Tap into new revenue streams

Key Points

With a little creativity and a commitment to efficiency, internists and family doctors in economically depressed small towns or major cities also can do quite well.

The bad news: Two-thirds of PCPs express dissatisfaction with their income or the number of hours they must work to earn what they want. And little wonder: On average, internists and family physicians bring home about half the pay of the cardiologists, radiologists, and gastroenterologists to whom they commonly refer, Stone says, citing a recent salary survey.

Medical Economics scoured the country looking at ways your colleagues have successfully boosted their incomes. We'll present the results of our efforts over several issues, starting with this article about activities that build revenue streams by going outside of the standard practice location, hours, and payment structure. Future articles will examine ancillary services and products that can boost revenues in the office; we'll look at a few of those services in greater depth.

Why look beyond the office?

Although it may seem easier to add services that can be performed in the office, new revenue sources from outside activities offer some advantages.

George Ellis, MD, an internist in Youngstown, Ohio, practices in a former steel town where the median household income is less than $22,000 and 25% of the population lives below the poverty line. Healthcare for many of his patients is covered through government programs.

"In a depressed area, patients frown on it when you do a lot of different things in your office. They think you have an ulterior motive for offering the service," he says. "It's easier for me to do things they don't see, and it preserves my patients' trust in me."

In some states, legislatures have taken as dim a view of self-referrals as Ellis' patients and strictly limited them, even beyond the requirements of "Stark law" provisions. A recent court case in Maryland upheld that state's very restrictive laws, which eliminate the "in-office ancillary services" exception for many services. Similar bills regularly appear for consideration by other state legislatures.

Some physicians are reluctant to add services or sell products for fear that the related technology quickly may become outdated or won't achieve a positive return on investment. Others worry that a new service may not be supported by scientific evidence in the long term and could make them seem unprofessional.

But "in today's economic situation, physicians need to look at all the options," Ellis says. "I'm not going to turn my back on my patients as reimbursement declines, but I need make up that lost income."