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

[drusso]

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.

I think that's the question we want to be answered: What do the Million-Dollar-Ballers actually **DO** that's different from the "normal" busy pain doctor. I think it's being more efficient and "working through others." If you own a restaurant, do you want to be the Maitre-d or the guy in the back flipping the burgers?

If you're just flipping burger or drilling teeth it's going to be hard to ball a Million. But, if you "own the means of production" you can leverage your time and effort.

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[lobelsteve]

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

Physician Enterprise Value

 

[drusso]

Physician Enterprise Value

A new formula to track the ROI of your employed physicians

When thinking about the financial performance of the employed physician enterprise for your health system, is your first instinct to focus on the operating loss of the medical group as a standalone business? While this is certainly an important part of the equation, it's by no means the whole

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[SommeRiver]

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

I have all of our billing, collecting, etc. All the doctors, midlevels, ancillaries...

Edit - That's kind of my point BTW. I know how busy I am and what I bill and collect. I cannot under any circumstance imagine making 1.5 million OR collecting that...Even with ASC ownership. I'm going to get my contracts out again. I just emailed our admin and I'm taking a look at them once they're all pulled for me.

 

[deleted993114]

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?

I used to make that much and I hated it. Here is the "secret"

1. payer mix: must have 65+ plus commercial insurance. Cap your medicare at 35% per month.
2. Cap Medicaid at 1%
3. Lots of overhead- I had $1 million per year
a. two NPs
b. 5 RNs and LPNs
c. two receptionists
4. Referral base- must get most patients from spine practices, not primary care. These are mostly direct procedure referrals.
5. 4 exam rooms per doc to keep things moving
6. work from 7;30 am to 6 pm
7. Geographic area- Midwest and southeast (except FL) are the best for reimbursement.
8. IMEs- you can make $10K on each weekend

Bonus bit- if you want to be a *****, you can be a "spokesman" for one of the equipment companies (or several) or employee a bunch of other pain docs as slaves. We all know the names of crooks who do that.


Sounds like big fun, right? I am an employee making half as much and I love it.

 

[deleted993114]

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.

Committing fraud? BS- I made that much and had a practice fed by neurosurgeons. I worked my butt off and hated it. I would routinely turn away scheduled procedures and did not do things that were not indicated. I didn't do the crook things of a zillion stim trials and test blocks with no subsequent procedure done. I didn't do PRP, prolotherapy, or any of the scam procedures. I let my NPs keep whatever they generated and did not make a dime off them (they made about $200K).

Just very high volume, rapid fire, procedure oriented.

Not many people can do procedures fast enough to perform at that pace.

Personally, I do not know why ANYONE (despite the money) would want such a life (it sucked and ruined my health). I am an employee now and love it.

 

[Ronin1]

There are worlds of difference in reimbursement based on the setting. Unless you have significant ASC ownership in a well run busy ASC you are probably better off financially doing everything in your office.

other ways to make $$$. Ancillaries (lab etc), vig off of employee docs, Legal work, LOP work etc.

 

[hyperalgesia]

1. payer mix: must have 65+ plus commercial insurance. Cap your medicare at 35% per month.
4. Referral base- must get most patients from spine practices, not primary care. These are mostly direct procedure referrals.
7. Geographic area- Midwest and southeast (except FL) are the best for reimbursement.

Just to drive these points home, if you don't the leverage in your area, you can't have 1 and 4.

In my area, all the spine docs take medicaid so you can't refuse it if you want their pts. They also expect a lot of scut work from you or they'll just send it to the next guy who will gladly absorb whatever is available.

You want leverage with referring docs, patients, and payers.

 

[SommeRiver]

Committing fraud? BS- I made that much and had a practice fed by neurosurgeons. I worked my butt off and hated it. I would routinely turn away scheduled procedures and did not do things that were not indicated. I didn't do the crook things of a zillion stim trials and test blocks with no subsequent procedure done. I didn't do PRP, prolotherapy, or any of the scam procedures. I let my NPs keep whatever they generated and did not make a dime off them (they made about $200K).

Just very high volume, rapid fire, procedure oriented.

Not many people can do procedures fast enough to perform at that pace.

Personally, I do not know why ANYONE (despite the money) would want such a life (it sucked and ruined my health). I am an employee now and love it.

Okay, so YOU did not commit fraud, and instead were drenched by your neurosurgery colleagues.

How many pain doctors can say that?

