Outpatient PA supervisor question

[jikenyson]

I wasn’t sure how to title this..

There is a PA I work with who has an outpatient suboxone and testosterone clinic basically, he started doing ozempic for weight loss recently as well. He has a retired ER doc that started the practice and now just has his name on it for legal purposes. His current doc is retiring from everything and I was approached to take his place.

I’m interested because I’m getting burned out and would like to do some outpatient medicine. I’ve been considering ketamine clinic, suboxone, marijuana, HRT, etc..

I don’t want to do any cosmetic stuff or b12 infusion type bs..

Anyway, I wonder if anyone here has experience with this type of thing. What is the usual percent split between doc and PA? What are some red flags or things I should avoid/watch out for?

Thanks

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[BoardingDoc]

I wasn’t sure how to title this..

There is a PA I work with who has an outpatient suboxone and testosterone clinic basically, he started doing ozempic for weight loss recently as well. He has a retired ER doc that started the practice and now just has his name on it for legal purposes. His current doc is retiring from everything and I was approached to take his place.

I’m interested because I’m getting burned out and would like to do some outpatient medicine. I’ve been considering ketamine clinic, suboxone, marijuana, HRT, etc..

I don’t want to do any cosmetic stuff or b12 infusion type bs..

Anyway, I wonder if anyone here has experience with this type of thing. What is the usual percent split between doc and PA? What are some red flags or things I should avoid/watch out for?

Thanks

Without even considering the risks yet (they may be minor, they may be major. All depends on what exactly this PA is doing and whether they're a loose cannon or not), why don't you ask the person who approached you what the terms with the previous doc were?

 

[turkeyjerky]

A combo testosterone and suboxone clinic? WTF--one stop shopping for former drug addicts who have now come gym bros?

Just go fully over to the dark side. Functional medicine FTW

 

[Janders]

The combo test/suboxone clinic is just making me giggle, can you add some ADHD meds and Xanax as well just to cover all 4 bases?

 

[Apollyon]

What are some red flags or things I should avoid/watch out for?

The whole kit and caboodle?

 

[jikenyson]

Without even considering the risks yet (they may be minor, they may be major. All depends on what exactly this PA is doing and whether they're a loose cannon or not), why don't you ask the person who approached you what the terms with the previous doc were?

Previous doc was 50/50. He started it, had business and process. I would presumptively get less..

 

[turkeyjerky]

Ok, here's what you do. Sign on as an employee. Enable all sorts of shady shiite. Then you contact the DEA or CMS or whatever, turn states' witness and you get 1/3 of whatever they eventually collect as a whistleblower.

 

[jikenyson]

The combo test/suboxone clinic is just making me giggle, can you add some ADHD meds and Xanax as well just to cover all 4 bases?

He basically knew people who were getting these meds through other providers and he can offer them for less cost and hassle.

One of his questions was if I’d be comfortable with adderall. I don’t have a problem prescribing meds for adults who know what they’re getting into. I wouldn’t want to do harm. So I personally wouldn’t do opiates or escalating doses of anything with abuse potential

 

[jikenyson]

It seems like there are some big red flags I’m missing. Is anyone aware of a doc getting into trouble or causing harm by prescribing appropriate doses of these medications?

 

[DrDrummer]

It seems like there are some big red flags I’m missing. Is anyone aware of a doc getting into trouble or causing harm by prescribing appropriate doses of these medications?

Are you going to start doing formal assessments for ADHD? Are you qualified to do such assessments? Is a PA? Are you going to start doing inductions and managing precipitated withdrawal for the suboxone patients? Do you know how to deal with someone who has been using a gram of Fentanyl daily for a year who wants to get on Bupe? Are you going to be checking (and do you know how to interpret) hormonal assays for the guys you're prescribing hormones for?

I am sure there are plenty of people doing this and getting away with it. It makes me sad and angry. I hope when complications arise that the providers are sued to ashes. Beyond all of my ethical and philosophical objections to this idea, I certainly wouldn't want to be the "supervising" physician holding the bag when that happens.

