It's really good to see there are still other physicians out there that really value lifestyle and it's not only about money. Thank you so much for your input.
I initially wanted to do PCP as well but came to not like it anymore after a few rotations. At places, you become a glorified referral machine cause your income is mostly tied to how many patients you can see a day (some can see up to 30+), not on the quality of care for each patient.
The whole biologic obsession is mostly hot air to be honest. Not sure why people think biologics are so sexy… they’re not. Most of them are for like 3 indications and simply crowd the market instead of advancing the scope of the specialty. They’ve also been around for decades now so most aren’t even “new and exciting.” If anything, rheum is going the way of small molecule medications and not biologics. You know what are actually new and exciting biologics? The new diabetes drugs like Ozempic.
You might have to do this in Rheumatology as well since you're targeting the 90th percentile income. I'm a numbers/data guy and I guess I'm just not as convinced as you are. In any case, if you figure it's your calling then go for it. I would also look through job search engines and maybe ask graduating fellows about the offers they're getting.
Thank you!
Do you know any allergist in your private practice? How are they doing now?
It’s a good lifestyle. Perhaps @hotsaws can comment on that.
This is 100% true more so in major metros. In rural areas, there’s enough real rheumatic disease per rheumatologist to have good job satisfaction. In cities, rheumatologists are basically dumps for PCPs who don’t want to deal with random complaints. It’s not just pain… but the random symptoms of human existence which certain patients simply can’t cope with.
I do agree with a lot of this.
I seem to remember a time not too long ago where A/I was extremely competitive because of the big ancillary potential from allergy shots? Back when I was in medical school, I remember hearing stories of A/I docs making mucho dinero this way. But then this changed at some point?
Sounds very similar to my first (hospital) job out of fellowship, where I was way underpaid compared to what I have made since. Academic affiliated generally = fakedemia.
Not great but as far as fakedemia goes, I have seen much worse.
You can get 250k/yr as a hospitalist working half the year, and at your choice of desirable cities. Unless you don’t want to deal with the BS of inpatient medicine. At least rheum has good lifestyle.
Not hard but you may need to deal with some chronic pain and fatigue.
You couldn’t pay me enough to round or do consults.
To be fair most IM grads prefer inpatient work and rather get their teeth pulled than deal with outpatient nonsense. And I don’t blame them. Inbasket and mychart messages in a city is a fate I wouldn’t wish on my worst enemy.
that's why one hires a midlevel as an outpatient.
how do they do that?
I think they just charge an out of pocket fee if you try to contact the doctor with question. Though I’m not sure how far they go with that.
It’s possible but idk that it’s particularly a good idea for most people. A lab and PT is not even worth the headaches and overhead. I had these dreams too as a fellow but once you get out into the real world it’s very different. Orthos have their hands in every crevice of every locale (even rural) and you won’t just have your pick of msk pts you can easily refer to your own PT. A patient with shoulder pain won’t come see you first. They may see you after ortho has referred them to their own PT, performed at least 3 injections and 2 scopes. Then when ortho has no other money making scheme to offer, they refer the exasperated patient to you so you can spend 50 minutes in clinic discussing the futility of most therapies for degenerative pathology and the numerous side effects of daily nsaid use. Medicare will generously pay you $170 for your time, while ortho pocketed about $8000.
I feel like if one doesn’t have a strict policy about mychart messages and whats acceptable, things can quickly get out of hand. To answer @Renal_Prometheus , I really dislike hospital work and actually like the inflammatory part of rheumatology more than anything else in medicine. As long as I can make a decent living with good work/life balance I am fine making less than my friends who did other procedural specialties, I just don’t look at their grass.
You would have more patients as a pcp, if your goal is to open PT and labs.
Hospitals in metro areas do not have a strict policy about my chart messages. Granted we will see what happens from the whole charging for online messages rule that Cleveland Clinic implemented. But as a general rule, your well being is not their concern.
What kind of patients/ pathologies end up getting infusion the most/ as first line?
PM'd you
Almost none except the rare cases of vasculitis or myositis. Infusions are never first line for our bread and butter unless it’s a Medicare with supplement patient.
Different strokes for different folks. I’ve detailed my reasons for my distaste for inpatient work several times recently around here.
Exactly. It’s true - severe OA is one of the worst and most frustrating things to have to deal with as a rheumatologist - which is why I dump it to sports medicine immediately as soon as I know it’s not inflammatory.
You can’t bill it as a phone visit unless patient agrees to it. Most just expect it as an entitlement.
I definitely was not a fit for rheumatology. That’s what I get for taking the “easy” specialty with good hours. On that front, rheumatology has not disappointed.
I have an ISTAT because that's the only way i can easily run ABGs (for certain pulmonary cases like OHS evaluation, COPD, and for CPET testing) in my office. I also did obtain their point of care chemistry panels for the occassional renal patient I see...
Classic folder sign. Almost always FMS. I guess being a fellow I just deal with the mychart messages and unless it is a real thing that I am concerned about I just dont give them much leeway there. I hope as an attending to have some sort of policy if any complaint is new that would need either in-person or telehealth follow up, otherwise you are doing unpaid work. I hear you about location/pathology, that’s why I don’t mind going somewhere semi-rural.
if you run the private practice you can take care of these folder tasks (or delegate to your staff members ) and then use the 99491 and 99487 chronic complex care codes (if applicable to the task) and get paid for it.
The way you describe rheumatology has surprising similarities to this one other IM sub-specialty.
What makes you think heme onc would be making more in metro areas? It seems most heme onc in metro areas are either academic (low pay) or in the 300k-400k range salary
nephrology?
is it really gonna be that bad?..
The most important things for multispecialty PP is how the infusion profits are split, what kind of ancillary revenue they have, how this ancillary revenue is split, and what is the overall overhead.
