Unique Opportunity - Thoughts and Recommendations?

[PainAnonymous]

Hi everyone, I am a long-time member but wanted to make an anonymous post on this opportunity and get feedback/guidance.

I am currently a new fellow, but have had more experience (four months) rotating through our interventional pain program as a resident than any other person in the history of our program except our fellowship director. I am at my home institution and our large community hospital is being acquired by my academic institution. I am in a unique opportunity that is going through discussion right now to start a pain clinic at that hospital under the flag of our institution. I would be the sole physician of the clinic. The current leadership of the division, both anesthesia and pain departments, support this clinic being made under my operation. Facility is already set up with fluoro suites, MRI, and ORs. I'd also be able to offload the main hospital where we are already booking our interventional pain docs out by 3-4 months (hospital is a 30-45 min drive from main academic center).

Basically, I have potential with starting a clinic with my academic center at the large community hospital with no money investment from myself. Some major benefits to me are that it is in an area I want to live, its a hospital ive worked at as a resident and like the place, and I would be eligible for loan forgiveness (huge amount).

Right now I am putting together a package to present to the CMO of the hospital and working with the team with the merger. Preliminary is just to get the go ahead with this project. After that I'll need to submit what additional (if any services) I would supply (ie inhouse consults, pain emergency coverage, etc). I'd need to have a timeline and/or starting request for staffing, fluoro time, OR time, etc.

Thoughts on this opportunity? I want to make it work and be obviously beneficial. Happy to answer more direct questions and heed any advice from you wise sages.

Thank you for your time.

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[GlowInTheDark]

I’d model it as a watered down version of the main center. What you’re describing is a satellite clinic/an appendage off the mothership.

I would personally steer clear from setting yourself up as doing in house consults, do it wrong and they’ll abuse you. If you wish to provide that service set pretty specific guidelines…those consults are almost always primary team calling for you to bless them to discharge on opioids and then follow up with you.

Maybe consider setting up a potential mechanism to fast track appropriate ED patients with acute radic for you to treat same/next day.

What is a pain emergency? Sounds like something I don’t want to be involved in.

 

[BobBarker]

It is just going to be a standard rvu employee comp plan. Don’t overthink this. You don’t need to put a package together.

 

[PainAnonymous]

I’d model it as a watered down version of the main center. What you’re describing is a satellite clinic/an appendage off the mothership.

I would personally steer clear from setting yourself up as doing in house consults, do it wrong and they’ll abuse you. If you wish to provide that service set pretty specific guidelines…those consults are almost always primary team calling for you to bless them to discharge on opioids and then follow up with you.

Maybe consider setting up a potential mechanism to fast track appropriate ED patients with acute radic for you to treat same/next day.

What is a pain emergency? Sounds like something I don’t want to be involved in.

Yes my attending stated the same. If any consults it needs to be delineated on my schedule. Such as if you want me to do consults I do them Monday afternoon 1-4pm and consults need to be received before 12pm on Monday.

Pain emergency is because we do a lot of pumps at our institution but I’d negotiate fellow being first call for pump emergency or that they should be routed to the main for pump issue.

I’m leaning towards as a sole person there I need to focus on clinic, fluoro, and OR so those are just possible additions if required and need to be negotiated

 

[PainAnonymous]

It is just going to be a standard rvu employee comp plan. Don’t overthink this. You don’t need to put a package together.

I think currently since there is no pain physician there they might just continue without it. It’s more to get the cmo interested

 

[PainAnonymous]

How would I make it work for me taking vacation. Since I’ll have a staff dedicated to me? Or is that for the hospital To figure out

 

[BobBarker]

They make $700-2000 for every basic procedure you do. They make $500-2000 for every MRI you order. They make about $1000 off every PT referral. They are interested or ignorant.

 

[BobBarker]

You are going to have one MA and a shared receptionist with ortho to start with. You don’t need to worry about vacation.

 

[PainAnonymous]

Thank you both. For a four day work week would you start 2 clinic days 1.5 fluoro days and 0.5 OR days?

And staffing? One X-ray tech to start? Shared receptionist as stated. I’m guessing 1-2 MA and 1-2 nurses for procedures and follow up calls etc ?

 

[BobBarker]

2 days clinic, 3 days marketing. No procedures until week 4. Stop doing pumps. No consults.

Stop worrying about staffing. You are going to do these in the HOPD. They will have 13 staff members available. These things are not your problem.

