Jumping back into private practice

[AndyDufrane]

So am reaching another fork in the career road, been out 9 years, shuttered my solo inpatient rehab unit medical director private practice 2 years to join the VA, strictly outpatient mostly msk, EMGs, fluoroscopy guided spine injections, am in the process of setting up prolotherapy, but was hoping by now i would have attained some sort of career growth boost, like maybe a pmr chief title ,(since am 1 of 2 physiatrist) , and the facility used to have a pmr chief , but nothing like that is in the works, plus for the salary offers I have gotten in the last 2 years outside the VA, I am not it’s worth the 30-40% drop in salary to continue at VA, the hours are cush, not terribly busy, my point is I am mid career, my gut tells me the VA will be great in the last 5-7 years of my career, not good place while you are in early 40s and want to maximize your productivity and earning potential, I am concerned about jumping out of the VA given the economic woes the non VA physiatrist may be facing, we have not had any salary reductions, if anything I got a raise and bonus , any insight would be appreciated about whether it’s wise to leave the VA at this point

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[PMR2008]

stay in the VA for now. Look around next summer for opportunities. A glut of residents, residents who ended up doing fellowships to extend entry to the market and other attendings looking for work will hit the market this summer. This will result in lower compensation offers. That is at least what I am seeing.

 

[AndyDufrane]

stay in the VA for now. Look around next summer for opportunities. A glut of residents, residents who ended up doing fellowships to extend entry to the market and other attendings looking for work will hit the market this summer. This will result in lower compensation offers. That is at least what I am seeing.

Thanks , that is what I am afraid of as well, the unknown job market in the next 6-12 months

 

[j4pac]

Never a bad idea to look. I’d be aggressive. If you know you want to live in a specific area, reach out to the local recruiters of the major groups. Practices hate to recruit...it’s expensive and takes time. By having your name out there you could potentially get an unposted position. And the truth is that most people out of training are going to be passive regarding job searches...be active to get the upper hand.

 

[RangerBob]

I agree it doesn’t hurt to look. I’m compensated entirely from insurance/patient billings plus a fixed administrative stipend. Aside from a couple weeks after the virus initially appeared where our inpatient numbers were down 20-30%, we’ve been busier the past year than prior and done quite well financially. However, I’ve heard some units in more competitive markets have actually closed, so there are absolutely others out there hurting.

In general I’d imagine private inpatient practices are doing better than outpatient (in almost all specialties). I don’t have any data for that so I could totally no wrong, but I hear lots of patients are avoiding elective outpatient visits and that outpatients docs aren’t being as productive with all the telemedicine woes.

As j4pac mentions, be active and reach out to places you’re interested in.

 

[AndyDufrane]

Thanks for the input, I feel like trying to be outside the box for once, I have weekends and every other Friday off due to my VA compressed schedule, within the last year I met with a chiropractor who showed interest in him sending me patients for prolotherapy and prp, if I did it his office, as he currently is sending several patients a month to a sports med family practice doc, so chiropractor prefers to offer service in his office...I also recently talked with a direct pay family doc (doesn’t take any insurance) just to see if pmr can be direct pay model too,but he himself was thinking of offering prolotherapy but would do injects himself, am still pondering it, I am thinking of just dipping my toes in the water, maybe do chiropractor office tpi and prolotherapy knee injections as cash only on weekends or every other Fridays off, if it goes well then go down to 3-4 days a week at VA if they allow it, I was also looking into medical weight loss clinic, apparently there is a CME pathway for obesity boards, so that might be an option, am just concerned that in obesity medicine if any hypertension or hyperlipidemia needs management, then would have to refer back to pcp, thanks for any further input

 

[j4pac]

Thanks for the input, I feel like trying to be outside the box for once, I have weekends and every other Friday off due to my VA compressed schedule, within the last year I met with a chiropractor who showed interest in him sending me patients for prolotherapy and prp, if I did it his office, as he currently is sending several patients a month to a sports med family practice doc, so chiropractor prefers to offer service in his office...I also recently talked with a direct pay family doc (doesn’t take any insurance) just to see if pmr can be direct pay model too,but he himself was thinking of offering prolotherapy but would do injects himself, am still pondering it, I am thinking of just dipping my toes in the water, maybe do chiropractor office tpi and prolotherapy knee injections as cash only on weekends or every other Fridays off, if it goes well then go down to 3-4 days a week at VA if they allow it, I was also looking into medical weight loss clinic, apparently there is a CME pathway for obesity boards, so that might be an option, am just concerned that in obesity medicine if any hypertension or hyperlipidemia needs management, then would have to refer back to pcp, thanks for any further input

Hedging your bets sounds like a pretty good strategy, assuming you don’t spread yourself too thin. Let me know how the cash pay business goes. I think we are always of hearing of such stories on this forum.

 

[AndyDufrane]

Thanks, I figured if I try the cash pay business route, if it fails while I am working at the VA, its less of a financial risk , I just stick with my main VA job, the key is figuring out the finances, the cash only family med docs usually charge a monthly fee for unlimited access, as a specialist, I am thinking fee per visit and fee per procedure, what those numbers are I am not sure, I have heard of psychiatrists in our area charging cash hourly rates of up to $350/hour, so I am not sure I could charge that much, but will probably be a number somewhere what medicare pays for an outpatient level 3 or 4 initial consult visit

 

[Sushirolls]

If you are a DO, and willing to also do OMM/OMT, you could have a cult following of patients who get their adjustments (routine follow up patients). Then you fill the rest of your schedule doing whatever you want for injections, EMG, etc that PM&R is doing these days.

You plus one MA who is a mix front desk clerk. Small office with 1-2 room and waiting room. Could be a great setup.

This thread will have some basics to get you started, one post is a complete how to guide for starting your own practice with step by step instructions.

Private Practice in Progress

Building a private practice, N of 1. Enjoy. Month zero: Grand plan was to use money from inpatient gig where independent contractor doing own billings to expedite insurance paneling, so all I had to do was switch over the practice address once opened. Long story short, not a quality place I...

forums.studentdoctor.net

 

[AndyDufrane]

If you are a DO, and willing to also do OMM/OMT, you could have a cult following of patients who get their adjustments (routine follow up patients). Then you fill the rest of your schedule doing whatever you want for injections, EMG, etc that PM&R is doing these days.

You plus one MA who is a mix front desk clerk. Small office with 1-2 room and waiting room. Could be a great setup.

This thread will have some basics to get you started, one post is a complete how to guide for starting your own practice with step by step instructions.

Private Practice in Progress

Building a private practice, N of 1. Enjoy. Month zero: Grand plan was to use money from inpatient gig where independent contractor doing own billings to expedite insurance paneling, so all I had to do was switch over the practice address once opened. Long story short, not a quality place I...

forums.studentdoctor.net

Thanks for providing lots of good useful information