Is the "Privademic" (Private-Academic) Practice Model a Game Changer for Pain?

[drusso]

Barriers to advancing the specialty of Pain Medicine in large academic centers have created an opportunity for more distributed private-academic (Privademic) practice models. These practices often recruit and train fellows, conduct leading-edge research and are recognized as prestigious practices in their regions.

Is this the future for pain? How will you participate? Get on the buss or get out of the way?

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[oreosandsake]

Barriers to advancing the specialty of Pain Medicine in large academic centers have created an opportunity for more distributed private-academic (Privademic) practice models. These practices often recruit and train fellows, conduct leading-edge research and are recognized as prestigious practices in their regions.

Is this the future for pain? How will you participate? Get on the buss or get out of the way?

why pay for a midlevel to run your clinic when you can get a acgme CMS funded fellow to do it, write some papers for you, and knock out 99.999% rvus.

 

[Status Sciaticus]

Barriers to advancing the specialty of Pain Medicine in large academic centers have created an opportunity for more distributed private-academic (Privademic) practice models. These practices often recruit and train fellows, conduct leading-edge research and are recognized as prestigious practices in their regions.

Is this the future for pain? How will you participate? Get on the buss or get out of the way?

can i still be a million dollar baller in this practice setting?

 

[drrosenrosen]

I know that Wake Forest/Carolina Pain Institute are just finishing up a pretty messy divorce due to "irreconcilable differences", so maybe privademic isn't the wave of the future

 

[Orin]

It is the wave of the current, but not sure what the future will hold.

The incentive structure and barriers in academic hospital based practices drive this behavior to some extent.

CPI will be fine. The pain fellowship at Wake will be weaker for it but I'm sure they'll get some great inpatient pain training.

 

[oreosandsake]

can i still be a million dollar baller in this practice setting?can easier than normal private

can i still be a million dollar baller in this practice setting?

Easier than normal private unless you’re a needle for pills operation

 

[Status Sciaticus]

I know that Wake Forest/Carolina Pain Institute are just finishing up a pretty messy divorce due to "irreconcilable differences", so maybe privademic isn't the wave of the future

wasnt CPI the whole draw of the program?

 

[10KHertz]

Private practice cannot have any credence until site of service payments are equalized. I remember hospital administrators drooling over private practices. No more

 

[hyperalgesia]

I think it's a match made in heaven.

The academic component lures patients in with prestige and validates the practice.
The medical component commoditizes the patient.

It's the Death Star of medicine.

 

[painfree23]

I think it’s easier bc u don’t feel forced to write opiates in these settings.

 

[Pain2021]

I know that Wake Forest/Carolina Pain Institute are just finishing up a pretty messy divorce due to "irreconcilable differences", so maybe privademic isn't the wave of the future

It wasn't messy, it was simply WF program grew to be much larger than CPI and no longer needed to outsource to PP. Wake Forest program is a hybrid model - academic but at the same clinical volume as private practice. Nature of the fellowship only changed to include PMR and Neurology residents in addition to Anesthesiology residents. Despite other posts - no, there was no increase in inpatient time (possibly less since the fellows used to have to cover the entire private practice hospital in town for CPI physicians). Fellows were well trained by CPI when there was no Wake Forest pain program, they remain equally well trained now.

 

[Pain2021]

I know that Wake Forest/Carolina Pain Institute are just finishing up a pretty messy divorce due to "irreconcilable differences", so maybe privademic isn't the wave of the future

The Wake Forest/CPI relationship wasn't a divorce in the negative sense. Wake Forest had no pain program of its own prior to 4 years ago, so it relied on CPI to train residents and fellows. Wake Forest now has a program larger than CPI and can train its own fellows. CPI was no longer needed, therefore the contract ended. The Wake Forest program is a hybrid program in all of the faculty physicians practice with the speed and efficiency (and volume) of traditional private practices when doing clinical/procedural work. The remainder of the time they are doing research, teaching, etc. Privademic, in this sense, is probably the way to go. No more academic practice where you see a couple patients a day and only do a few procedures...

 

[Pain2021]

It is the wave of the current, but not sure what the future will hold.

The incentive structure and barriers in academic hospital based practices drive this behavior to some extent.

CPI will be fine. The pain fellowship at Wake will be weaker for it but I'm sure they'll get some great inpatient pain training.

You are right there are enormous barriers to academic practice, but they can be overcome. Regarding your comments on CPI/Wake Forest, CPI will likely be fine, just less busy. The Wake Forest fellows remain just as busy doing clinic and procedures and no, the inpatient time did not increase, it actually decreased now that the fellows aren't required to cover the local PP hospital for CPI. The inpatient pain service is run by the attending MD and NPs.

 

[Pain2021]

wasnt CPI the whole draw of the program?

CPI was the Wake Forest program, up until about 4 years ago. Now the Wake Forest program is independent, the draw to the WF program remains an emphasis on procedures including SCS, PNS and the addition of kypho, basivertebral ablation, bone tumor ablation, vertiflex, etc.

 

[Orin]

I assume the CPI faculty didn't want to lose money, time, and opportunities to the inpatient needs and hospital inertia, necessitating bringing in outside faculty. Pain fellowships are driven by the faculty, their work ethic, and the healthcare environment feeding them.

Regardless of the politics, finances, egos, and visions involved there, replacing either Rauck, Kaparul, North, or Gilmore with anyone would be a challenge, but replacing all of their combined clinical, research, and industry experiences would be implausible at best. The fellowship will be fine, but it would be pure hubris to think a fellowship without CPI will be as strong unless WF recruited Deer, Pope, etc while I was out of trick or treating.