Graduating fellows....any advantage of going into PP instead of hospital employee?

[drusso]

Perhaps this ridiculous over abundance of pain, sports and spine, whatever the eff you call yourself will spark a decrease in applicants to programs similar to what we saw in anesthesiology in the mid 90s. The number of fellows trained yearly is outrageous. Now will begin a period where either you can’t find a job or you will get paid some ridiculous salary. Same thing in anesthesiology in the 90s. Either no job or $75k starting salary. Then we had to troll Europe and Asia for residents for a few years. No American wanted to go into anesthesiology. This is what happens when you open the process to every specialty and develop alternate routes to certification. “Fellowship” programs want bodies and specialty boards want $$$. Why don’t I hear this happening in other fields??? Something is seriously wrong with us that we have let this become a free for all.

Nothing is more valuable than scarcity.

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Members don't see this ad.

 

[Sooshi]

I don’t know what graduating fellows are finding. It seems to me that the field is so flooded (perhaps by non-ACGME interventional spine”fellowship” trained docs) that the only jobs available in half way desirable locations are medical Mgmt jobs. I’ve inquired about two jobs in the last week, one in WA and the other in CA. Both responded leading with- “ in the interest of not wasting your time.... this is a medical management job with minimal in office simple procedures (TPI, GON)”. On further investigation each facility has both anesthesiologists and PM&R doing interventions and looking for a sucker to deal with the meds and take a bullet for the team.

Almost nobody I know has signed yet. Overwhelmingly, the jobs I've come across have been:

1) Brand new(ish) offices in the middle of nowhere, where practices from more saturated areas are looking to capture a new piece of the market. The group will wine and dine you at the central location in a nice area, then tell you that you'll be commuting between three remote villages and working Saturdays.
2) Groups looking for a sucker to deal with meds/take the fall for the shady **** they're doing, with minimal to no procedures. Googling the practice owners returns "Felony" with surprising regularity (I wish I was joking).
3) PM&R based jobs looking for PM&R grads to do all the things PM&R grads went into pain to get away from in the first place.

 

[drusso]

Almost nobody I know has signed yet. Overwhelmingly, the jobs I've come across have been:

1) Brand new(ish) offices in the middle of nowhere, where practices from more saturated areas are looking to capture a new piece of the market. The group will wine and dine you at the central location in a nice area, then tell you that you'll be commuting between three remote villages and working Saturdays.
2) Groups looking for a sucker to deal with meds/take the fall for the shady **** they're doing, with minimal to no procedures. Googling the practice owners returns "Felony" with surprising regularity (I wish I was joking).
3) PM&R based jobs looking for PM&R grads to do all the things PM&R grads went into pain to get away from in the first place.

How's the sense of collegiality?

 

[lobelsteve]

How's the sense of collegiality?

Not too bad on the forums. Even I can make a friend.

 

[NJPAIN]

Almost nobody I know has signed yet. Overwhelmingly, the jobs I've come across have been:

1) Brand new(ish) offices in the middle of nowhere, where practices from more saturated areas are looking to capture a new piece of the market. The group will wine and dine you at the central location in a nice area, then tell you that you'll be commuting between three remote villages and working Saturdays.
2) Groups looking for a sucker to deal with meds/take the fall for the shady **** they're doing, with minimal to no procedures. Googling the practice owners returns "Felony" with surprising regularity (I wish I was joking).
3) PM&R based jobs looking for PM&R grads to do all the things PM&R grads went into pain to get away from in the first place.

Meanwhile, you are probably coming out of a program with 12-15 attendings training 8-10 fellows a year. Multiply that by the total # of “fellowship” programs and you will see why jobs are scarce. It’s just plain irresponsible to train that number of people. I saw it first hand as a facility member. Chairman just wanted bigger residency, more fellowships and more fellows. I kept thinking, if I ever leave this place (which I did) this is going to flood the pool I’m jumping into.

 

[nvrsumr]

The numbers are only going to expand with the new NASS PMR spine fellowships. A whole new group of "PDs" that will never give up their fellows.

Its kinda scary for new grads to read some of the EM and Radonc forum posts on oversaturation. Supply and demand is a thing.

These things happen -gradually then suddenly-

 

[drusso]

The numbers are only going to expand with the new NASS PMR spine fellowships. A whole new group of "PDs" that will never give up their fellows.

