Omicron & 2022 Business Plans for Pain?

[drusso]

What are your goals and objectives next year for pain? More posterior fusions, more PNS implants, more BVN ablations? Opening a new office, hiring more staff/providers? Inking deals with ASC's or PE firms? Establish a new neuromonitoring company, anesthesia company, tox lab? Doubling down on DME? More KOL work?

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[Agast]

Dropped my schedule to 4.5 days and hope to go to 4 days now that I have a partner

Incorporate appropriate use of regenerative medicine

 

[dc2md]

No changes. Going great

 

[lobelsteve]

What are your goals and objectives next year for pain? More posterior fusions, more PNS implants, more BVN ablations? Opening a new office, hiring more staff/providers? Inking deals with ASC's or PE firms? Establish a new neuromonitoring company, anesthesia company, tox lab? Doubling down on DME? More KOL work?

None of the above. 99214. 64483. MBB/Rf. 63650. 63685. 20796. 20610.

That’s 95% or more of my upcoming year. Keep it simple. Treat what you can. Order more PT.

 

[NJPAIN]

None of the above. 99214. 64483. MBB/Rf. 63650. 63685. 20796. 20610.

That’s 95% or more of my upcoming year. Keep it simple. Treat what you can. Order more PT.

I love “ treat what you can” and “treat what you can diagnose”. All too often we are expected to treat the mysterious symptom of pain in the absence of identifiable pathology or to have a successful treatment for each and every patient.

 

[hyperalgesia]

I'm hoping to slowly decrease my hours in medicine and diversify my income stream, possibly to include commercial real estate and/or software development.

Also, hopefully another year of avoiding traps and pitfalls

 

[Dr. Ice]

More regen, more stim (even though I just don’t like it), especially after depo gets “outlawed” or whatever..maybe do some subacute consults and ask people how many stairs they have in their homes..and the beat goes on and on

 

[cowboydoc]

Agree with lots of bread and butter, becoming more efficient and doing the same amount of work in 4 days instead of 4.5. Building passive income streams, exercising more and enjoying the kids and some happy hours I’ve missed since the beginning of the pandemic.

 

[DrMDAware]

More regen, more stim (even though I just don’t like it), especially after depo gets “outlawed” or whatever..maybe do some subacute consults and ask people how many stairs they have in their homes..and the beat goes on and on

Honestly curious - what don’t you like about stim? Looking to learn.

 

[Dr. Ice]

Honestly curious - what don’t you like about stim? Looking to learn.

Psych consult, denials for thoracic mri, not to mention in 12 years of clinical practice, I’ve seen countless patients with implants who want them out, are non functional, they can’t get in touch with their reps, they told me it never should have been implanted to begin with, etc etc

 

[DODOCSS]

Psych consult, denials for thoracic mri, not to mention in 12 years of clinical practice, I’ve seen countless patients with implants who want them out, are non functional, they can’t get in touch with their reps, they told me it never should have been implanted to begin with, etc etc

Placebo works for approximately 12 months

 

[nopain1234]

I'm hoping to slowly decrease my hours in medicine and diversify my income stream, possibly to include commercial real estate and/or software development.

Also, hopefully another year of avoiding traps and pitfalls

Real estate is so over heated it’s not even funny

 

[TIVAndy]

isn't it omicron? not omnicron.. (omnicron sounds much more potent.. )

 

[thecentral09]

Dropped my schedule to 4.5 days and hope to go to 4 days now that I have a partner

Incorporate appropriate use of regenerative medicine

Same thoughts here, minus having a partner. Is there anywhere in particular to look regarding insurance/Medicare coverage for regenerative medicine. I have a poiadtry colleague stating he does very well with amnio on Medicare.

 

[Agast]

Same thoughts here, minus having a partner. Is there anywhere in particular to look regarding insurance/Medicare coverage for regenerative medicine. I have a poiadtry colleague stating he does very well with amnio on Medicare.

Be really careful about amniotic membranes and Medicare. That whole misuse of hcpcs code business is skirting fraud and I’m waiting for CMS to start nailing people to the wall for that one. Just ask yourself, does it make sense for the government to shell out $2000 bucks for you to inject amniotic gunk into someone’s hip? Say that out loud and then don’t do it.

