Father's Day & Pain Doctor Million-Dollar Baller Club

[drusso]

You work hard. And, most of us know pain doctors pulling in $500K, $600K, or $700K per year. These docs have mastered the arts of efficiency and "turn and churn" and put their nose to the grindstones and crank it out while still doing some routine maintenance and oil changes on marriage, family, etc.

But, I'm curious about the docs pulling $1.1M, $1.2M, or $1.3M. What's in their secret sauce? Geographic arbitrage and making their nut in a low COL part of the country? FIRE and diversification in real estate and other alternative revenue streams? Effectively working through others and leveraging the talents of employed physicians and other employees?

If you are a million-dollar baller or recently had a beer with one, how is it that they are able to shake their moneymaker twice as fast as even the most productive of us?

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[10KHertz]

You work hard. And, most of us know pain doctors pulling in $500K, $600K, or $700K per year. These docs have mastered the arts of efficiency and "turn and churn" and put their nose to the grindstones and crank it out while still doing some routine maintenance and oil changes on marriage, family, etc.

But, I'm curious about the docs pulling $1.1M, $1.2M, or $1.3M. What's in their secret sauce? Geographic arbitrage and making their nut in a low COL part of the country? FIRE and diversification in real estate and other alternative revenue streams? Effectively working through others and leveraging the talents of employed physicians and other employees?

If you are a million-dollar baller or recently had a beer with one, how is it that they are able to shake their moneymaker twice as fast as even the most productive of us?

Hardwork, good hands , some luck...

 

[SommeRiver]

I personally do not see how a pain physician could make that much money without providing less than quality care.

 

[gaseous_clay]

I’m pretty sure there aren’t many of these guys and I doubt the ones who do make that much are going to acknowledge it on here.

 

[hyperalgesia]

I'm not in this club but here's what I would do.

Step 1. Eliminate all self-doubt. Believe you deserve millions/year.
Step 2. In your mind, understand you are a salesman, a profit machine. Embrace it.
Step 3. Find/accommodate every situation where there is profit to be had. Procedures, meds, labs, imaging, almost every human can be sold something. Delegate whenever possible.
Step 4. Expand, expand, expand. It's your destiny.

 

[RM38]

I think someone on here said at one point in time in their career they were pulling down>1 mil. I know 1 guy personally that does and it is through volume and efficiency. He owns his own building and has single specialty surgery center on 1 floor with multiple rooms. 2 docs in practice split half days in surgery center and half day in clinic. They usually have 3 scribes that room the patient, take vitals and place orders and prep the Rx for them. They will see 20-25 patients per half day in clinic this way and usually do 15-20 injections per half day in ASC. They do other stuff in ASC like kypho, SCS/pump implant, superior, etc as well. He has been around for >20 years in area growing quickly. Has really good referral sources due to long time established relationships with clinics and markets heavily. They also have 2 NPs seeing 25-30 patients a day. They each have 2 scribes as well that operate the same way. They work hard and usually don't leave until after 6-630 most nights.

 

[drusso]

I’m pretty sure there aren’t many of these guys and I doubt the ones who do make that much are going to acknowledge it on here.

What's to be ashamed of?

 

[BobBarker]

I think someone on here said at one point in time in their career they were pulling down>1 mil. I know 1 guy personally that does and it is through volume and efficiency. He owns his own building and has single specialty surgery center on 1 floor with multiple rooms. 2 docs in practice split half days in surgery center and half day in clinic. They usually have 3 scribes that room the patient, take vitals and place orders and prep the Rx for them. They will see 20-25 patients per half day in clinic this way and usually do 15-20 injections per half day in ASC. They do other stuff in ASC like kypho, SCS/pump implant, superior, etc as well. He has been around for >20 years in area growing quickly. Has really good referral sources due to long time established relationships with clinics and markets heavily. They also have 2 NPs seeing 25-30 patients a day. They each have 2 scribes as well that operate the same way. They work hard and usually don't leave until after 6-630 most nights.

I think he is clearly making quite a bit more than $1M.

 

[gdub25]

It’s hard to establish credibility in an online forum due to the mostly anonymous nature of the interaction with others we have so it’s possible I’m wasting time typing this but here it goes anyway.

