California Pain Docs + Obamacare = Consolidation

[Tenesma]

there was just an article in Connecticut - a retired marketing/business professor makes 267k per year in pension right now - which is more than he made as a professor.... he reports that it was a no brainer choosing retirment, because it would be financially smarter....

these deals won't exist for much longer - basically anybody who retired from state employment prior to the market collapse of 2007/2008 got a ridiculous ride at the taxpayer expense...

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[hyperalgesia]

How about, instead of 'class warfare', we do 'generation warfare'...

 

[CaliDr]

Wow, this topic really took on a life of it's own! While there are a number of different ideas and points of view, it is refreshing to see how diverse the field is - in not just practice type but also political palate. I currently work in a rural setting and TRULY enjoy helping this patient population - I also TRULY enjoy the guaranteed salary that comes with it - Private Practice in a non-rural setting will be a financial and personal uphill battle not just due to reimbursement differences but also in patient population. I love working hard and helping underserved patients to make money, but if a new practice is going to survive it appears I have no choice but to carefully adjust my patient population to offset reimbursement changes. My patient population now did not have access to a local Pain doc until I opened my clinic, so it will be a change with a venture into private with a more affluent demographic.

I personally am postponing my practice start date to re-determine the best business model - opt out of MC/focus on more % of driving cash only/PI/WC vs ramp up volume asap. As previously mentioned, driving patients in by saying "Yes" to all patients will be great but in a year's time, I might be regretting that decision (not only due to smoke-smelling waiting rooms) @hyperalgesia . And yes, a mandate on Medicaid will really be a game changer. I don't think it will come to this, but at this point who knows?! Luckily, we have done research on our local market demand for another pain doc...and while it is high now, the big concern is the slowish transition to single-payor. Long term viability is just too uncertain. We are currently trying to play with the numbers and see how best to utilize NP/PA into the equation to squeeze out every cent per patient interaction over time. Efficiency will be of utmost importance in all private practice settings and maximizing personnel cost/benefit will be paramount to keeping your head well above water.

@stim4u I did see the meet the press and I did speak one-on-one with one of the consultants helping implement the CoveredCalifornia launch - they essentially said the same thing, verbatim. The option to join another larger group would be great, but unfortunately defeats the purpose of my original goal of running my own private practice. But...I am in discussions with a large ortho group to potentially partner resources and develop a mutually beneficial partnership...in addition I am also in talk with a local smaller hospital to partner. Both of these are my best hedge against decreased reimbursement. Being quick and nimble is an absolute necessity now that the battlefield conditions have worsened.

Any of you hearing what current Med students are saying? I cannot imagine how many are switching to Engr, Dentistry, or Vet. Speaking of Veterinarians...wow, cash up front, endless amount of pet lovers - Our local guy is absolutely crushing it! Just got a bill for my cat. Had to do a double take.

 

[Silent Cool]

Wow, this topic really took on a life of it's own! While there are a number of different ideas and points of view, it is refreshing to see how diverse the field is - in not just practice type but also political palate. I currently work in a rural setting and TRULY enjoy helping this patient population - I also TRULY enjoy the guaranteed salary that comes with it - Private Practice in a non-rural setting will be a financial and personal uphill battle not just due to reimbursement differences but also in patient population. I love working hard and helping underserved patients to make money, but if a new practice is going to survive it appears I have no choice but to carefully adjust my patient population to offset reimbursement changes. My patient population now did not have access to a local Pain doc until I opened my clinic, so it will be a change with a venture into private with a more affluent demographic.

I personally am postponing my practice start date to re-determine the best business model - opt out of MC/focus on more % of driving cash only/PI/WC vs ramp up volume asap. As previously mentioned, driving patients in by saying "Yes" to all patients will be great but in a year's time, I might be regretting that decision (not only due to smoke-smelling waiting rooms) @hyperalgesia . And yes, a mandate on Medicaid will really be a game changer. I don't think it will come to this, but at this point who knows?! Luckily, we have done research on our local market demand for another pain doc...and while it is high now, the big concern is the slowish transition to single-payor. Long term viability is just too uncertain. We are currently trying to play with the numbers and see how best to utilize NP/PA into the equation to squeeze out every cent per patient interaction over time. Efficiency will be of utmost importance in all private practice settings and maximizing personnel cost/benefit will be paramount to keeping your head well above water.

