Comments on: Volume and time

By: Dennis Blackmore

Dennis Blackmore — Fri, 18 Apr 2008 15:55:13 +0000

I repeat, I want the best and brightest taking care of me………..They need to make a good living doing such.

By: amy

amy — Fri, 11 Apr 2008 15:06:23 +0000

I agree, billing costs me 15$ per encounter and the amount of paper generated by insurance companies another 5$ per encounter, on average (time spent to sort, scan, shred or disregard). That means that a 50$ visit becomes a 70$ visit.

By: dr. bean

dr. bean — Tue, 08 Apr 2008 20:32:17 +0000

If I had an overhead of 30% or so which I could do by renting a small space, taking cash up front and having no employees, I could make $120K/year (more than I make now) by seeing 12-18 patients/day if average receipts were approx $60 per patient! Not accounting for costs or fees for in-office testing of any kind. How much would you pay out of pocket for 30 minutes with a doctor who listened to you and thought about your problems even after you left?

Taking insurance doubles overhead due to increased administrative complexity. Additional employee/s (0.5-2.0 FTE depending on volume) additional space for employee/s, and billing whether outsourced or in house about 8% of receipts.

Above models are approximate and do not include health insurance for physician or staff, of course

By: Dr. Bob FP

Dr. Bob FP — Tue, 08 Apr 2008 16:33:37 +0000

Some physicians have already gone outside of that solution. It’s variously called concierge care or low volume/low overhead. Many see 12-18 patients a day. They are often very happy physicians. Many do not take insurance and instead have a retainer or cash up front. Cuts their overhead to 30% or so instead of 50-60%. Actually allows for less expensive care. In my former practice we could have cut our fees in half if we quit accepting/working with insurance and instead did every thing cash up front.

By: Aaron

Aaron — Tue, 08 Apr 2008 14:45:01 +0000

Can you translate this into dollar figures? I can speculate, but health care economics are far from being my forte.

What I would like to know is, based upon the wage you believe a primary care physician should earn, at sixteen patients per day, what average fee per patient is necessary to support that salary, and how does that compare to current fees charged?

By: Jared

Jared — Tue, 08 Apr 2008 14:14:25 +0000

Why do physicians increase volume to create higher return before other things? As one of my Physical Chemistry instructors taught us; oftentimes it is instructive to look for the trivial solution–to find it and avoid it. Simply making up for smaller payment on volume is a trivial solution and should be avoided as an argument for diminishing return.

The issue that physicians must contend with if they wish to not fall into the trap of the trivial solution is figuring out how to optimize their practice in a way that they can understand the mechanics of. Most physicians do not self-identify as astute business-persons. In fact, I would posit that most primary care physicians are not in a position to even make a fundamental change in their business plan–short of breaking their contract with a group and going out on their own.

I agree that payment must be brought back to sane levels to ensure that primary care is interesting for physicians. But, I also think that medicine as a business is ignored by medical education, which places physicians at a disadvantage when it comes to how to think about optimizing their business so that they can succeed without falling into the trivial solution trap.