rra

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Does anyone have any information on what it's like to be a pain doctor at Kaiser Permanente? My impression is that their system is very algorithmic, but apparently providers across the board are extremely happy working there.

Any info on hours, procedure mix, salary, benefits would be great. Thanks!
 
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willabeast

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Does anyone have any information on what it's like to be a pain doctor at Kaiser Permanente? My impression is that their system is very algorithmic, but apparently providers across the board are extremely happy working there.

Any info on hours, procedure mix, salary, benefits would be great. Thanks!
I worked for TPMG (Kaiser) as a 4/5 pain doc for about 15 years, and full time pain doc for another 10 years.
boarded IM, Anesthesiology and Pain (ABMS). 90% spine. I think TPMG was the best possible fit for me however
no Doc is "extremely" happy anywhere unless they are retired or delusional. I think i was the first accredited pain fellowship trained pain doc hired by TPMG (Northern California Kaiser). I have to point out that no two positions in Pain at TPMG are identical or even similar. It really depends on who your "chief" is. During my tenure i had stints with chiefs in Anesthesiology (with a neurosurgeon mentoring me), Orthopedics, and PM+R. All very different experiences. So the only way to know the answer to your questions would be for you to ask the "chief" who is hiring you, with the caveat that your chief could change at any time. Also realize that the state you practice in affects your income. California is terrible in terms of taxes and housing costs. I will say that the retirement benefits at TPMG are outstanding. Not all Kaiser jobs are TPMG however. So not all retire benefits as an MD at a kaiser job are equivalent. For example, Southern California Kaiser is NOT TPMG, although it is PMG, and has different retirement benefits and salary structure.
 

hyperalgesia

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I recently learned that when you retire from Kaiser, you can get your entire pension in a "lump sum". This is awesome...
 
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lord_jeebus

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I interviewed for a job at one of their Southern California hospitals in 2013 when I was a fellow. Salary was determined by base specialty, for anesthesia it started around 230K with increases to about 300K after 5 years. Very generous pension, if I remember correctly, if you worked there for 30 years you would get 50% of your maximum salary for life after age 65. 40% if you worked there for 20 years. The pain doctors at the hospital I saw were not busy at all, 1 hour blocks for new consults and 1 hour per injection (!). 35 hours/week. They said the (unionized) staff would not let them turn over the procedure room any faster so there was lots of downtime. No medication management, no inpatient consults. Another plus was that it sounded like there was no prior auth process, you could do whatever you thought was medically necessary.
 

clubdeac

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I interviewed for a job at one of their Southern California hospitals in 2013 when I was a fellow. Salary was determined by base specialty, for anesthesia it started around 230K with increases to about 300K after 5 years. Very generous pension, if I remember correctly, if you worked there for 30 years you would get 50% of your maximum salary for life after age 65. 40% if you worked there for 20 years. The pain doctors at the hospital I saw were not busy at all, 1 hour blocks for new consults and 1 hour per injection (!). 35 hours/week. They said the (unionized) staff would not let them turn over the procedure room any faster so there was lots of downtime. No medication management, no inpatient consults. Another plus was that it sounded like there was no prior auth process, you could do whatever you thought was medically necessary.
Sounds like the VA... with a lot worse pay that is
 

hyperalgesia

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Sounds like the VA... with a lot worse pay that is
The Kaiser in my area pays 300+ to start. Their pension is more than double the VA at 2% annual salary x years worked. If you take the "lump sum" when you retire, they throw in 100k+ to offset your taxes. This amounts to way more than the VA. If you work at the VA for 20 years, you make only 20% of your salary compared to 40% at Kaiser.
 

