Future salaries for interventional pain management physicians

[Medman2737]

Greetings all,

I have to make my decision regarding fellowship soon and would like some real world advice from the attendings out there. I hate to be so blunt about this, but I do not trust the posted numbers I find on MGMA or Cjeka or others.


Given that healthcare "reimbursement" for what we do is on the decline, I would like to know what the attendings on the board feel that a hard-working pain doctor could be averaging in salary in the next few years.

I know the days of $500K+/year are over, but realistically what will it go down to if the cuts happen and the pieces fall where they may?

$350K/year? $300K/year? Less?

Please don't respond with the whole "standardized salaries across the board once we are totally socialized" canned response.

What salary should a (group pain practice w/ASC) IPM doc be making once the cuts are in?

Again, thanks in advance for any replies

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[Aether2000]

I do not believe there is any reasonable estimate that could be given. The variables that have not yet been determined include the continued acceptance of interventional pain procedures as effective and reimbursed and the levels of reimbursement for each procedure. Furthermore, there is no consensus on the indications for specific procedures as defined by insurers...

 

[drusso]

How hard to you want to work?

 

[Mister Mxyzptlk]

Let's see . . . Berwick at the helm of CMS . . . big admirer of Britain's NHS, which cut ESI's from 60,000/yr to 3,000/yr . . . factor in inflation . . . carry the "1" . . .

. . . According to my calculations, you'll make about $2,000/week, assuming 40 hours writing prescriptions at $50/hr. However, your employer will provide health insurance a la Obamacare, and a retirement package (bankrupt Social Security system, 100% vested after 7 years), plus 2 weeks personal time after the first 12 months.

Government-run, socialized pill mills.

 

[olafa]

you must have been a math major- sounds pretty accurate But I definitely don't like it!

Let's see . . . Berwick at the helm of CMS . . . big admirer of Britain's NHS, which cut ESI's from 60,000/yr to 3,000/yr . . . factor in inflation . . . carry the "1" . . .

. . . According to my calculations, you'll make about $2,000/week, assuming 40 hours writing prescriptions at $50/hr. However, your employer will provide health insurance a la Obamacare, and a retirement package (bankrupt Social Security system, 100% vested after 7 years), plus 2 weeks personal time after the first 12 months.

Government-run, socialized pill mills.

 

[axm397]

Depends on set up. If you do cash only pill mills or needle mills - if u live in an area where people are willing to pay cash, then you will be fine. If you plan on living in an area with a lot of competition you won't do well. If you work for the VA, kaiser, or any other big institution with salary, you can probably count on 150-200k/year. If you go academic, about the same or worse. If you go private, depends on payor mix. Reimbursement will probably continue to decrease, "elective" stuff will be cut first, and hospital lobbyists will probably get all procedures to be done at hospitals with fees that are bundled/capitated/etc. with more docs working for hospitals on a salary that will be high at first to lure them in then lowered as the hospital administrators try to take bigger chunks of the profit.

But this could be said for most "elective procedures" and probably also "preventive procedures".

 

[hyperalgesia]

I think around $200-250, working regular hours, with or without Medicare cuts. The way things are going, I really think the salary will eventually be determined by whatever the general public thinks we deserve. That may end up being $150 in the next 10-15 years. On the other hand, if there's a political revolution, Medicare could be abandoned along with the rest of the nanny state, the free market restored, along with the days when hard work and enterprise were handsomely rewarded. But don't hold your breath...

"The natural progress of things is for liberty to yield and government to gain ground." Thomas Jefferson

 

[PMR 4 MSK]

The way things are going, I really think the salary will eventually be determined by whatever the general public thinks we deserve. That may end up being $150 in the next 10-15 years.

Assuming you work 40 hours per week of billable time, that's about $75 /hour.

I'm not sure who you've talked to who isn't a doctor, but the average Joe on the streets think that the average doctor is waaaaaaaaaayyyyyyyy overpaid and $75/hour is outrageous, especially when he's working 50+ hours per week at the local factory for $15 - 20/hour. If the public had their way, we'd make probably 1/2 that if we were lucky.

The fact that you went to school for 12 years more than him does not matter. What does matter is supply and demand - big demand for doctors and small supply relative to that demand. As people become more responsible for a larger portion of their health care dollars, that demand is eroding, and with it, physician pay.