 

[anonperson]

He basically knew people who were getting these meds through other providers and he can offer them for less cost and hassle.

One of his questions was if I’d be comfortable with adderall. I don’t have a problem prescribing meds for adults who know what they’re getting into. I wouldn’t want to do harm. So I personally wouldn’t do opiates or escalating doses of anything with abuse potential

This whole enterprise sounds terrible.

Started by an unethical physician and now you have some over eager PA with a chip on their shoulder trying to continue this mess.

You are just a liability sponge for when things go wrong.

So if you prescribe Adderall and the patient strokes out or something, there will probably be a pi$$ed family member with a malpractice lawyer waiting in the wings to sue you into oblivion.

The practice setup will be exposed as something run by some charlatans ( which is true) and you will get dragged through the mud while the PA gets away scot free.

 

[Janders]

Just sets off a bunch of chiropractor-pill-mill-fad-of-the-day-I-want-to-get-paid-cash red flags in my brain man. Not my gig.

If ONE of these single topics interested you and said PA (lets choose ozembic / medical weight medicine)… could you do a few courses, study, learn the ins-and-outs and open a side hustle focused on that, and perhaps do good by your patients and make money? It passes my potentially reasonable test.

But hey lets do…
Suboxone for things
Weight loss meds
Adult ADHD
Testosterone for grown men
And we can look into more.

Its one stop shopping for uncontrolled prescribing of medications that a patient wants (not necessarily needs) with the main motive being profit. If, philosophically, you are some type of medication libertarian and morally thing its great to give people whatever med they want if they pay cash… then I guess it matches your world view. I would suspect a few of these are somewhat risky medico-legally.

Personally if you must, I would focus on building non-controlled substance things first?

 

[bravotwozero]

Oh God no. Run far, far away. My level of shadiness wouldn’t go beyond some clinic with vitamin B/12 or Magnesium infusions. At least that stuff is benign and won’t get the feds on your tail.

Suboxone? Fuggedababoudit!

 

[RustedFox]

I do some addiction med.

In a controlled setting, with a clinic that provides comprehensive addiction health treatment for opioid use disorder with medication assisted therapy.

It's not just me and a pretender in a clinic. That's amazingly reckless.

 

[gutonc]

There is a PA I work with who has an outpatient suboxone and testosterone clinic basically, he started doing ozempic for weight loss recently as well. He has a retired ER doc that started the practice and now just has his name on it for legal purposes. His current doc is retiring from everything and I was approached to take his place.

I’m interested because I’m getting burned out and would like to do some outpatient medicine. I’ve been considering ketamine clinic, suboxone, marijuana, HRT, etc..

I love that while you're trying to justify the above clearly dangerous bulls*** you're a hard no on this benign BS...

I don’t want to do any cosmetic stuff or b12 infusion type bs..

As @Janders pointed out, if you're all in on this from some sort of misguided profit motivated libertarian mindset and are fine with the inevitable medico-legal fallout, then go nuts.

Just make sure that you're well compensated for it (a former non-medical boss of mine used to say "never compromise your integrity for less than half a million dollars...he was the sleaziest person I've ever worked for and this was 35 years ago, so adjust your own personal number accordingly...for me and the situation you describe, I'm thinking $2M/y at a minimum) and be sure to deposit it immediately in an untraceable offshore account, while also establishing citizenship in Belize or some other country without an extradition treaty with the US. You're going to need it.

 

[turkeyjerky]

He basically knew people who were getting these meds through other providers and he can offer them for less cost and hassle.

I also find it a hassle to drive down to mexico once a month

 

[Brigade4Radiant]

Honestly unless your doing CMS fraud the liability is less than EM

 

[jikenyson]

I do some addiction med.

In a controlled setting, with a clinic that provides comprehensive addiction health treatment for opioid use disorder with medication assisted therapy.

It's not just me and a pretender in a clinic. That's amazingly reckless.

I haven’t researched much yet. It sounds like access to suboxone is an issue in my area. There are very few who prescribe and they charge a lot. I know some academic places are starting people on it in the ER and it seems like it’s going well.