It is an outlier that makes 1.5 million dollars per year.

1,500,000 ÷ 2 = 750k

The overwhelming majority of pain doctors in America don't make anything CLOSE to 750k, which is half of the number we're discussing...

According to all these surveys ppl fill out and submit regarding income, you're avg pain doctor is taking home like 425k or so...Somewhere in that ballpark.

It is simply not possible for the vast majority of pain doctors to bring home 1,000,000 without some form of fraud.

 

[Gauss]

anyone working that hard is a noob
its all about the passive income

 

[clubdeac]

I think having a scribe would be a game changer. I could probably go from seeing 20 to 30 patients in a day. However that means I'd have to trust them... and I trust nobody!

 

[Ducttape]

fastest way, without doubt in my mind, is to get in bed with industry and focus on 100% interventional.

by getting in to bed, I mean get money from industry for devices, and take primarily WC or personal injury, no Medicare/Medicaid.

 

[10KHertz]

Most lucrative physicians are audited often. CMS is in bed with BCBS . Ours ‘accelerate Medicare payments’ came directly from BCBS bank accounts. The system is all interlinked and lucrative practices are targets in general. When I get audited , at least 5 more insurance follow suit. It’s not coincidental...

 

[gdub25]

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.

You mentioned several times you do clinic and ASC procedures with ownership shares in the ASC. The following thought process my friends is the difference between the ballers and regulars.

If I’m SommeRiver then no way am I doing procedures in an ASC unless I own a big ole chunk of it. Like 50% or more. Here’s why:

Overhead in my efficiently run clinic is going to be somewhere in the low 40s, high 30s percent of collections. Let’s call it 45% and stay on the high end. I’ll get paid around $260 for an epidural, minus 45% overhead I’ve got $143 in my pocket. Overhead in the ASC is going to be 75-80% and the facility fee on the ESI is a measly $315. That means only 20% of the $315, or $63, is going to be profit for the ASC. Best case scenario you’re 50% owner then you just got $32 in distribution which you can add to your $102 for your professional fee for a total of $134. Now factor in that you’re probably sedating patients for procedures and only doing around 4 injections per hour and you can see that I’m going to win in my clinic by a wide margin if I can slim my overhead down another 4-5%, move fast and get 7-8 injections done an hour, and take into consideration that most likely you own way less than 50% in the ASC.

I have 5% ownership in an ASC and only do stim implants there. All procedures are done in the office with no sedation. All trials in the office as well.

 

[gdub25]

I used to make that much and I hated it. Here is the "secret"

1. payer mix: must have 65+ plus commercial insurance. Cap your medicare at 35% per month.
2. Cap Medicaid at 1%
3. Lots of overhead- I had $1 million per year
a. two NPs
b. 5 RNs and LPNs
c. two receptionists
4. Referral base- must get most patients from spine practices, not primary care. These are mostly direct procedure referrals.
5. 4 exam rooms per doc to keep things moving
6. work from 7;30 am to 6 pm
7. Geographic area- Midwest and southeast (except FL) are the best for reimbursement.
8. IMEs- you can make $10K on each weekend

Bonus bit- if you want to be a *****, you can be a "spokesman" for one of the equipment companies (or several) or employee a bunch of other pain docs as slaves. We all know the names of crooks who do that.


Sounds like big fun, right? I am an employee making half as much and I love it.

This formula may work but there’s more than one way to skin a cat.

1. Our Medicare is 45% and I’d take more if I could get it. They pay fast and have clear cut medical guidelines, no authorization required meaning I can give a patient an ESI the same day they walk in for a new patient eval with their MRI in hand and pain down their leg.
2. Medicaid pays ok in our state, no reason to cap. That being said we don’t see them, don’t need the headache.
3. This holds true for us, overhead is very high.
4. Not our model, we try to get from PCP first so we control the referral flow but direct procedure referrals make it much easier.
5. Exact opposite in our model, zero RNs or LPNs, only well trained MAs. Nurses are too expensive and a well trained MA will do the same job and if paid $20 an hour will never quit to go work anywhere else.
6. I start clinic at 8am and leave by 4:30 every day.
7. Don’t know about other areas, I only know what I see and have only worked in one place.
8. Have never done this. I do see MVA patients but this accounted for 8% of my total collections last year.

 

[SommeRiver]

You mentioned several times you do clinic and ASC procedures with ownership shares in the ASC. The following thought process my friends is the difference between the ballers and regulars.

