The primary care productivity squeeze

it would be nice to see an accurate breakdown of average work hours/week with income. Primary care practices are quite diverse,

some doc’s are employed.
some doc’s are self employed.
some have heavy evening and nightime call demands in addition to normal office hours. some have no call.

some do procedures in office(increased reimbursement), some refer out.

my avearge work week is typical, about 62-68 hours/week. If it’s a bad ER
“unattached” patient call night the hours can easily approach 75-80/week.
income/hour worked is about 43 bucks/hour.

the Gordon Moore model http://www.aafp.org/fpm/20020300/25goin.html is quite interesting as the model allows one to work less hours but get paid more/hour.
usually these kind of practices do make less income but work hours are MUCH better…hence the rapid sprouting of these low cost models.

similar beneficial income/hour changes are seen by cash paying practices http://www.simplecare.com

from what I gather Physician assistants and nurse practitioners are increasingly avoiding primary care and choosing “specialty ” practice for the same reason.

economics 101

First of all, you are assuming that the compensation will be $150K a year. In some markets it isn’t that high.
Between federal, state and local taxes at that income level, subtract 40%.
But you need someplace to live. Too bad that in some of the highest taxed areas of the country a modest house exceeds $400K. If you want to live close to your officce or the hospitals where you have to cover call, you may not even find something acceptable at that price. Ask why so many practices in northern California can’t recruit. Then you need a car, and insurance, and a vacation once in awhile and all the other things in middle-class life that people employed in other occupations expect. Oh, someday your kids might want to go to college, and someday you might want to retire. Well, the college thing is just like everywhere else, not cheap, and the retirement, well, that is entirely your dime. No matching, unless you work for a big university or a large HMO. And retiring on that 401K, you better plan on something in addition to that, because 401k as a retirement tool is only going to cover a small part of the cost, so you better start saving now. A lot. Now remember, you lost eight to ten years of your working life in medical school and residency. And now you can also make your payments on that $200K school loan. Now plan on an annual escalation in your malpractice insurance premium, and while you are at it, expect to have to pay for targeted continuing education credits for “training and physician education” on some state legislator’s pet disease. Oh, and don’t get too upset when the same state that is only too happy to impose high licensing and other charges on you also feels free to chisel you by not paying or under-paying your Medicaid claims. After all, we want you to be a valued member of the community.

compensation is hard to judge “great” or “decent” or “lousy” unless we have data to figure out avarage compensation/hour worked.

specialists /hour do better.
for a debt of $200,000 looming over a medstudents head…income data is a major reason why primary care is seeing a huge decline among graduating medical students.

self employed electricians, plumbers, carpenters would easily earn >100,000 /year if they worked 62-75 hour work weeks.