How to Get the Best Compensation for Your Time.

The newly proposed change in Medicare payments has a profound impact on the strategy that I teach young clinicians for generating greater compensation for working the same amount of time.


It makes the strategy even more effective.


The strategy is based on the premise that most of the compensation in your job comes from actually seeing patients, the rest—the “bonuses,, the “value-based adjustments”—require significantly more work than the additional salary they generate.


It’s true. Your employer talks a good game when it comes to “value-based compensation” but what they really want, what they are trained to see, is productivity.  And productivity, to them, boils down to seeing patients.  That’s what they want and that’s what they are going to pay for.



Decide how much time you want to devote to working. Per week, per month, per year—you pick.


Then figure out how little effort you can put in at your job while still earning a level of compensation that you consider a satisfactory “base” and taking good care of the patients presented to you .


Then take the extra time and gig.


Telemedicine, expert-witness, hospice or nursing home medical director.


You’ll earn more per hour using your extra time doing these things than working at your primary job.


It’s simply how your employer has designed the system.


With minor variations, all employers design their systems the same way.


Now that every office visit is $93, your compensation is going to depend on how many patients you see—there is no way to finesse the system by putting in an extra five minutes work to “upcode” from a level 3 to a 4.


You think you’re on the treadmill now—just wait.


If the treadmill is going to go faster, you have two choices:


Work harder:  That is, run it flat out within the limits of how much time you want to devote to working.




Work smarter:  That is, run it as fast as you like and but spend time off the treadmill to devote the rest of your working time to other service lines which might pay your more. And if they don’t pay you more, at least provide enough variety that they won’t burn you out.


Either strategy is fine.  The choice is yours.


What you don’t want to do is waste time on meeting your “quality” metrics


The return on your time there is very low.


Especially if you want to practice with joy.