Moonlighting in suboxone clinic as a fellow

[Madden007]

I plan to fast track into a CAP fellowship. During fellowship, I was hoping to start a lean, cash based, private practice, seeing mostly/only suboxone patients (moonlighting). The clinic will operate on Saturdays and 1-2 weekdays after work, and my hours would be in 100% compliance with ACGME rules and regulations. Plan would be to rent and office and work out of that office. My wife would work as my secretary, scheduling appointments and etc...Bad idea? Doable? Anyone see any potential issue with doing this? Thank you.

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[Guyton]

It is doable, but a tall order. Suboxone patients tend to be rather needy and there are some SAMHSA guidelines you should be aware of.

Physicians undertaking suboxone treatment should have contingency plans for patients who may not be appropriate for suboxone treatment and arrangements to provide comprehensive care outside of MAT to include evaluation and treatment of common comorbid conditions- hepatitis B/C, HIV, and tuberculosis. Additionally, physicians should establish agreements for other physicians with DATA 2000 waivers to be available to provide care in the treating physician’s absence.

Having your wife staff the clinic may be an issue as well. Staff members are supposed to be trained and educated about opioid addiction, treatments, behavioral characteristics of addiction, and the medical approach to addiction. While I suppose you could do this with her, a DEA audit might find such an arrangement a little fishy.

Also, MAT should be combined with an ongoing substance abuse program (e.g., therapy groups, support groups, residential therapeutic communities, sober‐living options) that needs to be arranged and monitored for compliance.

 

[keifernny2]

I knew someone that did this in residency and he had a hard time making any money at it once overhead was accounted for. It takes time to build up a practice and your fellowship will be over as your practice fills. If the goal is cash, Try moonlighting evenings at a cmhc instead. Much easier to start up and you should have a team answering calls while you're at your day job.

Plus, do you plan to keep this place open when you graduate? What will you do with all of your patients?


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[hamstergang]

This idea of moonlighting in a private practice has been discussed before:
http://forums.studentdoctor.net/threads/private-practice-in-residency.1052051/
http://forums.studentdoctor.net/threads/private-patients-during-fellowship.1004210/

Things to consider include:
-money. You need malpractice insurance, rent, pay wife, EMR(?). You won't have time for many patients yet they need to cover these costs. And where are you getting patients from? It takes a while to fill.

-will your program allow it?

-coverage for your patients when you're at your fellowship work?

 

[Doctor Bagel]

This is a pretty high risk way to make money. Why not accept hourly work at an already existing suboxone practice that has all those supports outlined above. Suboxone prescribing is only easy if you're not doing it well.

 

[dl2dp2]

I don't think this is a good idea either. I have Suboxone in my private practice and while it's quite profitable it's totally *not* like what you are thinking of (i.e. not exactly a high turnover mill). You need to market to the high functioning pill users, but unless you live in a major metro and know what you are doing (i.e. have existing relationships with fancy substance programs, etc.) it's not easy to fill with this type of patients. Most of the Suboxone patients you can easily recruit are Medicaid heroin users who are more CMHC (i.e. "Suboxone mill") candidates than patients for a cash private practice, and if you run a lot of those in your practice it won't be "lean"--you'll need to hire additional staff.

IMHO, since you are C&A bound, I would just start a garden variety outpatient cash adolescent (i.e. 18-25) practice, perhaps focus on things you have some interest in like ADHD/school issues, or even adolescent addiction etc. That's just as high in demand as Suboxone.

Please note though you are not board eligible if you fast track until the second year. Getting malpractice may become a problem.

 

[notdeadyet]

I don't think this is a good idea either. I have Suboxone in my private practice and while it's quite profitable it's totally *not* like what you are thinking of (i.e. not exactly a high turnover mill). You need to market to the high functioning pill users, but unless you live in a major metro and know what you are doing (i.e. have existing relationships with fancy substance programs, etc.) it's not easy to fill with this type of patients.

This.

OP- There are MANY people trying to get rich by running suboxone mills (suboxone is a great med, but if your practice is exclusively supplying suboxone without any other services, you're running a mill). If you're trying to do exclusively cash-only, you need to target a very specific subset of customers that every mill runner is going after. Setting up a part-time practice as a child fellow, you are not going to be the number to call.

 

[daru1]

Please note though you are not board eligible if you fast track until the second year. Getting malpractice may become a problem.

Call and check on this. I was able to get malpractice insurance after 3rd year very easily. This may vary from state to state.

 

[TexasPhysician]

Call and check on this. I was able to get malpractice insurance after 3rd year very easily. This may vary from state to state.

True I got it as an early PGY-2

 

[Madden007]

Thank you all for the responses. They are helpful and insightful.