Medical student: “They’re training us to abuse patients in assembly-line clinics.” →

AssemblyLineMedicinePleaseShare

Dear Dr. Wible, 

So I just walked out of clinic today and I have to tell you I feel awful. Just awful. I was so excited to work at this particular clinic and now having seen how we went through patients like they were scraps to be tossed out, it is so disheartening. 

The doc I was working with was lovely. She was very nice. But she kept telling me that I was making the “classic mistake of trying to ask patients about their problems” (!!!) apparently we don’t have time for that.

Another doctor told me, ”you only get sued if you are an asshole, so always pretend to be interested.” My mentors are kind, but they’re also so disconnected. They were clicking through visit logs to point out the “slacker” docs with 25 patients in an afternoon because we saw 30. 

I just can’t. Holy crap.

I can’t imagine practicing like that, celebrating the fact that we went in told someone they had diabetes to go “lose weight” and walk out 5 minutes later and we’re supposed to be proud of ourselves for efficiency?Completely brush off the trauma a patient is telling us about her rape and PTSD because whatever we don’t have time. 

It just kept going and going.

I felt like breaking down and crying every time I walked out of a room. How could I possibly be okay with turning my back on these people so grateful to see us?? But  honestly now I’m just terrified. Of residency. I always knew it would be like that, and I do want to do it and get board certified, but holy crap. How could I ever survive that?  

Eventually I’ll open my own clinic, you’ve inspired me too, but I always felt like I want to “work” for a bit, get comfortable with being a full-fledged doctor, and have a steady salary and savings before plunging into opening my own clinic. That I could just “survive” residency the way I’ve been surviving med school, but now it sounds awful. Is there really a residency that won’t crush my soul??

Sorry for ranting. I just needed to vent, but I’m alone in California on this internal medicine rotation and I know you will understand. They’re just training us to abuse patients in assembly-line clinics.

Thank you for being a shining light, and a great example. Without the hope of my own ideal clinic someday, there’s no way I could do this.

~ Jonathan

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Hey Jonathan,

My best advice is to open your ideal clinic as soon as possible. Do not delay. Every day you wait, you continue to support this sick system that abuses you—and your patients. If you are a true healer, you can no longer be a victim. You must stand up for human rights. Yours. And your patients. 

I’m here if you need help. . . .

~ Pamela

P.S.  These videos with totally inspire you! Don’t let your job suck the life out of you and How 4 doctors found their dream clinics (and you can too!)

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

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.

Posted in Business Strategy
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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.

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.

Posted in Business Strategy Tagged with: , , , , , , ,
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