California pain clinic with 23 locations suddenly closes

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It's not that hard to do 60/day if you're primarily doing med refills on stable patients and you have significant support staff. Not that that's good medical practice...
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sloh said:
Should go over to ophtho forum. It’s not unusual ophtho’s see 50-60 per day in clinic. Many of them make bank based off clinic and not procedures
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Hmm I know exactly what pain doctors do in 60 patient per day practices, but what does an optho do for a 60 patient per day practice?
 
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Ferrismonk said:
It's not that hard to do 60/day if you're primarily doing med refills on stable patients and you have significant support staff. Not that that's good medical practice...
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60 patient a day practice is definitely not what I would recommend to my mother if she needed care
 
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jonnylingo said:
UNLESS you somehow see 25-30+ straight-forward acute radics and acute lumbar sprain/strain all day every day, there is no effing way the patient is getting time and education needed to address their pain issues.
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Disagree.

Just because your process is slow doesn't mean mine is slow.

I am constantly looking to improve my practice and shave time.

I see 4-5 per hr, and use a chart review paragraph at the beginning of every note. The chart review is a paragraph containing pertinent info that keeps my visit contained and neat. I don't get into the weeds, and I will cut you off the moment you say something about an MVC in 1976.

cc - Low back pain

Chart Review - Joe Bob is s/p right L3-4 + S1 TF 12/15/21, right L5-S1 TF 6/21/2018, left L4-S1 RFA 3/17/2017, and caudal ESI 11/8/15. PT x 6w Fall '20, Spring '21 and Winter '22. MRI 5/2021 reveals x, y and z.

HPI - Today, Mr Bob reports...


The Chart Review is modified and brought fwd every visit. I have one sentence that lists meds, and a sentence that lists pertinent PMH.

All I do is open a note, read my chart review and go in the room.

My outcomes are no worse than your outcomes, and my 25-30 pts per day isn't anything to write home about considering my partners double my volume. My ortho and spine surgeon partners see way, way more than I do, and while that includes post op 30 sec wound checks, it also includes scheduling 3 level spinal fusions.

Educate your pts, I certainly do. While educating them please understand Mrs Smith is still going to climb on the table for an L4-S1 MBB and you're still going to have to explain everything to her again.

There's no reason to think I can't provide well rounded pain care seeing 25-30 per day.

If you give pelvic pain and weird total body fibro pain pts access to you, there will be a price for that. I applaud you for doing that, but I'm not going to see those ppl.

My community is loaded with an endless supply of spine and joint pain. That's all I'm going to see.
 
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bedrock said:
60 patient a day practice is definitely not what I would recommend to my mother if she needed care
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Nor would I, on the other hand a pain doctor who can successfully run that practice has a lot of experience dude.

You want your mother's epidural or stimulator done by someone who does a ton, or a doctor who sees 15 per day?

I know my answer.

I've had probably 5 conversations with one of the bigger KOL in our field. This individual worked closely with the biggest KOL in our field for awhile.

He has a tremendous amount of support staff, and I can't imagine his overhead but he sees 30 in a routine half day.

Best thing he ever told me was don't mix procedure time with clinic time.

I know some ppl do that successfully.

Little things like taking lead on and off is useless time. That may add up to 5-10 min over the course of a day depending on where you hang it relative to where you wear it.
 
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MitchLevi said:
Little things like taking lead on and off is useless time. That may add up to 5-10 min over the course of a day depending on where you hang it relative to where you wear it.
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That’s why I never take my lead off, not even to shower. It makes things a little awkward during sexy times so that’s why you go for the vest and skirt combo, for the flap in the front.
 
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Agast said:
That’s why I never take my lead off, not even to shower. It makes things a little awkward during sexy times so that’s why you go for the vest and skirt combo, for the flap in the front.
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Where there's a will, there's a way.
 