 

[lobelsteve]

Assuming you work 40 hours per week of billable time, that's about $75 /hour.

I'm not sure who you've talked to who isn't a doctor, but the average Joe on the streets think that the average doctor is waaaaaaaaaayyyyyyyy overpaid and $75/hour is outrageous, especially when he's working 50+ hours per week at the local factory for $15 - 20/hour. If the public had their way, we'd make probably 1/2 that if we were lucky.

The fact that you went to school for 12 years more than him does not matter. What does matter is supply and demand - big demand for doctors and small supply relative to that demand. As people become more responsible for a larger portion of their health care dollars, that demand is eroding, and with it, physician pay.

Lexapro 20mg po QD. Good luck.

 

[dc2md]

The income discrepancy between the specialty (PM&R, anesthesia, psych) and their pain-trained colleagues is equalizing; and with more scrutiny of interventional procedures, and decreasing reimbursement, the income will continue to equal out. If that depresses some people, Dr. Lobel has a prescription for you.

So then residents in those specialties will have to decide whether spending an extra 1-2 years of fellowship is actually worth it. If they want to do pain for the money, it probably isn't worth it. If they think the hours/lifestyle is better with pain, well, it probably isn't. But if you truly love treating patients in pain, and want to be that expert other MDs turn to to help with their difficult patients, they of course it's worth it.

 

[hyperalgesia]

As people become more responsible for a larger portion of their health care dollars, that demand is eroding, and with it, physician pay.

But when people were responsible for ALL their own healthcare costs, ie. before Medicare, Medicaid, employer provided HMOs, etc., physicians were respected and well compensated. Not that I was around back then... But it sure seems like all these contemporary brokers, public and private, that stand between the provider and patient and constantly assert their own importance and necessity, end up draining considerable resources.
Anyway, this is just my pointless rumination. Can you mix Lexapro with vodka?

 

[eljefe]

Slightly off topic, but got a head hunter letter for 700K+ in Iowa the other day for "interventional pain". What's the angle on these too good to be true offers? a) its BS, b) year 1 $$$ is great then they screw you once you are there, c) huge hours, d) you never leave the procedure room, e) all of the above.

Obviously if it was that great they wouldn't be sending these letters out all over the country...but loans would get paid back real quick with that kind of change.

 

[bronx43]

I think around $200-250, working regular hours, with or without Medicare cuts. The way things are going, I really think the salary will eventually be determined by whatever the general public thinks we deserve. That may end up being $150 in the next 10-15 years. On the other hand, if there's a political revolution, Medicare could be abandoned along with the rest of the nanny state, the free market restored, along with the days when hard work and enterprise were handsomely rewarded. But don't hold your breath...

"The natural progress of things is for liberty to yield and government to gain ground." Thomas Jefferson

Yeah, definitely don't hold your breath. The only good thing coming out of all this is watching the absurdly lucrative fields (radiology, radiation oncology, etc) drop down to reality.

 

[bronx43]

Slightly off topic, but got a head hunter letter for 700K+ in Iowa the other day for "interventional pain". What's the angle on these too good to be true offers? a) its BS, b) year 1 $$$ is great then they screw you once you are there, c) huge hours, d) you never leave the procedure room, e) all of the above.

Obviously if it was that great they wouldn't be sending these letters out all over the country...but loans would get paid back real quick with that kind of change.

Reading the fine print is key when you see those advertised jobs. There are many many horror stories out there about the devil being in the details.

 

[Tenesma]

those advertisements with HUGE salaries are primarily "fish & bait"....

when you call that recruiter, they will get ALL of your personal info and what you are looking for, and then tell you that that PLUM job has already been filled, but that they will help you to find a place....

this is just a way for recruitment firms to get your info and start pestering you.

as far as OP: if you work very, very hard in 3-5 years you would make about 350k/yr.... if you work avg you would make about 250-275k/yr...

dont go into pain medicine for the income --- anesthesia will be MUCH safer in 3-5 years from reimbursement cuts than pain.

