another job advice post (TIA)

[ScawtyDawg]

Hello SDN, long time lurker first time poster in this community. Current fellow with about 200k in student loans. Looking at a few jobs (all W2) that are all in decent locations and have a moderate cost of living, so these extraneous factors are all ~equivocal . Your advice is sincerely appreciated.

1. Large Hospital System Based
--position is open due to previous MD leaving. there is some room for negotiation
Pay: base 350k, ~$52/wRVU after 7000 (I know the latter isn't ideal)
Sign-on: ~20k
Referral base is from all over (high MME), largely PCP but no expectation to work for referrals
~20 patients/day, ~16 procedures/day (all advanced are approved) but done at HOPD
Excellent benefits package (401k 5% match, occurrence malpractice, health insurance, CME, vacation 4 weeks, etc), PLSF eligible
No Call; have 1 NP support for follow ups; 2-3 MAs assigned to each MD;
Practice currently has 1 MD, previously had 2. current MD has one procedure day per week (which I found odd)
Cons: questionable productivity as I don't have access to their RVU data (yet), has message baskets from direct patient messages through the app, technically do not make profits off the NP

2. Private Practice
--position open due to previous MD leaving. no room for negotiation
Pay: 300k base, keep ~45% after >500k net collections as bonus
Future ASC ownership potential. unclear partnership track (buy in: 375k)
Good mixed referral base (lots of surgical referrals, minimal MME), but expected to keep working on referrals
expect to build up to ~27 patients/day, ~20 procedures/day, probably at least 2 procedure days/week -- all in office procedures except what I choose to go to ASC for (all advanced approved)
Limited benefits (health insurance HMO, malpractice, 3 weeks vacation, no CME)
Technically pager call for own patients (but current MDs say it's nominal) ; no NP support; one MA
Cons: no sign on, PLSF, unclear partnership potential, must do some EMGs, no rad tech (MA moves c-arm), minimal mentorship

3. Large Academic
Pay: base 300k, ~$42/wRVU after 4200 -- no negotiating
Typical academic referral base (mild MME)
~20 patients/day, ~18 procedures/day (minimal advanced are approved) done
Excellent benefits package (401k 5% match, malpractice, health insurance, CME, vacation 4 weeks, etc)
PLSF eligible
Fellow is on call, attending as backup; some NP support for follow ups; 1 RN assigned to each MD;
4 day work week with resident and fellow help/teaching
Cons: hard to hit RVUs in this academic environment, has message baskets from direct patient messages, some really complex patients, some inpatient consult days spread throughout the year (~20 d) as attending for fellow

4. Small Private Practice
--position open due to growth/expansion, some negotiating potential
Pay: base 375k, keep 40% after 500K net collections as bonus
Partnership after 2 years (buy in: 50k) - will make profit off NPs
No current ASC (may have future plans for one)
Community referral base (very high MME), expected to keep working on referrals
Current MD has 4 NPs and now does 4 days/week of procedures while NPs see consults and funnel procedures
Offered similar set up: 4 days/week of mostly procedures and oversee NP consults -- all in office procedures except what I choose to go to hospital surgery center for
Good mentorship from this MD
Some opportunity for teaching rotating trainees/med students
Limited benefits (health insurance HMO, malpractice, 3 weeks vacation, no CME)
No call ; exclusively NP support (would be supervising at least 2 NPs); one MA assigned
Cons: no sign on, no PLSF, no rad tech (MA moves c-arm), very high MME (manage pumps), no ASC buy in

I have learned a lot from this community recently and really would appreciate your insight and opinions. If I left anything out please let me know. Thank you!

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[TheNolano]

Current fellow in a very similar spot. I defer to the wisdom of others but one point I am strongly weighing in my search is availability of mentorship/learning stuff I missed in fellowship.