Its kinda scary for new grads to read some of the EM and Radonc forum posts on oversaturation. Supply and demand is a thing.

These things happen -gradually then suddenly-

Why doesn’t organized pain oppose NASS fellowships and emphasize the more comprehensive ACGME path as preferred? NASS fellowships are a reincarnation of the PASSOR fellowships of ye’ olden times...

 

[Sooshi]

Meanwhile, you are probably coming out of a program with 12-15 attendings training 8-10 fellows a year. Multiply that by the total # of “fellowship” programs and you will see why jobs are scarce. It’s just plain irresponsible to train that number of people. I saw it first hand as a facility member. Chairman just wanted bigger residency, more fellowships and more fellows. I kept thinking, if I ever leave this place (which I did) this is going to flood the pool I’m jumping into.

Actually, quite the opposite, which is what absolutely broke my heart. I'm training at a small program at a storied institution, with complex cases and a generous amount of time devoted to comprehensive care and interventional management... which is the exact opposite of what real-world pain management is all about. Guess I had to wake up and face reality at some point.

 

[nvrsumr]

PMR needs to lead on NASS fellowships and halt them as they will likely contribute to this oversaturation but like mentioned in the EM and Radonc forums all the incentives for the academic depts favor expansion. To be honest it is much easier for PMR docs to get into pain fellowships these days due to already declining reimbursement causing decreased interest from anesthesia residents. The NASS fellowships are unnecessary and only for the turf and prestige of the programs not to fill a training need unmet by current acgme pain and sports fellowships, the PP and regen fellowships and the many PMR programs have adequate spine procedure numbers for graduating residents to safely perform B&B interventions.

 

[Frazier]

Talking with my colleagues in EM, you can expect increasing volume of ED doc applicants in the future. This is also reflected on the EM forum here.

 

[DrSpine]

Almost nobody I know has signed yet. Overwhelmingly, the jobs I've come across have been:

1) Brand new(ish) offices in the middle of nowhere, where practices from more saturated areas are looking to capture a new piece of the market. The group will wine and dine you at the central location in a nice area, then tell you that you'll be commuting between three remote villages and working Saturdays.
2) Groups looking for a sucker to deal with meds/take the fall for the shady **** they're doing, with minimal to no procedures. Googling the practice owners returns "Felony" with surprising regularity (I wish I was joking).
3) PM&R based jobs looking for PM&R grads to do all the things PM&R grads went into pain to get away from in the first place.

This is legit 100% accurate. Describes my entire process looking for jobs during fellowship. I finally started my hospital based gig a few months after graduation. #1 was the best. I talked with a group in SF, they immediately asked me if I was an "outdoorsy" person. Then sure enough, yeah, remote location 3.5 hours North. Gee, thanks.

#2 was also another classic. Talked to a group in another state, they had a few Pain guys. Basically, I would be doing "spine" but they wanted to hire a guy to dump all the opioid patients on and weaning protocols. Yeah, I'll pass.

 

[Peterluger]

Perhaps this ridiculous over abundance of pain, sports and spine, whatever the eff you call yourself will spark a decrease in applicants to programs similar to what we saw in anesthesiology in the mid 90s. The number of fellows trained yearly is outrageous. Now will begin a period where either you can’t find a job or you will get paid some ridiculous salary. Same thing in anesthesiology in the 90s. Either no job or $75k starting salary. Then we had to troll Europe and Asia for residents for a few years. No American wanted to go into anesthesiology. This is what happens when you open the process to every specialty and develop alternate routes to certification. “Fellowship” programs want bodies and specialty boards want $$$. Why don’t I hear this happening in other fields??? Something is seriously wrong with us that we have let this become a free for all.

It’s because anesthesiology is full of weak people. That’s why Pain, which is a subspecialty of Anesthesiology, opened up to applicants from other specialties.

 

[NJPAIN]

Actually, quite the opposite, which is what absolutely broke my heart. I'm training at a small program at a storied institution, with complex cases and a generous amount of time devoted to comprehensive care and interventional management... which is the exact opposite of what real-world pain management is all about. Guess I had to wake up and face reality at some point.

