How to triple your income on every patient (& boycott big-box medicine) →

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Okay this is Medical Economics 101. Today we’re going to talk about overhead. It is big-box medicine versus an ideal clinic. This is my true life story.

My Overhead—Before and After

When I worked at a big-box medical clinic my overhead was 74%. Then I opened my own ideal clinic and my overhead was 7%. What does that mean for you? Well, here comes a patient who is bringing you $100 for a medical visit. And guess how much you get to keep if your overhead is 74%? Seventy-four dollars goes out the window and you get to keep (before tax) we’re talking $26. Here’s your income for seeing one patient at the big-box clinic: $26. How does that sound? But if you see the same patient at your ideal clinic, you’ll end up with a nice income of $93. What do you prefer—$93 or $26 income?  So that’s one way of looking at overhead.

How Many Days I Worked Yearly To Pay Overhead

Another way of looking at overhead is kind of how it destroys your personal life. And the way I was able to figure that out is I multiplied my overhead by the number of days I worked each year in my contract, which I believe was 193 days back at the big-box clinic. Which meant that I worked 143 days for free just to pay my overhead every year. Now I can pay my yearly overhead in 11 half days. Awesome! Right? So much better for your personal lifestyle. They promise you everything at these big-box clinics. You’re going to have time for climbing mountains and enjoying the scenery. Come on! You’re going to be exhausted because you’re not going to have any time for yourself because you’re working for free and you’re only getting $26 per patient—or less. 

How Many Patient I Saw Yearly To Pay Overhead

So then I wanted to figure out how many patients I had to see per year just to pay my overhead. So I took my days needed to work for overhead which is 11 half days at my ideal clinic and I multiplied that by the average number of patients that I saw per half day (8 patients) which is 88. So with 88 patients I’m able to pay my yearly overhead and it’s pretty outrageous but back at the big-box clinic I was seeing like 28-30 patients per day at 143 days per year working just to pay overhead equals 4004 patients that you will see for free every year just to pay your overhead.

I was being totally screwed! What a rip-off!

This is Medical Economics 101. This is exactly what most doctors don’t know and they get in serious trouble working for really crappy organizations and wondering why they’re so miserable. 

The deal is (let me put this another way) for the $93 over here that you’re earning basically from seeing this one patient in order to earn that same amount of money at the big-box clinic you’d need to see four patients! So it gets kind of tiring at the end of the day after working four times as hard to make just the same money at the big-box clinic as you could make in your own ideal practice. 

So I’m going to leave this up to you. And you decide what would work better for you. You want to take another job, another crappy job at a big-box clinic or do you want to live happily ever after in your own office?

Medical Economics 101. This is Dr. Pamela Wible. 

** YOU MUST KNOW YOUR OVERHEAD **

1) Percent Overhead  (% OH = Overhead/Total Revenue)

My Big-Box Clinic %OH: 74%

My Ideal Clinic %OH: 7%

2) DNW (Days Needed To Work) For Overhead (DNW = % OH x Days Worked Yearly)

My Big-Box Clinic DNW: 143 days

My Ideal Clinic DNW: 11 half days

3) NNT (Numbers Needed To Treat) For Overhead (NNT = DNW x avg pts per day)

My Big-Box Clinic NNT: 4004

My Ideal Clinic NNT: 88

If patient pays (or insurance reimburses) $100 per visit:

My Big-Box Clinic Income: $26

My Ideal Clinic Income: $93

What are your overhead numbers?  

I earn more than triple per patient in my ideal clinic. You can too.

I’d have to see 3.5 big-box patients to make the income from one patient in my own clinic. Now I’m earning more than triple the income per big-box patient just seeing ONE patient in my own clinic. Can YOU replicate this? YES! I know docs who pay 85% overhead at big-box clinics so they’re getting paid just $15 per patient! Even if they only reduce their overhead to 55% in their ideal clinic, they’d still triple their income per patient.

Want to triple your income per patient? Contact Dr. Wible for your free guide.

Pamela Wible

Pamela Wible, M.D., is the founder of the Ideal Medical Care Movement and is a “liberator of physicians from treadmill medicine.”  She hosts physician retreats to help docs launch their dream clinics.


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How four physicians found their dream clinics (& you can too!) →

Read full transcription of Delicia Haynes, M.D.

Read full transcription of Ann Cordum, M.D.

Read full transcription of Jennifer Zomnir, M.D. & her husband Kolin

Read full transcription of Kat Lopez, M.D.

** Download your free guide to launching your dream clinic **

Pamela Wible, M.D. is a family physician and “liberator of physicians from treadmill medicine.” These videos were filmed by GeVe at our biannual physician retreat. Come join us! Questions? Contact Dr. Wible.

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I work from 10 to 3. I don’t work weekends. I’m an incredibly happy doctor in my ideal clinic. →

My name is Jennifer Zomnir and I have a very important message for the doctors out there that may be suffering like I was. About two years ago I worked in a big-box clinic and I saw a lot of patients a day in 5-10 minute slots, went home at night and worked on charts, worked on charts on the weekend and I missed time with my family and my children. I thought that was the way that it was and there weren’t any other options out there. And my husband Kolin he found Dr. Pamela Wible and I read her book, Pet Goats & Pap Smears, and I was inspired and came to a conference. This is my fourth time to be here now and since meeting her and finding out there were other ways to do this, I have opened up my ideal medical clinic. 

