block jocks

[blokjok]

Hi
I want to start a thread to share experiences among guys like me who perform mostly injections. I do only epidurals, RF an discograms. On very few occasions prescribe opioids (mostly to older patients). 85% of my patients do great and love me. The PCP's trust me for any interventional spine procedure, they hate local pain docs who only want to do pumps and stims. Vertebro and Kypho's go to the NS who refer me back all their patients. Complex patients go to the comprehensive University Rehab Pain Center. Schedule 8-5 . Last year made close to 2M.

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[Aether2000]

So what is your point? You can be a technician and make $2,000,000 a year while telling patients who need a doctor to manage their pain to go elsewhere? What does "85% do great" mean? What outcome study diagnostic testing are you using to define "great"? How many visits do you see them back after the invasive procedures to assess "great"?
Grrrrrrr.....

 

[Tenesma]

blockjocks are doctors too... just look at interventional radiologists...

 

[Aether2000]

lol...my point exactly...

 

[Doctodd]

Since we are all into evidence based medicine, how did you reach 85%?

T

 

[Tenesma]

it is funny how every practice has this high success rate... but nobody can publish it in the literature... and how do discograms help people?

 

[Doctodd]

it is funny how every practice has this high success rate... but nobody can publish it in the literature... and how do discograms help people?

On another note, i dont like doing pumps and stims. I can relearn how to do them if it is absolutley necessary in the future. But i dont enjoy doing them, so id much prefer doing perc discs and RF.

I envy the financial success the OP is having though. If he is enjoying it and helping people at the same time, then kudos. I hope to build as successful a practice too, and helping people is what makes me sleep at night. I dont think the tone of the OP was to gloat or brag. And i meant no harm or sarcasm with my "evidence based medicine" post earlier.

So maybe the OP wants to share some secrets?

T

 

[Aether2000]

It is very unlikely he is "helping people" with that one trick pony approach. We, who have practiced pain medicine for years realize the quite limited utility of injection therapies as a treatment since the results are short term only except for the occasional exception. Unless he is performing a double or triple diagnostic block series of the medial branches as a prelude to RF, it is not possible to achieve 85% success rate period. Those who elect such a myopic approach to pain medicine that they believe simple injections and RF are really helping people long term 85% of the time a) are not doing followup studies on their patients, b) have inadequate followup measurement tools, or c) really don't give a damn about patient outcomes except in the most efficient use of the physician's time in order to line their pocketbooks with patient's money.
I go out of my way to point out the avarice and lack of education to insurers and family practitioners alike when they deal with block jocks.

 

[Tenesma]

well to be the devil's advocate... if you don't do procedures then you are left with providing patients with long-term narcotics (after the usual physical therapy, massage, aquatherapy, acupuncture, biofeedback)... what are the long-term consequences of providing narcotics? i would argue that there are many... the NNH (number needed to harm) is ACTUALLY lower than the NNT (pretty amazing). In fact, prescription narcotics are the 3rd most commonly abused product in the United States after Alcohol and Tobacco --- far higher rates of abuse then heroin, cocaine, marijuana, etc... In fact, if you believe Manchikanti's numbers = up to 78% of patients don't take their narcotics as prescribed...

i would argue that I can sympathize with a block jock who provides a few months of relief far more than I can sympathize with a legal narcotic dealer who provides a few month of relief followed by years of dependency... or even worse: years of dependency and hyperalgesia

 

[Aether2000]

