Has this specialty improved or declined since you've been in it?
Started by drusso
Get help with your application
Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.
I think we have improved with technology.
I still love the regular old ILesi...works the best. I truly wish we could do it 3 to 4 times a year without the 3 month lapse.
I have been doing this for 15 years. I can tell you some of my most satisfied patients jist ask for that and a rfa and they are happy
Complete shtshow.
Advertisement - Members don't see this ad
Said this many times, the two most important procedures I do are the RFA and ILESI. Reliable procedures, not perfect. Many ppl do great with them, or well enough to tread water for awhile.
Overall, it’s really just RFA that we should be proud of in our field. That’s about it.
And Intracept. It's not magic, but it really makes life substantially better, permanently, for the correct candidates.
F’ing pain surgeons should sum up the situation perfectly
Telling a patient there is nothing else you can do for them is the hardest thing in chronic pain. Cant polish a turd.
Reimbursement is low. Honestly you can make more per clinic visits at this time.
Depending on how you can get set up, may be worth doing level 4 visits opiates, 10 per minute
Depending on how you can get set up, may be worth doing level 4 visits opiates, 10 per minute
Is that already gone ? Or at end of year ?
Last edited:
Advertisement - Members don't see this ad
This thread has been an healthy injection of pessimism for someone who just matched pain last week. lol
It will have to get much worse before it’s not a significant improvement compared to your training.
Everything gets worse every year. My favorite restaurant gives me a little bit lower quality food in less quantity for higher prices than they did a couple years ago. It’s still my favorite restaurant. Pain is worse than when I started but still the best thing I could be doing.
Insurance coverage for procedures and shenanigans on denials is worse. The high-dose opioid refugees are far fewer. Because I’m more efficient and adept at avoiding nonsense, it’s better than 11 years ago.
Upside is I make more every year than the year before. Downside is I don’t get those huge anesthesia vacation weeks
Yea, telehealth will be fixed. I’m proceeding as previous. Too disruptive to change the workflow that we have set up, just to switch back the next week. They are almost all mbb f/u’s or to document before a kypho anyways.
Pain is about the same. I have been in practice 10 years. Things come and go. I have gotten a lot better at my job. Changing lives one RFA at a time.
Pain is about the same. I have been in practice 10 years. Things come and go. I have gotten a lot better at my job. Changing lives one RFA at a time.
Hey man
I'm a current fellow. The current sentiment around pain from the attendings I have talked to is not great especially the private practice guys.
One guy said that on his procedure days (averaging 25-30 patients doing bread and butter stuff), he's collecting only around 7-8k daily and after overhead, he's barely staying afloat (Not sure how much truth there is to that because collection should seem higher based on my own research). Can anyone comment on that?
If you want a HOPD gig, most places are going start around 400k. In a year or 2, you should be able to break 500k. If you want to start in PP, most places will start around 300k and your ceiling will depend on your contract.
That number is correct if all he is doing are epidurals and joints.
Epidurals (TESI), MBB, caudal, SIJ, RFA mostly with other such as hip, shoulder. SSN mixed in.
If what you are saying is true, then why are guys on this forum saying that PP has higher potential? Even if you were to increase your volume to 40/day, I feel like you would make around the same or less than a HOPD guy seeing 25/day
PP always has higher potential. Massive shifts and efficiencies are on the horizon with AI and SOS. You can run your practice off your phone.
i say its better.
a lot of the garbage that was being put out as "procedures that will cure all chronic pain" have not stood the test of time. opioid referrals are significantly less and people now agree that narcotics are not the way to go (well, at least the doctors all agree).
otoh, the insurance stuff gets worse and worse for the amount of work we have to do. patient expectations have not changed - they still want a cure even though our repertoire is limited.
PP has higher potential for increased efficiency of the practice (what drusso mentioned) and allows you the flexibility to do procedures that are not "covered" or are limited by hospitals for whatever reason - approval, admin, insurance coverage - at a faster rate with fewer staff that need to be involved. in addition, you can use other avenues to generate better income streams, both from ancillaries and from how you "get paid" (ie tax benefits from being a small business vs an employee)
a lot of the garbage that was being put out as "procedures that will cure all chronic pain" have not stood the test of time. opioid referrals are significantly less and people now agree that narcotics are not the way to go (well, at least the doctors all agree).
otoh, the insurance stuff gets worse and worse for the amount of work we have to do. patient expectations have not changed - they still want a cure even though our repertoire is limited.
he is telling you that HOPD and any employed status means that you will never be as efficient as a private practice.
