Thoughts of possible pain job opportunity

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You need ancillary revenue streams and access to facility fees to push the income substantially higher than that though.

This is what is wrong with medical care today. Hire a tech to do emgs and sign your name for the money. Find ultrasound machine and add to your billing. Start doing VNG on everyone. Get into the IOM field. Run your own UDS company.

It's a slippery slope from doing what your patients need to being a greedy monster to running a criminal enterprise.

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I thought my experience in private practice would be similar to my time as a hospital employee. Boy was I wrong. They are sooooo different. It takes a really long time to build up a solid patient base in private practice, if you practice ethically in a competitive market. At least 2 years, or so it seems.
I typically get 1-2 new patients a day.

Hospital employment? Completely different animal. I was up to my eyeballs in patients after 3 months. 10 new patients a day in that setting was very plausible. Hospital employment can really skew a person's perspective on practice growth. Private practice is more challenging in this respect.

I agree that an ethical doc in private practice, with a full schedule and no ancillary revenue streams, can definitely clear $200,000/yr. Probably close to $350,000/yr. You need ancillary revenue streams and access to facility fees to push the income substantially higher than that though.


Thanks for the post. I appreciate your perspective.
From what it sounds like from many of you in PP is that getting a referral stream of patients and obtaining new patients can be one of the more challenging aspects on PP and staying afloat since revenue is generated mostly from seeing patients. How do you establish a referral stream being the new doctor in town especially in a major city? Any marketing strategies that anyone found helpful?

Again, thank you to everyone who hasn't commented. All of this is helpful and I enjoy reading everyone's perspective.
 
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Thanks for the post. I appreciate your perspective.
From what it sounds like from many of you in PP is that getting a referral stream of patients and obtaining new patients can be one of the more challenging aspects on PP and staying afloat since revenue is generated mostly from seeing patients. How do you establish a referral stream being the new doctor in town especially in a major city? Any marketing strategies that anyone found helpful?

Again, thank you to everyone who hasn't commented. All of this is helpful and I enjoy reading everyone's perspective.

Basically you have to swing by tons of local doctors offices and try to meet with the docs in person, in order to promote yourself. It's very similar to what drug reps do. Awkward as hell but there's no way around it. You'll need referral pads for the offices that you visit. Also, you can enlist the support of local device reps to help arrange dinners with local spine surgeons.

If you're in a competitive market like I am, get ready for an uphill battle. It's a slow process.
 
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This is what is wrong with medical care today. Hire a tech to do emgs and sign your name for the money. Find ultrasound machine and add to your billing. Start doing VNG on everyone. Get into the IOM field. Run your own UDS company.

It's a slippery slope from doing what your patients need to being a greedy monster to running a criminal enterprise.

Yep. I agree 100%.
 
I thought my experience in private practice would be similar to my time as a hospital employee. Boy was I wrong. They are sooooo different. It takes a really long time to build up a solid patient base in private practice, if you practice ethically in a competitive market. At least 2 years, or so it seems.
I typically get 1-2 new patients a day.

Hospital employment? Completely different animal. I was up to my eyeballs in patients after 3 months. 10 new patients a day in that setting was very plausible. Hospital employment can really skew a person's perspective on practice growth. Private practice is more challenging in this respect.

I agree that an ethical doc in private practice, with a full schedule and no ancillary revenue streams, can definitely clear $200,000/yr. Probably close to $350,000/yr. You need ancillary revenue streams and access to facility fees to push the income substantially higher than that though.
Why are you guys saying it's so much harder to net > $350 in pp? My annual collections cleared 1 million after 18 months in private practice. With a 50% overhead I would've been making > 500k and that was seeing approximately 100 patients/week with 35/65 procedure/clinic time.
 
Why are you guys saying it's so much harder to net > $350 in pp? My annual collections cleared 1 million after 18 months in private practice. With a 50% overhead I would've been making > 500k and that was seeing approximately 100 patients/week with 35/65 procedure/clinic time.

How many new patients were you seeing in a week out of 100 patients?
 
Basically you have to swing by tons of local doctors offices and try to meet with the docs in person, in order to promote yourself. It's very similar to what drug reps do. Awkward as hell but there's no way around it. You'll need referral pads for the offices that you visit. Also, you can enlist the support of local device reps to help arrange dinners with local spine surgeons.

If you're in a competitive market like I am, get ready for an uphill battle. It's a slow process.

Agrees with the above, except dinner with local spine surgeons...