The top job I am considering now is in a smallish town near where I am from though not a place I would choose to live. But it has a very well established private practice pain group with a pain doc I respect immensely who wants to pass the torch to someone new. They want to bring in someone they can mentor, show how they run their practice, and pass on their knowledge of some advanced stuff I don’t have in fellowship. To me, that mentorship is worth a lot and may make this less desirable area worth it.

Maybe I’ll feel differently at the end of fellowship, but I like the idea of having people to bounce ideas off of for the next few years. I would lean towards academics honestly for the chill job since the pay isn’t considerably less than the other private groups.

 

[Ducttape]

1. did you interview at these 4 spots, and which one made you feel most comfortable?
2. remember that your first job will not in all likelihood be the one you end your career at.
3. each job has its "issues".
for example
a. small PP - taking over pumps, high MME? also, sounds like a block shop. those are no go for me...
b. HOPD - why is other doc leaving? get details. will see a lot of ppl with multiple medical problems. only 1 injection day per week because the volume of healthy ppl with good spines will be low.
b. large academic - not a great place to learn procedure skills. you will be much better off starting somewhere where you get to do the procedure, not supervise someone else. will get difficult patients, patients that have already seen other docs, and inpatient care - unless you like - is tedious...
d. private practice - why did previous doc leave? more of a red flag than HOPD. seems like you would work hardest here, but without some guarantee of partnership, you could get chewed and spit out.


i am in HOPD practice much like 1.

its good for me because i am older, feel more realistic about what we do, and have had plenty of experience taking care of patients with multiple medical conditions. not sure it is the right place to start, however.

 

[GlowInTheDark]

The only benefit for taking a job with any large hospital system is if they have an established opioid Rx policy that doesn’t involve the interventional pain physician doing medication.

I would never take a job with a hospital system that wants me managing opioids and doing procedures. If I’m being asked to do that I would be in private practice where I can choose to not accept certain referrals.

For #4: I want nothing to do with pumps so that’s a no TY

I’m looking for lifestyle and doing what I enjoy, which is teaching. So academic job for me.

 

[drusso]

Go private practice, be your own boss, and never look back. Working as a cog in a machine for Big Hospital will morally harm you. Academic medicine is just a ponzi scheme.

 

[Ducttape]

private practice is not always being your own boss.
case in point, the 2 job offers scawtydawg listed above.

you mean "set up your own practice", right?

 

[LineEmTubeEm]

Piggybacking on this - what % of receivables/net collection and after what amount (500k? 1M?) is considered good or reasonable? I've been learning and researching the MGMA wRVU percentiles only to now learn that my employer will not use wRVU in my contract offer but rather net collections as a marker for productivity.

To give some more insight - the offer is for a high volume busy private practice (2 clinic days with about 10-15 patients per day and 3 procedural days with about 40 procedures each day) starting at a 400k base with 30% profit sharing after collections exceeding 1M

 

[RoloTomassi]

Piggybacking on this - what % of receivables/net collection and after what amount (500k? 1M?) is considered good or reasonable? I've been learning and researching the MGMA wRVU percentiles only to now learn that my employer will not use wRVU in my contract offer but rather net collections as a marker for productivity.

To give some more insight - the offer is for a high volume busy private practice (2 clinic days with about 10-15 patients per day and 3 procedural days with about 40 procedures each day) starting at a 400k base with 30% profit sharing after collections exceeding 1M

25 clinic visits : 120 procedures? Mid-levels doing all the procedure ordering? You are going to burn out doing 480 procedures/month for your employer

 

[Centurion38]

Likelihood of moral (and community) injury is much higher in PP

 

[LineEmTubeEm]

25 clinic visits : 120 procedures? Mid-levels doing all the procedure ordering? You are going to burn out doing 480 procedures/month for your employer

Yes, that count is about accurate. Midlevels see most of the follow-ups and add any additional orders. I realize the procedure numbers are high, but, that’s why I want to make sure that the compensation is appropriately equivalent. I may be naive, but not worried about burning out with those numbers yet. Will taper down to part time if I need to

 

[hyperalgesia]

I would test the waters with each of these jobs to see how open they are to you molding your practice to your preference.