I fall in this million dollar category as does my partner, two other hospital employed doctors here that I know very well personally, as well as our main solo practice competitor right across the street. Those are just the guys in my close proximity. I know plenty of others and would say at least half of the graduates from my training program make this much (there’s only been 12 graduates, it’s a young program).

There is no secret to doing this. Work hard and efficient. Like if we were mowing lawns...I just mow more lawns in a more efficient time than the guy making half as much as me. I pay some cheap laborer to run the weed eater while I ride the biggest and fastest mower money can buy. The lawn mower making half as much insists on running the weed eater himself due to “lack of quality” if the other guy does it and refuses to use a riding mower because “push mowing is the proper, safe, and traditional way to mow”.

Every person I know making over a million a year sees more than 30 patients a day, runs an interventional type practice doing injections on roughly 50% of their patients, uses scribes and MAs to do a lot of the busy work, etc. If as a pain doctor you’re seeing patients for routine refills of gabapentin and tizanadine that’s a dead giveaway you’re not getting it. Gotta get them back to the PCP and go find some patients with burning pain down their leg who need an ESI!

If you are a national average pain doc only doing 6400 RVU a year I promise in an afternoon we could sit down and come up with an easy plan to improve efficiency and get you in the 9000+ range.

Maybe I’ll start a consulting business. Anyone?

 

[drusso]

It’s hard to establish credibility in an online forum due to the mostly anonymous nature of the interaction with others we have so it’s possible I’m wasting time typing this but here it goes anyway.

I fall in this million dollar category as does my partner, two other hospital employed doctors here that I know very well personally, as well as our main solo practice competitor right across the street. Those are just the guys in my close proximity. I know plenty of others and would say at least half of the graduates from my training program make this much (there’s only been 12 graduates, it’s a young program).

There is no secret to doing this. Work hard and efficient. Like if we were mowing lawns...I just mow more lawns in a more efficient time than the guy making half as much as me. I pay some cheap laborer to run the weed eater while I ride the biggest and fastest mower money can buy. The lawn mower making half as much insists on running the weed eater himself due to “lack of quality” if the other guy does it and refuses to use a riding mower because “push mowing is the proper, safe, and traditional way to mow”.

Every person I know making over a million a year sees more than 30 patients a day, runs an interventional type practice doing injections on roughly 50% of their patients, uses scribes and MAs to do a lot of the busy work, etc. If you are a national average pain doc only doing 6400 RVU a year I promise in an afternoon we could sit down and come up with an easy plan to improve efficiency and get you in the 9000+ range.

Maybe I’ll start a consulting business. Anyone?

Solid Gold...

 

[gdub25]

You know, I’d be happy to share some of what we do if it is helpful to others. Most of the time guys here are critical and/or dismissive of such claims which makes me think many are the exact ones who could really improve efficiencies in their practice.

I know another baller here who could chime in and help...

 

[lobelsteve]

Its not hard to do.
But is this what your area needs is the question?

Having 4 docs in a small town each making 1.5M might be just overutilization. Or it could be a large enough area to justify

I’m not talking what we do, or what we can do. But what is a reasonable amount of care needed to treat the pain needs of your population.
Easy to hit 14000 wrvu per year. See back monthly, peg your hit rate on patients needing procedures at 75%. Patient just wants meds, turf to PA/NP or out of practice. Aggressivity is the key to being a pain millionaire. This is capitalism. You can get paid, they can get care. But is it truly necessary? The beauty is that this is a judgement call by the doc at this time.

 

[drusso]

You know, I’d be happy to share some of what we do if it is helpful to others. Most of the time guys here are critical and/or dismissive of such claims which makes me think many are the exact ones who could really improve efficiencies in their practice.

I know another baller here who could chime in and help...

People are trying to pull their lives together after a COVID-kick-to-the-nuts. For many, it’s a total reboot of their practices. I’m certain that anything you can share would be appreciated.

 

[drusso]

You know, I’d be happy to share some of what we do if it is helpful to others. Most of the time guys here are critical and/or dismissive of such claims which makes me think many are the exact ones who could really improve efficiencies in their practice.