The referrals I received from local spine surgeons are some of the worst referrals I got. This would be universally true if your local spine surgeons are doing their own spinal injections (or whatever they think they are doing in the spine with their injections) and dumping you all patients on chronic opioids and failed multiple fusions? You might get a few stims out of it, but these will be in general some of the most frustrating patients you will have.
 
2/day? Ok, agree to disagree. But I challenge anyone to look at the fee schedule and determine it is possible for anyone in full time practice to only clear 200k.
internists do the type of practice you are expousing daily. average salary for PP is $200k. for self-employed family practice, it is $174K . it seems a little presumptuous to think that a non-interventional pain doc can easily attain or surpass that of the salary the average PP internist, or a salary 15% higher than the average PP FP.
 
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internists do the type of practice you are expousing daily. average salary for PP is $200k. for self-employed family practice, it is $174K . it seems a little presumptuous to think that a non-interventional pain doc can easily attain or surpass that of the salary the average PP internist, or a salary 15% higher than the average PP FP.


Thanks again for everyone's post and comments.
 
internists do the type of practice you are expousing daily. average salary for PP is $200k. for self-employed family practice, it is $174K . it seems a little presumptuous to think that a non-interventional pain doc can easily attain or surpass that of the salary the average PP internist, or a salary 15% higher than the average PP FP.

god, internists totally get hosed. i sometimes feel like im not a "real doctor" doing the stuff that we do, but for 2x the earnings of a generalist, ill take the self shame and guilt. e/m just needs to be reimbursed higher, with CPTs reimbursed lower. i wish this were not the case, but.......
 
god, internists totally get hosed. i sometimes feel like im not a "real doctor" doing the stuff that we do, but for 2x the earnings of a generalist, ill take the self shame and guilt. e/m just needs to be reimbursed higher, with CPTs reimbursed lower. i wish this were not the case, but.......

I think internists are in a great position these days, because demand for their services is extremely high, supply is low, and they can easily opt out of traditional insurance for direct pay/concierge models, which provide a VERY comfortable income for them. I wouldn't be surprised if internal medicine becomes more competitive to get into as more and more internists start opting out of insurance. In my area it seems like a lot of the doctors are doing this. They deserve to be paid well after being crapped on for so long (financially).
 
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I think internists are in a great position these days, because demand for their services is extremely high, supply is low, and they can easily opt out of traditional insurance for direct pay/concierge models, which provide a VERY comfortable income for them. I wouldn't be surprised if internal medicine becomes more competitive to get into as more and more internists start opting out of insurance. In my area it seems like a lot of the doctors are doing this. They deserve to be paid well after being crapped on for so long (financially).

not sure how easy it is. you are essentially only caring for the rich, who can afford concierge care. the vast majority cant. frankly, i see i lot of domestic internists doing this, and the crappier, medicaid-heavy jobs are filled by immigrants. 'merica!!! where the streets are paved with gold.
 
I think internists are in a great position these days, because demand for their services is extremely high, supply is low, and they can easily opt out of traditional insurance for direct pay/concierge models, which provide a VERY comfortable income for them. I wouldn't be surprised if internal medicine becomes more competitive to get into as more and more internists start opting out of insurance. In my area it seems like a lot of the doctors are doing this. They deserve to be paid well after being crapped on for so long (financially).

high-end-medical-care.html

I think that direct access is the future for any pain medicine job!
 
not sure how easy it is. you are essentially only caring for the rich, who can afford concierge care. the vast majority cant. frankly, i see i lot of domestic internists doing this, and the crappier, medicaid-heavy jobs are filled by immigrants. 'merica!!! where the streets are paved with gold.

It definitely favors the affluent but not necessarily. The beauty of these models is that they can implement a sliding scale for fees, if they want so do so. On the other hand, they can keep the fees sky high and cater exclusively to the wealthy and ultra wealthy. They are in total control of fee schedules, unlike the absurd dynamic with insurance companies, which dictate how much our services are worth.

They an charge a poor patient $5 for a visit and move on to the next patient who pays $1500/month. A lot of flexibility there. After all, internists didn't always take insurance. It used to all be cash based before insurance companies came into the picture.
 
It definitely favors the affluent but not necessarily. The beauty of these models is that they can implement a sliding scale for fees, if they want so do so. On the other hand, they can keep the fees sky high and cater exclusively to the wealthy and ultra wealthy. They are in total control of fee schedules, unlike the absurd dynamic with insurance companies, which dictate how much our services are worth.

They an charge a poor patient $5 for a visit and move on to the next patient who pays $1500/month. A lot of flexibility there. After all, internists didn't always take insurance. It used to all be cash based before insurance companies came into the picture.

right.....

so the internist who charges 5 bucks a pop will still get paid a low wage. it completely depends on your clientele'. i would love to think that doing the same amount of work (or more work in the case of the medicaid population) would garner the same wages regardless of who the patient is. doesnt really work that way here, does it? yay capitalism....