What do you see as the downside to offering it to an interested patient?

 

[jikenyson]

Honestly unless your doing CMS fraud the liability is less than EM

That’s what I thought. It seems to bother people ethically moreso than legally

 

[jikenyson]

Are you going to start doing formal assessments for ADHD? Are you qualified to do such assessments? Is a PA? Are you going to start doing inductions and managing precipitated withdrawal for the suboxone patients? Do you know how to deal with someone who has been using a gram of Fentanyl daily for a year who wants to get on Bupe? Are you going to be checking (and do you know how to interpret) hormonal assays for the guys you're prescribing hormones for?

I am sure there are plenty of people doing this and getting away with it. It makes me sad and angry. I hope when complications arise that the providers are sued to ashes. Beyond all of my ethical and philosophical objections to this idea, I certainly wouldn't want to be the "supervising" physician holding the bag when that happens.

For the adhd it would only be people with an established diagnosis who are getting overcharged by their current doc

For bupropion it seems like lack of access is a big issue in our area. I would follow whatever evidence is available. His patients are all Med refill basically, no acute withdrawal unless relapse

For hormones this guy is really into it, he sends and tracks using a more accurate assay that costs more. He does however give a recommended dose which he allows patients to go above if they prefer..

 

[allantois]

This is inappropriate supervision at least as far as ADHD is concerned. He needs an FM and/or psych supervisor

And it’s buprenorphine not bupropion

 

[jikenyson]

This is inappropriate supervision at least as far as ADHD is concerned. He needs an FM and/or psych supervisor

And it’s buprenorphine not bupropion

Sorry, autocorrect on bupropion, I tried to write bupe which I was replying to. Why FM supervisor over ER?

 

[RustedFox]

What do you see as the downside to offering it to an interested patient?

The dangers of:

1.) Precipitated withdrawal if initiated improperly.
2.) Enablement/abuse potential.
3.) Diversion/street value.
4.) Others that I'm not going to list.

It's not as simple as "here's your Rx, off you go". If that's what's going on, then there's a big, deadly problem.

 

[VA Hopeful Dr]

Stop tiptoeing around and just come out and say it:

"I'm burned out practicing emergency medicine and want a job that pays well with minimal stress."

99% of these places are basically "you want X treatment? Pay us in cash and we'll do it". Its almost always bad medicine but in the grand scheme not especially harmful on an individual patient level.

 

[Rekt]

Stop tiptoeing around and just come out and say it:

"I'm burned out practicing emergency medicine and want a job that pays well with minimal stress."

99% of these places are basically "you want X treatment? Pay us in cash and we'll do it". Its almost always bad medicine but in the grand scheme not especially harmful on an individual patient level.

Agree. Fill your bag OP.

I personally wouldn't touch Suboxone or methadone or THC Everything else is not even really unethical. Dad bod looking for his second wind or post divorce looking for some T? Go for it. Some kid blaming bad test scores on self diagnosed ADHD when in reality he's just dumb and lazy, sure take some Adderall. Ketamine for depression? At least has some evidence for it. Have backup equipment and enjoy the ride. Weight loss? Wegovy/Mounjaro are essentially magic pills for weight loss now. Going to be the next big thing once it goes mainstream. Might as well get in early.

 

[jikenyson]

Stop tiptoeing around and just come out and say it:

"I'm burned out practicing emergency medicine and want a job that pays well with minimal stress."

99% of these places are basically "you want X treatment? Pay us in cash and we'll do it". Its almost always bad medicine but in the grand scheme not especially harmful on an individual patient level.

I didn’t mean to tiptoe. Your quote is fairly accurate. I think I was hoping for insight from someone who’d done something like this before.

I wasn’t expecting such a negative reaction but it is giving me pause. It seems like for most on here there is a nebulous fear of doing something unconventional, with an assumption that there are highly qualified/better trained providers to whom I should refer people instead.