willabeast

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I interviewed for a job at one of their Southern California hospitals in 2013 when I was a fellow. Salary was determined by base specialty, for anesthesia it started around 230K with increases to about 300K after 5 years. Very generous pension, if I remember correctly, if you worked there for 30 years you would get 50% of your maximum salary for life after age 65. 40% if you worked there for 20 years. The pain doctors at the hospital I saw were not busy at all, 1 hour blocks for new consults and 1 hour per injection (!). 35 hours/week. They said the (unionized) staff would not let them turn over the procedure room any faster so there was lots of downtime. No medication management, no inpatient consults. Another plus was that it sounded like there was no prior auth process, you could do whatever you thought was medically necessary.
Southern Ca Kaiser is not the same as Northern California Kaiser. For one thing, Socal's MD retirement money is not separate from non MD Kaiser employees. In Norcal they are two distinct entities. Also - FYI in Norcal - my procedure times were typically 30 minutes for most lumbar ESI, RF times were determined by how many nerves i burned, but i did get 60 minutes for CESI which i always thought was generous. Also 60 minutes for any sympathetic plexus blocks. definitely 40 hours per week of patient contact time, and consult times were 45 minutes for everything except CRPS which were 60 minutes. 40 hours of patient contact time = minimum of 55 hours actual work. no way i could get everything done in 40 hours. typical 10 hour days and worked through lunch.
 
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rra

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Thank you all so much for the information! I am looking specifically at a SoCal location right now, so I appreciate the distinction between NorCal and SoCal, which I didn't realize there was one. A few more questions:

1. Is there any expectation (or opportunity, depending on how you look at it) to do OR anesthesia?

2. Is the "chief" who hires employees located at the specific hospital I may potentially be working at, or is he/she a regional "chief". Basically, will I be interacting with this person daily?

3. Are bigger procedures such as stim, kypho, and IT pump discouraged? Managed by other specialties altogether?

Thanks again for all this great info!
 

willabeast

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Thank you all so much for the information! I am looking specifically at a SoCal location right now, so I appreciate the distinction between NorCal and SoCal, which I didn't realize there was one. A few more questions:

1. Is there any expectation (or opportunity, depending on how you look at it) to do OR anesthesia?
i did one day a week OR anesthesia for years then i decided to end it and resigned my OR privileges when they tried to force me to take anesthesia OR call at night. It wasn't the work at night that bothered me, I honestly did not feel safe doing emergencies by myself. Best decision i ever made by the way - much happier doing interventional pain full time.

2. Is the "chief" who hires employees located at the specific hospital I may potentially be working at, or is he/she a regional "chief". Basically, will I be interacting with this person daily? There are all kinds of chiefs. Regional chiefs, department chiefs, assistant department chiefs, PIC's, there are layers and layers of supervision. You will not interact with them at all unless 1. you screw up 2. your yearly evaluation. Typically chiefs make about 20% more money, and have admin time, which means they do not have to see patients during admin time, which is awesome for lifestyle. Some chiefs have over 50% admin time. (which means over 50% less patient time). There are also chiefs of IT, legal, every kind of chief you can imagine.

3. Are bigger procedures such as stim, kypho, and IT pump discouraged? Managed by other specialties altogether?
There is no financial incentive to do procedures that are outside your normal scope of practice, but if you are hired with the understanding that you are to do these procedures, then make sure they are going to supply you with whatever you need to do those procedures. For example, they asked me in the middle of my career if I would take care of IT pumps. My response was Sure, let me figure out what staff and budget i will need and if you provide that i am happy. Never heard from them again. No one discourages stims, kyphos, pumps. Stims and IT pumps are done by anesthesia/pain, kypho done by interventional radiology at the medical centers i was at, but it may be different at a different Kaisers.

Thanks again for all this great info!
hope it is relevant to Socal.
 

lord_jeebus

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Thank you all so much for the information! I am looking specifically at a SoCal location right now, so I appreciate the distinction between NorCal and SoCal, which I didn't realize there was one. A few more questions:

1. Is there any expectation (or opportunity, depending on how you look at it) to do OR anesthesia?

2. Is the "chief" who hires employees located at the specific hospital I may potentially be working at, or is he/she a regional "chief". Basically, will I be interacting with this person daily?