I know another baller here who could chime in and help...

Who wouldn’t want to bring home more in 1 month than a pediatrician does in a whole year?

 

[oldiebutgoodie1211]

Who wouldn’t want to bring home more in 1 month than a pediatrician does in a whole year?

pediatrician makes 200k I doubt they’re making 2.5 M a year..

 

[Splenda88]

All I ever want to make is 350-400k as an IM hospitalist

 

[SommeRiver]

It’s hard to establish credibility in an online forum due to the mostly anonymous nature of the interaction with others we have so it’s possible I’m wasting time typing this but here it goes anyway.

I fall in this million dollar category as does my partner, two other hospital employed doctors here that I know very well personally, as well as our main solo practice competitor right across the street. Those are just the guys in my close proximity. I know plenty of others and would say at least half of the graduates from my training program make this much (there’s only been 12 graduates, it’s a young program).

There is no secret to doing this. Work hard and efficient. Like if we were mowing lawns...I just mow more lawns in a more efficient time than the guy making half as much as me. I pay some cheap laborer to run the weed eater while I ride the biggest and fastest mower money can buy. The lawn mower making half as much insists on running the weed eater himself due to “lack of quality” if the other guy does it and refuses to use a riding mower because “push mowing is the proper, safe, and traditional way to mow”.

Every person I know making over a million a year sees more than 30 patients a day, runs an interventional type practice doing injections on roughly 50% of their patients, uses scribes and MAs to do a lot of the busy work, etc. If as a pain doctor you’re seeing patients for routine refills of gabapentin and tizanadine that’s a dead giveaway you’re not getting it. Gotta get them back to the PCP and go find some patients with burning pain down their leg who need an ESI!

If you are a national average pain doc only doing 6400 RVU a year I promise in an afternoon we could sit down and come up with an easy plan to improve efficiency and get you in the 9000+ range.

Maybe I’ll start a consulting business. Anyone?

I'm not calling into question your character, what you stand for or how you were raised...but by definition you run an efficient block shop centered on needle therapy and I don't believe for a minute you do anything otherwise.

You run your practice like a surgeon, but you're not a surgeon. You offer treatments neither curative nor complete, unlike a surgeon looking to pull out an appendix or tie bowel together.

A huge part of our job is patient education and conservative management. There's no way you do that if you're constantly on the lookout for "burning pain down the leg" and refusing to see medication followups for gabapentin/Zanaflex.

Again, I'm not saying you're a bad guy for that, but that is what you do and I reject that as being good for the field in general.

Edit - Embarrassing thread. Now there are IM doctors coming into the forum reading about Pain MD's making tons of money which isn't reality...It is an outlier, and not typical without improper pt care.

 

[oldiebutgoodie1211]

I'm not calling into question your character, what you stand for or how you were raised...but by definition you run an efficient block shop centered on needle therapy and I don't believe for a minute you do anything otherwise.

You run your practice like a surgeon, but you're not a surgeon. You offer treatments neither curative nor complete, unlike a surgeon looking to pull out an appendix or tie bowel together.

A huge part of our job is patient education and conservative management. There's no way you do that if you're constantly on the lookout for "burning pain down the leg" and refusing to see medication followups for gabapentin/Zanaflex.

Again, I'm not saying you're a bad guy for that, but that is what you do and I reject that as being good for the field in general.

Edit - Embarrassing thread. Now there are IM doctors coming into the forum reading about Pain MD's making tons of money which isn't reality...It is an outlier, and not typical without improper pt care.

so you are saying he’s a bad guy because you’re saying he is providing improper care which kinda makes him a bad guy lol

 

[SommeRiver]

so you are saying he’s a bad guy because you’re saying he is providing improper care which kinda makes him a bad guy lol

A pain doctor making over a million dollars per year is sticking every pt he/she sees...You're not a bad guy for sticking everyone with stenosis and facet dz who hurts. You want to help improve their QoL, decrease pain, increase fxn, better sleep...

You're not a bad guy for that.

...but after a little while doing this YOU KNOW you're just buying them a little bit of time and they'll be right back...If you tell me you won't see a gabapentin or Zanaflex refill and you're always searching out a radic, all the while harping on efficiency, what you're telling me is that pts who are not "stickable" are not worth your time...Which I disagree with completely.

