I have zero pain experience so I can’t speak to that. But I think the 50/50 makes it tough to figure out what the right compensation is. Why not make it 100% pain, either full time or part time and let the new hire freelance anesthesia if they want to?
Also outpatient “acute pain” with referrals from attorneys and chiropractors may give some people pause. I realize it can be its own cottage industry. I know some personal injury lawyers claim to have their “own doctors”. “Call us. We’ll take care of everything. We’ll get you set up with the right doctors.” Not everybody would want to be one.
I guess so. But for me, interchangeability and flexibility in staffing is VVIP (from both ends). What I am finding with anesthesia is that I can find coverage with some of the independent docs on an agreed upon pay schedule, but I am the solo pain doc, its hard for me to find coverage on days if I want to take a few days off without stress. And the same will apply to whoever wants to join. Between us essentially we can do 1 FTE anesthesia and 1 FTE pain I suppose but I do not have 1 FTE worth of good pain work.
I can always find work, but I am very selective in which group I contract with - so I have been conservative. I would rather invest in my own practice, which I am - but as I said, I am unable to invest too much on that because I am busy with daytime anesthesia and pain. There are only so many hours in a day.
There were thoughts of getting an NP or PA and that's all great - but they cannot handle what physicians can handle...its not the same. So I would rather invest in one and vise versa - I would want the oncoming physician to come to grow the practice as well. Again, I am looking for a true partnership rather than employee employer dynamic.
Regarding the actual PI part. I don't hold the note. My job is to evaluate and do what a normal pain physician would do given a particular patient complaint. Nothing more or less. We have a strict protocol that's understandable and common sense - they have to fail conservative management and have symptoms, and if possible + MRI findings to qualify (although this may or may not be that clear). I do see all new patients for workup and often don't see them back after conservative mgt protocol - PT/gabapentin/mobic/flexeril etc. Perhaps that is why I have gotten busy because I don't treat patients like a pin cushion simply because I am not dependent on pain mgt for my income. I do not have any skin in this game nor partnership in any PI firm or any shares, and nor do I hold the note. If there comes a day pain mgt and PI starts becoming a headache, i'll do more anesthesia as that pays really well too.
Attorneys also typically follow guidelines to prevent denial from insurance company. I know this because I have audited close to over 2000 charts (maybe even more - I dont know) working for a large insurance defense attorney in TX. I am very familiar with pretty much all documentation from PI practices and how attorneys review them and what they value and look for in a good physician.
I agree PI has its own drawbacks but at the same time, independent physician evaluation and treatment has its own value and that's what attorneys are looking for. They are very strict on credentials - such as anesthesia pain and preferably someone who is not doing 100% PI and also does regular run of the mill patients at hospitals and takes insurance. Because a lot of this is about reputation and investigating financial links and kickbacks. We have none. I was very careful about that.
I have all these things developed now. That is why it took so long to develop the infrastructure - but it is because of this base I am getting busy. It takes time to develop strong base and foundation but to me that investment was important. No one can question the quality of work and credentials.
We are blinded to outcome in a sense because these aren't patients on our census like chronic pain. We are paid to perform interventional procedures if they meet the criteria (or modify it - I do not inject until I examine the patient first because often I will be sent really crazy requests for injections and they need to be modified or declined). I ensure that injection is done well, contrast and fluoro is appropriate and thats it. Its more of an IR type or practice than chronic pain and honestly thats what I wanted. Its just simpler. I do not have the bandwidth to have a full office back staff to fight insurance companies over $4 meds on walmart list.
Again, I wish I could give comparative compensation analysis but this type of practice is unique and personally extracted, and to me, it is best of both worlds - solo MD cases for anesthesia with experienced surgeons at nice facilities that value MD only anesthesia, and non narcotic, interventional pain mgt. Yes, this is not locums anesthesia, but its also not a burnout type of practice. Clinic starts at 9 ends around 5. You can manage your own schedule and aren't stuck at some ASC. Most anesthesia days start at 8 am and there is plenty of time in between to take breaks, catch up on email - cafeteria staff will prepare food and leave it in the lounge for you. One hospital starts at 730 but its a lax environment. We text/call our surgeons and are very collegial with each other.
Again, its not an AMC setting in a large hospital system with CRNAS, red tape and bureaucracy.
Most importantly, there are no teams meetings, orientations, and toxic culture. No antagonism from CRNAs.
I do my work and spend time with my family once done - no call no weekends. Then repeat.
