Viewpoint: How to practice your dream as a physician

January 22, 2010

Less than 10 years out of medical school, one primary care physician is living the dream-he does not accept insurance or Medicare, he won't file reimbursement paperwork for patients, and his practice is thriving.

It didn't happen and, having since talked to editors of small weekly newspapers, I realize my ideal was more fantasy than reality.

So what do primary care physicians dream about? Apart from the standard pipe dreams of winning the lottery or buying a tropical island, the fantasy might look something like this: regular hours, high income, many patients, grateful patients, minimal paperwork, and no third-party payer hassles.

Less than ten years out of medical school, the primary care physician in suburban Raleigh, North Carolina, has a thriving practice. He does not accept insurance or Medicare and he won't file reimbursement paperwork for patients.

He sees 16 patients a day at most, leaves at 5 p.m., doesn't work weekends and estimates his net pre-tax income at between $270,000 and $495,00 a year.

Sound good?

It required Forrest to take an unconventional approach to managing his practice. In his waiting room, he posts a list of common procedures and the price he charges for each, just like a Jiffy Lube.

Undignified? Maybe. Practical? Undoubtedly. Profitable? Yes.

Forrest's practice model isn't the dream of every family physician, but I think you'll find something to at least muse about in this latest entry in our "Practicing Excellence" series.

While you're thinking about what might be, circle the date of Oct. 1, 2013 on your mental calendar.

That might seem too distant to worry about (After all, doesn't the Mayan calendar tell us that the world will end in 2012?), but it's a date you should remember. It's the deadline for conversion to ICD-10. The coding changes are many and substantial and it is a good idea for you and your software vendor to start planning for them now. Coding expert Virginia Martin tells you what you should be doing now to ensure a smooth transition.

Planning is also a good idea when it comes to taxes.

There are substantial changes to the code for tax year 2009, including lifting the income cap on those eligible to convert an IRA to a Roth IRA and tax credits for home energy efficiency improvements. Tax expert Bill Cleveland tells you what you need to know.

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