 
Capitalism is not the best system by any means. It is the only system. Proven to lift 100s of millions out of poverty
 
Capitalism is not the best system by any means. It is the only system. Proven to lift 100s of millions out of poverty

when you are selling widgets? definitely. when you are selling health care? not so sure
 
Capitalism is not the best system by any means. It is the only system. Proven to lift 100s of millions out of poverty


or you can try socialism/communism as in former Soviet Union, and see where it ended up.

or you can try socialism/communism going capitalism (economically) like in current China (which is very innovative and productive in terms financial, economical scale), then see how it has advanced in last 20 years during the switch.
 
when you are selling widgets? definitely. when you are selling health care? not so sure

I agree it is different and we should be held to a much higher standard. I do think harnessing our innate greed(fee for service) provides for a robust healthcare environment. Could we do better for less? Yes on paper but not certain in practice.
Right now healthcare bureaucrats have the best of both worlds- many highly trained doctors whose opportunity cost to leave medicine is too high so they can decrease our reimbursement and autonomy. If we kill the golden goose (make medicine much less attractive financially compared to other professions) this could change though so many variables hard to say exactly how things would ultimately turn out.
 
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I agree it is different and we should be held to a much higher standard. I do think harnessing our innate greed(fee for service) provides for a robust healthcare environment. Could we do better for less? Yes on paper but not certain in practice.
Right now healthcare bureaucrats have the both of best worlds- many highly trained doctors whose opportunity cost to leave medicine is too high so they can decrease our reimbursement and autonomy. If we kill the golden goose (make medicine much less attractive financially compared to other professions) this could change though so many variables hard to say exactly how things would ultimately turn out.

I ABSOLUTELY would be less productive if there wasnt a carrot for me to do so. it would be nice if there was a mechanism that i would get paid for productivity, yet get paid the SAME for treating a poor patient with a disc herniation vs a rich patient with a disc herniation. its the same work, why not get paid the same? this is where the idea of health care as a "right" comes into play. im not sure you can have true capitalism in a situation where health is at stake. the free-marketers will say that government intrusion/creating an unfair playing field is where the problem is. i think thats a bit too simplistic.
 
OLD BRIDGE, NJ:

Interventional Pain Management Opportunity in New Jersey – 45 minutes to NYC & Philadelphia!! Thriving/Established Group seeking BC/BE Interventional Pain Management physician in Central NJ – Great location. Group of 5 pain management specialists, 1 physician assistant and over 200 employees including ancillary staff, medical assistants and nursing staff. Interventional based pain practice that offers patients treatment for painful disorders including epidural steroid injections, facet joint injections, major joint injections, spinal cord stim trials, discograms, percutaneous discectomies Position available due to Increased Patient Volume. No On Call Hours – Outpatient Based! Office Hours: Monday through Friday, 9-5 pm, 2 weekend days/month Patient Volume: 20 – 25 patients/day Payor Mix: 60% major health insurance, 30% medicare, 10% personal injury/ workers compensation. NO Medicaid or cash patients seeking medications Competitive Base Salary Bonuses & Incentives: 20% of physician collections after deducting salary and 55% expenses of running practice (i.e. if physician generates 1,000,000 on an annual basis: 1,000,000 – 300,000 (salary) – 55% expense x 20% = $63,000 bonus) Benefits include: Paid Malpractice, MCME, Vacations, Holidays, Group Medical & Dental. *Willing to increase productivity from 20% first year to 25% second year and 30% third year and possible shares in the ambulatory surgery center in the future.

Got this in email

Why the hell would 5 physicians need 200 Employees?
55% expenses
 
This is where the idea of health care as a "right" comes into play. im not sure you can have true capitalism in a situation where health is at stake. the free-marketers will say that government intrusion/creating an unfair playing field is where the problem is. i think thats a bit too simplistic.

Rand Paul's opinion on health care as a right...

18951401_1470224226332557_1067930516270547991_n.jpg
 
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nothing in life without constraint and conditions, is a god-given right!
 
Rand Paul's opinion on health care as a right...

18951401_1470224226332557_1067930516270547991_n.jpg

i think i agree more with the girl in the background. if it were up to rand and his dad, we would all be off the grid with shotguns on our porches, completely disengaged from each other and the rest of the world. libertarians always go too far -- thats why they will always be the red-headed stepchild.
 
