ancillary (non-bread&butter) procedures suitable for private practice?

[SMAS]

Hi all!

I've been a silent, but frequent observer of this forum for many years, and I really enjoyed many of your discussions! Eventually, I've decided to post a message, and ask for an advice. An experience from the practicing members would be particularly appreciated...

I am a young ENT specialist from the South-Eastern Europe, who recently finished my residency and started to work in a state-owned tertiary hospital. This is the most common pattern for young specialists to start, since majority of job opportunities are in hospitals. Namely, in my country there is a developed socialized medicine which provides good healthcare to all citizens, which works well for decades. So lot of people is used to this system, considering very unacceptable to pay for any kind of health service that they can reach in hospitals (especially seniors). Luckily, free market is humbly knocking at our doors, so in the last decade some private practices developed, yet most of them solo offices held by the older faculties with yearlong reputation. So, it is very hard to get any feedback about their organization and finances, while is rarely heard that someone young gets on the market…

I love my job, and I am dealing with an excellent caseload at my Department, but I am limited with my predetermined salary, no matter how hard I work and how many patients I see. So, what I am considering is a part-time outpatient private practice. But I will need to provide some ancillary procedures that would enable my exclusivity, since my serious limitations at current private market are very good services for most of bread&butter procedures (T&A, tubes, thyroid surgery, FESS etc.) that are people able to reach in hospitals for free.

So I would be very grateful if you can drop any thoughts on:

• Some non-classic (uncommon?) ENT procedures that helped some practitioners in the USA to build up a practice (I was thinking about snoring surgery, but I am concerned with low success rate with many patients. I doubt that anybody will spend money on a 50%-success rate procedure… What about pillars? They seem very suitable for private practice, but I don’t know much on them. Botox for headaches? Hair transplantation? Certainly, I strongly aim to fillers and plastics, but at this moment most of existing practices are streaming toward cosmetics, so this is probably the most competitive field…)

• Benefit of adding some of non-ENT procedures to the practice, like hair or vein-removal laser or similar?

Remember, I'll still do great ENT surgery at my hospital! So what I am looking for is one or few more exclusive procedures (preferably outpatient) which could help me to add on my basic salary. Please, don’t judge me - I think there is nothing wrong being young, ambitious and willing to go for an extra mile within existing environment…

I would greatly appreciate any help!!! resxn? TheThroat? neutropeniaboy?

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[neutropeniaboy]

I'm sorry, but I don't have any great ideas for you.

My academic practice is fairly limited. Fortunately, there is some incentive for working harder in terms of RVUs, publications, teaching, etc.

My initial thoughts would direct you toward cosmetic procedures, however. In the US, cosmetic procedures have suffered with the economy as of late, but perhaps in your country, this may not be an issue.

 

[resxn]

Pillars are a lucrative snoring procedure and work about 75% of the time to spouse's satisfaction when placing 4-5 implants. Going rate in my market is $1800US or so.

Other things that lots of ENT's do is allergy and hearing aid sales--don't know if those are covered by your system.

Other stuff: laser hair removal, botox, fillers, peels, setting up an aesthetician in your office. Working as the chief medical officer for a spa.

Way outside the box, there is a relatively large market for transgender laryngeal stuff--Thyroid notch removal and vocal fold tightening/shortening for higher voices. Once you open that door, however, you can't close it. I have a former attending who is now in his 50's that still regrets having done it in his 30's because although he hasn't done it in a decade, he still gets these patients seeking him out.

 

[SMAS]

Hey, resxn, neutropeniaboy, thanks for replying! I really appreciate your input!

Pillars are a lucrative snoring procedure and work about 75% of the time to spouse's satisfaction when placing 4-5 implants. Going rate in my market is $1800US or so.


Way outside the box, there is a relatively large market for transgender laryngeal stuff--Thyroid notch removal and vocal fold tightening/shortening for higher voices. Once you open that door, however, you can't close it. I have a former attending who is now in his 50's that still regrets having done it in his 30's because although he hasn't done it in a decade, he still gets these patients seeking him out.

75% success with pillars - this is already quite significant rate! Is it just success rate for selected groups of patients (like Friedman I and II tongue), or 75% in all with estimated component of palatal snoring?

And this laryngeal stuff - I remember that years ago while I was a resident - I stumbled upon one article about vocal fold "cosmetic surgery", but at that time they estimated that there are not so many patients... It was some article on the web, not a site for professionals. Is it really a relative large market?

And how do you perform it? How do you estimate the end result in terms of the voice pitch?

 

[resxn]

Hey, resxn, neutropeniaboy, thanks for replying! I really appreciate your input!



75% success with pillars - this is already quite significant rate! Is it just success rate for selected groups of patients (like Friedman I and II tongue), or 75% in all with estimated component of palatal snoring?

And this laryngeal stuff - I remember that years ago while I was a resident - I stumbled upon one article about vocal fold "cosmetic surgery", but at that time they estimated that there are not so many patients... It was some article on the web, not a site for professionals. Is it really a relative large market?

And how do you perform it? How do you estimate the end result in terms of the voice pitch?

As far as the Pillars go, 75% for the appropriately selected patients. The ideal patient has BMI < 30, does not have tonsillar hypertrophy, is a Friedman I or II, and the palate is not a thick muscular palate, but rather a longer thinner one. Additionally, the palatoglossal and palatopharyngeal arches are not overly prominent causing a narrow lateral dimension to the oropharynx. You don't need all of these criteria to meet the 75% chance of success, but the more of them you have the more likely the success is. I would say the BMI and lack of tonsils above 2+ are the most important features.

Can't really tell you about the laryngeal surgery. Removing the Adam's apple is quite obvious, but I am not up on the latest techniques in increasing vocal pitch, nor do I want to be.

From what I understand, because there are so few people doing it, the market is quite good. And it's cash pay, at least in the US, so that's always a good thing.