In my area the suboxone prescribers I’m aware of are scummy profiteers who overcharge and under deliver. I see relapses in the ER due to not being able to afford fees to get suboxone. Similarly with hrt where everyone male gets the same dose. Or adderall where someone’s been on the same dose for 15 years and has to pay their doc $120/month to get a refill rx.

 

[jikenyson]

Agree. Fill your bag OP.

I personally wouldn't touch Suboxone or methadone. Everything else is not even really unethical. Dad bod looking for his second wind or post divorce looking for some T? Go for it. Some kid blaming bad test scores on self diagnosed ADHD when in reality he's just dumb and lazy, sure take some Adderall. Ketamine for depression? At least has some evidence for it. Have backup equipment and enjoy the ride. Weight loss? Wegovy/Mounjaro are essentially magic pills for weight loss now. Going to be the next big thing once it goes mainstream. Might as well get in early.

I’m surprised suboxone is the one that worries you. My impression from medtwitter addiction experts is that lack of availability is the key issue, in terms of preventing mortality it’s one of the best drugs studied.

I worry about the pt types it’ll attract but no emtala in outpt world

 

[bravotwozero]

Weight loss? Wegovy/Mounjaro are essentially magic pills for weight loss now. Going to be the next big thing once it goes mainstream. Might as well get in early.

ozempic is all the rage right now for weight loss, to the point it’s on backorder. I’ve had nurses seriously ask me to prescribe it because their ex was in town and they were looking to slim up….SMH.

 

[Birdstrike]

.What are some red flags...I should avoid/watch out for?

You describe a practice run by an unsupervised PA that caters to addicts, anabolics and vanity treatments for cash, with no subspecialty board certification in relevant subspecialties. The whole thing is a red flag.

I've been through severe burnout. I know what it can do to a person. Don't let it cloud your judgement or allow you to make a decision you'll regret. If you're going to get out of EM, think it through and do it properly. There are reasonable and ethical ways to get out. Get board certified in something, do a fellowship to develop a niche, or anything else within the scope of what's reasonable for an EP. Don't do something that will lead to you getting sanctioned by your Medical Board for practicing out of bounds or compromise your ethics. Don't be the guy with a billboard featuring a shirtless, steroid-infested bodybuilder and a 1-800 number.

 

[RustedFox]

Agree. Fill your bag OP.

I personally wouldn't touch Suboxone or methadone or THC Everything else is not even really unethical. Dad bod looking for his second wind or post divorce looking for some T? Go for it. Some kid blaming bad test scores on self diagnosed ADHD when in reality he's just dumb and lazy, sure take some Adderall. Ketamine for depression? At least has some evidence for it. Have backup equipment and enjoy the ride. Weight loss? Wegovy/Mounjaro are essentially magic pills for weight loss now. Going to be the next big thing once it goes mainstream. Might as well get in early.

Your honesty is again refreshing.

You've seen the meme: "He jus-... He just like me FR!" - ?

I'll defend Suboxone in the setting of a medication assisted therapy construct because I have seen it change lives. The key is (like most other things in medicine), you have to know what you're doing... and this method needs to be TIGHTLY controlled and monitored for compliance.

I've read extensively about Special K for depression, and after careful scrutiny, I see it as a mixed bag.

But what I wanted to say originally was: "kid blaming bad test scores on ADHD when he's in reality just dumb" had me rolling. Bravo.

Addendum: Medical THC is straight farcical 99.9% of the time. I say: "Eff that noise" and call a hard bull**** on most of it.

 

[southerndoc]

ozempic is all the rage right now for weight loss, to the point it’s on backorder. I’ve had nurses seriously ask me to prescribe it because their ex was in town and they were looking to slim up….SMH.

I porked up quite a bit. Got on Ozempic for my diabetes, lost 55 pounds, and feel much better. A1C is now less than 6 (I have T2DM and was on metformin previously). Insurance covered it for $75 every 3 months. Best decision of my life. Doc wants to take me off of it as my BMI is <30 now, but I really would like to lose another 20 pounds. If only I could be like my college days when I was buff with abs. LOL

 

[bravotwozero]

Yeah…who has time for that pesky diet and exercise? /s

 

[Kryptocoin]

There's a T clinic every 5 miles in either direction where I lived. Filled with fat middle aged men with low self esteem and six-pack aspirations. Everyone seems to have low T. If you don't, well they'll just have to "optimize" your current level until you don't hate yourself anymore. Who knew T was also mood stabilizer?

