10% cms bump for office 2026

[MitchLevi]

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Appreciate the suggestions. I do offer a few things he doesn't do. ganglion impar blocks, botox for migraine/cervical dystonia and he doesn't do any advanced, so that will all come to me (only 1 stim trial in the pipeline right now though).

We don't even have an US machine in office. They will buy one for me if I want it and can make the business case for it. As of right now, I certainly don't have the case for it. US injections don't pay well and I only have a couple of people who may or may not benefit from things like a suprascapular block.

The ortho guys in the group do PRP for joints.

I do have same day availability and it definitely does help.

At the end of the day, I'm definitely getting busier, it's just that I feel like it's taking longer than it could, or maybe simply longer than I would like.

In EM, I was the fastest doc in my group by a decent margin. In this job, I'm not only twiddling my thumbs, but I'm watching the existing pain guy continue to hustle like a madman and I wish I were closer to that. That said, I don't know that I'm ever going to be as fast as he is.

This week for example, his schedule is:
Mon: 58 clinic
Tues: 43 clinic and 55 injections
Wed: 66 clinic
Thurs: 66 clinic
Fri: 49 injections.

Mine for comparison:
Monday 19 inj
Tues 13 clinic
Wed 12 inj
Thurs 12 clinic then a kypho in the PM
Fri 18 clinic

I mean, this probably isn't bad for having started in Aug, I'm just bored out of my mind most of the time at this pace.

You'll pay for the US machine in two-three months. Every old person needs a knee, shoulder or GTB CSI under US at some point. You just have to ask what hurts and treat it. You're going to be much busier in the next 6M; you literally just started. Offering ganglion impar will not do much for you, and you'll do maybe 4-6 per year at the most.

Doing or not doing "advanced" procedures helps, but not as much as you may think. Bread and butter pays the bills and moves the line, not stimulators or MILD.

Give it time, you will be fine.

 

[Dr. Ice]

You'll pay for the US machine in two-three months. Every old person needs a knee, shoulder or GTB CSI under US at some point. You just have to ask what hurts and treat it. You're going to be much busier in the next 6M; you literally just started. Offering ganglion impar will not do much for you, and you'll do maybe 4-6 per year at the most.

Doing or not doing "advanced" procedures helps, but not as much as you may think. Bread and butter pays the bills and moves the line, not stimulators or MILD.

Give it time, you will be fine.

This..I just started in July. I’m not worried, agree with bread and butter. I did 20 stim trials last year with my old group at a failing asc and all I can say for it is my radiation numbers went up

 

[Taus]

This..I just started in July. I’m not worried, agree with bread and butter. I did 20 stim trials last year with my old group at a failing asc and all I can say for it is my radiation numbers went up

Now that I do a ton of kyphoplasty in office, I have added a lead skirt under the table, lead side shield, and only use live fluoro on tfesi, kypho, scs, pulsed mode on the latter

 

[BoardingDoc]

Just started in August??!! I think you’re doing just fine. Take the time to hone your skills, market, etc. not just your clinical skills, master your EMR, build up your templates/macros, review all the insurance LCD for every procedure, make those templates during your downtime at work instead of night/weekends.

Your partner’s volume is truly insane imho…. You sure there’s no mirrors covered in white powder lying around?

I am full of the gills, don’t see how I could do any more, with 22 to 23 clinic (half new consults) per day and 25-30 procedures per day (incl 2-3 rfa and 1-2 Kypho, rare scs). Three days clinic, two days per procedure per week. About 1/3 to 1/2 of my procedures are directly referred by my partners who did not do cervicals, rfa and some ESI directly from spine surgeons. I don’t take direct referrals for the bigger procedures (Kypho, scs, etc)… those all get full office consult by me first.

Good advice. A lot of that is largely what I've done already. I'm using athena which I'm familiar with from fellowship already. I have macros written for all of my procedures and authorization boilerplate for every major insurer that I have in the area for ESI/MBB/RFA/Kypho. Going to start having lunches with some area PT clinics as well as I've already hit up all the PCP offices in the area.

As for my partner's volume, yeah, it's utterly insane. I'm fairly certain that he's the busiest pain doc by volume in the state. He doesn't strike me as the nose candy type though. More boomer + self made immigrant, work yourself to the bone type combo.

