Deciding on 3 options re:wisest path toward opening Solo Pain practice

[1gooddoc]

Hey folks,

This is a question for those of you who are either currently Solo Pain docs , have worked as solo in the past, or have a solid handle/experience on the business aspect of Pain management. I’ve worked in academic Pain practice and will leave that job soon. I did some locum in the past. I bill for my own visits and procedures, not much else in terms of managing/financial stuff at that job. I want to go solo in the next 1-2 years, but I don’t have much experience with the business aspect of Pain, or business at all, for that matter. I’m in the process of considering 3 jobs options, each with different setup. My question is, which of those 3 would you guys recommend that would give me the best “real world” exposure to the business side of things so I’m not totally green when I open my own practice, or should I just go straight to solo right out of academia?


Setup #1: A clinic that’s been bought by a large national Pain group. They have like 100s of clinics nationwide. They’re run by corporate, and looks like the admin stuff happens at the corporate level. Procedures in office. They’d give me a midlevel when I’m busy. I’m not sure how much I’ll learn business-wise if I join that practice, especially since it’s a bit different from the setup I’d have as a solo doc. There’s one doc at that site and they need one more. I went for a site visit and hit it off pretty good with that doc. Really cool dude. He’s been in practice for several years and he used to be part of a group practice that was sold to the big national group.


Setup #2: A solo practice with one doc, 2 midlevels, 1 office manager. Procedures in office. He’s looking for a doc to grow his patient volume.


Setup #3: Bypass being an employee altogether and instead work as Locum Pain for the next year or so, make some money to fund my practice from locum while waiting to get on insurance contracts. I’d start my own practice by subleasing and keeping staff lean, while reading books on solo practice/business stuff (which I’m currently doing) and maybe attend workshops. That way I wouln’td worry about non-competes, and I could pursue my dream now. Also I’m thinking doing locum in in the state where my practice is will help as it’ll give me a sense of local culture, networking opportunities, etc.


I want to go wisely about this, and I want to maximize my chances of success as a solo pain doc. Which setup do you guys recommend? Any thoughts about this would be appreciated.

Thanks in advance.

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[jsaul]

I'm solo. Option 3

 

[ateria radicularis magna]

Is locums pain a legitimate option? What if you sign on to cover for 2 weeks for a dude who does shady things? Your name would be in those charts and on those scripts. This is something I’ve wondered about for a long time. Please enlighten me.

 

[geauxg8rs]

Yeah pain Locs seems to be the shadiest of shade. I fear you either are working for a pill
Mill or doing blocks for a chiropractor

 

[DrMDAware]

Option 3

Read books about dentristy. They get patient experience, workflow, billing, etc.

Read about private equity, cash flow, EDIBTA.

Society for pain practice management SPPM annual meeting.

 

[RoloTomassi]

Society for pain practice management SPPM annual meeting

Never heard of this. Is it more for new grads or do you still find it useful?

 

[myrandom2003]

Never heard of this. Is it more for new grads or do you still find it useful?

It’s for billing

 

[drusso]

Option 3 or Option 2: Work for yourself and never look back.

 

[au bon pain]

Option 1 sounds like national or a clone. Avoid.

The guy who sold to them probably seems happy secondary to the fat check he got during the transaction and his pre-negotiated current comp plan. You won’t get the same deal.

And their non-compete will mean you need to move faaaar away to open your own practice one day.

 

[1gooddoc]

Thanks so much everyone for these helpful and informative replies. Yeah I'm inclined towards Option 2 and 3. The guy for Option 2 is solo, we had a good convo about his practice. He invited me for a site visit but he asked that I pay for the flight/hotel, but he'll give me a sign-on bonus to cover those costs, instead of him paying for my travel/lodging, which means if I don't join him, I won't be reimbursed these expenses. Is that a red flag? Or is that usual for solo practice people? I'm trying to see the big picture here, and I can pay it if that helps me learn the business of Pain in a setting I want to be in the future, but then again I don't wanna miss important cues early on.

 

[nopain1234]

Option 3, only work as gas passer while you build your practice to make a living until you can go full time

 

[geauxg8rs]

Thanks so much everyone for these helpful and informative replies. Yeah I'm inclined towards Option 2 and 3. The guy for Option 2 is solo, we had a good convo about his practice. He invited me for a site visit but he asked that I pay for the flight/hotel, but he'll give me a sign-on bonus to cover those costs, instead of him paying for my travel/lodging, which means if I don't join him, I won't be reimbursed these expenses. Is that a red flag? Or is that usual for solo practice people? I'm trying to see the big picture here, and I can pay it if that helps me learn the business of Pain in a setting I want to be in the future, but then again I don't wanna miss important cues

In my experience, (fwiw) whenever i was not reimbursed for an interview I either was not offered a job or I wanted to run far far away from that job.

