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

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Better or Worse?

  • Better

    Votes: 12 25.0%

  • Worse

    Votes: 36 75.0%
  • Total voters
    48
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callmeanesthesia said:
The big hospital in my town is losing 2 spine surgeons and a joint surgeon because they make no effort to support their productivity. They’re able to see a max of about 2 patients per hour. Similar issue with a hospital a couple hours away where we recruited our newest partner from. Doesn’t matter how good your $/wRVU is if the hospital admin won’t let you be productive.
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Typical.
 
Where I live, ortho and spine surgeons get what they want most of the time, and it is quite obvious they’re critical at every hospital bc they take call. Can’t imagine they would be neutered by admin.
 
MitchLevi said:
Where I live, ortho and spine surgeons get what they want most of the time, and it is quite obvious they’re critical at every hospital bc they take call. Can’t imagine they would be neutered by admin.
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These guys don’t take call. But they’re busy. Must be tens of millions of lost revenue for the hospital.
 
Dr. Ice said:
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
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Are you talking about the PP numbers or HOPD numbers?
 
Taus said:
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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Is this your own PP? Do you mind sharing your average collections and what of the country?
 
callmeanesthesia said:
The big hospital in my town is losing 2 spine surgeons and a joint surgeon because they make no effort to support their productivity. They’re able to see a max of about 2 patients per hour. Similar issue with a hospital a couple hours away where we recruited our newest partner from. Doesn’t matter how good your $/wRVU is if the hospital admin won’t let you be productive.
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"They will never love you back."
 
There's a hospital in my area that is really poorly managed from a financial POV and has been for decades. Given the opportunities that have been missed by them, I'm guessing the Board is really set in their ways and just not interested in becoming a profit center.
 
hyperalgesia said:
There's a hospital in my area that is really poorly managed from a financial POV and has been for decades. Given the opportunities that have been missed by them, I'm guessing the Board is really set in their ways and just not interested in becoming a profit center.
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I wonder if I work there
 
Dr. Ice said:
My experience thus far with hopd is that they are supportive of efficiency. I still don’t have my own MA, but there is a good amount of cross trained staff able to help. I’m in an office suite so procedures are turned around quickly and my tech is very good. I only started seeing patients in July and my right now I can churn out 22 procedures in the am and see about 20 patients in the pm. Will be switching to full day procedures soon once a week. The base is very good for my geographic location and they seem to know how to “get their moneys” worth. I am definitely not a fan of the obsession with press ganey scores and the weekly updates as to whether or not someone rated me as an 8 or a 10
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Isn’t Uncle Sam taking all of that? Or at least half?
 
Dr. Ice said:
Yes..it’s still seemingly a decent hopd job despite no tax shelter
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You started this gig 4 months ago and already have enough volume to fill 22 injections in the AM and 20 clinic visits in the PM? That is an absurd referral base.

I started in August in PP and my schedule is only about 50 clinic visits/wk and 20 injections/wk. Getting busier each week but it feels like really slow going at those numbers.
 
BoardingDoc said:
You started this gig 4 months ago and already have enough volume to fill 22 injections in the AM and 20 clinic visits in the PM? That is an absurd referral base.

I started in August in PP and my schedule is only about 50 clinic visits/wk and 20 injections/wk. Getting busier each week but it feels like really slow going at those numbers.
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I have patients from my old group following me and one of my offices is attached to an ortho urgent care which is a direct feeder. The group is basically an established ortho group with an existing presence that was acquired by a hospital system so they not only have their own patients but the hospital also now feeds
 
BoardingDoc said:
You started this gig 4 months ago and already have enough volume to fill 22 injections in the AM and 20 clinic visits in the PM? That is an absurd referral base.

I started in August in PP and my schedule is only about 50 clinic visits/wk and 20 injections/wk. Getting busier each week but it feels like really slow going at those numbers.
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You are 0% medication management. Those are good numbers for 3 months of practice.
 
NJPAIN said:
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.
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BobBarker said:
10 minute slots for all f/u office visits and injection/rfa. It takes longer than that to do a bilateral RF, but a cesi only takes two minutes so it evens out. Telemeds are double booked all through lunch. 20 min for scs trial and kyphos, 30 min si fusions, 20 min np. I pay the staff through lunch so they may get 15 minutes or they may get an hour but they are still paid so the expectation is to get started as soon as the afternoon patients begin arriving. I have done so many trials in my career that a bilateral cervical RF takes me longer than a trial. 90% of the time, I start with a big case at 7:20 and then office visits at 8:00am though. Usually double book post ops (not getting paid anyways), new patients due to the no show rate being 40%, also double book the early AM slots as they no show or arrive late routinely. I don’t eat lunch. I’ve lost about 70lbs from my peak in fellowship. I rather make more money than be obese again.

MA’s do most of the HPI. If it it is a good one from a surgeon referral, they might copy and paste it into the note. I type a sentence or three. Plan is just the procedure order and the macros needed for auth. I will also put in my 2nd and 3rd line plans typically to make the f/u easier.
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You drawing up your own meds?
How quickly are your staff putting the patient on the table to discharge? Mine are running at 15 minutes from check in to check out.

Ronin1 said:
Sure but I’d have to work too much. 800 for 3 1/2 days a week is a better life
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3.5 days for 800 is absurdly good.



Side note, what are yall getting for your $/wRVU?
 
