How do you bill for yourself?

[neutro]

Question: Are there any solo doctors here?

Do you do your own billing? if so, how does anesthesia billing work? I know that its based on units and each insurance company will pay differently based on units.

I see these AMC's offering 520 K salary - infact, I have one contract in hand for 520K, 10 weeks off, all benefits paid, q8 call in a place where I would like to live, but my wife would not.

How is this possible?

I would however, like to do half pain and half anesthesia in an area where both my wife and I would like to be at.
I know I will already have to form an LLC for pain (im fellowship trained), but in the beginning I will do anesthesia so I have an income coming - and do anesthesia ATLEAST once a week. I am getting locums rate of $175/8 hour in that area without benefits, which suits me since I will have to buy my own malpractice anyway for pain.

My question is, what if I did not want to do locums and just do my billing for anesthesia. How do I set that up? Who do I talk to? Are there specific surgeons that I need to work with?

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[Mman]

Question: Are there any solo doctors here?

Do you do your own billing? if so, how does anesthesia billing work? I know that its based on units and each insurance company will pay differently based on units.

I see these AMC's offering 520 K salary - infact, I have one contract in hand for 520K, 10 weeks off, all benefits paid, q8 call in a place where I would like to live, but my wife would not.

How is this possible?

I would however, like to do half pain and half anesthesia in an area where both my wife and I would like to be at.
I know I will already have to form an LLC for pain (im fellowship trained), but in the beginning I will do anesthesia so I have an income coming - and do anesthesia ATLEAST once a week. I am getting locums rate of $175/8 hour in that area without benefits, which suits me since I will have to buy my own malpractice anyway for pain.

My question is, what if I did not want to do locums and just do my billing for anesthesia. How do I set that up? Who do I talk to? Are there specific surgeons that I need to work with?

I suspect if you have this many questions that you should not be attempting to do it. For one, you need some sort of hospital that will let you work there and bill for your own services. Do you have this already lined up? The overwhelming majority of places will offer you a job to work somewhere, but that is with the understanding that they are doing the billing. I've never actually seen a place that would let you come in and bill for your own services, although I've heard rumors of small places like that which did exist.

Assuming you can find somewhere that will let you do this, you have to get credentialed with all the relevant insurers in the area. Since you have absolutely no leverage with them, I assume they will just pay you their lowest rate possible for the area. Then you need to collect all the relevant patient info on the day of surgery (insurance group #, policy #, etc) and submit a claim to that insurer with all the supporting documentation and codes.

 

[B-Bone]

More likely you would use a billing company and let them do all that for you. They take a percentage of the collections for their trouble. Maybe 5-8%?


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[neutro]

I suspect if you have this many questions that you should not be attempting to do it. For one, you need some sort of hospital that will let you work there and bill for your own services. Do you have this already lined up? The overwhelming majority of places will offer you a job to work somewhere, but that is with the understanding that they are doing the billing. I've never actually seen a place that would let you come in and bill for your own services, although I've heard rumors of small places like that which did exist.

Assuming you can find somewhere that will let you do this, you have to get credentialed with all the relevant insurers in the area. Since you have absolutely no leverage with them, I assume they will just pay you their lowest rate possible for the area. Then you need to collect all the relevant patient info on the day of surgery (insurance group #, policy #, etc) and submit a claim to that insurer with all the supporting documentation and codes.

The reason for inquiring this, is to learn about this myself. I think its worthwhile to know how a dollar is earned, dont you?

I do not have this lined up with a hospital actually - I am just curious about this practice. The only practice models I know for anesthesia are locums, hospital employment, AMC employment which contracts to hospital or PP/ partnership.
This is solo practice.
How does one negotiate with the hospital directly? Will I be competing with the anesthesia providers there already? Then who decides which cases I get? I was in Dallas last week, and the practice I interviewed with, the anesthesia staff follows their surgeon from facility to facility and bills the patient directly.

