OK, I will weigh in here. As the only remaining solo internist in my community I found it necessary to be creative and think outside the box. I am doing things that 10 years ago I would have found appalling. I tried very hard to make a living with my medical brain but was failing. I now contract services that come in and do ECHOs, other dopplers and ultrasounds. Another service comes in and does bone density scans and nerve conductions. I also recently added spirometry. One of the reasons I reluctantly added these is that many insurance companies now consider it "Quality of Care" measures. Read their recommendations....diabetics need nerve testing, all smokers over 45 should have spirometry...women need their bone densities. Also, even Medicare says all men over 65 who ever smoked should be screened for AAA. Glaucoma testing is also recommended but I have not found a good way to do this yet other than the old Schiotz tonometer. Years ago I used to do screening colonoscopies but gave that up because I did not want the liability issues. Everything I now do adds very little staff time, virtually no added liabilities and are very profitable. These ancillaries are the only reason I am still in business. Why should you give the money to the hospital for things that you are going to have the patient do anyway...you may as well get your cut. Granted, sometimes I wonder if I do more "things" now than I used to but I really do not. Having the tests readily available actually makes me think about getting the studies done that should be done. I have diagnosed a huge number of problems that I think I previously would have missed.
Also, a couple of years ago I began selling generics and some otc meds like omeprazole, zyrtec, calcium with D.....I started this after I ordered some meds for myself and my husband and was flabbergasted at how cheap they were. I got a price list for Mohawk Medical and picked out some of my most-prescribed generics. I keep these in my drug sample closet. I may make 2-6 bucks on a bottle, depending on what the typical price is at WalMart. I only stock those meds that I can compete with them on. I spend maybe 2 hours a month making labels which we stick on the bottles. These have my name and address and a space for the patient's name and directions/warnings for the specific meds. A little more labor-intensive but worth it. I do not file any insurance for these. The patients love it!! Many can get meds from me more cheaply than from their insurance company. Patients in the "Donut Hole" really like it.
Anyway, these maneuvers, like them or not, have kept my head above water. I really loathe the thought of having to join a group or to sell out to the hospital. PM me if you want any more info.
