consulting and you

[end stage fibro]

I learned about physician consulting on SDN years ago when I first entered med school. The idea of MD consulting gets thrown about occasionally but I never really understood what it meant. There are a few threads about consulting on SDN but they seem to talk around it vs about it.

I have a no name pedigree and only a 3 year residency under my belt along with several years work experience as a hospitalist and now doing a couple years of admin work. I am a small fish in this game. I literally got into consulting because I know a guy who knows a guy, and that guy's guy fell through on a project. The main guy who owns the firm has a stellar academic pedigree, years of experience on the clinical side, and has professional degrees besides his MD. I previously did not understand the interface of MD/JD or MD/PhD outside translational research...now I know;the interdisciplinary expertise matters when you are representing a Fortune 500 firm about to sign a contract valued in the 100s of millions. Anyways, that guy has good relationships with the Big 4/MBB and also used to work for some them. A lot of their work, at least in healthcare, gets subcontracted many levels deep. At times, I am about 6 levels removed from the original client. Once, I was directly approached by a Big 4 firm and my work experience sealed the deal.Each level of subcontracting takes roughly a 40-50% margin off your work, but this figure varies widely. The pay also is variable; one job where I literally clicked boxes paid $180/hr and I did it from my phone. Another required intense chart review, liaising with CMS reps, and trying to guess where CMS would move on a subject. That paid a lot. Frequently, the company asks for a discount or reduction on the hourly rate due to budget issues. I don't have a say in this and it is annoying, but worth it to keep the relationship.

The actual work I would characterize as mind numbing. It is mostly making sure the quality of XYZ is up to snuff. I spend a lot of time reviewing and editing appeals letters; adjudicating medical necessity for surgeries, home health, post acute, etc. Most of it finding the appropriate CMS manual and rule to apply.1 hour per chart is a typical speed to work at, though chart can mean a lot of different. There is a lot of leeway in interpretation and this is were having MD plus a few more letters helps out in applying the rules (not to mention my own experience). The ramification are enormous, although almost exclusively financial. I know it's vague but in one case company A wanted to buy company B, a provider of post acute services. Company B was too freewheeling in providing care that wasn't justified...the error rate was a little too high for comfort. Company A did not buy B. I later found out company B actually was heavily fined by a payor and had to declare bankruptcy. avoiding the purchase obviated a lot of headache for company A. OIG and large institutions like universities conduct audits and rely on independent review organization to examine internal work. I do that, too. Please try to not get audited by OIG. It is going to hurt.

There is no phoning it in. Deadlines are frequently pushed up and work added. Perform or get paid $0.00 USD. I on rare occasion have to put in long hours, like 14 hours a day of actual work. I don't always present findings (main guy usually does) but when I do, it is front of a large legal team and few medical directors that interrogate my findings mercilessly and bring up esoteric issues. Clients and colleagues expect you to be available almost 24/7, which I find very grating.

It is well paying, a nice change of pace though, and really solidifies my skills in this area. I don't think I would do this full time, though. It is a bad combo of boring and hard work. The guy who owns the firm mentions being directly employed by the consulting firm isn't much different until you start getting in the upper tiers of management. An MD won't get you there. You need the traditional consulting starter kit- target school education, right major, connections, etc.

note: there are of course other avenues for consulting. there are also careers as an expert witness, speaking for drug companies, performing boutique analysis (that is how I got hired for one of my jobs). I don't have experience with those fields.

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[whoknows2012]

I learned about physician consulting on SDN years ago when I first entered med school. The idea of MD consulting gets thrown about occasionally but I never really understood what it meant. There are a few threads about consulting on SDN but they seem to talk around it vs about it.

I have a no name pedigree and only a 3 year residency under my belt along with several years work experience as a hospitalist and now doing a couple years of admin work. I am a small fish in this game. I literally got into consulting because I know a guy who knows a guy, and that guy's guy fell through on a project. The main guy who owns the firm has a stellar academic pedigree, years of experience on the clinical side, and has professional degrees besides his MD. I previously did not understand the interface of MD/JD or MD/PhD outside translational research...now I know;the interdisciplinary expertise matters when you are representing a Fortune 500 firm about to sign a contract valued in the 100s of millions. Anyways, that guy has good relationships with the Big 4/MBB and also used to work for some them. A lot of their work, at least in healthcare, gets subcontracted many levels deep. At times, I am about 6 levels removed from the original client. Once, I was directly approached by a Big 4 firm and my work experience sealed the deal.Each level of subcontracting takes roughly a 40-50% margin off your work, but this figure varies widely. The pay also is variable; one job where I literally clicked boxes paid $180/hr and I did it from my phone. Another required intense chart review, liaising with CMS reps, and trying to guess where CMS would move on a subject. That paid a lot. Frequently, the company asks for a discount or reduction on the hourly rate due to budget issues. I don't have a say in this and it is annoying, but worth it to keep the relationship.