I am trying to figure out how to set this up, i.e. do we contract with surgeon or hospital? I have looked everywhere, there is not much information on this topic.

 

[aneftp]

The reason for inquiring this, is to learn about this myself. I think its worthwhile to know how a dollar is earned, dont you?

I do not have this lined up with a hospital actually - I am just curious about this practice. The only practice models I know for anesthesia are locums, hospital employment, AMC employment which contracts to hospital or PP/ partnership.
This is solo practice.
How does one negotiate with the hospital directly? Will I be competing with the anesthesia providers there already? Then who decides which cases I get? I was in Dallas last week, and the practice I interviewed with, the anesthesia staff follows their surgeon from facility to facility and bills the patient directly.

I am trying to figure out how to set this up, i.e. do we contract with surgeon or hospital? I have looked everywhere, there is not much information on this topic.

My buddy is in Texas and follows surgeon around.

It's very simple. Pay the billing company 6%. They will set it up for you. Let's the professionals handle the back end of things while you learn the system.

 

[Mman]

I do not have this lined up with a hospital actually - I am just curious about this practice. The only practice models I know for anesthesia are locums, hospital employment, AMC employment which contracts to hospital or PP/ partnership.
This is solo practice.
How does one negotiate with the hospital directly? Will I be competing with the anesthesia providers there already? Then who decides which cases I get? I was in Dallas last week, and the practice I interviewed with, the anesthesia staff follows their surgeon from facility to facility and bills the patient directly.

I am trying to figure out how to set this up, i.e. do we contract with surgeon or hospital? I have looked everywhere, there is not much information on this topic.

The thing is there are very few places you can actually do this. Most hospitals in this country either employ the anesthesiologists directly and bill for their services, or award the contract for services to a 3rd party (AMC or private group). In either of those situations, you cannot work as an independent 3rd party in those locations. The only way to do it is at a facility that allows it (not many do) and you probably need some sort of in at those places to get your foot in the door. Then gotta get credentialed and figure out how things get scheduled.

 

[neutro]

My buddy is in Texas and follows surgeon around.

It's very simple. Pay the billing company 6%. They will set it up for you. Let's the professionals handle the back end of things while you learn the system.

Thanks, did your friend contract directly with the surgeon? or does the surgeon ask for him to do his cases? or did he approach many surgeons himself and see if they would be interested in hiring him vs. other groups/AMCs.

 

[aneftp]

Thanks, did your friend contract directly with the surgeon? or does the surgeon ask for him to do his cases? or did he approach many surgeons himself and see if they would be interested in hiring him vs. other groups/AMCs.

If you are starting out brand spanking new. This is a less than ideal situation.

My friend was joined a group practice which was fee for service 3 year partnership track. So the group got him the business.

But the group dissolved. So he went out on his own. But surgeons still know him so more word of mouth business. So he kept most of his surgeons. And it's very lucrative spine.

If you are brand spanking new. The odds are stacked against you working with surgeons. Cause they don't know you.

 

[Mman]

If you are brand spanking new. The odds are stacked against you working with surgeons. Cause they don't know you.

correct. I'd say essentially impossible to get into fresh unless you find a surgeon so terrible nobody else will work with them. And then you get what you sign up for. Those sort of gigs are all spun off long time work relationships.

 

[somedumbDO]

6 % seems high, you could half that by shopping around

 

[bigeyedfish]

You need
1. an open house hospital or surgery center. Meaning no exclusive anesthesia contract, or some kind of carve out. If there is some entrenched anesthesia there they can make credentialing difficult if they are in committees.
2. Surgeons who want you to do your cases. This is where the value in this model of anesthesia is, relationships. You either have to have a brand new surgeon or break old relationships. Both are difficult to do. Once a surgeon gets comfortable with an anesthesiologist they don't severe ties for no reason. There's always a reason.
You find business for Monday, Tuesday, etc. this gets called your "book of business." And you guard it with your life.