3. Are bigger procedures such as stim, kypho, and IT pump discouraged? Managed by other specialties altogether?

Thanks again for all this great info!
I can only speak to the place where I interviewed (PM me for the location), but it was emphasized on my interview day that there would be no opportunity for OR anesthesia work. At this particular hospital, stim was an option, but referrals for kypho and IT pumps were sent to a different Kaiser hospital.
 

hyperalgesia

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Thank you all so much for the information! I am looking specifically at a SoCal location right now, so I appreciate the distinction between NorCal and SoCal, which I didn't realize there was one. A few more questions:

1. Is there any expectation (or opportunity, depending on how you look at it) to do OR anesthesia?

2. Is the "chief" who hires employees located at the specific hospital I may potentially be working at, or is he/she a regional "chief". Basically, will I be interacting with this person daily?

3. Are bigger procedures such as stim, kypho, and IT pump discouraged? Managed by other specialties altogether?

Thanks again for all this great info!
My experience, limited to one interview and friends working at the same place, is that procedures are completely voluntary. Pain docs start out their young professions anxious to do all kinds of procs and within a few years, some don't do ANY (by choice). There is no financial incentive to do them and it's more radiation and stress for the doc. Instead the docs do lots of clinic and some find a way to substitute power point presentations for seeing pts.

I was told by a doc who interviewed me that SCS was an almost never event. Presumably because of the cost.
 

willabeast

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My experience, limited to one interview and friends working at the same place, is that procedures are completely voluntary. Pain docs start out their young professions anxious to do all kinds of procs and within a few years, some don't do ANY (by choice). There is no financial incentive to do them and it's more radiation and stress for the doc. Instead the docs do lots of clinic and some find a way to substitute power point presentations for seeing pts.

I was told by a doc who interviewed me that SCS was an almost never event. Presumably because of the cost.
This could not happen where i worked (NCAL TPMG) because in addition to doing procedures on patients i worked up, i did procedures on patients that my colleagues worked up. For example, a PCP would refer a patient to a PMR doctor for eval, PMR doc would do the workup, read the MRI, etc. then refer the patient for a procedure which i would be expected to do in 30 minutes for a lumbar TF ESI, or 60 minutes for a cervical. A lot of my time was spent the day before the procedure reviewing the MRI's and history of patients i would be doing procedures on the next day. The best thing about this system is that you do not have any responsibilities for these procedure only patients other than immediately after or during the procedure. FOr this to work well you need a good EMR and standardized routines (for example coumadin protocalls) and of course good communication. I very rarely cancelled procedures, maybe one a month.
 
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hyperalgesia

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This could not happen where i worked (NCAL TPMG) because in addition to doing procedures on patients i worked up, i did procedures on patients that my colleagues worked up. For example, a PCP would refer a patient to a PMR doctor for eval, PMR doc would do the workup, read the MRI, etc. then refer the patient for a procedure which i would be expected to do in 30 minutes for a lumbar TF ESI, or 60 minutes for a cervical. A lot of my time was spent the day before the procedure reviewing the MRI's and history of patients i would be doing procedures on the next day. The best thing about this system is that you do not have any responsibilities for these procedure only patients other than immediately after or during the procedure. FOr this to work well you need a good EMR and standardized routines (for example coumadin protocalls) and of course good communication. I very rarely cancelled procedures, maybe one a month.
This sounds like an awesome set up...
 
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willabeast

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60 mins for a cervical ESI? Wow. I'd be expected to do RFA, TFESI and see 4 clinic patients all in 60 mins.
i always thought 60 minutes was a lot of time for a CESI seeming i can do one in 15 minutes but i feel like i got shorted on some other procedure times so it made up for the ones i got shorted on. and i had to talk to the patient, IV has to go in, etc.
besides, it wasn't just me, we had several docs doing them. i did my first epidural in 1980, some of the docs are fresh out of fellowship. takes time to get fast. 10K hours they say :)
 

hyperalgesia

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60 mins for a cervical ESI? Wow. I'd be expected to do RFA, TFESI and see 4 clinic patients all in 60 mins.
Well someone has to pay for your Admin supervision, insurance staffing and real estate, etc and you're the only one adding any value to the system so... Get up there and dance b!tch!
 

willabeast

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Well someone has to pay for your Admin supervision, insurance staffing and real estate, etc and you're the only one adding any value to the system so... Get up there and dance b!tch!
i am retired now. as i mentioned, great retirement benefits with TPMG.
 

