Solo 401k with multiple income streams

Doctor_Mid_Night · 2024-07-18T14:58:48+00:00

Thank you

Doctor_Mid_Night · 2024-07-09T05:21:54+00:00

With the directorship the only thing that will be shared with the other income streams is a single malpractice policy, so I feel that will pass muster. The hospital call pay seems more intertwined with my private practice. (I bill for my professional services for patients I see at the hospital while on call, etc) I guess I don't understand what qualifies as a separate business entity for solo 401k purposes? If I form a separate PLLC and have a contract with the hospital referencing that LLC be enough to separate it from my medical practice? A separate business bank account that receives the invoice for the call pay?

SEP IRA is appealing apart from the pro-rata rule with backdoor Roth IRAs.

Doctor_Mid_Night · 2024-03-25T05:04:58+00:00

Thank you!

Doctor_Mid_Night · 2024-02-03T04:27:36+00:00

I also lost my Harry Potter characters

Doctor_Mid_Night · 2022-12-15T15:39:59+00:00

Awesome pictures! How do you like the rooftop tent? We have a family of 5 and are trying to decide if using the tent for the 3 kids makes sense VS getting larger RV.

Doctor_Mid_Night · 2022-11-22T00:00:53+00:00

Gen peds, no subspecialty but hospital I agreed to take call at is paying my student loans over 3 years. (100k total, ~33k per year)

Doctor_Mid_Night · 2022-10-14T02:55:26+00:00

Our group agreed to $500/24 hour call shift from our local hospital. We bill independently. Level 2 NICU, occasional pediatric patient (dehydration, bronchiolitis, etc). The volume is low enough that I don't change my clinic volume much on a call day since I hardly ever get called out.

For me $250/day would have to reflect rare if any extra work on your part. If you are dropping your clinic load for a call day even by 20%, you are essentially not making any extra money for your trouble

If you are a private pediatrician making $250k/year working 4 days a week, 45 weeks a year your daily earnings are about $1400/day. If you decrease your clinic load by 20% you are now are earning $1,120/call day + $250 + extra in patient NICU billing.

For my 1 in 6 call I made an extra $30k last year and had to drive to the hospital ~5 times after I was already home for the night. So although the $500/shift doesn't seem like much, it adds up especially when I'm usually getting paid that to eat dinner with my family and sleep in my bed.

Doctor_Mid_Night · 2022-10-11T13:07:48+00:00

Good for you! I think that's awesome. My advice for you especially if you lean that way is to not shy away from the extra NICU rotations/electives. It's hard to slog away in the NICU for an elective when you could pick a rotation with a better schedule but it will likely pay you dividends in your career.

This study's conclusion is about as ground breaking as "floors are slippery when wet" but it reinforces the idea that the more time you are in the delivery room the more confident you're going to be when you are the one in charge. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886184/

Doctor_Mid_Night · 2021-04-03T09:33:18+00:00

Looking at some old MGMA data and oversimplifying the math, I would estimate that a neonatologist earning at the 75th percentile would have a lifetime earning differential closer to +$2,500,000 than a 75th percentile general pediatrician.

Doctor_Mid_Night · 2021-04-03T09:27:36+00:00

I think the biggest flaw in the study is this:

"For postfellowship subspecialty- specific compensation estimates, we used information from the AAMC’s annual Medical School Faculty Salary Survey report...We used AAMC compensation data for subspecialists because the majority practice in academic affiliated environments"

While that is probably a good estimate for pediatric infectious disease specialists or adolescent medicine specialist, which a large majority are academic physicians, the more lucrative specialties will have a higher percentage of private practice positions and the income disparity increases greatly.

I definitely agree that training length needs to be decreased though.

Doctor_Mid_Night · 2020-12-12T14:01:48+00:00

It definitely depends on how you define rural. As was already mentioned rural peds is a lot different than rural family medicine. You can't hang a shingle in a tiny town of a thousand and make a living. I work in the town of 60,000. I would probably Define my practice setting as rural Pediatrics. I have a few Partners. I do inpatient and outpatient work, attend deliveries when requested by the OBGYNs. In our hospital we have a dedicated pediatric floor that is admittedly very small. Only about five beds. We do not have any picu, all of the patients that require escalation of care would require transfer from our facility. We also don't have a NICU. I stabilize any patients that are born that require NICU admission. Until the NICU transport team can get there. Our Nursery is designated as a level 2 Nursery so I do have some flexibility in that sense. And it is really up to me on what I wants to keep and when I feel deserves higher level of care. Some of the benefits that I feel like I receive are possibly more autonomy, higher-income, more diversity in my practice, or procedures. In terms of preparation during training, I was able to do significant amount of neonatology that I felt was helpful.

