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

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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.

Please give us the benefit of the doubt and realize that MOST of us are NOT jealous of the money (what a simple and ridiculous assumption - jealousy).

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Please give us the benefit of the doubt and realize that MOST of us are NOT jealous of the money (what a simple and ridiculous assumption - jealousy).
Not going to give you the benefit of the doubt when you make the assumption that a poster must be doing something unethical because he/she makes $1+ million/yr in a field in which most people make 400-500k...
 
Not going to give you the benefit of the doubt when you make the assumption that a poster must be doing something unethical because he/she makes $1+ million/yr in a field in which most people make 400-500k...

Have you actually read this thread?
 
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Please give us the benefit of the doubt and realize that MOST of us are NOT jealous of the money (what a simple and ridiculous assumption - jealousy).

This thread is about how to incorporate Million-Dollar-Baller Pain Doctor best practices into average compensation level clinical care. We've arrived at a consensus of what some of those Baller habits are...working efficiently, working through others, not do sensory stim, etc...

No one wants to work for half of what they're worth when others are out there Ball' in seeing 30 patients per day, skipping sensory stims during their RFA, and collecting KOL paychecks.

Why settle for less?
 
This thread is about how to incorporate Million-Dollar-Baller Pain Doctor best practices into average compensation level clinical care. We've arrived at a consensus of what some of those Baller habits are...working efficiently, working through others, not do sensory stim, etc...

No one wants to work for half of what they're worth when others are out there Ball' in seeing 30 patients per day, skipping sensory stims during their RFA, and collecting KOL paychecks.

Why settle for less?

if only i had skipped doing sensory stims!!!! i could have retired years ago
 
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This thread is about how to incorporate Million-Dollar-Baller Pain Doctor best practices into average compensation level clinical care. We've arrived at a consensus of what some of those Baller habits are...working efficiently, working through others, not do sensory stim, etc...

No one wants to work for half of what they're worth when others are out there Ball' in seeing 30 patients per day, skipping sensory stims during their RFA, and collecting KOL paychecks.

Why settle for less?
Because settling for less money can mean gaining other intangible rewards.
 
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Heck I know guys that don’t do any testing at all. And don’t forget depos , one Dr. I know charges 7500$ an hour.
 
if only i had skipped doing sensory stims!!!! i could have retired years ago

Here are the things that people are saying make a difference between being a million-dollar-baller and a regular doctor: Using IV sedation for cases, selective use of guidelines, limited physical examination of patients, using mid-levels, seeing more new patients, churning for surgeons, not doing sensory stim on RFA, "numbing it real good," limiting your practice to only interventional work, seeing at least 30 patients per day five days per week, being a majority owner in ASC or doing most things that pay well in the office, speaking for device companies, doing beaucoup kypho & stim, having ancillaries in your practice, being of OON, doing everything in the HOPD and getting $O$ transfers to base salary or wRVU comp, using scribes and MA's to do your scut work, practice in low cost of living geographic location, and having a good payer mix.

Anything else?
 
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this sounds like the pain management recruitment thread. Drusso you are a sly one.
 
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Here are the things that people are saying make a difference between being a million-dollar-baller and a regular doctor: Using IV sedation for cases, selective use of guidelines, limited physical examination of patients, using mid-levels, seeing more new patients, churning for surgeons, not doing sensory stim on RFA, "numbing it real good," limiting your practice to only interventional work, seeing at least 30 patients per day five days per week, being a majority owner in ASC or doing most things that pay well in the office, speaking for device companies, doing beaucoup kypho & stim, having ancillaries in your practice, being of OON, doing everything in the HOPD and getting $O$ transfers to base salary or wRVU comp, using scribes and MA's to do your scut work, practice in low cost of living geographic location, and having a good payer mix.

Anything else?

If I'm EXTREMELY efficient, I could combine $C$ implant WHILE stripping nude and being paid for my body (my momma and daddy gave me good stuff).

Once I reach true baller level, I'll have 3 pts in one room and I'll treat all 3 simultaneously - Call it group session clinic visit. Like inpt psych.
 
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Are we the most hostile specialty?
If so, why? Stress, money?

Interventional pain management is a made-up specialty to do the procedures real surgeons can’t be bothered with and prescribe the medications real PCPs don’t want to touch. We are constantly under-valued and misunderstood by our colleagues. So despite the relative wealth in what isn’t really that hard a job, some people carry a giant chip in their shoulder. We don’t have enough problems so we create our own. That’s my psychoanalysis.
 
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If I'm EXTREMELY efficient, I could combine $C$ implant WHILE stripping nude and being paid for my body (my momma and daddy gave me good stuff).

Once I reach true baller level, I'll have 3 pts in one room and I'll treat all 3 simultaneously - Call it group session clinic visit. Like inpt psych.
I have to know. Which would you be paid more for? How do you keep a steady hand with those kind of ancillary revenue streams? What is the billing code for that type of ancillary service? Asking for a friend.
 
if only i had skipped doing sensory stims!!!! i could have retired years ago

If only you had known.........................................