The long term management of pain cannot be adequately provided through injections alone. Many patients will receive relief for one month alone or even less with injection therapy. To adequately treat their pain would require monthly injections. At a cost of $1500 per injection (ASC plus physician fees), this would effectively bankrupt the country's medical system considering there are over 25,000,000 patients with chronic pain. It should also be noted the relief afforded by epidural steroids is no different than epidural saline...so perhaps long term saline epidural infusions would be more cost effective.
The view of the uneducated is that chronic pain is purely a nociceptive peripheral process that can be treated by blocks alone. The lack of mandatory functional restoration in a block physician's practice is myopic and self serving to continue the cycle of chronic pain so the physician may extract even more of the patient's money over time. Psych is also not part of a block jock's practice....just send them somewhere, anywhere but my practice for psych. Yeah I know they are severely depressed but what the hell, I will perform an RF anyway and they can deal with the consequences on their own.
Medication management with or without narcotics, is certainly a part of chronic pain treatment and does indeed have its unpleasant side such as substance abuse or diversion. But it is the expertise of the pain physician that makes the risks of prescribing such tolerable to society and ensures safety of the patients taking these meds. Physicians who don't have a clue with respect to enforcement of clinic rules for prescribing such medications end up with out of control populations with incredibly high substance abuse issues. It is the lack of physician education, inadequate patient follow up, failure to apply strict rules, and gullibility of the physician and their staff that encourages substance abuse and diversion. These problems are easily managed with controls on prescribing and absolute rules in addition to patient monitoring.
There are several other avenues in treating pain: massage, topical compounded drugs, interferential stim, etc. Most physicians do not take the time to learn these techniques or analyze the ever increasing alternative medical treatments for validity.
Being a block jock is easy and lucrative...it is a mindless existence full of repetitive technician modalities sticking needles into 40-50 patients a day, with inadequate evaluation, and very limited success rates. Block jocks are not physicians: they are technicians. They eschew the more difficult role of being a doctor for the easy money of endless injections without analysis of results. My point is that block jocks are an anathema to patients if they are a one trick pony. Patients will continue to travel from one doctor to another seeking relief after their "series of 3" has been administered.

 

[blokjok]

What’s wrong Algos? You’re acting like an old grumpy man. It seems like you are an unhappy person. Cheer up a little and enjoy life. Might help you get some referrals. 85% is based on the pain scale and our satisfaction questionnaire. We consider a success when the patients pain is below 3 and are satisfied and happy with the outcome of the procedure. This is not exact science but isn’t this exactly what people are looking for?? Pain relief ???? We see patients two weeks after the procedure and then do an 8 week follow up. I enjoy what I do and do it the right way. I believe my success is based on our superb and dedicated service with focus on detail. We treat our patients like royalty. In my practice everyone is treated like a King or Queen. We have Persian carpets, Mahogany furniture, classic music and a variety of imported coffees and bottled waters in the waiting room. My staff is always smiling and always willing to accommodate any of the patient’s special needs. Everyone is seen on time. Our examining rooms and clinics are decorated professionally. Our procedure room and post procedure area is beautiful. Our referrals come from PCP’s and spine surgeons. They know we do not inject patients who are not going to be helped with injections. We refer patients who are not candidates for injections to the neurosurgeons, orthopedic surgeons and the university chronic pain rehab center or simply tell them we cannot help them. Hopefully, now we can share some more positive comments.

 

[Spine Specialist]

We treat our patients like royalty. In my practice everyone is treated like a King or Queen. We have Persian carpets, Mahogany furniture, classic music and a variety of imported coffees and bottled waters in the waiting room. My staff is always smiling and always willing to accommodate any of the patient’s special needs. Everyone is seen on time. Our examining rooms and clinics are decorated professionally.

blokjok-

Are you practicing in LasVegas? If you add some lapdance in your clinic...i will be your patient.

 

[Aether2000]

Ok...I get it now....
No one could be so mercenary, completely without compassion, absolutely greedy, and operating completely outside the norms of medicine, so blokjock must be a troll. Had me going there for awhile until I realized based on the last post that this must be the ultimate Hollywood style cherry picker or is simply trying to goad us with such drivel. Surely there are not real doctors who run these kinds of mills...or if they are, hopefully they will not be long lasting.

