Pain Physician Salaries?

[Med4ever]

Hey what is pain anesthisia like? What does one do? What does it pay thanks.

---

Members don't see this ad.

 

[timtye78]

I was told by a resident in Texas "If you are an anesthesiology pain medicine doc, if you aren't making 1.2 million; you're doing something wrong."

That being said, I have seen posted salaries 700-800K on job listing boards at anesthesiology programs in Dallas, TX.

The 1.2 million figure seems a bit high for starting pay. But I expect if you go from general anesthesiology to pain management, I would guess you could at least double or triple the regular STARTING pay.

You need to realize that average salaries don't mean a lot. There is quite a bit of variation some based on location, how much you actually want to work, how good are your business skills, do people know you exist? Your reputation, your experience etc. Eg. I keep seeing average anesthesiology pay at ~226K,etc. But I also actually meet and talk with a lot of people who are starting at $450K, 300K, even 500K. (general anesthesiology)

 

[Finally M3]

Another thread somewhere in this forum had the av. starting for a gas-pain > $200K, then going up to >$300K 5 years out.

I've also heard of pain docs making > 7 figures in Cali, but these were very tightly-run pain groups with a huge referral base....

Ultimately, if you are looking for job offers in the high 6 figures, be prepared to be joining large groups where you will be the injection monkey 24-7!

 

[Brass_Monkey]

No one in their right mind would waste another year on a pain fellowship to forgo a $300k+ salary.....

 

[Idiopathic]

Yah, especially when the pain guy here makes about $600K a year...not bad for one year of fellowship.

 

[IM/AnesthMD]

Whatever.

Actually I've heard numbers closer to $700k for pain. I dunno.... Why would you forgo one year of a $300k/yr salary to make a $700k/yr salary? Quick, someone do the math---I failed elementary school addition/subtraction.

 

[erasmus31]

Does anyone know a good site to find out which hospitals offer which Anes. Fellowships??? If there isn't a good summary site, can anybody list the programs that offer pain fellowships?

 

[Capsaicin]

From the private practice guys I have talked to, it sounds like it still makes financial sense to do the pain fellowship, though it is not like the golden days when $1 mill. a year was still within reach for a hard worker.

The decision is not financial, it's the style of practice. Do you want to give up the OR and the freedom of being able to walk away at the end of the day for the chronic pain population, clinic, and getting paged. The market is hot for OR anesthesia right now and for the foreseeable future, but if pain is more someone's bag, it's all good.

 

[Tenesma]

the opportunity cost of a pain fellowship for one year is definitely worth it... while you will forgo one year of salary, your future income will DEFINITELY make up for it.... most people i know have started their pain jobs at 325-400k/year!!! very few anesth. spots start at that salary today...

 

[timtye78]

I have seen printed flyers at Parkland (UT SW in Dallas) with a listed job for Pain Mgmt at $700K. This was in Jan of 2004. I cannot remember the location of the job.

Btw, my program OU offers one spot per year, although this might be flexible since we have been granted a nice increase in the total number of residents authorized (from total of 24 to 32 or 36). My question is this, to those of you more knowledgeable, if you apply for and do not match at your own program;

1. How hard is it to get one at another university?
2. Is leaving your institution for Pain Fellowship frowned upon in any way?

Also, if the average starting pay really is 300-400k then it really doesn't seem to be worth the trouble. UTSouthwestern, can you give us reliable income figures for a pain newbie?

Thanks!

 

[DigableCat]

Also, if the average starting pay really is 300-400k then it really doesn't seem to be worth the trouble.

If your goals for pain management are solely for the purpose of increasing your starting pay, than for an ANES it might not be worth it. Doing a pain fellowship will require a "shifting of gears" so to speak. The patient population(although it's not all difficult chronic pain patients), the necessity of being able to interpret MRIs and other diagnostic tests, the brushing up on your physical exam skills. If these are things you have no interest in anyway...it could make for a very long year and you'll end up going back to OR anesthesia anyway.

 

[MDEntropy]

the opportunity cost of a pain fellowship for one year is definitely worth it... while you will forgo one year of salary, your future income will DEFINITELY make up for it.... most people i know have started their pain jobs at 325-400k/year!!! very few anesth. spots start at that salary today...

I am not trying to start a debate; I am just writing to ask for clarification. Didn't you recently say that most of the people you graduated with got jobs at 300K and up (those entering private practice)? And didn't you finish in 2004? Perhaps your classmates were the ones getting the very few jobs? Or in the last six months have things really fallen off?

 

[Tenesma]

fair question.... i have a sense that the market is not what it was 2 years ago... quite a few people that i know that are graduating in 2005 will only be getting jobs starting at 220-250k/year which is significantly below 300k/yr last year and 325 the yr before...

