Entrepreneurial Opportunities in Anesthesiology

[FlamingFahad]

As non patient “owning” specialists, what are some entrepreneurial opportunities specific for anesthesiologists?

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[sevo00]

Very few have ownership shares in ambulatory surgery centers

 

[Dr. Rude]

As non patient “owning” specialists, what are some entrepreneurial opportunities specific for anesthesiologists?

Exploitation of your fellow physicians.

 

[Zekchar]

You are likely to be greeted with radio silence. It's a zero-sum game and this kind of information isn't shared so casually. Those making bank doing entreprenurial things aren't too keen on sharing their activities and having others enter the space and competing with them.

 

[Guillemot]

Uber, Lyft, Instacart

 

[GravelRider]

OnlyFans

 

[ambiturner]

In my area, there’s been a huge proliferation of anesthesiologist-owned mobile dental sedation practices. The dentist pays you cash by the hour (from the massive pile of cash they collect from the patient) for generally safe procedures. If you scale up, this probably qualifies as exploitation of your fellow physicians.

 

[Planktonmd]

Open a pain management/growth hormone/Botox... "medical spa"

 

[coffeebythelake]

In my area, there’s been a huge proliferation of anesthesiologist-owned mobile dental sedation practices. The dentist pays you cash by the hour (from the massive pile of cash they collect from the patient) for generally safe procedures. If you scale up, this probably qualifies as exploitation of your fellow physicians.

interesting to know what kind of set up they have, monitoring, equipment, and depth of sedation.
reminded of that thread about all those dental sedation deaths.

 

[D P356]

I really like a thread like this.

Be a pain doc,
Obtain an anesthesia contract to a rural hospital for some variable X, come on SDN and and try to indirectly hire two docs for 1/3X taking Q weekly call with “26 weeks vacation”
Pocket 1/3x without lifting a finger.
When no one inquires about the job, act like you don’t understand how one FTE job is worth at least 1/2X.
Try pitching a low overnight volume and light OB.
Still no bite, now claim the pay is worth 2/5X.
Get called out again.

Complain to the SDN moderator about your job ad getting too much hate for such a low amount of work and have it removed.

 

[ambiturner]

interesting to know what kind of set up they have, monitoring, equipment, and depth of sedation.
reminded of that thread about all those dental sedation deaths.

The good ones bring a machine and will do full GETA if needed. A dentist friend who uses these companies actually loves GETA for big cases since he doesn’t have to deal with a moving, swallowing patient, but the anesthesiologists he works with prefer MAC (less work/BP/airway issues).

 

[IMGASMD]

The good ones bring a machine and will do full GETA if needed. A dentist friend who uses these companies actually loves GETA for big cases since he doesn’t have to deal with a moving, swallowing patient, but the anesthesiologists he works with prefer MAC (less work/BP/airway issues).

How much does it really pay, especially cash?

Exploitation of your fellow physicians.

Getting a contract for 1.5M, then employee two physicians for a total of 750K. Pocket the 750k comes to mind.
It’s easy call, and you’re getting 26 weeks of vacation. You can totally take home call, the call back rate is like only 5%.

 

[coffeebythelake]

The good ones bring a machine and will do full GETA if needed. A dentist friend who uses these companies actually loves GETA for big cases since he doesn’t have to deal with a moving, swallowing patient, but the anesthesiologists he works with prefer MAC (less work/BP/airway issues).

doing GA would necessitate appropriate recovery resources as well...

 

[Status Sciaticus]

Open a pain management/growth hormone/Botox... "medical spa"

This is the way. Pain seems to not have a ceiling if you scale with ancillary services in a multispecialty group. (Adjoined PT/OT, Imaging center, lab/drug screen/cash based regen medicine). Skip the inhouse pharmacy to avoid drug addicts breaking in.

I really like a thread like this.

Be a pain doc,
Obtain an anesthesia contract to a rural hospital for some variable X, come on SDN and and try to indirectly hire two docs for 1/3X taking Q weekly call with “26 weeks vacation”
Pocket 1/3x without lifting a finger.
When no one inquires about the job, act like you don’t understand how one FTE job is worth at least 1/2X.
Try pitching a low overnight volume and light OB.
Still no bite, now claim the pay is worth 2/5X.
Get called out again.

Complain to the SDN moderator about your job ad getting too much hate for such a low amount of work and have it removed.

That was a fun thread. Good times.
But yeah, exploitation of your fellow physicians seems to be the predominant way of making money if you can stomach it. I cant.