 

[analgesic]

What’s wrong Algos? You’re acting like an old grumpy man. It seems like you are an unhappy person. Cheer up a little and enjoy life. Might help you get some referrals. 85% is based on the pain scale and our satisfaction questionnaire. We consider a success when the patients pain is below 3 and are satisfied and happy with the outcome of the procedure. This is not exact science but isn’t this exactly what people are looking for?? Pain relief ???? We see patients two weeks after the procedure and then do an 8 week follow up. I enjoy what I do and do it the right way. I believe my success is based on our superb and dedicated service with focus on detail. We treat our patients like royalty. In my practice everyone is treated like a King or Queen. We have Persian carpets, Mahogany furniture, classic music and a variety of imported coffees and bottled waters in the waiting room. My staff is always smiling and always willing to accommodate any of the patient’s special needs. Everyone is seen on time. Our examining rooms and clinics are decorated professionally. Our procedure room and post procedure area is beautiful. Our referrals come from PCP’s and spine surgeons. They know we do not inject patients who are not going to be helped with injections. We refer patients who are not candidates for injections to the neurosurgeons, orthopedic surgeons and the university chronic pain rehab center or simply tell them we cannot help them. Hopefully, now we can share some more positive comments.

Blok Jok it sounds like you have the kind of practice many pain fellows can appreciate. However, I have to agree with algosdoc. Too many pain physicians are focused on subjective relief of symptoms instead of objective restoration of functionality. It is my firm belief that the astute pain clinician should be goal oriented to resoliving the etiology behind the pain generator and if possible preventing such a nidus from resurfacing. Of course this is somewhat complicated in cases such as metastatic cancer. However from an interventional spine perspective, I have seen so many individuals with mild to moderate disc herniation undergo IDET with nucleoplasty or RFA devoid of any post intervention spinal rehabilitation. We are all aware that the spine is a kinetic entity that requires motion and sufficient erector spinae tone/endurance to function properly. Too much emphasis is put on the intervertbral disc without any evaluation of the external postural forces that create discopathy. How can a pain clinician service a pt. thoroughly unless they seek to correct the underlying pathomechanics of the involved vertebral subunits? I humbly urge you to incorporate more objective measures like degrees of flexion, extension, and rotation in addition to changes in the pain scale. This is the sole reason why I feel more pain fellowships should necessitate more integration between PM&R and Anesthesia. We have so much to learn from eachother.

"Can't we all just get along"
-Rodney King

 

[blokjok]

Hi again. Thank you for sharing your time!!
Objective restoration of functionality? What validated tool do you use to assess your outcomes of "functional restoration"? Please share.
Resolving the etiology of the pain generator?? Tell me which interventional pain procedures do you perform that “resolve the etiology of the pain”. I would like to add them to my practice.
I suggest you stop doing IDET and nucleoplasty. It is precisely that type of sham procedures the ones that we do not perform. PCP and neurosurgeons know it and is the reason I get so many referrals.
I refer all the patients to our own rehab facility. We have the most beautiful and nicest physical therapists extensively trained in all spinal disciplines. They are considered partners and coowners of the rehab center and therefore are extremely motivated. And yes, our rehab center can be compared to the nicest Spas of NYC or Hawaii. If you guys see our aquatherapy pool you would all drop dead.
I see nothing wrong with treating and providing all my patients with VIP services. A lot of cash and effort is invested but it is all worthwhile.

 

[Aether2000]

How sad...... he just doesn't get it, nor will he ever.

 

[analgesic]

Hi again. Thank you for sharing your time!!
Objective restoration of functionality? What validated tool do you use to assess your outcomes of "functional restoration"? Please share.
Resolving the etiology of the pain generator?? Tell me which interventional pain procedures do you perform that “resolve the etiology of the pain”. I would like to add them to my practice.
I suggest you stop doing IDET and nucleoplasty. It is precisely that type of sham procedures the ones that we do not perform. PCP and neurosurgeons know it and is the reason I get so many referrals.
I refer all the patients to our own rehab facility. We have the most beautiful and nicest physical therapists extensively trained in all spinal disciplines. They are considered partners and coowners of the rehab center and therefore are extremely motivated. And yes, our rehab center can be compared to the nicest Spas of NYC or Hawaii. If you guys see our aquatherapy pool you would all drop dead.
I see nothing wrong with treating and providing all my patients with VIP services. A lot of cash and effort is invested but it is all worthwhile.