 

[Agast]

You can’t discount the goodwill built up by being a community pain physician for years. He probably has a reputation that feeds him direct referrals. It takes at least 2 years to get that even if you’re a charismatic person.

 

[runfastnow]

For those of you consistently doing 30+ injections/procedures per day what is your room set up? Do you have a flip/multiple room or is it just injecting for 8-10 hours straight?

My current set up for in office procedures is: nurse runs C-arm and sets up bed/patient, I set up tray/inject, and MA has people in pre- and post-procedure. 15 minute ESI/SIJ/MBB, 30 min for RFA. Probably too long for SIJs and ILESIs but those give us time to catch up PRN.

 

[clubdeac]

For those of you consistently doing 30+ injections/procedures per day what is your room set up? Do you have a flip/multiple room or is it just injecting for 8-10 hours straight?

My current set up for in office procedures is: nurse runs C-arm and sets up bed/patient, I set up tray/inject, and MA has people in pre- and post-procedure. 15 minute ESI/SIJ/MBB, 30 min for RFA. Probably too long for SIJs and ILESIs but those give us time to catch up PRN.

I can only do 25 procedures in a day. That’s with one c arm, 2 Xray techs and 3 nurses. If I try to get them to be more efficient, I get complaints and nasty emails saying I’m creating a dangerous and unpleasant work environment 🤨

 

[stsa84]

I can only do 25 procedures in a day. That’s with one c arm, 2 Xray techs and 3 nurses. If I try to get them to be more efficient, I get complaints and nasty emails saying I’m creating a dangers and unpleasant work environment 🤨

I schedule 28, usually overbook to 30 or so. 15 minutes for everything. 1 rad tech, 1 RN making trays (I draw up my own for cervical), 1 MA charting and helping with room flow/turnover. We usually work steady for about an hour, get way ahead of schedule, then wait for 30 minutes for the next to arrive. I'd like to move to 10 minutes for all procedures except RF, with 20 minutes for that. But the rad tech would likely quit on the spot.

 

[clubdeac]

I schedule 28, usually overbook to 30 or so. 15 minutes for everything. 1 rad tech, 1 RN making trays (I draw up my own for cervical), 1 MA charting and helping with room flow/turnover. We usually work steady for about an hour, get way ahead of schedule, then wait for 30 minutes for the next to arrive. I'd like to move to 10 minutes for all procedures except RF, with 20 minutes for that. But the rad tech would likely quit on the spot.

Your staff seem more efficient and/or hard-working than mine. You’re lucky.

 

[po_boy]

Your staff seem more efficient and/or hard-working than mine. You’re lucky.

Fire them.

 

[BoardingDoc]

For those of you consistently doing 30+ injections/procedures per day what is your room set up? Do you have a flip/multiple room or is it just injecting for 8-10 hours straight?

My current set up for in office procedures is: nurse runs C-arm and sets up bed/patient, I set up tray/inject, and MA has people in pre- and post-procedure. 15 minute ESI/SIJ/MBB, 30 min for RFA. Probably too long for SIJs and ILESIs but those give us time to catch up PRN.

I'm not yet, as I've mentioned but the other pain doc here does 8/hr on average.
Injection happens, MA gets patient off the table and into recovery. Rad tech simultaneously changes the paper on the table and brings the next patient in. Doc is drawing meds at the same time. Injection happens. Rinse and repeat. I've seen him do 13 ESIs in an hour.

Things which help:
Room is extremely well organized. All meds are within arms reach and ready to go.
Every single patient has their kit prepped the day before and is lined up with their name on it. Open bag and shake out onto the field your spinal needles/syringes/18g/25g/whatever you need.
Rad tech is good at her job.
MA doesn't have people "take a minute to get your bearings" or anything. They immediately help the patient up and into the recovery room where they sit in a recliner for 10-15 min PRN.
If they're old and frail, the recliner gets wheeled to the room and they get plopped in and wheeled out.

 

[mdo1738]

For those of you consistently doing 30+ injections/procedures per day what is your room set up? Do you have a flip/multiple room or is it just injecting for 8-10 hours straight?