For example, if the hospital system, which is not pressuring you to get referrals, is enthusiastic about you weaning/deferring all MMEs as you see fit, that would change the picture. However if any of these jobs has the expectation that you will assume the position as the new pill guy, that's a total deal breaker. Also, non-competes in the contract are critical, esp with your first job.

 

[MitchLevi]

120 procedures per week?

Awful.

If you care about your health at all you'd avoid that like the plague.

 

[IYKYK]

I'm a recent grad now working for someone in PP. My 2 cents, for the collections based model, find out if its % total collections or % collections after overhead is removed. If its the latter, then the guy you're working for will make more money per patient you see than you. 45% sounds great but not if its after overhead (had a few offers like this). 30-40% total seems reasonable.

Like everyone always says, your first job is usually not your last. You should aim for whatever will give you the highest leg up in life or with the next opportunity. Good mentorship is never a bad thing.

Again, I'm in my first job so take it how you like it, but thats my opinion.

 

[pastafan]

Beware any deal based on net collections because this can be manipulated. Take a lower percentage on gross collections.

 

[BobBarker]

Modified net collections works well.

It is gross collections minus the cost of braces, viscosupplements, kypho kits, etc. It doesn’t not deduct for the cost of staff, overhead, basic injection supplies and meds.

If you are getting 40% gross collections and you are injecting a lot of Monovisc then your employer would lose a lot of money and you would make a lot of money.

 

[ScawtyDawg]

Go private practice, be your own boss, and never look back. Working as a cog in a machine for Big Hospital will morally harm you. Academic medicine is just a ponzi scheme.

Which one of the PP options do you prefer?

The plot has thickened slightly as another PP option has emerged (ortho spine group). It is in less desirable city but with a similar CoL. Otherwise it seems to have a lot of potential?

5. Ortho Group
--position open due to expansion and another MD retiring
Pay: 350k salary for year 1 (no bonus), then year 2+ keep ~45% of net collections (other % goes to overhead essentially)
Future ASC ownership potential as well as partnership track (buy in: nominal and just keep collections - overhead ~50k/mo) however some current Pain MDs opted not to become partners as they make more with current structure and get better referrals this way
Good referral base (mainly spine surgical referrals, nominal MME)
expect to build up to ~32 patients/day, ~30 procedures/day, probably at least 2 procedure days/week -- all in office procedures except what I choose to go to ASC/hospital for (all advanced approved). likely 1 day/week of EMGs
Excellent internal mentorship
Limited benefits during year 1 (health insurance HMO, malpractice, 3 weeks vacation, no CME) and none year 2+ (other than malpractice)
Technically pager call for own patients (but current MDs say it's nominal) ; no NP support; one MA, rad tech
Cons: no sign on, no PLSF, must do EMGs, less desirable city, and I would imagine at least somewhat beholden to spine surgeons


Again, appreciate everyone's thoughts on this. Never thought making a attending job decision would be this tough lol

 

[ScawtyDawg]

I'm a recent grad now working for someone in PP. My 2 cents, for the collections based model, find out if its % total collections or % collections after overhead is removed. If its the latter, then the guy you're working for will make more money per patient you see than you. 45% sounds great but not if its after overhead (had a few offers like this). 30-40% total seems reasonable.

Like everyone always says, your first job is usually not your last. You should aim for whatever will give you the highest leg up in life or with the next opportunity. Good mentorship is never a bad thing.

Again, I'm in my first job so take it how you like it, but thats my opinion.

Excellent point that I feel needs to be highlighted. How the job defines "net collections" is critical, as is the actual timeline and payout of said collections. I have seen some language in contracts saying bonus is paid annually after calendar year terms only.