If I’m SommeRiver then no way am I doing procedures in an ASC unless I own a big ole chunk of it. Like 50% or more. Here’s why:

Overhead in my efficiently run clinic is going to be somewhere in the low 40s, high 30s percent of collections. Let’s call it 45% and stay on the high end. I’ll get paid around $260 for an epidural, minus 45% overhead I’ve got $143 in my pocket. Overhead in the ASC is going to be 75-80% and the facility fee on the ESI is a measly $315. That means only 20% of the $315, or $63, is going to be profit for the ASC. Best case scenario you’re 50% owner then you just got $32 in distribution which you can add to your $102 for your professional fee for a total of $134. Now factor in that you’re probably sedating patients for procedures and only doing around 4 injections per hour and you can see that I’m going to win in my clinic by a wide margin if I can slim my overhead down another 4-5%, move fast and get 7-8 injections done an hour, and take into consideration that most likely you own way less than 50% in the ASC.

I have 5% ownership in an ASC and only do stim implants there. All procedures are done in the office with no sedation. All trials in the office as well.

I do 75% of my injxns in the clinic, and I'm 5% of the ASC with a bunch of ortho guys. I only sedate for stellate and stim. I haven't done a clinic trial, but I've been debating it. You think PO Valium 10-15mg and lido 2% would get it done?

 

[BobBarker]

It might be financially better to do the trial in the ASC. there is a bigger SOS differential than an injection.

 

[DOctorJay]

I do 75% of my injxns in the clinic, and I'm 5% of the ASC with a bunch of ortho guys. I only sedate for stellate and stim. I haven't done a clinic trial, but I've been debating it. You think PO Valium 10-15mg and lido 2% would get it done?

I do my SCS trials in office with local only. They’re less painful than RFA.


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[callmeanesthesia]

I do my SCS trials in office with local only. They’re less painful than RFA.


Sent from my iPhone using SDN

What’s your margin on those? And how sterile is your office injection suite?

 

[gdub25]

At 5% owner you should not do trials at the ASC, giving away all the facility fee and taking a huge pay cut on the pro fee. I’ve done the math on it given that I myself am 5% owner of an ASC.

Yes, Valium will be fine for trials, we use local only and they do fine. We’ve never had an infection with a trial, our group has done 200 a year for the last decade.

To make over a million a year in our model you’d need to be doing roughly 70 fluoro injections a week. In order to do this and see enough clinic patients to find that many patients who need injections we do clinic and injections at the same time. While room is turning over I’m seeing a patient.

 

[SommeRiver]

I'm going to try some clinic trials.

I had a very well known NANS guy tell me not to ever mix clinic and procedure time.

 

[lobelsteve]

I do 75% of my injxns in the clinic, and I'm 5% of the ASC with a bunch of ortho guys. I only sedate for stellate and stim. I haven't done a clinic trial, but I've been debating it. You think PO Valium 10-15mg and lido 2% would get it done?

99% trials in office without sedation since 2007.

 

[DOctorJay]

What’s your margin on those? And how sterile is your office injection suite?

I don’t know the margin since I’m a hospital employee. Injection suite is sterile enough to do these safely and never had an infection.


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[bedrock]

No reason to do trials in an ASC for sterility. As others have indicated, office is sterile. I’ve done hundreds of offices trials. No infections.

When you guys says no sedation for the office trials, do you mean no IV sedation? I still give trials P.O. Xanax, which many patients still appreciate for a office trial.

 

[DubVille]

What’s your margin on those? And how sterile is your office injection suite?

I do in office trials. Will give an oral benzodiazepine if they want but rarely required.

Margin is around 1600-2000. Gown and drape, chlorhexidine, and 50/50 1% lido and 0.5% bupivicaine. I only do about 1.5 trials a month. Dont know where people find all the candidates.

 

[oldiebutgoodie1211]

I do in office trials. Will give an oral benzodiazepine if they want but rarely required.

Margin is around 1600-2000. Gown and drape, chlorhexidine, and 50/50 1% lido and 0.5% bupivicaine. I only do about 1.5 trials a month. Dont know where people find all the candidates.

you make 2000 dollars on the procedure? How long does it take to do?

 

[DubVille]

Sepe

you make 2000 dollars on the procedure? How long does it take to do?

