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

[oldiebutgoodie1211]

No way I'd say, but if you add ortho industry plus all the checks they receive from their PAs, profit sharing, ASC x 2, clinic...etc. It is staggering. There are a couple that make SERIOUS money.

wait why would you not say I don’t get it

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[SommeRiver]

...that's their private business, and not everyone on the internet is anonymous.

The very character of this thread I find low, and this discussion should be moved to that private forum everyone's always talking about...

 

[oldiebutgoodie1211]

...that's their private business, and not everyone on the internet is anonymous.

The very character of this thread I find low, and this discussion should be moved to that private forum everyone's always talking about...

you find the character of the thread low? Lol

 

[chudat]

...that's their private business, and not everyone on the internet is anonymous.

The very character of this thread I find low, and this discussion should be moved to that private forum everyone's always talking about...

I, for one, agree with you.

 

[lobelsteve]

One guy in local ortho joint replacement group is paid 6M from industry alone.

 

[SommeRiver]

If you gave me that much money I wouldn't have a clue as to what to do with it. I guess I'd just hunt more often.

 

[10KHertz]

Entertaining stuff... feeling the love out there .

As for audits (some inquiries out there):
1. Make sure you support consult codes, with specific referring MD names, and proof your report was sent to them (ie EMR, zerafax, etc)
2. Some a-hole insurance reviewers don’t understand the term “b/l” or bilateral. Use “right & left” on your procedure notes.
3. Review your contracts regarding j/q/s/tray codes. Some insurances allow it for years and then claim ignorance. Ie BCBS bundles j codes but not others .
4. If multiple level procedures , note clearly all
Levels performed in body of note.
5. Now I basically code the note for insurance companies in the assessment section . Ie. 99214, moderate complexity procedure, new test interpretation, lab review, consult note review, etc.
6. Keep all your images well documented , and stored . Obviously

They play dumb until your rebuttal, and then radio silence until the next round...

okay, back to the entertainment. Millionaires typically don’t engage in nonsense. Best to be neutral in most matters...

 

[Splenda88]

I have a lot of respect for you and when you give technical advice I read it and pay attention.

Having said that, I do truly wonder if you read what OTHER ppl say, or are so used to giving advice you don't stop and listen yourself.

I have zero desire to get rich. I don’t friggin care about that. I make plenty, and don't plan on making more...

My position this entire time is what I perceive to be an EXTREME difference in care from what I offer vs the guys making over a million dollars.

The number 1.5 million was thrown in here earlier in this thread, and I make NOTHING EVEN CLOSE to that number, but I do not believe someone could do 3x the volume I am doing. There aren't enough hours in the day.

I do not care to make that. I am not focused on other people money. I am not jealous...I make more than probably 99% of America if I had to guess.

I look at 100% of my pt's images before I stick them...You're not tripling my volume AND doing that.

Your body doesn't move faster than mine.

What you're calling ppl today "working slower," dude your limbs don't move faster than mine...

What you're describing is to the point that we're talking about how fast your limbs move you from room to room. Do you run a 40 in 4.2? For whom did you play defensive back, the Colts?

Your wife being Catholic has nothing to do with anything man. That doesn't bring credibility to the conversation.

I maintain that someone tripling my volume is cutting corners somewhere.

Edit - Ppl worked faster back in the day...Yeah, no BS they did and there are tons of reasons for that. Documentation is different now, as are insurance requirements, and our culture is different. It is all different and can't be compared.

I know people in medicine don't like to hear that. Believe or not, some of your colleagues are smarter, better, faster and more productive than you. I used to say how one of my co-residents is leaving at 1pm and while I am still in the hospital a 5pm. I thought he was cutting corner until we were on the same team. The guy is just smarter and more efficient than I am.

 

[Centurion38]

Big money in pain medicine = Opioid Rx's. Mid-levels (either yours or the Surgeon's) drench the patients with Opioids, and they are quite happy to submit to endless needling. That's how you top 70+ procedures a week. There's no big secret. You're not faster/handsomer/more debonair than the other guy.

Get real folks

 

[gdub25]

I had our admin pull my payer contracts last week. Should be available for me Monday and I'm going to go back through them.

It's been awhile since I saw them (over 2 yrs at least).

I care so little about money that I've not even bothered to keep up with that stuff until I started reading this thread.

Again, it's not about getting rich and more specifically it is just about figuring out what some of yall are doing that I'm not...