 

[Brigade4Radiant]

Safe gigs to do as an EM doc is hair clinic sexual dysfunction ozempic and blood pressure management so quickly

If your board certified in EM insurance will have you as a a payor

The ADHD meds are equivocal do CMS and read some psych texts.

NPs do psych meds all day everyday with far less training than you

 

[Franzd'Epinay]

I don’t have a problem prescribing meds for adults who know what they’re getting into.

In my area the suboxone prescribers I’m aware of are scummy profiteers who overcharge and under deliver. I see relapses in the ER due to not being able to afford fees to get suboxone.

I can't get a good read on you, OP. On some posts you are basically like "I want to run an ethical pill mill" and in others you suggest that you want to help fill a critical need in addiction medicine.

If you're going into this (and it sounds like you are), you should at the very least attend several real medical conferences on these topics (no, medtwitter doesn't count). Hopefully that will keep you from doing something dumb and will serve as a plausible defense if you do end up getting into some legal issues.

And if you're actually serious the addiction thing, do an addiction medicine fellowship. It's just one year, it'll get you out of the ED, and you'll be an expert in the field.

 

[Brigade4Radiant]

You can learn from medtwitter same as these forums. Legal issues doing outpatient things are still less than EM.

an 8 hour course and you can prescribe Suboxone to patients. a fellowship you deal with more complex issues such as pregnant women.
Bup during pre-op, intra op and post op.

A fellowship will be more hours and less pay Rotations include inpt detox, otp in community and at tribal, consult liason, and private work.

There is more to addictions than opioids. Amphetamines and alcohol are still more prominent

 

[RustedFox]

I porked up quite a bit. Got on Ozempic for my diabetes, lost 55 pounds, and feel much better. A1C is now less than 6 (I have T2DM and was on metformin previously). Insurance covered it for $75 every 3 months. Best decision of my life. Doc wants to take me off of it as my BMI is <30 now, but I really would like to lose another 20 pounds. If only I could be like my college days when I was buff with abs. LOL

Good on yah.
[Encouragement Tone] - Every day you get stronger. Remember that.

 

[Brigade4Radiant]

Honestly OP you would do better to just run your own clinic. Many people online will try to gatekeep but doing another residency probably won't be that helpful.

IM does hospitalist for years and then moves to outpatient which will require a lot of learning no one says do an outpatient fellowship. Doing only specific things also makes it easier since people with complex medical problems you just refer to specialist. You can also do occupational med stuff like FMLA paperwork

 

[jikenyson]

I can't get a good read on you, OP. On some posts you are basically like "I want to run an ethical pill mill" and in others you suggest that you want to help fill a critical need in addiction medicine.

If you're going into this (and it sounds like you are), you should at the very least attend several real medical conferences on these topics (no, medtwitter doesn't count). Hopefully that will keep you from doing something dumb and will serve as a plausible defense if you do end up getting into some legal issues.

And if you're actually serious the addiction thing, do an addiction medicine fellowship. It's just one year, it'll get you out of the ED, and you'll be an expert in the field.

I do want to do something helpful for people, basically provide a service at least. My inclination would be to avoid suboxone due to pt population and lack of expertise. It seems like a huge underfilled need that may be helpful, particularly in my area. I have no interest in addiction Med fellowship. I feel comfortable appraising the evidence without spending a year devoted to it. If an addiction specialist moved to my area I would happily divert all pts their way.

I think I do have, as some suggested, a libertarian attitude toward many of these meds. I’m pro legalization of marijuana, psychedelics, etc. I don’t have an issue with an adult wanting more testosterone or hgh as long as they’re aware of potential harms.

I’m not committed to anything. I’m gonna talk to the guy seriously for the first time tomorrow. It sounds like no one here has a similar experience or real applicable advice but I appreciate the discussion.

