Here we go again . . . which job opportunity looks most intriguing?

[bedrock]

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All I know is, no matter what, any group that is PE backed - you'll be writing the same thread in 1-2 years, only faced with a bigger non compete and issue with your kids deeper in school and family entrenched.

Just perusing the jobs boards. It looks like about half of the pain jobs are PE backed. Any smart doc would do well to avoid a PE group. Some of the locations are tempting.
1- You'll never make serious money, because so much of your pay is being siphoned off to pay for useless PE executives.
2- It is very hard to make needed changes to the practice structure because of those same useless PE executives.
3- You be frustrated with staff because it's hard to get rid of someone again, because of those same useless PE executives.

The only time a PE job makes sense is maybe for a new grad who just has to live in a certain area to start out, while they look for other better options. But I've never seen anyone stay long term at a PE run group, for good reasons.

 

[Agast]

We were typing at the same time. This can totally work out. I have made 7 figures at two different surgical practices in my career.

Why leave that then?

 

[bedrock]

Why leave that then?

Because some things are more important than money.

My first job was in a medium sized community and I left it mostly to find my lady. I was nearing 40 and so I moved to Southern California where I met my partner and we are still together. That's worth more to me than any paycheck.

 

[Ready_User_1]

Plenty of ortho/NS + pain partnerships work out. The only time it doesn't work out is if the pain doc wants a comprehensive pain practice instead of an interventional spine practice, because then it creates the staffing issues described above.

The main thing to establish up front is that you won't be a dumping ground to write opioids for all their failed back patients.

Edit- them being willing to hand off kyphoplasties to you to be done in office is fantastic.

Eh, disagree, there are some that will treat you as a "partner" when sharing overhead, which makes you essentially an underpaid W2 employee and a disposition for patients the spine guy doesn't want to deal with.

But I agree, you have to tease it out up front. I say this in my jaded experience with ortho. Much happier elsewhere.

 

[callmeanesthesia]

Eh, disagree, there are some that will treat you as a "partner" when sharing overhead, which makes you essentially an underpaid W2 employee and a disposition for patients the spine guy doesn't want to deal with.

But I agree, you have to tease it out up front. I say this in my jaded experience with ortho. Much happier elsewhere.

I feel like in that regard neurosurgery would be better than an ortho group. Ortho has to have a lot of in office services that jack up overhead, like casting and xray. Also expectation for you to do a lot of joint injections which are easy, but pay way less per procedure. Neurosurg is just going to pack your schedule with spine injections and SCS trials. With that many in one group it sounds like a pretty cush life. Mostly it will depend on the quality of the doctors. Are they conservative, operate only when progressive neurologic deficits or treatment-refractory radicular pain? Or are they the 3 level anterior posterior fusion for 2mm disc bulges after they fail an ESI for their axial pain type? I think a quick conversation with a community doc or possibly shadowing one of them in clinic would sort that out.

 

[Orin]

While I agree that it could be great, I worry it could be the same problem later. These days the NSGY/spine docs are learning to do their own perc trials/DRG/endoscopic work. Where or how will you uniquely add value?

 

[hyperalgesia]

If it's the kind of group that wants pain services pre-op, as part of a conservative care regimen, that would be awesome. I could do ESIs/facets all day for that. I would optimize the set up and it's a win-win for all.

But if it's the group that wants me to take all the inappropriate failed back dumps because they never had appropriate conservative pre-operative treatment, that would suck.

 

[BoardingDoc]

If it's the kind of group that wants pain services pre-op, as part of a conservative care regimen, that would be awesome. I could do ESIs/facets all day for that. I would optimize the set up and it's a win-win for all.

But if it's the group that wants me to take all the inappropriate failed back dumps because they never had appropriate conservative pre-operative treatment, that would suck.

Stims for all!