I believe that Steve Loebel here is a higher up in SIS and has posted a few articles which suggest sensory stim is not necessary.

Several years ago, they had a policy statement which suggested NOT using sensory stim. I still do so on cervicals, but not on lumbar.

Their reccs were based on evidence, and not an "off the cuff" suggestion.
 
Derby was saying no need for sensory more than 10 years ago. I still do them cuz it only takes a few seconds and i dont see the harm.
 
but do you ever change what you are going to do based on a negative sensory stim?

I did them for the longest time, and would reposition based on negative stim... until I had a run of negative sensory stims. one person told me that he had wmuch better results than the RFAs they had with + sensory....
 
I wouldn't fault anyone for not doing sensory, but the article Steve posted wasn't a recommendation to skip sensory stim. The authors recommend it for a single burn but say 'inconclusive' if multiple burns.
 
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Are you guys doing sensory stim for medial branch thermal RF? I have not done sensory stim for RF for a decade...do motor for med-legal reasons, otherwise as long as you have SIS needle placement you are good. Sensory stim for medial branch thermal RF really serves little purpose, however I would not fault you for doing it if doing so to satisfy your curiosity. My curiosity is answered by the pain log.

Peripheral nerves and pulsed RF is a whole different story where sensory stim is very useful of course.
 
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this thread had the potential for epic-ness. Then came sensory stim:sleep:
 
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Here are the things that people are saying make a difference between being a million-dollar-baller and a regular doctor: Using IV sedation for cases, selective use of guidelines, limited physical examination of patients, using mid-levels, seeing more new patients, churning for surgeons, not doing sensory stim on RFA, "numbing it real good," limiting your practice to only interventional work, seeing at least 30 patients per day five days per week, being a majority owner in ASC or doing most things that pay well in the office, speaking for device companies, doing beaucoup kypho & stim, having ancillaries in your practice, being of OON, doing everything in the HOPD and getting $O$ transfers to base salary or wRVU comp, using scribes and MA's to do your scut work, practice in low cost of living geographic location, and having a good payer mix.

Anything else?

I interviewed at a practice a couple years back where the owners were very up front with me regarding the practice and expectations:

- multiple locations/employed physicians with monthly meetings regarding productivity (expectation of 150 injections+ month)
- in house pharmacy, everyone gets compounding cream
- opioids + hormone replacement therapy
- in house UDS (multiple machines), frequent testing, confirmatory testing, etc
- prescheduling future procedures (unilateral RF preferred on 3 month schedule, epidural x 3)
- no TPIs - not enough $$ for the time
- no pain psychologist - not profitable
- don't do lateral on TFESI, takes too much time
- in-house ASC
- cash pay ketamine infusion series


I can't confirm but suspect they were well into the 1 million dollar club.
 
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I interviewed at a practice a couple years back where the owners were very up front with me regarding the practice and expectations:

- multiple locations/employed physicians with monthly meetings regarding productivity (expectation of 150 injections+ month)
- in house pharmacy, everyone gets compounding cream
- opioids + hormone replacement therapy
- in house UDS (multiple machines), frequent testing, confirmatory testing, etc
- prescheduling future procedures (unilateral RF preferred on 3 month schedule, epidural x 3)
- no TPIs - not enough $$ for the time
- no pain psychologist - not profitable
- don't do lateral on TFESI, takes too much time
- in-house ASC
- cash pay ketamine infusion series


I can't confirm but suspect they were well into the 1 million dollar club.

Can't think of a worse way to live.
 
Better or worse for pain if trump or biden wins?
Nothing specific for pain but if you're a small business owner, who actually built that, I think the answer is pretty obvious.

Democrats believe that the federal government should protect your employees and your patients from YOU. Otherwise, you will stiff your employees and screw them over. Without Democratic mandates, you will likely refuse to collect and report "meaningful use" data to Medicare to assist them with further population health mandates. You probably won't even care about a diversified work place. It's also unfair that you don't pay your "fair share" of taxes because, the roads you drive on were built by all of us...

If you're a hospital employee, esp for the govt, probably better under Biden.
 
I think the first few years I made a million I felt good. But then I thought, if one million is good, you know what would be money? 2 million. But after making 2 million a year, I’m thinking 3 million next year will make me feel finally whole. Fingers crossed...
 
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I interviewed at a practice a couple years back where the owners were very up front with me regarding the practice and expectations:

- multiple locations/employed physicians with monthly meetings regarding productivity (expectation of 150 injections+ month)
- in house pharmacy, everyone gets compounding cream
- opioids + hormone replacement therapy
- in house UDS (multiple machines), frequent testing, confirmatory testing, etc
- prescheduling future procedures (unilateral RF preferred on 3 month schedule, epidural x 3)
- no TPIs - not enough $$ for the time
- no pain psychologist - not profitable
- don't do lateral on TFESI, takes too much time
- in-house ASC
- cash pay ketamine infusion series


I can't confirm but suspect they were well into the 1 million dollar club.

