more work worries

I met with the other younger surgeon today with whom I could potentially share space. It was all very encouraging and he would love that I could help defray his costs a bit. But he might not be there on a long term basis because he, too, is would potentially leave the hospital, leaving me to hold the bag for his 10 year lease.

We talked about his expenses and the way he runs his office in specifics, but also about the business of surgery in this area in general. There is an exceptionally large Kaiser type institution that sucks up a lot of potential business in this area, and all reports are that they are only getting larger. But I have also heard not good things about this institution and would rather not be a part of it if I could avoid it. So I asked him... if he could relocate, given the set up in our area and how hard it is to make it as a general surgeon, would he? Simply put, yes.

Which leaves me in a real bind. I have been suspecting this for some time. The insurance patterns are quite different here because there are so many doctors clamoring for work that the insurance companies can get away with paying less. A lot less.

Here's a good example. I recently operated on a young man who is very intelligent. He had a lot of questions during his hospital stay regarding various fees, to which I didn't know the answer. I've seen him several times in the office since his discharge, and this last time, I told him I didn't need to see him any more... he was better. At that point, he started talking to me about the fees. The hospital fees were outrageous and they charged him over $4,000 and made sure they talked to him about it two days after his surgery. Another doctor assisted me in the surgery because he likes to assist, but that meant he could collect an assistant fee. And since he saw him every day after the surgery, he charged a daily visit fee. But me? For the operation (which was in the middle of the night), the pre-operative consultation, the week's worth of in hospital management, and three post-operative office visits, I collected only $700. The assistant made just as much as I did.

This isn't the exception; it's the rule.

I don't have an MBA. I wasn't trained in billing, so I don't know how to make the most of my reports to But various insurance companies or even what is allowable.

So now I'm left wondering... do I stay in this area and avoid incurring more debt in salary repayment to the hospital? That could mean a less favorable business environment in a market already saturated with surgeons. Or do I take the temporary debt to repay my salary and move to a more favorable area for doctors? One where surgeons get paid to take ER call and don't have to deal with ridiculous insurance contracts that devalue their time and efforts?

I don't know. And tonight, all these questions are weighing on me. What am I supposed to do?