@stim4u I did see the meet the press and I did speak one-on-one with one of the consultants helping implement the CoveredCalifornia launch - they essentially said the same thing, verbatim. The option to join another larger group would be great, but unfortunately defeats the purpose of my original goal of running my own private practice. But...I am in discussions with a large ortho group to potentially partner resources and develop a mutually beneficial partnership...in addition I am also in talk with a local smaller hospital to partner. Both of these are my best hedge against decreased reimbursement. Being quick and nimble is an absolute necessity now that the battlefield conditions have worsened.

Any of you hearing what current Med students are saying? I cannot imagine how many are switching to Engr, Dentistry, or Vet. Speaking of Veterinarians...wow, cash up front, endless amount of pet lovers - Our local guy is absolutely crushing it! Just got a bill for my cat. Had to do a double take.

Interesting you mention vets. Vets on avg. make way less than a primary care doctor, I believe. Someone on a different thread posted a comparison of ROI for different health fields, and Vets. I believe were the worst. Interestingly, a lot of Chiropractors do well. I was looking at some Chiro. practices recently--minimal hours and cash payments. Interesting stuff.... Also, check out the recent medicare/medicaid (?) reimbursement changes. I think that Chiros got something like an 11% bump!

 

[lonelobo]

Does it get any Greasier than average Chiropractor?
Much rather get paid less to take care of Fido and be able to sleep at night.

 

[hyperalgesia]

I think it depends on the vet and what they do. Still better to be a vet health insurance ceo.

 

[SSdoc33]

Does it get any Greasier than average Chiropractor?
Much rather get paid less to take care of Fido and be able to sleep at night.

Squeezing a dog's butt glands all day isn't what it's cracked up to be.

 

[Silent Cool]

Squeezing a dog's butt glands all day isn't what it's cracked up to be.

"South Charlotte, NC Area - 16 year family practice bringing in over $700,000 annually. Recession Proof. Ask Why! Dependable income - Projected to collect $725,000 in 2013. Current DC has enjoyed success but is ready to pursue a new business venture. Dr.'s take home pay is $408,000 (before taxes). Fully staffed and equipped. Built in referrals. Minimal overhead. Balanced Life. Well respected practice with a fun environment. DIGITAL x-ray, Erchonia Cold Laser, Weight loss programs, 2 Sigma Instruments (Pro Adjusters). Dr. utilizes multiple techniques. A 2014 lease reduction is scheduled! A great investment and a real money maker! CALL TODAY for a practice profile containing practice overview, financials and other interesting stuff."

http://www.mergernetwork.com/for-sale/established-upscale-chiropractic-practice-for-sale/323371.htm

It's never too late to be a Chiropractor.

 

[Ducttape]

http://www1.salary.com/Chiropractor-salary.html

Median salary $133,000.

grass always seems greener, eh?

im not sure i would rely heavily on one sales pitch. if hes making that much, why is he selling?

 

[lonelobo]

Squeezing a dog's butt glands all day isn't what it's cracked up to be.

I do it on my mine own dogs for free

 

[CaliDr]

I think it depends on the vet and what they do. Still better to be a vet health insurance ceo.

Yeah you are spot on here. Did some research on them before our vet visits...even a few newer pet insurance companies had some less than terrible cash flow - racket indeed. But we live in a small tucked away town and he is the only vet for miles. He is overflowing with "patients". Probably not an average situation for a vet.

If that guy is selling, he is either sleeping on a bed made of cash or there is some funny business going on.

Have any of you actively sought out participating in clinical trials through med companies utilizing your current patient base (managed medical device and pharma trials in all stages)? If not, have any of you thought about it? Just curious what the experience was like..good...bad...too much paperwork.

 

[SCIronMike]

My personal story here in southern CA:

It was clear about 2-3 years ago that private practice pain management was going to become difficult in California. There were about 25 pain physicians within a 15 mile radius of my home. The area was completely saturated and it seemed that many were struggling to get enough patients. Big hospital groups were buying up physician practices. Reimbursements were dropping.

At that time, I was an assistant professor at USC. My split with the university was 45/55%. Finances became tough and my department chair decided to make our clinic hospital based. Before that the department was paying rent to the university and we were billing private office fees. Becoming hospital based brought a lot of new rules. I was also concerned that I was going to have to keep the same 45/55 split even though my billings would be lower as a hospital based practice.