Take comfort in the fact that good training under the supervision of good mentors will be with you forever. Don’t ever regret choosing that route. Perhaps it is the exact opposite of what real world pain medicine HAS BECOME. The focus now is on doing as many blocks as possible as quickly as possible and without regard for their necessity. The focus is no longer on the correct diagnosis and the correct treatment.
However, you are at the beginning of a long career. I strongly suspect that the cycle of job scarcity followed by decreased salaries followed by decreased interest in pain medicine has begun. It may take the better part of a decade but then perhaps some dignity will be restored to this field. This will happen during your career but not mine. I’ll be hanging it up in 10 years just as things turn around, hopefully.

 

[buddababa]

It’s because anesthesiology is full of weak people. That’s why Pain, which is a subspecialty of Anesthesiology, opened up to applicants from other specialties.

Huh?!?!?

 

[drusso]

This is legit 100% accurate. Describes my entire process looking for jobs during fellowship. I finally started my hospital based gig a few months after graduation. #1 was the best. I talked with a group in SF, they immediately asked me if I was an "outdoorsy" person. Then sure enough, yeah, remote location 3.5 hours North. Gee, thanks.

#2 was also another classic. Talked to a group in another state, they had a few Pain guys. Basically, I would be doing "spine" but they wanted to hire a guy to dump all the opioid patients on and weaning protocols. Yeah, I'll pass.

How transparent were the hospitals?

 

[NJPAIN]

It’s because anesthesiology is full of weak people. That’s why Pain, which is a subspecialty of Anesthesiology, opened up to applicants from other specialties.

I don’t know that it’s weakness. It’s an every man for himself attitude and lack of concern for the “health” of the specialty going forward. The entire CRNA concept, motivated by laziness and greed, tells it all. I also suspect that the ABA is making a boatload of money by opening the exam up to other specialties. They are clearly motivated by $$$.

 

[Ducttape]

Not too bad on the forums. Even I can make a friend.

wow.

im still trying.

 

[Agast]

Talking with my colleagues in EM, you can expect increasing volume of ED doc applicants in the future. This is also reflected on the EM forum here.

They’re going into aesthetics and hormone wellness/regenerative medicine like everyone else.

If you’re thinking of opening a medispa, now is the time to do it - before you see one on every corner run by an NP, burned out pain doc/IM/EM/FM. If you’re super enterprising learn how to shove a couple of breast implants in*. Unregulated medicine baby!

*It’s just like putting in two IPGs!

 

[NJPAIN]

They’re going into aesthetics and hormone wellness/regenerative medicine like everyone else.

If you’re thinking of opening a medispa, now is the time to do it - before you see one on every corner run by an NP, burned out pain doc/IM/EM/FM. If you’re super enterprising learn how to shove a couple of breast implants in*. Unregulated medicine baby!

*It’s just like putting in two IPGs!

Don’t say it too loud. Someone will shove in an DCS and a DRG IPG and charge cash for cosmetic surgery. Nothing surprises me.

 

[Laryngospasm]

It’s funny that people pick on Anesthesiologists, mid levels are coming for everyone.. the drive for cheaper healthcare and less education will only continue. Anesthesiologist are some of the toughest folks in medicine and have dealt with more stress than most can imagine.
If you think your specialty will be spared good luck. I feel like a lot of folks are just trying to make a buck while they can because if you listen you can almost hear the walls closing in.
Careful when you ask for whom the bell tolls..

 

[DrSpine]

How transparent were the hospitals?

Great question. So, hospitals I felt were a little different. Hospitals are more transparent up front about what they want, and generally, the experience is far better initially. In my case, non-opioids, purely interventional, tail covered, more vacation time, etc. Personally, I feel that hospital employment is at its best when you are being wined and dined, and sign on. Also, the first year was the "golden year." After that golden year, as you get closer off your base and enter wRVU, I noticed the situation wasn't as pretty. Goals aren't met of what they want, meetings begin, they have certain visions that you may not like, administrative turnover, etc. Just because you had a great relationship with one Admin, doesn't necessarily mean it stays forever. Administrative turnover was high, suddenly the new person comes and you may not get along with that person, and in my case, the relationship wasn't the same. Even if you produce well, they will want more, and as a new grad, you're pretty ignorant when it comes to appropriate compensation, $O$/facility fees. You realize that's all you were hired for, to be a Facility Fee producing hamster. I akin the experience to "blind comfort." Sure, initially you may be comfortable, but you have zero control over outside variables. One year your contract and experience might be great, in a few years, they may suddenly change their mind with compensation. It has happened to several people I know (especially in other fields), where suddenly they were blindsided by large pay cuts and a change in terms of their contracts. You don't want to be 5-10 years deep into something, and find out the hard way that the party is over, and now you're scrambling with kids in school on what to do. Ultimately, I decided owning my own practice on my own terms would be the best move for me in the long run; I control all variables, I control what I want to do, what I don't want to do, etc.