 

[coffeebythelake]

But yeah, exploitation of your fellow physicians seems to be the predominant way of making money if you can stomach it. I cant.

Agree. I can think of a lot of other ways to make money, without running the mental gymnastics of trying to justify screwing over colleagues.

 

[ToKingdomCome]

Open a pain management/growth hormone/Botox... "medical spa"

Instagram doc quit anesthesia and does injections in Miami after a year of practice. How much do you think he makes ?

 

[Status Sciaticus]

Instagram doc quit anesthesia and does injections in Miami after a year of practice. How much do you think he makes ?

You talkin about doc jarrett? idk if he truly quit entirely. But its not sustainable to only do botox in a city that is filled with some of the best plastic surgeons.

 

[IMGASMD]

Instagram doc quit anesthesia and does injections in Miami after a year of practice. How much do you think he makes ?

More than me.

 

[ToKingdomCome]

You talkin about doc jarrett? idk if he truly quit entirely. But its not sustainable to only do botox in a city that is filled with some of the best plastic surgeons.

I think he quit entirely…

 

[Status Sciaticus]

I think he quit entirely…

No one quits medicine entirely that quickly. Theres more to the story, methinks.
Similar to the other doc he hangs out with that got kicked out of residency for making distasteful posts, but still advertises himself as a physician conveniently leaving that tidbit out.

 

[ToKingdomCome]

No one quits medicine entirely that quickly. Theres more to the story, methinks.
Similar to the other doc he hangs out with that got kicked out of residency for making distasteful posts, but still advertises himself as a physician conveniently leaving that tidbit out.

Oh yes I know that story as well. Maybe there is who knows but he didn’t seem like the kinda guy who was super passionate about anesthesia to begin with

 

[OptionOffense]

Be a pain doc,

Is pain still lucrative ? Is chronic pain practice worth it?

 

[ambiturner]

How much does it really pay, especially cash?

Implants cost $1000-5000 per tooth, potentially over $50k for a full set - IN CASH! Granted there's a lot of overhead, including anesthesia. My guess is the sedation company gets whatever it can negotiate, in this market well over $300/hr with a minimum guarantee. But those secrets are proprietary.

 

[IMGASMD]

Implants cost $1000-5000 per tooth, potentially over $50k for a full set - IN CASH! Granted there's a lot of overhead, including anesthesia. My guess is the sedation company gets whatever it can negotiate, in this market well over $300/hr with a minimum guarantee. But those secrets are proprietary.

How many can you really put under general, wake up and recover safely per hour? If more than one, certainly a good deal for the dentist @ 300/hr.

 

[painballer27]

No one quits medicine entirely that quickly. Theres more to the story, methinks.
Similar to the other doc he hangs out with that got kicked out of residency for making distasteful posts, but still advertises himself as a physician conveniently leaving that tidbit out.

Who is the doc he hangs out with that got kicked out?

I think Dr. Jarrett said he does per diem anestheisa, prob not that often. I usually see him on insta either doing botox, sitting in a sauna, or running around Miami with his shirt off smiling

 

[jqueb29]

Is pain still lucrative ? Is chronic pain practice worth it?

Absolutely

 

[painballer27]

Absolutely

Care to elaborate?

 

[Status Sciaticus]

Absolutely

Yeah how much we talking?

 

[chocomorsel]

How much does it really pay, especially cash?



Getting a contract for 1.5M, then employee two physicians for a total of 750K. Pocket the 750k comes to mind.
It’s easy call, and you’re getting 26 weeks of vacation. You can totally take home call, the call back rate is like only 5%.

How do these solo physicians get these contracts? Y’all are making it sound like it’s quite a bit that this is happening.

 

[TeslaCoil]

Is pain still lucrative ? Is chronic pain practice worth it?

Most definitely still worth it.

 

[IMGASMD]

How do these solo physicians get these contracts? Y’all are making it sound like it’s quite a bit that this is happening.

Nah…. We’re just playing. There was someone who posted a job like that…. I’m just affirming that exploiting other physicians can be quite lucrative…

 

[TheLoneWolf]

Most definitely still worth it.

As a doc who practes both pain and anesthesia, I would disagree. Falling reimbursement, lots of paperwork, procedure denials, difficult patients and a lot of literature showing small or marginal benefits of most procedures.

Cms is proposing over a 10% cut on reimbursement for 2023 across the board in pain management.

 

[TeslaCoil]

As a doc who practes both pain and anesthesia, I would disagree. Falling reimbursement, lots of paperwork, procedure denials, difficult patients and a lot of literature showing small or marginal benefits of most procedures.

