How This Physician Escaped Medicare
How Does a Physician Escape Medicare?
I have a confession to make. I have been planning my escape since the first day I set foot in the office as an attending physician. The writing was on the wall. It’s not that I didn’t love the idea of being a physician. It’s not that I was already burned out. The truth is, I saw the state of healthcare (at that time) untenable. Back in 2002 I recognized that the mountain of compliance, politics, and electronic hand cuffs were going to turn my once noble profession into a disaster. My choice, at the tender age of 29, was to do everything in my power to escape Medicare.
Medicare is the governmental payor for the majority of health care delivered in America. Not only does it control the purse strings, but also helps regulate the legal and administrative compliance involved in the practice of medicine.
Being a primary care physician with a bent towards geriatrics, there was no way I was going to spurn my main patient source.
So I had to get smart.
Getting to 5X
In the beginning of my career, I couldn’t afford to escape Medicare completely. The majority of my patients were elderly and used the government as their main source of insurance. I did see, however, to limit my future liability, I needed to gain a secure economic footing.
So I spent the next decade building up my W2 wages by hustling at my main hustle. My beginning salary of X quickly multiplied into 5X over the years. I did this by front loading the sacrifice, working extra hours, and leaping before I looked into new opportunities.
Taking a page from Jim Dahle’s book of living like a resident, I didn’t allow life style inflation to erode my new found savings. Instead, I invested in the stock market and bought rental properties. If I truly wanted to escape Medicare, I needed a strong financial cushion or even a perpetual money machine to buy my freedom.
Uncorrelated Revenue Streams
I like to think of Medicare as the stock market of medicine. You can rely on it for steady returns but you are a fool if it is your only game plan. For me, my plan to escape Medicare required other revenue streams within medicine that weren’t dependent on the government. Enter in the lazy side hustle.
Medical expert work, nursing home directorship, hospice and palliative care consulting. Every one of these opportunities paid a stipend from a private company. Then I started a concierge medical practice where patients paid extra fees out-of-pocket for services not covered by insurance. Therefore, I built a base of money and income related to medicine but free from this gargantuan governmental behemoth.
I also created revenue streams completely unrelated to medicine like real estate and blogging.
Financial Independence
My high W2 wages, reasonable lifestyle, and uncorrelated revenue streams jet rocketed me to financial independence. I created enough money to allow the stock market and other relatively passive ventures like real estate help me escape Medicare.
Mind you, I have not mentioned retirement anywhere. I haven’t even spurned Medicare completely. I still see patients in the nursing home and bill accordingly. My hospice work is made possible by Medicare’s rules requiring physician certification for new admissions even though my paycheck comes from the business.
Final Thoughts
I realized early in my career that I needed to escape Medicare. This colossal governmental entity is one of the main reasons practicing medicine is so unenjoyable today. Between arcane billing and coding rules, mountains of compliance, and the ever increasing risk of audits, I had enough.
I didn’t want to be another one of those burned out physicians, so I spent a decade building a plan that would ensure my freedom.
And it did.
If Medicare decides it wants to cut physician payments 50% over the next yer. So be it.
It won’t affect me in the least.