This is the best anesthesia business model imo. It discourages clock punching mentality. Everyone is working with everyone else by choice. Your surgeons respect you because they choose to work with you. It's also the least layers between you and the payor.

 

[nimbus]

You need
1. an open house hospital or surgery center. Meaning no exclusive anesthesia contract, or some kind of carve out. If there is some entrenched anesthesia there they can make credentialing difficult if they are in committees.
2. Surgeons who want you to do your cases. This is where the value in this model of anesthesia is, relationships. You either have to have a brand new surgeon or break old relationships. Both are difficult to do. Once a surgeon gets comfortable with an anesthesiologist they don't severe ties for no reason. There's always a reason.
You find business for Monday, Tuesday, etc. this gets called your "book of business." And you guard it with your life.

This is the best anesthesia business model imo. It discourages clock punching mentality. Everyone is working with everyone else by choice. Your surgeons respect you because they choose to work with you. It's also the least layers between you and the payor.

This was a pretty common model in the western US until the 1990s when integrated anesthesia groups formed. Before then, many places had no "group" to speak of. Still things were much smoother if you showed up at a hospital at the invitation of the existing anesthesiologists. A couple of my classmates had to buy their own anesthesia machines and carts and wheeled them from room to room to do their cases.

 

[Mman]

This is the best anesthesia business model imo. It discourages clock punching mentality. Everyone is working with everyone else by choice. Your surgeons respect you because they choose to work with you. It's also the least layers between you and the payor.

It also is the model that most encourages you to do what keeps the surgeon happy instead of what is best for the patient. Now I'm not saying that is always the case and I'm not saying every surgeon is like that, but when you depend on the surgeon to personally give you work there is a massive incentive to do whatever it takes to please them.

And yes, I understand that the surgeon should want what is best for the patient. But we've all been there cancelling a case (or what I like to call postponing pending further workup/optimization) despite the protests of the surgeon that wants to operate now.

 

[bigeyedfish]

This was a pretty common model in the western US until the 1990s when integrated anesthesia groups formed. Before then, many places had no "group" to speak of. Still things were much smoother if you showed up at a hospital at the invitation of the existing snesthesiologists. A couple of my classmates had to buy their own anesthesia machines and carts and wheeled them from room to room to do their cases.

My group operates like this. You really exist as a group to cover overhead (billing cost) and cover call and vacations. But dynamics are the same. principle is the same.

 

[bigeyedfish]

It also is the model that most encourages you to do what keeps the surgeon happy instead of what is best for the patient. Now I'm not saying that is always the case and I'm not saying every surgeon is like that, but when you depend on the surgeon to personally give you work there is a massive incentive to do whatever it takes to please them.

And yes, I understand that the surgeon should want what is best for the patient. But we've all been there cancelling a case (or what I like to call postponing pending further workup/optimization) despite the protests of the surgeon that wants to operate now.

You could say the same for any consultant. Plus it goes both ways. It's in their interest to keep us happy too. If we're not happy we have enough business and are in a flexible enough market that we don't have to work with a surgeon if we don't want to. We can, and have, ceased to be available for surgeons. Just my experience. In a different market it may be different.

 

[neutro]

very interesting to learn all this, thank you for all your input.

"open house" hospital and ASC...hmmm that seems interesting. how does one find these? call specific facilities i supposes?

 

[nimbus]

very interesting to learn all this, thank you for all your input.

"open house" hospital and ASC...hmmm that seems interesting. how does one find these? call specific facilities i supposes?

Most of the hospitals in my community are open staff. Anybody can get privileges as long as they are qualified. Anesthesia contracts, if any, are for stipends to cover specific service lines like trauma or OB. Exclusive contracts and closed medical staffs are more the exception than the rule.

 

[aneftp]

Most of the hospitals in my community are open staff. Anybody can get privileges as long as they are qualified. Anesthesia contracts, if any, are for stipends to cover specific service lines like trauma or OB. Exclusive contracts and closed medical staffs are more the exception than the rule.

Yes for the most part true.

However some hospital committees can make it hard for a newcomer.