I mix clinic and procedures. Patients like my flexible schedule and I can always squeeze in a VIP. I start feeling too busy(but thankful) if I hit 35 patients. 25 is a cakewalk.

If I had an infinite supply of spine and joint patients I guess I could run two rooms doing 60 procedures a day if I split clinic and procedure days
 
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nvrsumr said:
I mix clinic and procedures. Patients like my flexible schedule and I can always squeeze in a VIP. I start feeling too busy(but thankful) if I hit 35 patients. 25 is a cakewalk.

If I had an infinite supply of spine and joint patients I guess I could run two rooms doing 60 procedures a day if I split clinic and procedure days
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To schedule 60 procedures per day you're seeing 85-100 clinic pts per day. Not every clinic pt gets a procedure; some pts are better after the previous procedure and are being seen in follow up; some people don't want injxns; some are new pts you've not worked up yet.
 
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MitchLevi said:
Nor would I, on the other hand a pain doctor who can successfully run that practice has a lot of experience dude.

You want your mother's epidural or stimulator done by someone who does a ton, or a doctor who sees 15 per day?

I know my answer.

I've had probably 5 conversations with one of the bigger KOL in our field. This individual worked closely with the biggest KOL in our field for awhile.

He has a tremendous amount of support staff, and I can't imagine his overhead but he sees 30 in a routine half day.

Best thing he ever told me was don't mix procedure time with clinic time.

I know some ppl do that successfully.

Little things like taking lead on and off is useless time. That may add up to 5-10 min over the course of a day depending on where you hang it relative to where you wear it.
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Some of the KOLs are in a league of their own and have implemented highly refined team-based care systems that facilitate throughput conversion into necessary pain surgeries that will help bring the opioid epidemic to a much-needed end. #nonopioid solutions #teambasedcare #advancedpracticepactitioners #painsurgery #facilityfees
 
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You can be fast because smooth, efficient, or fast because sloppy, careless.

You can be slow and meticulous, or slow because you don't know what you're doing.

Hard to judge anything based on speed.
 
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MitchLevi said:
To schedule 60 procedures per day you're seeing 85-100 clinic pts per day. Not every clinic pt gets a procedure; some pts are better after the previous procedure and are being seen in follow up; some people don't want injxns; some are new pts you've not worked up yet.
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Really depends on set up. Not throwing shade but if part of a surgical group you are triaging to some extent for the surgeons. A lot of nonprocedural spine pain comes into a spine surgeons office. Pcp mlps just refer all back pain then move on to working up the patients Htn and Dm.

At my solo shop I get a lot of self referrals and spine surgeon referrals. These patients have already played the nsaid and PT game and know before they come in the door they are being evaluated for interventional pain procedures. Plus I have been doing this awhile and could probably stop seeing new patients altogether and just see my repeat rf patients for a few years before attrition dropped my numbers. That’s basically my retirement plan.
 
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nvrsumr said:
I mix clinic and procedures. Patients like my flexible schedule and I can always squeeze in a VIP. I start feeling too busy(but thankful) if I hit 35 patients. 25 is a cakewalk.

If I had an infinite supply of spine and joint patients I guess I could run two rooms doing 60 procedures a day if I split clinic and procedure days
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I've always preferred not to mix clinic and procedures. The group I'm in now does a mixed schedule, in the name of always being able to get someone in for a procedure. It's probably not the most efficient use of time and space, but we make it work. Usually get in the weeds during the middle of the day but get caught back up by the end
 
MitchLevi said:
Nor would I, on the other hand a pain doctor who can successfully run that practice has a lot of experience dude.

You want your mother's epidural or stimulator done by someone who does a ton, or a doctor who sees 15 per day?

I know my answer.

I've had probably 5 conversations with one of the bigger KOL in our field. This individual worked closely with the biggest KOL in our field for awhile.

He has a tremendous amount of support staff, and I can't imagine his overhead but he sees 30 in a routine half day.

Best thing he ever told me was don't mix procedure time with clinic time.

