Personal Injury and/or Worker’s Comp Practices

[AlvinKamara]

What is unique about these practice models? I’m a current fellow and it seems as though these type of practices are almost frowned upon from the ivory tower fellowship attendings.

What is the workflow like for these patients? What are pitfalls of joining or partnering with a practice that sees a lot of these patients? Do these patients open you up to more litigation? Are the patients less motivated to get better? Is the medicine worse?

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[callmeanesthesia]

Are the patients less motivated to get better?

This is the root of the problem.

 

[AlvinKamara]

This is the root of the problem.

Outside of the professional satisfaction that comes from making patients feel better, any other things that suck about working at these kind of practices? The practice I’m thinking of joining already has their billing streamlined and has a good referral base. Just wondering if I’m gonna hate my life working at a place with these patients.

I personally don’t mind the idea of my patients not admitting to feeling better for a secondary gain. As long as I can do good work, practice good medicine, do right by my patients, and make a decent amount of money while doing it, I can sleep at night.

 

[Forwho]

Outside of the professional satisfaction that comes from making patients feel better, any other things that suck about working at these kind of practices? The practice I’m thinking of joining already has their billing streamlined and has a good referral base. Just wondering if I’m gonna hate my life working at a place with these patients.

I personally don’t mind the idea of my patients not admitting to feeling better for a secondary gain. As long as I can do good work, practice good medicine, do right by my patients, and make a decent amount of money while doing it, I can sleep at night.

let me rephrase your question: "i don't really care about patients or practicing sound medicine...i just want to rake in the money. but first...i want to know if this opens me up to legal issues while doing this? if not, i'm joining this practice"

hopefully this will get you the answers you're looking for

 

[SSdoc33]

Outside of the professional satisfaction that comes from making patients feel better, any other things that suck about working at these kind of practices? The practice I’m thinking of joining already has their billing streamlined and has a good referral base. Just wondering if I’m gonna hate my life working at a place with these patients.

I personally don’t mind the idea of my patients not admitting to feeling better for a secondary gain. As long as I can do good work, practice good medicine, do right by my patients, and make a decent amount of money while doing it, I can sleep at night.

this is not possible in a heavily comp-based practice.

you have to have the morals of a personal injury lawyer to make it work in the long term. if this guy is your alter ego, then go for it

 

[DubVille]

I'd rather make half my current salary than do 100% work comp if I had a decent mix of patients and potential to feel like I help people on occasion. 90% of the time it feels pointless with WC.

Goodluck, but sounds like a recipe for massive burnout to me, ymmv.

 

[Doctodd]

Here ya go….. I just received this from a recruiter. When I called, they have no interventional pain doc, but they have a C-arm. You have to commute to different offices every day. She obviously has no idea what traffic is like in Miami.


INTERVENTIONAL PRACTICE OPPORTUNITY
MIAMI, FL

• Longstanding multispecialty group #1 in their field of personal injury
• Growing practice with plans to open a 5th office
• Competitive salary with incentive and partnership potential

Practice Features:

• This group has been providing exceptional quality diagnostic and rehabilitative care services to traumatic injury victims throughout South Florida for almost 25 years. Their board-certified physicians, as well as licensed medical assistants, rehab nurse practitioner and physical and massage therapists, offer their patients coordinated, comforting medical care at their four facilities in Miami-Dade and Broward counties.
• Their physicians include a general physiatrist, 2 neurologists, a radiologist, and an orthopedic surgeon.
• This practice is #1 in their field with a foundation set upon a firm commitment to the highest standard of professionalism and ethics, as well as a determination to work with their patients to help improve their wellbeing.
• This group has forged a path to become South Florida’s premier rehabilitative medical provider with the use of its elite, cutting edge diagnostic and therapeutic systems which include a C-arm and MRI
• Divisions in neurology, orthopedic surgery and pain management.
• Continued growth and expansion with plans to open a fifth office

Responsibilities:

• Outpatient personal injury, mostly acute, little medications management, impairment ratings, initial history and physicals, final exams, EMG’s and nerve conduction studies, approximately 25 new consults per week, and about 30-50 follow ups/interims.
• Although they work closely with attorneys and patient representatives in relaying information on their patient's

relevant medical progress, their medical team and physicians still retain a majority of the oversight of the patient's course of care

• Travel to a different office/day within 20-30 miles of each other
• Visit each office once a week
• Procedures will be done 1 day/week by fluoro in the Hollywood office

Compensation:

• Competitive salary of $300,000
• Incentive and partnership negotiable

Benefits:

• Comprehensive to include malpractice, health insurance and more

Payors:

• Solely personal injury

Candidate
Qualifications:

• Board certified physiatrist who has medical-legal experience; Spanish ideal but not necessary; a team player with excellent interpersonal and communications skills

 

[Laryngospasm]

Lol salary of 300k competitive😂those guys will be making 300k a month off of you 🤣 Sounds good if you like being someone’s b…h

 

[MD87]

Outside of the professional satisfaction that comes from making patients feel better, any other things that suck about working at these kind of practices? The practice I’m thinking of joining already has their billing streamlined and has a good referral base. Just wondering if I’m gonna hate my life working at a place with these patients.

