement website. You can also

read about my practice model and fees at my website www.martyschulmanmd.com

Marty

From:

[mailto: ]

On Behalf Of roxywible

Sent: Wednesday, May 16, 2007

10:29 PM

To:

Subject:

Tipping doctors

Is it

legal to tip doctors? I do not see why not. Of course, it is declared

income. I heard of a guy, oncologist I believe, in a smallish town who

was going out of business because he could not afford his malpractice

premiums. Well, his patients threw a benefit and raised the money

for his malpractice premium so he could stay and take care of them.

This would be in the realm of tips or donations. Get the public

on board. Be transparent with your patients. Who knows? they'll

throw a benefit for your malpractice. Are things getting weird

or what???

I think primary care docs who are feeling strapped for income

(like Kathy with the 40K salary) should (after lowering overhead

as much as possible) put a tip jar out with a sad story on it about

having to make her own clothes and eat out of date food.

This would drive home the primary care predicament to patients

in " dead zones " and be sure to call in the media as this would be a

great story!

You guys will never leave me alone about this story but I must

share. My husband and a friend of his have a thing (maybe an

addiction) for dumpster diving. We (USA) throw out tons of

perfectly

good food, furniture, etc.. in dumpsters behind stores all

across the country. It is such a waste -environmentally and

also throwing away perfectly good food - that is just disturbing.

Well, my husband wanted me to go with him to Trader Joe's

(they throw tons of food away and are one of the few places

that doesn't lock their dumpsters) So you should have seen

me. I pulled out 100 cans of perfectly good smoked sardines

in olive oil from Portugal

(worth >$300). I called the company

the next day to make sure they were not recalled. NOPE!

perfectly good food. One leaked and nobody wanted to

clean the olive oil off the entire case so I did! I'm vegan so I do

not eat them but I gave them away. At the time we had a rental

so everyone that filled out an application got a few cans of

sardines. They thought we were pretty cool landlords.

Also bags of organic veggies, peanut butter, shampoo.

Here is the deal - if one item is damaged in a box they throw

the entire case out!!!

So...I told my husband to get a picture of me in the dumpster

with my stethoscope and white coat. The caption

should read physicians dumpster diving for dinner.

I think that would drive it home to the public.

I hope you guys are laughing and Kathy I am NOT suggesting

you start dumpster diving though it is certainly an eye

opening experience.

Now you all know the real secret to my success. I'm a scrounge.

(married to a scrounge with an addiction)

But seriously I do think we need to get the public in on our

plight as abused primary care physicians. They'll go to bat

for us too!

Pamela

June 12, 2007

You're an owner. Tipping not appropriate.

BUT voluntary contribution toward operating expenses at a reasonable per pt rate may be the way to go... so says another doc from Conn.

Dr Matt LevinFamily MedicinePittsburgh PaDr_Levin@... Office Fax.

More about me--Using SOAPware since 1997Solo Practice started Dec 1st 2004 in Greensburg PA, east of PittsburghPart-time practice management and technology consultant

RE: Tipping doctors

I have been toying with all kinds of ideas to increase my revenue (besides the obvious, start accepting insurance). I was thinking whether it would be tacky to have a sign “Tips accepted”. J I have had a few patients tell me I should charge more for my visits (usually those who have never had such service before and have high deductible so are aware of the costs). I never thought about replying “You can give me a tip if you want.”

Just wanting some opinions on this… maybe people would think it was a joke, but it might generate their question as to why the sign is present.

Thanks

Ramona

Ramona G. Seidel, MD

www.baycrossingfamilymedicine.com

Your Bridge to Health

410 349-2250

polis, MD

From: [mailto: ] On Behalf Of Marty SchulmanSent: Thursday, May 17, 2007 2:46 AMTo: Subject: RE: Tipping doctors

Okay, I’ve been reading the various post-gospel posts re: being tough to make a decent living strictly by micropracticing but didn’t have a chance to reply until now. I didn’t think that I would be able to make it as a solo doc just by minimizing my overhead, so I have my concierge-style practice membership fee. I tell my patients that I consider mine to be a patient-financed medical practice, and embellish this by saying that the return on their investment is the type of service they receive from me (same-day on-time unhurried office visits, 24/7 cell phone coverage by me, etc.). I suppose that we could look at my practice membership fee either as a mandatory tip or as my way of saving my patients from having to go to the trouble of holding a benefit for me.

