Number of Pain Docs

[klumpke]

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What do you guys think is on the horizon as far as the dwindling numbers going into pain and rise in the aging population? Any guesses on if there will be a similar shift in provider:need ratio like we saw in GA? Is anyone out there optimistic about the potential future of our salaries lol

 

[drusso]

What do you guys think is on the horizon as far as the dwindling numbers going into pain and rise in the aging population? Any guesses on if there will be a similar shift in provider:need ratio like we saw in GA? Is anyone out there optimistic about the potential future of our salaries lol

It's going to be on like Donkey Kong! Aging population/greying of America, dearth of qualified fellowship candidates, restricted access to GME funding for fellowships, etc.

Pain is a growth industry!

 

[nvrsumr]

Pain not like other specialties. No need to do a pain fellowship to do pain procedures

 

[drusso]

Pain not like other specialties. No need to do a pain fellowship to do pain procedures

Increasingly, more payers are requiring it, but historically that was true.

 

[Agast]

Peptides are going to fix everything so no one will be in pain

 

[mdo1738]

Too many variables for anybody to predict with any degree of certainty.

1. Will the dwindling numbers of fellowship applicants continue for an extended period of time or is this just a blip? The general anesthesia market, by any logical projection, should remain highly lucrative for quite a while. But logical projections and what actually ends up happening are not always the same in medicine.

2. Constantly changing payment situation is an absolute wildcard. I’ve only been doing this a little over 2 years, and already in that time we have had the introduction of G2211, the start of WISeR, -2.5% efficiency adjustment on many CPTs, the rebirth and re-death of MILD, and more. The introduction of the Ambulatory Special Model looms on the horizon.

3. Will the epidemic of cluneal neuralgia continue?

All told, I think our field will be like any other field in medicine: it will absolutely get worse as time continues long term. But it will probably still be a much better field than most other specialties.

 

[Status Sciaticus]

It's going to be on like Donkey Kong! Aging population/greying of America, dearth of qualified fellowship candidates, restricted access to GME funding for fellowships, etc.

Pain is a growth industry!

Just like you could do cardiac without a fellowship or get TEE certified without a fellowship as long as you passed. Still true in some states, but now, everything is paywalled behind a fellowship and certifications (ACE/PTEeXAM and cardiac fellowship)

 

[BoardingDoc]

the rebirth and re-death of MILD,

I only did a handful of MILD during fellowship and none since being out on my own. What happened there? I know that it didn't have a proper CPT code but could still get paid and that it was supposed to get something to make it easier to bill starting this year.... what actually happened with it?

 

[mdo1738]

I only did a handful of MILD during fellowship and none since being out on my own. What happened there? I know that it didn't have a proper CPT code but could still get paid and that it was supposed to get something to make it easier to bill starting this year.... what actually happened with it?

1. Massive restrictions on who qualifies for the procedure. Used to be that if you had neurogenic claudication and LFH, patient met criteria. Now, if your patient (like most 80 year olds) has severe foraminal stenosis at the proposed treatment level, even if they have clear-cut NC w LFH, patient is not able to have the procedure. Prior authorization is now required, or if you skip the PA then it is subject automatically to pre-payment review. So it’s better to just deal with the delay caused by PA.

2. Significant reimbursement decline. Professional fee and RVU value both got a major whack. Facility fee went up though, which only benefits someone with ASC ownership doing in ASC.

3. Changes in procedural requirements. On some patients, it was easy to get good decompression left, right and midline with unilateral access. Now, bilateral access is required. I did always bilateral on those who needed it, but about 1/3 of the time it was completely unnecessary.

So they made it to where many patients who would benefit are excluded due to reasons that don’t make clinical sense. For the much fewer patients you can do it on, it now pays 33% less and sometimes doubles the procedural time.

 

[pmrmd]

You have to show you went bilateral but no mention of duration.

 

[clubdeac]

In my opinion this was a very operator dependent procedure. In addition to appropriate patient selection, I think you have to be very experienced and skilled to see any meaningful relief from this procedure