 

[ostap747]

I disagree. If you have business sense, combined with decent physician skills, you will always be ahead of the pack, no matter what happens with our healthcare system. The problem with us is most of us have no business sense and are not actively looking for alternative revenue sources when govt./insurers push us around.

 

[Tenesma]

this has not much to do with business sense ... if you have an average practice where you aren't wasting overhead on overpaid staff or gold-plated faucets, you will still get stuck with lower payments - which in turn translates into lower incomes.... this will upset a lot of practitioners who will flock to becoming employees of larger institutions (i mean look at what happened with cardiac surgeons) - where their salaries will see little variability but won't have significant highs.

clearly if you are an entrepreneur and have ownership in sleep labs, diagnostic labs, imaging centers, etc... you will always be ahead...

however, comparing a physician to an entrepreneur is like comparing apples and oranges...

 

[hyperalgesia]

those advertisements with HUGE salaries are primarily "fish & bait"....

when you call that recruiter, they will get ALL of your personal info and what you are looking for, and then tell you that that PLUM job has already been filled, but that they will help you to find a place....

This happened to me. I called and, after getting all my info, the recruiter had no idea what job I was talking about. "I'm talking about the one that is still being advertised!". She didn't even wait for me to describe the ad. These guys are probably also calling practices to say they have a great candidate before they get any CVs.

In the tightly regulated healthcare environment, there's no way to make 700k to start out, unless you are dealing narcotics or in some kind of scheme. The money is just not available. Of course you can make that much money in business, anything is possible.

 

[Mister Mxyzptlk]

Hello Sir!

I am a pain doctor practicing in Nigeria and I am writing to see if you can help me deal with all the money my practice is making . . .

 

[lonelobo]

Hello Sir!

I am a pain doctor practicing in Nigeria and I am writing to see if you can help me deal with all the money my practice is making . . .

You don't by chance have a brother who is a lawyer there?

I sent $1000 and my checking acct info, but have yet to
receive the proceeds from the will settlement

 

[ostap747]

Tenesma, we are being forced to become enterpreneurs when Medicare or the Blues will pay $85 for us to put needles into patients' spines. I like what I do but the writing is on the wall, if you do not go outside the doctor box you will not make a living. I am switching to bariatric medicine, 5 minute visits, cash only !

 

[bronx43]

Tenesma, we are being forced to become enterpreneurs when Medicare or the Blues will pay $85 for us to put needles into patients' spines. I like what I do but the writing is on the wall, if you do not go outside the doctor box you will not make a living. I am switching to bariatric medicine, 5 minute visits, cash only !

Switching to bariatric medicine is still inside the doctor box. Cash only practices may be lucrative for awhile (if you can manage it well), but the problem is that the market will eventually even itself out, when more physicians enter said market due to lower reimbursement rates from private and public insurers. It's hard to swallow, but physicians' services are essentially commodities in the American health care system. Anyone with a MD can provide any type of medical service - as demonstrated by your switch from pain to bariatric medicine.

 

[Tenesma]

pls explain to me how bariatric medicine can be cash basis if you are contracted w/ their insurance co.? are you using non-covered CPT codes?

and how do you make a lot of money off bariatrics w/ 5 minute visits --- bariatrics requires a lot of counseling, psych issues, sleep issues, etc.?

 

[Finally M3]

Hello Sir!

I am a pain doctor practicing in Nigeria and I am writing to see if you can help me deal with all the money my practice is making . . .

If you could please email me your DEA and NPI number to help verify your practice address, I will send you a check for one-MILLION dollars*.

*Zimbabwaian dollars are worth something, no?

 

[ostap747]

That was a joke, but I do know a few practices that are essentially weight-loss medication dispensing mills that do not delve deep into social/sleep etc. issues, they do not accept insurance, cash only.

 

[lonelobo]

It is F-cking Great!

 

[emd123]

"The futures so bright, I gotta wear...shades."

 

[Ligament]

I agree with everybody that we are all FUXT, especially due to the tyrant Comrade Obama. If Billary gets elected, we are all RUINED. Thanks democrats!!!!!!

That said, I'd consider 250k/year to be "good money" in the next few years.

 

[clubdeac]

how about $400k

 

[emd123]

how about $400k

Yes

 

[chudat]

what kind of offers are current fellows getting this year?