I personally don’t mind the idea of my patients not admitting to feeling better for a secondary gain. As long as I can do good work, practice good medicine, do right by my patients, and make a decent amount of money while doing it, I can sleep at night.

If you want to be an interventionalist, don’t bother. WC accounts for 15-20% of my patients. I’d like to think I’m ethical, and that 15-20% ends up accounting for only 5% of my procedures. Most either are not good candidates for procedures or don’t want them (10/10 pain but I don’t want a shot, just an FCE after 5 months). There are of course completely legitimate WC patients (unicorns, I saw one today, which was refreshing). Unfortunately this is usually less than 50% from my experience. Literally every study looking at the efficacy of various treatments excludes WC patients - and for good reason. I don’t know anyone who cares about being a good doctor that would take a job that is 100% WC.

 

[Laryngospasm]

WC mixed with PI.. the worst of everything

 

[A Deep Breath]

I’ve yet to find one of these practices where anyone but the owner sticks around. Instead, they seem to churn through new grads.

The salaries I’ve seen would be on the low end for a normal job. For your trouble, you get the aforementioned issues in this thread, an owner with no real interest in partnership, working alongside non-physician quacks, and often travelling all over the place throughout the week.

I’d love to learn about practices that prove me wrong.

 

[Bostonspine]

What is unique about these practice models? I’m a current fellow and it seems as though these type of practices are almost frowned upon from the ivory tower fellowship attendings.

What is the workflow like for these patients? What are pitfalls of joining or partnering with a practice that sees a lot of these patients? Do these patients open you up to more litigation? Are the patients less motivated to get better? Is the medicine worse?

I try to avoid personal injury but workers comp is pretty straight forward if you get them early… stats show 80percent of the problem are 20% of the patients… so I avoid that 20% and see the slow pitch underhand patients from the city, GE, hospital and other relationships I’ve build… every now and again a profession injuries patient sneaks in but they tend not to stay as I rearly make anyone totally disable and that reputation proceeds me

 

[AlvinKamara]

I try to avoid personal injury but workers comp is pretty straight forward if you get them early… stats show 80percent of the problem are 20% of the patients… so I avoid that 20% and see the slow pitch underhand patients from the city, GE, hospital and other relationships I’ve build… every now and again a profession injuries patient sneaks in but they tend not to stay as I rearly make anyone totally disable and that reputation proceeds me

What’s the concern with PI patients?

 

[AlvinKamara]

let me rephrase your question: "i don't really care about patients or practicing sound medicine...i just want to rake in the money. but first...i want to know if this opens me up to legal issues while doing this? if not, i'm joining this practice"

hopefully this will get you the answers you're looking for

I refuse to be made to feel guilty about considering the jobs that are available to me. The job market is crap in the area I’m in. I just want to know what I need to be careful of if I do take a job with heavy wc/pi. And I need the salary to pay off my loans and actually start my life after fellowship.

Unless you want to gift me some money so I can hold out for a job that suits your sense of nobility, please reserve your judgement.

 

[RoloTomassi]

I refuse to be made to feel guilty about considering the jobs that are available to me. The job market is crap in the area I’m in. I just want to know what I need to be careful of if I do take a job with heavy wc/pi. And I need the salary to pay off my loans and actually start my life after fellowship.

Unless you want to gift me some money so I can hold out for a job that suits your sense of nobility, please reserve your judgement.

WC and PI are very different, polar opposites I would argue, and wouldn't lump them together. And WC plaintiff and WC defense are very different. Need more details.

 

[Status Sciaticus]

300K in Miami might actually be worse than 300K in LA.
Somebody is getting played out of an extra 700K lol.

 

[AlvinKamara]

WC and PI are very different, polar opposites I would argue, and wouldn't lump them together. And WC plaintiff and WC defense are very different. Need more details.

I’m interviewing at a place that does a lot of WC. Another place that does a lot of PI.

 

[RoloTomassi]

What is the workflow like for these patients?

WC anything you order has to go through the adjustor for approval, which can take a long time and have a lot of pushback, require extensive conservative tx failure. You also have to do return to work forms, impairment ratings, IMEs, depos, case manager meetings.