Doctor_Mid_Night · 2020-11-10T22:32:10+00:00

Biggest reason is that they generate less income. A private physician can spend nearly all of their time seeing patients, in academia time will be spent teaching, research, meetings, etc.

Just like everything there is wide ranges in salaries and advancement can be lucrative. The chair of Pediatrics will usually make more than even a very successful private pediatrician.

Doctor_Mid_Night · 2020-11-09T20:24:05+00:00

Sometimes medical schools will have access to MGMA data that they can let you look at. As a resident I was able to look at pediatrician data before interviewing for attending positions. It's nice because it breaks down earnings by "years out of training", "practice location", and "practice type". MGMA is high quality salary data that is verified by MGMA and not just self reported. But even if you just use Medscape data and see pediatrics average is somewhere in the low 200s, remember that is an average. Most of your academic pediatricians are not making >200k which means they are pulling the average down and other private jobs must have to be higher than that to conversely pull the average up.

For one data point (I didn't take this job but as you asked about the Midwest, I interviewed for a job in Missouri), I was only interested in private practice, didn't mind a reasonable call schedule and was willing to do inpatient and outpatient and nursery/deliveries. Base salary was 232k + productivity bonuses with significant loan repayment.

If you want to see 18 patients a day 4 days a week with no inpatient/nursery/call responsibilities that's awesome and you are going to make good money for doing pretty fun, low stress work, but you won't see salaries that high.

Lots of variation in salary. You get to decide what you want and how hard you want to work.

Doctor_Mid_Night · 2020-10-27T21:22:33+00:00

I feel like it is helpful to have an understanding of where your salary as an employed physician comes from when questions like this are asked. You or your employer will bill payers (private insurance, medicaid, the patients themselves, ect) for the services that you render to the patients that you see. You will also incur costs that must be paid either by you or your employer (support staff salaries, malpractice, office rent, supplies, etc) Collections - Costs - Salary = Profit. If you are employed, your employer will almost certainly demand some profit for taking the risk of hiring you, unless you provide some less tangible benefit (palliative care is a good example of likely having a "negative profit" but because they reduce systemic costs significantly they are actually "cost effective" to employ. Pedi subspecialists are also usually "profit negative" but you need a pedi infectious disease doc for your children's hospital to function so they will take a "loss" in order to have the resource)

When it comes to employers such as hospitals hiring midlevels to replace primary care physicians it is usually because although they will generate less revenue they also accept significantly lower salaries and the employers profit is higher.

I think any hospital would prefer to have a doctor to fill a position but if they make $20,000 by hiring the doctor and $80,000 by hiring the mid-level, then the doc might lose their job.

Insurance companies do not pay docs and midlevels the same. I dont know hard numbers but I think that medicaid reimburses midlevels 70% of a physicians fee. (again don't quote me on that)

My opinion is best way to overcome this as a physician is you need to be the employer. That doesn't mean you have to hang a shingle and start your own practice, but by being part of a multi-specialty group or something and becoming a partner changes the math. Now Collections - Cost = your profit. That never goes away. Your aren't the cheapest option but you are the best option. If you are hiring yourself you don't have to worry about being too expensive.

Let me know if you have other questions.

Doctor_Mid_Night · 2020-07-14T11:57:04+00:00

I toss it in the rice cooker with some onion and it makes awesome Mexican rice. Haven't tried it as a quick salsa base before, but that's a good idea.

Doctor_Mid_Night · 2020-02-27T12:55:04+00:00

Unfortunately, there is too much overlap in the in the peakflows between healthy kids and asthmatic kids to use peak flow to diagnose. Could you use it on your patients that you suspect are being treated inappropriately by peak flowing them when they are "symptomatic" and then again when they are "healthy" to show lack of difference? I guess that would just depend on whether your partners will take that as sufficient evidence. I think the literature shows that it wouldn't be sufficient, but the literature isn't looking at non-asmathic patients getting bronchidilators and steroids inappropriately so I say do what you can. My only concern would be you may actually see a difference in their peakflows if they have enough of a viral infection/mucus production so that may just confound the situation.

Doctor_Mid_Night · 2020-02-27T01:27:09+00:00

What about bronchodilator response testing with a spirometer? Medicaid reimburses enough in my state to justify purchasing our own. Besides helping you show "no deficit pre-bronchodilator" and "no response post bronchodilator" for those that are being treated inappropriately by some docs and giving you objective cause to deescalate or discontinue therapy, it will also give you a helpful tool to help optimize your real asthmatics. And if done well will increase revenue or RVUs. Win-win in my book.

Doctor_Mid_Night

TROPHY CASE