Again, I cannot speak of everyone's experience, but this was mine or several others I know about. Everything in life has its pros and cons. Just have to decide what is best for you.

 

[DrSpine]

Also: In an ideal world, if our debt wasn't so high coming out of fellowship and private practices didn't have a reputation of cutting young grads dry before "partnership" date, new grads could find great practices that they can help adequately contribute to, build, and eventually become a partner. But prior experiences of other doctors with failed partnership opportunities, and being straddled with so much debt all we think about is high income immediately to start with - contributes a bad recipe whereby many are choosing jobs that aren't the right fit and ultimately isn't mutually beneficial for both parties. From the employer perspective in private practice, I understand their hesitation as well with young grads. You don't want to build something and have some kid come and screw the whole thing up or after building something for 15 years some kid comes and expects to be a partner in 3 years.

 

[drusso]

Great question. So, hospitals I felt were a little different. Hospitals are more transparent up front about what they want, and generally, the experience is far better initially. In my case, non-opioids, purely interventional, tail covered, more vacation time, etc. Personally, I feel that hospital employment is at its best when you are being wined and dined, and sign on. Also, the first year was the "golden year." After that golden year, as you get closer off your base and enter wRVU, I noticed the situation wasn't as pretty. Goals aren't met of what they want, meetings begin, they have certain visions that you may not like, administrative turnover, etc. Just because you had a great relationship with one Admin, doesn't necessarily mean it stays forever. Administrative turnover was high, suddenly the new person comes and you may not get along with that person, and in my case, the relationship wasn't the same. Even if you produce well, they will want more, and as a new grad, you're pretty ignorant when it comes to appropriate compensation, $O$/facility fees. You realize that's all you were hired for, to be a Facility Fee producing hamster. I akin the experience to "blind comfort." Sure, initially you may be comfortable, but you have zero control over outside variables. One year your contract and experience might be great, in a few years, they may suddenly change their mind with compensation. It has happened to several people I know (especially in other fields), where suddenly they were blindsided by large pay cuts and a change in terms of their contracts. You don't want to be 5-10 years deep into something, and find out the hard way that the party is over, and now you're scrambling with kids in school on what to do. Ultimately, I decided owning my own practice on my own terms would be the best move for me in the long run; I control all variables, I control what I want to do, what I don't want to do, etc.

Again, I cannot speak of everyone's experience, but this was mine or several others I know about. Everything in life has its pros and cons. Just have to decide what is best for you.

Every Fellow should read this.

 

[Status Sciaticus]

Huh?!?!?

Hes "special". Pay him no mind.

Also: In an ideal world, if our debt wasn't so high coming out of fellowship and private practices didn't have a reputation of cutting young grads dry before "partnership" date, new grads could find great practices that they can help adequately contribute to, build, and eventually become a partner. But prior experiences of other doctors with failed partnership opportunities, and being straddled with so much debt all we think about is high income immediately to start with - contributes a bad recipe whereby many are choosing jobs that aren't the right fit and ultimately isn't mutually beneficial for both parties. From the employer perspective in private practice, I understand their hesitation as well with young grads. You don't want to build something and have some kid come and screw the whole thing up or after building something for 15 years some kid comes and expects to be a partner in 3 years.

So theres a catch 22 that I cant resolve. You say that young grads shouldnt expect a partnership after 3 years into a business that you spend 15 years building. But then you also mention that PP also screw over young grads before they can be made partner. So how do we reconcile these two contradictory issues?

 

[Ferrismonk]

Hes "special". Pay him no mind.



