Re: Does This Model Have A Financial Ceiling?

[Guest guest]

Most people who become well off don't do it by working harder to make

more money, but by making their money work for them.

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>

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>

>

> I am starting to understand the benefits of IMP with regards to

> patient care and physician quality of life. The ability of IMP to

> restore balance is priceless and it appears to have saved the lives of

> quite a few practices.

>

> I am very much in tune with striving to deliver high quality care but

> the realities of 3 kids all bound for college and my relatively

> expensive cost of living (East Bay, California)force me to focus on

> income. Plus, I enjoy earning money albeit I no longer enjoy how hard

> I have to work to do so. Hence my question regarding a ceiling on revenue.

>

> In the volume based model there does not appear to be a ceiling. It's

> true that growing larger requires all sorts of systems so as to

> maintain a high level of patient care and that it's very challenging

> to create and monitor these systems. But it is possible to do so all

> the while generating more revenue.

>

> In the IMP model it appears that delivering high quality care is

> relatively easier. However, the revenues generated are still a

> function of volume. It also seems that there is a ceiling in that the

> numbers of hours worked is the limiting factor.

>

> So, does it boil down to accepting a ceiling in exchange for an easier

> life and the ability to deliver high quality care vs. no ceiling and

> having a more hectic life and greater challenges to deliver great care?

>

>

--

Graham Chiu

http://www.synapsedirect.com

Synapse - the use from anywhere EMR.

[Guest guest]

i don't think it's a question of ceiling vs no ceiling.both methods have ceilings, but it's like comparing cottages and skyscrapers.on the one hand, you can increase volume, but it's not unlimited; there are only so many hours in a day/stories high you can go. yes, one could hire mid-levels, and other doctors, and more staff, but then one becomes an administrator, not a practicing doctor.the IMP path also has a ceiling, but it has a different floor, and that difference is in the overhead (talk about east bay! dirt vs marble mezzanine). that means the need for increased income just to meet expenses may be less. that's a huge difference, and it can translate into far less stress and far more time with one's family. what's that worth?if you want to subsidize your kids going through college, make dough, although quite frankly i think kids going through college should make their own way; i did, builds character and develops

values. but that's coming from someone who was working full-time in a factory when he was 16 and 17, so my perspective may be significantly different from yours.what do your kids and wife want? proceeds from a life insurance policy, or a father and husband?ultimately, in a higher and higher volume practice, there will be a point where you can't provide high quality care, but by then, you'd be locked into making dough, and that's when we slip down the slope, and it becomes the excuse for poor practice.don't go there, you don't have to-- but remember, if you choose a new path, it works best if you keep an open mind. you choose how you want to do it.LLdrquit wrote: I am starting to understand the benefits of IMP with regards to patient care and physician quality of life. The ability of IMP to restore balance is priceless and it appears to have saved the lives of quite a few practices. I am very much in tune with striving to deliver high quality care but the realities of 3 kids all bound for college and my relatively expensive cost of living (East Bay, California)force me to focus on income. Plus, I enjoy earning money albeit I no longer enjoy how hard I have to work to do so. Hence my question regarding a ceiling on revenue. In the volume based model there does not appear to be a ceiling. It's true that growing larger requires all sorts of systems so as to maintain a high level of patient

care and that it's very challenging to create and monitor these systems. But it is possible to do so all the while generating more revenue. In the IMP model it appears that delivering high quality care is relatively easier. However, the revenues generated are still a function of volume. It also seems that there is a ceiling in that the numbers of hours worked is the limiting factor. So, does it boil down to accepting a ceiling in exchange for an easier life and the ability to deliver high quality care vs. no ceiling and having a more hectic life and greater challenges to deliver great care? __________________________________________________

[Guest guest]

I have heard that as well but I question how accurate the statement

is. The wealthy people I have come across seem to be doing both, but I

get your point.

Most docs derive the majority of their livelihood from doctoring so

unless you have some investment tips for me ..,I will still be

checking BPs for the next few decades as my primary means of sending

my kids to college and living in my overpriced neighborhood.

LK

> >

> >

> >

> >

> >

> >

> > I am starting to understand the benefits of IMP with regards to

> > patient care and physician quality of life. The ability of IMP to

> > restore balance is priceless and it appears to have saved the

lives of

> > quite a few practices.