Yo GabbaPentin

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Well someone has to pay for your Admin supervision, insurance staffing and real estate, etc and you're the only one adding any value to the system so... Get up there and dance b!tch!
I do bust my butt and make way more money. However, in maybe 10 years I'd be all for 1 hr CESI and 1 hr NP visits. I can definitely see the benefits in that type of system with the low pay and good retirement.
 

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So in this type of system, could you knock out 8 CESI in the max 2 hrs is should actually take you and then call it a day. Like come in at 8 am, be done by 10 am, while calling it a "full days work?"
 

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So in this type of system, could you knock out 8 CESI in the max 2 hrs is should actually take you and then call it a day. Like come in at 8 am, be done by 10 am, while calling it a "full days work?"
Like how you think, but 30 min turnover time kills your plan to make it to brunch.
 

hyperalgesia

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So in this type of system, could you knock out 8 CESI in the max 2 hrs is should actually take you and then call it a day. Like come in at 8 am, be done by 10 am, while calling it a "full days work?"
At the VA you can do 20 cases in the AM but be prepared to stay until 4:30 (or whatever the end of your "tour of duty" is). At some point, you can sometimes use your productivity to justify a higher salary...

You "call it a day" when your pre-determined tour ends (usually set at 4 or 5), whether you've been busting your ass or you only saw one pt all day (or no pts). I'm not sure it's the same with Kaiser. Welcome to the machine...
 

willabeast

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So in this type of system, could you knock out 8 CESI in the max 2 hrs is should actually take you and then call it a day. Like come in at 8 am, be done by 10 am, while calling it a "full days work?"
What slowed me down doing procedures was the way the staffing and physical arrangement was done. I get one procedure nurse, one xray tech, one recovery area room, one procedure room. If i had two procedure rooms, two preop rooms a two bed recovery area and two xray techs and my own preop, post op and two procedure nurses i could easily go at least twice as fast, probaby three times faster. Another problem is scheduling. Patients cannot come in early for appointments. So you can be as fast as you want, you are still going to wait for the next patient, whom often is late anyway. Finally, it never happened that i had more than three cervical ESI in a row. Normally there is a lot of other stuff that takes more time. For example, i got 30 minutes for SI joint injections. Now sometimes i can get a nice arthrogram in 10 minutes especially a repeat customer but just as many take 45 minutes.
 
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SCIronMike

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I'm a SCPMG partner practicing in PM&R and pain medicine at Downey. I'm beginning my 7th year here. I worked in academic medicine prior to joining SCPMG. Positions vary greatly between different Kaiser medical centers. One of my previous colleagues from the university where we worked is at Kaiser Woodland Hills. He is an Anesthesiologist. The Anesthesiology pain physicians see patients in clinic and manage medications. They perform interventional procedures. Here at Downey, our Anesthesiology colleagues do not have clinic. They split their time between OR anesthesia and fluoro procedures. They perform inpatient consultations for acute pain service. The PM&R pain physicians do all the clinic management and also perform fluoro procedures. We consult on chronic pain inpatients. The pain chief here at Downey is a PM&R physician.

The Anesthesiology pain physicians make more than the PM&R pain physicians do. I think it has more to do with the weekends and nights worked in OR anesthesia. I'm making around $350k per year, but I only work 36 hours per week. I have 7 half days per week of clinic, 2 half days of fluoro time, and 1 half day of educational time that I'm away from the office. I'm on a weekly home call rotation that is 1:10. I average 5 calls per year. I haven't been called in in over two years.

My workload is much less than when I was in academic practice. I see between 6 to 8 patients in clinic per half day. I see 3 to 4 patients per half day for procedures. I get a decent amount of electrodiagnostic studies mixed into my clinic time. I also perform a fair amount of ultrasound guided procedures. I'm planning on introducing PRP to our clinic soon.