I made a really difficult decision to leave my academic practice at USC. I am a USC alum for undergrad and med school. I'm pretty much the biggest rah-rah USC guy ever. I joined Southern California Permanente Medical Group in 10/2011. Two years into the new position, I consider it a good decision. I enjoy my practice. There are some trade-offs, but I have great colleagues, good support staff, and a reasonable schedule. My compensation is on the low end, but it is not unreasonable considering the retirement benefits. Two of my USC faculty colleagues also left the university within the 6 months that I left, and both of them joined SCPMG and working with Kaiser. My department here at Kaiser just hired another physician who will start in April. He has been in private practice the past 7 years one of the premiere institutions in southern California and has one of the busiest practices there.

There is a lot of uncertainty in our profession.......... I think people are guessing at the best way to survive.

 

[drusso]

My personal story here in southern CA:

It was clear about 2-3 years ago that private practice pain management was going to become difficult in California. There were about 25 pain physicians within a 15 mile radius of my home. The area was completely saturated and it seemed that many were struggling to get enough patients. Big hospital groups were buying up physician practices. Reimbursements were dropping.

At that time, I was an assistant professor at USC. My split with the university was 45/55%. Finances became tough and my department chair decided to make our clinic hospital based. Before that the department was paying rent to the university and we were billing private office fees. Becoming hospital based brought a lot of new rules. I was also concerned that I was going to have to keep the same 45/55 split even though my billings would be lower as a hospital based practice.

I made a really difficult decision to leave my academic practice at USC. I am a USC alum for undergrad and med school. I'm pretty much the biggest rah-rah USC guy ever. I joined Southern California Permanente Medical Group in 10/2011. Two years into the new position, I consider it a good decision. I enjoy my practice. There are some trade-offs, but I have great colleagues, good support staff, and a reasonable schedule. My compensation is on the low end, but it is not unreasonable considering the retirement benefits. Two of my USC faculty colleagues also left the university within the 6 months that I left, and both of them joined SCPMG and working with Kaiser. My department here at Kaiser just hired another physician who will start in April. He has been in private practice the past 7 years one of the premiere institutions in southern California and has one of the busiest practices there.

There is a lot of uncertainty in our profession.......... I think people are guessing at the best way to survive.

Mike, I remember when you took the USC Gig. I think that your story is very typical. Medicine, like law and accounting, is become a profession of "have's" and "have not's." Most of the legal and accounting work done these days is increasingly dominated by large, multi-state practices with various "local" shops. These groups employ many, many associates and few partners...the "system" wants doctors herded and consolidated.

 

[stim4u]

My personal story here in southern CA:

It was clear about 2-3 years ago that private practice pain management was going to become difficult in California. There were about 25 pain physicians within a 15 mile radius of my home. The area was completely saturated and it seemed that many were struggling to get enough patients. Big hospital groups were buying up physician practices. Reimbursements were dropping.

At that time, I was an assistant professor at USC. My split with the university was 45/55%. Finances became tough and my department chair decided to make our clinic hospital based. Before that the department was paying rent to the university and we were billing private office fees. Becoming hospital based brought a lot of new rules. I was also concerned that I was going to have to keep the same 45/55 split even though my billings would be lower as a hospital based practice.

I made a really difficult decision to leave my academic practice at USC. I am a USC alum for undergrad and med school. I'm pretty much the biggest rah-rah USC guy ever. I joined Southern California Permanente Medical Group in 10/2011. Two years into the new position, I consider it a good decision. I enjoy my practice. There are some trade-offs, but I have great colleagues, good support staff, and a reasonable schedule. My compensation is on the low end, but it is not unreasonable considering the retirement benefits. Two of my USC faculty colleagues also left the university within the 6 months that I left, and both of them joined SCPMG and working with Kaiser. My department here at Kaiser just hired another physician who will start in April. He has been in private practice the past 7 years one of the premiere institutions in southern California and has one of the busiest practices there.

There is a lot of uncertainty in our profession.......... I think people are guessing at the best way to survive.

I think there is a lot of uncertainty with pain management, medicine as a whole, tax code, economy, stock market, etc... The insurance companies know this and are taking all measures to cut cost, dismiss high cost network doctors, etc.

The country should never be run this way....