i’m looking for a pain/anesthesia 50/50 physician

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AKMD_1984

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outpatient hybrid pain and anesthesia position
must be boarded in both
all outpatient

anesthesia is solo cases-2-3 days a week
pain is interventional and non narcotic only 2-3 days a week

will be splitting work with me

525-600k depending on how much vacation you desire

max 45 hrs a week
no call

must be practicing solo doc with recent case logs for anesthesia

prime dfw suburbs

please pm me
 
Ask aneftp to dissect it for you. Basically, the pay for the potential days worked (4-6) per week is not competitive with salaries these days. Being a block jock and sitting your own cases sounds like a tremendous nut stomp to me. This is a $700k job MINIMUM.
this isn’t idaho or nebraska.
 
this isn’t idaho or nebraska.
No sh_it. I realize DFW is a "desirable" area and will pay less because of that. I just don't think you're gonna catch many fish with your bait. I could be wrong; time will tell. I sincerely hope you can find someone.
 
yeah thanks.

if someone is paying 700k for solo md cases and pain with zero overhead with no call no weekends in dfw…

im going to pack up my practice and join them
 
this isn’t idaho or nebraska.
Fwiw I received worse job offers than this in Idaho 🤣

525-600k with zero nights or weekends sounds pretty fair to me. I prefer solo work too, but maybe I'm weird...

I guess the sticking point would be PTO and benefits. You can't claim that this is a 700k/year job without knowing those details.
 
Fwiw I received worse job offers than this in Idaho 🤣

525-600k with zero nights or weekends sounds pretty fair to me. I prefer solo work too, but maybe I'm weird...

I guess the sticking point would be PTO and benefits. You can't claim that this is a 700k/year job without knowing those details.
if you meet the criteria for above position we can chat.

i’m just overwhelmed with my contractual obligations and work and im looking for a good partner
 
outpatient hybrid pain and anesthesia position
must be boarded in both
all outpatient

anesthesia is solo cases-2-3 days a week
pain is interventional and non narcotic only 2-3 days a week

will be splitting work with me

525-600k depending on how much vacation you desire

max 45 hrs a week
no call

must be practicing solo doc with recent case logs for anesthesia

prime dfw suburbs

please pm me
I think this is fair compensation for own cases with no call + opportunity to do pain anesthesia hybrid.

People saying it’s lowball have zero idea of the economics involved in hours worked doing anesthesia or pain only versus the hybrid. The comp necessarily decreases as the specialization decreases. Jack of 2 trades but workhorse in neither.

You should get lots of traction in dfw imo
 
Hell no. I'm not a masochist.
ok great. thanks for the feedback

whoever meets the criteria and pain guys who want to cut back from chronic pain and do solo anesthesia cases - please reach out.

i do have the infrastructure in place now - after 18 months of hard work to add on a pain/ anesthesia partner

you can ask about me from some of the posters here - esp amyl - im a very transparent individual and the comp that i am offering is probably 65-70 percent median income in dfw…like within 10 minutes of downtown

it’s similar to what im making myself minus my overhead

yes its not 1m dollars like locums but again i believe this is sustainable, stable and long term work

i’m not exploiting anyone and i welcome a conversation and your own due diligence

thank you
 
this isn’t idaho or nebraska.
My bff of 33 years makes 1.2-1.4 million in dfw. Prime dfw (not even the up and coming suburbs like prosper Texas because that’s not prime dfw). But prime dfw real estate. Just doing general bread and butter anesthesia. All 1099 guarantee money work. He does hustle. But I’d be hustling for 1 plus million also. He took 13 weeks off last year. Work hard. Play hard. He’s been in Dallas area for 25 years doing anesthesia.

The pain docs make 1.5 million. But they own shares of the surgery center.

It’s difficult position you are in. The hybrid 50/50 pain/general anesthesia model.

I do think people who post jobs like they actually over value the “no calls” sales pitch

Unfortunately you are in no man’s land with your sales pitch. I don’t think it’s bad but it’s not something that will attract a 50/50 person.

Most pain docs are all in 100% pain and do some general on the side for side gig extra income. Or some pain docs just abandon 100% pain and go 100% general anesthesia locums like my other friend did 2 years ago to get his income up to 1.3 million in Florida general anesthesia.

I know I throw out extreme numbers. But are they extreme if multiple people are making similar money?

Unless surgery center shares are available and growth potential. This is a very hard sales pitch to make. Good luck.