Why?

They can grant u privileges but they want someone within the current hospital to cover u as "backup call" or who can cover for you in case you are available.

So if u are new to practice. U really think any existing anesthesia group will vouch for you if they suspect you are a threat to their business?

 

[nimbus]

Yes for the most part true.

However some hospital committees can make it hard for a newcomer.

Why?

They can grant u privileges but they want someone within the current hospital to cover u as "backup call" or who can cover for you in case you are available.

So if u are new to practice. U really think any existing anesthesia group will vouch for you if they suspect you are a threat to their business?

I never said it was easy....an uphill battle for sure but I've seen it done.

 

[chocomorsel]

You need to find your own surgeons and get privileges at multiple facilities. And drive around following them around. That's how my town works. Hardly any exclusive contracts. Verbal contracts with surgeons as far as I know.
And you find a billing company to bill for you.

 

[neutro]

You need to find your own surgeons and get privileges at multiple facilities. And drive around following them around. That's how my town works. Hardly any exclusive contracts. Verbal contracts with surgeons as far as I know.
And you find a billing company to bill for you.

Do you find that this practice is worth it? Are you getting paid more than market rate- employed anesthesiologist?
Certainly the quality of work and life, and satisfaction must be better?

 

[deleted162650]

Do you find that this practice is worth it? Are you getting paid more than market rate- employed anesthesiologist?
Certainly the quality of work and life, and satisfaction must be better?

Pay will depend entirely on payer mix and volume. But, at least no one is skimming off the top.

 

[pgg]

The arrival of bundled payments ought to make this kind of work interesting, too.

And by interesting of course I mean even more difficult.

 

[bigeyedfish]

The arrival of bundled payments ought to make this kind of work interesting, too.

And by interesting of course I mean even more difficult.

We're preparing to go through this now with cms cabgs, for several hospitals. There are so many variables unique to each situation as far as competition, relationships, administration. But I'm optimistic. It's hard to imagine a scenario where our cut of the bundle is less than a cms cabg, which I'm sure you know is abysmal.

 

[nimbus]

We're preparing to go through this now with cms cabgs, for several hospitals. There are so many variables unique to each situation as far as competition, relationships, administration. But I'm optimistic. It's hard to imagine a scenario where our cut of the bundle is less than a cms cabg, which I'm sure you know is abysmal.

Yep bundled payments will probably yield higher reimbursement in that situation.

 

[chocomorsel]

Do you find that this practice is worth it? Are you getting paid more than market rate- employed anesthesiologist?
Certainly the quality of work and life, and satisfaction must be better?

No hospitals give you subsidies, so likely others are making more with subsidies.
However, my QOL and satisfaction are so much better. I don't have to put up with administrative BS. No one is my boss. It's great.
Some practices negotiate good contracts with the insurance companies, some don't necessarily. Individuals like me have no negotiating power and there are plenty of us. The group that I work with mostly in town are making really good money, but they do a lot of cases. Their unit value is kinda crappy. If you find a good type of surgeon that's fast like and ortho where you can do blocks, a busy gyn-onc, a busy GS, spine, you can do well. There are a lot of variables.

 

[neutro]

No hospitals give you subsidies, so likely others are making more with subsidies.
However, my QOL and satisfaction are so much better. I don't have to put up with administrative BS. No one is my boss. It's great.
Some practices negotiate good contracts with the insurance companies, some don't necessarily. Individuals like me have no negotiating power and there are plenty of us. The group that I work with mostly in town are making really good money, but they do a lot of cases. Their unit value is kinda crappy. If you find a good type of surgeon that's fast like and ortho where you can do blocks, a busy gyn-onc, a busy GS, spine, you can do well. There are a lot of variables.