Blok Jok,

I think we all would like to give our patients the same VIP treatment but may differ in the manner we do it. I don't recall stating that I did IDET or Nucleoplasty. I am not here to bash anyone. I was suggesting that a pain scale tells you nothing about an individuals overall quality/quantity of function. I am not sure if this is a germane concept to you nor do I mean to sound condescending. I simply mean that more pain clinicians need to utilize measures that account for a patients degree of movement. Having modulation over pain perception can be therapeutically misleading. For instance, a pt. with discogenic pain that feels better post RFA could actually be worse off if the same spinal pathomechanical relationships that created the annular deformation/NP herniation reside. Correct me if I am wrong but killing the sinuvertebral nerve does nothing to the applied external vertebral forces. Only by altering segmental myogenic tone, suprasegmental cerebellar muscle spindle sensitivity, and resetting the gain of the errector spinae can you reestablish normal spinal biomechanics. Likewise this can further prevent discopathy from progressing to other vertebral segments in proximity. I at least try to approach the etiology of spinal pain in the absence of trauma from a top down hierarchy. My therapeutic regime is directed toward utilizing any and everything I can incorporate to alleviate pain and restore function. I am a big advocate of epidurals, transforaminals, acupuncture, interferential, TENS, joint mobilization(large diameter barage), physical therapy, cognitive behavioral therapy, and if necessary especially with FM pts biofeedback. As for what objective measures can be incorporated there are several(some more invasive than others). 1. intradiscal pressure in pts with MRI verified disc herniations pre and post therapeutic course. 2. MRI signal intensity and disc protusion alterations in the same population of pts. 3. EMG /NCV alterations pre and post therapeutic course in individuals with verified radiculopathy. 4.To asses spinal ROM you can always utilize goniometers or the new inertial sensors pre and post therapeutic course. Indeed this is only pertinent if you wish to ascertain more than just your pt's subjective degree of pain. Recall "one man's pain is another man's pleasure". I for one need something more to validate my therapeutic effectiveness. As for performing repetitive nerve blocks, I leave you with the immortal words of Albert Einstein "Insanity is doing the same thing over and over while expecting different results".

 

[blokjok]

Analgesic, It seems like your brain has been possessed by a chiropractor or you smoked some strange substance.

 

[Aether2000]

Analgesic is right on the money. It is not suprising given your penchant for and excessive focus on the material decorations of your office that you could not comprehend an erudite discussion of the salient features involved in pain management. You have lost sight of the purpose of medicine and certainly the goals of pain management.

 

[analgesic]

Analgesic, It seems like your brain has been possessed by a chiropractor or you smoked some strange substance.

Blok Jok,

I was hoping for a more intelligent reply. My brain is open to anything that works for the betterment of my patients as long as the treatment has efficacy. If you adopt a narrow focus you will remain grounded in imported coffees, persian rugs, and mahogany furniture to service your patients. I think you should add a Starbuck's sign and you could have the total package. Perhaps if you opened your mind to others like algosdoc you might be able to become more versatile and less materialistic.

 

[blokjok]

Algos and Analgesic: I am sorry you are both discontent and resentful. I never intended to create envy. Maybe you both should get together an pretend that you are minimally invasive spine surgeons and have erudite discussions about inertial sensors. And now, lets go back to our original discussion. All blockjocks are invited to share!!.

 

[blokjok]

Algos and Analgesic: I am sorry you are both discontent and resentful. I never intended to create envy. Maybe you both should get together an pretend that you are minimally invasive spine surgeons and have erudite discussions about inertial sensors. And now, lets go back to our original discussion. All blockjocks are invited to share!!.

 

[blokjok]

Blok Jok,

I was hoping for a more intelligent reply. My brain is open to anything that works for the betterment of my patients as long as the treatment has efficacy. If you adopt a narrow focus you will remain grounded in imported coffees, persian rugs, and mahogany furniture to service your patients. I think you should add a Starbuck's sign and you could have the total package. Perhaps if you opened your mind to others like algosdoc you might be able to become more versatile and less materialistic.

