Pain from a lifestyle (pay, hours, etc.) stand point

[Pain Applicant1]

I'm up around 5 AM, prep charts for the day, 7 AM breakfast meetings, work 8-5 (lunch at the desk), usually 6 PM-8 PM conference calls, after-work meetings, rainmaking, drug rep dinners, etc, 8 PM-10 PM sign notes. In bed by 11 PM. Later, rinse, repeat.

Private practice is all about discipline and focus.

That's a hell of a schedule? Are you happy with that? I would personally never want to work that hard in medicine at this point but to each their own. I don't do drug rep dinners and don't allow them in my office anymore as they take up too much time.

I imagine you're running a full operation and you're not just a solo practice provider.

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[SSdoc33]

2 hours to sign notes?

where are the soccer practices? family time?

somethin fishy about drusso's post, and it isnt the "jump the shark" avatar he used to have.

 

[drusso]

That's a hell of a schedule? Are you happy with that? I would personally never want to work that hard in medicine at this point but to each their own. I don't do drug rep dinners and don't allow them in my office anymore as they take up too much time.

I imagine you're running a full operation and you're not just a solo practice provider.

No. We have 60 employees.

 

[Pain Applicant1]

No. We have 60 employees.

That's really impressive!!! Great job!!!

I lack the leadership skills and organizational ability to ever get something like that accomplished. That's no easy feat.

 

[bedrock]

O

No. We have 60 employees.

60? Are you part of a large ortho or primary care group?

I thought you had a solo pain practice?

 

[sloh]

I'm up around 5 AM, prep charts for the day, 7 AM breakfast meetings, work 8-5 (lunch at the desk), usually 6 PM-8 PM conference calls, after-work meetings, rainmaking, drug rep dinners, etc, 8 PM-10 PM sign notes. In bed by 11 PM. Later, rinse, repeat.

Private practice is all about discipline and focus.

Is this satire?

 

[Pain Applicant1]

Is this satire?

I don't think it is. He often mentions that he works a 5 to 9 job.

I really don't want to give out business advice since he's better at it than I am but I know one thing that helped me was when I made a policy that I will never leave the office without my notes completed. That policy then evolved into never leaving the room (or appointment now with telemed) until the note is done. I eventually figured out how to do this. This was one of the best decisions I made. Until that point, I was up all night finishing my notes.

 

[nvrsumr]

Everyone runs their practice differently. Solo PP. 125 patients 80 of which are procedures this week. Own the building. 3 staff members(need another) and do billing in house. 40 hour work week. No dinners or work at home.

60 employees is on a different level. I was thinking @drusso was making 3 million/year. Need to raise my estimate ... alot.

 

[deleted131481]

I have no doubt @drusso works hard and smart. Many took it literally but I saw the 5-9 schedule as a bit tongue-in-cheek.

 

[drusso]

I have no doubt @drusso works hard and smart. Many took it literally but I saw the 5-9 schedule as a bit tongue-in-cheek.

 

[Pain Applicant1]

A snow bunny, lol!!!

Definitely hard out there for a pump. I concur. What I don't understand is if you're pimping out all day and night when do you have time time to hold your objectivism meetings?

 

[SSdoc33]

I have no doubt @drusso works hard and smart. Many took it literally but I saw the 5-9 schedule as a bit tongue-in-cheek.

i didnt. he has said it multiple times.

i took it as a "look how hard i work" / humblebrag type of comment.

it is great that drusso works hard. good for him. but no need to disparage those who dont work 80 hrs/week or those who don't work in PP

 

[Pain Applicant1]

i didnt. he has said it multiple times.

i took it as a "look how hard i work" / humblebrag type of comment.

it is great that drusso works hard. good for him. but no need to disparage those who dont work 80 hrs/week or those who don't work in PP

I don't think he's like that. So hard to read into texting/emailing/typing without context and other communication means. Sometimes it's like:

 

[Ducttape]

i used to work 40+ hours a week in the ER. when i quit, i had accumulated over 300 hours of overtime (above taking an extra week of vacation a year).


he is right. "they" will never love you back. unfortunately, he always points to HOPD as the offender.

truth is, no job will love you back. its just a job. you can love the job and all the accessories that go with the job (ie business), and thats great.

but after working all those years working (and loving) a high stress job environment, i have found it is much better to love yourself and your family than any job, and to never expect anyone at work to love me.