I no longer spend nights and weekends doing charts. I see my family everyday. I go to every event. I go to work at 10:00 in the morning. I leave at 3 or 4 in the afternoon. I don’t work on the weekends. I am incredibly happy. I had no idea how much I was suffering before. I thought that medicine had to be this way. I thought that I had to see people in 5-minute blocks of time, I thought that I had to rush, that this was just medicine and this is the way that it had to be. I really had no idea that there were alternative ways to practice medicine. I never thought I could open up my own clinic. That wasn’t something that I thought was even feasible for me. I thought that I had to work for a big group to have successful insurance contracts. I thought that I needed someone to manage my benefits. None of that is true. You can completely and totally do this on your own. It’s very simple. 

Download your free guide to physician liberation

You are told to stay where you are for a reason. Your employers, your hospital administrators they know what you’re worth. The problem is that you don’t. You bill out so much more than you actually bring home. You chase the carrot of your production bonus. You may be on a salary. You may not even get a production bonus. You may not even know how much you charge per office visit. How often does a patient ask you, “How much is this?” or “I got a bill and I don’t understand it.” How often do you have to say, “I really just don’t know about that. Go talk to someone up front and they’ll help you out with that. The less you know, the less empowered you are.

I encourage you to start looking into your situation. Look at your life. Are you happy? Do you take vacations? Do you avoid vacations because the catastrophe of your clinic would be so hard to take a vacation because there is so much to do when you get home that it’s not even worth leaving. Really look at your life and ask yourself, “Is this how I want to live for the next 20, 25, 30 years?”  “Would I encourage my own children to go into medicine?” “Would I do this again if I had the opportunity?” If the answers are “Absolutely not. I would do something different, I would not encourage my children, my life is miserable, I never see my family, my marriage in on the rocks. . .” whatever it is and certainly if you are feeling suicidal because your job sucks and you know it in your heart, it’s time to stop, change, do something different. If you’re to the point where you feel like your only option is suicide, stop. Please. There are other ways. 

I am so happy. Starting the business was so easy. I make my own schedule. Life is beyond fabulous now. My husband is happy. My children are happy. My children come to work with me. I’m training them how to be doctors. I would encourage them to go to medical school if they wanted to and I would be proud of that and know that they’re going into the best profession that there is. So please rethink your decision and look at other ways of doing this and understand that it’s not hard. You can be happy. You can do something different. And it’s okay. Please stop and think about what you are about to do.

Hi, I’m Jennifer’s husband Kolin. I met my wife right after she got out of residency so I got to see the transition from happy person to a very unhappy wife, unhappy family. It was like some other people said it’s the boiling frog in the water theory. You don’t notice the changes until it’s too late. Like she said our marriage was rocky, our family wasn’t very happy. She wasn’t home very much. And this was after 5 or 6 years of being in this treadmill system.

In the beginning it was fine, ya know. She didn’t have a whole lot of patients, she’d come home, she’d be happy, she’d get to treat people, take care of them. But I got to see the transition. It was hard to see myself too because it happened so slowly. But at a certain point you realize life isn’t good for anybody and there had to be some changes and we talked about a few things and you start doing some searches on the Internet and you find something about happy doctors and one thing leads to another and that’s how we finally ended up here. I think I’m the first spouse to come to one of these so the only thing I can say to spouses (and to the doctors that have a spouse) as a spouse if you see your doctor-spouse is not happy, encourage some changes and like I told some other people here at the retreat you can be supportive, but you also have to give that push. You can just “You can do it, you can do it, you can do it . . .” It’s gotta be “Let’s do it! Let’s go make these changes, let’s be happy people again.” 

For the doctors that have a spouse you need to understand that your spouse is in a tough place dealing with all the things you’re going through as well. So if you’re in a marriage or even in a relationship, to me it just kind of comes back down to love. If you love this person you want them to be happy. Sometimes it takes change so you got to do that and you get it done. 

HappiestDoctor

Pamela Wible, M.D. is a family physician and “liberator of physicians from treadmill medicine.” This video was filmed by GeVe at our biannual physician retreat. Come join us! Questions? Contact Dr. Wible.

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I was a martyr. Now I’m dating, dancing—and living my dream! →

Hi, my name is Delicia Haynes from Daytona Beach, Florida, and about a year ago, I felt stuck. I was in a clinic that I had started myself and I was seeing more and more patients just to make the overhead and I didn’t see that there was any solution in sight. I loved what I did. I loved taking care of patients. But how I did it was actually killing me. And the name of my practice was Family First Health Center, but I realized that I was never going to have my own family or be able to put my own family first if I continued in that model of seeing a patient every 10-15  minutes and having to worry about all the paperwork and the billing and all the headaches. And I really felt like I had to hire more and more people to support that side of medicine instead of the actual clinical care side of medicine and I felt like the joy that I went to medical school was just being drained out of me. But there’s a better way. 