I take a lot of vacation, and I still have 54 days saved up which I can cash out if I choose. I think I currently accrue 28 vacation days per year plus 5 education days for conferences. A few of my partners work a flex schedule. They start 30 min earlier each day and cut their lunch from 90 min to 60 min. In turn they only come into the office 4 days per week.

No job is perfect, but I really enjoy working here. I have great colleagues. The work-life balance is good. My wife is the primary earner in our family and she travels quite a bit for work. My schedule and hours allow me to drop the kids off at school every day and pick them up 3 days a week. I'm able to take 1/4 days or 1/2 days off when my wife is out of town to attend school functions. It's just a good situation for me.
 

Dr. Ice

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I'm a SCPMG partner practicing in PM&R and pain medicine at Downey. I'm beginning my 7th year here. I worked in academic medicine prior to joining SCPMG. Positions vary greatly between different Kaiser medical centers. One of my previous colleagues from the university where we worked is at Kaiser Woodland Hills. He is an Anesthesiologist. The Anesthesiology pain physicians see patients in clinic and manage medications. They perform interventional procedures. Here at Downey, our Anesthesiology colleagues do not have clinic. They split their time between OR anesthesia and fluoro procedures. They perform inpatient consultations for acute pain service. The PM&R pain physicians do all the clinic management and also perform fluoro procedures. We consult on chronic pain inpatients. The pain chief here at Downey is a PM&R physician.

The Anesthesiology pain physicians make more than the PM&R pain physicians do. I think it has more to do with the weekends and nights worked in OR anesthesia. I'm making around $350k per year, but I only work 36 hours per week. I have 7 half days per week of clinic, 2 half days of fluoro time, and 1 half day of educational time that I'm away from the office. I'm on a weekly home call rotation that is 1:10. I average 5 calls per year. I haven't been called in in over two years.

My workload is much less than when I was in academic practice. I see between 6 to 8 patients in clinic per half day. I see 3 to 4 patients per half day for procedures. I get a decent amount of electrodiagnostic studies mixed into my clinic time. I also perform a fair amount of ultrasound guided procedures. I'm planning on introducing PRP to our clinic soon.

I take a lot of vacation, and I still have 54 days saved up which I can cash out if I choose. I think I currently accrue 28 vacation days per year plus 5 education days for conferences. A few of my partners work a flex schedule. They start 30 min earlier each day and cut their lunch from 90 min to 60 min. In turn they only come into the office 4 days per week.

No job is perfect, but I really enjoy working here. I have great colleagues. The work-life balance is good. My wife is the primary earner in our family and she travels quite a bit for work. My schedule and hours allow me to drop the kids off at school every day and pick them up 3 days a week. I'm able to take 1/4 days or 1/2 days off when my wife is out of town to attend school functions. It's just a good situation for me.
Dude..you make 350/year and your wife is the primary earner?! This sounds amaze balls...I'm officially jealous. Sign me up! Congrats..
 

Yo GabbaPentin

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Yeah. She works for a biomedical device company and earns substantially more than I do.
If that were my situation, my post would sound something like. "I work as a stay at home dad. We travel internationally once a month."

Your set up sounds great. 6-8 in clinic and 4-6 in procedures? Holy $**t, that's awesome. I'm going to rake in as much as possible over the next decade and either retire or try to take your job after that.
 
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willabeast

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I'm a SCPMG partner practicing in PM&R and pain medicine at Downey. I'm beginning my 7th year here. I worked in academic medicine prior to joining SCPMG. Positions vary greatly between different Kaiser medical centers. One of my previous colleagues from the university where we worked is at Kaiser Woodland Hills. He is an Anesthesiologist. The Anesthesiology pain physicians see patients in clinic and manage medications. They perform interventional procedures. Here at Downey, our Anesthesiology colleagues do not have clinic. They split their time between OR anesthesia and fluoro procedures. They perform inpatient consultations for acute pain service. The PM&R pain physicians do all the clinic management and also perform fluoro procedures. We consult on chronic pain inpatients. The pain chief here at Downey is a PM&R physician.