Not saying money hungry or greedy, and def not saying incompetent or sociopath (spine surgeons are sociopaths).

 

[gaseous_clay]

What's to be ashamed of?

Nothing to be ashamed of. My point is that once these millionaires start giving out advice as to how they do it, someone inevitably starts chirping in with comments related to how that physician is doing too many unnecessary injections, quality of care is poor when they are that busy, physician is seeing way too many patients, practice may be committing fraud, etc. Looks like that already happened

 

[SommeRiver]

Nothing to be ashamed of. My point is that once these millionaires start giving out advice as to how they do it, someone inevitably starts chirping in with comments related to how that physician is doing too many unnecessary injections, quality of care is poor when they are that busy, physician is seeing way too many patients, practice may be committing fraud, etc. Looks like that already happened

It's true though.

 

[oldiebutgoodie1211]

A pain doctor making over a million dollars per year is sticking every pt he/she sees...You're not a bad guy for sticking everyone with stenosis and facet dz who hurts. You want to help improve their QoL, decrease pain, increase fxn, better sleep...

You're not a bad guy for that.

...but after a little while doing this YOU KNOW you're just buying them a little bit of time and they'll be right back...If you tell me you won't see a gabapentin or Zanaflex refill and you're always searching out a radic, all the while harping on efficiency, what you're telling me is that pts who are not "stickable" are not worth your time...Which I disagree with completely.

Not saying money hungry or greedy, and def not saying incompetent or sociopath (spine surgeons are sociopaths).

spine surgeons are sociopaths?

 

[BobBarker]

You don’t have to be a block shop or do anything unethical to do very well. @lobelsteve would make over $1M with a better conversion factor which he could probably get if he converted his procedure suite to HOPD. We all think that Steve is a good doctor, right?

 

[drusso]

You don’t have to be a block shop or do anything unethical to do very well. @lobelsteve would make over $1M with a better conversion factor which he could probably get if he converted his procedure suite to HOPD. We all think that Steve is a good doctor, right?

Steve will not be tempted by the evil fruit of $O$...

 

[BobBarker]

He can still do his kyphos in the office but even the knee viscos must go in the HOPD...

 

[gdub25]

Yeah, I agree Bob. And SommeRiver, afraid maybe you, as well as others, just haven’t been exposed to other models. I get all the preconceived ideas and assumptions but I promise you’re view of what these practices must be like just isn’t correct.

Regarding gabapentin refills...we don’t refuse them. We send them back to PCP with recommendations and an understanding of their problem, options moving forward, etc. And you are kind of right about the surgeon analogy. We have expertise and training for advanced procedures like injections, kypho, stim, Vertiflex...We see those patients and help them. We don’t over utilize, don’t poke every patient that walks in the door, don’t have any ownership in any lab, or compounding pharmacy, or any other ancillary. We work hard to develop relationships with referring docs who know what we can help with and send patients that need our services. We are in a big city with plenty of referring docs. If we have patients on the schedule for a simple gabapentin refill who is otherwise stable and doing well they are just as well off getting it from their PCP and allowing us to keep that appointment slot open for someone who has an issue the PCP can’t help with like radicular pain. PCPs love us getting patients in within a day or two of referring, patients are happy to see a specialist so fast, we get the type of patients we get satisfaction out of helping, everyone wins.

 

[drusso]

Yeah, I agree Bob. And SommeRiver, afraid maybe you, as well as others, just haven’t been exposed to other models. I get all the preconceived ideas and assumptions but I promise you’re view of what these practices must be like just isn’t correct.

Regarding gabapentin refills...we don’t refuse them. We send them back to PCP with recommendations and an understanding of their problem, options moving forward, etc. And you are kind of right about the surgeon analogy. We have expertise and training for advanced procedures like injections, kypho, stim, Vertiflex...We see those patients and help them. We don’t over utilize, don’t poke every patient that walks in the door, don’t have any ownership in any lab, or compounding pharmacy, or any other ancillary. We work hard to develop relationships with referring docs who know what we can help with and send patients that need our services. We are in a big city with plenty of referring docs. If we have patients on the schedule for a simple gabapentin refill who is otherwise stable and doing well they are just as well off getting it from their PCP and allowing us to keep that appointment slot open for someone who has an issue the PCP can’t help with like radicular pain. PCPs love us getting patients in within a day or two of referring, patients are happy to see a specialist so fast, we get the type of patients we get satisfaction out of helping, everyone wins.