Algos and Analgesic: I am sorry you are both discontent and resentful. I never intended to create envy. Maybe you both should get together an pretend that you are minimally invasive spine surgeons and have erudite discussions about inertial sensors. And now, lets go back to our original discussion. All blockjocks are invited to share!!

 

[Aether2000]

No envy here....just unabashed disgust and revulsion. Those who pretend to be physicians but are simple minded technicians with a singular focus on materialism are doing more damage to our profession than any external forces.

 

[analgesic]

Algos and Analgesic: I am sorry you are both discontent and resentful. I never intended to create envy. Maybe you both should get together an pretend that you are minimally invasive spine surgeons and have erudite discussions about inertial sensors. And now, lets go back to our original discussion. All blockjocks are invited to share!!

Blok jok,

I think your brain has been posessed by Starbuck's or you have had too many Carmel Machiatos. As for being a minimally invasive spine surgeon, I'll take that over being a barrista any day!

 

[C Fiber]

Blokjok,
I have to agree with Algos and Analgesic. I left a very very lucrative business 8 years ago to persue medicine because I did not want to deal with greedy people like you. It's sad that I have to see this again in pain medicine. We all have family and expensive hobbies to feed, but I am not willing to bankrupt the health system & steal our next generation's money, in order to buy my Persian rugs and designer coffee.

BlokJok, I think you should call your "practice" a "Spa". I might even consider help you market it with my extensive marketing background.

 

[blokjok]

Analgesic, you are not to smart. I bet you are a DO.

 

[DigableCat]

While it's probably not good to antagonize, I think that many of the people of the board feel that you do not help in breaking the stereotype of the trigger happy needle jockey who will do any injection for the right price. And given your elaborate layout, I doubt not every patient could afford such luxurious attention.

You are fortunate in that for now you have a good referral source for patients. There may come a time however when reimbursements will decrease and insurance may no longer approve such billing practices(unless patients decide to pay out of pocket-which is their prerogative-many plastic surgery centers pamper their clients too. I'm sure Blue Cross and Blue Shield isn't footing the bill). When the scratching and clawing begins, where do you think you'll be if you only have a "one trick pony"?

 

[analgesic]

Analgesic, you are not to smart. I bet you are a DO.

Blok Jok,

It is too smart! Of course, you are wrong again barrista boy!!!!!! When you assume you............. Perhaps if you spent more time with Osteopaths you might develop some understanding of biomechanics. Take some of that 2M and put it toward continuing medical education. God knows you need it

 

[blokjok]

Digable Cat
You need to live the present and things are excellent right now. I do not expect any changes in the near future. However, I have been working on plan B for a couple of years.
Analgesic is trying to blab some irrational thoughts. Maybe Algos can translate for us.

 

[tempperson]

I refer all the patients to our own rehab facility. We have the most beautiful and nicest physical therapists extensively trained in all spinal disciplines. They are considered partners and coowners of the rehab center and therefore are extremely motivated. And yes, our rehab center can be compared to the nicest Spas of NYC or Hawaii. If you guys see our aquatherapy pool you would all drop dead.
I see nothing wrong with treating and providing all my patients with VIP services. A lot of cash and effort is invested but it is all worthwhile.

Blokjok, pain management is an all encompassing practice. Lets say you pass your patients s/p injections to the "nicest of spas" with the "drop dead" pool in rehab, do you monitor their progress or write plans for their physical therapy? Lets not assume that a rehab facility that looks like a palace automatically makes it the best or most appropriate therapy. Anesthesiology-trained pain doctors are increasing using PM&R principles in terms of assessing long term pain and functionality. Such is the case at my school.

The biggest problem in interventional pain is patient accountability. I'm not criticizing your practice in particular, but there are some doctors out there who do not accept long term responsibility for their patients. They will do procedures and pass the patient to someone else for follow-up, psychiatric care, or rehab. Ideally these should all be on-site in a pain practice.

When 3 blocks are up, some docs just give up on their patients and send them back to family physician b/c they "can't do anything more for them." Shouldn't pain medicine, a multidisciplinary and holistic approach, force its practitioners into more accountability and long term investment in their patients?