I know some ppl do that successfully.

Little things like taking lead on and off is useless time. That may add up to 5-10 min over the course of a day depending on where you hang it relative to where you wear it.
Click to expand...

I know my answer too. Speed does not mean safety, if anything rushing is one of the biggest causes of sentinel events at our hospital. Our procedures do not take a ton of technical proficiency. How much technically better is the doc who has done 10000 ESIs vs the doc that has done 7000 or 5000? I would not have my mom go to some block shop where profits and speed are the goal. If some doc wants to spend 20mins reviewing moms chart, looking at the MRI, confirming her symptoms actually match the requested injection and then performs the epidural safely I am taking that every time. I've seen too many high volume docs that really don't give a **** about their patients and just want to keep turning the mill.
 
kstarm said:
I know my answer too. Speed does not mean safety, if anything rushing is one of the biggest causes of sentinel events at our hospital. Our procedures do not take a ton of technical proficiency. How much technically better is the doc who has done 10000 ESIs vs the doc that has done 7000 or 5000? I would not have my mom go to some block shop where profits and speed are the goal. If some doc wants to spend 20mins reviewing moms chart, looking at the MRI, confirming her symptoms actually match the requested injection and then performs the epidural safely I am taking that every time. I've seen too many high volume docs that really don't give a **** about their patients and just want to keep turning the mill.
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Tim Deer is better at stim than you.

That's my point, not the workup or general management. There's a trade off in ultra high vol practice where you probably won't ever see that KOL in the clinic, rather you'll be worked up by the PA and scheduled for that KOL to do your procedure.

I don't know you, but if my mom needed a stimulator I'd rather have Deer do it than you.
 
MitchLevi said:
Tim Deer is better at stim than you.

That's my point, not the workup or general management. There's a trade off in ultra high vol practice where you probably won't ever see that KOL in the clinic, rather you'll be worked up by the PA and scheduled for that KOL to do your procedure.

I don't know you, but if my mom needed a stimulator I'd rather have Deer do it than you.
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Hm I don’t know about that. Because the success of a stim is whether it was appropriate to do it in the first place. Someone who spends time with a patient has a better understanding of what correct procedure is needed. A midlevel can never replicate that.
 
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MitchLevi said:
Tim Deer is better at stim than you.

That's my point, not the workup or general management. There's a trade off in ultra high vol practice where you probably won't ever see that KOL in the clinic, rather you'll be worked up by the PA and scheduled for that KOL to do your procedure.

I don't know you, but if my mom needed a stimulator I'd rather have Deer do it than you.
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Does he have lower than average rates of lead migration, infection, etc? If so, I'd like to know what his tips and tricks are, seriously.
 
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Agast said:
Hm I don’t know about that. Because the success of a stim is whether it was appropriate to do it in the first place. Someone who spends time with a patient has a better understanding of what correct procedure is needed. A midlevel can never replicate that.
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"If my mom needed a stimulator..."

Like I clearly said in my post, if my mom needed a stimulator, I'd rather have Tim Deer do it than 99% of the other people in this field.

This implies the stimulator is the appropriate Tx.

Not everyone is good at Pain. Many do it never having done a fellowship.
 
Now I wonder if MitchLevi is Pain Applicants alt account. Same energy.
 
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Agast said:
Now I wonder if MitchLevi is Pain Applicants alt account. Same energy.
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I haven't read this full thread in detail but I do feel like I have a lot in common with this guy. I bet we'd be friends. I'd like to fight/spar with him and learn from him as I feel he would be able to take me down.
 
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Pain docs have such fragile egos. Never hear about cardiologists boasting about being the worlds greatest pacemaker implanter.

If my mom needed on I would take any spine surgeon who does them over Deer.
 
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nvrsumr said:
Pain docs have such fragile egos. Never hear about cardiologists boasting about being the worlds greatest pacemaker implanter.

