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. 


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.

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. 

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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. 

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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. 


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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