If I can just do my job better, let me figure out how bc I can't for the life of me see how I could bill and collect that much while still giving each of my pts due process.

Never in my life has my making 750k even entered my mind. NEVER...

It’s unlikely your contracts are a big source of the problem. All of what we do is based on volume, getting a good contract is just icing on the cake. None of our contracts are any better than Medicare rates. Got to look at the other factors that I mentioned earlier.

And I disagree about the character of the thread being negative. We all work hard and I believe you should be getting paid for the work that you do. If you’re doing $750k worth of work and only getting paid $500k I think it’s great to collaborate with other hard working colleagues to optimize the business side of your practice. There’s nothing wrong with being a good businessman in addition to a good physician. It is in fact possible to be both simultaneously.

 

[hyperalgesia]

One guy in local ortho joint replacement group is paid 6M from industry alone.

That's like a whole other job he's got...

 

[gdub25]

Big money in pain medicine = Opioid Rx's. Mid-levels (either yours or the Surgeon's) drench the patients with Opioids, and they are quite happy to submit to endless needling. That's how you top 70+ procedures a week. There's no big secret. You're not faster/handsomer/more debonair than the other guy.

Get real folks

This is simply just not true. Sure, pills for pokes is something that does exist and is not good for our specialty. We have no midlevels and an internal review of our practice in 2019 showed only 28% of our patients were prescribed opioids and of those, 54% had weaned to a lower dose after starting care with us. Average MEQ 39.

I truly believe I cannot improve myself, my knowledge, or my practice if I don’t first accept that I don’t know everything. I make a conscious effort every day to be open minded to considering new ways of seeing things, running the practice, treating patients. I didn’t invent the way our practice runs. I came in after it was established and have taken things from others, even here on this forum, to tweak it along the way. 3 years ago I couldn’t do an SCS implant in under 45 minutes, I had to take advice from others who were better than me to get there. Won’t we as a specialty be better off if we could get past these disbeliefs and start asking “how” instead of immediately poking holes in everything!?

And please, don’t think this is me saying how great I am because I’ve adopted this outlook. This is me saying how grateful I am for the mentors I’ve had who helped me. I know I wouldn’t have half the success I have had on my own.

 

[Greenbayslacker]

How does one buy into ASCs and get hooked up with IME opportunities?

 

[Splenda88]

Big money in pain medicine = Opioid Rx's. Mid-levels (either yours or the Surgeon's) drench the patients with Opioids, and they are quite happy to submit to endless needling. That's how you top 70+ procedures a week. There's no big secret. You're not faster/handsomer/more debonair than the other guy.

Get real folks

Disagree... Been in healthcare for ~15 yrs overall (nursing and medicine). There are few of us that are just faster than average...

 

[paindoc007]

If you gave me that much money I wouldn't have a clue as to what to do with it. I guess I'd just hunt more often.

You’d have a sexier portflio. My lifestyle hasn’t changed significantly in the last few years, but my income has. it’s sure nice to have options for the future though

 

[PMR2008]

How much did they offer you?

It was for a unaccredited fellowship position 8 years ago.

 

[jonnylingo]

You really can't imagine that a Million-Dollar-Baller delivers the SAME quality of care that you do? You can't imagine that the only difference is that she makes a million dollars doing the same thing you do (just more of it) and you don't?

I don't know. Depends on what you mean by "quality".

This thread and this forum in general focus on shots (and stims) -- imperfect tools in a shed full of other imperfect tools.

How about CBT? Lifestyle modification? Desk ergonomics? Posture? Lifting mechanics? Smoking cessation? Low inflammatory diet? Sleep hygiene? PT? Home exercise program? Understanding neuroplasticity/Pain education?

If you are spending only a few minutes with the patient, there is no way you are getting a true picture of their mood disorder/trauma/abuse, job description, life satisfaction, social support, sleep habits, exercise habits, despite how awesome you think your intake form is.

And unless you have a nurse educator who sticks around with your patient after you bail to see the next of your 30+ patients, there is NO WAY that the patient is getting the information they need to change their core/sleep/work/habits/mood/understanding.

It makes reason stare to think one can generate enough RVUs to join the Million-Dollar-Baller club AND give patients the time they need to change their situation.

 

[SommeRiver]

I don't know. Depends on what you mean by "quality".

This thread and this forum in general focus on shots (and stims) -- imperfect tools in a shed full of other imperfect tools.

