Pain fellowship still worth it?

[Drhappyface]

I heard from a older pain doc that pain is not what it used to be. The government has cut down on lots of reimbursement for procedures and deemed some of them as experimental. He himself thinks that it's better off just working in the OR because the salary is higher and more in demand as pain is saturated in a lot of urban areas. Is this the general shift these days?

Are there new therapies/treatments/procedures that you can see as game-changing in the foreseeable future?

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[deleted472101]

If you have the question of whether or not to go in based on compensation, then I would probably consider a different field.

pain isn’t enjoyable for those who don’t like it.

 

[Gnarvin]

I would not disagree with that. I could guaranteed make more money in private practice anesthesia. However, I did not find anesthesiology rewarding and I never want to have to rot away in house for any more call.

Pain is saturated everywhere that is desirable. I have to hustle every day and work my butt off. I don’t get morning, lunch, or afternoon breaks. I work straight through all day every day. However, I haven’t even had second thoughts about going back to OR anesthesia. If you are in it for the money, OR anesthesia (specifically cardiac anesthesia) is where it’s at.

 

[drusso]

I would not disagree with that. I could guaranteed make more money in private practice anesthesia. However, I did not find anesthesiology rewarding and I never want to have to rot away in house for any more call.

Pain is saturated everywhere that is desirable. I have to hustle every day and work my butt off. I don’t get morning, lunch, or afternoon breaks. I work straight through all day every day. However, I haven’t even had second thoughts about going back to OR anesthesia. If you are in it for the money, OR anesthesia (specifically cardiac anesthesia) is where it’s at.

Independent, private practice pain is a 5-9 gig.

 

[afob100]

Derm lifestyle with pain - 8-4, no nights/weekends/holidays - hour per hour, pay is better than anesthesia (average anesthesiologist with call works 50-60 hours). pain is more like 40-45 hrs (depending on set up).

check out hospital employed pain jobs - less headache...show up to a filled clinic/injection schedule without marketing hassles/hiring-firing folks etc. - and earn >50% MGMA without working too hard. Milk the $o$

 

[Nodolor]

Independent, private practice pain is a 5-9 gig.

4 hrs a day...that PRP is paying well

 

[mid|ine]

I heard from a older pain doc that pain is not what it used to be. The government has cut down on lots of reimbursement for procedures and deemed some of them as experimental. He himself thinks that it's better off just working in the OR because the salary is higher and more in demand as pain is saturated in a lot of urban areas. Is this the general shift these days?

Are there new therapies/treatments/procedures that you can see as game-changing in the foreseeable future?

Agree to everything in part 1.

Also, I don't see any new game-changing therapies on the horizon.

 

[Drhappyface]

If you have the question of whether or not to go in based on compensation, then I would probably consider a different field.

pain isn’t enjoyable for those who don’t like it.

Don't get me wrong. I do love pain and it was my favorite rotation in school however I don't want to put a year into a fellowship and then face the chances or both decreased pay and a poor hiring market.

 

[Drhappyface]

Derm lifestyle with pain - 8-4, no nights/weekends/holidays - hour per hour, pay is better than anesthesia (average anesthesiologist with call works 50-60 hours). pain is more like 40-45 hrs (depending on set up).

check out hospital employed pain jobs - less headache...show up to a filled clinic/injection schedule without marketing hassles/hiring-firing folks etc. - and earn >50% MGMA without working too hard. Milk the $o$

Are these kinds of jobs available, let's say near a city but not within it? (Eg 30 mins out of Philly, Chicago, SF etc...)

 

[DOctorJay]

Are these kinds of jobs available, let's say near a city but not within it? (Eg 30 mins out of Philly, Chicago, SF etc...)

Yup

 

[nvrsumr]

From what I read on this board the hospital employed pain docs seem to have a great set up with great hours and pay. I think it is possible to double mgma 50% owning your own practice but it is going to be 25% more work.

if working 5-9 u may be triple mgma which is almost baller $ @drusso

 

[fathead88]

Yup

Yes these are absolutely available. Since starting pain I have not been in a hospital or clinic after 530, and have never had to come into a hospital on a weekend or night. If you value sleeping in your bed every night, getting to see your family in the morning, and still making equivalent money to anesthesia with a higher ceiling, this might be for you. As long as you don’t mind pain patients. And as a bonus you’re actually treated like a doctor, if that matters to you.