You may be better off finding a crna paying them equivalent of 400k 1099 to do the general cases solo. That’s the best solution.
 
i don’t think that’s accurate because one of my colleagues just joined a large f/t pain group and he was offered 450k

anesthesia jobs for outpatient are in 520-550k range with 8 weeks off but some of those days are 7-5 medical direction at asc
 
Aneftp must be the most friendly person ever because it doesn't matter what you talk about he always has a friend/family member in your exact location and of course he knows exactly how much they work and their income. And of course it's always some ridiculous numbers. Doesn't sound made up at all.
 
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Aneftp must be the most friendly person ever because it doesn't matter what you talk about he always has a friend/family member in your exact location and of course he knows exactly how much they work and their income. And of course it's always some ridiculous numbers. Doesn't sound made up at all.
My networking is huge in many parts of the country. I keep in contact with so many people. I’ve had a long career and the networking keeps building.

If you take the lower offered. You settled.

I “settled” also at my current w2 job for around 500k. See…except I told them to double the vacation. Many ways to skin the cat. I’m taking 26 weeks off this year. Making less than last year. But I only took 9 weeks off last year. Becuase I backed filled many weeks off with locums last year. This year I’ll probing only make 750-800k. If I work 17 extra weeks. That gets me up to 1.1-1.2 again. And still leaves me with 9 weeks off

Thads why those 500k/8 weeks off jobs are trash.

And yes I’m very friendly.
 
From a pure pain prospective that seems low.

Let's assume the procedures are lumbar ESI (middle of pack in terms of reimbursement), that every patient is Medicare, and that the schedule is full (30 appts per day). We will use 2.5 days worked per week.

That's $200 per procedure so $6000 per day collected and $15000 per week. Let's assume 48 weeks worked so $720k per year. At $525k per year/2 = 263k you are paying the physician 36% of collections. This is quite low. For a job like this I would expect the collections rate to be at least 45% but probably even higher as the overhead costs are pretty fixed.

And not every procedure is an ESI. I'm sure there's a fair number of RFA, SCS, and other higher reimbursement procedures. And not every patient has Medicare.
 
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From a pure pain prospective that seems low.

Let's assume the procedures are lumbar ESI (middle of pack in terms of reimbursement), that every patient is Medicare, and that the schedule is full (30 appts per day). We will use 2.5 days worked per week.

That's $200 per procedure so $6000 per day collected and $15000 per week. Let's assume 48 weeks worked so $720k per year. At $525k per year/2 = 263k you are paying the physician 36% of collections. This is quite low. For a job like this I would expect the collections rate to be at least 45% but probably even higher as the overhead costs are pretty fixed.

And not every procedure is an ESI. I'm sure there's a fair number of RFA, SCS, and other higher reimbursement procedures. And not every patient has Medicare.
It all boils down to facility fees these days

Unless you own a share of the center or have agreement with the center that they subsidize ur psi and anesthesia coverage with guarantees.

Look at any breakdown in terms of facility fees Vs reimbursement
 
there is no chronic pain or opioid mgt.
our pain patients are acute pain and referrals from chiro/ pt/ attorneys/ surgeons to do diagnostic injections. we get paid based on service and fee schedule.
it’s their headache to do billing.

it’s a really clean way to practice.

in between there are some injections for arthrograms and myelograms before their scanning. we don’t read it but i find these quite fun. it’s essentially a joint injection except of steroid, dye for ct scan or mri goes in.

if you’d like to grow the chronic pain mgt component of the practice, be my guest. i do have my own clinic and in house fluoro setup and OBA certification and i do see chronic pain pts and direct referrals for injections from mostly chiro (chiropractors charge them
cash but if they have medicare or commercial i bill).

im looking for a good team mate who can do the work for fair price and most importantly provide good service.

i made the jump to work independently about 2 years ago and at that time it was scary to set up relationships and surgeons, but now i have gotten very busy.

ofcourse there will be a production aspect to all this.

re: chronic pain - overall, my experience with injections and med mgt for chronic pain has been abysmal. insurance companies deny basic meds such as robaxin and even naproxen for no clear reason and it’s too much time spent on the phone to do peer to peer.

direct referrals are much better way to do it imo.

i personally do not believe in long term opioid management and because of that i never wanted to do 100% chronic pain as an anesthesiologist, despite the fellowship training.

we do tons of rfa. scs trial as well. unfortunately at this time part of my practice has been referral for injections from attorneys for PI, and they don’t really approve scs that much.