 

[drusso]

i didnt. he has said it multiple times.

i took it as a "look how hard i work" / humblebrag type of comment.

it is great that drusso works hard. good for him. but no need to disparage those who dont work 80 hrs/week or those who don't work in PP

 

[SSdoc33]

tom hanks is great

 

[Ferrismonk]

Yep. We recently had a long-term partner choose to retire. We had a nice party for him and a few months later nobody mentions him at all and even his old patients who he's been taking care of for 20+ years rarely bring him up anymore.

If you enjoy it or work hard for the financial reward, that's fine, but have no illusions that you're particularly valued at your workplace, even if you own everything.

 

[MitchLevi]

Yep. We recently had a long-term partner choose to retire. We had a nice party for him and a few months later nobody mentions him at all and even his old patients who he's been taking care of for 20+ years rarely bring him up anymore.

If you enjoy it or work hard for the financial reward, that's fine, but have no illusions that you're particularly valued at your workplace, even if you own everything.

Salient point.

 

[hyperalgesia]

I only work 4 days and it's still too much. Not too much work by any means, just too much of one kind of work.

 

[Aldertonghen]

I only work 4 days and it's still too much. Not too much work by any means, just too much of one kind of work.

How does one make a pain practice more interesting/more diverse in terms of stuff to do?

 

[Agast]

Yep. We recently had a long-term partner choose to retire. We had a nice party for him and a few months later nobody mentions him at all and even his old patients who he's been taking care of for 20+ years rarely bring him up anymore.

My patients still speak fondly of their old PCPs. Perhaps they don’t want to remind you how much more they like your old partner

 

[Pain Applicant1]

I only work 4 days and it's still too much. Not too much work by any means, just too much of one kind of work.

This is a wise man. One man's vacation is another man's daily grind.

How does one make a pain practice more interesting/more diverse in terms of stuff to do?

Consider introducing other things into your practice. I started a suboxone clinic several years ago and I really enjoy it. You can consider cosmetics, vein clinic, etc. There are probably a million things you can offer your patients. Check out weekend seminars.

Also, make sure you have outside hobbies that you can look forward to and you can think about during the day. Sports, exercise, nature, investing, another business venture, etc.

 

[ateria radicularis magna]

I'm up around 5 AM, prep charts for the day, 7 AM breakfast meetings, work 8-5 (lunch at the desk), usually 6 PM-8 PM conference calls, after-work meetings, rainmaking, drug rep dinners, etc, 8 PM-10 PM sign notes. In bed by 11 PM. Later, rinse, repeat.

Private practice is all about discipline and focus.

I call bs

 

[drusso]

I call bs

Abbott gives better support in our region.

 

[Pain Applicant1]

I call bs

Why would someone lie in here? What would anyone have to gain? He probably doesn't know most of us and he lists his real name.

I can understand if he was trying to make money in here or impress a woman but this is just a random semi-anonymous forum used to gather opinions, blow off steam, and break up the workday.

 

[drusso]

Why would someone lie in here? What would anyone have to gain? He probably doesn't know most of us and he lists his real name.

I can understand if he was trying to make money in here or impress a woman but this is just a random semi-anonymous forum used to gather opinions, blow off steam, and break up the workday.

Women are impressed by my strong work ethic. "Good provider..."

 

[Agast]

Why would someone lie in here? What would anyone have to gain? He probably doesn't know most of us and he lists his real name.

I can understand if he was trying to make money in here or impress a woman but this is just a random semi-anonymous forum used to gather opinions, blow off steam, and break up the workday.

 

[ateria radicularis magna]

Why would someone lie in here? What would anyone have to gain? He probably doesn't know most of us and he lists his real name.

I can understand if he was trying to make money in here or impress a woman but this is just a random semi-anonymous forum used to gather opinions, blow off steam, and break up the workday.

I’m sorry, but he is obviously making fun of this lifestyle. If I am wrong I’ll eat my words and put a ring on it.

 

[Pain Applicant1]

View attachment 355362

That one I can understand

Urban Dictionary: male dog

A male Hoe. A man who sleeps with may partners.

www.google.com

I’m sorry, but he is obviously making fun of this lifestyle. If I am wrong I’ll eat my words and put a ring on it.

Joking around and making fun of, you might be right.

Is @drusso being sincere about his working hours? Let's investigate. I think this is him.

