Both of you have success and I feel better hearing these things are possible but the fact is that for my particular situation, the financials are what is holding me back. In my state, even gyn only, major surgery insurance can run between 35-70,000!

Dr. Ethiope, which EMR are you using?

I have been doing research into the business side of practice and it sounds like overhead still runs higher for our specialty than others because of malpractice insurance and in my area rental fees are very expensive, 25-30$/squre feet. With my tail, it will take me more than the average three years to start maturing and making a stable salary so I am trying to figure out when the right time is. Sounds like my patients who try to plan their pregnancy, all the best laid plans, when in reality there is probably no perfect time to take the plunge.

Do you have a general sense of what your
overhead is running? In most ob practices, it runs 55-65% because of insurance and needing so many employees to support the MDs, but for gyn what do you experience? I am trying to figure this number out to help me if I try to negotiate staying and doing gyn only in my group, maybe even for a year to "try" it and see if it makes sense.

Thanks again for sharing!

I'm using eClinical Works. Although I've had some issues with their technical support, I love using the EMR over paper.

My overhead is about $16,000 on average. Some months (when I don't have to pay my malpractice premium) it's as low as $13,000. It's greater than 50% now but as I get busier, the overhead is staying about the same, so the rest is for me. Supplies will go up some as I get busier, but I don't think that will be a huge increase. But, the really big expenses (rent, malpractice and salaries) are unaffected by increased volume, at least until I get so busy that I'll have to hirer someone else.

I don't remember what the cost per square foot is for my space.

Oh, by the way, I meant to ask what state you're in?

I am practicing in New Jersey which is notorious for a broken insurance system. We hit our low about 4 years ago when many insurance companies pulled out of the market and noone offered occurence policies so almost everyone was forced to get a claims made policy. In addition the area of NJ I live in is very costly, in terms of housing, taxes etc. I long to live in a quieter part of the country but for now with my kids and my family being here, I don't see moving for many years.
I am still trying to weigh the pros and cons of trying to stick it out within my own practice, which of course is more secure and easier, but there are so many insurance issues, i.e., tail expenses and the fact that we are still not clear how to pay a gyn only doc within our group since so far, noone has dropped down yet to gyn only. I am pushing my group to look at this so I know what to compare but it sounds like you are in a good state for insurance and that you will be as busy as you want to be. I feel confident that I can be busy, but the reimbursements are lower than ever and in NJ the Dept of Insurance and Banking is working on a motion to cut out of network provider fees to 150% of medicare rates!!! One more way the NJ state govt is screwing the docs, so why am I still in NJ?????

I wonder about it every day.

kobgyn,

I had no idea NJ was such a toxic state in which to practice. If your call is relatively infrequent, what is your reason for wanting to stop ob? Maybe it would be easier to go 80% time, take a 20% pay cut, work 20% less? I did this with the group I was with right after my 2nd was born. I'm older (i assume) than you, almost 46 and finally have the ideal practice situation. Your kids actually need you more as they get older...mine are now 11 & 13. I know you don't want to jepordize your family's financial future.
There is a season for everything, and I hope this works out for you.

happymamadoc,
6
you know, that is a good question, why do I want to stop ob? maybe it's not that I want to stop, but maybe that I want to do it less, or less than the volume now.
being in ob we tend to do everything 150% and don't even realize that there are alternative work arrangements. My kids are 12 and 9, and I am 43, so I am not sure if I should just cut back, like you suggested or just start over with gyn. Although when I am on call, it's brutal and busy, I have good office hours and because our group is all docs with families, we all have similar goals of trying to leave each other alone when we are off to have family time, even the guys. The difference is they don't feel the volume like the women do, probably because they see it as more $, and I see it as more stress, and not worth the small extra $.

Maybe the thought of cutting back percentage wise is a better compromise for now. So if you did 80%, what does that mean, 80% office hrs what about call?

Where are you practicing? Any place has got to be better than New Jersey, except maybe PA. which I hear is just as bad.

Timing is everything, I agree.
This July our group is up for another round of shopping for insurance. I hope to get better tail terms with another company and there is rumor that next year occurence policies may become available again, so I am hoping it will better. It certainly can't get worse.