Were they checking sensory stim on RFA?
 
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Nothing specific for pain but if you're a small business owner, who actually built that, I think the answer is pretty obvious.

Democrats believe that the federal government should protect your employees and your patients from YOU. Otherwise, you will stiff your employees and screw them over. Without Democratic mandates, you will likely refuse to collect and report "meaningful use" data to Medicare to assist them with further population health mandates. You probably won't even care about a diversified work place. It's also unfair that you don't pay your "fair share" of taxes because, the roads you drive on were built by all of us...

If you're a hospital employee, esp for the govt, probably better under Biden.
BS argument that has no basis in fact...."Obama was going to be death of Healthcare"...nope.

Once you have been in practice for a few more years...you might understand.
 
BS argument that has no basis in fact...."Obama was going to be death of Healthcare"...nope.

Once you have been in practice for a few more years...you might understand.


Neither major political party cares about the needs of physicians. Neither party is really trying to support us.

However, Republicans are the lesser of two evils. Democrats are clearly worse for physicians and healthcare than republicans.
 
Neither major political party cares about the needs of physicians. Neither party is really trying to support us.

However, Republicans are the lesser of two evils. Democrats are clearly worse for physicians and healthcare than republicans.
True. Aside from their virulent anti-business platform, Democrat lawmakers are heavily supported by trial lawyers and regularly prevent any kind of tort reform in congress. Not to mention the Democrat mouthpiece, the NYT, constantly trashes docs.
 
Please tell me how your medical practice has been better under Trump than Obama?
 
I think the first few years I made a million I felt good. But then I thought, if one million is good, you know what would be money? 2 million. But after making 2 million a year, I’m thinking 3 million next year will make me feel finally whole. Fingers crossed...

$2M is the sweet spot. You feel like you're being fairly compensated for your work, but not running around like a chicken with your head cut-off. A little time between cases to get coffee and eat skittles.
 
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Neither major political party cares about the needs of physicians. Neither party is really trying to support us.

However, Republicans are the lesser of two evils. Democrats are clearly worse for physicians and healthcare than republicans.
At what cost. Worse for healthcare “professionals” but way better for society as a whole
 
At what cost. Worse for healthcare “professionals” but way better for society as a whole

Not really. Spending huge sums of money on bureaucrats and paper pushers (which is what the government does best) instead of on medication, beds, nurses, and physicians.

“There is no industry that is run so poorly that it can’t be made worse and more costly by putting the government in charge of it”
 
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I interviewed at a practice a couple years back where the owners were very up front with me regarding the practice and expectations:

- multiple locations/employed physicians with monthly meetings regarding productivity (expectation of 150 injections+ month)
- in house pharmacy, everyone gets compounding cream
- opioids + hormone replacement therapy
- in house UDS (multiple machines), frequent testing, confirmatory testing, etc
- prescheduling future procedures (unilateral RF preferred on 3 month schedule, epidural x 3)
- no TPIs - not enough $$ for the time
- no pain psychologist - not profitable
- don't do lateral on TFESI, takes too much time
- in-house ASC
- cash pay ketamine infusion series


I can't confirm but suspect they were well into the 1 million dollar club.
I'm sure they were. Of course this is now widely recognized as Medicare fraud and many offices near me have been busted for basically the exact same scheme. Only difference was that TPIs every visit were mandatory for opiate Rx.
 
Please tell me how your medical practice has been better under Trump than Obama?
In 2017, CMS raised the MIPS exemption threshold from 30k to 90k. This encouraged me to keep my practice open for another 2 years.

Do you like the "meaningful use" criteria - the proudest healthcare accomplishment and legacy of the Obama/Biden administration?

If so, don't be ashamed about it. Just stand up like a man and say you love it. You might be one of the docs who feels good about being forced to provide metrics to Medicare on a "certified" EHR system, instead of taking care of patients.
 
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Not really. Spending huge sums of money on bureaucrats and paper pushers (which is what the government does best) instead of on medication, beds, nurses, and physicians.

“There is no industry that is run so poorly that it can’t be made worse and more costly by putting the government in charge of it”

Trump and a Republican controlled Congress were not able to replace the ACA with a better alternative. Presumably ACA is better for Republicans or at least those who vote than the status quo was.

Do you like the "meaningful use" criteria - the proudest healthcare accomplishment and legacy of the Obama/Biden administration?

See above.

ACA is much bigger than "meaningful use." Of course anything that large is going to have significant deficiencies. Trump's strategy: can't find a better option so just weaken the ACA as much as possible, and continue to blame all healthcare woes on Obama.
 
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