Example: 2 year contract. Start date is 8/1/24, then you would be eligible for bonus 1/1/25 (which you would likely not make) and again on 1/1/26 (which you likely will make, based off your net collections for calendar year 2025). But then when your contract expires 8/1/26 you are not given a bonus unless you are in bonus territory by that date, and then you may get paid on 1/1/27. However it seems to me it would be in the financial interest of the practice to not renew your contract to avoid having to pay your bonus (assuming you were close to making one).

Just playing devil's advocate as one of my mentors recently gave me the following advice:
Envision the most likely scenario, best case scenario, and most importantly worst case scenario of each job opportunity before signing.

 

[Agast]

Which one of the PP options do you prefer?

The plot has thickened slightly as another PP option has emerged (ortho spine group). It is in less desirable city but with a similar CoL. Otherwise it seems to have a lot of potential?

5. Ortho Group
--position open due to expansion and another MD retiring
Pay: 350k salary for year 1 (no bonus), then year 2+ keep ~45% of net collections (other % goes to overhead essentially)
Future ASC ownership potential as well as partnership track (buy in: nominal and just keep collections - overhead ~50k/mo) however some current Pain MDs opted not to become partners as they make more with current structure and get better referrals this way
Good referral base (mainly spine surgical referrals, nominal MME)
expect to build up to ~32 patients/day, ~30 procedures/day, probably at least 2 procedure days/week -- all in office procedures except what I choose to go to ASC/hospital for (all advanced approved). likely 1 day/week of EMGs
Excellent internal mentorship
Limited benefits during year 1 (health insurance HMO, malpractice, 3 weeks vacation, no CME) and none year 2+ (other than malpractice)
Technically pager call for own patients (but current MDs say it's nominal) ; no NP support; one MA, rad tech
Cons: no sign on, no PLSF, must do EMGs, less desirable city, and I would imagine at least somewhat beholden to spine surgeons


Again, appreciate everyone's thoughts on this. Never thought making a attending job decision would be this tough lol

The easiest way to evaluate the ortho group offer is to see what the retiring MD pain guy was making before he started dialing down his practice

 

[ScawtyDawg]

The easiest way to evaluate the ortho group offer is to see what the retiring MD pain guy was making before he started dialing down his practice

Thank you. I forgot to mention this. He told me collections were usually ~1.2m per year. He was a partner so minus overhead (50k/mo x 12 mo = 600k) he was getting paid 600k but with some additional partnership equity payouts and ASC shares dividends etc about ~700k total.

 

[LineEmTubeEm]

I'm a recent grad now working for someone in PP. My 2 cents, for the collections based model, find out if its % total collections or % collections after overhead is removed. If its the latter, then the guy you're working for will make more money per patient you see than you. 45% sounds great but not if its after overhead (had a few offers like this). 30-40% total seems reasonable.

Like everyone always says, your first job is usually not your last. You should aim for whatever will give you the highest leg up in life or with the next opportunity. Good mentorship is never a bad thing.

Again, I'm in my first job so take it how you like it, but thats my opinion.

It seems like collections are % total collections and paid out 28 days after the end of the applicable month

It is a high volume PP but the mentorship here will be second to none and I think it's a good way to continue learning under an umbrella after training

What is the average collections per year brought in by a pain doc? I saw MGMA wRVUs are around 7k but know nothing about collections. Is it 750k? 1M?

 

[GlowInTheDark]

Which one of the PP options do you prefer?

The plot has thickened slightly as another PP option has emerged (ortho spine group). It is in less desirable city but with a similar CoL. Otherwise it seems to have a lot of potential?