My current set up for in office procedures is: nurse runs C-arm and sets up bed/patient, I set up tray/inject, and MA has people in pre- and post-procedure. 15 minute ESI/SIJ/MBB, 30 min for RFA. Probably too long for SIJs and ILESIs but those give us time to catch up PRN.

HOPD: Circulating RN to connect the usually unnecessary BP cuff and pulse ox, and administers the IV sedation for the occasional patient that we do it for. Charts the unnecessary vital signs. X-ray tech for fluoro. My MA applies bandage after injection, cleans the bed, and runs the RFA machine. Another nurse transports the patient into the room and then back to postprocedure bay. One scrub tech drawing meds, another going back and forth to check-in making note of the actual patient order, helping open supplies, changing trash bag like 5 times a day, taking RFA probes to sterile processing, and other random tasks (the 2 scrubs trade places every 10ish injections). So overall it is me and 6 other people in the room. That’s about 4 more people than I would use if not employed at the hospital, but if the hospital is willing to provide them then I will certainly use them all. It is very easy to do 40+ in 7 hours with this set up.

 

[BobBarker]

I commonly do 25 in a morning. Just me and a MA running the c arm. The other MA’s do get the procedure patients back to the exam rooms closest to the procedure room and make sure we are doing the procedure the patient expects, blood thinners, etc.


Usually the MA cleans the bed as the first patient is exiting, loads the patient name in the c arm. Whoever is available grabs the next patient (sometimes me, sometimes the in room MA, sometimes the MA who is loading rooms and helping the other doctor with clinic). I open all of the trays, draw up myself. Nothing done the day before.

 

[stsa84]

I commonly do 25 in a morning. Just me and a MA running the c arm. The other MA’s do get the procedure patients back to the exam rooms closest to the procedure room and make sure we are doing the procedure the patient expects, blood thinners, etc.


Usually the MA cleans the bed as the first patient is exiting, loads the patient name in the c arm. Whoever is available grabs the next patient (sometimes me, sometimes the in room MA, sometimes the MA who is loading rooms and helping the other doctor with clinic). I open all of the trays, draw up myself. Nothing done the day before.

You're an absolute machine.

 

[MitchLevi]

Yall have too many ppl involved. You and an XRAY tech can do 20+ in an AM.

I do everything, including pulling the sheets off the table, getting the metal trays, setting up the room, dumping trash…

 

[SpineandWine]

It all depends on culture. I wouldn’t rock the boat as you’re building your name - go with flow until you’ve been there for a while

Last job, me and one MA did 30 patients.
This year, I have 3 check in staff, 4 nurses and an X-ray tech and we do 30/day in HOPD

 

[Taus]

Yall have too many ppl involved. You and an XRAY tech can do 20+ in an AM.

I do everything, including pulling the sheets off the table, getting the metal trays, setting up the room, dumping trash…

This. Me and an xray tech. One MA to get patients checked in and signed out after

 

[clubdeac]

Fire them.

I’m an employee and have no say and no power

 

[cowboydoc]

It all depends on culture. I wouldn’t rock the boat as you’re building your name - go with flow until you’ve been there for a while

Last job, me and one MA did 30 patients.
This year, I have 3 check in staff, 4 nurses and an X-ray tech and we do 30/day in HOPD

Skeleton crew! I have 2 nurses and a CNA in "pre-op" alone. There has to be at least 10 people clocked in most of the time.

 

[MitchLevi]

Wed AM I did two lumbar ILESI, a lumbar TFESI and a CESI from 0800 to 0820. That’s XRAY and me, an MA outside the procedure room.

 

[BobBarker]

Hospitals have as part of their overall mission to employ the community. Part of that is they need staff for call, part of it is the red tape they have created for themselves. I’m sure there is a pain doc at a hospital right now doing a hip injection under GA in an OR with the patient fully draped out, c arm covered, and the c armor installed in case he needs a lateral.

 

[buddababa]

Wed AM I did two lumbar ILESI, a lumbar TFESI and a CESI from 0800 to 0820. That’s XRAY and me, an MA outside the procedure room.

From 8-820 I barely have my patient on the table. Sigh.

 

[MitchLevi]

From 8-820 I barely have my patient on the table. Sigh.