You are going to be in a clinic seeing patients. You will put an order in for an ESI. The hospital will get auth. They will schedule the patient in a procedure suite or IR in a few weeks from your office visit.

 

[PainAnonymous]

2 days clinic, 3 days marketing. No procedures until week 4. Stop doing pumps. No consults.

Stop worrying about staffing. You are going to do these in the HOPD. They will have 13 staff members available. These things are not your problem.

You are going to be in a clinic seeing patients. You will put an order in for an ESI. The hospital will get auth. They will schedule the patient in a procedure suite or IR in a few weeks from your office visit.

Thank you

 

[PainAnonymous]

For compensation…. I’d want guarantee with rvu addition? That whole side is completely foreign to me since I’ve just been a resident/fellow for five years

 

[BobBarker]

Salary MGMA median. Bonus for each rvu in excess of median.

 

[Orin]

Ask them if they want to make money or help the health system. Then tell them they can do both by having you supervise an NP to do the inpatient stuff and help out in clinic while you crank procedures from the mothership.

 

[GlowInTheDark]

Yes my attending stated the same. If any consults it needs to be delineated on my schedule. Such as if you want me to do consults I do them Monday afternoon 1-4pm and consults need to be received before 12pm on Monday.

Pain emergency is because we do a lot of pumps at our institution but I’d negotiate fellow being first call for pump emergency or that they should be routed to the main for pump issue.

I’m leaning towards as a sole person there I need to focus on clinic, fluoro, and OR so those are just possible additions if required and need to be negotiated

Leave the pumps to the main center, that is fellow work. Consults at small community hospital is begging for abuse/stupid consults. If you’re seeing consults it is an absolute waste of your time. Even as a fellow out our major center we’d see consults within 24 hours. Weekend consults were chart review and phone call with primary team.

 

[epidural man]

do it until student loan repayments is exhausted.

 

[mdo1738]

No inpatient consults. No “pain emergencies”. No pumps. No midlevels. Plenty of great jobs out there that have none of these things, don’t willingly bring these things upon yourself.

 

[Laryngospasm]

No in inpatient. Mgma median guarantee for as long as you can get it. Loan repayment with as short of an obligation as you can get. No pumps. Mgma average per rvu above median. They deal with staffing. I would recommend minimum number of nurses guaranteed. Vacation at least 10 weeks per year available at your discretion.

 

[PainAnonymous]

Loan repayment will be due to PSLF of 120 (of which I'll have 60 after fellowship) qualifying payments. This will likely still be under the umbrella of Dept of Anesthesiology, so not sure I can command such a high salary and time off. That being said, all of our anesthesiologists get 1x Non-clinical Day a week (4x day work week)

 

[MitchLevi]

That being said, all of our anesthesiologists get 1x Non-clinical Day a week (4x day work week)

Everything has been said already, but don't take a weekday off. Your productivity will suffer more than you believe.

 

[RoloTomassi]

Put your staffing needs in contract

 

[PainAnonymous]

Everything has been said already, but don't take a weekday off. Your productivity will suffer more than you believe.

If there is no incentive? Just straight salary?

 

[MitchLevi]

If there is no incentive? Just straight salary?

Well...That's dumb. Why would anyone do that?

 

[PainAnonymous]

Well...That's dumb. Why would anyone do that?

If salary guarantee is good with a 4x day work week and potentially getting my 500k+ loans forgiven in 5 years... I would consider it.

 

[RoloTomassi]

What kind of straight salary are you thinking they would give you?

 

[PainAnonymous]

What kind of straight salary are you thinking they would give you?

No idea yet tbh. If straight under the academic contract around $375. For 4 day work week and ... for me... the PSLF continuation vs private would be a $600-700k untaxed bonus in 5 years..

 

[Ducttape]

rvu with base salary contract: ask for 50% MGMA as base salary. negotiate for 65$/wrvu when you get over median MGMA. negotiate for 2 years to reach the target of 50% MGMA.

request that they hire an APP as soon as you reach a set amount of wrvus per year - such as 4500 (which is not busy, but you are pushing the potential to really ramp up).

no non-compete clause in the contract if possible - i dont know if they have been all officially declared illegal... they will be hopefully soon in my state.


you dont have to negotiate the hours or days that you do. that is up to you. i would not be nitpicky about this aspect in your contract. that is up to your discretion.

you can ask for paid vaca and cme. but keep in mind with rvu contract, you can take as much or as little time as you want as long as you meet your rvu requirements.


and most importantly, after they give you the contract, have an attorney review it.