So theres a catch 22 that I cant resolve. You say that young grads shouldnt expect a partnership after 3 years into a business that you spend 15 years building. But then you also mention that PP also screw over young grads before they can be made partner. So how do we reconcile these two contradictory issues?

Here's the answer. Partnership does not equal more money. EVERYONE gets paid for what they do. Be transparent. Be fair with spreading out the good and poor payors.

Pay a reasonable starting salary. Practice will likely take a loss on the new employee years 1 and 2 unless your system is overflowing with procedures. Monitor collections minus overhead those two years and have the new employee pay back any of those losses with his/her growth in years 3 and 4 but always guaranteeing the starting salary. Anything they make above their salary is theirs to keep. Company investments (ASC, UDS, etc) are company investments, not part of the partner or employee reimbursement package.

Keep partnership for controlling the company. If you want to bring in a new person into a co-ownership situation, there is a cost to that which is easily figured out by a 3rd party evaluator. They can pay for it upfront or take the buy-in out of their paycheck.

This way you won't be screwed with a random new partner sinking your business, bur the new employee does not get screwed.

 

[Laryngospasm]

Here's the answer. Partnership does not equal more money. EVERYONE gets paid for what they do. Be transparent. Be fair with spreading out the good and poor payors.

Pay a reasonable starting salary. Practice will likely take a loss on the new employee years 1 and 2 unless your system is overflowing with procedures. Monitor collections minus overhead those two years and have the new employee pay back any of those losses with his/her growth in years 3 and 4 but always guaranteeing the starting salary. Anything they make above their salary is theirs to keep. Company investments (ASC, UDS, etc) are company investments, not part of the partner or employee reimbursement package.

Keep partnership for controlling the company. If you want to bring in a new person into a co-ownership situation, there is a cost to that which is easily figured out by a 3rd party evaluator. They can pay for it upfront or take the buy-in out of their paycheck.

This way you won't be screwed with a random new partner sinking your business, bur the new employee does not get screwed.

Well said.. it doesn’t have to be all or none.. just some transparency and well laid out expectations.

 

[DrSpine]

Here's the answer. Partnership does not equal more money. EVERYONE gets paid for what they do. Be transparent. Be fair with spreading out the good and poor payors.

Pay a reasonable starting salary. Practice will likely take a loss on the new employee years 1 and 2 unless your system is overflowing with procedures. Monitor collections minus overhead those two years and have the new employee pay back any of those losses with his/her growth in years 3 and 4 but always guaranteeing the starting salary. Anything they make above their salary is theirs to keep. Company investments (ASC, UDS, etc) are company investments, not part of the partner or employee reimbursement package.

Keep partnership for controlling the company. If you want to bring in a new person into a co-ownership situation, there is a cost to that which is easily figured out by a 3rd party evaluator. They can pay for it upfront or take the buy-in out of their paycheck.

This way you won't be screwed with a random new partner sinking your business, bur the new employee does not get screwed.

Well said. We have to think reasonable. The issue is what I stated, too many young doctors are coming out woefully ignorant with basic concepts of business, investments, etc. The other issue is they're saddled with debt. This is a bad recipe. It creates people who have no understanding of how the business of medicine works, yet demand a high salary (because they largely have no choice being put in a corner to pay this off). Private practices have to approach these people from a more fair standpoint as well, and not take advantage of their ignorance. Requires effort from multiple fronts.

 

[Ducttape]

Also: In an ideal world, if our debt wasn't so high coming out of fellowship and private practices didn't have a reputation of cutting young grads dry before "partnership" date, new grads could find great practices that they can help adequately contribute to, build, and eventually become a partner. But prior experiences of other doctors with failed partnership opportunities, and being straddled with so much debt all we think about is high income immediately to start with - contributes a bad recipe whereby many are choosing jobs that aren't the right fit and ultimately isn't mutually beneficial for both parties. From the employer perspective in private practice, I understand their hesitation as well with young grads. You don't want to build something and have some kid come and screw the whole thing up or after building something for 15 years some kid comes and expects to be a partner in 3 years.

and every fellow should read this.

its all "fine and dandy" to encourage private practice. but PP as an employee has challenges equally as problematic as an hospital employee.

the other alternatives are academic and private practice. seems unlikely that most new grads would have the business knowledge and the financial capital to start their own independent practice.

