Doctors - how to reduce hours without a huge impact on pay?

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hg064754
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Doctors - how to reduce hours without a huge impact on pay?

Post by hg064754 »

A friend finished residency recently and I see him working ridiculous hours. He is salaried primary care physician (IM), so he is not getting overtime pay. He enjoys the impact part of his job (he is saving lives quiet literally) but complains that the hour (documentation, etc.) is not sustainable and may burnout. Burnouts are very common in primary care. I suggested he reduces his hours but he indicated that he has a huge student debt.

Q: What are some of the ways to earn as much money as possible by working less than 50 hours a week as a primary care physician? (No hospitalist. He likes to stay in primary care / out patient.)
Dottie57
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by Dottie57 »

What is considered ridiculous hours? 50 hrs per week?
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hg064754
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by hg064754 »

Dottie57 wrote: Tue Oct 26, 2021 7:41 pm What is considered ridiculous hours? 50 hrs per week?
About 65, my guess. I will need to ask.
Rex66
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by Rex66 »

He should work that pace for a while

It’s unlikely that someone just finishing residency is able to reduce hours but maintain pay.

Being a doctor requires the hours to become better.
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by Misenplace »

This thread is now in the Personal Finance (Not Investing) forum (employment issues).
Blue456
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by Blue456 »

hg064754 wrote: Tue Oct 26, 2021 7:36 pm A friend finished residency recently and I see him working ridiculous hours. He is salaried primary care physician (IM), so he is not getting overtime pay. He enjoys the impact part of his job (he is saving lives quiet literally) but complains that the hour (documentation, etc.) is not sustainable and may burnout. Burnouts are very common in primary care. I suggested he reduces his hours but he indicated that he has a huge student debt.

Q: What are some of the ways to earn as much money as possible by working less than 50 hours a week as a primary care physician? (No hospitalist. He likes to stay in primary care / out patient.)
Have him check out primary care in the VA. I see 12 patients per day, work 8-430, go home at 430. Currently VAs offer $40,000 per year tax free towards students loans for 5 years, it's called EDRP program. I get paid more than what I did working in the private sector. There is no reason to work more than 40 hours per week as an attending right after residency.
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hg064754
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by hg064754 »

Blue456 wrote: Tue Oct 26, 2021 8:04 pm
hg064754 wrote: Tue Oct 26, 2021 7:36 pm A friend finished residency recently and I see him working ridiculous hours. He is salaried primary care physician (IM), so he is not getting overtime pay. He enjoys the impact part of his job (he is saving lives quiet literally) but complains that the hour (documentation, etc.) is not sustainable and may burnout. Burnouts are very common in primary care. I suggested he reduces his hours but he indicated that he has a huge student debt.

Q: What are some of the ways to earn as much money as possible by working less than 50 hours a week as a primary care physician? (No hospitalist. He likes to stay in primary care / out patient.)
Have him check out primary care in the VA. I see 12 patients per day, work 8-430, go home at 430. Currently VAs offer $40,000 per year tax free towards students loans for 5 years, it's called EDRP program. I get paid more than what I did working in the private sector. There is no reason to work more than 40 hours per week as an attending right after residency.
Extremely useful information, both the number of patients and the loan repayment plans. Is there a catch? I was thinking the pay but you indicated it is better than private sector for you.
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by Blue456 »

hg064754 wrote: Tue Oct 26, 2021 8:50 pm
Blue456 wrote: Tue Oct 26, 2021 8:04 pm
hg064754 wrote: Tue Oct 26, 2021 7:36 pm A friend finished residency recently and I see him working ridiculous hours. He is salaried primary care physician (IM), so he is not getting overtime pay. He enjoys the impact part of his job (he is saving lives quiet literally) but complains that the hour (documentation, etc.) is not sustainable and may burnout. Burnouts are very common in primary care. I suggested he reduces his hours but he indicated that he has a huge student debt.

