<p>I have in my immediate family, a physician, a lawyer who works in biglaw and one who works in a hedge fund. So far the person in the hedge fund makes the most money and he is only 28 years old with no grad school education.But he has a stressful job with zero job stability.</p>
<p>Is it a better wager to do your own private practice after graduating medical school or to practice in a hospital? Which pays more, gives more security, and has the leverage to grow too?</p>
<p>Most join a group practice, the solo practice has almost disappeared, at least in non-rural areas. The well managed fee-for-service type of practice with the lowest overhead pays the most.</p>
<p>
</p>
<p>1.) “Most” going part-time is a very strong claim. Documentation?</p>
<p>2.) Physicians tend to be paid more in rural areas, not in major cities, because it’s otherwise difficult to attract them there.</p>
<p>3.) Many specialists do make above $300K per year, but the point was the apples-to-apples comparison – not sensible to evaluate only high-paid doctors and then claim that medicine as a whole pays over $300K.</p>
<p>What specialists can earn 500k or more a week and work 20 hours? Are we talking radiologists and urologists here?</p>
<p>I’ve never heard of such a field. I’m waiting for documentation to be provided about such a claim.</p>
<p>Bluedevilmike, I am rather surprised at your post. It is accusative and unproductive.</p>
<p>
</p>
<p>A family member is a physician in a multi-specialty group with over 1500 physicians in offices spanning 4 Bay Area counties. I am privy to inside information and I can assure you more than 70% of female physicians work part time, i.e. less than 4 1/2 days a week. Many split a practice with another female physician. I can only count several who are working full time after more than 5 years of practice. Do you have documentation to the contrary? If you know many female physicians personally, how many are doing it full time after 5 years of practice?</p>
<p>
</p>
<p>This just made me laugh. It is completely inaccurate. Do you really think a physician charges more in North Dakota or Mississippi than someone in NYC or San Francisco doing the same procedure?</p>
<p>The fee that a physician is paid has three components: the relative value for the service, a GPCI, and a national dollar conversion factor. The relative value portion of this equation is composed of the following: 1) a physician work component that measures the time, skill, and intensity associated with the service provided – this component accounts for 54.5% of a service’s relative value; 2) a practice-related expense component that measures average practice expenses such as office rents and employee wages and that varies on a code-by-code basis depending on whether the service is performed in a facility or nonfacility setting – this accounts for 42.3% of a service’s relative value; and 3) malpractice expense component that reflects average insurance cost – this accounts for 3.2% of a service’s relative value.[2] The GPCI is designed to account for variations in the costs of practicing medicine. A separate GPCI is determined for each of the three component of the RVU and takes into consideration median hourly earnings of workers in the area, office rents, medical equipment and supplies, and other miscellaneous expenses. There are 90 GPCI areas nationwide. The conversion factor is a dollar figure that converts the geographically adjusted relative value for a service into a dollar payment amount.Current Procedure Terminology coding and RVUs are important not only with regard to reimbursement from Medicare but also for private insurers. Although no data have been published, there is a general notion that CPT coding and RVUs are used by most private insurers as a basis for reimbursement of physician-related services.</p>
<p>In the Bay Area, Santa Cruz county was designed as rural in 1966 when GPCI was initiated, and there is now a difference in 25% in physician reimbursements there than in Santa Clara county, 25 miles away and the cost of living index is almost equal. There is a bill that has been introduced to change Santa Cruz county GPCI but passage has been slow.</p>
<p>*GPCI Justice Act </p>
<p>Bill title: GPCI Justice Act</p>
<p>Bill number: H.R. 2820</p>
<p>Date introduced: June 11, 2009</p>
<p>Status: Language from this bill has been included in the House version of national health care reform legislation.</p>
<p>Summary: The bill’s goal is to correct a flaw in the application of a federal Medicare formula (Geographic Practice Cost Index, known as GPCI) that results in lower Medicare reimbursements for doctors in more than a dozen California counties.</p>
<p>In 1966, when GPCI was initiated, counties were designated as either “rural” or “urban” depending on costs associated with running a practice, with the expectation that those designations would be updated every few years. That never happened, and as a result doctors in counties that have seen economic growth are being compensated at levels significantly lower than those in nearby counties.</p>
<p>The bill would not affect the reimbursement formula itself, but rather force CMS to update its geographic designations using Metropolitan Statistical Area (MSA) data. Designations would be immediately updated, then again every three years to keep reimbursements in line. Studies by the Government Accountability Office, the Medicare Payment Advisory Commission and Acumen, a non-partisan policy research organization, have all concluded that this solution is appropriate.</p>
<p>More about the bill:</p>
<pre><code>* Counties that would see a geographic designation change: El Dorado, Monterey, Placer, Riverside, Sacramento, San Benito, San Bernardino, San Diego, San Joaquin, San Luis Obispo, Santa Barbara, Santa Cruz, Sonoma and Yolo.