ok, thanks. I appreciate everyone's input here. It helps everyone.
Do you mind sharing with us briefly how one goes about setting up this sort of a practice?
Perhaps I should explain my circumstances...
My situation is: I do both pain mgt and anesthesia. I am currently a hospital employed physician for pain, and my contract will end in 9 months.
My wife and I are planning to move to DFW area, which unfortunately has a LOTTTT of pain doctors. I did interview over the phone with a couple of pain practices there, but when I inquired into the details after initial conversation, it turned me off as they all seemed like they wanted to employ me and give me a salary (less that what I am earning) and then put a non-compete as well. And most of them were opioid heavy practices.
Going solo in pain management and focusing on ortho/spine for injections/stim and and cancer patients for med mgt seemed to be the most obvious choice. That is currently my practice in the hospital.
I also do general anesthesia once a week, which I enjoy more than my pain practice tbh, so I was thinking to do anesthesia and then start pain after my anesthesia shift/ saturdays. To me, long term, will be the best strategy. I may struggle the next two years but it will be worth it after that.
I am thus going to form an LLC for my pain practice. I'll have to take a line of credit loan for fluoro, real estate and staff salaries...I know the risk and investment involved and its putting me off already. To offset this, I intend to do anesthesia while that practice builds up. I have realized that to start a procedure heavy and minimal opioid type of practice outside a hospital system, will take me a longer time - but that's ok. Therefore, two options exist for anesthesia work:

1) locums anesthesia for 6 month to one year 7 am - 3pm type of work. I had been considering this all along...but I feel they treat locums doctors like a commodity.
2) Contracting directly with the surgeons since I will already have to get credentialed through payors for pain management. Maybe I can do it for anesthesia also. This will allow me to build relationships and it will also keep an option open for PRN work.

Now for option # 1, locums I can find through gaswork, etc.
For option # 2, I suppose as others have mentioned, it will be hard to find surgeons to work with. Do I improve my chances if I was to join a IPA?
When you say a busy spine surgeon or gyn-onc? How do you approach them? By cold calling? How do you market and advertise yourself? I suppose having a clinic and office space in a medical complex for pain management may help give me an identity...but I am not sure.

 

[chocomorsel]

Trust me, the good established surgeons are already taken. Sometimes, groups poach surgeons from other groups, or a surgeon gets unhappy with the group he is with and seeks out new anesthesiologists.
But, there are always residents graduating, and if they are out there starting their practices, then you can approach them. If they join an established group, then that group is already all set up with anesthesia.
I have only ever approached one surgeon who I heard was unhappy about his anesthesiologists because quite frankly they were doing him wrong and putting him at the bottom of their list because he had a higher percentage of Medicare patients. So far he is still sticking it out with them. And honestly, one of my friends is the one who asked me to, otherwise I wouldn't have. I am terrible at marketing myself and stealing surgeons and I don't think it's right anyway.

Your best bet, is to join a group unless you already know some surgeons needing help. Join a group, yes they will make money off you but then you will make connections and down the line you meet more people and can recruit your own once you develop a reputation. Dallas is a competitive market in Anesthesia. I can't speak for pain. And everyone is selling out in Dallas. So be careful.

Why are you relocating to a town where there is so much competition?

 

[Arch Guillotti]

Trust me, the good established surgeons are already taken. Sometimes, groups poach surgeons from other groups, or a surgeon gets unhappy with the group he is with and seeks out new anesthesiologists.
But, there are always residents graduating, and if they are out there starting their practices, then you can approach them. If they join an established group, then that group is already all set up with anesthesia.
I have only ever approached one surgeon who I heard was unhappy about his anesthesiologists because quite frankly they were doing him wrong and putting him at the bottom of their list because he had a higher percentage of Medicare patients. So far he is still sticking it out with them. And honestly, one of my friends is the one who asked me to, otherwise I wouldn't have. I am terrible at marketing myself and stealing surgeons and I don't think it's right anyway.

Your best bet, is to join a group unless you already know some surgeons needing help. Join a group, yes they will make money off you but then you will make connections and down the line you meet more people and can recruit your own once you develop a reputation. Dallas is a competitive market in Anesthesia. I can't speak for pain. And everyone is selling out in Dallas. So be careful.