 

[drubabe92]

Unbiased opinions on reimbursement now that Trump has been elected?

 

[willabeast]

Depends on set up. If you do cash only pill mills or needle mills - if u live in an area where people are willing to pay cash, then you will be fine. If you plan on living in an area with a lot of competition you won't do well. If you work for the VA, kaiser, or any other big institution with salary, you can probably count on 150-200k/year. If you go academic, about the same or worse. If you go private, depends on payor mix. Reimbursement will probably continue to decrease, "elective" stuff will be cut first, and hospital lobbyists will probably get all procedures to be done at hospitals with fees that are bundled/capitated/etc. with more docs working for hospitals on a salary that will be high at first to lure them in then lowered as the hospital administrators try to take bigger chunks of the profit.

But this could be said for most "elective procedures" and probably also "preventive procedures".

i beg to differ. no offense. i worked for Kaiser for 25 years, retired in 2016. i was making over twice what you said "you can probably count on 150-200k/year." in base full time pay when i retired, and now have a pension that pays 45% of my base pay along with continued lifetime medical and dental coverage. Kaiser is not for everyone, but financially it was one of the better decisions i made in my career. BTW i spent 5 years in private practice before joining Kaiser (actually called The Permanente Medical Group).

 

[drusso]

Post-Trump Election: A concierge/direct care practice with a careful mix of cash and commercial payers will still pencil out and offer RIO in terms of career satisfaction. Things will always be rough for those employed "doc in a box" in terms of having so many masters to please.

 

[deleted185747]

Working harder does not equal more pay. I worked for a guy for a year and saw more than 50 patients per day and was paid 40% of Medicaid so $12.60 for a 99213. The 50+ patients included about 15 in office procedures, again 40% of Medicaid.

When I took the job I thought I was going to see all types of insurance and get 40% of DME and UDT. Big fat wrong.

 

[drusso]

Working harder does not equal more pay. I worked for a guy for a year and saw more than 50 patients per day and was paid 40% of Medicaid so $12.60 for a 99213. The 50+ patients included about 15 in office procedures, again 40% of Medicaid.

When I took the job I thought I was going to see all types of insurance and get 40% of DME and UDT. Big fat wrong.

If you were an employee of the group then you couldn't be compensated by volume for DME & UDT due to Stark. Did you/your lawyer negotiate another kind of arrangement up front?

 

[deleted185747]

If you were an employee of the group then you couldn't be compensated by volume for DME & UDT due to Stark. Did you/your lawyer negotiate another kind of arrangement up front?

My arrangement was independent contractor.

 

[epidural man]

Greetings all,

I have to make my decision regarding fellowship soon and would like some real world advice from the attendings out there. I hate to be so blunt about this, but I do not trust the posted numbers I find on MGMA or Cjeka or others.


Given that healthcare "reimbursement" for what we do is on the decline, I would like to know what the attendings on the board feel that a hard-working pain doctor could be averaging in salary in the next few years.

I know the days of $500K+/year are over, but realistically what will it go down to if the cuts happen and the pieces fall where they may?

$350K/year? $300K/year? Less?

Please don't respond with the whole "standardized salaries across the board once we are totally socialized" canned response.

What salary should a (group pain practice w/ASC) IPM doc be making once the cuts are in?

Again, thanks in advance for any replies

300-350 seems reasonable.

 

[Lostin_space]

300-350 seems reasonable.

Obviously I'm not an attending and not in Pain, but this poster says the days of 500k+ are over. A number of jobs I've seen are offering that and more as partnerships. Im simply asking here - is that an unrealistic salary to expect these days? Are the 300's more the typical norm for pain docs?

 

[bedrock]

Obviously I'm not an attending and not in Pain, but this poster says the days of 500k+ are over. A number of jobs I've seen are offering that and more as partnerships. Im simply asking here - is that an unrealistic salary to expect these days? Are the 300's more the typical norm for pain docs?

most jobs offering 500k have something ethically wrong with the practice, either a block jock practice that does unnecessary procedures on patients or that's handing out opioids like candy.

There are no normal jobs offering 500-600K. You might be able at some normal practices to make that much if you work super hard, but any place that is so certain you'll make 500K plus they advertise it, is likely morally bankrupt.