> >

> > I am very much in tune with striving to deliver high quality care but

> > the realities of 3 kids all bound for college and my relatively

> > expensive cost of living (East Bay, California)force me to focus on

> > income. Plus, I enjoy earning money albeit I no longer enjoy how hard

> > I have to work to do so. Hence my question regarding a ceiling on

revenue.

> >

> > In the volume based model there does not appear to be a ceiling. It's

> > true that growing larger requires all sorts of systems so as to

> > maintain a high level of patient care and that it's very challenging

> > to create and monitor these systems. But it is possible to do so all

> > the while generating more revenue.

> >

> > In the IMP model it appears that delivering high quality care is

> > relatively easier. However, the revenues generated are still a

> > function of volume. It also seems that there is a ceiling in that the

> > numbers of hours worked is the limiting factor.

> >

> > So, does it boil down to accepting a ceiling in exchange for an

easier

> > life and the ability to deliver high quality care vs. no ceiling and

> > having a more hectic life and greater challenges to deliver great

care?

> >

> >

>

>

>

> --

> Graham Chiu

> http://www.synapsedirect.com

> Synapse - the use from anywhere EMR.

>

[Guest guest]

Interesting comments. Are you finding that IMP is primarily about

balance between your personal and work lives?

I am starting to

understand the benefits of IMP with regards to

> patient care and physician quality of life. The ability of IMP to

> restore balance is priceless and it appears to have saved the lives of

> quite a few practices.

>

> I am very much in tune with striving to deliver high quality care but

> the realities of 3 kids all bound for college and my relatively

> expensive cost of living (East Bay, California)force me to focus on

> income. Plus, I enjoy earning money albeit I no longer enjoy how hard

> I have to work to do so. Hence my question regarding a ceiling on

revenue.

>

> In the volume based model there does not appear to be a ceiling. It's

> true that growing larger requires all sorts of systems so as to

> maintain a high level of patient care and that it's very challenging

> to create and monitor these systems. But it is possible to do so all

> the while generating more revenue.

>

> In the IMP model it appears that delivering high quality care is

> relatively easier. However, the revenues generated are still a

> function of volume. It also seems that there is a ceiling in that the

> numbers of hours worked is the limiting factor.

>

> So, does it boil down to accepting a ceiling in exchange for an easier

> life and the ability to deliver high quality care vs. no ceiling and

> having a more hectic life and greater challenges to deliver great care?

>

>

>

>

>

> __________________________________________________

>

[Guest guest]

I'm going to take another tact and try to answer this physicians

question. I'm sure by now he's convinced that everybody on this

listserv is innovative, reasonably happy and extremely nice and

fascinating people (I'm certainly convinced). However, I think he

really wants to know how much money people make on this listserv.

I will go first. Admittedly, I am not a true IMP and do a semi-IMP

type of practice-I work for a hospital system, work three days a week

and do see at this point a good number of patients-anywhere from 16 to

21 in a full day (20 minute visits). I make 80-90 K.

Now I'm going to take a stab at it and say that fewer than 10% of the

physicians here make the family medicine average of 150 to 160K. I

also think he needs to know that I think Pam Wible being where she is

is an outlier in terms of compensation. (I also think that women

physicians tend to have an advantage in terms of demand and

compensation at this point with regards to primary care)

So, if I'm off base I am waiting to be reprimanded and/or corrected.

[Guest guest]

We looked at all sorts of areas across the country many years ago and

fell in love with this area. We also like Orange County which is in

Southern California. We have contemplated a move but it would be down

south and not out of California...it's hard to beat California!

> >

> >

> >

> >

> >

> >

> > I have heard that as well but I question how accurate the statement

> > is. The wealthy people I have come across seem to be doing both,

but I

> > get your point.

> >

> > Most docs derive the majority of their livelihood from doctoring so

> >

> unless you have some investment tips for me ..,I will still be

> > checking BPs for the next few decades as my primary means of sending

> > my kids to college and living in my overpriced neighborhood.

> >

> > LK

> >

>

> --

> Graham Chiu

> http://www.synapsedirect.com

> Synapse - the use from anywhere EMR.

>

[Guest guest]

,

It does seem like the small IMP practice is more flexible. What

happens to the model if a doc has to ramp up for whatever reason? What

do you think would be the experience of say 4 IMP practices under the

same roof?

Lowell

I am starting to

> understand the benefits of IMP with regards to

> > patient care and physician quality of life. The ability of IMP to

> > restore balance is priceless and it appears to have saved the lives of

> > quite a few practices.