The Anesthesiology pain physicians make more than the PM&R pain physicians do. I think it has more to do with the weekends and nights worked in OR anesthesia. I'm making around $350k per year, but I only work 36 hours per week. I have 7 half days per week of clinic, 2 half days of fluoro time, and 1 half day of educational time that I'm away from the office. I'm on a weekly home call rotation that is 1:10. I average 5 calls per year. I haven't been called in in over two years.

My workload is much less than when I was in academic practice. I see between 6 to 8 patients in clinic per half day. I see 3 to 4 patients per half day for procedures. I get a decent amount of electrodiagnostic studies mixed into my clinic time. I also perform a fair amount of ultrasound guided procedures. I'm planning on introducing PRP to our clinic soon.

I take a lot of vacation, and I still have 54 days saved up which I can cash out if I choose. I think I currently accrue 28 vacation days per year plus 5 education days for conferences. A few of my partners work a flex schedule. They start 30 min earlier each day and cut their lunch from 90 min to 60 min. In turn they only come into the office 4 days per week.

No job is perfect, but I really enjoy working here. I have great colleagues. The work-life balance is good. My wife is the primary earner in our family and she travels quite a bit for work. My schedule and hours allow me to drop the kids off at school every day and pick them up 3 days a week. I'm able to take 1/4 days or 1/2 days off when my wife is out of town to attend school functions. It's just a good situation for me.
bottom line - kaiser jobs are all different. you cannot generalize between medical centers. you cannot generalize between Kaiser systems - Socal works 35 hours a week, Nocal works 40 hours for full time. Socal is different than Nocal, and within Nocal different medical centers do things differently. It would be equally wrong to say all Kaiser jobs are similar as to say all private practice jobs are similar.
 

clubdeac

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Yeah. She works for a biomedical device company and earns substantially more than I do.
Wow! Working for a biomed dvice company pays that well?! Which company? I'm assuming she's more than a device rep
 

NJPAIN

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I'm a SCPMG partner practicing in PM&R and pain medicine at Downey. I'm beginning my 7th year here. I worked in academic medicine prior to joining SCPMG. Positions vary greatly between different Kaiser medical centers. One of my previous colleagues from the university where we worked is at Kaiser Woodland Hills. He is an Anesthesiologist. The Anesthesiology pain physicians see patients in clinic and manage medications. They perform interventional procedures. Here at Downey, our Anesthesiology colleagues do not have clinic. They split their time between OR anesthesia and fluoro procedures. They perform inpatient consultations for acute pain service. The PM&R pain physicians do all the clinic management and also perform fluoro procedures. We consult on chronic pain inpatients. The pain chief here at Downey is a PM&R physician.

The Anesthesiology pain physicians make more than the PM&R pain physicians do. I think it has more to do with the weekends and nights worked in OR anesthesia. I'm making around $350k per year, but I only work 36 hours per week. I have 7 half days per week of clinic, 2 half days of fluoro time, and 1 half day of educational time that I'm away from the office. I'm on a weekly home call rotation that is 1:10. I average 5 calls per year. I haven't been called in in over two years.

My workload is much less than when I was in academic practice. I see between 6 to 8 patients in clinic per half day. I see 3 to 4 patients per half day for procedures. I get a decent amount of electrodiagnostic studies mixed into my clinic time. I also perform a fair amount of ultrasound guided procedures. I'm planning on introducing PRP to our clinic soon.

I take a lot of vacation, and I still have 54 days saved up which I can cash out if I choose. I think I currently accrue 28 vacation days per year plus 5 education days for conferences. A few of my partners work a flex schedule. They start 30 min earlier each day and cut their lunch from 90 min to 60 min. In turn they only come into the office 4 days per week.