 

[Dr. Ice]

I think being a hospital employed pain doctor is probably a fantastic gig. A lot comes down to personality. Nothing wrong with being a good soldier..there are actual holidays celebrated to being such.

I work for a private practice ortho group. I’m the only interventional doc with the group. They treat me well, I do what I want, no one questions me or asks me
to do anything I don’t want to do. With Covid, we have switched to block scheduling and I work 7am-1pm or 1pm-7pm. If I have a really busy clinic morning I get a PA. I’m half office and half Asc based. I took a pay cut with this new schedule but not that substantial. I would be ok going back to 8-4 schedule but it seems like the majority of the group doesnt want to go back now that they got a sense of some free time.

Biggest regret honestly is becoming part of the asc. It didn’t work out at all the way the group had envisioned.

if I had to do it all over I would probably work out a situation where I was doing a lot more in office. ASCs seem like a great investment but a lot is based on geography, the business acumen of the owners and luck..

 

[BobBarker]

From what I read on this board the hospital employed pain docs seem to have a great set up with great hours and pay. I think it is possible to double mgma 50% owning your own practice but it is going to be 25% more work.

if working 5-9 u may be triple mgma which is almost baller $ @drusso

Owning your own practice is 250% more work than being employed, not 25%.

 

[lobelsteve]

Owning your own practice is 250% more work than being employed, not 25%.

Goes with @drusso 5am to 9pm schedule.

 

[nvrsumr]

pay seems to have gone up quite a bit since I was an employee so I guess the hours could have gone down as well.

N of 1 solo PP doc-worst case is 43 hours/week for me and 8 weeks off. Zero work taken home.

 

[Drhappyface]

I think being a hospital employed pain doctor is probably a fantastic gig. A lot comes down to personality. Nothing wrong with being a good soldier..there are actual holidays celebrated to being such.

I work for a private practice ortho group. I’m the only interventional doc with the group. They treat me well, I do what I want, no one questions me or asks me
to do anything I don’t want to do. With Covid, we have switched to block scheduling and I work 7am-1pm or 1pm-7pm. If I have a really busy clinic morning I get a PA. I’m half office and half Asc based. I took a pay cut with this new schedule but not that substantial. I would be ok going back to 8-4 schedule but it seems like the majority of the group doesnt want to go back now that they got a sense of some free time.

Biggest regret honestly is becoming part of the asc. It didn’t work out at all the way the group had envisioned.

if I had to do it all over I would probably work out a situation where I was doing a lot more in office. ASCs seem like a great investment but a lot is based on geography, the business acumen of the owners and luck..

Why would an ASC be a bad investment? Isn't that might most PP pain docs thrive for?

 

[BobBarker]

Orthopedists are really bad at running ASC’s and the stuff they do is not that profitable compared to what we do.

 

[Nodolor]

Orthopedists are really bad at running ASC’s and the stuff they do is not that profitable compared to what we do.

Depends on your ASC, I am part of an extremely profitable one here that 75% of revenue is generated By Ortho, Total Joints being added has been great for bottom line

 

[drusso]

Orthopedists are really bad at running ASC’s and the stuff they do is not that profitable compared to what we do.

Implant costs can eat your bottom line. The new pricing models for many implants and "advanced procedures" are not built from the bottom up but reverse-engineered from what they know the facility will get paid. As usual, the doctor or doctor/owner is last in line.

 

[BobBarker]

SCS/PNS is very profitable here. The issue is that you can’t afford to do anything else in the ASC as the overhead is too high. Vertiflex profit gets gobbled up by the sales tax, management fee, disposable cost, case allocation of the rent, etc. Cant afford the employees to do injections in the ASC either.

 

[paindoctor2014]

Spine, joints and pain carry our asc. Spine is amazingly profitable

 

[bedrock]

SCS/PNS is very profitable here. The issue is that you can’t afford to do anything else in the ASC as the overhead is too high. Vertiflex profit gets gobbled up by the sales tax, management fee, disposable cost, case allocation of the rent, etc. Cant afford the employees to do injections in the ASC either.

unless you run two ASC rooms

 

[NJPAIN]

Depends on your ASC, I am part of an extremely profitable one here that 75% of revenue is generated By Ortho, Total Joints being added has been great for bottom line

Same here. ASC with a really talented joint replacement guy. He is one of about 20+ docs and brings in 20% of the revenue. Problem is as more orthos come on everyone’s shares dilute and the more productive guys get more shares when asked for to keep them from leaving. I don’t own enough shares for it to be as good as I would like. As drusso said the new implantables don’t make the money promised in an ASC. They are best in HOPD.