Good grief that sounds difficult.

 

[deleted171991]

It also is the model that most encourages you to do what keeps the surgeon happy instead of what is best for the patient. Now I'm not saying that is always the case and I'm not saying every surgeon is like that, but when you depend on the surgeon to personally give you work there is a massive incentive to do whatever it takes to please them.

That can happen very well in PP groups, too, especially in AMC territory. The groups who are afraid of takeover will do anything to keep the surgeons and hospital happy, much more than an independent anesthesiologist who may lose just 20% of his business.

 

[neutro]

Trust me, the good established surgeons are already taken. Sometimes, groups poach surgeons from other groups, or a surgeon gets unhappy with the group he is with and seeks out new anesthesiologists.
But, there are always residents graduating, and if they are out there starting their practices, then you can approach them. If they join an established group, then that group is already all set up with anesthesia.
I have only ever approached one surgeon who I heard was unhappy about his anesthesiologists because quite frankly they were doing him wrong and putting him at the bottom of their list because he had a higher percentage of Medicare patients. So far he is still sticking it out with them. And honestly, one of my friends is the one who asked me to, otherwise I wouldn't have. I am terrible at marketing myself and stealing surgeons and I don't think it's right anyway.

Your best bet, is to join a group unless you already know some surgeons needing help. Join a group, yes they will make money off you but then you will make connections and down the line you meet more people and can recruit your own once you develop a reputation. Dallas is a competitive market in Anesthesia. I can't speak for pain. And everyone is selling out in Dallas. So be careful.

Why are you relocating to a town where there is so much competition?

Thank you for your reply.
DFW area because of weather (I'm tired of the cold), my wife's employment (this is probably the most important...she is not working at this time as she does not have any opportunities), and diversity/ethnic food/community etc.
I currently live in a town which is 30,000 people. Its nice, its rural, I like my hospital and people and most of my patients...and I intend to finish my contract, but I do not have a future here.
I am therefore, going to relocate after my contract ends. I also do not want to keep moving every 1-2 years. I am already dreading this upcoming move with my current 4 month old baby. I have also realized that my temperament is not suited to be an employee, so I want to work for myself and start a practice, buy a house, and stay there for the next while.

 

[Mman]

That can happen very well in PP groups, too, especially in AMC territory. The groups who are afraid of takeover will do anything to keep the surgeons and hospital happy, much more than an independent anesthesiologist who may lose just 20% of his business.

Of course that can happen with anybody, I'm just pointing out an anesthesiologist following around a surgeon is the setup that most incentivizes that sort of behavior. In my group if I piss of a surgeon, that's <1% of our case volume. What are they going to do? Whine about it? Perhaps. But nobody is picking up and going somewhere else with their business because there is nowhere else to go unless they want to close up shop and move. That's not nearly the same as following a surgeon that is a large chunk of your business who can fire you today and have somebody else doing their cases in the same building tomorrow morning with a phone call.

In the end you do what's right for the patient, you just have to recognize the economic incentives that are different depending on the model you are in. Generically "keeping surgeons and hospital happy" is quite different than needing to not piss off 1 particular person. Remember hospitals want cases that will have complications cancelled since they don't get paid when bad things happen.

 

[nimbus]

The point missing in this discussion is that you keep surgeons happy by preventing complications so they can move on to their next case at the next hospital. If you're someone who cancels or delays cases for BS reasons, you will lose business for sure. But usually the goals of the patient, the surgeon and the anesthesiologist are aligned. Most surgeons are reasonable people...around here we actually never get push back from surgeons for delaying a case. In fact many of them are even more conservative than we are. Maybe we have them well trained.

 

[bigeyedfish]

Of course that can happen with anybody, I'm just pointing out an anesthesiologist following around a surgeon is the setup that most incentivizes that sort of behavior. In my group if I piss of a surgeon, that's <1% of our case volume. What are they going to do? Whine about it? Perhaps. But nobody is picking up and going somewhere else with their business because there is nowhere else to go unless they want to close up shop and move. That's not nearly the same as following a surgeon that is a large chunk of your business who can fire you today and have somebody else doing their cases in the same building tomorrow morning with a phone call.

