Original attraction was overall under utilization of a treatment modality that simply gets results. Nothing is better than ECT for depression. I collected data with my previous practice of 64% remission, 18% response, and 18% limited / no benefits. Before I started that service I found my self frustrated not being able to offer the service to patients, who would have clearly benefited, or people routinely be re-admitted on inpatient unit. I found it professionally rewarding to see the drastic transition from severe depression to functional for most patients.
I criticize C/L strongly, despite training at a residency that is definitely a quality place to train for that fellowship, and some people criticize ECT as boring and simply pushing a button. I get what people people are saying with limited interest in ECT, just as I'm sure people might get why I say C/L is boring. For me though I find ECT to be quite stimulating with nuances of thinking about seizure threshold, medication impact on that, prognosis factors in the treatment, patient selection, lead placements, challenging cases of refractory Bipolar mania/psychosis or catatonia with +/- malignancy/NMS. Having one person who spent more days in hospitals then outside of them, go almost 2 years without a hospitalization. The ISEN-ECT journal articles and nuances of publications, I get excited about that journal. Simply put it just resonates with me, I like the articles, and seeing patients get better, and doing the procedure itself. Time flies. Also thinking about the next step after ECT, and options of continuation phase, or maintenance phase. I've had one person who had 100+ treatments over life for decades, and if ECT were messed with, that patient would relapse into depression.
However, because of CMS, it is not on an approved list be done Ambulatory Surgery Centers, and means free standing psych hospitals or regular hospitals are the options. When you set foot in a hospital, you sign up for politics, and bureaucracy. I loathe the politics, I loathe the bureaucracy. I'm in the process of trying to set up ECT/TMS/Ketamine, but its not an easy road, and I can't add much more at this point other than I'm still plinking away at getting the ECT to be a go. Financially, I was insulated from it at previous job and had no idea the renumeration, but noted my patient panel to be heavy on the medicare/medicaid, naturally. Now that I have contracts in hand, I can say ECT can pay well, but you are definitely limited by the pre amble of time/staffing resources to get the insurance auth in the first place. The heavier medicaid/medicare payer mix will pull down the better numbers of private insurance. Assume you will only get 2 procedures per hour done (if you could do 3 it could be more lucrative than med checks for sure, but +/- med checks with therapy add on codes). You also will have no shows for ECT, and also need to block treatment procedure time from normal schedule so whether the volume is there or not. Could possibly do worse than basic med checks for that total blocked time. If the volume is robust and consistently 6+ per treatment day, could pencil out as worthwhile. Other issues include patients that might have post ictal agitation and require time at bedside, which can delay exodus to go to clinic. Other issues are rotation of anesthesia and pacu nurses - less is best, and consistency is preferable - so much to talk on that subject but some hospitals that's really out of your control. Also, your outpatient practice and hospital have travel time, which means time not seeing patients, lowers your income and needs to be factored in. So financially, its possible for ECT to be quite lucrative in the right set up, but realistically in real worled, assume its the same as basic med check, and prepare yourself to be worse overall.
If you have a 100% ECT like one poster on here, then yeah, that's financially lucrative, but those set ups exist only in large groups or academia (or Kaiser?) and not a smaller community practice. So those employers won't be giving the extra money but instead putting it in the coffers of the department.
