Job Market for Pain in Southern California

[lonelobo]

Kaiser in SoCal (I forget exactly which one) offered to fly me out to an interview because I was planning on leaving my first job. I asked them if I could have a ballpark salary figure. The guy said, let's see... PM&R... Fellowship trained... BE/BC in Pain... Salary starts at $130k.

Would be happy to pay that in taxes

---

Members don't see this ad.

 

[SCIronMike]

I'm in my 5th year at Kaiser Permanente Downey. My salary this year will be slightly above $300,000, plus our standard bonuses (documentation, online education modules, merit bonuses) and partner profit sharing. I'm sure it'll be over $320,000 this year. The benefits package is still stellar. I work 9 half days per week. I get Tuesday afternoons off. I have 7 half days of clinic and 2 half days of fluoro time. They allow me to inject 4 patients per half day of my fluoro time and 30 min clinic follow-up. It is not strenuous.

 

[SCIronMike]

By the way, all Kaiser physician salaries are standardized. The starting pay for a non-fellowship trained PM&R physician currently is $201,000 + signing bonus. When I started at Kaiser back in 2011, the pay for straight PM&R was $183,000 + $20,000 signing bonus and a $20,000 / year retention bonus until partnership.

 

[101N]

I'm glad to see the progression since I left. I hope Northern CA is keeping pace.

 

[bedrock]

I'm in my 5th year at Kaiser Permanente Downey. My salary this year will be slightly above $300,000, plus our standard bonuses (documentation, online education modules, merit bonuses) and partner profit sharing. I'm sure it'll be over $320,000 this year. The benefits package is still stellar. I work 9 half days per week. I get Tuesday afternoons off. I have 7 half days of clinic and 2 half days of fluoro time. They allow me to inject 4 patients per half day of my fluoro time and 30 min clinic follow-up. It is not strenuous.

Not bad mike. I'm sure this is why there is a huge line, 40 deep, of applicants for the next available Kaiser pain position in SoCal

 

[alohaahola]

I would like to add a couple things about being a pain physician at Kaiser SoCal from someone just finished fellowship last year:
1. I finished pain fellowship in July, started at Kaiser per diem in August (they DO start everyone as per diem for Anesthesia pain now), and just became a full time Associate last month. It does not have to be 2 years …
2. The pain dept at each Kaiser branch is different, some are very organized, others not so much. I really like my group, all young guys and very collegial.
3. Obamacare has helped Kaiser in SoCal a lot, everyone got a big raise this year, membership is growing crazily, there is more patients to see and more procedures to do than the number of physicians we have, at least in our group. My suspicion is as long as Obamacare continues (most likely the case), Kaiser will continue to thrive in California, not so much in other parts of the country though. Kaiser is not doing so well in mid-atlantic, georgia et al.,
4. I got offers from academic places as well as a couple PP places in SoCal last year. I think the offer from Kaiser makes the most sense in terms of a good balance between pay and life style. It is not as intellectually stimulating as an academic center or as rewarding as PP. However I work 4.5 days a week and there is minimal stress at work. There is NO pre-authorization, I can do a stim trial if I think patient will benefit from it, I do not need to have peer to peer review with anyone!
5. For the graduating fellows who want to live in SoCal cities, I would be very careful signing contract with private groups in SD or LA, I interacted with quite a few of them and it just did not feel right. One big group did offer 300 salary, but there is no vacation or any benefit, any day off you take will be deducted from the base salary. Another place wanted to give me only 2-week vacation per year. The truth is a lot of guys switch jobs after a year or two anyway, why not invest the time and energy in a big institution like Kaiser, at least you are investing towards partnership. Most PP guys in SD or LA are not going to offer you partnership or with unreasonable buy in. Why do they need to make you partner when they can hire a cheap fresh graduate in 2 years? Finally most of the Kaiser jobs will pop up after March or April. Both me and my co-fellow are working at Kaiser and both jobs opened up very late. You just have to go through the torture and wait if you really want to come to Kaiser …

 

[drusso]

What I seem to be reading is that working at Kaiser is not stressful, the compensation is adequate, but the whole operation seems to be supported by the artificial economies of Obamacare. Is that right?