- Marin County, which is already labeled as “urban,” would also see increases because its MSA includes San Francisco.
- The legislation is limited to California, establishing the state as a pilot program. If successful, the changes could later be applied nationwide.
- The fix includes a hold-harmless clause, meaning other counties designated as “rural” won’t suffer when the updates take place.
- Use of MSA data, updated annually, means the most current information will be used in geographic designations. Also, CMS already uses MSA data for hospital reimbursements.*
</code></pre>
<p>Rural physician income is also affected by differences in
policy and patient demographics. Rural patients are more
likely to be self-employed or to lack health insurance1 and
rural states often have stricter Medicaid eligibility standards
and higher proportions of low-income families. Each
of these factors has the potential to lower average incomes
for rural physicians. While rural physicians have the same
costs as urban physicians for salaries, supplies, and transportation,
they cannot take advantage of economies of scale
that spread those costs over a large number of patients.</p>
<p>
</p>
<p>Did you read my post carefully? Where did I say medicine as a whole pays over $300K?
I said Most non primary care physicians who work full time in and around major cities do make over $300K. See those words “non primary care”?</p>
<p>This is a law forum and if you wish to further discuss this, you should go to the medicine forum.</p>
<p>
</p>
<p>… if you say so.</p>
<hr>
<p>
Well, okay. I’m privy to outside information, and:
[The</a> Physician Workforce: Projections and Research into Current Issues Affecting Supply and Demand](<a href=“http://bhpr.hrsa.gov/healthworkforce/reports/physicianworkforce/female.htm]The”>http://bhpr.hrsa.gov/healthworkforce/reports/physicianworkforce/female.htm)</p>
<p>If 70% are working less than full-time (say 30 hours a week), that remaining 30% would have to be working 93.33 hours a week to compensate. Is this your claim?</p>
<p>
<a href=“http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495474/[/url]”>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495474/</a></p>
<hr>
<p>
</p>
<p>You appeared to be responding to my #62, which was a response to B4L’s #61, which referenced a chart discussing attorneys as a whole. If he wants to discuss attorneys as a whole, then he needs to discuss physicians as a whole.</p>
<hr>
<p>I didn’t read your comments regarding the rural thing, but some quick googling indicates that you’re right. (The flood of e-mails trying to recruit me to rural areas, however, indicates otherwise.) Regardless, consider the point withdrawn.</p>
<p>Look, we keep circling around the same point: my law school classmates all seem to envy doctors, while my medical school classmates all envy lawyers. The reality is that neither profession is all wins relative to the other.</p>
<p>There’s a tradeoff involved, and people who keep trying to prove that one profession is an all-out win are sadly mistaken.</p>
<p>^all of them envy lawyers? That seems rather odd. I can imagine though lawyers envying doctors because they help others and have a humanitarian role exhibited by their profession. Doctors are, undoubtedly, much more respected/reputable than lawyers, bar none. And that’s because, to my knowledge, entry into medical school has the lowest rate out of all others schools. </p>
<p>Plus I think an MD carries national weight-no specific state exam that needs to be met for and you can practice anywhere, is this right? Versus attorneys who need special state designation in order to practice. DO’s need an additional requirement, but MD’s don’t.</p>
<p>You underestimate just how miserable medical school and residency are. (Similarly, they tend to underestimate just how miserable being a young associate is.) Being 27 years old, working longer hours than your lawyer friends while making less than a quarter the money really sucks.</p>
<p>
</p>
<p>Sure, but there isn’t a pure stability-for-pay tradeoff that you seem to think exists. The bottom line is that the vast majority of doctors make more than the vast majority of lawyers, even the ones who get biglaw offers. According to the BLS, the 75th percentile salary for lawyers was about $160K in '08, compared to a median salary of about $340K for specialists.</p>
<p>
</p>
<p>Again, you have to compare all docs to all lawyers, if you’re going to do this comparison.</p>
<p>But you’re right that generally the high-risk profession would have not just more upside, but also a higher average. And that’s probably not the case here.</p>
<p>Haha, this video clip took away all the confusion I had about biglaw and made me realize that ultimately, it really isn’t worth it, and the cons definitely outweigh any “pros” biglaw may have.</p>