If my mom needed on I would take any spine surgeon who does them over Deer.
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People are people.

I'm sure every field in medicine has this, no different than car salesmen, lawyers, roofers...

What sets us apart is we live in a world of subjectivity, a different thing from cardiology or oncology.

I do a good amount of stim, but I'd rather someone with 2000 implants do my stimulator instead of a guy with a few hundred.
 
Pain Applicant1 said:
I haven't read this full thread in detail but I do feel like I have a lot in common with this guy. I bet we'd be friends. I'd like to fight/spar with him and learn from him as I feel he would be able to take me down.
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Before we continue this discussion I’d like everyone to list his/her bench, deadlift, squat, penis size, total number of sexual partners, net worth.
 
nvrsumr said:
Pain docs have such fragile egos. Never hear about cardiologists boasting about being the worlds greatest pacemaker implanter.

If my mom needed on I would take any spine surgeon who does them over Deer.
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It takes a certain type of person to be able to listen to complaints of subjective pain, day after day, year after year. Pain docs are themselves fragile, otherwise they would have chosen to treat pain. Cardiologists think they are the **** because the world falsely believes you can’t live without your heart…
 
Dr. Ice said:
It takes a certain type of person to be able to listen to complaints of subjective pain, day after day, year after year. Pain docs are themselves fragile, otherwise they would have chosen to treat pain. Cardiologists think they are the **** because the world falsely believes you can’t live without your heart…
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I follow you completely
 
nvrsumr said:
Pain docs have such fragile egos. Never hear about cardiologists boasting about being the worlds greatest pacemaker implanter.

If my mom needed on I would take any spine surgeon who does them over Deer.
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This is an astute observation. Are there any interventional cardiologists on Linked In or Instagram posting pictures of them doing pacemaker implants with device reps?
 
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drusso said:
This is an astute observation. Are there any interventional cardiologists on Linked In or Instagram posting pictures of them doing pacemaker implants with device reps?
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It's because they're not a production-based specialty. Like I said, social media is a means to an end, $$$. IC doesn't make more by hustling, they get what ambulance brings them. That's why on LinkedIn you get pain, ortho, NSG (spine, not cranial).
 
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RoloTomassi said:
It's because they're not a production-based specialty. Like I said, social media is a means to an end, $$$. IC doesn't make more by hustling, they get what ambulance brings them. That's why on LinkedIn you get pain, ortho, NSG (spine, not cranial).
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Yep. SpineFixIt or whomever is not going to send you checks if you don’t “partner” with SpineFixIt.
Remember that part in in Avatar when the sexy alien told the protagonist, “R-r-r-r, we are mated for life”? That’s what is happening in those instagram and LinkedIn photos. Under the frame two giant blue tails are entwining in passionate coitus. It’s just like love: oxytocin, insomnia, devotion, the whole thing…but each partner turns out to be a sociopath, and the end of the movie includes scenes of 28 hour plastic/vascular/neurosurgery to separate the blue tails, overeating to hide the shame of having sold countless SpineFixIts to worshipful blue grandmothers, alcoholism, lawsuits, praying for forgiveness in jail cells, homemade tattoos. I am only reporting what I’ve been told by veteran 37 year old KOLS and whistleblowing reps.
Instagram love is the gateway drug. Come take a picture with Ur Mama.
 
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ateria radicularis magna said:
Yep. SpineFixIt or whomever is not going to send you checks if you don’t “partner” with SpineFixIt.
Remember that part in in Avatar when the sexy alien told the protagonist, “R-r-r-r, we are mated for life”? That’s what is happening in those instagram and LinkedIn photos. Under the frame two giant blue tales are entwining in passionate coitus. It’s just like love: oxytocin, insomnia, devotion, the whole thing…but each partner turns out to be a sociopath, and the end of the movie includes scenes of 28 hour plastic/vascular/neurosurgery to separate the blue tales, overeating to hide the shame of having sold countless SpineFixIts to worshipful blue grandmothers, alcoholism, lawsuits, praying for forgiveness in jail cells, homemade tattoos. I am only reporting what I’ve been told by veteran 37 year old KOLS and whistleblowing reps.
Instagram love is the gateway drug. Come take a picture with Ur Mama.
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Is this part of the psilocybin thread?
 