Depends. 30-50 min from start of draping to helping off bed in office. We get about 1800-2000 reimbursement typically. 2 leads are 110 each, meds which oddly some insurances actually pay for bupivicaine fairly well. Drapes for me and gloves. Not much overhead

 

[oldiebutgoodie1211]

Sepe
Depends. 30-50 min from start of draping to helping off bed in office. We get about 1800-2000 reimbursement typically. 2 leads are 110 each, meds which oddly some insurances actually pay for bupivicaine fairly well. Drapes for me and gloves. Not much overhead

so you are clearing possibly 1500 per hour of work with these procedures? A couple a day and you are for sure going to be clearing 1 million per year net income..damn good for you!

 

[Ferrismonk]

Sepe
Depends. 30-50 min from start of draping to helping off bed in office. We get about 1800-2000 reimbursement typically. 2 leads are 110 each, meds which oddly some insurances actually pay for bupivicaine fairly well. Drapes for me and gloves. Not much overhead

I thought there was no JCode for bupivicaine?

 

[SommeRiver]

so you are clearing possibly 1500 per hour of work with these procedures? A couple a day and you are for sure going to be clearing 1 million per year net income..damn good for you!

Not that simple.

 

[DubVille]

Not e

so you are clearing possibly 1500 per hour of work with these procedures? A couple a day and you are for sure going to be clearing 1 million per year net income..damn good for you!

No not even close. I do maybe 18 a year. Plus there is overhead for entire office, rent, etc at all times. I basically lose money on clinic days compared to overhead. Follow up after trial is bundled, etc. It is a nice procedure but isnt so straightforward.

 

[DubVille]

I thought there was no JCode for bupivicaine?

J3490 is what we use. Some insurances pay nothing, but some pay like 5-9 bucks here in AZ.

 

[SommeRiver]

Dont know where people find all the candidates.

I see FBSS quite literally all day every day bc I work with two spine surgeons. I still only do 30-35 per year. I follow my trial to perm ratio and I've only had two failed trials...I should probably trial more pts bc this tells me I'm not offering the Tx to enough pts.

Positive trial does NOT mean positive implant though...Let's set that record straight...

 

[Laryngospasm]

If I did a trial on every post lami syndrome I’d never leave the office

 

[SSdoc33]

I see FBSS quite literally all day every day bc I work with two spine surgeons. I still only do 30-35 per year. I follow my trial to perm ratio and I've only had two failed trials...I should probably trial more pts bc this tells me I'm not offering the Tx to enough pts.

Positive trial does NOT mean positive implant though...Let's set that record straight...

sounds like your partners are really hitting it out of the park.....

 

[SommeRiver]

sounds like your partners are really hitting it out of the park.....

You should see their monthly productivity numbers.

 

[SSdoc33]

You should see their monthly productivity numbers.

im sure. i guess i should have used this color.

my point was that if you see tons of failed backs, then your partners must be.... how do i put it??? "bad" is the best word i guess.

 

[myrandom2003]

99% trials in office without sedation since 2007.

So PO benzo. What about the abx? You doing PO or the IM abx?

Anyone putting IVs in for these trials?

Draping then c-arm or just the patient and sterile gown for yourself?

I would this the overhead would add up.

Us plebs want to know


Sent from my iPhone using SDN

 

[deleted993114]

Okay, so YOU did not commit fraud, and instead were drenched by your neurosurgery colleagues.

How many pain doctors can say that?

It is an outlier that makes 1.5 million dollars per year.

1,500,000 ÷ 2 = 750k

The overwhelming majority of pain doctors in America don't make anything CLOSE to 750k, which is half of the number we're discussing...

According to all these surveys ppl fill out and submit regarding income, you're avg pain doctor is taking home like 425k or so...Somewhere in that ballpark.

It is simply not possible for the vast majority of pain doctors to bring home 1,000,000 without some form of fraud.

It really depends on where you are working. Granted, I had an unusual situation in which I was a procedure slave for neurosurgeons. Any such practice could generate $1.5 million and even more, depending on how fast you work. However, the folks who took over my very same practice (newbies with poor training who couldn't work fast) went broke and had to leave. Very same environment and very markedly different outcome.

I am an employee now and make $750K My job is easy as hell and I go home at 3;30-4;00 every day. However, I am in the Midwest, which tends to be not very appealing to many. I personally like the Midwest. There are markets that are VERY LUCRATIVE. Indianapolis is one of them. I would offer that MOST pain providers there make $1 million + per year. Would I want to do it today? No...……………….. I don't want to work that hard and find time more valuable than money. Also, I like to be close to national forests and parks where I can hike.