5. Ortho Group
--position open due to expansion and another MD retiring
Pay: 350k salary for year 1 (no bonus), then year 2+ keep ~45% of net collections (other % goes to overhead essentially)
Future ASC ownership potential as well as partnership track (buy in: nominal and just keep collections - overhead ~50k/mo) however some current Pain MDs opted not to become partners as they make more with current structure and get better referrals this way
Good referral base (mainly spine surgical referrals, nominal MME)
expect to build up to ~32 patients/day, ~30 procedures/day, probably at least 2 procedure days/week -- all in office procedures except what I choose to go to ASC/hospital for (all advanced approved). likely 1 day/week of EMGs
Excellent internal mentorship
Limited benefits during year 1 (health insurance HMO, malpractice, 3 weeks vacation, no CME) and none year 2+ (other than malpractice)
Technically pager call for own patients (but current MDs say it's nominal) ; no NP support; one MA, rad tech
Cons: no sign on, no PLSF, must do EMGs, less desirable city, and I would imagine at least somewhat beholden to spine surgeons


Again, appreciate everyone's thoughts on this. Never thought making a attending job decision would be this tough lol

Be cautious of joining what may appear as an ortho “gravy train”. If they’re going to treat you as the dumping ground for any failures or med patients be wary. Nothing worse than someone on opioids who had a borderline surgical indication that gets operated on and is suddenly your problem 4 weeks later.

 

[sdnuser001]

Which one of the PP options do you prefer?

The plot has thickened slightly as another PP option has emerged (ortho spine group). It is in less desirable city but with a similar CoL. Otherwise it seems to have a lot of potential?

5. Ortho Group
--position open due to expansion and another MD retiring
Pay: 350k salary for year 1 (no bonus), then year 2+ keep ~45% of net collections (other % goes to overhead essentially)
Future ASC ownership potential as well as partnership track (buy in: nominal and just keep collections - overhead ~50k/mo) however some current Pain MDs opted not to become partners as they make more with current structure and get better referrals this way
Good referral base (mainly spine surgical referrals, nominal MME)
expect to build up to ~32 patients/day, ~30 procedures/day, probably at least 2 procedure days/week -- all in office procedures except what I choose to go to ASC/hospital for (all advanced approved). likely 1 day/week of EMGs
Excellent internal mentorship
Limited benefits during year 1 (health insurance HMO, malpractice, 3 weeks vacation, no CME) and none year 2+ (other than malpractice)
Technically pager call for own patients (but current MDs say it's nominal) ; no NP support; one MA, rad tech
Cons: no sign on, no PLSF, must do EMGs, less desirable city, and I would imagine at least somewhat beholden to spine surgeons


Again, appreciate everyone's thoughts on this. Never thought making a attending job decision would be this tough lol

Is this W2 or 1099? No benefits and W2 sounds unfair

 

[pastafan]

Rare ortho group that doesn’t look down on everyone else. That said, local large group has 2 PMR interventionalists that are the top compensated in the entire group. This was told to me by a resentful orthopod in that group. I suspect they are spending all their time doing procedures.

 

[GoBeers]

Be cautious of joining what may appear as an ortho “gravy train”. If they’re going to treat you as the dumping ground for any failures or med patients be wary. Nothing worse than someone on opioids who had a borderline surgical indication that gets operated on and is suddenly your problem 4 weeks later.

In these scenarios, can't the pain doc just not prescribe opioids and have patient go elsewhere? at that point what does the group or orthopod care?

 

[GlowInTheDark]

In these scenarios, can't the pain doc just not prescribe opioids and have patient go elsewhere? at that point what does the group or orthopod care?

They care if their partner “refuses to take care of my patients”. It’s a dynamic you’ll never fully know until you work for/with them.

 

[MitchLevi]

They care if their partner “refuses to take care of my patients”. It’s a dynamic you’ll never fully know until you work for/with them.

I've never had that experience, in fact it's the other way.

 

[GlowInTheDark]

I've never had that experience, in fact it's the other way.

I certainly agree the chance of a good supportive group is high. Mainly written thing for the OP to be aware of when evaluating options.

 

[GoBeers]

They care if their partner “refuses to take care of my patients”. It’s a dynamic you’ll never fully know until you work for/with them.

that would be unfortunate.
but we all know "refusing to take care of patients" and "refusing to prescribe opioids" are completely different things.