No job is perfect, but I really enjoy working here. I have great colleagues. The work-life balance is good. My wife is the primary earner in our family and she travels quite a bit for work. My schedule and hours allow me to drop the kids off at school every day and pick them up 3 days a week. I'm able to take 1/4 days or 1/2 days off when my wife is out of town to attend school functions. It's just a good situation for me.
Can't believe that organization varies so much from site to site and that your chiefs have that much autonomy. Sounds like a great job.
 

hyperalgesia

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I was wondering about the pension plan since I've heard conflicting info... My understanding is that you have to have 5 years FT with Kaiser to be "vested" but that you need 10 years with Kaiser to "collect". Does this mean you can do 5 years FT and 5 PT to get a pension? My biggest issue with Kaiser is the 10 year commitment because I don't plan to do FT pain for 10 more years.

Can anyone clarify this? I also heard the retirement packages have changed over the years...
 

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These Kaiser jobs sound incredibly easy with great benefits. I think I work at least 25 hours a week just at home and on the weekends on business stuff for my clinic, not to mention clinic hours.
 
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These Kaiser jobs sound incredibly easy with great benefits. I think I work at least 25 hours a week just at home and on the weekends on business stuff for my clinic, not to mention clinic hours.
I wonder how it is possible that one doctor can "cover his nut" doing 60 min CESI's in a large HMO and another has to work 25 hours per week just to keep the lights on in a small business? What sort of health policies permit this kind of inequity of effort?
 

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I was wondering about the pension plan since I've heard conflicting info... My understanding is that you have to have 5 years FT with Kaiser to be "vested" but that you need 10 years with Kaiser to "collect". Does this mean you can do 5 years FT and 5 PT to get a pension? My biggest issue with Kaiser is the 10 year commitment because I don't plan to do FT pain for 10 more years.

Can anyone clarify this? I also heard the retirement packages have changed over the years...
10 years of service to vest the pension. Our partnership rules changed last year (This is Southern California specific. In Nor Cal, physicians are not partners), and we voted to allow physicians working only 5/10 to still become partners. So a physician can work 2.5 days per week and still become a full partner. However it'll take 6 years then to log the 3 years of service to be voted into partnership. It'll take 20 years to generate the 10 years of service to vest the pension. Two of my colleagues work 9/10 schedules. That is 4 days per week. If a person works less than 7/10, then the half day weekly of educational time goes away.
 
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SCIronMike

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I wonder how it is possible that one doctor can "cover his nut" doing 60 min CESI's in a large HMO and another has to work 25 hours per week just to keep the lights on in a small business? What sort of health policies permit this kind of inequity of effort?
I get 90 minutes for any new patient during my fluoro time. 60 minutes for any returning patient. That time includes the time I spend talking to the patient and getting a H&P, getting the consent, performing the procedure, and post-procedure time. We normally run 2 rooms between 3 physicians so one of my colleague is injecting and the room is getting turned over while I'm talking to my patient. If a colleague of mine is doing a longer procedure like a RFA, then I'll talk to a couple patients and get them consented. When the room opens up, I'll do the two procedures back to back. Between 3 physicians, each procedure suite will turn 2-3 cases per hour.
 
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Ligament

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I get 90 minutes for any new patient during my fluoro time. 60 minutes for any returning patient. That time includes the time I spend talking to the patient and getting a H&P, getting the consent, performing the procedure, and post-procedure time. We normally run 2 rooms between 3 physicians so one of my colleague is injecting and the room is getting turned over while I'm talking to my patient. If a colleague of mine is doing a longer procedure like a RFA, then I'll talk to a couple patients and get them consented. When the room opens up, I'll do the two procedures back to back. Between 3 physicians, each procedure suite will turn 2-3 cases per hour.
That sounds fantastic. I do 15 minute blocks in the ASC for basic procedures. 30-45 mins for RFA. 45 mins for SCS trials.
 

SCIronMike

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That sounds fantastic. I do 15 minute blocks in the ASC for basic procedures. 30-45 mins for RFA. 45 mins for SCS trials.
I voluntarily stopped doing SCS trials and implants about 4 years ago. I only get two half days of fluoro time per week, and I feel that I can make more of a impact giving epidurals to three patients with acute radiculopathy versus one SCS trial. One of my Anesthesiology colleagues really enjoys doing the stims and he does a good job, so I send my patients over to him. I also started doing hip injections and glenohumeral joint injections in my regular clinic with ultrasound instead of fluoro to open more fluoro time for the spine procedures.
 