I'm curious how much pressure the Hospital Admin exerts upon you to drive volume to the HOPD and how they create the necessary incentives/required penalties to induce behavioral alignment to achieve their results?

 

[gdub25]

We don’t do anything at the hospitals. We’re private and do everything in our clinics. We have small ownership in an ASC where we do our perms but even trials are done in the office.

The only thing we see the hospitals doing is hiring their own pain docs to try to keep the referrals in house. They have moderate success with this but they have a hard time recruiting anyone good because we usually get first pick if someone’s looking to come to town.

 

[SommeRiver]

You don’t have to be a block shop or do anything unethical to do very well. @lobelsteve would make over $1M with a better conversion factor which he could probably get if he converted his procedure suite to HOPD. We all think that Steve is a good doctor, right?

If I was HOPD I would be over a million, but there's obvious reasons for that.

I'm clinic and ASC and I'm very busy...I'm swamped to be honest, but there's simply NO WAY I could make that much money without sacrificing something.

I don’t know where relative to one million you guys are, but you don't do twice my volume and I make half of that...

 

[SommeRiver]

Yeah, I agree Bob. And SommeRiver, afraid maybe you, as well as others, just haven’t been exposed to other models. I get all the preconceived ideas and assumptions but I promise you’re view of what these practices must be like just isn’t correct.

Regarding gabapentin refills...we don’t refuse them. We send them back to PCP with recommendations and an understanding of their problem, options moving forward, etc. And you are kind of right about the surgeon analogy. We have expertise and training for advanced procedures like injections, kypho, stim, Vertiflex...We see those patients and help them. We don’t over utilize, don’t poke every patient that walks in the door, don’t have any ownership in any lab, or compounding pharmacy, or any other ancillary. We work hard to develop relationships with referring docs who know what we can help with and send patients that need our services. We are in a big city with plenty of referring docs. If we have patients on the schedule for a simple gabapentin refill who is otherwise stable and doing well they are just as well off getting it from their PCP and allowing us to keep that appointment slot open for someone who has an issue the PCP can’t help with like radicular pain. PCPs love us getting patients in within a day or two of referring, patients are happy to see a specialist so fast, we get the type of patients we get satisfaction out of helping, everyone wins.

Like I said a few times (and will say again bc I know how things read on internet forums), I don't think you're a bad guy.

I just simply cannot wrap my head around how a pain doctor doing clinic and ASC procedures (not HOPD) is so "efficient" he/she makes over a million dollars per year.

For example, in my practice we have a couple of spine surgeons and I am inundated...nay, flooded with FBSS. The only way I could even begin to start approaching that is with my putting a stimulator in every single pt I see...Which I won't.

What do you collect? Clinic and ASC.

 

[Ronin1]

regardless of how busy and efficient you may be, your reimbursement will still be tied to pay or mix and quality of contracts. Obviously this varies tremendously

 

[lobelsteve]

I could do 1.5 by changing SOS and negotiating. Owning everything and going OON to my ASC and easily 2M. Own the land/lease to several others and $10M.

I made 90k in 07 speaking fees. My dad was a salesman. I gave up on money and being a salesman in 2008. I feel better about my day to day and what I do for my community. I never went into getting an MD to make more than $200k per year.

 

[SSdoc33]

regardless of how busy and efficient you may be, your reimbursement will still be tied to pay or mix and quality of contracts. Obviously this varies tremendously

this is the key --- and why you cant equate practice's volume and pay vs. another's.

 

[Sig123]

this is the key --- and why you cant equate practice's volume and pay vs. another's.

Bingo!

2 practices with identical volume and case load can have vastly different revenue based on contracts.

 

[drusso]

this is the key --- and why you cant equate practice's volume and pay vs. another's.