Where low overhead helps is allowing me to keep my annual fee much lower than most concierge medicine practices, in which this fee is typically in the $1500-$2400 range (and sometimes is much higher than that). I describe my hybrid model in The Office column on page 49 of the May 1 issue of Family Practice News. I expect to receive it in the mail any day now, but it’s available online at www.familypracticenews.com, and I attached the pdf. In the article I give a shout out to Gordon, the IMP movement, and the Practice Improvement website. You can also read about my practice model and fees at my website www.martyschulmanmd.com

Marty

From: [mailto: ] On Behalf Of roxywibleSent: Wednesday, May 16, 2007 10:29 PMTo: Subject: Tipping doctors

Is it legal to tip doctors? I do not see why not. Of course, it is declaredincome. I heard of a guy, oncologist I believe, in a smallish town whowas going out of business because he could not afford his malpracticepremiums. Well, his patients threw a benefit and raised the moneyfor his malpractice premium so he could stay and take care of them.This would be in the realm of tips or donations. Get the publicon board. Be transparent with your patients. Who knows? they'llthrow a benefit for your malpractice. Are things getting weird or what???I think primary care docs who are feeling strapped for income (like Kathy with the 40K salary) should (after lowering overhead as much as possible) put a tip jar out with a sad story on it about having to make her own clothes and eat out of date food. This would drive home the primary care predicament to patients in "dead zones" and be sure to call in the media as this would be a great story!You guys will never leave me alone about this story but I must share. My husband and a friend of his have a thing (maybe anaddiction) for dumpster diving. We (USA) throw out tons of perfectlygood food, furniture, etc.. in dumpsters behind stores allacross the country. It is such a waste -environmentally and also throwing away perfectly good food - that is just disturbing.Well, my husband wanted me to go with him to Trader Joe's(they throw tons of food away and are one of the few placesthat doesn't lock their dumpsters) So you should have seenme. I pulled out 100 cans of perfectly good smoked sardinesin olive oil from Portugal (worth >$300). I called the companythe next day to make sure they were not recalled. NOPE!perfectly good food. One leaked and nobody wanted toclean the olive oil off the entire case so I did! I'm vegan so I donot eat them but I gave them away. At the time we had a rentalso everyone that filled out an application got a few cans ofsardines. They thought we were pretty cool landlords. Also bags of organic veggies, peanut butter, shampoo.Here is the deal - if one item is damaged in a box they throw the entire case out!!!So...I told my husband to get a picture of me in the dumpsterwith my stethoscope and white coat. The captionshould read physicians dumpster diving for dinner. I think that would drive it home to the public.I hope you guys are laughing and Kathy I am NOT suggestingyou start dumpster diving though it is certainly an eye opening experience.Now you all know the real secret to my success. I'm a scrounge.(married to a scrounge with an addiction)But seriously I do think we need to get the public in on ourplight as abused primary care physicians. They'll go to batfor us too!Pamela

June 12, 2007

Got it! So that is why one never tips the hair salon owner? I never

got that until now…

J

Have been also thinking about the voluntary

contribution angle: “Optional technology users’ fee”???

R

Ramona G. Seidel, MD

www.baycrossingfamilymedicine.com

Your Bridge to Health

410 349-2250

polis, MD

From: [mailto: ] On Behalf Of Dr Levin

Sent: Monday, June 11, 2007 7:11

PM

To:

Subject: Re:

Tipping doctors

You're an owner. Tipping not appropriate.

BUT voluntary contribution toward operating expenses at a

reasonable per pt rate may be the way to go... so says another doc from Conn.

Dr Matt Levin

Family Medicine

Pittsburgh Pa

Dr_Levincomcast (DOT) net

Office

Fax.

More about me--

Using SOAPware since 1997

Solo Practice started Dec 1st 2004 in Greensburg

PA, east of Pittsburgh

Part-time practice management and technology consultant