 

[Status Sciaticus]

isn't it omicron? not omnicron.. (omnicron sounds much more potent.. )

Omnicron sounds like a new Marvel Villain. Avengers: Age of Omnicron.

 

[thecentral09]

Be really careful about amniotic membranes and Medicare. That whole misuse of hcpcs code business is skirting fraud and I’m waiting for CMS to start nailing people to the wall for that one. Just ask yourself, does it make sense for the government to shell out $2000 bucks for you to inject amniotic gunk into someone’s hip? Say that out loud and then don’t do it.

Correct. So again my question is what resource do you use to learn what is covered, and if not how are they getting paid for?

 

[DrMDAware]

Psych consult, denials for thoracic mri, not to mention in 12 years of clinical practice, I’ve seen countless patients with implants who want them out, are non functional, they can’t get in touch with their reps, they told me it never should have been implanted to begin with, etc etc

Thanks for the quality reply.

For someone who has less experience what do you recommend I do in order to feel out if a rep will be responsive to the patient?

Do u recommend taking out other peoples’ implants of the patient isn’t pleased? Just curious.

 

[Baron Samedi]

When taking out other peoples' implants I tell the patient that I won't have any additional treatments to offer and no additional procedures are likely to improve their pain or function. If they still want it out after hearing that then it's probably reasonable to do so.

 

[soccrwz]

I tell patients just like your car needs a tune up these devices, programming and options are continually improving. I have the rep reprogram, get XR make sure the leads are in place, contacts are functioning and have the reps try several programming options. Many times this helps the patient. Now remember these low threshold "parathesia" free programs take time to onload. If after meticulious programming they still want it out this options is more valid to pursue. Alot of theses aren't reprogrammed, or explained to the patient how to properly use, or they lost their charger or controller.

 

[10KHertz]

Probably should network more this year. Been lazy and comfortable for last ten years… all the PCPs are either retired , moved to Florida/Texas , or coexisting in an indifferent hospital system.

 

[drusso]

Probably should network more this year. Been lazy and comfortable for last ten years… all the PCPs are either retired , moved to Florida/Texas , or coexisting in an indifferent hospital system.

Have a group over for dinner at the house.

 

[NJPAIN]

Same thoughts here, minus having a partner. Is there anywhere in particular to look regarding insurance/Medicare coverage for regenerative medicine. I have a poiadtry colleague stating he does very well with amnio on Medicare.

Podiatry…1 notch above chiropractic in terms of scamming.

 

[10KHertz]

Have a group over for dinner at the house.

Can’t , then they will never refer to me … ha ha ha 😆

 

[10KHertz]

Podiatry…1 notch above chiropractic in terms of scamming.

I should post some ‘chiro radiologist ‘ reads or chiro EMG/NCV studies. Really scary stuff.

 

[Pain Applicant1]

My plan is to finally gather the courage to retire so I can spend my time working out, running, reading, hiking, fishing, hunting, fighting, building, farming, and making music but I know I'll be doing the exact same thing I'm doing now in my office with visits to SDN and Reddit talking about how I'd rather be spending my time working out, running, reading, hiking, fishing, hunting, fighting, building, farming, and making music.

 

[Pain Applicant1]

Thanks for the quality reply.

For someone who has less experience what do you recommend I do in order to feel out if a rep will be responsive to the patient?

Do u recommend taking out other peoples’ implants of the patient isn’t pleased? Just curious.

No good salesperson would let you think otherwise. Have no fear, you will find out as the pts will give you feedback and they will complain if they're ignored or neglected. At that point, tell them you'll start using another company. Your stim rep should be your best employee.

 

[Agast]

 

[Doctodd]

Have a group over for dinner at the house.

are you asking for their papers? (vacc papers)

 

[Doctodd]

My plan is to finally gather the courage to retire so I can spend my time working out, running, reading, hiking, fishing, hunting, fighting, building, farming, and making music but I know I'll be doing the exact same thing I'm doing now in my office with visits to SDN and Reddit talking about how I'd rather be spending my time working out, running, reading, hiking, fishing, hunting, fighting, building, farming, and making music.

so what is the new number that you can live off per year if you have no debt(minus property taxes). I said $100k per year is an easy number to calculate from, but inflation is quickly changing that(multiply by 3 if you have a spouse that spends your money). If you have $1mill in savings, that is at least 10 years of living off $100k. I dont expect to be spending anywhere near that in my 80's-90's.