Columbia Pain Management - Oregon's Original Regenexx® Provider

Columbia Pain Management is Oregon's premier pain management clinic & provider of Regenexx® Non-Surgical Procedures for orthopedic conditions.

columbiapain.org

I like this mindless debate. Nice meaningless escape from thinking about the tragedy in Texas.

 

[lobelsteve]

That one I can understand

Urban Dictionary: male dog

A male Hoe. A man who sleeps with may partners.

www.google.com

Joking around and making fun of, you might be right.

Is @drusso being sincere about his working hours? Let's investigate. I think this is him.

Columbia Pain Management - Oregon's Original Regenexx® Provider

Columbia Pain Management is Oregon's premier pain management clinic & provider of Regenexx® Non-Surgical Procedures for orthopedic conditions.

columbiapain.org

I like this mindless debate. Nice meaningless escape from thinking about the tragedy in Texas.

Nope, that's just a Regenexx advert.

 

[drusso]

That one I can understand

Urban Dictionary: male dog

A male Hoe. A man who sleeps with may partners.

www.google.com

Joking around and making fun of, you might be right.

Is @drusso being sincere about his working hours? Let's investigate. I think this is him.

Columbia Pain Management - Oregon's Original Regenexx® Provider

Columbia Pain Management is Oregon's premier pain management clinic & provider of Regenexx® Non-Surgical Procedures for orthopedic conditions.

columbiapain.org

I like this mindless debate. Nice meaningless escape from thinking about the tragedy in Texas.

Frontiers | The Motivational Make-Up of Workaholism and Work Engagement: A Longitudinal Study on Need Satisfaction, Motivation, and Heavy Work Investment

Drawing on Ryan and Deci’s Self-Determination Theory, this study examines longitudinally how need satisfaction at work affects four forms of intrinsic and ex...

www.frontiersin.org

"If you love your job, you never work a day in your life."

In my experience, PP-oriented people (high drive, high autonomy, high self-efficacy) just have a different level of engagement in all spheres of their life.

 

[nvrsumr]

If you love your job you need a hobby.

 

[Ducttape]

i used to be that, in a past career.


one of these days, consider hanging out with us losers who are loving life itself and stop and smell the flowers... before hacking at them to find our wayward golf ball.

 

[Status Sciaticus]

36 hr weeks for me

How much are you grossing annually for this 36 hour work week?

Anesthesia makes more to start with more vacation to start. Pain tends to have higher upside long term, especially in private practice owner scenario and if you can factor in ownership in ASC etc that anesthesiologists don’t have access to.

For me, I enjoyed the practice of pain but I also felt that the long term play in total (financial, life balance, burnout, etc) was better pursuing pain.

What do you think is the upside in pain for working 40 hours/week if you end up owning your own ASC or being part of a multispecialty group?

Base plus wrvu production bonus plus some other bonuses for metrics/directorship. Not rural

at 12000, I would imagine thats breaking 1M+. Is this on point?

I'm up around 5 AM, prep charts for the day, 7 AM breakfast meetings, work 8-5 (lunch at the desk), usually 6 PM-8 PM conference calls, after-work meetings, rainmaking, drug rep dinners, etc, 8 PM-10 PM sign notes. In bed by 11 PM. Later, rinse, repeat.

Private practice is all about discipline and focus.

How much are you making for that 5-9 gig? Asking for research purposes.

Also how realistic is it to work 35-40 hours/week and break the 750k mark? dont really care for doing shady stuff.

 

[SgtThunderfistMD]

How much are you grossing annually for this 36 hour work week?


What do you think is the upside in pain for working 40 hours/week if you end up owning your own ASC or being part of a multispecialty group?

at 12000, I would imagine thats breaking 1M+. Is this on point?

How much are you making for that 5-9 gig? Asking for research purposes.

Also how realistic is it to work 35-40 hours/week and break the 750k mark? dont really care for doing shady stuff.

Wiser folks than I can correct me if I'm wrong, but ASC's are not the cash cows they once were. It's hard to get decent rates with insurance unless you partner with a bigger ASC overlord.

Don't think 750k for 35-40 hours is a reasonable expectation nowadays. I'm sure some will make it there, but it's gonna be a lot of luck, and skills you may not know if you even have right now. I would expect something reasonable like 400-450k and then you won't be disappointed, can be more selective on location, and will still be able to buy (almost) anything you want in the world.