PI you can generally do whatever you want with the limiting factor being the insurance policy of the at-fault party. Treatment is generally less restrictive than insurance/Medicare requirements. You will have depos.

What are pitfalls of joining or partnering with a practice that sees a lot of these patients?

WC heavy practice is almost always defense friendly, meaning you basically have to suck up to the insurance companies, and if you aren't very conservative and rack up big charges, they'll stop referring to you.

PI is the opposite, where you may have pressure from the plaintiff attorney to be more aggressive, depending on how unscrupulous.

Do these patients open you up to more litigation?

I don't think so.

Are the patients less motivated to get better?

WC yes they rarely get better. This can be draining.

Is the medicine worse?

How much you let someone influence your treatment is up to you but there is more pressure in WC to do less than there is in PI to do more. For instance you can pretty much never do an SCS in a WC pt if you don't want to be blackballed.

The thing is, if you're employed, the culture is already established and you will have to fall in line, so you're only autonomous to a certain degree.

 

[SSdoc33]

I refuse to be made to feel guilty about considering the jobs that are available to me. The job market is crap in the area I’m in. I just want to know what I need to be careful of if I do take a job with heavy wc/pi. And I need the salary to pay off my loans and actually start my life after fellowship.

Unless you want to gift me some money so I can hold out for a job that suits your sense of nobility, please reserve your judgement.

Ok. Just so I understand….

You have a crapton of loans and absolutely have to work in a certain area. Therefore, you well sell your soul to the highest bidder and practice crappy medicine and do what ambulance chasing lawyers tell you instead of what you learned in your 13 years of post high school studies. Got it. Good life choice

 

[Laryngospasm]

PI is often paid by the plaintiffs attorney and you often have to wait years for payment at they will try to get you to take less than the original fee. It’s all about getting the future “cost to treat” up high so they can maximize the settlement and then trying to pay you less. That’s why they will pay you 2k for an epidural. Some people don’t seem to understand how PI works.and that’s if you are lucky and are the one billing and not just taking a fee while the “owner” keeps the real profit.

 

[AlvinKamara]

Ok. Just so I understand….

You have a crapton of loans and absolutely have to work in a certain area. Therefore, you well sell your soul to the highest bidder and practice crappy medicine and do what ambulance chasing lawyers tell you instead of what you learned in your 13 years of post high school studies. Got it. Good life choice

Not highest bidders. Only bidders.

Again, if this bothers you, I’m happy to not work while I wait for a job and can send you an invoice of my CoL expenses which I’m sure you’ll be happy to cover for me.

 

[sloh]

Not highest bidders. Only bidders.

Again, if this bothers you, I’m happy to not work while I wait for a job and can send you an invoice of my CoL expenses which I’m sure you’ll be happy to cover for me.

Where’s your location?

 

[SSdoc33]

Not highest bidders. Only bidders.

Again, if this bothers you, I’m happy to not work while I wait for a job and can send you an invoice of my CoL expenses which I’m sure you’ll be happy to cover for me.

The world doesnt exist to hand you your perfect job.

You can choose to ignore the hundreds of years of collective wisdom of this group…. Or you might actually listen and learn something. Either way, I don’t GAF and will laugh at your COL expense sheet.

 

[PinchandBurn]

PI is often paid by the plaintiffs attorney and you often have to wait years for payment at they will try to get you to take less than the original fee. It’s all about getting the future “cost to treat” up high so they can maximize the settlement and then trying to pay you less. That’s why they will pay you 2k for an epidural. Some people don’t seem to understand how PI works.and that’s if you are lucky and are the one billing and not just taking a fee while the “owner” keeps the real profit.

Why do pi and WC attorneys want you to bill health insurance rather than hold your charges. I am told not billingnhealth insurance is usually better. But why

 

[Doctodd]

WC will not or should not tell you to bill health insurance because WC is insurance. WC pays more usually.

PI attorneys will want you to bill insurance because they pay less than usual and customary.....ALOT less. Then the attorney can use that as a precedent to pay any remaining balance. Usually the insurance company has a form they make the patient fill out saying this wasnt work or auto related, but that's it. However many of these patients dont have insurance at all.

 

[AlvinKamara]

The world doesnt exist to hand you your perfect job.

You can choose to ignore the hundreds of years of collective wisdom of this group…. Or you might actually listen and learn something. Either way, I don’t GAF and will laugh at your COL expense sheet.

I’m genuinely curious what you think I should do? Are you suggesting I not work? I’ve said multiple times in this thread these are the only jobs available in the area.