 

[blokjok]

Temp
We take great care of our patients. We offer compassionate care and make sure that everyone gets the best we can offer.I have never abandoned a patient.

 

[Aether2000]

You could offer much more than you do....you cherry pick your patients and do not want to deal with the difficult issues in pain management. Therefore, you de facto abandon your patients everyday, shipping the undesirables (read: less lucrative) to other entities. I think you picked the wrong forum in which to post. GQ magazine has forums for people like you.

 

[blokjok]

You could offer much more than you do....you cherry pick your patients and do not want to deal with the difficult issues in pain management. Therefore, you de facto abandon your patients everyday, shipping the undesirables (read: less lucrative) to other entities. I think you picked the wrong forum in which to post. GQ magazine has forums for people like you.

These patients are better served in multidisciplinary pain centers, and we direct them there. We have strong ties and an excellent relationship with our university pain rehab center. We consider this better care care than loading patients with narcotics and count their pills or refill their pumps every month.

 

[Aether2000]

You are not practicing medicine. You are a mindless blockjock, a detriment to the profession, and to patients.

 

[Tenesma]

algosdoc... while i respect and admire your position on most things, I am a bit miffed at your attitude that the only way to practice medicine is your way or the highway... there are many medical professionals who practice medicine by providing patients with procedures without medicating them...

would you call plastic surgeons, radiation oncologists, interventional radiologists, radiologists, cardiac surgeons, etcc... just "technicians" or would you grant that they practice medicine just the same way Blokjok does? they get a referral, determine that their highly-specialized skills are of use and then apply those skills to the patient to provide short term to long-term relief...

 

[Spine Specialist]

algosdoc... while i respect and admire your position on most things, I am a bit miffed at your attitude that the only way to practice medicine is your way or the highway... there are many medical professionals who practice medicine by providing patients with procedures without medicating them...

would you call plastic surgeons, radiation oncologists, interventional radiologists, radiologists, cardiac surgeons, etcc... just "technicians" or would you grant that they practice medicine just the same way Blokjok does? they get a referral, determine that their highly-specialized skills are of use and then apply those skills to the patient to provide short term to long-term relief...

Tenesma-

algosdoc is advocating good practice of medicine which is evaluating the patient, doing the thorough physical exam and perform the procedure if necessary. If procedure is not indicated refer the patient to physical therapy and other modalities of management. I am positive also good surgeons follow the same practice. My ex-chairman of PMR always says this....get the story from your patient and put your hands and examine them thoroughly. you have treated them 50% already.
I guess algosdoc is against just injecting on patients who is referred and being a technician.

 

[Tenesma]

in all fairness, i don't think blokjok ever said he didn't evaluate patients... and he did state that he refers his patients out...

 

[Spine Specialist]

in all fairness, i don't think blokjok ever said he didn't evaluate patients... and he did state that he refers his patients out...

I also would love to practice pain medicine ( not like a jockey) in a 5 star facility like blockjoc describes his practice. may be in a more comfy atmosphere. who doesn't like comfort and style in life?
My dream practice would be in a place like his with variety of coffee parlor supply, mahogony furniture, spa, state of the art fluroscopic machine with angio imaging, top tier RF and discograhy machines, good looking (HOT)physical therapists and PAs, Intelligent physicians wearing armani suits and neck ties, equipped with state of art PT gym, constant melody flowing through BOSE stereo system which soothens the atmosphere etc. ( ofcourse top notch physiatry surgical skills included). Style and skills with quality of practice going hand in hand. Please let me know if a practice like this exists. I wanna apply for a job.

 

[analgesic]

in all fairness, i don't think blokjok ever said he didn't evaluate patients... and he did state that he refers his patients out...

Tenesma,

Keep in mind that Blok jok refers his complex or indigent 15% of patients to the university multidisciplinary pain center. While the patients are probably better served there than in his practice, a pain specialist is a referral entity and should maintain the continuity of care. If he is incapable of seeing the job through then the referral should go directly to the university and bipass blok jok. The fact that a pain specialist has to refer to another pain center implies a lack of resources or education. Either scenario needs remedy. This is another perfect example why there needs to be an integrative pain residency.