What about one's sense of control and autonomy? Do you feel like you get to call your own shots? Something I value is getting to direct and control the work of my employees. If I don't like the quality coming out of my clinic, then I can fire people. Is it an act of God to fire a Kaiser employee? Are there levels and levels of burdensome administrative procedures and appeals? How do you cope with that?

When I was doing hospital work it always frustrated me that the union-member RN's didn't REALLY relate to me like their boss..."the contract" was their boss. Is there a sense of entitlement or union-malaise among rank-and-file employees at Kaiser?

 

[SCIronMike]

A few thoughts after reading Alohaahola's post:

I agree with Alohaahola that there is variability between regional Kaisers. At my location, the Anesthesiology pain crew splits time between anesthesiology in the OR and fluoro time for procedures. They do not have any clinic. They staff the inpatient pain service. The PM&R pain physicians split time between outpatient pain clinic and fluoro time. In locations such as Woodland Hills, the Anesthesiology pain physicians have outpatient pain clinic. In San Diego, PM&R pain physicians do not get fluoro time.

Yes, it does not necessarily require two years in a per diem pool to become an associate. It entirely depends on how many people are in the per diem pool and when the next position opens up due to someone retiring, leaving (rarely happens), or a new spot opening up.

Anesthesiology pain gets paid quite a bit more than PM&R pain.

I actually don't regret having started in academics, but I enjoy being at Kaiser a lot and could not see myself leaving for another job.

Kaiser mid Atlantic is actually doing well again, and Georgia is turning around. The Pacific Northwest and Colorado are doing well. Hawaii is doing well also. Kaiser just bought Group Health in Seattle to expand into Washington. I think we will hear of other expansions in the future.

 

[SCIronMike]

What I seem to be reading is that working at Kaiser is not stressful, the compensation is adequate, but the whole operation seems to be supported by the artificial economies of Obamacare. Is that right?

What about one's sense of control and autonomy? Do you feel like you get to call your own shots? Something I value is getting to direct and control the work of my employees. If I don't like the quality coming out of my clinic, then I can fire people. Is it an act of God to fire a Kaiser employee? Are there levels and levels of burdensome administrative procedures and appeals? How do you cope with that?

When I was doing hospital work it always frustrated me that the union-member RN's didn't REALLY relate to me like their boss..."the contract" was their boss. Is there a sense of entitlement or union-malaise among rank-and-file employees at Kaiser?

Kaiser Permanente was doing very well before Obamacare. Since Obamacare, our membership has grown significantly, but it's also a challenge because reimbursements are down. All the support staff in my clinic are union employees. They do the work that we ask of them, but we are not their bosses. Occasionally you get a really bad employee and yes it is a challenge to get rid of them. But overall the people who work there are really great. I really like the MAs and NPs and front and back office staff in my office.

 

[hyperalgesia]

Kaiser Permanente was doing very well before Obamacare. Since Obamacare, our membership has grown significantly, but it's also a challenge because reimbursements are down. All the support staff in my clinic are union employees. They do the work that we ask of them, but we are not their bosses. Occasionally you get a really bad employee and yes it is a challenge to get rid of them. But overall the people who work there are really great. I really like the MAs and NPs and front and back office staff in my office.

Do you get your own office? At my place doctors are tied to trees.

 

[powermd]

I'm in my 5th year at Kaiser Permanente Downey. My salary this year will be slightly above $300,000, plus our standard bonuses (documentation, online education modules, merit bonuses) and partner profit sharing. I'm sure it'll be over $320,000 this year. The benefits package is still stellar. I work 9 half days per week. I get Tuesday afternoons off. I have 7 half days of clinic and 2 half days of fluoro time. They allow me to inject 4 patients per half day of my fluoro time and 30 min clinic follow-up. It is not strenuous.