I follow rob orman stimulus and emcrit. I’ve thought about doing “wild medicine” they espouse but it seems like bull****.

I’ll still be working ER at least part time for the foreseeable future and I’m ok with that. I’d love to get all the way out at this point though. Covid ruined it for me in ways I don’t completely understand

 

[Brigade4Radiant]

I do want to do something helpful for people, basically provide a service at least. My inclination would be to avoid suboxone due to pt population and lack of expertise. It seems like a huge underfilled need that may be helpful, particularly in my area. I have no interest in addiction Med fellowship. I feel comfortable appraising the evidence without spending a year devoted to it. If an addiction specialist moved to my area I would happily divert all pts their way.

I think I do have, as some suggested, a libertarian attitude toward many of these meds. I’m pro legalization of marijuana, psychedelics, etc. I don’t have an issue with an adult wanting more testosterone or hgh as long as they’re aware of potential harms.

I’m not committed to anything. I’m gonna talk to the guy seriously for the first time tomorrow. It sounds like no one here has a similar experience or real applicable advice but I appreciate the discussion.

I follow rob orman stimulus and emcrit. I’ve thought about doing “wild medicine” they espouse but it seems like bull****.

I’ll still be working ER at least part time for the foreseeable future and I’m ok with that. I’d love to get all the way out at this point though. Covid ruined it for me in ways I don’t completely understand

One of my EM friends did a coding bootcamp and makes 150k while doing 8 shifts a month. The hard part is getting your first job but a lot of people are interested in a doctor who codes

 

[jikenyson]

One of my EM friends did a coding bootcamp and makes 150k while doing 8 shifts a month. The hard part is getting your first job but a lot of people are interested in a doctor who codes

Interesting. I’m currently not computer savvy but the idea of learning some basic coding to help me understand the modern world has crossed my mind a few times. Ive never heard of demand for a doctor who codes. Do you have any links to more info?

Thanks

 

[VA Hopeful Dr]

Honestly OP you would do better to just run your own clinic. Many people online will try to gatekeep but doing another residency probably won't be that helpful.

IM does hospitalist for years and then moves to outpatient which will require a lot of learning no one says do an outpatient fellowship. Doing only specific things also makes it easier since people with complex medical problems you just refer to specialist. You can also do occupational med stuff like FMLA paperwork

The difference is that IM has the background in outpatient primary care.

 

[RustedFox]

One of my EM friends did a coding bootcamp and makes 150k while doing 8 shifts a month. The hard part is getting your first job but a lot of people are interested in a doctor who codes

Is this 150k from his coding gig, and then does 8 shifts a month for a total of 300K+?
It had better be.

 

[Brigade4Radiant]

The difference is that IM has the background in outpatient primary care.

Yes but after 10 years as a hospitalist you are more rusty and behind by not doing outpatient medicine also doing EM you are able to treat wounds suture, pregnant patients and kids on an outpatient basis. Most EM is ambulatory medicine

Is this 150k from his coding gig, and then does 8 shifts a month for a total of 300K+?
It had better be.

Yes 150k from coding gig so yeah he makes about 400k

Interesting. I’m currently not computer savvy but the idea of learning some basic coding to help me understand the modern world has crossed my mind a few times. Ive never heard of demand for a doctor who codes. Do you have any links to more info?

Thanks

You mean coding bootcamps or income and hours coding

 

[RustedFox]

Yes but after 10 years as a hospitalist you are more rusty and behind by not doing outpatient medicine also doing EM you are able to treat wounds suture, pregnant patients and kids on an outpatient basis. Most EM is ambulatory medicine


Yes 150k from coding gig so yeah he makes about 400k


You mean coding bootcamps or income and hours coding

Both

 

[anonperson]

...don’t have an issue with an adult wanting more testosterone or hgh as long as they’re aware of potential harms.

I’m not committed to anything. I’m gonna talk to the guy seriously for the first time tomorrow. It sounds like no one here has a similar experience or real applicable advice but I appreciate the discussion.