The doctor sets the tone in the room. I am changing bed sheets, managing the trash, do everything. I have grabbed pts too. Help on/off table.

XRAY tech needs to put every name in the XRAY machine before the first pt walks in the building, we pull trays and prep them before the first pt even walks in the door.

Music playing in the room, talk about Netflix documentaries and be sociable, but never stop moving.

I am literally doing something at every second.

 

[clubdeac]

The doctor sets the tone in the room. I am changing bed sheets, managing the trash, do everything. I have grabbed pts too. Help on/off table.

XRAY tech needs to put every name in the XRAY machine before the first pt walks in the building, we pull trays and prep them before the first pt even walks in the door.

Music playing in the room, talk about Netflix documentaries and be sociable, but never stop moving.

I am literally doing something at every second.

I used to do that and apparently I got “too aggressive”. Staff complained stating I was hurting morale and hurrying everyone so I gave up. Can’t beat the corporate machine when you’re nothing more than a cog in the wheel

 

[MitchLevi]

I used to do that and apparently I got “too aggressive”. Staff complained stating I was hurting moral and hurrying everyone so I gave up. Can’t beat the corporate machine when you’re nothing more than a cog in a wheel

I get that, but in a PP ortho practice it’s just the culture I think. We’re an old fashioned practice too, established in the 1960s. I’ve had to fight to get certain things brought into the practice.

 

[Taus]

The doctor sets the tone in the room. I am changing bed sheets, managing the trash, do everything. I have grabbed pts too. Help on/off table.

XRAY tech needs to put every name in the XRAY machine before the first pt walks in the building, we pull trays and prep them before the first pt even walks in the door.

Music playing in the room, talk about Netflix documentaries and be sociable, but never stop moving.

I am literally doing something at every second.

This. Put the work in yourself and treat your staff very well and it makes it work. Be a dck to them and it does not. I buy them all lunch couple times a week, hang out and eat with them, give fat quarterly and holiday cash bonuses out of my pocket. Treat like friends/colleagues, part of the team, not servants. They all work their ass off for me, much higher volume than my partners, and don’t complain.

 

[Dr. Ice]

I’m actually impressed by the efficiency even though hopd in my setup. Procedures every 15 minutes, rf is upto the doc I chose 20 for unilateral 30 for bilateral. X-ray is solid. Helps me draw. She is constantly moving and quickly. It’s because it was a private group acquired by a health system so they kept the private practice efficiencies. I think honestly there was more wasted time in my private group previously.

 

[MitchLevi]

This. Put the work in yourself and treat your staff very well and it makes it work. Be a dck them and it does not. I buy them all lunch couple times a week, hang out and eat with them, give far quarterly and holiday cash bonuses out of my pocket. Treat like friends/colleagues, part of the team, not servants. They all work their ass off for me, much higher volume than my partners, and don’t complain.

I give cash as well. Come to my house each Dec and I cook for them or cater.

 

[callmeanesthesia]

I guess some of you must just be faster than me. I mean, I think I’m reasonably fast at procedures but 2 ILESIs are still probably going to take me 20 minutes (from first patient in to third patient in. No way I could do 4 in 20 minutes.

Overall schedule is M-Th 7-4, 15 minute lunch, and I try to avoid taking work home. I do often end up with a few notes to finish, referral to review, or prescriptions to send on Friday though. Mostly procedures, with one clinic visit per hour. I do have 1 full and 1 part time NP. One is excellent and sometimes I have to double check whether I wrote the note or she did; one is new and still needs a lot of training. I also accept direct injection referrals from my partners and a few surgeons in town. 15 minute regular procedures and unilateral RFs, 30 minute bilateral RFs, and 45 minute SCS trial and kypho.

I’m in private practice. I have 2 MAs in the room with me - one for c arm and one to drop trays and scribe. However, I am completing procedure notes and looking up the next patient (reviewing hx notes and if needed, looking at imaging) while they’re turning over the room. Sometimes also sign a few PT renewals, review a referral, etc during turnover. We have an HL7 interface set up between our PACS an EMR, so placing the billing code in the EMR and clicking a button sends it to the work list on the c arm. We drop trays from individual supplies, not pre-made trays (since I have that extra MA it doesn’t make financial sense to use trays for everything).