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RoloTomassi said:
It's because they're not a production-based specialty. Like I said, social media is a means to an end, $$$. IC doesn't make more by hustling, they get what ambulance brings them. That's why on LinkedIn you get pain, ortho, NSG (spine, not cranial).
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I don't think this is accurate. Interventional cardiology is production based like any other specialty. True they don't control the ambulance volume, but one may do a cath on you while the other does medical management. They have the financial incentive just like every other procedure-based specialty.
 
ateria radicularis magna said:
Yep. SpineFixIt or whomever is not going to send you checks if you don’t “partner” with SpineFixIt.
Remember that part in in Avatar when the sexy alien told the protagonist, “R-r-r-r, we are mated for life”? That’s what is happening in those instagram and LinkedIn photos. Under the frame two giant blue tales are entwining in passionate coitus. It’s just like love: oxytocin, insomnia, devotion, the whole thing…but each partner turns out to be a sociopath, and the end of the movie includes scenes of 28 hour plastic/vascular/neurosurgery to separate the blue tales, overeating to hide the shame of having sold countless SpineFixIts to worshipful blue grandmothers, alcoholism, lawsuits, praying for forgiveness in jail cells, homemade tattoos. I am only reporting what I’ve been told by veteran 37 year old KOLS and whistleblowing reps.
Instagram love is the gateway drug. Come take a picture with Ur Mama.
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lobelsteve said:
Is this part of the psilocybin thread?
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In a roundabout way…
VR is created by Silicon Valley. Silicon Valley is a top proprietor of psychedelics. Avatar is about VR.
But you keep dodging the main issue, which is WHY HAVE YOU NOT YET SET UP YOUR FAKE INSTAGRAM KOL ACCOUNT???
 
To be a KOL you need to be able to implant in under 40 min on an heroic dose of psilocybin.

Try having some real challenges in your life bros.
 
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ateria radicularis magna said:
In a roundabout way…
VR is created by Silicon Valley. Silicon Valley is a top proprietor of psychedelics. Avatar is about VR.
But you keep dodging the main issue, which is WHY HAVE YOU NOT YET SET UP YOUR FAKE INSTAGRAM KOL ACCOUNT???
Click to expand...
Planning meeting this weekend.
Metallic orange bikini briefs ordered.
 
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MitchLevi said:
Tim Deer is better at stim than you.

That's my point, not the workup or general management. There's a trade off in ultra high vol practice where you probably won't ever see that KOL in the clinic, rather you'll be worked up by the PA and scheduled for that KOL to do your procedure.

I don't know you, but if my mom needed a stimulator I'd rather have Deer do it than you.
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Plot twist: Tim deer is on this forum under a pseudonym
 
drusso said:
You don't know half of it. There are a BUNCH of lurkers from the KOL-dom and Ivory Tower here. This forum has shaped all kinds of policy discussions. It's the Silk Road of IPM...
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The number of policy decisions shaped by this forum is a tiny fraction of the number of policy decisions shaped by the motivation by industry and KOL lap dogs to extract maximum profit from every grandmother and grandfather hesitantly entering their names in the industry funded Facebook ads/pages that follow them from site to site showing them pics of healthy grandparents lifting their grandchildren into the air.
Ad: “Get your life back!”
(Subtext: see NP in white coat who is pressured or bamboozled by KOL sociopath and private equity owner overlords to put patient into a category or “basket,” which will be then be lined up neatly for every intervention including the newest titanium legos regardless of efficacy or patient experience. Patient never sees doctor’s face.
)
 
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