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Calculator · Practice P&L simulator
OB/GYN wRVU Insurance Treadmill vs Integrative DSC Micro-Practice P&L Simulator
Enter your current schedule, wRVUs, conversion factor, overhead and malpractice, then a target membership panel and fee. The simulator puts both practices side by side — gross revenue, overhead, net pre-tax income, effective hourly rate and face time per patient — and calculates the member count that covers a lean overhead. In the IntegrativeGyn.com benchmark, 300 members at $200 a month plus a dispensary and ancillary services gross about $951,000 and net $640,000–$680,000.
01How to use this calculator
Fill in the left column with your current practice: patients per day, clinic days per week, annual wRVUs, your conversion factor in dollars per wRVU, overhead as a percentage of collections and your current malpractice premium. Then set the target model: panel size, monthly membership fee, whether you will drop obstetrics, the share of members who buy supplements through your dispensary and ancillary revenue per member. The results update as you type. Copy the shareable link to send the model to a partner, accountant or attorney, or print the brief for a planning meeting. Use conservative inputs first; you can always test the optimistic case second.
Interactive calculator · shareable · printable
OB/GYN wRVU Insurance Treadmill vs. Integrative DSC Micro-Practice P&L Simulator
Every change updates the result and this page’s link, so you can send your exact scenario to a partner, clinic coordinator or CPA. Nothing you enter leaves your browser unless you send it.
02Your current practice: how the insurance side is calculated
Most employed and group OB/GYNs are paid on work RVUs, so the simulator starts there.
- Net physician income ≈ annual wRVUs × conversion factor. At 7,000 wRVUs and $43 per wRVU, that is about $301,000 before benefits.
- Gross collections behind that income = net ÷ (1 − overhead %). Overhead covers billing and coding staff, prior-authorization work, clearinghouse fees, clinical staff, space and the combined OB/GYN malpractice premium you enter.
- Effective hourly rate = net ÷ (clinic days × working weeks × clinic hours per day). At five 10-hour days for 48 weeks, $301,000 is about $125 an hour before call.
- Face time per patient is estimated from your daily volume: 28 patients in a clinic day leaves roughly 11–15 minutes each once charting and messages are counted.
For reference, the IntegrativeGyn.com benchmark for a typical insurance OB/GYN is 6,200–7,500 wRVUs at $40–$46, 24–32 patients a day, 58%–66% overhead on $1.35–$1.65 million of practice collections, and $310,000–$420,000 net. Private-practice owners whose income is not paid per wRVU can still use the tool: choose the wRVU and conversion-factor combination that reproduces your actual net income.
Call and obstetrics matter more than the hourly figure shows. The calculator counts clinic hours only, so nights on labor and delivery call lower your true hourly rate further. If you take regular call, add the average weekly call hours to your clinic hours when you compare the two hourly figures in your head.
A preset for a high-volume generalist: 30 patients a day, 7,500 wRVUs, 64% overhead.
03The micro-practice side: revenue, overhead and malpractice
The target practice has three revenue lines:
- Membership = panel × monthly fee × 12. Example: 300 × $200 × 12 = $720,000.
- Dispensary net margin = panel × share buying supplements × average monthly order × 12 × practitioner margin. The model assumes an average order of about $115 a month (range $95–$150) and a margin of about 30% (range 25%–35%). Example: 300 × 73% × $115 × 12 × 30% ≈ $91,000.
- Ancillary = panel × ancillary revenue per member per year, covering labs, in-office procedures and program fees. Example: 300 × $467 ≈ $140,000.
Overhead is mostly fixed. The benchmark lean practice runs at 28%–34% of revenue, about $285,000 a year, built from lines like these:
| Overhead line | Illustrative annual range |
|---|---|
| One nurse or MA and one care coordinator, with benefits | $130,000–$160,000 |
| Rent and utilities | $36,000–$60,000 |
| Membership billing, EHR, phone and fax software | $12,000–$24,000 |
| Gyn-only outpatient malpractice | $18,000–$26,000 |
| Clinical supplies and equipment | $15,000–$25,000 |
| Marketing | $12,000–$24,000 |
| Accounting, legal and business insurance | $10,000–$20,000 |
| Total | ≈ $233,000–$339,000 |
Table 1 · Illustrative IntegrativeGyn.com estimates; rent and salaries vary widely by metro.
Dropping obstetrics swaps your current malpractice premium for gyn-only coverage of about $18,000–$26,000. If you keep obstetrics, the calculator carries your current premium into the new practice. A tail endorsement on your old claims-made policy is a one-time cost not included in annual overhead; the DSC transition blueprint explains how to price it.
