Has this specialty improved or declined since you've been in it?

Started by drusso
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Better or Worse?

  • Better

    Votes: 12 24.5%

  • Worse

    Votes: 37 75.5%
  • Total voters
    49
Dr. Ice said:
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
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Total nonsense.
 
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Ferrismonk said:
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.
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if i have to do more work for less pay, then i'd rather take less pay and more vacation and less paperwork
 
buddababa said:
if i have to do more work for less pay, then i'd rather take less pay and more vacation and less paperwork
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So anesthesia?

Arguably it might have higher pay.

I know this ruffles a lot of feathers on this board but a huge question is is the person coming from Anesthesia or PM&R?

The former can easily get you 500k with 10 weeks off without clinic/paperwork *and* the ability to pick up shifts and call to boost income even more. Thus, its a very real conundrum for a lot of new grads in pain.
 
Only upside to pain now vs anesthesia is no nights or call and 9-5. Getting to see my kids every morning and evening and sleeping in my own bed every night is the only thing keeping me from going back into anesthesia.
 
CleanUp said:
So anesthesia?

Arguably it might have higher pay.

I know this ruffles a lot of feathers on this board but a huge question is is the person coming from Anesthesia or PM&R?

The former can easily get you 500k with 10 weeks off without clinic/paperwork *and* the ability to pick up shifts and call to boost income even more. Thus, its a very real conundrum for a lot of new grads in pain.
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yup
 
Baron S said:
Even PM&R has lots of opportunities right now. Loads of zero-time side gigs available and low stress main gig makes the ceiling extraordinarily high depending on how involved you want to get.
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Doing what exactly? I guess if you do regen all day and charge cash..
 
Dr. Ice said:
Doing what exactly? I guess if you do regen all day and charge cash..
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Medical directorships, APP supervision, SNF coverage, consulting, expert witness work, chart review, IMEs, monetized Youtube videos, you name it. All take very little extra time and can fit into your downtime at your main gig. Probably not if you're doing outpatient MSK but I wouldn't take that on as that's just Pain Lite.

There are places advertising 50k stipend per year per APP for SNF coverage, with the option to work remotely. I haven't looked into that too much but it sounds interesting.
 
Baron S said:
Medical directorships, APP supervision, SNF coverage, consulting, expert witness work, chart review, IMEs, monetized Youtube videos, Only Fans, you name it. All take very little extra time and can fit into your downtime at your main gig. Probably not if you're doing outpatient MSK but I wouldn't take that on as that's just Pain Lite.
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K-hole said:
Only upside to pain now vs anesthesia is no nights or call and 9-5. Getting to see my kids every morning and evening and sleeping in my own bed every night is the only thing keeping me from going back into anesthesia.
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Several people I know “sell” their nights and weekends, so the option is there to do anesthesia without these even at level 1 trauma centers
 
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Baron S said:
Even PM&R has lots of opportunities right now. Loads of zero-time side gigs available and low stress main gig makes the ceiling extraordinarily high depending on how involved you want to get.
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Psych was the same way a few years ago -

The money just went through the roof! I know a couple of pain trained psychiatrist that left pain to go to private practice 1099 psych jobs full time.
 
Ferrismonk said:
I'm an anesthesiologist and still cover some OB, but there is no way that bending to the will of surgeons every day or dealing with GSWs at 2AM or dealing with 500lb ASA 4.5s with full beards and mallampati 4s is worth doing full time main OR anesthesia to me.
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I agree -

But I would work at a surgicenter doing eye balls, colonoscopies, and hysteroscopies for $300/hr - And these jobs ARE out there.
 
It was good. My partner saw 41. He did mostly procedures in the AM. We had time for me to do a bunch of same day procedures in the afternoon. We had only two MA’s. I room my own patient frequently and do the doctor stuff then let the MA catch up behind me. If it is a medial branch block I will just do the procedure by myself. I did one scs trial and one bilateral cervical rfa. The rest were just office visits, 8 telemeds at lunch, a couple scheduled esi’s and then same day esi’s and si joints. I’m good at controlling the office visits in a nice way. We don’t get bogged down in talking about a fall at age 8.
 
About 30 years in. Technologically we have grown… BVN, PNS, etc. But, we have become delusional about what we can do as pain surgeons and to some extent what we can accomplish with Neuromodulation. The culture of the field has become a circus.
 
