Answer this poll honestly...
Started by drusso
0%. Market is on lock down with PCPs owned only by hospital systems
No independent PCPs
Wow...
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Just to be clear: There is patient demand, but there is a bottleneck in getting the patients. Is someone else "steering" those patients away from an aspiring private-practice doctor in your region?
Probably 70% or more. But it would be hard to be as successful as my current job, and almost impossible to reach that success without doubling how much I work.
yes the hopsitals keep referals in house. The large orthopedic group has a big marketing dept. A solo guy can;t compete unless you degrade yourself to do some tik tok shenanigans that may get some likes and followers and maybe go somewhat viral. Then you may have a chance
I think I could do it but I would have to advertise as being a one stop shop - come one, come all, to hyperalgesia's laser pain emporium. I could blanket the airwaves with ads, heavily market to pcps, etc.
do you know how expensive "blanket the airwaves with ads" is?
Yes because I already did it. Left job i didnt like because of PE. Restarted about 3 years ago. I make MGMA salary.
Caveats:
1) Need to be willing to get a loan/use capital.
2) Bad billing companies will retire you for good. Almost did me in. Another 6 weeks and it would have. It took me 2.5 years to get to current state. Bad billing company defiinitely prolonged it by at least a year.
3) You have to be willing to market.
4) You have to be able to leverage some of your previous referral sources.
5) You have to keep expenses down. Avoid extravagance and overstaffing.
If you are willing to drive an hour there are several small community hospitals that will support you and also defend you from competitors. You can do this to supplement if you are falling source.
With all of that said hanging your own shingle is not easy and not for the faint of heart. It is really hard work.
If you have limited capital to start, get a bad billing company, don't control overhead, and dont leverage previous relationships your chance of failure goes up exponentially.
Caveats:
1) Need to be willing to get a loan/use capital.
2) Bad billing companies will retire you for good. Almost did me in. Another 6 weeks and it would have. It took me 2.5 years to get to current state. Bad billing company defiinitely prolonged it by at least a year.
3) You have to be willing to market.
4) You have to be able to leverage some of your previous referral sources.
5) You have to keep expenses down. Avoid extravagance and overstaffing.
If you are willing to drive an hour there are several small community hospitals that will support you and also defend you from competitors. You can do this to supplement if you are falling source.
With all of that said hanging your own shingle is not easy and not for the faint of heart. It is really hard work.
If you have limited capital to start, get a bad billing company, don't control overhead, and dont leverage previous relationships your chance of failure goes up exponentially.
I dont see social media marketing as shenanigans. In today's world it is smart. I get 8-10 referrals from my website and just started a facebook marketing campaign last month. 4 patients have signed on for appts but I haven't seen any yet.
I agree that you as a solo guy cant do the same marketing spend as the big ortho groups, the PE backed practices, or the hospitals. You have to be smarter with your dollars but it can be done.
Hospital employed PCP here. Our in-house pain guys kinda suck. I refer to private groups way more often than our group.
What makes your in house group suck / what do you prefer about the private groups?
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Are you pressured to refer to in-house guy?
It’s not just pcps.. it’s the surgeons.. around here people refer straight to surgery.. hospitals have all the neurosurgeons.. they keep it in house.
100%, because I did it. I'm not making MGMA primarily because I intentionally limit my schedule to about 1/2 of what I could potentially do. After business expenses and health insurance, I make about $425k in a desirable area of my state. Practice revenue continues to grow year over year desite increasing competition. About 1/3 of my practice revenue is all cash services. I focus on improving that and avoiding work that doesn't pay fairly.
Probably worth noting that I don't rx opioids (although do rx tons of LDN), and reject patients from time to time, even from good referral sources, if they show evidence of being an undesirable in any way. Anyone who is uncooperative with my scheduler is DOA as far as I'm concerned.
Probably worth noting that I don't rx opioids (although do rx tons of LDN), and reject patients from time to time, even from good referral sources, if they show evidence of being an undesirable in any way. Anyone who is uncooperative with my scheduler is DOA as far as I'm concerned.
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Impact of prescribing vs not prescribing opioids would be its own good poll.
I recently changed jobs to start up a semi-rural non-opioid hospital-based clinic (in an area that was ravaged by heroin and fentanyl past decade) despite lots of warnings for other guys saying it wouldn’t work unless I prescribed opioids. Turns out that being non-opioid has been of specific appeal to many patients who came to me from other pain clinics. I still have a lot of work to do on clinic / OR efficiency etc to get more patients in, but with zero external marketing my new patient wait time are ~4 months out.
That said, it would be much more difficult in my area if I was private practice—primarily due to the costs of attracting/retaining decent staffing.
Why are you 4 months out? I see over 90th percentile of MGMA rvus and I am no more than 2 weeks out.
If you and the rest of your pain community are really over 4 months out on NPs, without looking at anything else I would argue that your area could easily support an independent pain doc.
If you and the rest of your pain community are really over 4 months out on NPs, without looking at anything else I would argue that your area could easily support an independent pain doc.
4 months out? Why? Just see more patients per day. Double book to account for no shows. Hint, it is 15-20% on mondays and 10% every other day with you doing your best to notify them.
I’m a month out and I’m hiring my third app to address this problem!
