RZehr wrote: ↑Wed Apr 05, 2023 12:33 pm
This morning I asked an attorney here if he would encourage a young person to become a rural small town general practice attorney as he is. He said no. 30 - 40 years ago when he came to town there was about 16-17 attorneys. Now, he is the only one left in the county that does general practice. Just him and his assistant.
His old partner left the business to do contract work for the state as a public defender. The state pays this guy $14,700 per month, and the work is very simple, and there is no assistant to pay, very little overhead. The next county over is down to only about 3 attorneys.
So sounds like these professions, doctor and lawyer, are not immune to the problems that other small businesses have.
The difference is that a lot of small businessmen want to actually run a business and that is where their skillset lies. They thrive in doing business, the wheeling and dealing, managing people, etc. Whereas a lot of medical professionals go into medicine and spend their youth training in medicine because that is where their interest and skills lie. And then they find that running a small private practice is as much business as medicine and and they are neither equipped for nor enjoy the constant demands of the business side.
My wife stays in touch with the other doctors that she went through residency with. Neither the doctors in small private practice, nor the doctors in big groups are particularly happy. Both have their frustrations and burnouts. Her only colleague who seems to be thriving is the one who went into concierge medicine in Houston and works for some sort of fancy boutique practice that only sees rich people for cash and is basically at their beck and call. That is kind of a sell out too. But at least they have rosewater and a soothing indoor fountain in their plush waiting room that has a view of the Houston skyline. And she doesn't have to stay late doing dozens of charts every night.
I’m not at all convinced that it is all that different. A ton of sole proprietor’s start businesses because they like doing the work. In fact, I believe that the reason there are so many small businesses that plateau after some years, are ones that are started by men who are primarily craftsmen, and not businessmen.
Of course there are some who like business, and wouldn’t care if they were building/selling/servicing any particular thing. These just like business and the specific industry they are in is secondary.
But the craftsman, is the sort who loves what he does. A man who loves making furniture; a chef who loves to cook. They types often end up with a successful business, but they don’t like the “business” side of it.
What I specifically had in mind in my previous post, is the trend that has been happening toward squeezing out the really small business. It’s told that it is easier to make money with no employees than with 2, for example. I’m told that in the past, where a 2-8 employee company was viable, it now is forced to be about 15 people.
This is just due to regulatory compliance, low margins, higher labor costs, etc. And I suspect that the small town lawyer and doctor suffer from the same.
This is just what I’m told, but I do think there is truth to this trend.
Oh yeah. That is true too. The economies of scale also don't work anymore for small scale practices. Price out a digital x-ray machine or digital ultrasound machine used for echocardiograms that you might only use once a week and see what I mean.
Larger practices can amortize equipment across a lot more physicians and also do things like all their lab work in-house which lets them achieve economies of scale that are impossible for small sole practitioners.
And if you are only going to perform the most routine primary care like wellness visits then you are consigning yourself to only the lowest reimbursed parts of medicine. It is a catch-22. There might be certain rare communities like Holmes County where you can make a living doing simple primary care on a cash basis. But that isn't most of America. It is a vanishingly small slice of America. Everywhere else the vast majority of your patents will have some form of insurance and expect to be able to use it. Expecting that to change is like expecting buggy whips to make a comeback.
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A fool can throw out more questions than a wise man can answer. -RZehr
I guess it depends on if you want to practice medicine or run a business. I have two cousins who have or had their own independent practices. And at least half their time is consumed with the business end rather than medicine. One finally gave it up and now does urgent care because she couldn't stand the endless 24/7 hassles of running a business rather than practicing medicine. And lost a lot of money in the process. The other is basically stuck and can't retire because he can't find anyone who wants to take over his business and buy him out.
That’s because dealing with insurance, Medicaid, and Medicare is a gigantic waste of time.
The business of medicine in primary care is pretty simple. Charge $80 for a doctor visit. The end.
So no labs? No X-rays? No MRI? No endoscopes or angiograms? No echocardiograms?
Just a doctor and a stethoscope like in the 1850s?
He orders labs and X-rays you can get at any facility that does then. I haven’t been to a PCP office in a while that did either thing on-site. I definitely have never seen a PCP office with an on-site MRI.
All those things are charged and billed separately from a primary care office.
President Joe Biden on Monday signed a House bill immediately ending the Covid-19 national emergency, first enacted during the Trump administration in 2020.
The White House initially announced plans to extend the Covid-19 national emergency, as well as the public health emergency, until May 11.
About the author (2018) https://books.google.com/books/about/Ea ... NXEAAAQBAJ
Ivor Cummings is a world-renowned chemical engineer with a long career in the medical device and other industries. Although he has been in many roles as technical leader, his specialty is leading teams in complex problem-solving efforts. Ivor trained at University College Dublin and graduated in 1990. His first six years were spent in the development and optimization of medical devices such as hemodialysis units, hemo-perfusion cartridges, and coronary stent assemblies. In recent years Ivor has continued his professional development by becoming a Chartered Engineer (CEng) and Project Management Professional (PMP); he also completed an Innovation and Entrepreneurial Management Certificate with Stanford University. In 2015, he was one of 6 candidates shortlisted from 500 for the title of Irish Chartered Engineer of the Year. Ivor lives in Dublin, Ireland, with his wife and five children.
COVID-19 / “Truly EPIC! The best Liars Compilation EVER. Watch and See!” / 13min
Let this serve as a warning. This is “The Formula” - - - not isolated to the pandemic.
Relatively small study on Medscape showed increase in heart rate and decrease in O2 saturations in young healthy adults wearing N95s.
Not the best data, but suggests that there could be risk for someone with respiratory problems.
Of course we knew this from established gas exchange rates precovid for N95s. https://www.medscape.com/viewarticle/993056
Note the word “recent” in that highlighted sentence. I don’t think this is referring to the deaths that happened earlier, especially in light of what the article has to say about excess deaths in the earlier years.
Note the word “recent” in that highlighted sentence. I don’t think this is referring to the deaths that happened earlier, especially in light of what the article has to say about excess deaths in the earlier years.
If close to a third of current Covid deaths are being over-reported, I'm not sure I have a whole lot of trust in previous numbers.
Note the word “recent” in that highlighted sentence. I don’t think this is referring to the deaths that happened earlier, especially in light of what the article has to say about excess deaths in the earlier years.
If close to a third of current Covid deaths are being over-reported, I'm not sure I have a whole lot of trust in previous numbers.
I understand that concern, but as the article mentions, they are looking at excess deaths, and in the beginning of the pandemic there was a noticeable amount of excess deaths. That is no longer happening.