How To Make Money In Family Medicine

[Editor's Note: Today's guest post is from Gerardo Bonilla, a family medicine physician in Woodland, California. Dr. Bonilla is the founder of StatNote and author of StatNote: Dot Phrases to Expedite Your Medical Documentation. His company provides tools that facilitate medical documentation so doctors can enjoy seeing patients and get fair compensation while doing so. We have no financial relationship.]

It is easy to understand why there has been a decline in med school graduates choosing primary care as their career pathway. Choosing a specialty other than primary care often means a higher paycheck. Yet, the U.S. will face a shortage of primary care physicians within a decade or so, and it is critical for the next generation of physicians to understand how to close the inter specialty income gap.

As the WCI explains in his blog post, How To Double Your Income as a Primary Care Physician, the intraspecialty pay variation is higher than the interspecialty one. In the article, several docs share the things they do to have a significantly higher salary than their peers. Here are some additional tips on how to increase your income as a primary care physician.

4 Tips to Increase Your Primary Care Physician Income

#1 Preventive Medicine

The annual physical is falling out of style, at least in adult medicine. But insurance companies pay for preventive care for a reason. An ounce of prevention is worth a pound of cure. Some doctors sprinkle health maintenance throughout their patient's visits, but an annual physical ensures that your patients get all the evidence-based screening and disease prevention recommendations.

According to the AAFP, the average payment for the preventive visit is 25-percent higher than for the problem-oriented visit.

Just by doing preventive medicine, and billing for it, you could see about a $70k annual increase in revenue in your practice while ensuring better patient care. (Take a look at the comparison of Physician A and B in this article from the FPM (Family Practice Management) Journal and calculated revenue on the table below.) You don't need to see more patients. The patients are already coming to your clinic. You just need to spend more time with them.

increase physician income

However, spending more time with each patient and providing more services means more documentation. Having templates or using dot phrases in your EHR will help you effectively chart all the onerous documentation requirements. This is especially true if you want to meet the ones required to bill for a Medicare Wellness visit.

Conduct a wellness visit and, when appropriate, conduct a problem-oriented visit at the same time. Most patients have chronic problems to discuss at their wellness visits. CMS allows physicians to report both the problem-oriented visit and the wellness visit at the same time, and the revenue implications of reporting both services are significant. [Note that patients on a high deductible plan who thought their visit was going to be free even though they also talked about their problems might not be so pleased, however.-ed]

The burden of medical documentation is the main cause not only of physician burnout, but also of frustrated patients who only get five-minute visits with their doctors. That is why optimizing your documentation is strongly encouraged.

This is where your dot phrases come in handy. They enable you to expedite your medical documentation and spend less time in front of the computer. Therefore, you can spend more quality time with your patient. Your patients will love it. They will think you are an old-school doctor with good bedside manners.

By using dot phrases and templates, physicians can capture the essentials of the visit with minimal effort. You can document what actually goes on in the exam room instead of selectively picking from the laundry list of problems the patient presents at the visit.

#2 Practice Full-Spectrum Medicine

Have you thought about doing some inpatient shifts or working at an urgent care? Maybe being the medical director for a nursing home or being on-call coverage for OB? Having work outside of the clinic obviously increases your income, but it is also a nice change of pace that might give you some sanity and time away from the never-ending inbox.

Practicing full-spectrum family medicine is rare now, but there is no reason why you shouldn't practice at the top of your license, spending less time doing clerical work and more time taking care of the patient. You can practice at the top of your license by using your training and expertise to take care of patients.

This is sometimes limited by time. We often don't have the time to do that joint injection or remove that mole, so we end up referring the patient to a specialist, adding to the fragmentation of care and the burden of healthcare cost — not to mention wasting the patient's time.

By carving out some time to make room for these and other minor surgical procedures, you will see an increase in your practice revenue. Using dot phrases and templates helps you by giving you more time to do this. Check out this study that found that for every hour of direct clinical facetime with patients, doctors typically spend two additional hours on EHR and desk work within the clinic day.

#3 Know Your Coding

how to increase income as a doctor

Gerardo Bonilla, MD

If you want to get better at billing, you need to get better at coding. Know the rules of the game inside out. Read the AAFP's FPM Journal and the FPM's Blog Getting Paid. They are a great starting point.

Other good resources are Optum360 EncoderPro and the AMA CPT Professional book. They are good reference tools when you want to get the right CPT code for your procedure. You can also have favorites saved in your EMR for your most frequently used E&M and CPT codes used for billing. It will save you time.

Physicians routinely undervalue services they are already providing. Taking a coding training course might help you become more confident in the worth of the work that you are doing.

There are many courses available out there. For example, the E&M CodeRight® course by MediSync can help you gain a clear understanding of the key components needed to calculate the level of coding. [Also consider the WCI partner Medical Coding and Billing Course.-ed]

As part of the quality strategy to reform how healthcare is delivered and paid for, CMS is implementing initiatives to assure quality healthcare. These value-based programs reward healthcare providers with incentive payments for the quality of care they give to their patients. Your group may receive annual incentive payments from insurers based on quality measures that are used to calculate that pay.

It's important to pay attention to any quality incentive measures that you may have in your office, as this might represent a bonus in your salary. This might mean documenting or clicking the right box for your diabetic foot exam and ordering an annual microalbumin lab, recording in the EHR that controlled blood pressure reading from home, and making sure you don't prescribe an antibiotic if your ICD-10 code is acute bronchitis. If these ensure you a $30k quality bonus in your paycheck, for example, suddenly it doesn't become an annoyance anymore.

#4 Optimize Your Medical Documentation

Being more efficient at documenting your progress notes can have a huge impact on your time and therefore could potentially enable you to increase your income. Practicing at the top of your license, doing preventive care, minor procedures, or work outside the clinic are ways to maximize that revenue.

By reducing time in front of the computer, you can spend more time with your patient. For example, you can take the time to do Advance Care Planning with your senior patients, counseling on tobacco and alcohol use, or even do psychotherapy with your depressed and anxious patients. All of these counseling services should typically be reimbursed if they are properly documented.

Comprehensive care and doing what is best for your patient and for the healthcare system will also be the best for you. This will ultimately increase the joy of practicing medicine and enable you to be a Rockstar Doctor!

What do you think? Have you taken a coding course? Read a book on it? What tips and tricks do you have? What have you done to improve your income as a Primary Care Physician? Comment below!