Even if you don't have an issue with patients getting testosterone therapy that doesn't mean there won't be consequences from your end.

Widow Files Testosterone Therapy Medical Malpractice Lawsuit | The Product Lawyers

The widow of a man who died of cardiac arrest in 2016 is suing 25 Again, a chain of hormone clinics with eight locations in Kentucky, Ohio and Indiana, accusing the company of providing her late husband with negligent medical treatment, the Courier Journal reports. Learn More: Bacterial...

theproductlawyers.com

Again, all that's needed is an angry relative/spouse etc to get the lawsuit ball rolling.

I'm not saying physicians need to practice in such fear of liability but it's not smart to completely dismiss this especially when practicing outside the typical comforts of your specialty.

Regarding fair compensation for your hypothetical setup.

That is all dependent on the location, need/desperation of the PA, amount of total money rolling in etc.

It's like asking how much is a fair price for a house. The price of housing in Detroit has no bearing on the price of a house in Malibu.

What total compensation would make you feel like you were properly paid for your services?

Are you looking to completely replace your EM pay or is this just some added vacation money you're trying to generate?

 

[VA Hopeful Dr]

Yes but after 10 years as a hospitalist you are more rusty and behind by not doing outpatient medicine also doing EM you are able to treat wounds suture, pregnant patients and kids on an outpatient basis. Most EM is ambulatory medicine

Acute ambulatory medicine sure, but to the best of my knowledge EM training doesn't ever address chronic disease management which these days is the majority of primary care.

 

[jikenyson]

Yes but after 10 years as a hospitalist you are more rusty and behind by not doing outpatient medicine also doing EM you are able to treat wounds suture, pregnant patients and kids on an outpatient basis. Most EM is ambulatory medicine


Yes 150k from coding gig so yeah he makes about 400k


You mean coding bootcamps or income and hours coding

I meant coding jobs for physicians. I couldn’t really find anything with google search.

 

[jikenyson]

Even if you don't have an issue with patients getting testosterone therapy that doesn't mean there won't be consequences from your end.

Widow Files Testosterone Therapy Medical Malpractice Lawsuit | The Product Lawyers

The widow of a man who died of cardiac arrest in 2016 is suing 25 Again, a chain of hormone clinics with eight locations in Kentucky, Ohio and Indiana, accusing the company of providing her late husband with negligent medical treatment, the Courier Journal reports. Learn More: Bacterial...

theproductlawyers.com

Again, all that's needed is an angry relative/spouse etc to get the lawsuit ball rolling.

I'm not saying physicians need to practice in such fear of liability but it's not smart to completely dismiss this especially when practicing outside the typical comforts of your specialty.

Regarding fair compensation for your hypothetical setup.

That is all dependent on the location, need/desperation of the PA, amount of total money rolling in etc.

It's like asking how much is a fair price for a house. The price of housing in Detroit has no bearing on the price of a house in Malibu.

What total compensation would make you feel like you were properly paid for your services?

Are you looking to completely replace your EM pay or is this just some added vacation money you're trying to generate?

Interesting case. It sounds fairly egregious but consistent with what a lot of those clinics do. I would be wary of high doses of T as I’ve seen some cases of cva, renal failure, and even scad in a female, that were likely related to hormone abuse.. thanks for link. Interestingly Owensboro is where my dad lives. They’re the first I’ve heard to cancel their envision contract, hopefully the first domino..

Regarding pay I don’t have a discrete plan of how much I want to make. If ER near me continues its downward spiral I would like to get out but don’t see this as the way to replace my total income. I do like having my kids in their current school and being able to travel.

It sounds like no one on here has done anything like this. I do appreciate the discussion though

 

[TooMuchResearch]

I haven’t researched much yet. It sounds like access to suboxone is an issue in my area. There are very few who prescribe and they charge a lot. I know some academic places are starting people on it in the ER and it seems like it’s going well.

What do you see as the downside to offering it to an interested patient?

I start Subutex for withdrawal from community and rural EDs. A few local FPs will then continue with Suboxone.