There are also places in "Siberia" (areas of North Dakota and South Dakota) where you can make big bucks. Why? The only people who want to live there grew up there.

I would guess that the guys working in the Southeast do pretty well also. Just a guess, but I have met guys from the Southeast who were making big bucks.

Life is a balance- be happy and enjoy your TIME more than money. Essentially every pain doc will be able to retire and not have to eat cat food. My cats really like their cat food and I think I could get used to it, but I would prefer to eat human food.

 

[SommeRiver]

im sure. i guess i should have used this color.

my point was that if you see tons of failed backs, then your partners must be.... how do i put it??? "bad" is the best word i guess.

Ha! "Leg pain is gone, back ain't my fault."

 

[oldiebutgoodie1211]

It really depends on where you are working. Granted, I had an unusual situation in which I was a procedure slave for neurosurgeons. Any such practice could generate $1.5 million and even more, depending on how fast you work. However, the folks who took over my very same practice (newbies with poor training who couldn't work fast) went broke and had to leave. Very same environment and very markedly different outcome.

I am an employee now and make $750K My job is easy as hell and I go home at 3;30-4;00 every day. However, I am in the Midwest, which tends to be not very appealing to many. I personally like the Midwest. There are markets that are VERY LUCRATIVE. Indianapolis is one of them. I would offer that MOST pain providers there make $1 million + per year. Would I want to do it today? No...……………….. I don't want to work that hard and find time more valuable than money. Also, I like to be close to national forests and parks where I can hike.

There are also places in "Siberia" (areas of North Dakota and South Dakota) where you can make big bucks. Why? The only people who want to live there grew up there.

Life is a balance- be happy and enjoy your TIME more than money. Essentially every pain doc will be able to retire and not have to eat cat food. My cats really like their cat food and I think I could get used to it, but I would prefer to eat human food.

employee making 750k..damn this field is sick

 

[Yo GabbaPentin]

I see FBSS quite literally all day every day bc I work with two spine surgeons. I still only do 30-35 per year. I follow my trial to perm ratio and I've only had two failed trials...I should probably trial more pts bc this tells me I'm not offering the Tx to enough pts.

Positive trial does NOT mean positive implant though...Let's set that record straight...

Your partners are surgeons? It’s becoming more clear to me why you can not wrap your head around a 7 figure non fraudulent income.

 

[SommeRiver]

Your partners are surgeons? It’s becoming more clear to me why you can not wrap your head around a 7 figure non fraudulent income.

How is that?

 

[deleted993114]

So PO benzo. What about the abx? You doing PO or the IM abx?

Anyone putting IVs in for these trials?

Draping then c-arm or just the patient and sterile gown for yourself?

I would this the overhead would add up.

Us plebs want to know


Sent from my iPhone using SDN

Nope- po Xanax of valium- no IV. Either 1 mg Xanax or 20 mg valium- half as much for older folks.

Gown and glove myself and drape the C-arm.

Stim trials take a grand total of about 10 minutes, so it is not something to arrange in an OR or surg center. As I am now hospital based, we do our perm stims after 3 pm so that we can use more than one room and get the hell out at a good time. That is the only time I am there after 3:30. I am mostly training our new guy, so it takes 1.5- 2hr hrs to do a stim (I have to bite my tongue and be patient, allowing him to make mistakes and then suggest the "right" way)

Bonus tip- 99.9% of "difficult lead placements" are due to the needle being TOO STEEP. If you are right handed, use a left paramedian approach and start the needle AT MINIMUM at the disc space level below the epidural space you are targeting. The paramedian approach gives you a bigger "target" and allows a more level approach. If a lead is "difficult", it aint the patient or the lead- its your needle approach.

 

[deleted993114]

Your partners are surgeons? It’s becoming more clear to me why you can not wrap your head around a 7 figure non fraudulent income.

I did my own perms when I made $1.5 million. I was very "machine like". Now I am an old machine that leaks oil and misses on a few cylinders.

Today, I have neurosurgeons that will do lamy leads on their own patients. We still do quite a few perc perms, as we have ones they don't want to do, better served with a perc, or come from somewhere else. Our new guy needs to get up to 100 or so pretty quick so he can feel comfy, so we are just scrubbing in with him and having him do the case while we are there for comedic relief.