<p>[YouTube</a> - The Big Law Environment](<a href=“The Big Law Environment - YouTube”>The Big Law Environment - YouTube)</p>
<p>“Working 80 hours/week for 8 years straight hoping to make it to partner and then get laid off before you can apply for the spot simply isn’t worth it…”</p>
<p>^True that! And doctors have much more of a reputation/career/stability than biglaw can offer anyone.</p>
<p>And, the BEST argument against biglaw is at 2:56, “Big private law firm is like the law school itself, a large bureaucratic institution, that does not love the law student for his/her distinct qualities. They don’t have time for it, and they don’t care…”<br>
-LoL, it’s just like working at Red Robin as a waiter then, your boss doesn’t care about you. </p>
<p>Doctors, on the other hand, have a huge reputation and respect in comparison.</p>
<p>
</p>
<p>That’s probably because the average law grad is a lower ‘potential’ individual. As long as law schools like Western States and Univ of Phoenix accept anyone who is breathing – in contrast to med schools which require a mid-3 gpa just for an interview…the average law grad will be below the average med grad. And, of course, this ignores states like California which allow anyone to sit for the bar, regardless of whether they attend LS. Sure, few pass, but the point is few do.</p>
<p>This is an apples to oranges comparison.</p>
<p>[Resident</a> Wife: Residency Sucks!](<a href=“http://residentwife.typepad.com/resident_wife/residency_sucks/]Resident”>Resident Wife: Residency Sucks!)</p>
<p>Residency does not “suck”, that is hardly the case, plus it is ephemeral, short-lived, 3 years or so, so it is the means, not the end like in biglaw, where you work for years and years before you even get a chance to make partner, which is not even guaranteed and you can be laid off easily. I’m just stating the objective facts.
After residency which is short you are guaranteed a high status, whereas in biglaw you simply are not, and it takes endless years to even be a consideration, so the odds are well against it. </p>
<p>There was a letter from a former biglaw employee who resigned because of the following (I can post it if you’d like): </p>
<p>He realized the main practice of law consists of: reviewing contracts, editing contracts, drafting contracts, research corporate law, and other strenuous/tedious work. I can imagine why he resigned, I’d probably go crazy and would want more out of life as well. I mean, that’s just my take on it, it seems absolutely mechanical and a tedious way of work/job, something I’d hardly want to partake in. Post #7 in that blog alludes to the fact that lawyers can’t even pick their own hours and hardly can create their schedules.</p>
<p>Conversely, doctors can, and some can work only 3 days a week, and have other opportunities made available to them. </p>
<p>It’s just what you prefer most. Some people love the practice of law I guess. I bet I would love law school myself, as I am still considering it, but the practice I aver is far different, which is what may cause others to disavow it.</p>
<p>
</p>
<p>Well, the median for primary care physicians was $186K. As I understand it, that’s the lowest-paying subset of physicians, and they still make significantly more than nearly all lawyers. </p>
<p>
</p>
<p>Right, again, that’s the light at the end of the tunnel that doctors have but lawyers don’t. Sure, it may be frustrating to see your college classmates who went to law school making significantly more during your residency, but it’s also short-sighted.</p>
<p>what is all this talk about md vs jd… imo, md is better cuz at least MD’s can get the jobs in the field of their studies, while JD’s are getting pounded in this market.</p>
<p>bluedevil -</p>
<p>I read somewhere that many associates at biglaw move onto other careers like 4-5 years after they start. but, in your opinion, are there ample career options, that are lucrative/ legal - related, that these people can reasonably find? I read somewhere that there are tons of lawyers who were laid off from biglaw in this economy who can’t find any legal jobs at all. I am beginning to really question the long-run career stability/ opportunity of any new law grad. Any insights?</p>
<p>
</p>
<p>In this economy, not always – but still usually. Things were really quite bad during the massive layoffs, but generally former biglaw attorneys have quite acceptable exit options. Again, these are the same fallbacks: prior work experience helps; a T14 diploma helps; and, yes, law school grades still matter. This is one of the main reasons to seek a top-tier firm, is to preserve exit options.</p>
<p>Bluebayou’s #95 brings up a good point which somehow I lost track of during the discussion.</p>