anesthesiology is great but so is a well run interventional pain practice with a good staff and reasonable work flow and respectful leadership.

i looked at pain fellowship simply as an extension of anesthesiology and not completely replace being an anesthesiologist.

i hope atleast some physicians think somewhat along those lines.

ofcourse if you want to do both pain and anesthesia - taking call and unpredictable schedule becomes very hard given outpatient practice and surgeries are typically on fixed days of week. it is increasingly becoming rare to do both within an AMC setting as well.

academics is an option but the pay is probably 2/3 of above.

but i personally won’t practice it any other way. the term jack of all trades is not really applicable since i have done more cases personally in one year than my 5 years working for various AMCs combined which were 1:4-1:6 direction/supervision. i do not consider signing charts and doing consents for other people “anesthesia”. there is no crnas.

thank you
 
there is no chronic pain or opioid mgt.
our pain patients are acute pain and referrals from chiro/ pt/ attorneys/ surgeons to do diagnostic injections. we get paid based on service and fee schedule.
it’s their headache to do billing.

it’s a really clean way to practice.

in between there are some injections for arthrograms and myelograms before their scanning. we don’t read it but i find these quite fun. it’s essentially a joint injection except of steroid, dye for ct scan or mri goes in.

if you’d like to grow the chronic pain mgt component of the practice, be my guest. i do have my own clinic and in house fluoro setup and OBA certification and i do see chronic pain pts and direct referrals for injections from mostly chiro (chiropractors charge them
cash but if they have medicare or commercial i bill).

im looking for a good team mate who can do the work for fair price and most importantly provide good service.

i made the jump to work independently about 2 years ago and at that time it was scary to set up relationships and surgeons, but now i have gotten very busy.

ofcourse there will be a production aspect to all this.

re: chronic pain - overall, my experience with injections and med mgt for chronic pain has been abysmal. insurance companies deny basic meds such as robaxin and even naproxen for no clear reason and it’s too much time spent on the phone to do peer to peer.

direct referrals are much better way to do it imo.

i personally do not believe in long term opioid management and because of that i never wanted to do 100% chronic pain as an anesthesiologist, despite the fellowship training.

we do tons of rfa. scs trial as well. unfortunately at this time part of my practice has been referral for injections from attorneys for PI, and they don’t really approve scs that much.

anesthesiology is great but so is a well run interventional pain practice with a good staff and reasonable work flow and respectful leadership.

i looked at pain fellowship simply as an extension of anesthesiology and not completely replace being an anesthesiologist.

i hope atleast some physicians think somewhat along those lines.

ofcourse if you want to do both pain and anesthesia - taking call and unpredictable schedule becomes very hard given outpatient practice and surgeries are typically on fixed days of week. it is increasingly becoming rare to do both within an AMC setting as well.

academics is an option but the pay is probably 2/3 of above.

but i personally won’t practice it any other way. the term jack of all trades is not really applicable since i have done more cases personally in one year than my 5 years working for various AMCs combined which were 1:4-1:6 direction/supervision. i do not consider signing charts and doing consents for other people “anesthesia”. there is no crnas.

thank you
Just my own question

Are you allowing anyone to buy into the surgery center?
 
Just my own question

Are you allowing anyone to buy into the surgery center?
i don’t have a surgery center sir. i just have a clinic.

i have stayed away from asc investment since i don’t really need it but if the group grows then ofcourse the cost and profit will be split
 
Seems reasonable. Solo guy has created value out of nothing in 2 short years and offering to share half of it. Of course, I am just commenting on what is being shared at face value. Instead of criticising, someone interested in being in this area should be asking intelligent questions and understanding how to grow in this set up. This is a great opportunity.
 
Anesthesiologists seem to fixate on their hourly wage. I also understand that practice owners tend to inflate the value of their enterprise. But, generating enough volume in referrals to take home 500-600k and then offering the same deal to someone else in two years is solid. Most large pain practices will offer 350k-400k to start with some nebulous bonus structure.
 
Anesthesiologists seem to fixate on their hourly wage. I also understand that practice owners tend to inflate the value of their enterprise. But, generating enough volume in referrals to take home 500-600k and then offering the same deal to someone else in two years is solid. Most large pain practices will offer 350k-400k to start with some nebulous bonus structure.

But this is 50/50 anesthesia/pain. Not the same thing.
 
give me some intelligent ways to structure compensation in this scenario.


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.
 
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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.
 
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