 

[Lostin_space]

most jobs offering 500k have something ethically wrong with the practice, either a block jock practice that does unnecessary procedures on patients or that's handing out opioids like candy.

There are no normal jobs offering 500-600K. You might be able at some normal practices to make that much if you work super hard, but any place that is so certain you'll make 500K plus they advertise it, is likely morally bankrupt.

Ok. So even as a partner 500k or so is unrealistic is what you are saying? What is a normal partner salary?

 

[101N]

There was a very well known physiatrist who used to boast that any PM&R/Pain doc worth their salt should easily make $750K/yr. He is soon to be going to jail.

If you want data on salaries find the MGMA data for the region you are interested in. Folks who at the high end of that are usually doing something unethical/fraudulent: over-prescribing opioids, over performing procedures, over utilizing UDS labs that they have a stake in. No, Lostin_space, there is no Santa Claus.

 

[Lostin_space]

There was a very well known physiatrist who used to boast that any PM&R/Pain doc worth their salt should easily make $750K/yr. He is soon to be going to jail.

If you want data on salaries find the MGMA data for the region you are interested in. Folks who at the high end of that are usually doing something unethical/fraudulent: over-prescribing opioids, over performing procedures, over utilizing UDS labs that they have a stake in. No, Lostin_space, there is no Santa Claus.

Ha, yeah I know there's no Santa Claus. Trust me that I'm not assuming pain docs are making a million plus like a lot of people say. And yes I know there are lots of unethical practitioners out there. Just thought that it was realistic to make more than in the 300k range.

 

[BobBarker]

I don't think there are many jobs that will guarantee greater than 400k period, ever in private practice. Nobody is that certain that the new guy won't be a lard ass, and take 40 minutes for a trigger point. A hospital would be willing to take the plunge as they know that will do well off the MRI's and hopd fees even if the physician isn't paying his own way with professional fees for the first year or two. But there are great jobs out there... I would talk more about it in the private forum.

 

[Lostin_space]

I don't think there are many jobs that will guarantee greater than 400k period, ever in private practice. Nobody is that certain that the new guy won't be a lard ass, and take 40 minutes for a trigger point. A hospital would be willing to take the plunge as they know that will do well off the MRI's and hopd fees even if the physician isn't paying his own way with professional fees for the first year or two. But there are great jobs out there... I would talk more about it in the private forum.

Yeah i'm not talking necessarily starting salary, but long term partner type salary. I would not expect 500k or something like that to start off, but I was under the impression that was an avg partner salary in say 5 years post fellowship or so. Maybe i'm wrong

 

[BobBarker]

yes, that isn't an unrealistic number at all.

 

[EtherBunny]

Obviously I'm not an attending and not in Pain, but this poster says the days of 500k+ are over. A number of jobs I've seen are offering that and more as partnerships. Im simply asking here - is that an unrealistic salary to expect these days? Are the 300's more the typical norm for pain docs?

I think it's highly dependent on location and practice setup, quite frankly. If you go to the South and Midwest, the income potential is substantially higher than highly saturated areas in the Northeast and West Coast. I know plenty of pain physicians in the South and Midwest who earn well above the figures in this thread, and they're not unethical. All of them have access to ancillary revenue streams and have equitable partnership in group practices though. I wonder if the low figures on this thread are more representative of practice settings on the West Coast and saturated locations in the Northeast (Boston, NYC, DC, etc.), or perhaps early career salaries in employed settings like Kaiser???

As for the future of salaries for interventional pain--nobody knows. So many factors are at play right now that it's literally impossible to predict. Just take the Trump factor as an example: we have NO IDEA what impact this will have on health care economics as a whole and the field of interventional pain, in particular. What if a completely different model of healthcare is implemented during his presidency? What if Medicare is privatized? What happens if the insurance industry gravitates towards catastrophic care/high deductible plans and reliance on HSA accounts? What about the rise of "direct pay" practices in primary care? Will this work it's way into other specialties, including interventional pain? What's going to happen with the intense focus on the "opioid epidemic" and increasingly strict regulation of prescription opioids? Will the pendulum swing away from reliance on opioids and more emphasis on interventional treatments? Who knows.

I wouldn't worry about it.