The actual work I would characterize as mind numbing. It is mostly making sure the quality of XYZ is up to snuff. I spend a lot of time reviewing and editing appeals letters; adjudicating medical necessity for surgeries, home health, post acute, etc. Most of it finding the appropriate CMS manual and rule to apply.1 hour per chart is a typical speed to work at, though chart can mean a lot of different. There is a lot of leeway in interpretation and this is were having MD plus a few more letters helps out in applying the rules (not to mention my own experience). The ramification are enormous, although almost exclusively financial. I know it's vague but in one case company A wanted to buy company B, a provider of post acute services. Company B was too freewheeling in providing care that wasn't justified...the error rate was a little too high for comfort. Company A did not buy B. I later found out company B actually was heavily fined by a payor and had to declare bankruptcy. avoiding the purchase obviated a lot of headache for company A. OIG and large institutions like universities conduct audits and rely on independent review organization to examine internal work. I do that, too. Please try to not get audited by OIG. It is going to hurt.

There is no phoning it in. Deadlines are frequently pushed up and work added. Perform or get paid $0.00 USD. I on rare occasion have to put in long hours, like 14 hours a day of actual work. I don't always present findings (main guy usually does) but when I do, it is front of a large legal team and few medical directors that interrogate my findings mercilessly and bring up esoteric issues. Clients and colleagues expect you to be available almost 24/7, which I find very grating.

It is well paying, a nice change of pace though, and really solidifies my skills in this area. I don't think I would do this full time, though. It is a bad combo of boring and hard work. The guy who owns the firm mentions being directly employed by the consulting firm isn't much different until you start getting in the upper tiers of management. An MD won't get you there. You need the traditional consulting starter kit- target school education, right major, connections, etc.

note: there are of course other avenues for consulting. there are also careers as an expert witness, speaking for drug companies, performing boutique analysis (that is how I got hired for one of my jobs). I don't have experience with those fields.

For subspecialists especially in fields like hem/onc there is good money to be made through either direct consulting or through market research firms. I have a gi onc friend who also has his hand in ad boards and pharma consults, that easily clears 50K+ from these consulting gigs (3rd party firms who connect clients to “KOLs.”). The work to make let’s say $1000 per week could be as little as 1-2h/week….

I have personally found it’s somewhat difficult to find the sweet spot of $/hr rate but for the services of a highly experienced (5yr+) academic oncologist is 750-1000/h

In addition at big meetings the pay is quite a bit more to talk about updates from the meeting itself

 

[end stage fibro]

holy toledo that is a nice hourly rate. My highest paying rate for this stuff was about 600/hr, but that was a one off. average is more like 300 to 400.
I know of a couple sub-specialists that make 100k+/year speaking for pharma but they were flying out 1-2x a week to give short talks. that was pre-covid... not sure how it works these days. they were just community cards and heme/onc, not KOLs.

as i've see many times here, it pays to go into heme/onc!

 

[whoknows2012]

holy toledo that is a nice hourly rate. My highest paying rate for this stuff was about 600/hr, but that was a one off. average is more like 300 to 400.
I know of a couple sub-specialists that make 100k+/year speaking for pharma but they were flying out 1-2x a week to give short talks. that was pre-covid... not sure how it works these days. they were just community cards and heme/onc, not KOLs.

as i've see many times here, it pays to go into heme/onc!

Yea it’s pretty nuts-I have a gig at 600 and two at 750 they’re market research firms though and not consulting gigs so they reach out to me on behalf of clients-the higher I push the rate I start to worry about getting selected less. I’ve been ramping this up a bit over the last year it’s been kinda fun and can do it while commuting or at my desk during lunch

 

[osprey099]

For subspecialists especially in fields like hem/onc there is good money to be made through either direct consulting or through market research firms. I have a gi onc friend who also has his hand in ad boards and pharma consults, that easily clears 50K+ from these consulting gigs (3rd party firms who connect clients to “KOLs.”). The work to make let’s say $1000 per week could be as little as 1-2h/week….

I have personally found it’s somewhat difficult to find the sweet spot of $/hr rate but for the services of a highly experienced (5yr+) academic oncologist is 750-1000/h

In addition at big meetings the pay is quite a bit more to talk about updates from the meeting itself

How much does pharma pay for an onc to give a drug dinner talk to nurses/mid-levels/fellows? I've attended several as a fellow and we've had even community oncs who come from several states away (one even flew in same-day from the other coast) to give these talks. The exact amount probably depends on the drug company but I imagine they must be getting paid at least several thousand per talk.

