05/25/2026 Bret M. Ribotsky, DPM
Salary Raises for Physicians (Paul Kesselman, DPM)
Dr. Kesselman’s recent commentary struck a chord
because it echoes concerns I began writing about
more than twenty years ago.
https://podiatrym.com/search3.cfm?id=4631 At that
time, I compared physician economics—particularly
for podiatric physicians—to other professions and
argued that most doctors were focusing on gross
income while ignoring delayed earnings, debt
accumulation, overhead, and lost investment
opportunity. Two decades later, the situation has
not improved.
This is not an argument that teachers, transit
workers, hotel employees, executives, nurses, or
any other profession are overcompensated.
Competitive markets should reward labor fairly.
The question is why the physician—the individual
assuming ultimate responsibility for diagnosis,
treatment, outcomes, regulatory compliance,
malpractice exposure, and years of specialized
training—has become increasingly squeezed
economically.
The traditional physician business model no longer
works as it once did. Many physicians still
evaluate success by annual collections or top-line
revenue. That is outdated thinking. The real
metrics today are operating margin, free cash
flow, revenue per clinical hour, overhead ratio,
staff cost percentage, payer mix, denial rates,
accounts receivable days, return on invested
capital, and physician compensation per work RVU.
Physicians are frequently surprised to discover
that seeing more patients does not necessarily
improve profitability.
At the same time, reimbursement pressure
continues. Medicare adjustments have often failed
to keep pace with inflation. Commercial payers
increasingly benchmark downward. Administrative
work has exploded. Documentation requirements,
prior authorization, quality reporting, compliance
obligations, cybersecurity, staffing shortages,
and technology costs consume hours of unpaid labor
each week.
Meanwhile, hospitals, insurers, consultants,
revenue-cycle companies, technology vendors, and
administrators all participate in the healthcare
economy.
The physician remains responsible for the outcome.
So what can physicians implement today?
First, adopt physician-level financial dashboards.
Every practice should know monthly:
• Net collection percentage
• EBITDA or operating margin
• Labor expense as a percentage of collections
• Revenue per visit and per provider hour
• Days in accounts receivable
• Denial and write-off rates
• New patient acquisition cost
• Cash reserves measured in months of operating
expense
Second, aggressively automate low-value
administrative work. AI tools now exist to assist
with documentation, coding support, inbox triage,
patient communication, scheduling optimization,
and prior authorization preparation. Even reducing
administrative burden by one hour per day restores
hundreds of physician hours annually.
Third, renegotiate payer relationships based on
data rather than habit. Many physicians continue
participating in contracts signed years earlier
without understanding actual contribution margins
by payer.
Fourth, evaluate ancillary services and adjacent
revenue opportunities where legally and ethically
appropriate—durable medical equipment,
diagnostics, regenerative services where supported
by evidence, wellness programs, imaging, procedure
optimization, or direct-pay offerings.
Fifth, collaborate. Independent practices do not
necessarily need to sell, but scale matters.
Shared management services, physician alliances,
clinically integrated networks, and selective
consolidation can create negotiating power and
operational efficiency.
Finally, physicians need greater business
education. Medical schools teach anatomy and
pathology but rarely teach balance sheets,
negotiation, operations, valuation, or capital
allocation.
Medicine remains one of society’s most meaningful
professions. But physicians must stop assuming
that working harder alone solves structural
economic problems.
For years I have argued that if physicians
practice in 2026 the same way they practiced in
2005, they should not expect different financial
outcomes.
The future belongs not simply to the best
clinician—but to the physician who combines
excellent care with operational discipline,
technology adoption, and economic literacy.
Bret M. Ribotsky, DPM, Fort Lauderdale, FL
