Anesthesiology Pain Docs Switching to OR Anesthesia?

[Dawkter]

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In my region it seems as though many friends and colleagues trained in chronic pain are gravitating toward anesthesia only practices. Is this a trend across the nation? I assume this is motivated by declining reimbursements and increased insurance paperwork burden, but curious to hear others thoughts on this important issue.

This is a separate conversation from the decline in pain fellowship interest by anesthesia residents.

 

[IYKYK]

I don't think its a separate conversation. The reasoning is the same. All of the things you said plus Anesthesia pays more on a per hour basis right now, unless you own your own practice or are killing it.

 

[mdo1738]

I don't think its a separate conversation. The reasoning is the same. All of the things you said plus Anesthesia pays more on a per hour basis right now, unless you own your own practice or are killing it.

Agreed, the two go hand in hand.

 

[Dr. Ice]

Why listen to the whining when you can just put em to sleep..

 

[K-hole]

If I could find a gig that pays decent with no nights, call, or weekends I would jump back to anesthesia haha

 

[Ferrismonk]

It's simple. Anesthesia pay is up, pain pay is down. Anesthesia time off is higher. Anesthesia is less paperwork, pain gets more every year. Anesthesia doesn't deal with insurances (usually), and pain is getting squeezed by insurance companies.

 

[Laryngospasm]

Pain is being killled I believe intentionally. It’s pretty rough compared to 15 years ago. I do both and find myself increasingly doing more anes and less pain.. will switch back at some point.

 

[BobBarker]

Pain has some issues, I don’t disagree. But if you have the Auth process figured out and are willing to see patients (99214/g2211 pays well) then I don’t see how anesthesia pays more per hour. If you want to see a limited amount of clinic and do your procedures all in an ASC where you own a tiny percentage then I understand needing to get out of pain.

 

[IYKYK]

I fully agree. Most people are employed which limits you. Seeing return patients when you're wRVU based doesn't compare to anesthesia right now. The answer is to open your own practice, which is why I'm doing just that.

Side note, does G2211 only pay well in the HOPD setting or does it also work in PP?

 

[Laryngospasm]

Pain has some issues, I don’t disagree. But if you have the Auth process figured out and are willing to see patients (99214/g2211 pays well) then I don’t see how anesthesia pays more per hour. If you want to see a limited amount of clinic and do your procedures all in an ASC where you own a tiny percentage then I understand needing to get out of pain.

This is true.. a well run pain practice that is busy pays more than anesthesia. For now. However if you are hopd with poor patient population and crappy referrals and staff anesthesia pays more and allows more flexibility.. pick up some extra days and make a lot of extra money or sell some days and have an easy month. Also seeing 35 a day is getting old and only converting a small percent to procedures sucks too.
I’ve been waiting for pain to get better for a while now and while I appreciate that some of you have a great niche mine is not.

 

[mdo1738]

I fully agree. Most people are employed which limits you. Seeing return patients when you're wRVU based doesn't compare to anesthesia right now. The answer is to open your own practice, which is why I'm doing just that.

Side note, does G2211 only pay well in the HOPD setting or does it also work in PP?

I see a lot of return patients. 1 day of procedures a week and 3 days of clinic. 1400 RVU for this month. That handily beats anesthesia for me.

 

[Laryngospasm]

I see a lot of return patients. 1 day of procedures a week and 3 days of clinic. 4100 RVU for this month. That handily beats anesthesia for me.

So you made 300k this month? You are top 0.1%. 400 patients a week is a bit much for me.

 

[mdo1738]

So you made 300k this month? You are top 0.1%. 400 patients a week is a bit much for me.

Sorry major typo. 1400, not 4100. It certainly is a lot of work while at work. Anesthesia was a different type of hard work for sure. A less enjoyable hard work for sure, but I can certainly see the appeal if the local pain market is not great.

 

[Laryngospasm]

Sorry major typo. 1400, not 4100.

Still great.. congrats to you. I would love to have that kind of production

 

[Dr. Ice]

I see a lot of return patients. 1 day of procedures a week and 3 days of clinic. 1400 RVU for this month. That handily beats anesthesia for me.

How many procedures/day and clinic visits/day? I have that same breakdown and can get to 1k rvu/month but can’t exceed it

 

[mille125]

It's simple. Anesthesia pay is up, pain pay is down. Anesthesia time off is higher. Anesthesia is less paperwork, pain gets more every year. Anesthesia doesn't deal with insurances (usually), and pain is getting squeezed by insurance companies.