 

[MDEntropy]

fair question.... i have a sense that the market is not what it was 2 years ago... quite a few people that i know that are graduating in 2005 will only be getting jobs starting at 220-250k/year which is significantly below 300k/yr last year and 325 the yr before...

So starting salaries are down about 30% in the last two years. Ouch!!!

That is basically a market crash.

 

[UTSouthwestern]

I have seen printed flyers at Parkland (UT SW in Dallas) with a listed job for Pain Mgmt at $700K. This was in Jan of 2004. I cannot remember the location of the job.

Btw, my program OU offers one spot per year, although this might be flexible since we have been granted a nice increase in the total number of residents authorized (from total of 24 to 32 or 36). My question is this, to those of you more knowledgeable, if you apply for and do not match at your own program;

1. How hard is it to get one at another university?
2. Is leaving your institution for Pain Fellowship frowned upon in any way?

Also, if the average starting pay really is 300-400k then it really doesn't seem to be worth the trouble. UTSouthwestern, can you give us reliable income figures for a pain newbie?

Thanks!

As always, income varies widely by location. Do pain in a midsize city like Tulsa where one of our recent graduates will be heading to after finishing his fellowship at Texas Tech and you are likely to rake in more cash simply because there is less competition in town. In talking with a couple of our pain faculty that have left for private practice jobs, the starting salaries they were offered were higher than fellows straight out of fellowship ($300-350K) with partnership salaries in the $500-700K range depending on how hard you wanted to work.

Nevada remains a fertile ground for anesthesiologists of any type and salaries are highest in Las Vegas, Reno, etc. than just about anywhere else due to skyrocketing demand and supply that hasn't been able to come anywhere near catching up. Heck, I got a Nevada license just to be able to do locums there when I have a week off from the group I signed with.

That being said, I have heard of partnership salaries in the $400-500K range and very few in the $700+ range with one couple in Plano making $1.1M each but they are very well established and have cornered the market on the rich yuppie and rich fogey crowd up there. Gorgeous clinic.

Basically you have to decide if that lifestyle suits you. I got out of IM to get away from the clinic, H&P's, rounding, etc. and pain to me would mean a return to the clinic and H&P's. Having an office manager, nurse(s), equipment maintenance issues, and having a patient population that is highly likely to include at least a few drug seeking personas was not something that I felt ready to jump into after having so recently left IM.

Like I said earlier, I just have not seen our residents who have gone into pain having any difficulty getting into pain fellowships, so if your home base program fills up, I don't see that it would be difficult to get another spot at another program. Other programs also don't ask why you didn't get into your home program although they may ask why you didn't APPLY to your home program. If you are coming from a super competitive program, they will understand that the number of positions was limited and you may have come up a little short. If you are coming from a very lowly regarded program, they will think you just wanted to get the hell out of Dodge.

Pain is a very interesting and challenging field and over the next few years, you will see some new innovations coming out that will require close cooperation between yourself and a surgeon to implant long term, direct and variable current nerve stimulators on exposed lumbar paravertebral, sciatic, etc. nerves for chronic pain. If you are confident in your surgical skills, you are welcome to go it alone.

Shameless plug to follow: With the move of one of the last big pain guys from Texas Tech to Southwestern, we will be gearing up for another big expansion of our pain program and our fellowship number now stands at 3 fellows and will likely increase in the future to accomodate increasing demands, especially with the aforementioned techniques.

 

[C Fiber]

I heard that Nevada has one of the highest medical liability in the country. Is that true? Are they sue happy? I would hate to have a little lawsuit to keep me awake at night.

 

[DrBarna]

The national average for an anesthesiologist is about 300K and a pain specialist who is interventional likely makes on average about 50K more...about 350K average. This number factors in all parts of the country, all practice types (academic, private). A physician making more than 600K is likely in the top 1 % of anesthesia/pain salaries in the U.S. Again, the 350K salary is an average and likely does not reflect starting salary, and is achieved within 1-3 years in practice. Salaries north of 600K, top 1% as mentioned, are real, but very rare. Typically, that kind of salary reflects a very busy mature private practice with a heavy emphasis on procedures, potentially some ownership of a surgical center(s), other business income besides what is generated with one's two hands.

 

[Spine Specialist]

Thanks DrBarna for your reply.
Is there any difference in salaries of PMR trained pain specialists (ACGME) and Anesthesia trained pain specialists ( 100% pain)? I hear stories like they are paid differently eventhough both can perform the procedures with same skills?