In the end you do what's right for the patient, you just have to recognize the economic incentives that are different depending on the model you are in. Generically "keeping surgeons and hospital happy" is quite different than needing to not piss off 1 particular person. Remember hospitals want cases that will have complications cancelled since they don't get paid when bad things happen.

I've never had a disagreement with my surgeons like you're describing. We choose to work together, so we respect each other's opinion. We also have a good working relationship. We talk about the case the night before. The relationship is symbiotic. We need each other. I know guys who have worked with the same surgeons for decades and literally plan together what time the cases will start, what weeks they are on vacation etc. The situation you're describing sounds much worse and very adversarial.

 

[bigeyedfish]

ok, thanks. I appreciate everyone's input here. It helps everyone.
Do you mind sharing with us briefly how one goes about setting up this sort of a practice?
Perhaps I should explain my circumstances...
My situation is: I do both pain mgt and anesthesia. I am currently a hospital employed physician for pain, and my contract will end in 9 months.
My wife and I are planning to move to DFW area, which unfortunately has a LOTTTT of pain doctors. I did interview over the phone with a couple of pain practices there, but when I inquired into the details after initial conversation, it turned me off as they all seemed like they wanted to employ me and give me a salary (less that what I am earning) and then put a non-compete as well. And most of them were opioid heavy practices.
Going solo in pain management and focusing on ortho/spine for injections/stim and and cancer patients for med mgt seemed to be the most obvious choice. That is currently my practice in the hospital.
I also do general anesthesia once a week, which I enjoy more than my pain practice tbh, so I was thinking to do anesthesia and then start pain after my anesthesia shift/ saturdays. To me, long term, will be the best strategy. I may struggle the next two years but it will be worth it after that.
I am thus going to form an LLC for my pain practice. I'll have to take a line of credit loan for fluoro, real estate and staff salaries...I know the risk and investment involved and its putting me off already. To offset this, I intend to do anesthesia while that practice builds up. I have realized that to start a procedure heavy and minimal opioid type of practice outside a hospital system, will take me a longer time - but that's ok. Therefore, two options exist for anesthesia work:

1) locums anesthesia for 6 month to one year 7 am - 3pm type of work. I had been considering this all along...but I feel they treat locums doctors like a commodity.
2) Contracting directly with the surgeons since I will already have to get credentialed through payors for pain management. Maybe I can do it for anesthesia also. This will allow me to build relationships and it will also keep an option open for PRN work.

Now for option # 1, locums I can find through gaswork, etc.
For option # 2, I suppose as others have mentioned, it will be hard to find surgeons to work with. Do I improve my chances if I was to join a IPA?
When you say a busy spine surgeon or gyn-onc? How do you approach them? By cold calling? How do you market and advertise yourself? I suppose having a clinic and office space in a medical complex for pain management may help give me an identity...but I am not sure.

In a market like dfw as a new independent, unaffiliated anesthesiologist who has no connections, no reputation, no credentials, no knowledge of existing relationships, you will starve. Unless your cousin or brother in law or something is a surgeon and uses you you will never get your foot in he door.

I know less about pain. You might have more of a shot in pain. You left out one big expense, advertising. You'll need some billboards or something. Ads in local publications, "best doctors" lists.
good luck.

 

[Mman]

I've never had a disagreement with my surgeons like you're describing. We choose to work together, so we respect each other's opinion. We also have a good working relationship. We talk about the case the night before. The relationship is symbiotic. We need each other. I know guys who have worked with the same surgeons for decades and literally plan together what time the cases will start, what weeks they are on vacation etc. The situation you're describing sounds much worse and very adversarial.

That's great for you and is certainly possible. I've heard from many docs that personally had far worse experiences in such situations.