 

[whoknows2012]

How much does pharma pay for an onc to give a drug dinner talk to nurses/mid-levels/fellows? I've attended several as a fellow and we've had even community oncs who come from several states away (one even flew in same-day from the other coast) to give these talks. The exact amount probably depends on the drug company but I imagine they must be getting paid at least several thousand per talk.

It’s a big no no from my academic center to be involved in these but as far as I’ve heard it’s about 2-3k

 

[CCM-MD]

I work with some market research firms occasionally. $400-500/h for 1-2 hours at a time. It’s easy money but inconsistent for critical care/neurocritical care.

 

[DrMetal]

I learned about physician consulting on SDN years ago when I first entered med school. The idea of MD consulting gets thrown about occasionally but I never really understood what it meant. There are a few threads about consulting on SDN but they seem to talk around it vs about it.

Meh . . .I'd rather work a couple extra shifts and call it good.

 

[Osteoth]

Meh . . .I'd rather work a couple extra shifts and call it good.

A lot of people look at it if they don’t like clinical medicine.

There are several programs through the big consulting companies for MDs, problem is its $200-240k all in for 60 hrs a week and no job security. Even a PCP is a better job than that.

 

[whoknows2012]

A lot of people look at it if they don’t like clinical medicine.

There are several programs through the big consulting companies for MDs, problem is its $200-240k all in for 60 hrs a week and no job security. Even a PCP is a better job than that.

Agree which is why I think it’s better to do this as a side gig whenever time is available for some extra bucks

 

[Ubba]

It seems like the grind is overall not (much) better than clinical medicine unless one hates patient interactions. Though I have fantasized about a dream world in which I wear fancy suits, am flown everywhere first-class, and get paid buckets of money to simply grace important meetings with my austere medical presence; I'm happy to learn from your post that this reality doesn't exist and I'm not missing out!

Greener-grass syndrome affects all of us...

 

[end stage fibro]

Meh . . .I'd rather work a couple extra shifts and call it good.

If I were still a full time hospitalist and there were infinite shifts, there would be no way in hell I would be doing this consulting crap. however, in my neck of the woods, shifts are slowly dwindling thanks to the biggest game in town overstaffing and cutting down open shifts. i still do hospitalist shifts on the weekend but it is nice to do consulting during the weekdays

It seems like the grind is overall not (much) better than clinical medicine unless one hates patient interactions. Though I have fantasized about a dream world in which I wear fancy suits, am flown everywhere first-class, and get paid buckets of money to simply grace important meetings with my austere medical presence; I'm happy to learn from your post that this reality doesn't exist and I'm not missing out!

Greener-grass syndrome affects all of us...

lol aint that the truth. in clinical medicine, I at least felt like i was making a good contribution, even if the day to day sucked and felt meaningless. right now my day consists of learning excel keyboard shortcuts and navigating the dark corners of CMS policy manuals. Titillating, i know.

 

[sloh]

It seems like the grind is overall not (much) better than clinical medicine unless one hates patient interactions. Though I have fantasized about a dream world in which I wear fancy suits, am flown everywhere first-class, and get paid buckets of money to simply grace important meetings with my austere medical presence; I'm happy to learn from your post that this reality doesn't exist and I'm not missing out!

Greener-grass syndrome affects all of us...

Here I am doing unglamorous SNF work.

But making 600-700+/hr. I like the unglamorous work

 

[Osteoth]

Here I am doing unglamorous SNF work.

But making 600-700+/hr. I like the unglamorous work

How

 

[Ubba]

Here I am doing unglamorous SNF work.

But making 600-700+/hr. I like the unglamorous work

Happy for you. Get it while the getting is good!

 

[sloh]

How

Pretty much just consult on pain, MSK, rehab barriers for patients in SNF’s. I am able to see a very high volume of patients bc I’m a consultant and don’t need to manage all the other comorbidities. I also don’t get looped into social or dispo issues. Patients getting rehab in SNF’s generally progress quite slow (which is why they aren’t in acute inpatient rehab) so the majority of my patients are quick follow-ups.

I can literally walk into the PT gym in the morning and see like 6-8 follow-ups in a matter of minutes. Let’s say I get paid on average $60 per follow-up and documentation takes like 1-1.5 minutes per patient with good templates and dot phrases. You can do the math and see how this type of gig can be very lucrative.

It’s not glamorous. I don’t get to wield, circle jerk, and mentally masturb*** about super expensive and time consuming ultrasound procedures that reimburse trash per unit of time. I don’t get to perform fancy pain procedures while getting f***** by declining insurance reimbursements and denials. I don’t get to sit in pain clinic all day listening to chronic pain patients. I don’t get to swindle cash paying patients with PRP and stem cells. But it pays very well. I love it!

