Physicians Who Work Part-Time

[brady23]

From what I've heard, it seems FM is the easiest specialty to make your own hours and work part-time (ex: 3-4 days per week)

I'm assuming it's more difficult to do this in other lifestyle specialities like Rheum, Geriatrics, Endocrinology, and Allergy/Immunology (as you may not have enough patients to solely do outpatient/clinic work and rely on hospitalist coverage as well to supplement your income) - is this a valid assumption?

 

[ellorie]

Outpatient psychiatrists can, it just decreases your billings. 

[brady23]

5 minutes ago, ellorie said:

Outpatient psychiatrists can, it just decreases your billings. 

Do psychiatrists have enough patient volume to solely do outpatient practice? I know the billing decreases from $92 to $80 for inpatient vs. outpatient, but the flexibility of making your own hours seems worth it. 

[ellorie]

1 hour ago, brady23 said:

Do psychiatrists have enough patient volume to solely do outpatient practice? I know the billing decreases from $92 to $80 for inpatient vs. outpatient, but the flexibility of making your own hours seems worth it. 

Depends how much money you want to make - there are definitely lots of psychiatrists who seem satisfied with their billings who work in the community doing solely outpatient.  You definitely make less, but it's still nothing to sneeze at.

I did the math once with some other residents in my year - if you see 7 patients per day for two units each (so a psychotherapy focused practice) and work about 48 weeks of the year (so 4 weeks of vacation), you'd make about 270k in gross billings - except of course that that assumes that everybody comes to their appointments, which they obviously don't, and many people once they're staff want more vacation than that, and you have to think about overhead as well.  But even factoring all that in, I bet you could do okay.  If you adjust down to 6 patients per day (which I guess allows for one no show per day, or just seeing less people - I've heard different staff have different tolerances for how many psychotherapy patients they can see in a day) and give yourself 6 weeks of vacation per year, it works out to 220k not including overhead.  Conversely, you could improve the numbers by doing a bunch of consults, which will bill higher, providing high risk care to hit those premiums, or doing some group therapy.  Or if you do 20 minute medication management appointments, you could increase your volume by fitting 3 units into an hour instead of the 2 units that typically fit into a psychotherapy hour (with 10-14 minutes for paperwork and buffer between patients).  I suppose if you wanted to, you could also do IMEs but I don't think I really want to do that.  

I'm sure I could talk to some staff and do more accurate math but those are some numbers that I've run.

[brady23]

6 minutes ago, ellorie said:

Depends how much money you want to make - there are definitely lots of psychiatrists who seem satisfied with their billings who work in the community doing solely outpatient.  You definitely make less, but it's still nothing to sneeze at.

 I did the math once with some other residents in my year - if you see 7 patients per day for two units each (so a psychotherapy focused practice) and work about 48 weeks of the year (so 4 weeks of vacation), you'd make about 270k in gross billings - except of course that that assumes that everybody comes to their appointments, which they obviously don't, and many people once they're staff want more vacation than that, and you have to think about overhead as well.  But even factoring all that in, I bet you could do okay.  If you adjust down to 6 patients per day (which I guess allows for one no show per day, or just seeing less people - I've heard different staff have different tolerances for how many psychotherapy patients they can see in a day) and give yourself 6 weeks of vacation per year, it works out to 220k not including overhead.

 I'm sure I could talk to some staff and do more accurate math but those are some numbers that I've run.

Yeah I came up with similar numbers! I mean working 4 days a week, with 6-8 weeks of vacation and making ~100k post-tax seems amazing haha! 

[goleafsgochris]

If you do only outpatient, you can in any specialty.  From a neuro perspective, I have seen those that don't to hospital work do 3 days/week.  Of course, you make 60%ish of the money you would make working 5d/w. 

Ive also seen in neuro (and psych) people choosing to do 4 long-ish days of fairly compact 8am-5pm seeing patients, meaning by the time youre done dictating its often 630-7.  The 5th day is either taken off or used to catch up on some notes.  In this way you get a 4 day work week and it approximates 5 days in terms of pay, which is nice because you only have to travel to work 4 times.  Ive considered that once im in practice for a few more years.

[goleafsgochris]

14 hours ago, brady23 said:

Do psychiatrists have enough patient volume to solely do outpatient practice? I know the billing decreases from $92 to $80 for inpatient vs. outpatient, but the flexibility of making your own hours seems worth it. 

Im neuro not psych (but Im a year out of practice and have some outpatient psychiatrists at one of the clinics I work at).  Theres easily enough volume (they have impressively long wait lists), but they get a ton of no shows which is frustrating, because they are torn between just losing income or double-booking and dealing with potentially long days and long wait times for patients if everyone shows up one day.

[NeuroD]

1 hour ago, goleafsgochris said:

Im neuro not psych (but Im a year out of practice and have some outpatient psychiatrists at one of the clinics I work at).  Theres easily enough volume (they have impressively long wait lists), but they get a ton of no shows which is frustrating, because they are torn between just losing income or double-booking and dealing with potentially long days and long wait times for patients if everyone shows up one day.

Are no-shows as much of a concern in neuro?

Side note for anyone: are psychiatrists the only ones who can bill for psycotherapy in Ontario? I bet it would be useful many in many neuro/family med clinics, but I was told it was restricted or psych.

[ralk]

24 minutes ago, PhD2MD said:

Are no-shows as much of a concern in neuro?

Side note for anyone: are psychiatrists the only ones who can bill for psycotherapy in Ontario? I bet it would be useful many in many neuro/family med clinics, but I was told it was restricted or psych.

FM has some specific mental health/therapy billing codes. Don't think they're anywhere near as lucrative as the psych codes though, they just help bridge the gap caused by the fact that mental health visits often take quite a bit of time and so would be a major cost if we could only bill the same as a regular visit (which are much, much faster).

[ellorie]

I believe only FP and psychiatry can bill psychotherapy. Which makes sense. When we do psychotherapy we are applying evidence based modalities, not just talking to people for a longer period of time  Psychotherapy training is not part of a neurology residency as far as I know. And GP psychotherapists typically do additional training. 

[NeuroD]

1 hour ago, ellorie said:

I believe only FP and psychiatry can bill psychotherapy. Which makes sense. When we do psychotherapy we are applying evidence based modalities, not just talking to people for a longer period of time  Psychotherapy training is not part of a neurology residency as far as I know. And GP psychotherapists typically do additional training. 

I'm not implying that psychotherapy is just talking for longer time (I had a strong psych background before switching to Neuro). Psychotherapy has major benefits outside of the typical pure psych patient. FPs definitely see these cases, but so do others. My guess is that outside of psych/family, Neuro sees these the most. But I guess the way billing codes are setup now, even if we have sufficient training and a patient that would benefit, our only option is to refer and have the pt wait several months.

[ACHQ]

On 6/30/2018 at 10:55 PM, brady23 said:

I'm assuming it's more difficult to do this in other lifestyle specialities like Rheum, Geriatrics, Endocrinology, and Allergy/Immunology (as you may not have enough patients to solely do outpatient/clinic work and rely on hospitalist coverage as well to supplement your income) - is this a valid assumption?

 

You don’t need to rely on hospitalist coverage in those specialties. If you wanted you could open up your own Clinic much like FM. The majority (if not all) of patients that require endo/rheum/Geri/allergy care do so in an outpatient setting, you shouldn’t have trouble filling your clinic (especially if your working part time), initially it might be hard  when you start off because you need to establish a referral base, but if you market yourself well to the local FMs you won’t have any issues.

obviously part time purely outpatient practice will pay less than a full time practice or a mixed practice (but that’s the sacrifice you have to make)