 

[PainAnonymous]

rvu with base salary contract: ask for 50% MGMA as base salary. negotiate for 65$/wrvu when you get over median MGMA. negotiate for 2 years to reach the target of 50% MGMA.

request that they hire an APP as soon as you reach a set amount of wrvus per year - such as 4500 (which is not busy, but you are pushing the potential to really ramp up).

no non-compete clause in the contract if possible - i dont know if they have been all officially declared illegal... they will be hopefully soon in my state.


you dont have to negotiate the hours or days that you do. that is up to you. i would not be nitpicky about this aspect in your contract. that is up to your discretion.

you can ask for paid vaca and cme. but keep in mind with rvu contract, you can take as much or as little time as you want as long as you meet your rvu requirements.


and most importantly, after they give you the contract, have an attorney review it.

Can you explain "negotiate for 2 years to reach the target of 50% MGMA?"

 

[mdo1738]

Can you explain "negotiate for 2 years to reach the target of 50% MGMA?"

That means negotiate for them to give you a guaranteed salary for 2 years, then after that you’re largely productivity based and need to be hitting the 50th percentile of RVUs per MGMA from a production standpoint. Productivity bonus beyond that level.

 

[MitchLevi]

No idea yet tbh. If straight under the academic contract around $375. For 4 day work week and ... for me... the PSLF continuation vs private would be a $600-700k untaxed bonus in 5 years..

No incentives leaves A LOT of money on the table.

 

[Ducttape]

it also allows you to request to maintain the guaranteed salary component if it turns out that there is a high proportion of poorly paying insurance patients (Medicaid, Workers Comp in some states).

 

[DrSpine]

This isn’t a unique opportunity. It’s a standard hospital gig. You’ll be compensated guaranteed for a year or two probably followed by purely wRVU.

 

[BobBarker]

it also allows you to request to maintain the guaranteed salary component if it turns out that there is a high proportion of poorly paying insurance patients (Medicaid, Workers Comp in some states).

Yes, didn’t realize how awful WC could be. Had a very difficult personality wise patient referred by NES for SCS trial. Got paid less than $1500. Really frustrating/disappointing.

 

[PainAnonymous]

This isn’t a unique opportunity. It’s a standard hospital gig. You’ll be compensated guaranteed for a year or two probably followed by purely wRVU.

Not sure I agree.. As it stands currently I'll be hired as a professor of anesthesiology and start this clinic at the other hospital. Whether that is good or bad I'm not sure. I am going to talk to them about some sort of rvu compensation. Right now its looking like just 4x days a week for a specific salary.

I am not sure if there are many of these jobs. I have over 500k in med school debt and 5 years away from PSLF. That is why I am considering this opportunity.

 

[bedrock]

Yes, didn’t realize how awful WC could be. Had a very difficult personality wise patient referred by NES for SCS trial. Got paid less than $1500. Really frustrating/disappointing.

How much were you expecting for an ASC trial?
Cigna pays about that and Medicare much worse.

 

[BobBarker]

I get $4000 for a Medicaid trial and usually around $3400 for a medicare trial in the office.

 

[bedrock]

I get $4000 for a Medicaid trial and usually around $3400 for a medicare trial in the office.

Damn, your state Medicaid pays a lot better than mine. Is that also for an office based trial?

Though I generally avoid stimming Medicaid patients to to 3x more drama, worse outcomes, and in my area they certainly don’t pay very well.

 

[lobelsteve]

Damn, your state Medicaid pays a lot better than mine. Is that also for an office based trial?

Though I generally avoid stimming Medicaid patients to to 3x more drama, worse outcomes, and in my area they certainly don’t pay very well.

One shot of depo and they are cured for years. No need for stim.

 

[GatorCHOMPions]

One shot of depo and they are cured for years. No need for stim.

Don’t you mean “cortisone”?

 

[BobBarker]

Yes, also office based for Medicaid trial. Medicaid patients here are the same as any other patient.

 

[MitchLevi]

Sorry to hear that Bob...I rarely do stim for WC patients, but we would expect higher collections than probably any other payer. Stim in a WC pt is doomed to fail. I usually just won't do it.

 

[nvrsumr]

4k a trial and I would have a closet of pointy shoes

 

[BobBarker]

Yea, no pointy shoes here. Lol.