Is Pain Medicine better of now compared to 4 years ago?

[drusso]

Will the field thrive or dwindle under the Republican's AHCA?

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[SSdoc33]

Will the field thrive or dwindle under the Republican's AHCA?

doesnt it have to pass first?

i think it will change pain medicine very little.

now vs. 4 years ago? maybe a touch worse now. but not by much. i cant see it "thriving" under the AHCA.

 

[drusso]

doesnt it have to pass first?.

“But we have to pass the [health care] bill so that you can find out what’s in it....”

 

[SSdoc33]

“But we have to pass the [health care] bill so that you can find out what’s in it....”

touche'

 

[hyperalgesia]

I don't think the bill will make much difference because it mostly deals with a small subset of pts.

In the past 4 years...

MACRA may be a slight improvement from the SGR/meaningful use of old. It's not gonna save the country but docs are not worried about a 20% reduction in Medicare fees every year. Also, the trend of creating more oversight/regulation of our practices by arm-chair academics in DC is clearly waning.

On the downside, widespread payer adoption of pre-auth requirements by 4th party fly-by-night companies is a major burden and I don't see it getting better.

Overall, I think our field is fine but we need include cash in our practices to counter the increased burdens of insurance and govt payers.

 

[lobelsteve]

Things are better now than they were four years ago or 10 years ago. We're writing less opiates doing the same number of procedures and I think with this combination we're helping more people out. My patients have replaced prescriptions with exercise and that the only way to get and keep people better.

 

[DOctorJay]

I agree with Steve. I think we're seeing people earlier nowadays and the PCPs and surgeons aren't creating as many monsters on mega dose regimens.

I give patients the fire extinguisher injection so they can participate appropriately in PT and then transition to what should be a life long HEP.


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[clubdeac]

Idk it looked pretty good 10 years ago. I followed a pain doc as an elective during my internship and he had it made. He tried doing a strictly med management clinic for awhile but got bored and went 50/50 procedural/med and then went 100% procedural. The guy worked 30 hrs/week and made over 1 mil. He did suck at teaching though

 

[NJPAIN]

I think it makes BIG difference if you are employed vs on your own. As someone on my own I am scrambling more for patients, making much less money and dealing much much more with insurance and regulatory BS.


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[SSdoc33]

Things are better now than they were four years ago or 10 years ago. We're writing less opiates doing the same number of procedures and I think with this combination we're helping more people out. My patients have replaced prescriptions with exercise and that the only way to get and keep people better.

not to put words in anybody's mouth, but the real question I believe the OP was asking is: "will i make more money in the future?" rather than "what is best for pain pain patients?". lets call a spade a spade here.....

 

[Ducttape]

following up on lobelsteve's concepts - i think its better.

a bunch of the outliers - those with huge opioid prescribing practices, those who abuse interventional fee-for-service schedules - have been weeded out.

following up on ssdoc33's concepts - no, we wont be making as much money. but hopefully there will be less abuse and it will overall be better for patients...

 

[drusso]

not to put words in anybody's mouth, but the real question I believe the OP was asking is: "will i make more money in the future?" rather than "what is best for pain pain patients?". lets call a spade a spade here.....

Hmm. I really did just ask, "Would the field thrive or dwindle under the Rebuplican's AHCA?" Sometimes a cigar is just a cigar.

Personally, I think that any shift that re-centers the physician-patient relationship, relieves burden from the administrative state, and aligns patients to direct access and market-based forces is good for the field. IPM is the next cosmetic surgery, Lasik, etc.