> >

> > I am very much in tune with striving to deliver high quality care but

> > the realities of 3 kids all bound for college and my relatively

> > expensive cost of living (East Bay, California)force me to focus on

> > income. Plus, I enjoy earning money albeit I no longer enjoy how hard

> > I have to work to do so. Hence my question regarding a ceiling on

> revenue.

> >

> > In the volume based model there does not appear to be a ceiling. It's

> > true that growing larger requires all sorts of systems so as to

> > maintain a high level of patient care and that it's very challenging

> > to create and monitor these systems. But it is possible to do so all

> > the while generating more revenue.

> >

> > In the IMP model it appears that delivering high quality care is

> > relatively easier. However, the revenues generated are still a

> > function of volume. It also seems that there is a ceiling in that the

> > numbers of hours worked is the limiting factor.

> >

> > So, does it boil down to accepting a ceiling in exchange for an easier

> > life and the ability to deliver high quality care vs. no ceiling and

> > having a more hectic life and greater challenges to deliver great

> care?

> >

> >

> >

> >

> >

> > __________________________________________________

> >

[Guest guest]

Thanks! This is exactly what I was wanting to know. I will share my

numbers as well. Since being in solo practice (2000) I have been

earning around 200 - 250k/year. As I have added more services (nursing

home care, NP, house calls, Saturday hours) my revenues have climbed

and I may even approach 300k this year.

When I was in a group (1994 - 2000) I earned 1/2 this amount and

worked slightly less hard.

What I am trying to reconcile is does IMP offer an advantage from the

financial, personal and professional aspects so that it makes sense to

change from the high volume approach? Or, should I be working towards

becoming a better manager/physician and stay with the high volume

approach?

By the way, I am also wondering if the outcomes are better with IMP.

Outcomes are so tricky to measure but this sounds like a separate thread.

Lowell

>

> I'm going to take another tact and try to answer this physicians

> question. I'm sure by now he's convinced that everybody on this

> listserv is innovative, reasonably happy and extremely nice and

> fascinating people (I'm certainly convinced). However, I think he

> really wants to know how much money people make on this listserv.

>

> I will go first. Admittedly, I am not a true IMP and do a semi-IMP

> type of practice-I work for a hospital system, work three days a week

> and do see at this point a good number of patients-anywhere from 16 to

> 21 in a full day (20 minute visits). I make 80-90 K.

>

> Now I'm going to take a stab at it and say that fewer than 10% of the

> physicians here make the family medicine average of 150 to 160K. I

> also think he needs to know that I think Pam Wible being where she is

> is an outlier in terms of compensation. (I also think that women

> physicians tend to have an advantage in terms of demand and

> compensation at this point with regards to primary care)

>

> So, if I'm off base I am waiting to be reprimanded and/or corrected.

>

[Guest guest]

Hey-you work hard and make a lot of money (which is better than

working hard and making a little bit of money).

I think you need to look at it from another perspective-what is the

required overhead for your lifestyle? (do you have a mortgage,

school loans, house loans? Anyone else bringing in money? Anyone

going to college shortly?)

In my opinion, you will not make close to this amount of money doing

any type of ideal medical practice as defined by most of us on this

listserv. (But you could be a lot happier).

Money can't buy happiness (but as Eliot Spitzer found out, you can

rent it)

> >

> > I'm going to take another tact and try to answer this physicians

> > question. I'm sure by now he's convinced that everybody on this

> > listserv is innovative, reasonably happy and extremely nice and

> > fascinating people (I'm certainly convinced). However, I think

he

> > really wants to know how much money people make on this listserv.

> >

> > I will go first. Admittedly, I am not a true IMP and do a semi-

IMP

> > type of practice-I work for a hospital system, work three days a

week

> > and do see at this point a good number of patients-anywhere from

16 to

> > 21 in a full day (20 minute visits). I make 80-90 K.

> >

> > Now I'm going to take a stab at it and say that fewer than 10%

of the

> > physicians here make the family medicine average of 150 to

160K. I

> > also think he needs to know that I think Pam Wible being where

she is

> > is an outlier in terms of compensation. (I also think that

women

> > physicians tend to have an advantage in terms of demand and

> > compensation at this point with regards to primary care)

> >

> > So, if I'm off base I am waiting to be reprimanded and/or

corrected.

> >

>