 

[Tenesma]

forgive me my lack of understanding.... but why should pain physicians become primary care physicians. From my point of view, a pain physician should be a consultant specialist who makes recommendations and provides treatment options that the PCP/referrer is unable to do....

When you refer a patient to a cardiologist, do you expect the patient to follow with the cardiologist for the rest of his life regarding HTN management??? i don't think so... another example: Interventional cardiologists diagnose the problem and put in the stent and then the patient goes back to the PCP or the cardiologist for further work-up or maintenance...

i think we can agree that there are those pain physicians who want to be the all-encompassing physician providing hand-holding, chronic narcotic management and interventions, and there are those pain physicians who want to practice only the interventional aspect of pain medicine....

one way doesn't trump the other...

and it doesn't imply a lack of resources or education... trust me... setting up a chronic narcotic program doesn't take much education... in fact, in some pain practices it is entirely run by RNs with a supervising NP who writes the scripts...

blokjok has chosen to operate beverly hills style with an emphasis on materialism... that is his choice... I wouldn't be surprised if he has patients who love and respect him, and referring physicians who are happy with his services... because, if that wasn't the case there is NO way that he could maintain that salary for more than a year or two...

 

[Aether2000]

Practicing medicine by solely administering injections is short sighted, ill fated without possible success, and demonstrates a lack of fundamental knowledge regarding pain. While this style of practice is undoubtedly lucrative, if chronic pain patients who have been treated with this type of abysmal excuse for medical care are queried (which I have done on internet forums), it becomes clear these docs are (correctly) viewed as money grubbing charlatans. A person who simply sends people to rehab because they don't know anything about rehab or PT, and sends people to university programs because they don't know anything about medication management or alternative therapies, attempts to shunt patients away from spinal cord stim or intrathecal pumps because they can maintain a steady supply of repeat customers on which to perform serial blocks, the motives for such behavior become clear and it is certainly not the patient's best interest. A person making $2,000,000 per year is NOT performing adequate evaluation of the patients, period. They operate a block mill which is just as repulsive as a drug mill. I will do whatever I can to stamp out such non-sensical behavior and already have started writing articles to family practice and neurosurgery journals.
Patients often do not know the difference between the mindless block jock and the physician since the block jocks rarely advertise in their persian rug laden lobbies:
WE DO NOT PRESCRIBE ANY MEDICINES
WE DO NOT OFFER PSYCHOLOGY COUNCILING
WE DO NOT OFFER EVALUATION OF FUNCTIONAL RESTORATION (although we are happy to send you to our expensive PTs that are part of our practice that know far more than we do about functional restoration)
WE DO NOT OFFER ADVANCED MEDICAL PROCEDURES
WE ONLY STICK NEEDLES INTO PEOPLE'S SPINEs, PERIOD, AND WITHOUT MUCH TIME FOR EVALUATION OF YOUR PAIN PROBLEM
AFTER WE STICK NEEDLES INTO YOUR SPINE, YOU ARE TO GO SOMEWHERE, ANYWHERE BUT OUR CLINIC FOR ANY OF YOUR FURTHER NEEDS FOR WE ARE NOT DOCTORS BUT TECHNICIANS.

 

[f_w]

blokjok,

What exactly is the name of your facility ? Needle-spa ?

What share of your 2mil comes out of the cut you get for the PT services ? I would find it hard to believe that there is a lawful way to make this kind of dough from professional fees. Some self-referral kickback component is almost a necessity.