Net pre-tax income = membership + dispensary + ancillary − overhead. In the benchmark, about $951,000 − $285,000 ≈ $666,000, or roughly $450 an hour at four eight-hour days for 46 weeks.
04Break-even members and the 12-month ramp
Break-even members = fixed overhead ÷ annual contribution per member. Contribution per member is the membership fee × 12 plus that member’s expected dispensary margin and ancillary revenue. In the benchmark that is $2,400 + about $304 + about $467 ≈ $3,170, so $285,000 ÷ $3,170 ≈ 90 members cover overhead. Adding a target income to the overhead gives the panel that replaces it: ($285,000 + $365,000) ÷ $3,170 ≈ 205 members.
The ramp projects month-by-month members and cash flow during conversion. It assumes 12%–18% of your existing insurance panel converts over the transition, plus new patients from referrals and search. Each month’s cash flow = members × monthly contribution − monthly overhead. Early months are usually negative; the month where the line crosses zero is your operating break-even.
Fee level moves break-even faster than any other input. At $150 a month, contribution falls to about $2,570 and the income-replacement panel rises to roughly 253 members; at $250 it falls to about 172. Many practices offer two tiers — a core membership and a higher tier with more visits or a hormone program — which raises average revenue without pricing out every patient.
Try a cautious launch scenario: 150 members at $175, 40% dispensary uptake, $300 ancillary. If the patient side of the fee question interests you, the superbill net-cost calculator shows what members recover on visit codes, and the Hint vs Cerbo vs Elation comparison covers the software line.
05How to read your result
The big number is the change in your net pre-tax income between the two models. Under it, the side-by-side P&L shows each line for both practices.
- Sage lines are gains: higher net income, lower overhead, malpractice savings.
- Clay lines are costs or risks: overhead, a negative ramp month, or a panel below break-even.
- Ochre lines flag assumptions worth checking, such as conversion rate and dispensary uptake.
Look at three figures before the headline. First, break-even members: if it is above the panel you can realistically convert in year one, plan more runway. Second, the share of net income that comes from the dispensary and ancillary lines: a model that only works because of product sales is fragile, and patients notice markups (see the supplement dispensary audit). Third, effective hourly rate and face time per patient, which are usually the reasons physicians make the move.
06Limitations
- Insurance-side simplification. Real compensation plans add bonuses, quality payments, call pay and benefits that wRVUs × conversion factor does not capture.
- Fixed overhead is a single estimate. Rent and salaries vary widely by metro; replace the defaults with your own quotes.
- Churn is not modeled in the steady state. Losing 10%–15% of members a year means you must keep adding new members to hold a panel.
- One-time costs are excluded. Tail coverage, build-out, legal formation and working capital sit outside annual overhead.
- Legal and tax structure. Corporate practice of medicine rules, Medicare opt-out and entity choice change what is possible; confirm with counsel and a CPA.
The simulator is business education, not legal, tax or financial advice; figures are IntegrativeGyn.com estimates and must be checked against your own data.
FAQFrequently asked questions
How is the break-even member count calculated?
The calculator divides fixed annual overhead by the annual contribution of one member, which is the membership fee times 12 plus that member’s expected dispensary margin and ancillary revenue. In the benchmark, about $285,000 of overhead divided by about $3,170 per member gives roughly 90 members to cover costs. Adding your target income to the overhead shows the panel needed to replace your current pay.
What overhead does a cash-pay integrative gynecology practice have?
A lean gyn-only micro-practice typically runs at 28%–34% of revenue, about $285,000 a year in the benchmark. The main lines are one nurse or medical assistant and one care coordinator, rent, membership billing and EHR software, gyn-only malpractice of about $18,000–$26,000, supplies, marketing and professional fees. There are no insurance billers or prior-authorization staff.
What dispensary assumptions does the model use?
It multiplies your panel by the share of members buying supplements, an average order of about $115 a month and a practitioner margin of about 30%. The benchmark assumes 220 of 300 members buy, producing about $91,000 a year. You can lower the uptake slider to test a practice that treats supplements as an occasional recommendation rather than a revenue line, which many physicians prefer.
Does the calculator include the cost of malpractice tail coverage?
No. Tail coverage on a claims-made policy is a one-time cost, often about 1.5–3 times the expiring annual premium for an OB/GYN, and it is excluded from annual overhead. Check whether your employer pays it under your contract or whether a new carrier will cover prior acts, then add it to your first-year cash plan.
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