I know having NPs and direct referrals slows me down, because at least twice a day, I’ll change the procedure or change levels. And I introduce myself to each patient I haven’t seen before and at least get a brief history and review imaging.

Are you guys doing your notes later? Looking up patients ahead of time? Or do you just have a better memory than me? I’ve thought of dictating any variation to the template etc or writing on the paper schedule, and having my scribe put in the procedure notes later, but not sure if it’s worth it.

 

[Taus]

I guess some of you must just be faster than me. I mean, I think I’m reasonably fast at procedures but 2 ILESIs are still probably going to take me 20 minutes (from first patient in to third patient in. No way I could do 4 in 20 minutes.

Overall schedule is M-Th 7-4, 15 minute lunch, and I try to avoid taking work home. I do often end up with a few notes to finish, referral to review, or prescriptions to send on Friday though. Mostly procedures, with one clinic visit per hour. I do have 1 full and 1 part time NP. One is excellent and sometimes I have to double check whether I wrote the note or she did; one is new and still needs a lot of training. I also accept direct injection referrals from my partners and a few surgeons in town. 15 minute regular procedures and unilateral RFs, 30 minute bilateral RFs, and 45 minute SCS trial and kypho.

I’m in private practice. I have 2 MAs in the room with me - one for c arm and one to drop trays and scribe. However, I am completing procedure notes and looking up the next patient (reviewing hx notes and if needed, looking at imaging) while they’re turning over the room. Sometimes also sign a few PT renewals, review a referral, etc during turnover. We have an HL7 interface set up between our PACS an EMR, so placing the billing code in the EMR and clicking a button sends it to the work list on the c arm. We drop trays from individual supplies, not pre-made trays (since I have that extra MA it doesn’t make financial sense to use trays for everything).

I know having NPs and direct referrals slows me down, because at least twice a day, I’ll change the procedure or change levels. And I introduce myself to each patient I haven’t seen before and at least get a brief history and review imaging.

Are you guys doing your notes later? Looking up patients ahead of time? Or do you just have a better memory than me? I’ve thought of dictating any variation to the template etc or writing on the paper schedule, and having my scribe put in the procedure notes later, but not sure if it’s worth it.

I also take direct referrals and spend about 20 minutes per procedure day reviewing the cases in advance. Makes the day more efficient and also allows time to fix or clarify any issues/change procedure and get the prior authorization done for that.
I can immediately walk over to the next patient, know who sent them, know the exact injection, indication, blood thinner, allergy issues and a brief bit of their history to make it appear like I know what’s going on besides just to do the shot.

I also cannot really get more than four per hour done, five occasionally with an add-on is pushing it. Just me and rad tech in room and MA checking them in/out.
I book a full hour for Scs trial or kyphoplasty, which includes the time needed for the added prep, set up, cleanup, etc.

 

[Agast]

I like to be efficient when I’m doing procedures but I slow it down to talk to the patients before their injections. Small things like not appearing rushed or distracted, personally delivering post care instructions, are protective against law suits and negative reviews

 

[BobBarker]

I’m nice but don’t let them linger. My partner talks to them before and sometimes after. Our reviews are both excellent. I’m more likely to ask about if the fish are biting or if Jerry ever finished that deck, he talks to them about the procedure.

 

[giddyup]

For those of you consistently doing 30+ injections/procedures per day what is your room set up? Do you have a flip/multiple room or is it just injecting for 8-10 hours straight?

My current set up for in office procedures is: nurse runs C-arm and sets up bed/patient, I set up tray/inject, and MA has people in pre- and post-procedure. 15 minute ESI/SIJ/MBB, 30 min for RFA. Probably too long for SIJs and ILESIs but those give us time to catch up PRN.

procedure suite in office with its own waiting area, also 2 pre-procedure bays and 1 post op room for people who have prolonged recovery from vagal etc. LPN puts patients in pre procedure bays from waiting area and does pre procedure checklist and checks vitals. x ray tech cleans bed and linens, opens tray and needles/meds (puts meds in vial holder that i draw up) that are prepared in bins ahead of time. grabs patient. i have desk with 2 monitor setup in procedure room - can have all notes and imaging up. review my pre-procedure note when they are getting prepped. patient comes in room, we sign consent and answer Q, do injection, they go to waiting area for 10 more min and get scheduled for follow up, get discharge instructions, then leave. 5 slots per hour, everything is 1 slot except RFA is 2.