Q: What are some of the ways to earn as much money as possible by working less than 50 hours a week as a primary care physician? (No hospitalist. He likes to stay in primary care / out patient.)
Have him check out primary care in the VA. I see 12 patients per day, work 8-430, go home at 430. Currently VAs offer $40,000 per year tax free towards students loans for 5 years, it's called EDRP program. I get paid more than what I did working in the private sector. There is no reason to work more than 40 hours per week as an attending right after residency.
Extremely useful information, both the number of patients and the loan repayment plans. Is there a catch? I was thinking the pay but you indicated it is better than private sector for you.
Yes there is a catch. You don't get burned out on seeing patients but you can get burned out on administrative, medical records, electronic medical records issues and and staff who at times is poorly trained and unwilling to change. It is still a welcomed change from seeing patients every 15 minutes and feeling like you are in a factory instead of healthcare. The sweet spot for primary care is going part time and I am planning to do that in 5 years after my loans are paid off and I earn my pension. The benefits are really awesome thou. The way I looked at $40,000 yearly tax free repayment, the private sector would need to give me a sign on bonus of $72,000 per year for 5 years. The pension is based on highest 3 years of pay and I calculated that for every 5 years of works I get $12,000 per year at the age of 58.
Activesloth
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by Activesloth »

My wife and I are both doctors. I’m retired, she’s still working. What made life difficult before was having to cover both the clinic and the hospital. We also had to go in at all hours of the night. At least, we were actually taking care of patients. Your friend doesn’t have that problem. He just stays in the office. What’s killing him is the administrative work, because doctors spend so much time with paperwork. Notice how doctors just stare at their laptop nowadays instead of really interacting with their patients. It’s not the doctoring that’s a problem, it’s record keeping. Since he’s just completed residency, maybe he’ll eventually get the hang of it. Some people get more efficient after a while. Another solution is to get a scribe, someone who’ll do the record keeping stuff. Or he can join the Indian Health Service where the load is much lighter. Or he can be the boss by opening his own clinic. Or he can shorten his clinic notes. Or he can just take the base pay, and stop trying to earn the big bonuses. Medicine has been turned into a business. The traditional concept of caring for the patient is dying, drowned by rules and excessive record keeping.
Rex66
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by Rex66 »

There’s nothing wrong with checking out the VA or other jobs but in most locations the pay is lower too. Very few pursue VA jobs bc of both pay and the “system frustration factor”. People typically do see fewer patients and like the idea of a pension. Seems to work best for those who previously served on active duty.
J45
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by J45 »

Can also look into state system and/or corrections. Most of them have good retirement plans, loan payments and stable jobs. You can also work adjust by doing more hours on some days and less on others.
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by Katietsu »

Are these private loans? Has he explored PSLF? Has he spoken to a student loan counselor? Send him to whitecoatinvestor.com. Lots of stuff on all these topics.
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hg064754
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by hg064754 »

Katietsu wrote: Wed Oct 27, 2021 7:51 am Are these private loans? Has he explored PSLF? Has he spoken to a student loan counselor? Send him to whitecoatinvestor.com. Lots of stuff on all these topics.
Thanks for the suggestions! I am going to send him this thread (and WCI) and encourage him to consider alternatives that best fits his goal. Thanks again!
Ophiuchus
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by Ophiuchus »

If he is willing move to a rural area. Significantly more pay and work less hours
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Picasso
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by Picasso »

How much do PCPs make these days?
Count of Notre Dame
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by Count of Notre Dame »

hg064754 wrote: Tue Oct 26, 2021 7:36 pm A friend finished residency recently and I see him working ridiculous hours. He is salaried primary care physician (IM), so he is not getting overtime pay. He enjoys the impact part of his job (he is saving lives quiet literally) but complains that the hour (documentation, etc.) is not sustainable and may burnout. Burnouts are very common in primary care. I suggested he reduces his hours but he indicated that he has a huge student debt.