But for how long. I could be wrong but I don't think that current anesthesiology salaries are sustainable especially as hospitals start to get squeezed more.

 

[mille125]

This is true.. a well run pain practice that is busy pays more than anesthesia. For now. However if you are hopd with poor patient population and crappy referrals and staff anesthesia pays more and allows more flexibility.. pick up some extra days and make a lot of extra money or sell some days and have an easy month. Also seeing 35 a day is getting old and only converting a small percent to procedures sucks too.
I’ve been waiting for pain to get better for a while now and while I appreciate that some of you have a great niche mine is not.

Call sucks though...

 

[mdo1738]

How many procedures/day and clinic visits/day? I have that same breakdown and can get to 1k rvu/month but can’t exceed it

Recently it has been about 30 injections (usually at least 5 or more of these are bilateral RFA) and 35-40 clinic patients. Many times I will run over and do a kypho at noon on a clinic day.

 

[Laryngospasm]

Call sucks though...

Night call.. can be sold. Also plenty of surgery center jobs paying really well. Like 90th percentile pain well. No weekends holiday nights or call.

 

[Timeoutofmind]

I’m employed pain
15 minutes slots for clinic visits/injections (30 min for RF)
I don’t work at all outside the office, finish my note after each patient encounter
Make about $500 an hour (about 7.3rvu/hr, $70/rvu)

Anesthesia without any nights or holidays or weekends is not getting me $500 an hour

Also, I can takeoff whenever I want without having to coordinate schedules with a bunch of other doctors, etc.… close clinic early for my kids activities etc

 

[clubdeac]

I see a lot of return patients. 1 day of procedures a week and 3 days of clinic. 1400 RVU for this month. That handily beats anesthesia for me.

That’s insane. You must see like 35+ patients a day. 5 min visits I’m guessing.

 

[DOctorJay]

How many procedures/day and clinic visits/day? I have that same breakdown and can get to 1k rvu/month but can’t exceed it

I have 36 patient contact hours per week. my goal is to average 50 wRVUs per day with 3 days of procedures and 2 days of clinic (one half being ultrasound procedures, which i probably need to either decrease or become more efficient with - 15 minute slots).

so a 20 day month yields 1,000 wrvus. hard for me to do better than that. 35 days vacation plus the big holidays off.

 

[Dr. Ice]

I have 36 patient contact hours per week. my goal is to average 50 wRVUs per day with 3 days of procedures and 2 days of clinic (one half being ultrasound procedures, which i probably need to either decrease or become more efficient with - 15 minute slots).

so a 20 day month yields 1,000 wrvus. hard for me to do better than that. 35 days vacation plus the big holidays off.

Similar but 1 full procedure day and 3 clinic days, no midlevels. The months that I’m at 1k/month I feel like I worked a lot lol

 

[IYKYK]

What metros are you guys in? Noone around me is making $70/rvu.

 

[BobBarker]

1000 wrvu is less than 30 clinic visits per day for 16 days using the 2021 e&m wrvu values and some g2221 utilization.

If you “can’t” get 1000 then you need to examine the external and internal factors limiting you. Ultrasound unless it is just a rare one in clinic (like a bonus procedure) really limits your wrvu production.

 

[BobBarker]

Yes, bilateral lumbar RF on a grandmother snoozing on 1 and 1, can’t have a better yield for time and lack of stress.

 

[BobBarker]

I don’t understand.

 

[Status Sciaticus]

In my region it seems as though many friends and colleagues trained in chronic pain are gravitating toward anesthesia only practices. Is this a trend across the nation? I assume this is motivated by declining reimbursements and increased insurance paperwork burden, but curious to hear others thoughts on this important issue.

This is a separate conversation from the decline in pain fellowship interest by anesthesia residents.

Going through this dilemma myself. Currently looking at clinic spaces in a Texas major metro, but doing locums in the interim at $25,000/week. (50 hours + 1 weeknight call + occasional OT). Hard to turn that money down to make zero dollars knocking on doors to get referrals.

Pain has some issues, I don’t disagree. But if you have the Auth process figured out and are willing to see patients (99214/g2211 pays well) then I don’t see how anesthesia pays more per hour. If you want to see a limited amount of clinic and do your procedures all in an ASC where you own a tiny percentage then I understand needing to get out of pain.

How long till one can ramp up to that volume? Likely 2 years before getting that busy.
Skipping locums for that long is easily a 1.5M lost opportunity.