Why are you guys saying it's so much harder to net > $350 in pp? My annual collections cleared 1 million after 18 months in private practice. With a 50% overhead I would've been making > 500k and that was seeing approximately 100 patients/week with 35/65 procedure/clinic time.

100 patients? wow thats a LOT. i see like 7 patients a day and thats like a full day. it's hard to clear 1 patient in 1 hr, and there are so many notes, follow ups, call back w questions etc
 
Are you still a fellow? $700/day is not enough to pay the overhead. You need to see at least 15/day.
 
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100 patients? wow thats a LOT. i see like 7 patients a day and thats like a full day. it's hard to clear 1 patient in 1 hr, and there are so many notes, follow ups, call back w questions etc
Uhm 1 patient an hour sounds awesome but will not keep the lights on anywhere. Even I am doubling that number at the VA hospital which is notorious for inefficiency and lack of ancillary support
 
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I ABSOLUTELY would be less productive if there wasnt a carrot for me to do so. it would be nice if there was a mechanism that i would get paid for productivity, yet get paid the SAME for treating a poor patient with a disc herniation vs a rich patient with a disc herniation. its the same work, why not get paid the same? this is where the idea of health care as a "right" comes into play. im not sure you can have true capitalism in a situation where health is at stake. the free-marketers will say that government intrusion/creating an unfair playing field is where the problem is. i think thats a bit too simplistic.
Liberals need to demonstrate universal healthcare as a "right" in the great state of California, one of the largest economies in the world. This is their chance to show all the ignorant folk in the rest of the country how it's done...
 
Wow thats crazy!. How do you see each patient so quickly??

how do you see them so slowly? if i saw 1 patient / hour, i would stick a hot poker in my eye. i have trouble listening to patients for more than a few minutes at a time
 
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Liberals need to demonstrate universal healthcare as a "right" in the great state of California, one of the largest economies in the world. This is their chance to show all the ignorant folk in the rest of the country how it's done...

Yes after state income tax is no longer a federal deduction.... Otherwise the rest of us will just continue to help pay for Cali profligacy.
 
Yes after state income tax is no longer a federal deduction.... Otherwise the rest of us will just continue to help pay for Cali profligacy.
If they can make it work sustainably, even with the tax breaks, that would be fine with me. But they can't and they won't. Instead they will make excuses about how other states and the Fed are sabotaging their noble efforts.

Socialism/communism only works when EVERYONE drinks the cool aid. In North Korea, for example - they live in a utopian paradise. You just gotta believe. Or else...
 
If they can make it work sustainably, even with the tax breaks, that would be fine with me. But they can't and they won't. Instead they will make excuses about how other states and the Fed are sabotaging their noble efforts.

Socialism/communism only works when EVERYONE drinks the cool aid. In North Korea, for example - they live in a utopian paradise. You just gotta believe. Or else...

id like to see how great the american economy would be without california. the make most of our food and have our best, legitimate export (hollywood). they are doing some things right...
 
id like to see how great the american economy would be without california. the make most of our food and have our best, legitimate export (hollywood). they are doing some things right...
I think its diversity, climate (weather), the fact that it faces Asia, and its long-standing market positions in technology and culture are what make it strong. But are those things the result of govt policies or are govt policies the result of those things?

Anyway, we agree they are strong and powerful. If they truly want universal, free, government sponsored healthcare, they have zero excuses. California has a larger economy than Norway or France or Canada. The only explanation for California not providing a better system to their people is that they don't have a practical, viable plan or are unwilling to make the sacrifices required to implement a plan. Californians need to put up or shut up.

Progressive should understand that empty platitudes are the enemy of their cause.
 


"On primary care, the Dutch require each citizen to register with a general practitioner, who often ends up acting as “gatekeepers” to more expensive care."
- basically, the whole country is a giant HMO system.


"In Australia, the public option, Medicare, does cover everyone, but with a few caveats. You may not be the captain of your own ship. “Your general practitioner (GP) usually determines what medical treatment you need to manage your condition and symptoms.” Suppose your GP thinks she can treat you herself? Another Marcus Welby. Who needs a specialist?
If your GP believes you do need to see a specialist, he will send a letter to the local public hospital, which “will be reviewed and assessed by the hospital.” This all takes time, and is only the beginning of the wait. “If the referral is accepted, you will be put on an outpatient wait list to see a specialist.”
You will then fall into one of three categories for your specialist consultation or elective surgery. If urgent, you will be attended to within 30 days. Of being added to the wait list, not from when you first saw your GP. Semi-urgent conditions have a wait list of 90 days and non-urgent problems wait up to 365 days."
- is this what you want for your family? semi-urgent care have to 3 months?