Q: What are some of the ways to earn as much money as possible by working less than 50 hours a week as a primary care physician? (No hospitalist. He likes to stay in primary care / out patient.)
Work for Kaiser. Sure he'll enjoy is job even less but the pay/benefits per hour are outstanding.
Count of Notre Dame
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by Count of Notre Dame »

hg064754 wrote: Tue Oct 26, 2021 7:36 pm A friend finished residency recently and I see him working ridiculous hours. He is salaried primary care physician (IM), so he is not getting overtime pay. He enjoys the impact part of his job (he is saving lives quiet literally) but complains that the hour (documentation, etc.) is not sustainable and may burnout. Burnouts are very common in primary care. I suggested he reduces his hours but he indicated that he has a huge student debt.

Q: What are some of the ways to earn as much money as possible by working less than 50 hours a week as a primary care physician? (No hospitalist. He likes to stay in primary care / out patient.)
Also, pay for a scribe. My wife got one and now she can see more patients in less time.
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by Ophiuchus »

Picasso wrote: Wed Oct 27, 2021 11:39 am How much do PCPs make these days?
Highly variable. Depends on location, how many procedures they do, any additional roles etc. Average is typically 200K
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by White Coat Investor »

hg064754 wrote: Tue Oct 26, 2021 7:36 pm A friend finished residency recently and I see him working ridiculous hours. He is salaried primary care physician (IM), so he is not getting overtime pay. He enjoys the impact part of his job (he is saving lives quiet literally) but complains that the hour (documentation, etc.) is not sustainable and may burnout. Burnouts are very common in primary care. I suggested he reduces his hours but he indicated that he has a huge student debt.

Q: What are some of the ways to earn as much money as possible by working less than 50 hours a week as a primary care physician? (No hospitalist. He likes to stay in primary care / out patient.)
1. Own the practice
2. Hire people to work under you
3. Do more procedures
4. See fewer people who don't pay you or don't pay you well and more who do.
5. Negotiate a raise or simply more vacation time and less call if you're not willing to do any of the above.

Refinance the loans or get them forgiven via PSLF.
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by White Coat Investor »

Ophiuchus wrote: Wed Oct 27, 2021 4:06 pm
Picasso wrote: Wed Oct 27, 2021 11:39 am How much do PCPs make these days?
Highly variable. Depends on location, how many procedures they do, any additional roles etc. Average is typically 200K
That's a little low compared to recent salary surveys. Average is probably closer to $250K. Even peds is at $225K last year.

Looking at this survey it says $243K on average for PCPs. $221K for peds, $236K for FM, $248K for IM. But realize there is a huge range around that average. There are academic pediatricians in this country with five figure salaries and plenty only making in the low 100s.

https://www.medscape.com/slideshow/2021 ... -6013761#3

That link may be behind a firewall FYI.
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by Ophiuchus »

White Coat Investor wrote: Wed Oct 27, 2021 4:16 pm
Ophiuchus wrote: Wed Oct 27, 2021 4:06 pm
Picasso wrote: Wed Oct 27, 2021 11:39 am How much do PCPs make these days?
Highly variable. Depends on location, how many procedures they do, any additional roles etc. Average is typically 200K
That's a little low compared to recent salary surveys. Average is probably closer to $250K. Even peds is at $225K last year.

Looking at this survey it says $243K on average for PCPs. $221K for peds, $236K for FM, $248K for IM. But realize there is a huge range around that average. There are academic pediatricians in this country with five figure salaries and plenty only making in the low 100s.

https://www.medscape.com/slideshow/2021 ... -6013761#3

That link may be behind a firewall FYI.
Does that include benefits?
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by esteen »