How about CBT? Lifestyle modification? Desk ergonomics? Posture? Lifting mechanics? Smoking cessation? Low inflammatory diet? Sleep hygiene? PT? Home exercise program? Understanding neuroplasticity/Pain education?

If you are spending only a few minutes with the patient, there is no way you are getting a true picture of their mood disorder/trauma/abuse, job description, life satisfaction, social support, sleep habits, exercise habits, despite how awesome you think your intake form is.

And unless you have a nurse educator who sticks around with your patient after you bail to see the next of your 30+ patients, there is NO WAY that the patient is getting the information they need to change their core/sleep/work/habits/mood/understanding.

It makes reason stare to think one can generate enough RVUs to join the Million-Dollar-Baller club AND give patients the time they need to change their situation.

...basically saying what I feel.

I do my best to operate day-to-day on good faith, so these guys and gals killing the game may absolutely have a large support staff (huge overhead) doing the nuts and bolts while the physician does a narrow and focused encounter specific to grabbing up pts needing interventions.

 

[drusso]

I don't know. Depends on what you mean by "quality".

This thread and this forum in general focus on shots (and stims) -- imperfect tools in a shed full of other imperfect tools.

How about CBT? Lifestyle modification? Desk ergonomics? Posture? Lifting mechanics? Smoking cessation? Low inflammatory diet? Sleep hygiene? PT? Home exercise program? Understanding neuroplasticity/Pain education?

If you are spending only a few minutes with the patient, there is no way you are getting a true picture of their mood disorder/trauma/abuse, job description, life satisfaction, social support, sleep habits, exercise habits, despite how awesome you think your intake form is.

And unless you have a nurse educator who sticks around with your patient after you bail to see the next of your 30+ patients, there is NO WAY that the patient is getting the information they need to change their core/sleep/work/habits/mood/understanding.

It makes reason stare to think one can generate enough RVUs to join the Million-Dollar-Baller club AND give patients the time they need to change their situation.

 

[SommeRiver]

...you can have both when Earth spins at a slower rate.

 

[lonelobo]

It’s unlikely your contracts are a big source of the problem. All of what we do is based on volume, getting a good contract is just icing on the cake. None of our contracts are any better than Medicare rates. Got to look at the other factors that I mentioned earlier.

My worst contract is 180% of medicare rates

 

[SommeRiver]

My worst contract is 180% of medicare rates

Yeah, and this obviously matters considering volume is probably the major component to collecting a lot.

Two doctors seeing 30 pts per day and one is doubling the collections...It matters.

We have a guy who only does WC. He sees minimal numbers and collects a hell of a lot money.

 

[GoBeers]

My worst contract is 180% of medicare rates

180% is that for real? What area of the country are you in?
Correct me if I'm wrong, but I feel like in highly saturated areas of LA, SF, NY.... there's no way any single specialty private practice will be able to get anything more than equal to medicare rates...

 

[lonelobo]

180% is that for real? What area of the country are you in?
Correct me if I'm wrong, but I feel like in highly saturated areas of LA, SF, NY.... there's no way any single specialty private practice will be able to get anything more than equal to medicare rates...

100% real, trade off is living in rural area that is not the greatest(Lots of mouth Breathers)

 

[SommeRiver]

100% real, trade off is living in rural area that is not the greatest(Lots of mouth Breathers)

You tell your pts that you're not only morally superior, but also of superior intelligence too?

 

[Doctodd]

You tell your pts that you're not only morally superior, but also of superior intelligence too?

he/she tries to tell us also lmao. And if you get on his radar, he sends you little private messages saying about the same thing.

 

[SommeRiver]

he/she tries to tell us also lmao. And if you get on his radar, he sends you little private messages saying about the same thing.

Modern liberalism has been radically altered by the dopaminergic effects of social media addiction. It is profoundly maladaptive and dangerous with no finish line in sight bc nature doesn't care about equality.

 

[Doctodd]

Modern liberalism has been radically altered by the dopaminergic effects of social media addiction. It is profoundly maladaptive and dangerous with no finish line in sight bc nature doesn't care about equality.

More likely he was just bullied as a child, or molested. But IM THE TROLL....lol

 

[SommeRiver]

More likely he was just bullied as a child, or molested. But IM THE TROLL....lol

What's especially disturbing is the fact that leftist whites felt their political machinations should take precedence over correcting black injustice in law enforcement.

 

[lonelobo]

he/she tries to tell us also lmao. And if you get on his radar, he sends you little private messages saying about the same thing.