BobBarker said:
It was good. My partner saw 41. He did mostly procedures in the AM. We had time for me to do a bunch of same day procedures in the afternoon. We had only two MA’s. I room my own patient frequently and do the doctor stuff then let the MA catch up behind me. If it is a medial branch block I will just do the procedure by myself. I did one scs trial and one bilateral cervical rfa. The rest were just office visits, 8 telemeds at lunch, a couple scheduled esi’s and then same day esi’s and si joints. I’m good at controlling the office visits in a nice way. We don’t get bogged down in talking about a fall at age 8.
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Is that 5 days a week? You better be making 5M+/year with that workload
 
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Clinic is open 4 days a week. My partner doesn’t work on Friday. I take one Friday off a month. The other Fridays is the ASC for me. But try to only do 1/2 day those days if possible.
 
I upped my game based on @BobBarker and others on this forum

Relevant to OP as I was making similar $ 15 years ago seeing a lot less patients. more surgeon mindset then not doing follow ups -just procedures. never had an opioid practice so no refill fu

Now I see myself as derm with higher volume and lots of fu.
 
BobBarker said:
It was good. My partner saw 41. He did mostly procedures in the AM. We had time for me to do a bunch of same day procedures in the afternoon. We had only two MA’s. I room my own patient frequently and do the doctor stuff then let the MA catch up behind me. If it is a medial branch block I will just do the procedure by myself. I did one scs trial and one bilateral cervical rfa. The rest were just office visits, 8 telemeds at lunch, a couple scheduled esi’s and then same day esi’s and si joints. I’m good at controlling the office visits in a nice way. We don’t get bogged down in talking about a fall at age 8.
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are a lot of your e/m visits level 3's? I'm guessing you're in the room 5 min max with each patient. You must be a master of the short and sweet, in and out
 
I am always so impressed when I read about how others are seeing 40-50 patients a day. A “busy” day for me is 25 patients or so. I have 15 minute slots for followups and 40 minute slots for new patients. I have become more efficient with new patients and get them done in about 15-20 minutes most of the time now. But even then, I feel like I have just enough time to see the patient and finish my notes. I need to get on your level.
 
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BobBarker said:
It was good. My partner saw 41. He did mostly procedures in the AM. We had time for me to do a bunch of same day procedures in the afternoon. We had only two MA’s. I room my own patient frequently and do the doctor stuff then let the MA catch up behind me. If it is a medial branch block I will just do the procedure by myself. I did one scs trial and one bilateral cervical rfa. The rest were just office visits, 8 telemeds at lunch, a couple scheduled esi’s and then same day esi’s and si joints. I’m good at controlling the office visits in a nice way. We don’t get bogged down in talking about a fall at age 8.
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Thanks for the breakdown. We see max 24 a day, but we can't do same day procedures because they won't pay and I'm taking my lunch, dammit. Telehealth is bad medicine anyway in my opinion. I would also never do a procedure by myself for liability reasons.

Glad you're doing awesome though.
 
Ferrismonk said:
Thanks for the breakdown. We see max 24 a day, but we can't do same day procedures because they won't pay and I'm taking my lunch, dammit. Telehealth is bad medicine anyway in my opinion. I would also never do a procedure by myself for liability reasons.

Glad you're doing awesome though.
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same set up as you.
 
justAstudent said:
I am always so impressed when I read about how others are seeing 40-50 patients a day. A “busy” day for me is 25 patients or so. I have 15 minute slots for followups and 40 minute slots for new patients. I have become more efficient with new patients and get them done in about 15-20 minutes most of the time now. But even then, I feel like I have just enough time to see the patient and finish my notes. I need to get on your level.
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This is me 12 years in. Clinic 8-430 maxed at 22/23 half new half follow up.
Procedures 28/day max 2x/week all in office usually w 1 Kypho and 2 rfa
 
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BobBarker said:
Well, I do own the business. So the take home is dependent on how well I can control costs. Which I do a good job at.
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How are you getting same day authorization and procedures paid for? I haven’t done this in years for these reasons. What is your secret? Or are you just billing the patients when insurance doesn’t pay?
 
justAstudent said:
I am always so impressed when I read about how others are seeing 40-50 patients a day. A “busy” day for me is 25 patients or so. I have 15 minute slots for followups and 40 minute slots for new patients. I have become more efficient with new patients and get them done in about 15-20 minutes most of the time now. But even then, I feel like I have just enough time to see the patient and finish my notes. I need to get on your level.
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Are you in private practice? What EMR are you using?
 
Many bcbs employer plans don’t require auth, aarp/uhc med advantage, traditional Medicare, state employee insurance does not require auth. So at least 50% of the patients are no auth required.
 
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