I personally don't like going to the OR, as things move too slow and I hate wearing scrubs. I would prefer to stay in the clinic and work up patients. The thrill of surgery was gone years ago, but nobody else would do them.

 

[Laryngospasm]

If you want to lose money do lots of stuff in the OR lol. I’m being silly of course but nothing ruins your productivity like the OR.

 

[Ferrismonk]

Nope- po Xanax of valium- no IV. Either 1 mg Xanax or 20 mg valium- half as much for older folks.

Gown and glove myself and drape the C-arm.

Stim trials take a grand total of about 10 minutes, so it is not something to arrange in an OR or surg center. As I am now hospital based, we do our perm stims after 3 pm so that we can use more than one room and get the hell out at a good time. That is the only time I am there after 3:30. I am mostly training our new guy, so it takes 1.5- 2hr hrs to do a stim (I have to bite my tongue and be patient, allowing him to make mistakes and then suggest the "right" way)

Bonus tip- 99.9% of "difficult lead placements" are due to the needle being TOO STEEP. If you are right handed, use a left paramedian approach and start the needle AT MINIMUM at the disc space level below the epidural space you are targeting. The paramedian approach gives you a bigger "target" and allows a more level approach. If a lead is "difficult", it aint the patient or the lead- its your needle approach.

I'm sure you're more efficient than I am, but it takes me 5-10 minutes just to use my local, let it set up, and drive two touhys to the epidural space and another 10+ minutes to remove stylets, suture in leads, steri-strip, pad, coil, mastisol, and tegaderm. Again, I'm not judging, but I also suppose you are cutting corners and aren't doing intraoperative testing.

 

[SommeRiver]

It really depends on where you are working. Granted, I had an unusual situation in which I was a procedure slave for neurosurgeons. Any such practice could generate $1.5 million and even more, depending on how fast you work. However, the folks who took over my very same practice (newbies with poor training who couldn't work fast) went broke and had to leave. Very same environment and very markedly different outcome.

I am an employee now and make $750K My job is easy as hell and I go home at 3;30-4;00 every day. However, I am in the Midwest, which tends to be not very appealing to many. I personally like the Midwest. There are markets that are VERY LUCRATIVE. Indianapolis is one of them. I would offer that MOST pain providers there make $1 million + per year. Would I want to do it today? No...……………….. I don't want to work that hard and find time more valuable than money. Also, I like to be close to national forests and parks where I can hike.

There are also places in "Siberia" (areas of North Dakota and South Dakota) where you can make big bucks. Why? The only people who want to live there grew up there.

I would guess that the guys working in the Southeast do pretty well also. Just a guess, but I have met guys from the Southeast who were making big bucks.

Life is a balance- be happy and enjoy your TIME more than money. Essentially every pain doc will be able to retire and not have to eat cat food. My cats really like their cat food and I think I could get used to it, but I would prefer to eat human food.

I practice in Georgia. Your avg pain doctor makes nothing close to 750k. I value my time more than anything; I have a family. I make plenty of money, but I simply cannot imagine a situation where I made that much, nor do I see it as even possible without 2 min pt visits (I refuse) and fraudulent documentation at a minimum.

GDub said they do 70 fluoro shots per week, and that is possible how? You're going to convince me you can sit down with a pt and take a history, do a PE, review imaging, look at PDMP, etc... and still schedule volume like that?

That is looking at an MRI report and searching out words like "moderate" and "severe," walking into the room, 1-2 min conversation with no PE, leave room and move on...Someone else dictates your note. That pt gets stuck 3x and you're done with them bc you can't see them again bc they don't offer injections anymore. Move on to NPV only...

 

[deleted993114]

I'm sure you're more efficient than I am, but it takes me 5-10 minutes just to use my local, let it set up, and drive two touhys to the epidural space and another 10+ minutes to remove stylets, suture in leads, steri-strip, pad, coil, mastisol, and tegaderm. Again, I'm not judging, but I also suppose you are cutting corners and aren't doing intraoperative testing.

I hardly ever use two leads, unless I am doing lateral stims.

Speed is just a parlor trick, as it doesn't make much difference unless you have several.

 

[SommeRiver]

I hardly ever use two leads, unless I am doing lateral stims.

Speed is just a parlor trick, as it doesn't make much difference unless you have several.

You do 2 lead perms no?