WOW. I would go stir crazy in an environment like that.

What are the waits like for patients who want a procedure?

Between the shear volume of members and minimal productivity of staff, I would think it would take forever to get in for an ESI.

 

[SCIronMike]

Do you get your own office? At my place doctors are tied to trees.

Yup. Pretty big one actually. Beautiful view of the mountains

 

[SCIronMike]

WOW. I would go stir crazy in an environment like that.

What are the waits like for patients who want a procedure?

Between the shear volume of members and minimal productivity of staff, I would think it would take forever to get in for an ESI.

Depending on the time of year, any where from 1 week to 4 weeks. If a patient urgently needs an epidural, we'll move stuff around to get him/her accommodated within a week. When access starts getting long, my chief will ask for a couple volunteers to come in on Saturday to do some epidurals. We get paid 120% of our usual fee for the Saturday clinic. That's only happened twice in the 4+ years that I've been here though.

 

[Ligament]

Kaiser is now moving into the Seattle area. What can I expect?

 

[drusso]

Kaiser is now moving into the Seattle area. What can I expect?

I wonder if Kaiser has a good track record of partnering with local community and independent physician groups when they come into a market?

 

[101N]

I wonder if independent community docs have a good track record of partnering with Kaiser when they come into a market?

 

[olafa]

I wonder if Kaiser has a good track record of partnering with local community and independent physician groups when they come into a market?

doubtful. They are on their own island , everything stays within. But patients can sometimes go to outside physicians if specialty care is not available but its sort of like VA patients. Imaging report can be a hassle to get and other records are sporadic or unavailable to community docs

 

[drusso]

I wonder if independent community docs have a good track record of partnering with Kaiser when they come into a market?

I don't know. they purchase practices like other large physician employers? I've never heard of anyone selling their business to Kaiser? Does anyone know if they've done joint ventures for ASC's or other patient service lines?

The goal would be to NOT be employed and controlled by them, but work on mutually beneficial services.

 

[SCIronMike]

Kaiser is now moving into the Seattle area. What can I expect?

My understanding is that the Group Health physicians will become Kaiser partner physicians, and Kaiser is going to a lot of money into building up services throughout the northwest region with a goal of capturing as much market share as possible throughout the entire west coast.

 

[Stim4me]

different specialties under the same roof? in the same family? overhead will be different for each type of doc, as will the billing, contracts, etc. hey, by all means, go for it. i dont have all the facts, but this is not a standard practice set up, and things can get ugly when you do business in the family. especially in-laws.

Remember the show Private Practice? That's the dream set up. My advice is the tax rate of 16% will leave you house poor... Try Miami, no income tax, great weather, lots of oldies... Good luck

 

[Disciple]

In San Diego, PM&R pain physicians do not get fluoro time.

So, that sounds like the population health, psyche focused, opioid weaning position that everyone dreads. For 25-35 years no less.

Who would take that position?

Just thinking about it is giving me a tension headache and flash-backs to residency.

 

[Disciple]

I wonder if independent community docs have a good track record of partnering with Kaiser when they come into a market?

Kaiser Occ-Med farms out old work-comp cases (involving Kaiser/non-Kaiser employees) to community doctors.

Makes sense.

Loss prevention.

 

[Disciple]

I wonder if Kaiser has a good track record of partnering with local community and independent physician groups when they come into a market?

Why do that when they can just run them over?

 

[Disciple]

Kaiser sounds great if you don't have any major aspirations for independent practice.

Or, if you no longer have any major aspirations for independent practice.---Hope that does not become me. Time will tell.

 

[101N]

My understanding is that the Group Health physicians will become Kaiser partner physicians, and Kaiser is going to a lot of money into building up services throughout the northwest region with a goal of capturing as much market share as possible throughout the entire west coast.

I think their model will work well along the entire I-5 corridor. The smaller rural environments are another story.