Though there's little physicians can do about declining reimbursements, some of you are finding other ways to boost revenue.
Physician compensation is declining at steady and significant rates as a result of ongoing reimbursement declines. In fact, 20 percent of you experienced compensation declines of more than 10 percent between 2011 and 2012, according to our 2012 Physician Compensation Survey.
Though there's little you can do about declining reimbursements, some of you are finding other ways to boost revenue.
Revenue Booster #1: Telemedicine
Internal medicine physician Robert Galamaga decided to pursue a fellowship in transfusion medicine after three years of practicing in primary care. He's currently a third-year fellow in hematology and oncology.
"It's especially pertinent for me to find new revenue sources because, for physicians in training, compensation tends to be more limited, just based on how the structure of our training is," says Galamaga, who is based near Chicago.
His previous attempts to supplement his income include covering extra shifts in the ER and some clinic coverage. But he says his latest venture, telemedicine, is by far the most convenient.
"Honestly it was a lot easier than I thought," Galamaga says of getting involved in the web-based patient consultations three years ago. After a couple of training sessions on Consult A Doctor's telemedicine platform, he signed on as a consultant with the company.
Essentially, that means Galamaga receives a phone call when a potential patient needs a consultation within his scope of practice. He can then choose to perform the consultation, or if it's not convenient for him, he can turn it down and the patient will be referred to another doctor.
"Basically you work as much as you want to and it's not such that you're wholly committed; if you have things that come up, that's fine," says Galamaga, who has participated in as many as 17 consultations per day and as few as one or two. "All it takes is a couple of minutes out of my day from doing whatever I might be doing, whether I'm home, traveling, sitting in a coffee shop, or somewhere where I can step aside and talk for a few minutes with a patient," he says.
Overall, telemedicine has "significantly supplemented" his income, even helping him pay off his student loans while in training, says Galamaga. "If a physician is available to take consultations and can speak to three to five patients per day, you could potentially increase your income by several thousand per month."
Revenue Booster #2: In-House Dispensary
Adding an in-house pharmacy is another great revenue booster - and it's not as difficult as it sounds, says practice-management consultant Owen Dahl.
"There are companies that will actually help set up dispensing for you," he says, noting that practices have to give a portion of their related profits to such companies. "They have dispensing units, almost like vending machines, where you can have your stock of drugs and they handle the quantities and shipping very easily."
But in-house dispensing is not right for every practice. First, Dahl says, interested practices need to determine if they generate the amount and type of prescriptions necessary to support the cost of implementing and operating a dispensary. "If the volume is there, then you go the next step," he says.
Prior to setting up any kind of in-house dispensary, talk with your state board of pharmacy and state board of medical examiners, cautions Dahl. Pay attention to licensure restrictions and ensure that your dispensing plans comply with your state's laws relative to prescribing, administering, and dispensing drugs. "The cost can be relatively high if the state requires that you have a pharmacist in the practice," Galamaga says.
But if you find that dispensing is the right fit for you, it's something to seriously consider, says Dahl, noting that one two-physician primary-care practice he worked with brought in an additional $6,000 per month by in-house dispensing.
"That's not a small number for a two doctor primary-care practice," he says. "That's a nice big number."
Revenue Booster #3: Medical Legal Consulting
Nonpracticing pediatrician Gene DeBlasio is founder of National Medical Consultants, P.C., a firm that provides attorneys with expert medical opinions. He started the company in an effort to increase his own compensation. Now, he helps many other physicians do the same.
"I was fed up with dealing with HMOs and I was making about one-third of what I was making pre-HMO and I decided there had to be a better way," says DeBlasio. "A friend of mine who's a nurse asked me to review a couple of defense cases she was working for a defense firm, and I said, 'Well this is fun, I enjoy doing it.'"
That experience eventually led him to start up the only doctor-owned and doctor-run medical expert consulting firm in the country.
Physicians who serve as expert consultants often keep their day jobs while providing honest, objective opinions about medical cases on the side, says DeBlasio.
"In terms of earning extra money, it's probably the easiest and best way to do it," says DeBlasio, noting that his consultants earn up to $375 per hour for reviewing cases, and $6,000 a day plus expenses if a case goes to trial.
The other great perk about serving as an expert consultant is that it's less stressful than other revenue-boosting options, like moonlighting, he says. "You do it in your leisure time, you don't have to worry about medical malpractice because you're just giving an opinion, and it also makes us a better doctor by reviewing how people are dealing with certain situations."
Revenue Booster #4: Wellness Programs
The Affordable Care Act is ushering in many changes for physicians, some of which could present revenue boosting opportunities, says Dahl.
"One of the things that I've been encouraging my clients to do is to look at a wellness program," he says, noting that as emphasis on preventative medicine increases, and more employers shoulder the burden of providing insurance to employees, such programs will become more popular.
Here's how that could help you.
In 2014, businesses with 50 or more full-time employees will be required to provide health insurance to their employees or pay a fine.
Practices, or even sole physicians within practices, could look to affiliate with nutritionists for dietary programs, and fitness centers for exercise programs, says Dahl. The goal would be to develop a partnership with these individuals, then target employers who might be interested in paying for these wellness services.
The demand will be there because these large employers will want to take steps to keep their employees healthier in order to reduce their health insurance costs.
"There might be some way that those entities could work together, and then go to employers and offer employers package deals that would say, 'We will give your employees a physical, we will help monitor their nutritional components, and we will help monitor their exercise activity,' and they'd do that for a certain fee," says Dahl. "I think there's a lot of room for some affiliations and some program development."