"The French healthcare system, legendary for its excellence, is about to become much more accessible and affordable to expats."
- com'on, you can find better articles than this one, even from huffpost!
 
Okay... FYI you won't like how the US ranks...

https://www.usnews.com/news/best-co...most-well-developed-public-health-care-system

U.S. Health-Care System Ranks as One of the Least-Efficient

Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally

In each of these studies, the US ranks below countries with public healthcare systems... I use France, Netherlands, NZ and Australia all as models with socialized medicine with better healthcare than the US...


Sent from my iPhone using SDN mobile
 
Okay... FYI you won't like how the US ranks...

https://www.usnews.com/news/best-co...most-well-developed-public-health-care-system

U.S. Health-Care System Ranks as One of the Least-Efficient

Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally

In each of these studies, the US ranks below countries with public healthcare systems... I use France, Netherlands, NZ and Australia all as models with socialized medicine with better healthcare than the US...


Sent from my iPhone using SDN mobile

Ranking really mean nothing if you don't control the variables. US as a nation is unique in every aspect, compared to other countries. For one thing we have huge amount of bio-diversity and cultural variation. Now if you take the healthiest ethnic group in US, and compare relevant metrics with country (Japanese American vs. Japanese in China, Chinese American vs. Chinese in China, Jewish American vs. Jews in other countries), you might not have this much variation.

Another huge difference is about life style management. We as a nation do very well with diversity of lifestyle. If cigarette smoking is outlawed in US, we would have much better score. If everyone is required to walk and ride bus to work, instead of driving, we'd probably have much less obesity-related healthcare expense.

These are just a few examples on a macro scale.

Then about efficiency, my high school history teacher once told us in the class, dictatorship is probably one of the most efficient political system, while democracy is definitely not. Well, look how efficient Hitler was to modernize Germany's military power before WWII, and then look again what dictatorship brought to the country.

Another point, I would argue, when it comes to service industry, especially healthcare, efficiency is on much lower priority list, compared to quality and access.

Lastly, on a personal level, have you actually personally experienced what's it like to try to get care in socialized medicine?

I have, and it's ugly.
 
you are attempting to justify the poor showing for the US healthcare system. almost none of your arguments are applicable when comparing the US system to the Australian model.

I am saddened that you had problems getting care in the past. imagine, however, that the only care you could get would be that which would lead to bankruptcy and make you have to declare financial insolvency.



on your other point, are you invoking Godwins Law.

Urban Dictionary: Godwin's Law
Argument closed.
 
you are attempting to justify the poor showing for the US healthcare system. almost none of your arguments are applicable when comparing the US system to the Australian model.

I am saddened that you had problems getting care in the past. imagine, however, that the only care you could get would be that which would lead to bankruptcy and make you have to declare financial insolvency.



on your other point, are you invoking Godwins Law.

Urban Dictionary: Godwin's Law
Argument closed.

Actually, there was no argument here. You might think we're arguing about the pros/cons of universal healthcare, I am not, actually. I'm just giving you counterpoints of your sited examples.

I don't even know what Godwins Law is and really care nothing about it. If my high school history teacher was able to figure out the efficiency has nothing to do with long term quality of a public health, I think you as a well-educated physician should understand it as well. So throw away nonsense online argument, get back on earth to think about what my high school teacher taught us.

Efficiency (or cost) has nothing to do with quality or access.

There's a golden rule I learnt in healthcare economy: there are three points in a healthcare triangle, cost, access and quality. You can maximize on two, but always sacrifice one.

Besides, I don't even think you even address my question, do you want your family, your 90 years grandmother, your 2 months newborn, in a giant HMO system? If you do, I rest my case, as we are definitely on different boat.
 
you are attempting to justify the poor showing for the US healthcare system. almost none of your arguments are applicable when comparing the US system to the Australian model.

I am saddened that you had problems getting care in the past. imagine, however, that the only care you could get would be that which would lead to bankruptcy and make you have to declare financial insolvency.



on your other point, are you invoking Godwins Law.

Urban Dictionary: Godwin's Law
Argument closed.
"Experts" and professor-types of the world who like to give political grades are naturally biased against a free-market. These folks believe in supervision and the echo chamber school of management.

Fareed Zacharia was on a few months ago with a few so-called "experts" and was pleading with viewers to use Canada as a "zhrole model" (sorry I mean that in good humor) to remake American health care. I see this palpable discomfort among liberals in actually leading the world. No matter how great our system is, forget the fact that every world leader who has a real challenging medical issue comes to Mayo or Cleveland, forget all that, we have to find someone's "report card" and go by that.
 
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