2 staff: LPN and XR tech

 

[No_Pain_No_Gain]

10 is the goal. im not sure that gets it done nowadays.

Do you really think you couldn't live off 10m in retirement? What are your expenses? My goal is ~4.5m. That will give us 180k/year which I think is probably much more than we'll actually need.

 

[clubdeac]

Do you really think you couldn't live off 10m in retirement? What are your expenses? My goal is ~4.5m. That will give us 180k/year which I think is probably much more than we'll actually need.

Agree, currently I think we could comfortably live on $150k/yr. If you need $400k/yr, you’re living excessively large

 

[Agast]

I wonder if living expenses typically go down when you’re retirement age. You probably don’t accumulate as much “stuff.”

Memory care costs $8-10k a month right now, though. You have to consider that one or both members of the marriage may require advanced health services. Unless there’s a huge advancement in Alzheimer’s treatment

 

[SSdoc33]

Do you really think you couldn't live off 10m in retirement? What are your expenses? My goal is ~4.5m. That will give us 180k/year which I think is probably much more than we'll actually need.

I don’t know

I know I just spent 8 bucks for a sprite for my daughter at dinner tho. Tax and tip puts that at 10 bucks. And I’m the a-hole bc I tell the wife she can’t have a sprite? But i digress

Use to think 10 would be plenty. But then I see that things cost twice as much now vs 3 years ago…. Not sure

 

[BobBarker]

We all have this distorted picture of what retirement and the need for funds looks like based on our current lifestyles. Are there some 80 year olds going to Europe or Australia for vacation? Yes. But that is the very rare exception for any retiree. Most are in normal homes that are paid off (can’t escape property taxes in OK or TX, big house has to be sold) and go out to eat at local spots a couple times a week. They stay home and watch TV 95% of the day. They eat sandwiches at home. They don’t have energy for much else. We are all going to be fine unless we have a troubled kid we support into their 50s. Which does happen, even to doctors. But hopefully not.

I know how to live comfortably on 1/20th my present income. It doesn’t include Botox, Kobe Bryant rookie cards, and a full gun safe though. But two of those things are easily sold and won’t depreciate.

 

[bedrock]

I wonder if living expenses typically go down when you’re retirement age. You probably don’t accumulate as much “stuff.”

Memory care costs $8-10k a month right now, though. You have to consider that one or both members of the marriage may require advanced health services. Unless there’s a huge advancement in Alzheimer’s treatment

Honestly, I wouldn't want to put my loved ones through that or live like that. euthanasia is better than that kind of life.

 

[BobBarker]

Yes, I agree but there is a tipping point where you know you are losing your mind, and have the autonomy to act on it, but it is such a narrow window that you miss your opportunity to act on it.

I have a pleasantly demented 70 something lawyer as a patient. He is perfectly comfortable misspeaking every sentence and letting his wife decide everything. I’m sure he still has a pleasurable quality of life.

 

[agolden1]

These threads are always fascinating. I'll throw mine in for comparison sake. Not baller territory.

Split anesthesia/pain practice in NE which presently trends more towards anesthesia. Hospital employed, academic-ish.

Usually 3-4 days a week doing anesthesia at level 1 trauma center with high risk OB and inpatient pain service. Cover inpatient pain 2-3 times a month. Usually out around 7-4 or 430 on non call days. One weekday overnight a month, one weekend call per month split in two 12 hour shifts. All in house. Can volunteer to work a 24hr shift on weekday calls for 5k. Mix of solo, CRNA supervision, and teaching residents.

1-2 pain days per week either seeing my own patients or supervising two fellows. No consistent days per week. Some days I might be in clinic Monday, Tuesday. Others might be Weds and Fri. It's random. Typically capped at 20 ish patient encounters or procedures if by myself, or with fellows its around 30 patients per day. 20 mins per procedure with 40 min RFA, 40 min new patients, 20 min follow up. No RVU component or bonus based on pain work, although I wish there was one. I've asked to be able to see/do more, but admin continues to decline for various reasons. Hours 7-4.

