Isn't it pathetic that fellowship programs train people how to do the technical stuff but fail miserably in giving physicians the tools they need to successfully run a business in pain medicine? Some of this is due to entrenched recycling of physicians in an institutional system that does not have requirements of business knowledge anywhere in their training or practice. For instance, a doc goes through 4 years of anesthesia training having been given a paucity of business skills training, then goes through fellowship that emphasizes patient care but is devoid of training into setting up an office/cash flow management/computer-EMR evaluation/hiring appropriate staff etc etc. Then the doc recycles back into a university system as a faculty member, then rises to become pain medicine director, never having practiced in the world of private practice that composes the vast majority of physicians in pain medicine.
Options for those that want to escape from this cycle and do not mind the increased responsibility required with ownership of your own practice:
a) join a group for a year and examine their business model and practices...then if the group does not suit you, you may have acquired enough business skill to implement opening your own practice elsewhere (since you have no ties)
b) jump in and start your own business. You should start many months in advance in deciding location, achieving hospital privileges, insurance contracts, and setting up an office. Expect there will be many mistakes along the way. Some physicians use expensive consultants to jump start their practices or will use services that will fill out credentialing forms for you (not a bad idea if you are working non stop in fellowship). Or you can do it all yourself. Credentialing has become markedly less cumbersome over the past 3 years due to centralized insurance credentialing companies that many insurers now require such as CAQH. I changed practices from a group to solo in the same town 3 years ago and it required 4 months to obtain Medicare and Anthem Blue Cross billing numbers. I hired a new partner 2 weeks ago with a planned start date for 3-4 months but due to the improvements in Medicare and Anthem systems, she had her billing numbers in one week.
c) become an employee of a neurosurgeon/spine surgeon. This is a very rapid way to build a patient base but it will never be your own practice and you will always be limited in what you do by your employer. Most neurosurgeons/OSS take a percentage cut from your income that ranges from 30% to 60% to cover "overhead". Be wary of this arrangement if you are doing a significant amount of Anthem or Medicare cases and must perform your procedures in an ASC or hospital. In such cases your income per case is reduced by 2/3 because you are not performing the procedures in an office, then the remaining income is being reduced by an additional 30-60% by the neurosurgeon/OSS for their "overhead".
See the link to the guide below for some helpful hints and start very small with the expenditures initially. Build your practice by shaking hands, communicating effectively with PCPs and referring specialists, and defining your scope of practice up front.
http://algosresearch.org/Education/StartingPractice/index.html