Cms is proposing over a 10% cut on reimbursement for 2023 across the board in pain management.

Are you performing si fusions? MILD? Permanent implants? Minuteman? Vertiflex? If not that may be your problem. Otherwise its definitely profitable.

 

[nimbus]

Are you performing si fusions? MILD? Permanent implants? Minuteman? Vertiflex? If not that may be your problem. Otherwise its definitely profitable.

Do you get good results? I’m not pain so just asking out of curiosity.

 

[TeslaCoil]

Absolutely. MILD pts come back clickin their heels. RFA’s can achieve excellent results. I dont understand why anesthesiologists think pain doctors are all crackpots.

 

[nimbus]

Absolutely. MILD pts come back clickin their heels. RFA’s can achieve excellent results. I dont understand why anesthesiologists think pain doctors are all crackpots.

Admittedly my experience in pain clinic was a long time ago, but it was not that great. Difficult patients with difficult problems. Our pain attendings were very devoted and not crackpots at all. But they could help only a small proportion of the patients. I’m glad the new procedures are more effective.

 

[Guillemot]

My guess would be that the big money in pain is a result of being part of a group that owns the facility.

 

[TheLoneWolf]

Are you performing si fusions? MILD? Permanent implants? Minuteman? Vertiflex? If not that may be your problem. Otherwise its definitely profitable.

Late to reply:

money wise, here you go, from the pain forum :

What's Your Plan for After the Medicare Cuts?

Does anyone think that the D's will come to the rescue?

forums.studentdoctor.net

Next addressing the scope of pain management, the American Association of Neurological Surgeons came out with a position statement regarding spine instrumentation by non-neurosurgeons and non-orthopedic surgeons in response to pain docs doing increasingly more invasive spine procedures.

The AANS, the CNS and AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves recently adopted a new position statement titled “Arthrodesis of the Spine by the Non-Spine Surgeon.” Increasingly, non-surgeon spine practitioners are performing interventional services, such as percutaneous instrumentation, without the requisite training or ability to handle complications. The neurosurgical groups believe optimal and safe patient care occurs when neurosurgeons and orthopaedic surgeons — trained in the full spectrum of spinal biomechanics, including instrumentation and fusion techniques — manage surgical diseases affecting the spine."

I did a pain fellowship at a heavily interventional program, arguably the top-tier program in that state. Regarding SI fusions and MILD, I don't believe we have any business doing fusions or shaving down the ligamentum flavum after a year of fellowship training. I concede that this is a controversial point in the pain world but the other side has a vested financial interest in pushing the scope of what a pain physician can do. Likely ups the medicolegal stakes if the above position statements are presented in a court post complication and no shortage of NS and ortho guys happy to testify that they view this as inappropriate. One shouldn't perform a procedure in which you cannot deal with a foreseeable complication.

my 2 cents

 

[GassYous]

Late to reply:

money wise, here you go, from the pain forum :

What's Your Plan for After the Medicare Cuts?

Does anyone think that the D's will come to the rescue?

forums.studentdoctor.net

Next addressing the scope of pain management, the American Association of Neurological Surgeons came out with a position statement regarding spine instrumentation by non-neurosurgeons and non-orthopedic surgeons in response to pain docs doing increasingly more invasive spine procedures.

The AANS, the CNS and AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves recently adopted a new position statement titled “Arthrodesis of the Spine by the Non-Spine Surgeon.” Increasingly, non-surgeon spine practitioners are performing interventional services, such as percutaneous instrumentation, without the requisite training or ability to handle complications. The neurosurgical groups believe optimal and safe patient care occurs when neurosurgeons and orthopaedic surgeons — trained in the full spectrum of spinal biomechanics, including instrumentation and fusion techniques — manage surgical diseases affecting the spine."

I did a pain fellowship at a heavily interventional program, arguably the top-tier program in that state. Regarding SI fusions and MILD, I don't believe we have any business doing fusions or shaving down the ligamentum flavum after a year of fellowship training. I concede that this is a controversial point in the pain world but the other side has a vested financial interest in pushing the scope of what a pain physician can do. Likely ups the medicolegal stakes if the above position statements are presented in a court post complication and no shortage of NS and ortho guys happy to testify that they view this as inappropriate. One shouldn't perform a procedure in which you cannot deal with a foreseeable complication.

my 2 cents

That's why I don't do any central lines or blocks. Because I can't do a cutdown or place a chest tube to deal with my foreseeable complications.