How much do you need in the bank/retirement account/mattress to retire? Will i even get my social security pennies at 65?

 

[SSdoc33]

so what is the new number that you can live off per year if you have no debt(minus property taxes). I said $100k per year is an easy number to calculate from, but inflation is quickly changing that(multiply by 3 if you have a spouse that spends your money). If you have $1mill in savings, that is at least 10 years of living off $100k. I dont expect to be spending anywhere near that in my 80's-90's.

How much do you need in the bank/retirement account/mattress to retire? Will i even get my social security pennies at 65?

Ill respond to your financial posts, b/c they are always good.

i just did some calculations. the family of 5 spends close to 230K/year. i think i have to be around 8M net worth to finally close up shop. maybe 10.

FWIW, i spend WAY less than some others in my family (not including my kids, if you catch my drift). why do we need 15 types of facial creams again?

 

[Dr. Ice]

I don’t think if I work for the next 20 years, that I would be able to accumulate even half that in net worth. 8-10 mill?! Jeez

 

[Pain Applicant1]

so what is the new number that you can live off per year if you have no debt(minus property taxes). I said $100k per year is an easy number to calculate from, but inflation is quickly changing that(multiply by 3 if you have a spouse that spends your money). If you have $1mill in savings, that is at least 10 years of living off $100k. I dont expect to be spending anywhere near that in my 80's-90's.

How much do you need in the bank/retirement account/mattress to retire? Will i even get my social security pennies at 65?

I'm really not sure but I think I have way more than I'll ever need and my real estate company should generate more than enough for us each year.

It's more of a psychological hurdle thing for me. I don't want to have regrets in closing up my practice and feel like I'm unappreciative of what I have. My biggest concern is that I created a naive and idealistic lifestyle in my mind that won't hold up in reality. As in: I live the way I think I want to live and after a few weeks I discover I'm bored and I made a terrible decision. I don't think this is the case but you never know. Any psych people out there care to give me some insight, lol.

With that said, I decided to take my stock market earnings and pay off all of my remaining liens on my properties. For various reasons, that's a big step in the direction of retirement for me.

 

[Baron Samedi]

I don’t think if I work for the next 20 years, that I would be able to accumulate even half that in net worth. 8-10 mill?! Jeez

Obviously everyone's personal situations differ in terms of obligations and debt, but most physicians should be able to obtain that net worth by retirement age assuming a >50% savings rate(doable, for most).

My wife and I have a combined income of $300k/yr and project to have between 10-12m net by retirement age using relatively conservative returns rates. We live a bit more modestly than a lot of our peers but by not by a lot.

 

[SSdoc33]

Obviously everyone's personal situations differ in terms of obligations and debt, but most physicians should be able to obtain that net worth by retirement age assuming a >50% savings rate(doable, for most).

My wife and I have a combined income of $300k/yr and project to have between 10-12m net by retirement age using relatively conservative returns rates. We live a bit more modestly than a lot of our peers but by not by a lot.

what is "retirement age"? i dont want to be doing 50 shots a week as a 65 year old

 

[drusso]

Ill respond to your financial posts, b/c they are always good.

i just did some calculations. the family of 5 spends close to 230K/year. i think i have to be around 8M net worth to finally close up shop. maybe 10.

FWIW, i spend WAY less than some others in my family (not including my kids, if you catch my drift). why do we need 15 types of facial creams again?

With inflation, eroding purchasing power, ballooning entitlement programs, etc $8M is the bare minimum one would need to retire and live comfortably. "Thank you, Obama."

 

[Dr. Ice]

With inflation, eroding purchasing power, ballooning entitlement programs, etc $8M is the bare minimum one would need to retire and live comfortably. "Thank you, Obama."

Wow..guess 75 is the new 65

 

[Dr. Ice]

Couldn’t even imagine if I had 250k in student loans to pay off..daunting

 

[10KHertz]

Man , you guys really made others rich with your hard-work… we need site of service reversal and more private practices(small businesses). Otherwise your just working for the machine. 53% of the insurrectionists were doctors , lawyers and small businesses owners. Food for thought .