Activesloth wrote: Wed Oct 27, 2021 6:08 am My wife and I are both doctors. I’m retired, she’s still working. What made life difficult before was having to cover both the clinic and the hospital. We also had to go in at all hours of the night. At least, we were actually taking care of patients. Your friend doesn’t have that problem. He just stays in the office. What’s killing him is the administrative work, because doctors spend so much time with paperwork. Notice how doctors just stare at their laptop nowadays instead of really interacting with their patients. It’s not the doctoring that’s a problem, it’s record keeping. Since he’s just completed residency, maybe he’ll eventually get the hang of it. Some people get more efficient after a while. Another solution is to get a scribe, someone who’ll do the record keeping stuff. Or he can join the Indian Health Service where the load is much lighter. Or he can be the boss by opening his own clinic. Or he can shorten his clinic notes. Or he can just take the base pay, and stop trying to earn the big bonuses. Medicine has been turned into a business. The traditional concept of caring for the patient is dying, drowned by rules and excessive record keeping.
Agree with Activesloth. He can:
1. get a new job that has a slow pace and is usually government-led like the VA or Indian Health suggestions above.
2. go part-time (this usually becomes more feasible for outpatient PC a few years after residency, not right away)
3. get more resources to help with the administrative burden (use dictation, get a scribe, have someone manage his inbox, etc.)
4. get better at charting (get help from others in his company, hone his dot phrases, take typing classes, etc). Efficient charting is a big problem with a lot of physicians right out of residency, they practice so much inpatient stuff during residency and then to move into a full clinic-only practice is a jolt and requires much better time management and note-taking skills than they were required to develop in training).

Best of luck to your friend. Remind him that he has the power to change this, he just has to get creative.
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by jayk238 »

hg064754 wrote: Tue Oct 26, 2021 7:36 pm A friend finished residency recently and I see him working ridiculous hours. He is salaried primary care physician (IM), so he is not getting overtime pay. He enjoys the impact part of his job (he is saving lives quiet literally) but complains that the hour (documentation, etc.) is not sustainable and may burnout. Burnouts are very common in primary care. I suggested he reduces his hours but he indicated that he has a huge student debt.

Q: What are some of the ways to earn as much money as possible by working less than 50 hours a week as a primary care physician? (No hospitalist. He likes to stay in primary care / out patient.)
VA suggestion is a joke. Dont know what pay comprisons were made but last I checked the starting va wage was 180k in a poorly desirable area. Look for rural -category locations (small cities below 100k surprisingly can qualify i think as long as several hours away from larger cities)

Even w the retirement guarantee and student loan forgiveness private pay IS better.

Not only that but the top end pay in private sector IS MUCH HIGHER. When I spoke to the VA recruiter where I was interested she said the topline was 220k a year and thats after a DECADE of experience. (This was all pre covid around 2017).

Easiest way to reduce burnout:
1. Get a scribe. I use a virtual scribe. Amazing. I sign off notes within the hour.
2. Get a admin promotion. I got promoted recently. Typical hospitals pay .1 fte for every 4 hours of admin work. If you do it on top of your fte the pay adds up. Compared to patient care-easy peasy. Usually takes 2-3 years work before ppl promote you
3. Switch some hours to telehealth. If its video you can bill same. Our hospital allows 20% of billable hours to be tele.
4. Have a hobby. I golf. It takes the mind off stress.
5. Exercise. I run 5 milea every other day and row other days
6. Live below your means- i know that even w a 50% pay cut it wont affect my qol. Pay off loans.
hidradenitis
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by hidradenitis »

I transitioned to direct primary care several years ago. This has resulted in fewer hours and increased satisfaction. Pay is about the same. The trade-off is the stress and opportunity cost inherent to opening a new practice. For me it was worth it.
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by ram »

Let's say he wants to work 80% of his current ridiculous hours.
In general he will have to take about 70% of his current salary to work 80% hours.

The hourly rate is best for those who work ridiculous hours.

The employer likes a physician who can work ridiculous hours.

The fixed costs (MA cost. space cost, license, CME, liability insurance) are essentially the same irrespective of whether you work 40hrs/wk or 60 hrs/week.
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by whodidntante »

You want to be Cuddy, not House.
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by JPM »

Random thoughts on IM hours and pay.