Base around ~580, 9 weeks of vacation. Can sell back days of vacation for 5k a piece. Work two major holidays (which I loath). Base pay goes up in a year after a little bit more service to the institution. I sell back vacation and work 24s regularly, so my take home is quite a bit higher.

There's a few HOPD pain jobs around which are full presently. I keep an eye on them hoping one day they'll decide to expand. A few private practices. One with partnership track that was unsustainable (salary 100k for two years seeing 40-60 per day) and another group that was full. Continue to keep an eye out for that baller gig. Uncertain I have the cojones to start my own for now.

 

[Agast]

My max capability at a surgery center is 20 injections/RFAs during a half day. And then I go home my back is so stiff, I need an RFA for my own facets :/

 

[painER]

When is everyone doing consents in their workflow and how to do this more efficiently? What slows me down the most is walking out of the procedure room to consent the patient, who of course has a million questions that may or may not be about the procedure.

 

[giddyup]

When is everyone doing consents in their workflow and how to do this more efficiently? What slows me down the most is walking out of the procedure room to consent the patient, who of course has a million questions that may or may not be about the procedure.

do the consent in the procedure room - have them bring the patient in the room and i do it in there. prior to this my LPN does a pre-procedure checklist with them and she can answer many basic questions so saves me time. this is in my office though - at surgery center its tougher

 

[Taus]

When is everyone doing consents in their workflow and how to do this more efficiently? What slows me down the most is walking out of the procedure room to consent the patient, who of course has a million questions that may or may not be about the procedure.

Patients I saw myself in the office… At that time. They just sign it the day of. Direct referrals, I go over it verbally with them immediately before injection and then they sign. I politely redirect them when they ask questions not directly related to the injection and tell them we can discuss that during the injection and while I’m getting things prepped, etc., as we have time then.

 

[clubdeac]

When is everyone doing consents in their workflow and how to do this more efficiently? What slows me down the most is walking out of the procedure room to consent the patient, who of course has a million questions that may or may not be about the procedure.

Have nurse do it during check in process. Most patients I’ve already gone over it ad nauseum in the office

 

[BoardingDoc]

When is everyone doing consents in their workflow and how to do this more efficiently? What slows me down the most is walking out of the procedure room to consent the patient, who of course has a million questions that may or may not be about the procedure.

Discussion of the procedure is had when I book them. They sign a consent form at the check-in desk the day of, long before I actually see them in the procedure room.

 

[Ducttape]

consent and skin marking done prior to procedure. procedure is discussed ad nauseum before, so most commonly just a formality.

procedures primarily in ASC. slow, cumbersome, too many people involved, they have specific rules they are required to follow to meet ASC standards

but its my fun day. 80s and 90s alternative, unless in the mood for 90s rap or motown (noone seems to like my ska playlist). talk sports, discuss newest tik tok craze, find out what patients want for breakfast, etc.

so i go with the flow.

and i dont need the extra radiation exposure. one of the local pain docs had to stop all procedures in part due to radiation exposure.

other days of the week, as a salaried employee, i am sitting around determining which social determinant of health to document or whether a long diatribe on obesity is of any value...

 

[buddababa]

The doctor sets the tone in the room. I am changing bed sheets, managing the trash, do everything. I have grabbed pts too. Help on/off table.

XRAY tech needs to put every name in the XRAY machine before the first pt walks in the building, we pull trays and prep them before the first pt even walks in the door.

Music playing in the room, talk about Netflix documentaries and be sociable, but never stop moving.

I am literally doing something at every second.

trust me i've done all that, including opening the kit, etc, however, working for HOPD as its drawbacks

 

[giddyup]

This. Put the work in yourself and treat your staff very well and it makes it work. Be a dck to them and it does not. I buy them all lunch couple times a week, hang out and eat with them, give fat quarterly and holiday cash bonuses out of my pocket. Treat like friends/colleagues, part of the team, not servants. They all work their ass off for me, much higher volume than my partners, and don’t complain.

what do you cash bonus them out of curiousity?