 

[Baron Samedi]

what is "retirement age"? i dont want to be doing 50 shots a week as a 65 year old

The math is pretty easy. Retirement age is whatever you want it to be.

 

[ateria radicularis magna]

With inflation, eroding purchasing power, ballooning entitlement programs, etc $8M is the bare minimum one would need to retire and live comfortably. "Thank you, Obama."

8 million will buy you a pauper’s retirement in a rural town. You’ll be a greeter at Walmart.

 

[NJPAIN]

The math is pretty easy. Retirement age is whatever you want it to be.

You calculation is very nice. I’ve never been an exceptional earner or investor. We live very modestly. On top of that, life happens and much of it is unexpected such as an ill parent on fixed income needing 24 hour care while dying, a sibling needing your financial help more than once, an adoption, etc. I’ve been working 30 years already. I have never ever put away $150,000 in a year and I have no where even close to 10 million put away. I could hit 10 million if I work another 60 years. If you are smart enough to diversify into real estate or other enterprises or if your spouse is a physician perhaps the story is different.

 

[DOctorJay]

I was fortunate to stumble upon white coat investor and physician on fire right about the time that I graduated from fellowship. We rented a place for the first 2 years when I started my first attending job then built a reasonable house in a nice neighborhood once we knew we'd be sticking around.

I've been saving 20% of my gross pay all along investing in a diversified index fund portfolio (very similar to physician on fire's) across 403b, 457, and backdoor Roth IRAs. Paid off my student loans after about 6 years as an attending. 529s in place for the kids. With this plan I should be able to FIRE at 55.

 

[Yo GabbaPentin]

I was fortunate to stumble upon white coat investor and physician on fire right about the time that I graduated from fellowship. We rented a place for the first 2 years when I started my first attending job then built a reasonable house in a nice neighborhood once we knew we'd be sticking around.

I've been saving 20% of my gross pay all along investing in a diversified index fund portfolio (very similar to physician on fire's) across 403b, 457, and backdoor Roth IRAs. Paid off my student loans after about 6 years as an attending. 529s in place for the kids. With this plan I should be able to FIRE at 55.

Similar story here…. However, how can you assume when you will be able to retire given the numerous ways our government (Ds and Rs) are messing up healthcare? And more importantly messing up the country. How do you account for constantly decreasing reimbursement in the face of massive inflation? At what point do we quit to work at Dunkin’ Donuts for $50 per hour?

 

[DOctorJay]

Similar story here…. However, how can you assume when you will be able to retire given the numerous ways our government (Ds and Rs) are messing up healthcare? And more importantly messing up the country. How do you account for constantly decreasing reimbursement in the face of massive inflation? At what point do we quit to work at Dunkin’ Donuts for $50 per hour?

healthcare expenses in the future and out of control inflation are my biggest concerns regarding realistically achieving FIRE.

 

[Yo GabbaPentin]

healthcare expenses in the future and out of control inflation are my biggest concerns regarding realistically achieving FIRE.

My concern is that our income is not inflation adjusted. Every year we take cuts while inflation works it’s magic. So while Dunkin’ can raise the price of donuts and subsequently pay me more to work there, healthcare will continue to pay me less each year.

 

[DOctorJay]

My concern is that our income is not inflation adjusted. Every year we take cuts while inflation works it’s magic. So while Dunkin’ can raise the price of donuts and subsequently pay me more to work there, healthcare will continue to pay me less each year.

great point. my calculations are off of my base salary which I currently don't anticipate decreasing but honestly who knows.

 

[drusso]

My concern is that our income is not inflation adjusted. Every year we take cuts while inflation works it’s magic. So while Dunkin’ can raise the price of donuts and subsequently pay me more to work there, healthcare will continue to pay me less each year.

We can use our collectie power to raise prices.

 

[buddababa]

We can use our collectie power to raise prices.

That's the problem. Most doctors dont care about one another, its get my money and get out mentality.

 

[Baron Samedi]

We can use our collectie power to raise prices.

I'm curious what the attitude towards a physician union would be on this forum.