(careful that you don't end up like this guy:
http://www.nwitimes.com/articles/2004/10/22/news/top_news/dd376bb9e13801f986256f34008398d7.txt
http://www.nwitimes.com/articles/2004/11/20/news/lake_county/06324f4aeed5280386256f520006d7c7.txt
another 'maverick' who found the gold-mine that all the other idiots in medicine passed by)

 

[Tenesma]

f_w... there is a lawful way of making that much money... let's say your professional fee for a procedure averages $500... and you do 20 procedures a day 5 days a week 11 months a year (4 weeks of vacation) that comes to 2,200,000$ per year. Now add $55,000 for new patient visits (average 5/day).. plus 20 follow-ups per day comes to $200,000... so the total is 2,455,000 per year. That means 20 procedures (3.3 hours), 5 new patients (2.5 hours) and 20 follow-ups (4.5 hours). totally doable if you have a well-oiled efficient system and are willing to work 11 hours per day. Now let's say you have 10 staff and your monthly non-payroll expenses are about 10,000/month, and you pay your staff 50,000 each (!!!!) which includes benefits etc... that means your overhead is about 600,000/year (which is kinda high but this is a luxury office setup with all new equipment... that leaves you with 1,800,000 per year...
now if you want to run a narcotic clinic on the side, that is doable with one R.N and N.P. and the visits will cover their salaries...

now of course, this scenario ONLY works if you work in an area with minimal managed care penetration and minimal to no competition from other doctors, and you have created an excellent referral base that keeps you well supplied... Of course you could spend ONE whole day a week providing free care in the form of stims and pumps in the local hospital and you would still make about 1,400,000 per year... that way you provide 1) narcotics 2) procedures 3) free care to the community including stims and pumps and you are still bringing home 65,000 PER MONTH AFTER TAXES...

 

[f_w]

let's say your professional fee for a procedure averages $500... and you do 20 procedures

Please enlighten me, which procedure taking 10 minutes including room turn around will make you a professional fee of $500 ?

 

[Aether2000]

And now a dose of reality:
At least 35% of the chronic pain population are on Medicare so you can slash your $500 private pay non participating insurance rate (an increasing rarity)to about $220 and if you count minimal overhead, your income per patient is about $160 per procedure. Factor in Anthem (non-HMO) and your rate per procedure minus overhead is $220. Factor in PPOs (non-HMO) and your rates drop even lower for some. If you take any Medicaid at all, the rate per procedure drops to less than $100. It is only possible to do 6 procedures an hour a) in a non-hospital situation since ORs move far too slow b) in an ASC but Medicare and Anthem/Wellpoint rates are cut by 2/3 vs doing these in your office with more companies to follow soon c) in an office setting where you bear the overhead expenses. It is not possible to accurately perform RF if any standards at all are used for guidance in less than 20 minutes for 3 levels.
Most pain physicians do not work 11 hours per day on the average.
In a fantasy world or in a world that does not treat large numbers of patients due to their insurance or age, then yeah, it is possible to make $2mil a year. But for those who treat real patients with real problems, $2mil a year is way way out of line.....unless you are referred only non-chronic pain patients with acute disc herniations. Many neurosurgeons are becoming increasingly aware of the mindless block jock taking home 3-4 times that of the neurosurgeon and such physicians are taking steps to stop the inequity of a nearly unidirectional referral of patients with continual feeding of the millionaire technicians.

 

[f_w]

And now a dose of reality:

Why would I want to deal with reality ?

I don't doubt that there are pain-physicians with an office in a tony suburb with rich drug-seekers paying cash out of pocket who will net 2 mill (but this kind of clientele doesn't like to be herded through like cattle either).

While I don't have insight in how to run such a needle-Spa, the calculation given above had a number of very optimistic assumptions.

(sure I can tell you how to make 3mil/year in internal medicine. You only see healthy pre-op clearance patients for $280 a piece. You should be able to finish one of them in 12 minutes or so. And as all of them pay an undiscounted rate and you do that 12 hours/day 6 days/week ....)

 

[Tenesma]

medicare pays 375 for a lumbar transforaminal and 2nd transforaminal is 178 which totals $550 for a bilateral transforaminal at one level... and private payer is higher than that. now if you choose your community well you can avoid medicaid, minimize medicare and managed care HMOs, and the private payers will reimburse at a negotiated rate above medicare. If you are the only player in town you should be able to negotiate (over time) between 180 and 240% of medicare with the private payers....

 

[f_w]

Are you in practice ?

 

[Tenesma]

f_w... why? you want to join up?... btw, i only do pain part-time...