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Income: April 2017

How much income I made April 2017 working per diem

 

I know it appears to have been a busy month but I worked less than the average doc works in a week. In this post, I will talk about each income stream, the tax implications, and my hourly wage.

 

So many gigs!

Sure, it seems as though I am working for 6 different companies. But I don’t look at it that way.

As the CEO, CFO and CMO of Dr. Mo, I am responsible for diversifying, making sure I am getting the best remuneration for my time and to ensure future sustainability.

Currently, I cannot automate my work. If I stop working, no more income will come in. This is the part that I am focusing most on, automating the income, decoupled from my input.

  • Kaiser Permanente – urgent care & telemedicine
  • American Well – telemedicine
  • Just Answer – medical professional consulting
  • Medical Marijuana Clinic – reviewing medical charts
  • Remedy Medical – telemedicine
  • HealthTap – telemedicine

 

Kaiser Permanente

I am doing mostly telemedicine with them but also picking up shifts in the urgent care in person. I enjoy the in-person urgent care more than the telemedicine.

I pick up 2-4 hour shifts when doing KP telemedicine. I am able to call most/all patients in 25-50% of the time. Which means, my $100/hour wage bumps up to $200-300/hour.

We have 2 urgent cares really far away, not locations which I can get to on my little folding bike. However, a buddy of mine likes picking up shifts there because they pay more for docs willing to go all the way there.

Not only is the income higher in those locations, but my buddy and I pick up the shifts at night so when we are done seeing patients we get to leave. Which often means that we get an extra hour of pay.

I also get 4 hours a month of admin pay. I attend the meetings and put in some effort arranging speakers and doing some other work. Realistically, I am putting in 5 hours a month for this admin role, paid at $100/hour – let’s call it $80/hour.

The income with KP is a W2. I considered petitioning the IRS to have them change it to a 1099 income but decided against it – don’t bite the hand that feeds you.

I get no work benefits since I am per diem.

However, I also have purchased my own KP health insurance. I can order my own tests and manage my own health by being in the per diem pool. There are some major savings by having my foot in this door.

American Well

Frankly, I’m just being lazy with these guys, they are great!

They pay a 1099 and $50 per patient visit. I just haven’t put in the adequate effort to see patients on their platform.

I have to be in a quiet environment because they are all video or telephone visits and patients don’t like it if I’m doing the work from a coffee shop. So, that’s my excuse.

Just Answer

I actually am starting to enjoy them much more than before. In the past, I got frustrated with all the difficult patients whom I had the displeasure of dealing with.

I have reworked my flow. I log on more frequently, snag a few of the easy cases and I don’t care as much about how many ‘stars’ I get. The work seems easier and I’m making more money.

***(I am answering some questions while typing out this post)***

I probably only did 30 minutes worth of work for JA in April which makes it a very nice income.

I am starting to get referral money as well for referring doctors to their service, though I don’t care much for that – just a nice byproduct.

Medical Marijuana Clinic

I am really starting to like this work. $50/patient and they are scheduling me for 4 patients an hour.

They send me the charts ahead of time to review which means I already know what I am going to write to the Oregon Medical Board regarding the patient’s MM status.

Therefore, I can see 8-10 patient in an hour. They are trying to accommodate that and have even hired an extra front desk person to help with the potentially higher flow.

The limiting factor is that there aren’t enough patients. There are 2 other docs who also see MM patients but I think their flow process is a bit slower.

Remedy Medical

Boy, what do I say about these guys… love their business model, love their dedication to the concept but the work can be erratic and the workflow is incredibly tedious.

Ordering medications and filling out paperwork for patients can take a long time.

Still, I only work maybe 5 hours a month for these guys. In this past month I probably only worked 2 hours just because they are advertising a little less to work on the app.

I earn a set $1,700 every 2 weeks, after taxes. I get no benefits and it is a W2 income.

This weekend they will be proposing a more permanent gig to me. I am very curious to see what it will entail.

HealthTap

Oh, HealthTap. What a disaster of a company. I’m telling ya, it’s so easy to get fooled with all the fancy layouts of a website. Lesson learned.

It’s been 2 weeks that I contacted them about wanting to remove myself from their website and still, no reply.

They took my $3,600 and left me hanging. I hope nobody else falls for their scam but thankfully it was a cheap lesson to learn.

 

My hourly wage

When I was working full-time, my hourly wage was closer to $130/hour of gross wages. I believe it was $93/hour after taxes – I did the math in one of my posts.

This month, April 2017, my wage after tax has been $303/hour. 

I continue to do more of the work I like, working fewer hours per week, while getting a higher hourly wage for it.

 

Taxes

I am not sure how much more work I will do which is why I haven’t committed to any tax planning.