 

[SSdoc33]

I’m genuinely curious what you think I should do? Are you suggesting I not work? I’ve said multiple times in this thread these are the only jobs available in the area.

so, that certainly is possible, but it is also hard to believe.

there has to be some sort of local hospital that you can work for at least until you get your feet wet. depending on the situation, the hospital may be able to help with some of the loans. many hospitals have occurence-based malpractice, so you dont have to pay a tail when you leave. make sure there is no restrictive covenant and you can bolt whenever you want.

even better, if you know you have to be in a certain geographical area, contact the local ortho and/or spine groups. make yourself attractive to them. that is probably your best bet.

worse comes to absolute worse, you can work in your primary specialty for a while, whatever that is.

just b/c someone serves you a sh$t sandwich, doesnt mean you have to eat it

 

[sloh]

worse comes to absolute worse, you can work in your primary specialty for a while, whatever that is.

Just to play devil's advocate here, per this thread below:

Ability to do Bread and butter procedures coming out of fellowship

Current fellow here. 9 months in and starting to doubt myself on whether or not I know how to perform bread and butter procedures proficiently. Will struggle with the occasional LESI and even some lumbar medial branch blocks. Attendings don’t really give me a chance to correct myself and I...

forums.studentdoctor.net

If the OP works in his primary specialty after fellowship, won't he suffer extreme procedural skill atrophy, potentially wasting his fellowship?

 

[SSdoc33]

Just to play devil's advocate here, per this thread below:

Ability to do Bread and butter procedures coming out of fellowship

Current fellow here. 9 months in and starting to doubt myself on whether or not I know how to perform bread and butter procedures proficiently. Will struggle with the occasional LESI and even some lumbar medial branch blocks. Attendings don’t really give me a chance to correct myself and I...

forums.studentdoctor.net

If the OP works in his primary specialty after fellowship, won't he suffer extreme procedural skill atrophy, potentially wasting his fellowship?

probably.

when you limit your scope to a specific area and a specific type of job, it might not be possible to get exactly what he/she wants

 

[wendalltwolf]

Required reading for this kind of job?

 

[A Deep Breath]

I’m genuinely curious what you think I should do? Are you suggesting I not work? I’ve said multiple times in this thread these are the only jobs available in the area.

Piggybacking off of what SSdoc said, I'd be going to every entity that could possibly employ a pain doctor and your area to find out if they'd like to start a discussion. Just because a group doesn't have an advertisement up doesn't mean they wouldn't consider bringing in the right person with strong local ties.

From watching friends search for jobs, I can tell you that a common type of job is starting a pain division for some entity, such as a hospital system or a neurosurgery/ortho group. If you're an anesthesiologist, sometimes a group without pain will want you to start with a mixed practice, then transition to more pain as that practice builds up.

You could also start your own pain practice. Find some per diem work in your primary speciality. Save up some cash. Then build slowly.

Finally, I'd do some soul searching about your geographic restriction. Are there jobs with a longer commute you haven't been considering? Are there jobs where you could stay in a hotel for a few weeknights, then get back to your preferred location for long weekends? Is there another place you'd be willing to live for a year while looking for other jobs? Are you making assumptions about what the other humans in your life want and you need to open up a discussion?

Just to play devil's advocate here, per this thread below:

Ability to do Bread and butter procedures coming out of fellowship

Current fellow here. 9 months in and starting to doubt myself on whether or not I know how to perform bread and butter procedures proficiently. Will struggle with the occasional LESI and even some lumbar medial branch blocks. Attendings don’t really give me a chance to correct myself and I...

forums.studentdoctor.net

If the OP works in his primary specialty after fellowship, won't he suffer extreme procedural skill atrophy, potentially wasting his fellowship?

The thread you linked is about someone who doesn't feel comfortable with bread and butter procedures upon completion of fellowship, which is not normal. I predict someone could go years without "extreme procedural skill atrophy" after a pain fellowship, but I don't have anecdotal evidence to back it up.

I do know that people go years without practicing anesthesiology, then quickly get back into the groove. I know which one I'd be more worried about returning to after a break.

 

[MitchLevi]

Call all the local ortho and NS groups. They ONLY benefit from you.

 

[Ducttape]

I’m genuinely curious what you think I should do? Are you suggesting I not work? I’ve said multiple times in this thread these are the only jobs available in the area.

late to the convo, but does it not give you some concern that these are the only jobs aailable in the area?


odd, the doctors who were arrested and lost their DEAs from the florida pill mills said exactly the same thing you are stating... that they had tons of loans and these were the only jobs available.

whatever, find a job that will sit well with your soul - which appears to be any job. but dont expect any sympathy when you are out of a job because you decide you do not want lawyers to dictate your medical treatment.

 

[BobBarker]

Go work at a hospital in Iowa for 4 years