I draw up my own meds. One gloved hand, one free hand. Use the tray wrap or sterile glove wrap to help unscrew the 18g draw needle. I can do 7-8 injections an hour pretty easy. The free MA puts the upcoming procedures in the exam rooms closest to the procedure room. She makes sure the patient has their auth confirmed, pertinent allergies, thinners, etc. I’m still doing the injection if we screwed up the auth. They are already there and if we made a mistake it is our fault. The in room MA and I help the post procedure patient off the bed. We might store them in an exam if they are wobbly after a cervical mbb. But generally they just walk right out. The in room MA cleans the bed with a purple wipe. Sometimes I grab the next patient, sometimes she does. Generally, she loads the patients name and bday in the c-arm and preps/gets lined up while I get the tray and meds ready.
 
If the first patient is slow off the bed, we will get everything prepared for the next patient while they are collecting themselves. We don’t allow a lot of lingering or questions after the procedure. If the patient is needy, the free MA will circle back with them in an exam room. Generally, that never happens.
 
When I say injections, I’m specifically excluding RFA’s. Hard to go faster than 12 minutes on a bilateral lumbar rfa.
 
DOctorJay said:
last year was $53.25/wRVU for me
miraculously things have finally improved and if I do the same volume as last year it'll be $66.50/wRVU
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How did you get them to increase it? I didn’t realize you were ever at $53, ughh that’s rough
 
clubdeac said:
How did you get them to increase it? I didn’t realize you were ever at $53, ughh that’s rough
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I was at $53 because the way our model worked the value declined the more we produced and I'm the most productive in our group.

Over the past couple years we did present to admin how the model was affecting those of us producing more and I think it finally made a difference.
 
DOctorJay said:
I was at $53 because the way our model worked the value declined the more we produced and I'm the most productive in our group.

Over the past couple years we did present to admin how the model was affecting those of us producing more and I think it finally made a difference.
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Sorry to hear that. Hard to wrap my head around those numbers
 
Is your wRVUs going to go down since they are decreasing physican fees or not really?
 
Malayil said:
Is your wRVUs going to go down since they are decreasing physican fees or not really?
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the wRVUs won't go down based on the physician fee issue but the value ($/wRVU) could be adjusted down in the future.
 
DOctorJay said:
the wRVUs won't go down based on the physician fee issue but the value ($/wRVU) could be adjusted down in the future.
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Sorry that’s what I meant to ask, will the multiplier will be lower in the future.
 
bubaghanush said:
I'm seeing fellows with PE offering $30/wRVU in the clinic and $100/wRVU in the ASC.
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I would love to know how that’s done by the books because there’s so many barriers that I’ve been told that could prevent that from being that way
 
bubaghanush said:
Actually yes, and one in Arizona.
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bubaghanush said:
Yes. Incentivizes them to have the NPs run the clinic.
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I interviewed here and passed. Too sketch for me.

When they say their biggest producer makes 2M, dont fall for that BS. Get the median number, and you will learn that its close to 500-600k at best. Their top earner earns that much because he bought into multiple surgery centers for the practice, not because of his volume alone.
 
BobBarker said:
And the buy in was probably substantial
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add on the fact that now those mature surgery centers have a 4-5M EBITDA and buy in for docs is usually 4x.
Looking at $200k for each 1%.

And if you decide to leave, you cant if you bought into the ASC. Its a pain in the butt to sell.
 
Yes. I have a ton of debt related to my ASC buy in. At least it includes the land and building too. Most are operations only and you aren’t going to have much insight into operations and management with 1-2%.
 
Asc-170k buy in for 1/2 a share. I’m at like 4% shareholder, possibly less. Haven’t seen a dime in distribution since 2018. Covid killed the new center that was built and operational only 4 months before lockdown. It never recouped. They are apparently gonna do a cash call for all investors cause it’s tanking bad. I will likely tell them to pound sand. Could really care less anymore about the place as it killed my finances for years and now I’m being asked to keep feeding the dying animal.

Worst. Investment. Ever.
 
BobBarker said:
Yes. I have a ton of debt related to my ASC buy in. At least it includes the land and building too. Most are operations only and you aren’t going to have much insight into operations and management with 1-2%.
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Likewise. We're planning on selling it eventually to a PE group and just sit on the real estate and cash in on the rent check. Mailbox money.

Dr. Ice said:
Asc-170k buy in for 1/2 a share. I’m at like 4% shareholder, possibly less. Haven’t seen a dime in distribution since 2018. Covid killed the new center that was built and operational only 4 months before lockdown. It never recouped. They are apparently gonna do a cash call for all investors cause it’s tanking bad. I will likely tell them to pound sand. Could really care less anymore about the place as it killed my finances for years and now I’m being asked to keep feeding the dying animal.

Worst. Investment. Ever.
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Jeeeez.
Is this single specialty pain or multispecialty? How busy are you guys?
 
Dr. Ice said:
Asc-170k buy in for 1/2 a share. I’m at like 4% shareholder, possibly less. Haven’t seen a dime in distribution since 2018. Covid killed the new center that was built and operational only 4 months before lockdown. It never recouped. They are apparently gonna do a cash call for all investors cause it’s tanking bad. I will likely tell them to pound sand. Could really care less anymore about the place as it killed my finances for years and now I’m being asked to keep feeding the dying animal.

Worst. Investment. Ever.
Click to expand...

SOS is shifting to the office/OBL.
 
Dr. Ice said:
Asc-170k buy in for 1/2 a share. I’m at like 4% shareholder, possibly less. Haven’t seen a dime in distribution since 2018. Covid killed the new center that was built and operational only 4 months before lockdown. It never recouped. They are apparently gonna do a cash call for all investors cause it’s tanking bad. I will likely tell them to pound sand. Could really care less anymore about the place as it killed my finances for years and now I’m being asked to keep feeding the dying animal.

Worst. Investment. Ever.
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That sucks man.
Do you feel like it is being mismanaged or it's variables beyond anyone's control?
Thanks for sharing.
 
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