 

[SeniorWrangler]

I would suggest not factoring partnership into your decision at all, assume that the job offer is the best they’re willing to do and it will never get better than what’s in the contract, and that way you can only be positively surprised.

 

[MitchLevi]

Rare ortho group that doesn’t look down on everyone else. That said, local large group has 2 PMR interventionalists that are the top compensated in the entire group. This was told to me by a resentful orthopod in that group. I suspect they are spending all their time doing procedures.

Makes no sense at all to me.

We have a total joint guy whose ASC receipts as of November are over 3.6M.

That's just ASC.

A large ortho group's payer contracts will virtually always skew towards the surgeries they do. I'm competitive in my group with regard to clinic collections, but I can't compete with our top earners.

It's crazy to even think I could compete with our hand/wrist guys, spine surgeons and our guys who only do totals and stack them on top of one another.

 

[cowboydoc]

Makes no sense at all to me.

We have a total joint guy whose ASC receipts as of November are over 3.6M.

That's just ASC.

A large ortho group's payer contracts will virtually always skew towards the surgeries they do. I'm competitive in my group with regard to clinic collections, but I can't compete with our top earners.

It's crazy to even think I could compete with our hand/wrist guys, spine surgeons and our guys who only do totals and stack them on top of one another.

I'm doing a bit better than half of what our busy total joint guys did. I would be in the 3rd quartile compared to the entire group of ortho surgeons. Not too bad for 4.5 days a week, no real call/nights/weekends.

 

[RoloTomassi]

I know two ortho groups locally, one where the top pain is top earner, and one where the top pain guy is above the 50%ile of orthos. I'm sure there's a lot of factors.

 

[Agast]

I know two ortho groups locally, one where the top pain is top earner, and one where the top pain guy is above the 50%ile of orthos. I'm sure there's a lot of factors.

They probably have in-house ancillaries and the pain guy does more PT and imaging referral, and/or they have a fluoro suite

 

[pastafan]

They probably have in-house ancillaries and the pain guy does more PT and imaging referral, and/or they have a fluoro suite

They have fluoro suite and fully owned ASC plus all ancillaries.

 

[bedrock]

Makes no sense at all to me.

We have a total joint guy whose ASC receipts as of November are over 3.6M.

That's just ASC.

A large ortho group's payer contracts will virtually always skew towards the surgeries they do. I'm competitive in my group with regard to clinic collections, but I can't compete with our top earners.

It's crazy to even think I could compete with our hand/wrist guys, spine surgeons and our guys who only do totals and stack them on top of one another.

Are those 3.6 millions his facility fees? Either way that is impressive. He must do a lot of you get commercial patients as Medicare doesn’t pay that well, and until January 24, you can’t do total shoulder arthroplasty in the ASC.

Regarding orthopedic specialties income, I clearly outearn our hand guy, foot/ankle, and joint guy.

Ortho sports medicine and ortho spine surgeon out earn me, but I’m in their ballpark.

 

[BobBarker]

Yea, office based pain should out gross ortho most of the time. By myself, I can collect office based around $3M a year. Seeing Medicaid/medicare/advantage mostly. No facility ownership.

 

[bedrock]

Yea, office based pain should out gross ortho most of the time. By myself, I can collect office based around $3M a year. Seeing Medicaid/medicare/advantage mostly. No facility ownership.

You are the man, collecting 3M seeing mostly federal insurance!
I came close to 2M several times in my first job (office based), a dozen years ago when we could still bill separate fluoro codes.

 

[callmeanesthesia]

Yea, office based pain should out gross ortho most of the time. By myself, I can collect office based around $3M a year. Seeing Medicaid/medicare/advantage mostly. No facility ownership.

That is an extraordinary volume. How many hours a week do you work?