PP has higher potential for increased efficiency of the practice (what drusso mentioned) and allows you the flexibility to do procedures that are not "covered" or are limited by hospitals for whatever reason - approval, admin, insurance coverage - at a faster rate with fewer staff that need to be involved. in addition, you can use other avenues to generate better income streams, both from ancillaries and from how you "get paid" (ie tax benefits from being a small business vs an employee)
Those sound like northeast numbers. Those numbers are accurate for where I’m at. You can likely make a lot more in both settings in southwest, southeast and Midwest
That being said, you’re never gonna really make money as a W2 anything..private practice will at least give you access to ancillary revenue streams, potential for 1099, etc.
It’s laughable for any W2 to talk about their base salary anymore and brag about it..it’s all going to Uncle Sam..I became hopd finally, cause I got sick of the New Jersey pp scam systems, and didn’t have the balls/capital to start up something, so here I am now. If I lived somewhere else, I would have probably stayed private or maybe at least tried to venture into a start up
It’s laughable for any W2 to talk about their base salary anymore and brag about it..it’s all going to Uncle Sam..I became hopd finally, cause I got sick of the New Jersey pp scam systems, and didn’t have the balls/capital to start up something, so here I am now. If I lived somewhere else, I would have probably stayed private or maybe at least tried to venture into a start up
Advertisement - Members don't see this ad
Maximal tax savings available in private practice. Cash balance pension plan and self employed 401k for doctor and spouse office manager.
Ask again once CMS rolls this out:
Correct. That would be catastrophic.
if this happens, im going to strongly consider doing anesthesia againAsk again once CMS rolls this out:
It is hard for me to assess the specialty as a whole as I am a little bit on an island. Rural hospital employed and basically a Department of 1 (me plus a couple APPs)
I think my practice is a little atypical in that I do a lot of osteopathic manipulation and acupuncture along with the bread and butter pain procedures. Honestly for some patients the OMT/acup seems to work better than anything else and I think it reduces my burnout being able to offer those modalities
I think a lot of us become the patient's second primary care physician which has its pluses and minuses, overall I see as a positive
I think my practice is a little atypical in that I do a lot of osteopathic manipulation and acupuncture along with the bread and butter pain procedures. Honestly for some patients the OMT/acup seems to work better than anything else and I think it reduces my burnout being able to offer those modalities
I think a lot of us become the patient's second primary care physician which has its pluses and minuses, overall I see as a positive
I just accepted a PM&R position. The writing is on the wall for this specialty.
I just don’t think I can ask people how many steps they have in their house for the rest of my life..but if it pays maybe I’ll reconsider it
Actually if injections all get killed in the next couple years, I won’t be too sad. Frankly they’re over utilized. Couple young guys joined our practice, one in particular is a huge overutilizer. Seems like anymore, I enjoy the clinic educational part much more than procedures
Yeah, ultimately it'll just allow me to spend more time with my family. Private practice pain outlook is just doing more for the same or less. I don't want to leave work physically and mentally exhausted every day.
This.. especially the part about opioids.. I used to have that argument with patients multiple times per day.. now it’s rare and maybe once a week. Huge.
Last edited:
If this goes through the cardiologists are going to get hosedAsk again once CMS rolls this out:
Didn’t you just switch into private practice?
Yup. Decided it's not for me.
Don’t like Porsches after all?
Advertisement - Members don't see this ad
Oh the Porsche is still happening! PM&R market is doing quite well, at the moment. Plenty of Money & Relaxation.
What kind of job is it? Outpatient msk or snf medical director?
I'm sorry, how is this different than the Obamacare, MIPS, BCBS Quality measures, etc? It's more stupid paperwork that doesn't change anything, but it's not hard to obtain compliance.
Glad you are getting paid and going to get the Porsche. I think the beige Camry is the official car of the specialty, but you have to be yourself!