 

[Status Sciaticus]

Wiser folks than I can correct me if I'm wrong, but ASC's are not the cash cows they once were. It's hard to get decent rates with insurance unless you partner with a bigger ASC overlord.

Don't think 750k for 35-40 hours is a reasonable expectation nowadays. I'm sure some will make it there, but it's gonna be a lot of luck, and skills you may not know if you even have right now. I would expect something reasonable like 400-450k and then you won't be disappointed, can be more selective on location, and will still be able to buy (almost) anything you want in the world.

thanks for the insight. Just weighing the pros/cons of going pain in this anesthesia market.

 

[Agast]

If you want to make over $750k you really have to choose a specialty with a high level of reimbursement. Pain is not that. Not without getting involved in side projects and investments, which do not fall into your lap. If you are a natural hustler you’ll find a way to make it (legally).

Manage your expenses and don’t marry someone with champagne tastes who can’t pay their own tab.

 

[Ronin1]

How much are you grossing annually for this 36 hour work week?


What do you think is the upside in pain for working 40 hours/week if you end up owning your own ASC or being part of a multispecialty group?

at 12000, I would imagine thats breaking 1M+. Is this on point?

How much are you making for that 5-9 gig? Asking for research purposes.

Also how realistic is it to work 35-40 hours/week and break the 750k mark? dont really care for doing shady stuff.

I think they are so many variables. I work more hours than I did when I did anesthesia as well but none of them are at night or on the weekends or holidays. I definitely outearn them in my market but if u go anesthesia in the Midwest u can do well. Pain gives me freedom from nights and weekends which suck especially as you get older.

I probably average about 35 hours a week right now. I’m only doing about 10500wrvu because there is a max compensation cap(750k) and they are using the old values. I’m planning to hover right around this number and cruise along.

If by nature you are entrepreneurial, start your own practice keep everything in house. Work 5-9 and the sky’s the limit on revenue

 

[drusso]

Wiser folks than I can correct me if I'm wrong, but ASC's are not the cash cows they once were. It's hard to get decent rates with insurance unless you partner with a bigger ASC overlord.

Don't think 750k for 35-40 hours is a reasonable expectation nowadays. I'm sure some will make it there, but it's gonna be a lot of luck, and skills you may not know if you even have right now. I would expect something reasonable like 400-450k and then you won't be disappointed, can be more selective on location, and will still be able to buy (almost) anything you want in the world.

The battle against the scourges of Modic-related back pain, refractory non-surgical back pain, medial branch causalgia, SIJ instability, and end-stage cluneal neuralgia will not be won with shots, but instead implanted cold, hard steel. Let that sink in...

 

[jsaul]

The battle against the scourges of Modic-related back pain, refractory non-surgical back pain, medial branch causalgia, SIJ instability, and end-stage cluneal neuralgia will not be won with shots, but instead implanted cold, hard steel. Let that sink in...

This is a battle that I don't think you can win. However sometimes it's better to try figh6t standing on your feet in the OR instead of being on your knees in clinic

 

[lobelsteve]

The battle against the scourges of Modic-related back pain, refractory non-surgical back pain, medial branch causalgia, SIJ instability, and end-stage cluneal neuralgia will not be won with shots, but instead implanted cold, hard steel. Let that sink in...

Or home exercise and acceptance.

 

[drusso]

Or home exercise and acceptance.

Roger Chou called and wants his therapeutic nihilism back when you're done using it.

 

[drusso]

This is a battle that I don't think you can win. However sometimes it's better to try figh6t standing on your feet in the OR instead of being on your knees in clinic

Another awesome Pain Surgeon tattoo!

 

[hyperalgesia]

I would expect something reasonable like 400-450k and then you won't be disappointed, can be more selective on location, and will still be able to buy (almost) anything you want in the world.

Oh, you can still be disappointed...

 

[Pain Applicant1]

Also how realistic is it to work 35-40 hours/week and break the 750k mark? dont really care for doing shady stuff.

I think very realistic and pretty easy. Keep overhead low and see many patients. Learn the nuances of the admin/billing nonsense parts of the job so you can simplify them so a monkey can complete these tasks. Then plug an employee in to take them over. Start a UDS lab and dispense DME. Hire an NP so you can focus your time on procedures. If you're busy enough run 2 fluoro rooms and bounce back and forth and you should be well into the 7-figure range.

