Andrew Yang, MD | Hand Surgeon

Board-certified orthopedic surgeon. Solo private-practice hand surgeon (NJ/NY). Breaking down physician pay, Medicare, insurers & policy. Not medical advice.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

https://t.co/IjBaXuESPw

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@SBakerMD Same playbook with insurers. They own the clinics, the doctors and the pharmacies, then decide what care is necessary.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@zweidner @DuchinRick They have a lot of pull. Lawmakers still rarely hear from the doctors in their own district. That part is on us. We should also hold our medical associations accountable for the annual dues we pay them.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

Insurers won't negotiate with a solo doc. Hospitals keep buying the practices that could compete with them.

This isn't a free market. It's a monopoly.

The one job I want government doing: break up the monopolies.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@onefabulosfind 100%

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@Knishtix @lungmedonc I'm only 5 years out of training. Employed for 3, then opened my own office with a bank loan. There are other ways to get patients, like advertising and covering community football games. It takes time, but if you give good care and are genuine, your practice will grow.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

Employed surgeons get told "your collections don't cover your salary."

Then why does the hospital keep recruiting you?

Your cases fill their OR. That facility fee just never shows up on your line.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@formerhairmodel Right. The hospital covers that gap with the facility fee. Then it tells surgeons their collections don't cover their salary.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@DuchinRick Opening my own practice was my answer. I also wrote my senators and congressman this week on the out-of-network cap bill.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

Full breakdown with the numbers: https://t.co/FYruytwCIB

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

https://t.co/2Q6yvgzSYg

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

I can't raise my fees. Insurers won't negotiate.

So I cut costs. VAs at $4/hr. Billing at 3.75%. A used mini C-arm. $3,000 in-office WALANT.

Still 45 to 55 patients a day, weekends off. Wrote up exactly how I run lean as a solo hand surgeon.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

https://t.co/2Q6yvgzSYg

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@Carsonmd True, hand surgery can survive on current rates. But we can't play the out-of-network game like other surgical specialties. Our cases aren't worth enough compared to spine, for example.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

Residents: 5 years out, 2 years owning my own practice. Office 4 days, OR 1 day, most weekends off.

You've been told private practice is dead. It isn't.
What's stopping you?

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@crowanmd True, it's harder for primary care. Consider adding injections, ultrasound, a mini C-arm in the office to bill for x-rays, and dispensing DME. It helps fill the gap.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@DuchinRick True. Hospitals and insurers outspend us every year. Is the AMA really fighting this for independent docs, or just for the big systems?

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@CloudDesks IPAs can do it, but only if the doctors share risk or are clinically integrated. Otherwise it's price fixing under antitrust law. Insurers just merge.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@DrJimNoble That's the math they never show you. Owning my practice was the first time I saw every dollar my work brings in.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@DrOzCMS @WHFraudTF That money went to insurers for people who weren't there. When Medicare overpays a doctor, it takes it back with interest. Same rule for insurers?

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@csikes221 In my office I don't bill a facility fee. At a surgery center you need ownership or a buy-in to share that side. Hospitals keep that whole line.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@PaulGrewalMD Same script. They call you a loss leader while your cases fill their OR. Owning is how you see the real number.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@JamesNNY1 It's another law that keeps doctors in the dark and employed.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@lemmiwenks Yes until theres a monopoly, which is where healthcare is headed, thats why governments break up monopolies.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

@prestons2019 Depends on the structure. Private practice often makes more than employed if you are a partner. Ancillary income adds to your professional fees, buying into surgery centers adds to it as well. Obviously not every specialty is the same