 

[RoloTomassi]

Yea, office based pain should out gross ortho most of the time. By myself, I can collect office based around $3M a year. Seeing Medicaid/medicare/advantage mostly. No facility ownership.

What's your procedure volume?

 

[BobBarker]

Guessing around 80 procedures a week. Probably average 3 trials or kyphos/week cumulatively. They have the same financial impact after paying for the kypho kit. 7:30-4:00, no lunch.

 

[LineEmTubeEm]

Guessing around 80 procedures a week. Probably average 3 trials or kyphos/week cumulatively. They have the same financial impact after paying for the kypho kit. 7:30-4:00, no lunch.

Trying to understand the system better - if you applied that to every pain doc in the country, would their total collections be similar or is it very variable due to different reimbursements? Does it fluctuate by 100k or by 1M? What else does total collections depend on?

 

[nvrsumr]

That’s awesome need to step my game up.def don’t have 150 kyphos and trials a year.

 

[Agast]

Trying to understand the system better - if you applied that to every pain doc in the country, would their total collections be similar or is it very variable due to different reimbursements? Does it fluctuate by 100k or by 1M? What else does total collections depend on?

Bob is on the busier side of things. Not every doctor is that busy. That’s why the MGMA data, even if it’s a few years old, is important to understand.

 

[callmeanesthesia]

Guessing around 80 procedures a week. Probably average 3 trials or kyphos/week cumulatively. They have the same financial impact after paying for the kypho kit. 7:30-4:00, no lunch.

I do at least 80 procedures a week too, but my collections for just me for the year so far is about 1.5M. All our payors pay right around Medicare rates. I do way fewer clinic visits than you, but almost all in-office procedures (1 day a month at the ASC). Do you make that much off clinic visits to make up that difference?

 

[BobBarker]

Could depend on procedure mix? Bilateral RFA pays much more than a hip injection. If you do 15 bilateral RFA’s a week that is over $500k a year just with that procedure. You add in the medial branch blocks and clinic visits then that is $1M. But yes, clinic visits make plenty. Medial branch follow ups, RFA follow up, med refill, it all adds up.

 

[bedrock]

Could depend on procedure mix? Bilateral RFA pays much more than a hip injection. If you do 15 bilateral RFA’s a week that is over $500k a year just with that procedure. You add in the medial branch blocks and clinic visits then that is $1M. But yes, clinic visits make plenty. Medial branch follow ups, RFA follow up, med refill, it all adds up.

Very nice of Steve to do opioid CMEs for pain forum.

But I’d like to suggest that bobbarker do an online CME course for SDN in clinical practice and pain procedure efficiency.

I’d definitely sign up !

 

[BobBarker]

You are too kind. I just like running numbers. I think most physicians are not honest observers with regards to their practices. I don’t have any special contracts, or other magic up my sleeve. No facility ownership. No gc/ms machine. I just work probably the equivalent of 2.5FTE.

 

[DODOCSS]

You are too kind. I just like running numbers. I think most physicians are not honest observers with regards to their practices. I don’t have any special contracts, or other magic up my sleeve. No facility ownership. No gc/ms machine. I just work probably the equivalent of 2.5FTE.

Goats also help

 

[callmeanesthesia]

Could depend on procedure mix? Bilateral RFA pays much more than a hip injection. If you do 15 bilateral RFA’s a week that is over $500k a year just with that procedure. You add in the medial branch blocks and clinic visits then that is $1M. But yes, clinic visits make plenty. Medial branch follow ups, RFA follow up, med refill, it all adds up.

I guess it must be the clinic visits. All the easy follow ups and new patients go to my mid-levels. I do lots of RFAs, mostly bilateral. Usually at least 4 per day. Relatively few lower-reimbursing procedures like peripheral joints.

 

[BobBarker]

Correct, don’t delegate the easy work. I have my medial branch block follow ups as telemed and use macros to do the notes while we are talking. It is refreshing to get to talk to your successful patients as well.