 

[paindoc007]

Hospital gigs in more rural settings often have loan repayment deals too. So I’ve been given 100K over my first 5 years to pay down loans. A nice little perk you’d never get in a pp

 

[avalon10]

I believe that this problem is worse in our field than most. There is an epidemic of greed amongst us.

What industry isn't like that?!? Show me one. That's human nature in general- why would doctors be any different??

 

[drusso]

What industry isn't like that?!? Show me one. That's human nature in general- why would doctors be any different??

"The needs of the patient come first."

Unfortunately, hospitals have turned their doctors into RVU mills.

 

[DOctorJay]

"The needs of the patient come first."

Unfortunately, hospitals have turned their doctors into RVU mills.

are you in favor of salaried models?

 

[lobelsteve]

"The needs of the patient come first."

Unfortunately, hospitals have turned their doctors into RVU mills.

both.

 

[afob100]

Personally I'm a fan of the wrvu model. Regardless of a patient's insurance, I know exactly what I'm getting paid for every clinic visit and injection as soon as I sign the chart. Very transparent, open and fair system. My group does a strictly wrvu system (no base salary)..multiple wrvu x conversion factor - set your own yearly salary and true up every quarter based on actual wrvus.

I feel like I have complete control of my schedule and production/$$$.

 

[drusso]

Personally I'm a fan of the wrvu model. Regardless of a patient's insurance, I know exactly what I'm getting paid for every clinic visit and injection as soon as I sign the chart. Very transparent, open and fair system. My group does a strictly wrvu system (no base salary)..multiple wrvu x conversion factor - set your own yearly salary and true up every quarter based on actual wrvus.

I feel like I have complete control of my schedule and production/$$$.

The RVU system was designed to divorce physicians from the real economics of providing a professional service. It's bunk. Do you ever ask why lawyers don't work on RVU's?

 

[TIVAndy]

Personally I'm a fan of the wrvu model. Regardless of a patient's insurance, I know exactly what I'm getting paid for every clinic visit and injection as soon as I sign the chart. Very transparent, open and fair system. My group does a strictly wrvu system (no base salary)..multiple wrvu x conversion factor - set your own yearly salary and true up every quarter based on actual wrvus.

I feel like I have complete control of my schedule and production/$$$.

this would be a decent system if your payor mix is bad. if you have good payor mix then you are losing a lot of money (depending on your wrvu contract)

 

[Ducttape]

The RVU system was designed to divorce physicians from the real economics of providing a professional service. It's bunk. Do you ever ask why lawyers don't work on RVU's?

I'm sure you absolutely despise salaried positions...

 

[afob100]

The RVU system was designed to divorce physicians from the real economics of providing a professional service. It's bunk. Do you ever ask why lawyers don't work on RVU's?

We get a quarterly statement with our actual billing and collections in addition to wrvu. However our pay is based on wrvu x conversion only

 

[Status Sciaticus]

The RVU system was designed to divorce physicians from the real economics of providing a professional service. It's bunk. Do you ever ask why lawyers don't work on RVU's?

They kind of do.... they bill you per hour... which is a certain amount of dollars per unit time. WRVU is simply your fee for a visit which should typically take a certain unit of time.

 

[DrSpine]

They kind of do.... they bill you per hour... which is a certain amount of dollars per unit time. WRVU is simply your fee for a visit which should typically take a certain unit of time.

Except lawyers all set their personal rate; its not a national value unit nor do lawyers get a professional modest fee while some overlord gets 10x the amount in a facility fee telling the lawyer they need to work and produce X amount every year. WRVU is a flawed model inspired by the automotive assembly factory line industry and imposed on physicians to turn them from skilled leaders to menial labor workers.

 

[drusso]

Except lawyers all set their personal rate; its not a national value unit nor do lawyers get a professional modest fee while some overlord gets 10x the amount in a facility fee telling the lawyer they need to work and produce X amount every year. WRVU is a flawed model inspired by the automotive assembly factory line industry and imposed on physicians to turn them from skilled leaders to menial labor workers.

I love this.

 

[Status Sciaticus]

Except lawyers all set their personal rate; its not a national value unit nor do lawyers get a professional modest fee while some overlord gets 10x the amount in a facility fee telling the lawyer they need to work and produce X amount every year. WRVU is a flawed model inspired by the automotive assembly factory line industry and imposed on physicians to turn them from skilled leaders to menial labor workers.