Doesn't mean much from a Jibarito

 

[lonelobo]

You tell your pts that you're not only morally superior, but also of superior intelligence too?

Yep lots have drank the Orange Kool Aid like you...... fact deniers, science deniers, anti-maskers

 

[SommeRiver]

Yep lots have drank the Orange Kool Aid like you...... fact deniers, science deniers, anti-maskers

It's unfortunate.

I make a comment about how gross the left has become (any honest and objective liberal would agree), so you call me a "fact denier, science denier, anti-masker."

You've got no reason to think you're superior in any way to the posters in this forum.

Your immediate dismissal of posters you disagree with is arrogant and in keeping with the strategies of the modern leftist movement.

I have no idea why you think I'm a "science denier."

 

[SSdoc33]

More likely he was just bullied as a child, or molested. But IM THE TROLL....lol

what's the matter with you?

 

[deleted131481]

It's unfortunate.

I make a comment about how gross the left has become (any honest and objective liberal would agree), so you call me a "fact denier, science denier, anti-masker."

You've got no reason to think you're superior in any way to the posters in this forum.

Your immediate dismissal of posters you disagree with is arrogant and in keeping with the strategies of the modern leftist movement.

I have no idea why you think I'm a "science denier."

I can't speak for lonelobo, but the way I read his post is he is an area with patients that are "fact deniers, science deniers, anti-maskers" and that they (and you) are Trump supporters, albeit in more colorful (orange) language. Even were I a Trump supporter, I'd find that less offensive than Doctodd's child bullying/molestation post which you quote.

 

[SommeRiver]

I can't speak for lonelobo, but the way I read his post is he is an area with patients that are "fact deniers, science deniers, anti-maskers" and that they (and you) are Trump supporters, albeit in more colorful (orange) language. Even were I a Trump supporter, I'd find that less offensive than Doctodd's child bullying/molestation post which you quote.

All it takes is for me to declare the left has spiraled wildly out of control, and from that statement I am busted as a Trump supporter?

I despise Donald Trump, so there's that...

I didn't address Doctodd's "bullied/molested" post bc those two have urinated on 500 threads in this forum (I may be taking a dump on this one), and it isn’t my responsibility to be their peacemaker.

Having said that, one individual's personal attack against another isn't any more offensive than blanket statements of superiority (tons of mouthbreathers). Same thing, one is just directed at someone by name through personal interaction while the other merely casts a wider and more anonymous net.

The American story has been derailed by the left, and the moment you say that you're automatically labeled ignorant, like I just was (for reasons unclear to me).

The supposed moral and intellectual superiority is a low and easy attack to make, and here's what the left needs to know - TODAY, you're the good guys (according to yourselves), but tomorrow will bring with it a new crop of leftists who found ways to go even further left, and when that happens YOU are racist...You didn't go far enough when it was your turn.

 

[10KHertz]

Are we the most hostile specialty?
If so, why? Stress, money?

 

[VA Hopeful Dr]

Are we the most hostile specialty?
If so, why? Stress, money?

Nah, although I wouldn't blame you if you were. Chronic pain patients can be trying at the best of times.

 

[paindoc007]

I guess I’m stupid bc I don’t even understand the insult. What’s a mouth breather?

 

[SommeRiver]

I guess I’m stupid bc I don’t even understand the insult. What’s a mouth breather?

Traditionally? That term refers to ppl with Down Syndrome...

I'm sure our friend Lonelobo means it as a reference to ignorant ppl with inbreeding proximally in the family tree.

 

[Splenda88]

All it takes is for me to declare the left has spiraled wildly out of control, and from that statement I am busted as a Trump supporter?

I despise Donald Trump, so there's that...

I didn't address Doctodd's "bullied/molested" post bc those two have urinated on 500 threads in this forum (I may be taking a dump on this one), and it isn’t my responsibility to be their peacemaker.

Having said that, one individual's personal attack against another isn't any more offensive than blanket statements of superiority (tons of mouthbreathers). Same thing, one is just directed at someone by name through personal interaction while the other merely casts a wider and more anonymous net.

The American story has been derailed by the left, and the moment you say that you're automatically labeled ignorant, like I just was (for reasons unclear to me).

The supposed moral and intellectual superiority is a low and easy attack to make, and here's what the left needs to know - TODAY, you're the good guys (according to yourselves), but tomorrow will bring with it a new crop of leftists who found ways to go even further left, and when that happens YOU are racist...You didn't go far enough when it was your turn.

Pretty easy to find out... Did you vote for Trump?