 

[Aether2000]

The block jocks, ie. those who do a very cursory evaluation and give everyone steroid injections whether there are any criteria met for such or not, and treat chronic, subacute, and acute pain all alike, do not manage patients except with injections, implantables, and RF can make over 1 mil per year. These are simply technicians who have given up being physicians for $$$$. Often patients new to pain management will be routed through their mills and will only too late realize exactly what happened to them and their pocketbooks when they have been unceremoniously dumped by the pain technician back into the lap of their family doctor for treatment of pain.
Legitimate pain physicians who take the time to make diagnoses, establish long term relationships with patients, and personally use multiple modalities of therapy (not just writing a script for the PTs to take over care), will make substantially less...on the order of $250-500k per year. But these are physicians, not technicians. So one must select quality vs quantity, educated assessment vs assembly line treatments, and whether your goals in life are to become a businessman hawking steroid injections vs a physician.

 

[greywater]

Amen! I am so sick of cleaning up after these ******. They cherry-pick the procedures and leave the pt twisting in the breeze when the procedures don't work.

Some of them have seen the pt only for the initial visit and all f/u's are with PA or NP. Good luck figuring out someone's pain pattern and coming up with a diagnosis when you see them once. One of my former pts who moved out of town says the new doc has NEVER seen him.

Characteristic behavior: everyone gets a TFESI whether they need it or not. If the condition really does warrant a TFESI, they do multi-level ipsilateral blocks, like L3,4,5 all on the same side.

Characteristic call: "I don't prescribe narcotics. Narcotics are for cancer patients."

 

[lobelsteve]

PM&R docs that I know who are graduating from fellowship this year are making a base of 150-270k with bonuses ranging from none to 40% of collections over twice salary.

I think the myth of 700k to start does not seem reasonable. If I owned the group I would not pay anyone that salary. Figure what a procedure pays and multiply that by the number that can be done in a year.

It is reasonable that a first year doc can have 600-800k in collections (depends how soon he/she can get on the panels). THis number should double in 18 months and again in 18 more months than flatten out to the demographic and competition of the area.

THe above numers are unpublished data and gathered from conversations with several pain physcians. They may be totally inaccurate or pretty darn close- that's why we are on the internet. A strong reply by forum members should drive some sort of more accurate range.

 

[greywater]

It is reasonable that a first year doc can have 600-800k in collections (depends how soon he/she can get on the panels). THis number should double in 18 months and again in 18 more months than flatten out to the demographic and competition of the area.

According to the above formula, one should expect $3 million in collections after 36 months. Keep dreaming. There may be pain factories out there that grind out patients at that rate, and if they are in the right area where fees are high, it is possible, but those numbers are ridiculous for the vast majority of practices.

I know one guy who does 300 procedures a month. In the area where he practices that's going to get him into that range. He also has a team of 5-6 people that probably cost a small fortune.

God only knows what the quality of care is like.

 

[lobelsteve]

According to the above formula, one should expect $3 million in collections after 36 months. Keep dreaming. There may be pain factories out there that grind out patients at that rate, and if they are in the right area where fees are high, it is possible, but those numbers are ridiculous for the vast majority of practices.

I know one guy who does 300 procedures a month. In the area where he practices that's going to get him into that range. He also has a team of 5-6 people that probably cost a small fortune.

God only knows what the quality of care is like.

I agree completely. Except I think that 2.4M collections after 3-4 years would be the plateau of a busy practice with extenders (PA/NP). I do know of busy local practice that did 400k in collections last month. All without selling Oxy to the street- at least in the sense that monitoring is in place (ie- not a kiosk shop selling Rx's)- rates probably similar to Manchikanti's study.

I think after 20 FU, 4-5 new, and 10 procedures in a day- the quality of care drops precipitously. I don't think I can handle more than that.

 

[mdonline01]

The block jocks, ie. those who do a very cursory evaluation and give everyone steroid injections whether there are any criteria met for such or not, and treat chronic, subacute, and acute pain all alike, do not manage patients except with injections, implantables, and RF can make over 1 mil per year. These are simply technicians who have given up being physicians for $$$$. Often patients new to pain management will be routed through their mills and will only too late realize exactly what happened to them and their pocketbooks when they have been unceremoniously dumped by the pain technician back into the lap of their family doctor for treatment of pain.
Legitimate pain physicians who take the time to make diagnoses, establish long term relationships with patients, and personally use multiple modalities of therapy (not just writing a script for the PTs to take over care), will make substantially less...on the order of $250-500k per year. But these are physicians, not technicians. So one must select quality vs quantity, educated assessment vs assembly line treatments, and whether your goals in life are to become a businessman hawking steroid injections vs a physician.

I think it was possible to make that much in California a few years ago if you owned a surgical center, non-contracted, doing primarily workers comp cases. It was not unusual for these places to clear 300k per month. All that changed with the new fee schedule in 2005 where reimbursement dropped by 75%.