It’s really about getting back into relationship with your patients and having a business model that supports that relationship. So now I have transitioned my practice from an insurance-based model where my services were not being valued. We tried as hard as we could to spend a lot of time with them but we just never really felt like they got the personal attention that they deserved. Now I’m in a model where all of my visits are 30 minutes to an hour long and they can talk to me on the phone if they need to talk to me on the phone. I use a membership-based model which is really convenient for them and it’s just what’s going on in the background. What is always in the forefront is the care. 

Now I am not only practicing medicine the way I went to medical school to practice it but I’m also becoming the doctor I always wanted to be. When I was a kid I always knew that I wanted to be a doctor or a teacher or a lawyer and I wanted to advocate for my patients, I wanted to teach my patients, and I wanted to heal them and I felt like in that old model I never really got to do that. Now every single day I am teaching, I am advocating, I am meeting my patients where they are and helping them move forward. So if you find yourself in that dark place where you feel like you are stuck, you feel like there is nothing that you can change, there is. The same intellect that took you through medical school and that desire and that passion can get you to change your practice and be able to serve your patients in a way that is fulfilling both to you and of really high service to them. 

Family has always been really important to me and I wanted to take care of my own family and have my own family. When I was in my previous model, I just put my patients first. I was a martyr. I was always sacrificing my own needs and stealing time from my family and the activities that brought me joy just to stay in this cycle that I didn’t like that was not what I really signed up for in the first place. I felt I was drained all the time and I started to feel resentful at times because I wasn’t really practicing medicine the way that I thought it would be when I went to medical school and at times I thought well maybe I was just idealistic in the past and this is just the way that it is but I recognized that it’s not. That same passion and that so-called idealism, that passion that you have to serve your patients can be used in a different model.

Today I have time to go to my dance class, I do ballet, I am dating. Things that before in my old practice I wouldn’t have time for. I did not take time to invest in myself. I take vacations now. I tell my patients that I am going on vacation. I recommend that they go on vacation. I am not a hypocrite anymore. I used to tell people all the time maybe you should consider sleeping this much, eating this way, while I wasn’t sleeping that way, I was’t eating really well. I was always rushing and just trying to get to the next thing and now I’m really living my life the way I would recommend for my patient to. I really enjoy eating well and just taking care of my body and doing the things that just fill my cup and give me joy and encouraging my patients to do the same. 

It’s a night and day in both my mindset, how I think about my work and my job and my mission. It’s not a job, it’s a calling. Now I’m really respecting my calling and I’m practicing medicine the way I felt I should have been doing all along. I’m proud of myself. My patients are happier. I see that when other physicians look at me they see possibility. They realize that it doesn’t have to be the way that their doing it even though all these people are saying that you can’t do it on your own, you need all these administrators and all these people to handle all these little details. That somehow you with all of your education might not be able to do it. That’s a lie. You are completely able to run a clinic. You are completely able to practice medicine in alignment with your vision and there are people like Pamela who will help you and all of us will help you get to that goal

So I would just encourage you to go for it. You know what you’re doing and you can definitely do it. It’s simple. There’s people out here who will help you and your patients and the people who you are meant to serve are going to benefit so much from it.

Pamela Wible, M.D. is a family physician and “liberator of physicians from treadmill medicine.” This video was filmed by GeVe at our biannual physician retreat. Come join us! Questions? Contact Dr. Wible.

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You can’t bake a cake in 15 minutes and you can’t see an elderly patient in 15 minutes →

Hi. My name is Ann Cordum and I’m an MD internal medicine doctor. If you are a medical student, intern, resident, practicing doctor, I am here to tell you that you no longer have to put up with abuse and you no longer have to listen to administrators that are not clinical (that have no idea what it’s like to sit with a patient) tell you how fast to see patients. You can’t bake a cake in 15 minutes and you can’t see an elderly patient in 15 minutes.

So if you are feeling miserable, if you are wondering why you went into medicine in the first place, I want you to know that there is a better way, you can quit that job. If you are not feeling good about it, don’t stay in it—quit it like many of us have done here at Breitenbush retreat where we are focusing on growing and starting our ideal medical practices.

Before my life as a doctor was fraught with a lot of fatigue, some depression, some anxiety, some unsettled feelings and since I started my own ideal medical practice 15 months ago I feel at peace. I feel like I am able to serve those patients. I love going to my job every day. I look forward to it. I know my patients. I enjoy my patients. I have free time. I get to hike. I get to exercise. I get to go to my French class. I get to enjoy music and watch movies and live life again—all while being a doctor and serving patients. I do that free of non-medical administrators and third parties. It is very, very simple. It is just you and the patient and your mission to serve in your called field of medicine.

So if you are feeling like their is no hope, there is hope. Come join us on a retreat or contact Dr. Pamela Wible or one of us that have broken free and please know that there is a way to be happy in medicine.

Pamela Wible, M.D. is a family physician and “liberator of physicians from treadmill medicine.” This video was filmed by GeVe at our biannual physician retreat. Come join us! Questions? Contact Dr. Wible.

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