 

[Dr. Rude]

Late to reply:

money wise, here you go, from the pain forum :



Next addressing the scope of pain management, the American Association of Neurological Surgeons came out with a position statement regarding spine instrumentation by non-neurosurgeons and non-orthopedic surgeons in response to pain docs doing increasingly more invasive spine procedures.

The AANS, the CNS and AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves recently adopted a new position statement titled “Arthrodesis of the Spine by the Non-Spine Surgeon.” Increasingly, non-surgeon spine practitioners are performing interventional services, such as percutaneous instrumentation, without the requisite training or ability to handle complications. The neurosurgical groups believe optimal and safe patient care occurs when neurosurgeons and orthopaedic surgeons — trained in the full spectrum of spinal biomechanics, including instrumentation and fusion techniques — manage surgical diseases affecting the spine."

 

[TheLoneWolf]

That's why I don't do any central lines or blocks. Because I can't do a cutdown or place a chest tube to deal with my foreseeable complications.

The procedures you mention does not irrevocably alter the anatomy to a significant degree nor would anyone raise an eyebrow to an anesthesiologist placing invasive lines or blocks. No one could reasonably allege that such activities falls outside the established scope of practice. Also, you probably can name reasonable indications to supports why you specifically placed such lines or nerve blocks.

If you placing screws through a joint or shaving paraneural structures, you are facing multiple surgical society's position statements stating that you shouldn't. A smart lawyer could argue the indication may be sound but did the patient really exhaust all other nonsurgical options, and then a spine surgeon decided they are not a surgical candidate? Rock and a hard place.

Apples to oranges

 

[kidthor]

One shouldn't perform a procedure in which you cannot deal with a foreseeable complication.

Yeah except a bunch of interventionalists (IR, cardiology, pulm, etc) do all sorts of things that require surgeon backup.

 

[kidthor]

The procedures you mention does not irrevocably alter the anatomy to a significant degree nor would anyone raise an eyebrow to an anesthesiologist placing invasive lines or blocks. No one could reasonably allege that such activities falls outside the established scope of practice. Also, you probably can name reasonable indications to supports why you specifically placed such lines or nerve blocks.

If you placing screws through a joint or shaving paraneural structures, you are facing multiple surgical society's position statements stating that you shouldn't. A smart lawyer could argue the indication may be sound but did the patient really exhaust all other nonsurgical options, and then a spine surgeon decided they are not a surgical candidate? Rock and a hard place.

Apples to oranges

What about kyphoplasties?

 

[patriot6]

it's raising eyebrows because it's new. in a few years, it'll be fine.

 

[IMGASMD]

it's raising eyebrows because it's new. in a few years, it'll be fine.

We have a pm&r guys who would do them…. Still don’t “feel” right. One year of fellowship and “operating” on my spine……. No thank you.

 

[D P356]

We have a pm&r guys who would do them…. Still don’t “feel” right. One year of fellowship and “operating” on my spine……. No thank you.

It can be done as long as you don’t cancel the case for a K+ of 5.7.

 

[mdo1738]

The procedures you mention does not irrevocably alter the anatomy to a significant degree nor would anyone raise an eyebrow to an anesthesiologist placing invasive lines or blocks. No one could reasonably allege that such activities falls outside the established scope of practice. Also, you probably can name reasonable indications to supports why you specifically placed such lines or nerve blocks.

If you placing screws through a joint or shaving paraneural structures, you are facing multiple surgical society's position statements stating that you shouldn't. A smart lawyer could argue the indication may be sound but did the patient really exhaust all other nonsurgical options, and then a spine surgeon decided they are not a surgical candidate? Rock and a hard place.

Apples to oranges

"Multiple surgical society's position statements stating that you shouldn't". And the CRNA societies say they should have independent practice. It's almost like societies are full of **** and make statements saying things that benefit them are good things.

 

[IMGASMD]

"Multiple surgical society's position statements stating that you shouldn't". And the CRNA societies say they should have independent practice. It's almost like societies are full of **** and make statements saying things that benefit them are good things.

Except asa and ama.

Part of the arguments is the lack of knowledge and/or experience with CRNAs. I would hope most physicians have a little more self-awareness.

 

[secretasianman]

Our society is so stupid, they coined the term physician anesthesiologist.

Except asa and ama.

Part of the arguments is the lack of knowledge and/or experience with CRNAs. I would hope most physicians have a little more self-awareness.

 

[Gilakend]

Would it be more likely to be owner in a surg center as pain than as a PP anesthesia group?