The caveat with my gig is I practice in a location and have a setup where my SNF’s have a high volume of patients getting rehab and I round at 2-3 SNF’s per day which is only practical bc they are close to each other.

And don’t get looped into medical directorship positions at SNF’s guys. It’s almost never worth the time, money, liability, and stress.

 

[end stage fibro]

And don’t get looped into medical directorship positions at SNF’s guys. It’s almost never worth the time, money, liability, and stress.

Can you expound on this? Is 25k reasonable comp for this position? Seems like an easy gig

Also I agree about SNF. Not a bad gig and pretty lucrative. PCC effing sucks

 

[Osteoth]

Can you expound on this? Is 25k reasonable comp for this position? Seems like an easy gig

Also I agree about SNF. Not a bad gig and pretty lucrative. PCC effing sucks

I’ve heard of people making $4-10k/month for directorships, sounds light.

 

[end stage fibro]

I’ve heard of people making $4-10k/month for directorships, sounds light.

For hospital medical directorships, I see those figures commonly. I am not sure what is reasonable for a SNF. I trust the guy asking me to do it and he says it’s an easy job. The SNF is part of a large corporation that already has lots of pathways and algorithms in place so I wouldn’t be involved in developing things like thay.

 

[Prehealth1011]

Here I am doing unglamorous SNF work.

But making 600-700+/hr. I like the unglamorous work

I've heard some IM folks rounding in rehab facilities. Are they doing the same type of work?

 

[Osteoth]

For hospital medical directorships, I see those figures commonly. I am not sure what is reasonable for a SNF. I trust the guy asking me to do it and he says it’s an easy job. The SNF is part of a large corporation that already has lots of pathways and algorithms in place so I wouldn’t be involved in developing things like thay.

It’s not about the work, it’s the liability.

Every time someone gets a decubitus, becomes septic and does you’re on the hook for it, and you can’t possibly look at every ass.

 

[sloh]

I've heard some IM folks rounding in rehab facilities. Are they doing the same type of work?

Unlikely bc they are likely the primary. When you’re primary and have to manage all other comorbidities, families, social/dispo issues the financial ROI per unit of time drops precipitously.

 

[sloh]

Can you expound on this? Is 25k reasonable comp for this position? Seems like an easy gig

Also I agree about SNF. Not a bad gig and pretty lucrative. PCC effing sucks

YMMV if it’s truly a unicorn medical directorship position but I’ve rarely seen it. I round at 7-8 SNF’s per week and have been doing so for the last 2-3 years. The turnover rate of medical directorship positions I’ve observed speaks for itself.

Also check out attached screenshots from FM forum. I already suspected/knew medical directorship positions are in the large majority of cases not worth it but asked in a very curious manner to not bias the MD/DO who has actually taken on a medical directorship position in the past.

In general, I feel most physicians will make more money just working more at their primary clinical job—and optimizing their workflow, getting very very efficient. Make a high income and sock it into index funds bogleheads style baby!!!!

 

[sloh]

Oh and I also have a personal friend who took on a medical directorship position for 1 year. He said it was absolutely not worth it and he will never do it again.

 

[sloh]

It sounds like other specialties can get training/experience in rehab medicine though based on the post below. If IM or Neuro can do inpatient rehab well, SNF work should be even more feasible due to the lower acuity. All one has to do is make clear terms with the facility that they are acting as rehab consultants and NOT primary, and they can achieve a similar workflow to you. Would you agree?

Why is PM&R becoming competitive?

I personally don’t mind giving the detailed explanation. Patients and other physicians tend to love it. Hospitals and policy makers could care less unless you show the data, value and money.

forums.studentdoctor.net

It’s a little more complicated in a SNF setting bc you’d then have 2 of the same/similar specialists (if its FM/IM) billing for the same patient. This likely isn’t going to fly with the primaries bc they will think you are stealing their business. I can’t imagine the type of person who goes into Neurology would want to do this type of work.

There’s also a lot more to this line of work than just managing pain/rehab/MSK. Otherwise, you will get replaced or get kicked out of the SNF’s. Lots of politics bc the money is so good. I’m a 1099 for Medrina and see how the courting with admins, DON, DOR, therapist happens. It takes a lot of finesse. I do a lot of relationship finessing with MDS and DOR, optimizing PDPM diagnoses, ensuring the rehab department can pass Medicare audits with flying colors based off my documentation. I can’t divulge further on a public forum like this but our company offers services that minimize hospital readmissions post-discharge and other perks to the SNF’s. This is all music to the admin’s ears. The higher ups in our company also have great relationships with those in regional leadership positions. Doing this type of work as an independent in any moderately desirable location without the backing of a company like Medrina is not for the faint of heart. You can’t possibly offer what Medrina does or have the relationship ties we have nationwide.

 

[PMR2008]

Agree with all the above.