• Margaret Curtis, MD

Finance and the PCP

Updated: Jan 30, 2019

Today a patient told me that when she grows up she is going to be a doctor, a superhero and Elsa. Obviously I have the best job in medicine: I get to talk to kids all day, and my job is as awe-inspiring as "superhero" and "Elsa".

What I don't have is the income potential of many specialists. I spend a lot of time (too much) on physician finance websites and they are by and large populated by high earners: anesthesia, radiology, surgery. The primary care physicians seem to be scarce. Maybe that's because they don't make enough money to invest. (Says my husband. Urologists are hilarious.) Maybe they are too busy undergoing what a colleague calls "death by a thousand well-child checks". Or maybe those of us in primary care haven't learned what our more procedure-based colleagues seem to know already: that being an excellent physician and being financially savvy are not mutually exclusive.

The culture of service that exists throughout medicine competes with the culture of prestige attached to highly specialized fields. The greater prestige is paired with higher salary and no one could be blamed for thinking that those of us who go into primary care are a little dim. I won't go into the value of primary care, to our patients, to society and to the specialists who wouldn't have referrals without us (you're welcome). I also won't go into the absurdity of paying pediatric specialists the same as or less than general pediatricians, despite their 3 years of fellowship and literally life-saving skills. I will save those topics for another time and talk about how primary care physicians can be smarter with their money.

The paucity of PCPs on the personal finance scene is ironic, because we need to shepherd our assets even more carefully than the specialists. Doctors of any stripe can (and do) blow their money in foolish ways, but $600,000/year offers a lot more leeway than $180,000. Surgical specialists, radiologists and anesthesiologists (among others) also have opportunities for auxiliary income, such as ownership in surgical centers and imaging centers, that aren't available to primary care doctors thanks to Stark Law. Good thing my patients are so cute.

a love note to a pediatrician

So here are some ways those of us in primary care can be as savvy as our colleagues:

-negotiate like you mean it. Remember, the medical system doesn't work without us.

-know your contract, know how you earn a bonus and then do it. If you need help maximizing your billing, use some CME money for a coding course, or ask someone from the compliance office to sit down with you. Don't leave money on the table.

-learn to do procedures that you commonly refer out, such as placing long-acting contraceptives. If these are considered within your scope of practice and are covered by your malpractice, you can build a more procedure-based practice.

-if you supervise residents or midlevels, make sure you are paid adequately and/or are capturing appropriate RVUs.

-change the culture. Not just the culture that says that primary care isn't prestigious or intellectually rigorous, but the one that says we PCPs are too pure of heart to think about money. We can be pure of heart AND think about money.

Pediatricians have bills to pay, too. Unlike superheroes and Elsa.


Addendum: before anyone tells me that superheroes come from all walks of life, let me say two things:

1. I have a teenage son at home and have seen enough Marvel movies to be a near-expert. That is how I know:

2. Superheroes are either independently wealthy (Ironman, Batman, Black Panther) or attach themselves to someone who is (Antman). Those suits don't come cheap. Those of modest means (Spiderman, Deadpool) get their powers via some ghastly exposure, and they have to slave away at menial jobs while saving the world - much like a PCP. My analogy has now come full circle.

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