 

[BobBarker]

Looks like Medicare pays around $8000 for a total knee. How much does a joint typically cost? It may bring in a lot of total revenue but I don’t think the profit can be very good. You also have the cost of the hoods, a lot of suture, the big dressing they use is around $90, etc not to mention one hour of OR time minimum.

 

[cowboydoc]

Looks like Medicare pays around $8000 for a total knee. How much does a joint typically cost? It may bring in a lot of total revenue but I don’t think the profit can be very good. You also have the cost of the hoods, a lot of suture, the big dressing they use is around $90, etc not to mention one hour of OR time minimum.

IIRC, my former surgical colleagues were bickering for years about the knee implants ranging from $3500-6000. There were significant price variables by implant and a large discount for narrow contracts, but getting a dozen surgeons to agree to a single vendor was almost laughable.

 

[Dr. Ice]

outpatient total joints can be a cash cow with an aggressive, charismatic, talented, high volume Orthopod. We had one, but he left for greener pastures..

 

[BobBarker]

There isn’t near as much meat on the bone (lol) for a total joint vs a scs trial in the ASC setting.

I think there is a tendency in our specialty to sell ourselves short as to the huge financial impact we have as pain physicians when we partner with orthopedists. There is some negative group think, “I don’t deserve partner. I’m not ortho. I don’t make as much money for the group so I won’t bother to ask for shares in the ASC or partnership.” When factually looking at the Medicare fee schedule it is just not true. Most private practice orthopedists also have gentleman’s agreements with their main referring hospitals to keep cases in the referring system so there is always a huge amount of case leak out of the ASC.

 

[Agast]

There isn’t near as much meat on the bone (lol) for a total joint vs a scs trial in the ASC setting.

I think there is a tendency in our specialty to sell ourselves short as to the huge financial impact we have as pain physicians when we partner with orthopedists. There is some negative group think, “I don’t deserve partner. I’m not ortho. I don’t make as much money for the group so I won’t bother to ask for shares in the ASC or partnership.” When factually looking at the Medicare fee schedule it is just not true. Most private practice orthopedists also have gentleman’s agreements with their main referring hospitals to keep cases in the referring system so there is always a huge amount of case leak out of the ASC.

Well I’ve mentioned before how much we profit when I do a private pay stimulator implant but someone (think it was drusso) got really triggered by that and we don’t really need another thread to get ABBA’d

But I am the 2nd highest earner in our ortho-heavy ASC and that’s not factoring in how cheap it is to do my procedures

 

[bedrock]

Well I’ve mentioned before how much we profit when I do a private pay stimulator implant but someone (think it was drusso) got really triggered by that and we don’t really need another thread to get ABBA’d

But I am the 2nd highest earner in our ortho-heavy ASC and that’s not factoring in how cheap it is to do my procedures

Agree we shouldn’t sell ourselves short.

Similar to Agast, I’m also out earning more than half of my ortho colleagues at our ASC. No reason I shouldn’t also be a partner.
She also makes a good point on how cheap our cases are to do. Though many ASCs do make money on the anesthesia for full surgical cases.

 

[drusso]

Well I’ve mentioned before how much we profit when I do a private pay stimulator implant but someone (think it was drusso) got really triggered by that and we don’t really need another thread to get ABBA’d

But I am the 2nd highest earner in our ortho-heavy ASC and that’s not factoring in how cheap it is to do my procedures

You asked for it...SOS...

 

[gaseous_clay]

Agree we shouldn’t sell ourselves short.

Similar to Agast, I’m also out earning more than half of my ortho colleagues at our ASC. No reason I shouldn’t also be a partner.
She also makes a good point on how cheap our cases are to do. Though many ASCs do make money on the anesthesia for full surgical cases.

Why aren’t you? Is this up for discussion with your group?