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Dr. Ice

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85-95 patients per week. Travel to 4 different offices. Mixed of asc and in office procedures. No emoloyment agreement after 3 years. Eat what you kill with large overhead expense. Upside is obviously asc buy in/distribution..eventually. Although after hearing about this..I would love to convince my wife to move to cali.."I'm going going back back to.."
 

clubdeac

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I voluntarily stopped doing SCS trials and implants about 4 years ago. I only get two half days of fluoro time per week, and I feel that I can make more of a impact giving epidurals to three patients with acute radiculopathy versus one SCS trial. One of my Anesthesiology colleagues really enjoys doing the stims and he does a good job, so I send my patients over to him. I also started doing hip injections and glenohumeral joint injections in my regular clinic with ultrasound instead of fluoro to open more fluoro time for the spine procedures.
This is slower than the VA! That's amazing
 

lonelobo

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What slowed me down doing procedures was the way the staffing and physical arrangement was done. I get one procedure nurse, one xray tech, one recovery area room, one procedure room. If i had two procedure rooms, two preop rooms a two bed recovery area and two xray techs and my own preop, post op and two procedure nurses i could easily go at least twice as fast, probaby three times faster. Another problem is scheduling. Patients cannot come in early for appointments. So you can be as fast as you want, you are still going to wait for the next patient, whom often is late anyway. Finally, it never happened that i had more than three cervical ESI in a row. Normally there is a lot of other stuff that takes more time. For example, i got 30 minutes for SI joint injections. Now sometimes i can get a nice arthrogram in 10 minutes especially a repeat customer but just as many take 45 minutes.
If you had nott gotten in the joint in 15 min, what were you doing for the next 30 min?
 

willabeast

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If you had nott gotten in the joint in 15 min, what were you doing for the next 30 min?
trying to get in the joint. i must not understand your question.
 

willabeast

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I wonder how it is possible that one doctor can "cover his nut" doing 60 min CESI's in a large HMO and another has to work 25 hours per week just to keep the lights on in a small business? What sort of health policies permit this kind of inequity of effort?
i think the relevant quote here is "it is not how hard you work, it is how smart you work". another one is "**** rolls downhill".
 

willabeast

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If you have not gained access to the SIJ after trying for 15 min, what are you doing different over the next 30 min?
there are three different areas of the si joint, and six different c arm angles that i can try for each area , so that would be 18 possible strategies.
85% of the time if i get in using inferior approach (by get in i mean a nice arthrogram that is not debatable) and my favorite is inferior joint 5 degrees caudal tilt and 5 degrees lateral or medial tilt depending on what the CT showed. (i do not order pre procedure CT's but it is amazing how often these patients have had CT's in the past - easy to find if you have a really good EMR which we do have at Kaiser).
 

SSdoc33

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if i had to talk to a patient for 90 minutes, i might shoot myself.

i am way happier and content performing 5 procedures / hour. yes, i make more money doing it this way, but the worst thing for me if to be bored at work. i couldnt handle 2-3 procedures in a half day.

i find it intriguing that seeing only a few patient per day is some sort of medical utopia
 

clubdeac

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Yeah there's gotta be a happy medium. If I'm too busy I get stressed and irritable. If I have too many no shows I get really tired and bored...like today! Post lunch food coma
 

SCIronMike

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if i had to talk to a patient for 90 minutes, i might shoot myself.

i am way happier and content performing 5 procedures / hour. yes, i make more money doing it this way, but the worst thing for me if to be bored at work. i couldnt handle 2-3 procedures in a half day.

i find it intriguing that seeing only a few patient per day is some sort of medical utopia
I just finish early and leave early.
 

SSdoc33

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I just finish early and leave early.
so do i.

im glad it works for you.

i know that i would not be able to handle having to wait for a procedure room to "open up".

isnt it frustrating to see 8 patient a day when you know that you finish that amount of work in half a day (or less)?

also, im not sure how an hour/injection, nor 90 minute lunches are sustainable.
 
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