I see a lot of return patients. 1 day of procedures a week and 3 days of clinic. 1400 RVU for this month. That handily beats anesthesia for me.

I’m employed pain
15 minutes slots for clinic visits/injections (30 min for RF)
I don’t work at all outside the office, finish my note after each patient encounter
Make about $500 an hour (about 7.3rvu/hr, $70/rvu)

Anesthesia without any nights or holidays or weekends is not getting me $500 an hour

Also, I can takeoff whenever I want without having to coordinate schedules with a bunch of other doctors, etc.… close clinic early for my kids activities etc

How long till you guys got that busy?

 

[BobBarker]

@Status Sciaticus I have really never been in that situation. I had 13 visits my first day at the hospital and when I left the hospital, I was already a known entity and my private practice was 45 minutes away from the old practice. Sounds like a lot, but most of the patients were already coming to my new location to eat out and go to Sam’s Club or see other specialists once a month. So had plenty follow me initially. I can tell you that I could make more per hour with a remote VA, one MA, and a relative helping with the front desk seeing 3 patients an hour with no fluoro than most anesthesia jobs.

I did have a part time job that didn’t work out where I was collections only, I did no marketing for it, and I didn’t get any of the overflow from the partners.

99204/99214/g2211/joints/triggers/botox/DME all add up to a lot of you are in control and get all the collections.

 

[mdo1738]

How long till you guys got that busy?

About a year and a half

 

[po_boy]

I see a lot of return patients. 1 day of procedures a week and 3 days of clinic. 1400 RVU for this month. That handily beats anesthesia for me.

How did you negotiate 4 day work week as a 1.0 FTE?

 

[mdo1738]

How did you negotiate 4 day work week as a 1.0 FTE?

I didn’t negotiate it. The prior doc was doing 4 days (and there’s another 1.0 FTE doc doing only 3 days), my contract actually said 5 days but then the hospital themselves told me “hey, you can actually just do 4 days if you like”. I did like that idea.

For someone trying to negotiate that themselves, I would just point out that you could see, for example, 25 patients a day over 5 days or 31 a day over 4 days; seeing the same volume, but the hospital could reassign some of the other ancillary staff that other day you’re not in office. Present it as a cost saving option. Could also add that having an “administrative day” would make them more money, as it would give you time to do further administrative work to get denied procedures approved (“no matter what I do, WISER will deny 5 injections a week. This gives me time to get them approved so you can make a ridiculous $10k of facility fees you would otherwise lose.”)

 

[Dr. Ice]

This is correct. They don’t want to pay the docs but they also don’t want to pay staff. I’m 4 days/week. They prefer it that way

 

[hopefulgasman]

This is correct. They don’t want to pay the docs but they also don’t want to pay staff. I’m 4 days/week. They prefer it that way

This is also the case for me. I work 4 days a week 100% full time with no complaints, but also not by choice. I would not be able to work a 5th day because they can't and won't get or pay the nurses to come in an additional day.

 

[BobBarker]

Yes, they couldn’t have kept up with me ordering more procedures, and they would lose too much money if I was in clinic on Fridays seeing med mgmt mostly. Hence, 4 days a week it is. I tried to do a half day of procedures on Fridays at one point. It just resulted in doing the same amount of procedures and more time at the hospital.

 

[Dr. Ice]

I’m 4 days but I’m really 5, the two half days that I have, it’s childcare. Good times. Not like my colleagues playing golf and getting massages on their days off

 

[giddyup]

I did half and half when i was first out, but have been 100% pain for the last 7 years maybe. I'd be nervous to go back to OR, they are truly 2 different specialties and i would need a hardcore refresh and would want to do bread and butter only, no peds. i dont want to kill anyone's kid. call sucks and private practice pain is pretty good $ and flexible - take off when i want etc. i am certain i would not top what im making now, but i would have more time off. my friend is cardiac anes and gets 12 weeks and she doesn't even know what to do with them though...

 

[so55b]

I work at the pain clinic 4 days a week and I still do anesthesia a couple of Fridays a month just to keep my skills. I like my anesthesia days as I only do simple cases and patients are asleep and I play with my phone. I may fall back onto anesthesia when I become financially independent as I can do 1–2 week shifts a month and travel the rest of the time I have. I am also considering opening my own practice at some point and anesthesia will be good to do while my practice builds up to have enough volume. It is a good skill to have especially in the current job market.