But contracts alone can't explain the differences between the Million-Dollar Ballers and Half-Million Have-nots. There must be other factors...

 

[oldiebutgoodie1211]

Hahah low in this field is 500k damn you guys are making a killing hope the government doesn’t come for you next..

 

[Ferrismonk]

Low isn't 500k. Low is 200K. Average is 300-350.

 

[Ferrismonk]

@drusso, this is a money thread. Move to private forum?

 

[cowboydoc]

It's a "funny money" thread!

 

[oldiebutgoodie1211]

@drusso, this is a money thread. Move to private forum?

you trying to hide your money from the rest of us peasants? Smart thinking my man

 

[drusso]

@drusso, this is a money thread. Move to private forum?

A lot of residents and fellows don't have access to the private forum and since no real contract details are being discussed I think its fair game to ask the Million-Dollar Ballers here how they bring home that can kind of bacon while the rest of slobs are scrambling for scraps.

 

[SommeRiver]

Hahah low in this field is 500k damn you guys are making a killing hope the government doesn’t come for you next..

Low is NOT 500k in this field. Low is 225 or so...Most make 300-350. There's a reason pain doctors make more than perhaps IM, and that is bc we do subject ourselves and our pts to procedural risk.

I maintain a million dollar pain doctor is doing something drastically different than I am, and I'm really busy in my clinic and ASC (I have ownership shares). I will never see a million bucks, nor am I trying to bc my pt population doesn't need that...

 

[SommeRiver]

Bingo!

2 practices with identical volume and case load can have vastly different revenue based on contracts.

Please...You're talking the difference between making 350 and 500, not the difference of 400-500 to 1,000,000.

 

[SommeRiver]

I could do 1.5 by changing SOS and negotiating. Owning everything and going OON to my ASC and easily 2M. Own the land/lease to several others and $10M.

I made 90k in 07 speaking fees. My dad was a salesman. I gave up on money and being a salesman in 2008. I feel better about my day to day and what I do for my community. I never went into getting an MD to make more than $200k per year.

What do you mean "do?" As in, collect 1.5 million (requires you bill like 7 million-ish), or take home 1.5 million? You've posted your schedule before and it is similar to mine...

 

[lobelsteve]

What do you mean "do?" As in, collect 1.5 million (requires you bill like 7 million-ish), or take home 1.5 million? You've posted your schedule before and it is similar to mine...

Easy to take home $1.5M as long as you do not mind churning out procedures in most lucrative venue. Pills for shots is still popular,

 

[Sig123]

Please...You're talking the difference between making 350 and 500, not the difference of 400-500 to 1,000,000.

Do you run a private practice?

Do you know what your private payor reimbursements are?

 

[SommeRiver]

Easy to take home $1.5M as long as you do not mind churning out procedures in most lucrative venue. Pills for shots is still popular,

I would say it is "easy" to figure out a way to do it, but I don't see it being easy to live that way. In fact, a pain doctor making 1.5 million is absolutely committing fraud. TBH, I don't even see how that would be possible without a ton...and I mean a ton...of industry money and private investments.

 

[SommeRiver]

Do you run a private practice?

Do you know what your private payor reimbursements are?

Off the very top of my head I can't quote you my contracts but I've seen them yeah. It isn't hidden from me at all. I don't "run a private practice" but I'm in private practice and you're going to try and convince me that someone is being paid by...say United Healthcare 3x what they're paying us?

Lobell is saying it is "easy" to make 1.5 million as a pain doctor and I guess you're talking our contracts being multiplied by 5 or 6? Come on...

 

[lobelsteve]

Off the very top of my head I can't quote you my contracts but I've seen them yeah. It isn't hidden from me at all. I don't "run a private practice" but I'm in private practice and you're going to try and convince me that someone is being paid by...say United Healthcare 3x what they're paying us?

Lobell is saying it is "easy" to make 1.5 million as a pain doctor and I guess you're talking our contracts being multiplied by 5 or 6? Come on...

WC, atty liens. Drop your lowest payors. ABNs for everybody. Sell your wares.

 

[BobBarker]

@SommeRiver your employer may be wasting or making $100,000s of dollars off you. Do you know your gross annual revenue?