True, but in a PP model, you can charge patients what you want as well for your visits. 100 for a visit or 400 for a visit. Similar to lawyers.

Nonpartner lawyers are often salaried while the partners (overlords) collect their billings, similar to your analogy above.

 

[au bon pain]

True, but in a PP model, you can charge patients what you want as well for your visits. 100 for a visit or 400 for a visit. Similar to lawyers.

Nonpartner lawyers are often salaried while the partners (overlords) collect their billings, similar to your analogy above.

Agreed.

And even in pp, unless you're a rare cash-only bird, you are beholden to whatever the insurer decides they will pay you. Lawyers don't have to deal with the rigged system of trying to justify to Aetna that a visit is a level 4 vs 3.

 

[TeslaCoil]

Hospital employee jobs seem to trump PP jobs in every facet of the game. Higher starting pay, check. Less risk for the new physician, check. Strong in network referral system, check. Better retirement vehicles, check. I don't see how pp groups are able to recruit any fellows. Hospitals are reimbursed more for procedures too; I don't understand how pp pain groups can survive in this environment.

This is sooo far from the truth. Private pain clinics are some of the only remaining survivable practices out there. Hanging your own shingle takes time and a lot of effort but is WAY worth it in the long run. If doing injections, stim and mild only one can easily clear a million after overhead within 3ish years. Its easy to calculate how much you bring in for your practice. In my opinion every private practice pain doc should be asking for their accounts receivable reports regularly. You cant really do this with a hospital as you are a peon with no leverage. There are some non-profit hospitals in rural setting which will get you pretty close to what PP docs make though. I for one joined an established private pain practice, and my setup is very good. More money than I ever saw being offered at hospitals. Be careful out there. There are lots of sharks wanting to just exploit you and reap your rewards. 350-400k for incoming pain docs seems to be the going rate at hospitals. This is too low in my opinion. When you sign, you should establish a structure for salary growth within the first few years, whether its RVU based or simply graduated yearly. Those jobs are out there. I interviewed with ~12 practices before landing on the one.

 

[Status Sciaticus]

This is sooo far from the truth. Private pain clinics are some of the only remaining survivable practices out there. Hanging your own shingle takes time and a lot of effort but is WAY worth it in the long run. If doing injections, stim and mild only one can easily clear a million after overhead within 3ish years. Its easy to calculate how much you bring in for your practice. In my opinion every private practice pain doc should be asking for their accounts receivable reports regularly. You cant really do this with a hospital as you are a peon with no leverage. There are some non-profit hospitals in rural setting which will get you pretty close to what PP docs make though. I for one joined an established private pain practice, and my setup is very good. More money than I ever saw being offered at hospitals. Be careful out there. There are lots of sharks wanting to just exploit you and reap your rewards. 350-400k for incoming pain docs seems to be the going rate at hospitals. This is too low in my opinion. When you sign, you should establish a structure for salary growth within the first few years, whether its RVU based or simply graduated yearly. Those jobs are out there. I interviewed with ~12 practices before landing on the one.

How did you get interviews? Cold calling? fellowshi

 

[TeslaCoil]

How did you get interviews? Cold calling? fellowshi

Device reps were the best resources.

 

[gdub25]

My experience is the same as TeslaCoil’s. Interviewed at 11, found the perfect one for me. Device reps were the best source of leads.

 

[Status Sciaticus]

Device reps were the best resources.

My experience is the same as TeslaCoil’s. Interviewed at 11, found the perfect one for me. Device reps were the best source of leads.

Thanks! Wouldnt have thought that they would be that valuable to us lol. I'd be a little limited since I want to stay in TX, but I'm sure they'd know what places were looking and which ones to watch out for.

 

[TeslaCoil]

Thanks! Wouldnt have thought that they would be that valuable to us lol. I'd be a little limited since I want to stay in TX, but I'm sure they'd know what places were looking and which ones to watch out for.

I stayed in my home state...

 

[10KHertz]

Make sure your skill set is top notch and you can do everything from acupuncture to SCS.
If not you will struggle in PP when your outcomes are everything...

FYI Medicare pays for acupuncture now, not that it’s a money, more that it shows your diversity .