If I decide to keep doing work at this rate, approximately 20 hours a month, then I will open an Individual 401k.

It would be nice to stash this money away in tax-deferred accounts. However, I’m not very desperate to do so.

Having money in taxable accounts has its own advantages, too.

***(I’ve made $85 on JA in the time it took me to write this post)***

2 replies on “Income: April 2017”

Hey Dr. Mo. I love your site. I’ve been following for a while now. I’m a family NP, I do internal med and UCC per diem ($85/hr rate) and I’d love to have the freedom and flexibility you have. My question is: are there any telemedicine opportunities for NPs? Do any of the companies you work for hire them?

Also, I’d definitely like to be creative and bump up my income, but I’ve seen a lot of lowballing despite my productivity being the same as the docs I work with in UCC. Finance-wise, could I get a great income following a similar path as you as an NP? Or would you go back to med school? I became an NP not because I didn’t get into med school (I was in top 5% of my graduating class in one of the best schools in our state), I did it to avoid the student loans since I couldn’t afford to pay out of pocket. My parents made too much to get financial aid but not enough to help me through school so I needed to do all loans. Now I’m reconsidering everything. Financially would it be worth it to go back to med school or any tips on doing what you’re doing as an NP? I’m 28, married, own a small house (with mortgage-$250k), MAY have a kid in a couple years and have around 50k in student loans left. Also of note- I live in a state with independent practice for NPs. Any advice would be greatly appreciated. My ultimate goal would be to do a lot of telemedicine and some per diem UCC work as we love travelling.

Anthony, thanks for posting your comment and thanks for reading the blog. I think your situation is fantastic and very unique – let’s chat about it.

Yes! There are more and more companies hiring NP’s to do telemedicine. Some of the largest healthcare groups in the US are leading the charge. Kaiser Permanente is among them. Our NP’s in the UC’s are as strong and some stronger than our MD/DO’s – needless to say, by now we all know that it’s not your training that makes you a good clinician but how much ownership you take once you go out on your own.

Looking ahead, as you may have observed, family medicine doctors are becoming the fat & happy proverbial house slaves. Quite a few have sold their souls and skills for $100/hour which is the going rate for a family doctor, add benefits to that and it’s about $120/hour gross.

They are unhappy seeing 10-14 patients in a half day. They complain about the inbasket work. Their skills are used less and less as management diverts procedures to the specialists in order to bill at a higher level for them.

On the HMO side, the family docs do ever more. Not only quite a bit of the procedures but also manage renal disease, liver disease, dementia, psychosis, depression and type 1 DM. They are, no doubt, working their ass off. But once again, a good number of them believe they are too good for this work.

I’ve written about this before and want to reiterate it here to you again, Anthony, primary care will one day be done purely by NP’s and PA’s. They, as a professional group, would have to get out of their own way and do away with unions and these thoughts of inferiority which infuriates me – but that’s another post.

Let me give you an example of NP U. She is confident, competent and a team player. One of the strongest clinicians in our urgent care department. She had more admin positions than many MD’s, in charge of HealthConnect, in charge of orientation, one of the first to even do telemedicine before doctors did it. Why? Because she is confident, she didn’t give a fuck about unions and never cared to differentiate herself outside of anything but being a clinician. Much respect for that woman! When she comes to me to review a film I’m on alert because she knows her shit.

At 28, making $85/hour, shit…. you are so far ahead it’s not even funny. Aside from any conceptual motivations, I’d highly recommend against going the medical school/physician route. I see no advantage in your doing so. The part I can comment on most is the financial factor, you definitely will not come out ahead there – and you gonna be beat down emotionally and physically. You will undoubtedly jeopardize your relationship with the wifey and if you choose a specialty route then you know how hard those bastards worked to become the specialists they are – there is a reason ortho’s and anesthesia get paid what they get paid. It’s hard work to get in and their work ain’t easy, regardless of what they say.

We can talk offline some more as well, shoot me an email drmo@digitalnomadphysician.com. I would recommend staying the course. Keep making the money because you have situated yourself incredibly well. From here, consider 2 options – either going the admin route or going the telemedicine rout. I prefer the latter because you won’t be someone’s tool.

Start getting your foot in the doors of all these telemedicine platforms. Start your own blog, write about telemedicine. Don’t focus on affiliate clinicians vs doctors yet, focus on telemedicine as an alternative to physical medicine, there is so much to write about.

You can youtube about it, or podcast about it, write a fucking book about it. Then you’re the expert. Who will a telemedicine company hire? Some ugly dude like me from a medical school or an NP who is the expert on telemedicine?

Once you get a little clout start petitioning some groups, I can give you some leads though it shouldn’t be hard to find out about the major large telemedicine groups.

Cheers

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