 

[powermd]

I worked in a remote-ish location for 10 years and became a partner. This was a well-run group, so I learned a lot about business and running a tight practice. I also learned about what not to do, and how some problems get to be almost unsolvable once a business really grows. I learned how to hire, manage, and fire people (the latter two suck, btw- forget "managing" people, btw, you can't fix stupid, lazy, or disengaged). I learned about how to provide a great patient experience and make referring docs happy. I sold out to move to a more desirable area with better schools and opened my own shop in a competitive area with three dominant health systems- two of which are a roach motel for pain. Starting the whole thing out - soup to nuts - was haaaard! There are so many things that need attention it's tough to keep it all together. Previously I had staff that did literally everything. I just showed up and took care of the patient. Now patients are the easy part. Things are starting to pick up, but it's still very slow. I'm spending a ton of money on advertising just to get my name out there. I'm slowly building relationships with referring docs. It takes a real entrepreneurial mindset and thick skin to duke it out with the market- but I did my research. I know there is a niche for me here. Every time I see a patient who's been to the competition, I hear about their faults and how I do things differently and better. My marketing pries into those weak points. I LOVE being independent and having only one employee. No office politics (huge), no partners to argue with or persuade, no rigid schedule- if I want to start at 10 am everyday and leave at 3:30 and be closed each and every TG/xmas week- so be it. No annoying HR culture, DEI BS, or pointless meetings. No private equity a-holes treating me like a cog, and my patients widgets, just so they can skim off my back. I would NEVER go back to employment unless there is no other choice. But that's my personality- for better or worse.

 

[mid|ine]

Have you considered option #4? Work with a PP group? I think I have the best blend between your #1 and #2. I'm part of a local multi-specialty group. We have about 25 docs and are large enough to get great contract, we have a corporate division that takes care of everything, but the docs that are partners own the group and ultimately make the decisions. I only work 40 hours per week, but largely have the control of a solo doc without having to do all of the other non-medical stuff that comes with being in a small solo practice.

 

[1gooddoc]

Midline,
Thank you. It's funny that you brought up that option. I'm considering a sort of similar situation like the one you described. Multispecialty, 40hour-work week, guaranteed salary annually, % off net collections if I make > 2x salary. No ownership/partnership through. One guy owns the whole system, and looks like I have to take weekend calls on a rotating basis. Main thing is, I wouldn't have control of a solo doc.

 

[PainDoc2025]

What does locums pain consist of? Inpatient consults? How much is pay typically?

 

[1gooddoc]

From my experience it's outpatient, usually covering an MD pain clinic whereby you'e covering for a pain doc who's on vacation, or who abruptly left the practice and they have an immediate need for a doc. The other setting I know of is working for a chiropractor, largely doing procedures. In the latter case the pay can be higher, especially if you're treating Personal Injury patients (as opposed to medi-care/caid, for instance). I suspect what you get paid depends on a variety of factors (location, recruiting firm, contract terms, etc), so it might be tricky to state a specific number, compensation-wise.

 

[mid|ine]

Im not sure our group will be offering partnership track to most incoming docs do to changes in STARK laws going into effect in '22. However, I think there is something to be said for a private group with multiple docs for partners vs 1 "KING". I still think if you can find a similar group, its the best of both worlds.

 

[nvrsumr]

What changes will occur to Stark that affect your partnership?

 

[mid|ine]

What changes will occur to Stark that affect your partnership?

Our group had different divisions, and some divisions had their own ancillary services. Under Stark law changes, those ancillaries now need to be shared with all partners. Very good for me, but makes it less likely that our group is as open to new partners.

 

[drusso]

Our group had different divisions, and some divisions had their own ancillary services. Under Stark law changes, those ancillaries now need to be shared with all partners. Very good for me, but makes it less likely that our group is as open to new partners.

This is the way it should be.

 

[mid|ine]

This is the way it should be.

I agree, but it may change how likely the group as a whole is willing to take on new partners. Its still a very attractive group for non-partners. Before this change, any ancillary income for me was nominal. Any non-partners would basically be in the position I am until Jan 22