So there's 3 parts to it. One is a bunch of radiologists who you can basically place orders for them to inject whatever you want. I don't have the training to make that kind of decision. Could be ortho/neurosurgery use them to hard to inject places, which wouldn't be unreasonable, but I don't know for certain.
The second is a pain specialist who does procedures with that first group but is in an office by himself. I think he's actually pretty good (though doesn't do as many procedures as I'd like - never seen him do a RFA on anything ever), but patients really dislike him. Even the ones who just want injections don't like him. He will do opioids but has a pretty low ceiling which is fine with me.
Third is embedded in an ortho group. He's pretty good but just really lazy. Anything he can push off onto primary care he will. We're talking NSAID prescriptions, paperwork, PT referrals after the first one. Its irritating and somewhat insulting.
I like the private groups because a) if I send someone for pain in X area they take over everything for that joint: injections, medications, PT, handicap placards if they feel its warranted, and so on and b) patients generally like them.
my man!
**** rolls downhill. the guy probably has more patients than he knows what to with from ortho and doesnt feel like he "needs" to do anything extra. must admit, i dont Rx anything (essentially). and try to avoid as much paperwork as possible. if the PCP doesnt want to refer to me? shrug
You’re also admittedly a dick though, so there’s that
i dont disagre but my time is better spent seeing more patients, doing EMGs, and injections than titrating gabapentin or going over the risks of NSAIDs or filling out FMLA forms
sorry, but it is. this is why extenders exist
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Cool, then get one. Don't make your problem my problem.
My time is better spent getting people's A1c under 10, their blood pressure under 180, and their LDL under 200.
And in fairness, I've usually already done trials of most if not all non-opioid medications before I send someone to y'all unless I think they would benefit much more from procedural interventions.
That's why I don't refer to him anymore.
Plus, FWIW, its him and 2 orthos. I doubt they alone are keeping him that busy.
I give pts temporary work notes and restrictions and temporary handicap placards if needed for severe exacerbations or procedures.
If I were to offer permanent disability and handicap notes, I would become the "disability guy" and PCPs would not even have the discussion with pts, just refer to me for their disability paperwork.
I don't blame the PCPs one bit for referring to others who do these. I'm just not the guy.
See this could be fine. If you say "I understand you're still having pain but I don't think quitting work or getting a permanent handicap placard are going to be good for you", I'm 100% behind that.
This guy says (and I've seen it in his notes, not just 2nd hand from patients) that he "can't" fill out FMLA or handicap placards. Its that can't that pisses me off.
See, I’m going the other way here and encroaching on the PCPs’ turf directly. I got board certified in obesity medicine and just added an NP who’s doing medical weight loss, because the PCPs (mostly NPs and PAs) in my area aren’t doing it, or aren’t doing it well. I see multiple patients per week who should be on a GLP-1 and aren’t. Saw a lady yesterday with BMI 47 and severe knee OA, severe OSA and CPAP intolerant, lost 200 lbs with diet and exercise but plateaued. Not on a GLP1 but really wants to be. One this morning on 5 mg Mounjaro for T2DM. A1C good but still clearly weight to lose. Weight has been steady for months and they didn’t updose her.
I’ll do handicap placards where indicated, and short term disability where indicated. When they want me to fill out two pages on how much they can lift and how long they can walk or stand and blah blah blah, I tell them I can only fill it out with objective information from a functional capacity evaluation.
At the end of the day though, I’m pretty much what you’d call a block jock. I do mostly injections all day every day. I have 3 NPs who see most of my clinic patients. My schedule is still booked out several weeks for new patients.
Ugh I’m sorry you gotta deal with those other folks. The bar to cross to be helpful to you is so low lol.
You are the way. You are the light. You are the future.
I was sooo tempted to apply for your open position years ago, except for my fear of dying in a forest fire
I don’t do midlevels though, so I’ll always be “poor.”
I dont do midlevels in the conventional way. I see all new patients but I find them helpful on procedure followups and things like that.
Did they ask their PCP for help with weight loss? I'll be honest I don't typically bring it up unless they ask, mainly due to crap insurance coverage for the weight loss versions. I will increase doses for diabetics whose sugar is doing well but still obese, but recently I've started getting push back from insurance about higher doses with A1c of 5.2.
Yeah I hate those forms that require all that. I usually pawn those off on either occupational med or PT.
Some asked and were told no, some just weren’t being optimized.
So far today I’ve referred a patient to allergy due to multiple recent unexplained anaphylactic-like reactions, started a patient on estrogen patch due to untreated hot flashes, and ordered 2 screening DEXA scans.
If you are seeing the patient for the problem, you should fill out the form or tell them that they don't qualify (one or the other). I have no qualms about doing the latter. But if I put myself in their position, and I was truly injured, and my doctor agreed, I would hope that he/she would sign my FMLA form so I could try to get well. We should treat our patients as we would want to be treated.
ill do the paperwork if i think they are truly injured. MAYBE 5% of the time this is the case.
but i still put "unknown" when they ask when the pt will return to work or if they will need additional treatments or when they will feel better. i dont have a crystal ball
DrJekyllNj
Full Member
Unless you hedged by buying stock in health insurance companies, you lost because couldn’t keep your Dr and you couldn’t keep your plan. Concierge medicine is here to stay.
nothing wrong with that