When first coming into practice in IM, you are picking up a complex group of patients, probably 1200-1500 or so. Each one probably has multiple problems. You have to learn about them, go over their past medical, surgical, family, and social histories and get up to speed on their continuing problems and treatment programs. This takes a lot of time to do. If your predecessors have kept up the EMR(electronic medical record), you have a lot to work with but need to prep every day's schedule by going over that info, and perhaps reorganizing it, before the visits in order to be effective and avoid seeming confused. If your predecessors have not kept up the EMR, you have to obtain the info yourself at the visits or train your assistants to help you do that. While you are learning the patients and building the info into the EMR, you are necessarily time-inefficient in terms of "production" i.e. number of visits per time spent. Once you have the information in the EMR in a format that is efficiently available to you, then you can get a lot done in a clinic or hospital visit in a shorter time. In brief, you become more time-efficient as you learn your patients and your EMR system better.

Many employed IM docs have a lower pay rate for the first 1500-2500 RVUs (an RVU is a unit of production in this context) than for the RVUs beyond that so there is a strong monetary incentive to get to that higher tier and make the most of it.

Pay rates tend to be lower in large urban centers due to the attractiveness of the social scene for young educated professionals in those settings. It is harder to recruit new docs the further you get from the urban centers. Ten years ago, you could start a new IM grad in Chicago as low as $125,000 but ten miles out at $150,000 and 50 miles out at $200,000. A busy experienced employed IM in a good situation in the exurban midwest probably tops out at $350-550,000. Larger incomes are possible in particularly good situations or in direct pay or the supervision of a group of PAs and NPs in a large clinic.

In Epic EMR systems, learning to use the Notewriter feature efficiently helps a lot in making you more time-efficient on each visit so you have time to address the problems that need addressing and to perform exam items that need doing and making explanations that need making. In order to use it efficiently you need to populate your exam and system review with items that are easily brought forward into the current visit and can be edited efficiently. With Cerner you may need a general template but I haven't used Cerner for some years and it's probably better now than it was 9-10 years ago and may have an efficiency-promoting feature like Epic's Notewriter.

Some doctors like EMR templates a lot to enhance efficiency but that works better for specialists IMO. In general IM if the doctor is doing a lot of treatment himself (as opposed to relying on specialists) then he may need so many templates at one visit (those for diabetes, kidney disease, COPD, coronary disease, etc) that the templates detract from efficiency. Some doctors use the diabetes or coronary disease template regularly and modify it at each visit to fit each visit.

Dictating portions of the note with something like Dragon and bringing forward the ROS and exam templates from last visit to edit (when needed) this visit and then dictating the assessment/plan section in the presence of the patient reinforces your communication with the patient and gets you a complete note at the end of the visit. You can print out copies of the assessment and plan and give it to the patients or email it to the patients at the end of their visits.
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by White Coat Investor »

Ophiuchus wrote: Wed Oct 27, 2021 4:53 pm
White Coat Investor wrote: Wed Oct 27, 2021 4:16 pm
Ophiuchus wrote: Wed Oct 27, 2021 4:06 pm
Picasso wrote: Wed Oct 27, 2021 11:39 am How much do PCPs make these days?
Highly variable. Depends on location, how many procedures they do, any additional roles etc. Average is typically 200K
That's a little low compared to recent salary surveys. Average is probably closer to $250K. Even peds is at $225K last year.

Looking at this survey it says $243K on average for PCPs. $221K for peds, $236K for FM, $248K for IM. But realize there is a huge range around that average. There are academic pediatricians in this country with five figure salaries and plenty only making in the low 100s.

https://www.medscape.com/slideshow/2021 ... -6013761#3

That link may be behind a firewall FYI.
Does that include benefits?
I don't think so, but not my survey.
1) Invest you must 2) Time is your friend 3) Impulse is your enemy | 4) Basic arithmetic works 5) Stick to simplicity 6) Stay the course
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Re: Doctors - how to reduce hours without a huge impact on pay?

Post by changingtimes »

whodidntante wrote: Wed Oct 27, 2021 9:48 pm You want to be Cuddy, not House.
:beer
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