 

[lonelobo]

Traditionally? That term refers to ppl with Down Syndrome...

I'm sure our friend Lonelobo means it as a reference to ignorant ppl with inbreeding proximally in the family tree.

I meant it to refer to anyone that continues to be a Trump supporter. In my area that includes a strong presence of folks that refuse to wear masks, who believe Fracking has no ill effect on climate, who wear shirts declaring that government should stay away from my medicare, etc.

Sorry if you don't believe there are a lot of stupid people out there. You probably also believe that 99.5% of people are not racist in this country as well. I have lived in the South , Midwest, and West and Stupidity and racism abounds throughout.

I think it is comical that you state the "Left" has lost it's way. Might want to check the other side and see who many life long Republicans are Fleeing the party in the age of Trumpism.

 

[lobelsteve]

I meant it to refer to anyone that continues to be a Trump supporter. In my area that includes a strong presence of folks that refuse to wear masks, who believe Fracking has no ill effect on climate, who wear shirts declaring that government should stay away from my medicare, etc.

Sorry if you don't believe there are a lot of stupid people out there. You probably also believe that 99.5% of people are not racist in this country as well. I have lived in the South , Midwest, and West and Stupidity and racism abounds throughout.

I think it is comical that you state the "Left" has lost it's way. Might want to check the other side and see who many life long Republicans are Fleeing the party in the age of Trumpism.

3rd party time. Grab fleeing folks from both sides who are moderate. End the nonsense from both sides. Term limits, tort reform, sunset laws. The rule of law.

 

[Yo GabbaPentin]

Definitely agree on third party. The left and right are both awful. I have to pick between trump and an Alzheimer’s patient? That’s really all this entire country can put forward?

 

[Ducttape]

too late this election.

fwiw, biden is definitely more middle of the road in terms of leftist than almost all of the other candidates.

your impression of "alzheimers" may be related to his stuttering, a lifelong problem he has worked hard to overcome.

unfortunately, we rarely if ever do both, because the power of economics takes over, and $$$ is a more powerful driver in our society than psychosocial self-improvement.

Big time interventionalists paid by industry will state that the premise of high expense treatments is so "this will make it so you can learn to function better on your own", but in person the ones I know state "this will take care of your pain"...

 

[SommeRiver]

Pretty easy to find out... Did you vote for Trump?

I did not.

 

[SommeRiver]

I meant it to refer to anyone that continues to be a Trump supporter. In my area that includes a strong presence of folks that refuse to wear masks, who believe Fracking has no ill effect on climate, who wear shirts declaring that government should stay away from my medicare, etc.

Sorry if you don't believe there are a lot of stupid people out there. You probably also believe that 99.5% of people are not racist in this country as well. I have lived in the South , Midwest, and West and Stupidity and racism abounds throughout.

I think it is comical that you state the "Left" has lost it's way. Might want to check the other side and see who many life long Republicans are Fleeing the party in the age of Trumpism.

Definitely not going to discuss this with you bc I've read your other posts on this forum and you're a pretty unreasonable person IMO. I gain nothing from that back and forth which will inevitably result in your complete disregard for my opinion bc it won't align with yours.

...and that makes me stupid and immoral...

 

[Yo GabbaPentin]

your impression of "alzheimers" may be related to his stuttering, a lifelong problem he has worked hard to overcome.

Duct.... come on man. Biden has been in office for a loooong time. I’ve seen him a lot over the last couple decades. This is not the same Joe. And I hate to say it but it’s true.

 

[lonelobo]

Definitely not going to discuss this with you bc I've read your other posts on this forum and you're a pretty unreasonable person IMO. I gain nothing from that back and forth which will inevitably result in your complete disregard for my opinion bc it won't align with yours.

...and that makes me stupid and immoral...

not going to discuss because you don't have a good response...fair enough

 

[10KHertz]

Nah, although I wouldn't blame you if you were. Chronic pain patients can be trying at the best of times.

VA hopeful:
You cross-over forum threads a lot. I see your posts. Are we the most cantankerous bunch? Maybe that’s what makes us great...

 

[Splenda88]

Can we get back on topic, please?

This threat was about big baller in pain management; don't turn it into Biden vs. Trump (white power) thread.


Why are physicians jealous of their colleagues who make a lot more money than them? There are outliers in every field. There are FM docs out there who make 500k+. I know an IM doc who makes 600k+ (60 hrs/wk at $225/hr). However, I understand these are not the norms.