Outpatient IM Subspecialties

[ReferToMedicine]

What are the ballpark billings for  different outpatient IM subspecialties including GI, Cardiology (assuming 5 days a week, 45+ weeks a year)? 

[ACHQ]

On 1/11/2024 at 12:45 PM, ReferToMedicine said:

What are the ballpark billings for  different outpatient IM subspecialties including GI, Cardiology (assuming 5 days a week, 45+ weeks a year)? 

Doing no hospital based work/call?

Pure outpatient Cards I wouldn't be surprised if they billed 800k-1 mill (this is assuming they do the whole gambit of diagnostics, like stress tests, echos, nuc scans, holters, that is where is their money is)

GI (again I'm assuming they work at a scoping clinic of some sort), probably around the same.

Remember the overhead for these places are sometimes killer when your doing scopes or cardiac diagnostics. Sometimes 30+% of your billings in something that lucrative. So although billing 1 million sounds amazing, they take 650-700k which is still amazing (but its not a 1 million ahhaha). Some people get lucky and can swing an overhead in the 15-20% range which makes something that really worth it (take home of 800-900k)

[ReferToMedicine]

Thanks! 

Any insight regarding billing potential for:

• GIM (stroke prevention, thrombus, etc.)
• Resp (spirometry, sleep)
• Nephro (dialysis)
• Pain clinics

 

[garceyues]

On 1/12/2024 at 5:54 PM, ACHQ said:

Doing no hospital based work/call?

Pure outpatient Cards I wouldn't be surprised if they billed 800k-1 mill (this is assuming they do the whole gambit of diagnostics, like stress tests, echos, nuc scans, holters, that is where is their money is)

GI (again I'm assuming they work at a scoping clinic of some sort), probably around the same.

Remember the overhead for these places are sometimes killer when your doing scopes or cardiac diagnostics. Sometimes 30+% of your billings in something that lucrative. So although billing 1 million sounds amazing, they take 650-700k which is still amazing (but its not a 1 million ahhaha). Some people get lucky and can swing an overhead in the 15-20% range which makes something that really worth it (take home of 800-900k)

Even with ~30% overhead figures, the take-home income with no call sounds amazing haha. Maybe I'm being naive since I'm still earlier in my training, but the stress of running a business/outpatient practice seems far preferable to the stress of call and the perpetual sleep deprivation that comes with that.

[shikimate]

there is a hepatologist in my city who only does outpatient clinic + some inpatient medicine consult (no overnight, not MRP for inpatient) and that person billed about 350K last year (publicly available billing figure). The adult general GI in the city does outpatient + scope + inpatient consult including call but not MRP for inpatients. Their publicly available billings are 550K range.

disclaimer I am not IM

[ReferToMedicine]

On 1/25/2024 at 12:09 AM, ReferToMedicine said:

Thanks! 

Any insight regarding billing potential for:

• GIM (stroke prevention, thrombus, etc.)
• Resp (spirometry, sleep)
• Nephro (dialysis)
• Pain clinics

 

And Rheum/Endo/Allergy pls! Thanks again

[Recollections]

For full-time outpatient endo and rheum, you're probably looking at 250-400k although that's province-dependent. There are plenty of staff who embrace the "lifestyle" aspect of those specialties and only work part-time, though. The publicly reported billings probably skew lower for that reason. 

[futureGP]

In Ontario, subspecialists like endo/rheum/allergy/resp will do better in outpatient than GIM even if seeing the same issue due to extra premiums.
 

In busy outpatient clinics in GTA, endo/rheum can easily bill 500+/-100-200k if they work full time. You want to +/- 100-200k because of variables such as efficiency of clinic, efficiency of the physician, # of says worked per week. Their overhead tends to be lower - just pay rent and admin.

Resp varies if you have a PFT/sleep lab or not. If you do, then you’re doing pretty well (800-1 mill+), if not then 600-800k

GIM outpatient, you’d have to see 30-40 patients a day to reach 600-700k. Its hard, not impossible. Most probably see around 20-30 a day as outpatient and make 400-500k roughly. But your efficiency is limited if you work at hospital clinic - tend to be less efficient than private clinics due to bureaucracy.

Cards community - agree probably most bill 800-1mill+. Overhead probably higher.

 

None of the above applies to academia where cases are complex (thus longer consults), and less volume driven.

Another way I look at it is 

Assuming 48 weeks, 5 days work.

$480k/yr equals ~$2000/day

$960k/yr equals ~$4000/day

A medicine consult is roughly $170-185ish depending on subspec.

a subspec follow up is roughly $110-135 if there is chronic disease or $75-85 if not.

If any subspec is seeing ~30 pts a day which is a very reasonable number. Maybe 1/3 consult, 2/3 follow up. That can be around $3500/day ez.

 

The diff between subspecs then is the extras like diabetes mgmt fees, allergy tssts, joint injections for rheum, pft/sleep study, cardiac diagnostics etc.

The complexity of consults also play a role so an allergy consult can be simple vs an autoimmune disease nyd consult for rheum.

the other thing is competition. There are many endoscopy clinics in the GTA, many cardiaology clinics in the GTA. So you are competing to fill your volume with each other, which may not be hard given demand is generally high but still there.

 

One thing I would do as a trainee again is to do electives with physicians in whichever subspecialty who have an efficient practice and find out how they do it. This part of medical practice is not rlly taught in academia and something that will have a huge impact in anyone’s clinical practice their whole life.

[ReferToMedicine]

On 2/8/2024 at 11:30 PM, futureGP said:

 

[ReferToMedicine]

Just to confirm, PFT lab work in outpatient setting bills similarly per day vs Echo/MIBI/Holter?