 

[lobelsteve]

Roger Chou called and wants his therapeutic nihilism back when you're done using it.

You gotta put in a lotta metal to keep pace with feeding/housing your empire.

 

[Ducttape]

The battle against the scourges of Modic-related back pain, refractory non-surgical back pain, medial branch causalgia, SIJ instability, and end-stage cluneal neuralgia will not be won with shots, but instead implanted cold, hard steel. Let that sink in...

you are making orthopedic surgeons very happy...

 

[Status Sciaticus]

If you want to make over $750k you really have to choose a specialty with a high level of reimbursement. Pain is not that. Not without getting involved in side projects and investments, which do not fall into your lap. If you are a natural hustler you’ll find a way to make it (legally).

Manage your expenses and don’t marry someone with champagne tastes who can’t pay their own tab.

Well I'm in anesthesia, so I'm locked in to either Anesthesia or Pain. I do like me some Krug or Perrier-Jouet Epoque every now and then though.

I think they are so many variables. I work more hours than I did when I did anesthesia as well but none of them are at night or on the weekends or holidays. I definitely outearn them in my market but if u go anesthesia in the Midwest u can do well. Pain gives me freedom from nights and weekends which suck especially as you get older.

I probably average about 35 hours a week right now. I’m only doing about 10500wrvu because there is a max compensation cap(750k) and they are using the old values. I’m planning to hover right around this number and cruise along.

If by nature you are entrepreneurial, start your own practice keep everything in house. Work 5-9 and the sky’s the limit on revenue

are you calculating the admin/billing/charting/phone calls into the 35 hours/week?

The battle against the scourges of Modic-related back pain, refractory non-surgical back pain, medial branch causalgia, SIJ instability, and end-stage cluneal neuralgia will not be won with shots, but instead implanted cold, hard steel. Let that sink in...

Stims are made of steel right? Maybe not hard steel, but steel nonetheless

 

[Baron Samedi]

Yep. We recently had a long-term partner choose to retire. We had a nice party for him and a few months later nobody mentions him at all and even his old patients who he's been taking care of for 20+ years rarely bring him up anymore.

If you enjoy it or work hard for the financial reward, that's fine, but have no illusions that you're particularly valued at your workplace, even if you own everything.

I think back to a patient I saw as a resident. Seemed like a nice guy, we had met before and he was coming in to talk about his lower back. I was feeling under the weather, so I wore a mask(pre-covid).

Guy didn't ask about the mask at all. In the middle of the interview, I aspirated a big ole bunch of saliva and had a coughing fit. I sounded like I was dying and could not catch my breath the whole time. Just non stop coughing and gasping for air. The patient didn't stop even for a second to make sure I was okay, just talked about his back pain the entire time while I was in agony right in front of him. It made me realize just how one-sided and transactional these relationships are.

I could fall over and die in the exam room and the first thing most my patients would ask is, "So who's going to order my refills now?"

 

[drusso]

you are making orthopedic surgeons very happy...

Centeno breaks it down for you today "old school." @lobelsteve @Ducttape

Why Aren't Interventional Pain Management Physicians Offering More Regenerative Solutions? - Regenexx

Regenexx offers non-surgical, regenerative orthopedic treatment options for pain related to osteoarthritis, joint injuries, overuse conditions, spine pain, and common sports injuries.

regenexx.com

"There is nothing ever devised that you can place in the body that’s natural. Meaning if you place a piece of metal in the body, even if that’s placed in a less invasive way, that’s still a foreign object. We also know that these metals leech into the patient’s bloodstream and impact some patients more than others, with metal allergies now being a problem. Finally, that piece of metal or ceramic or plastic will eventually wear out, as it has no ability to repair and maintain itself.

This is perhaps the biggest growth area in IPM I have seen that concerns me. For example, we know from many studies that fusion is always a bad idea in that it leads to adjacent segment disease and abnormal motion. However, my colleagues are now placing SI joint fusion screws with wild abandon. Another problem is “interspinous spacers” which are used to treat spinal stenosis. These destroy the supra and interspinous ligaments with spine surgeons reporting that these devices are failing at an alarming rate, requiring their removal. Finally, placing implantable nerve stimulators to block pain signals is now a big thing. However, in the long run, my experience to date shows that these systems don’t last and often need to be removed or revised. In the end, none of these implantable solutions are as elegant as regenerating or helping maintain natural tissues."