In 2024, Medicare cut every physician’s rates about 2 percent to fund a code that 3 out of 4 of them never billed. The cut was automatic. The code has to be claimed by hand.
The code is G2211. CMS calls it a visit complexity add-on. In plain words, it pays for office visits where you are the patient’s ongoing doctor, either as the continuing focal point for all their care …
Physicians paid for G2211 twice. Most never bill it.
An excerpt from Essays and Echoes: Reflections from a Life in Medicine.
In the CBS series Blue Bloods, the 2014 episode “Most Wanted” finds Assistant District Attorney Erin Reagan considering leaving her government job to join a private law firm. The appeal is clear. The new job would pay much more, and her daughter is nearing college age. Erin is not choosing between good and greed. She is …
Why physician financial freedom matters more than salary
Americans give hundreds of billions of dollars to charity each year, making philanthropy a defining feature of our national culture. That generosity benefits more than the organizations and communities receiving support: Research suggests that giving can also improve the donor’s happiness, sense of purpose, and connection to others. Our government actively encourages this behavior through charitable tax deductions and other incentives, reflecting a longstanding public-policy judgment that private generosity serves …
Charitable giving for physicians: 7 strategies for 2026
Many physicians believe they can’t escape burnout or an unsustainable career until they’ve become financially independent. Thankfully, it’s not true.
The idea of financial independence (FI) is simple: build enough wealth such that earned income becomes optional. For financial planners, financial independence is a mathematical problem to solve. I might be able to run your numbers in a Monte Carlo analysis and demonstrate you have, say, an 84 percent chance of …
The sweet spot before physician financial independence
Most physicians who have ever asked for a raise or tried negotiating their compensation have likely heard some version of the same sentence: “We have a standard package for the whole department. I can’t make an exception for you.”
Most doctors hear that as a brush-off. It isn’t. It’s the most honest thing an administrator will say to you all year.
They genuinely can’t do it. A one-off adjustment creates a parity …
Negotiating physician compensation works better in groups
I have been pitched investments in a doctors’ lounge, at a conference dinner, and twice in a specialty group chat. Every one of them came from another physician. That is not bad luck. That is the design.
This piece is about the specific ways physician money gets lost, and what actually works against each one. Not general advice about saving more. Named failure modes, with the fix for each. I have …
How doctors lose money investing: 6 failure modes
Most independent practices know their accounts receivable to the dollar. Far fewer can say what their credit balances total, how old the oldest one is, or who is supposed to be doing something about them. A credit balance sits in the practice management system as a negative number on a patient or payer account, it rarely triggers an alert, and it quietly inflates the bank balance the owner looks at …
Credit balances in medical practices have a deadline
A friend told me he had counted it out. Eleven more years and he could stop. He said it the way you would read a lab value, flat, no feeling in it. He is a good doctor. He was not describing a job. He was describing a sentence he had to serve.
That word, trapped, comes up more than exhaustion does.
This piece is about that feeling and what the evidence actually …
Physician autonomy predicts who leaves, not exhaustion
A patient is checking out after a routine visit, and the front desk has to say the number out loud: 400 dollars, today, under the deductible. The patient’s face changes. The staffer wasn’t hired for this conversation and doesn’t have much beyond “that’s what the system says you owe.”
This exact scene runs in practices everywhere, multiple times a day, and almost nobody standing at that desk was ever specifically trained …
Patient balance collection is nobody’s actual job
Clinicians are trained to demand certainty before they act. In the operatory or the exam room, that risk-averse instinct is exactly what keeps patients safe. Applied to career decisions, the same instinct becomes one of the most expensive habits in modern health care.
There is a sentence I hear almost every week from young clinicians, and it sounds so responsible that nobody ever questions it: “I’ll think about ownership once my …
Student loans are not blocking your practice ownership
I have reviewed manuscripts for more than thirty journals. The habit is always the same. Skip the abstract. Go straight to the methods, because that is where the paper either holds up or falls apart.
Then a fund pitch lands in your inbox and the habit disappears. The deck opens with a big number, and most of us read that number the way we would never read an abstract.
First, the words, …
How to run private fund due diligence like a reviewer
The letter says denied. It’s not the first one this month, and the physician already knows how this goes: Read it, feel briefly annoyed, and move on to the next patient, because the last three appeals went nowhere and there’s no real reason to think this one would be different.
Nothing about that moment is really a decision anymore. It stopped being one a while back, and nobody noticed exactly when.
The …
Prior authorization appeals stopped being a decision
A resignation letter arrives with ninety days written on it. Most practices read that as ninety days to find a replacement, and the search starts that afternoon. What the letter actually started is three clocks running at once, and only one of them speeds up when the practice hires faster. The payer contracts have their own notice terms. The medical records have their own custody obligations. And the replacement physician, …
The revenue gap a physician notice period never closes
ADVERTISEMENT
Your net worth statement is the only financial document in America that routinely counts someone else’s money as yours.
It lists the retirement accounts, the brokerage, the house, the practice interest, and adds them with the quiet confidence of arithmetic. The number is not wrong so much as incomplete. It books your assets at gross, and the largest have a co-owner who has not yet invoiced you. A $5 million pre-tax …
Retirement account taxes distort physician net worth
In 2009, a New England Journal of Medicine analysis examined 84,730 patients undergoing inpatient general and vascular surgery and ranked the hospitals by risk-adjusted mortality. The expectation was that the best-performing hospitals would be the ones where less went wrong.
That is not what the data showed. Major complications occurred in 16.2 percent of patients at hospitals in the lowest-mortality quintile and 18.2 percent at hospitals in the highest. Overall complications …
How to run a drill on your physician succession plan
Your hospital recently adopted a new piece of technology. Maybe it was an EHR module. A patient monitoring upgrade. A documentation tool. A new device in the OR.
Think about what happened next. Some of your colleagues embraced it. Others resisted. The nurses figured out workarounds within a week. The IT department sent three emails about training sessions that nobody attended. Six months later, half the staff is using the new …
You already run clinical diligence on every rollout
A radiologist flags something on a scan that shouldn’t be there. The physician sends a referral to oncology that same day, the kind where a few weeks genuinely matter, not the kind you let sit in a queue. The system logs it, and the chart shows it as clean and complete: sent.
Four months later, at a visit for something unrelated (a sore shoulder, nothing serious), the physician asks how the …
Closed-loop referral management needs a defined owner
A patient records request arrives the way a supply order does. It comes in by fax, portal message, or across the front desk, and joins a queue behind every task with a patient sitting in a room. Two federal rules attach the moment it arrives, each on a different clock, and neither is enforced by the practice management system.
The result is a workflow most independent practices cannot describe in numbers. …
How to manage patient records requests and reduce delay
What if pursuing wealth and pursuing purpose aren’t competing goals, but two essential components of a fulfilling career and life? When I speak to fellow physicians about their financial lives, the conversation usually focuses on either:
It is rare that I have a conversation that encompasses both. And it’s not …
Financial freedom for physicians starts with purpose
Every physician on a production contract gets a compensation report. It arrives on schedule, formatted and official, with your wRVU total sitting in a box near the bottom. And almost every one of us treats that number the same way: We glance at it, feel vaguely that it seems low, and file it away.
Here is the uncomfortable question I would ask every production-paid clinician. If that number were wrong, how …
The physician compensation check almost nobody does
Get free updates delivered free to your inbox.