I think it is really difficult now to hit 600-700k in California even if you are a very busy technician. It is just hard to be a physician in California, period, given the cost of living here.

My friends in Texas are doing great. I hope the rest of the country is doing as well.

 

[PainFellow]

Reimbursement down by 75%?!?!?!?! Wow! I don't care about getting rich, but I hope I can still pay my loans!

 

[Doctodd]

I think it depends on who you are seeing(Workmans Comp, Auto, Medicare) and in what state you live in. I have been in a block factory, and now starting my own office and learning the business side. I want my office to be a compromise between:

1. The large volume and not so great quality of care in a block factory. (I did 30 blocks/day usually...not counting RF. Im not sure how accurate these numbers are, but the entire office billed about $5 million that year. I was told that i billed $2.5 million in the one year i was there. My salary was about 10% of what i billed. It was my first year out of fellowship so i basically just worked and did what was scheduled.)
2. A personal relationship between patient and doctor.
3. Good quality of care.

That being said, Florida also has high malpractice insurance, so subtract that from your income. A general rule of thumb is Medicare is the standard for reimbursement, WC and Auto pay 200-300% of Medicare. Medicare fees vary by county. Insurance plans will pay usually between 70-130% of Medicare, depending on what you negotiate. Workmans Comp is also negotiable to a degree. With attorneys, you sign the LOP and basically wait until the case is settled...this is not counting the $10,000 Florida PIP amount which gets paid first.

How much money is enough? How much do you want to work? Where is the fine line between quality of care and high volume blurred?

I think $500-700K is easy for an established pain doc who isnt a slave. A newly graduating pain doc will make about $150-200K in South Florida. This is if you can find a job. You might also charge for therapy and rehab in your office to increase revenue.

T

 

[Dryacku]

For all you practicing docs... I am sorry if this has already been addressed...

About how many hours a week do you work to maintain your own practice?

Also what is your salary and I know there are crazy stories of salary but what can I realisticly see myself making in 6 years?

Do you think pain will get phased out or still be strong in the future??

Is there any call with pain???

thanks

 

[Tenesma]

dryacku

1) Most people who are actually making money (not the residents or students) will not reveal their true salary

2) I have recently switched to 100% pain - work about 75 hours a week (but that includes paperwork, dinners with referring physicians etc, planning further clinic expansion)

3) I realistically think that my pain component of salary will be lower in 6 years (that is why it is good to invest and diversify yourself - ie: own medical arts buildings, MRI centers, do legal stuff) - primarily because there is a drive to decrease Medicare Reimbursements (and commercial insurances will follow). The other issue is that right now there are a LOT of people doing procedural pain stuff (internal medicine, rheumatology, family practice, CRNAs, etc) who don't have any training doing blind procedures (without fluoroscopy), and the amount they are billing is HUGE. For example, paravertebral injections (ie: facet injections, medial branch blocks) were billed 68% MORE in 2005 compared to 2004. So therefore it is just a matter of time before medicare cuts those injection reimbursements down (like what they did to cardiac surgery in the late 80's).

4) Pain will become a better field from an academic point of view, but I doubt that it will be as profitable in 5 years as it is now... just the nature of things

So basically it is like the stock market - med students and residents always seem to be hopping on to the hot, lucrative market when that stock already is hot.

 

[MDEntropy]

Most people who are actually making money (not the residents or students) will not reveal their true salary

I am surprised by this but I guess I have not paid attention to your posts as closely as i thought.

I know you were at MGH for your residency - did you stay there for fellowship? I thought you were in private practice doing 100% OR right out of residency in 2004. Apparently not. Why the switch to 100% pain?

 

[Tenesma]

when you want to do something well you got to do it 100%... money, lifestyle and more business stuff (which i enjoy)

 

[MDEntropy]

when you want to do something well you got to do it 100%... money, lifestyle and more business stuff (which i enjoy)

Did you do a pain fellowship? This may be obvious just don't remeber you mentioning it. If so, did you stay at the general for fellowship? I guess I am probing for your opinion on great pain programs as a recent graduate/fellow.

 

[preludexl]

I heard that Nevada has one of the highest medical liability in the country. Is that true? Are they sue happy? I would hate to have a little lawsuit to keep me awake at night.

I believe it IS the highest. Thats why all the OBGYNs left. FWIW my bro who is finishing fellowship this June got a offer in SOCAL for $200k to start with an HMO and this was after much negotiating along with negotiating with private firms who did not want to pay him that much or wouldnt commit other promises on paper.

 

[wes2308]

your brother finished a pain fellowship? the offer was only 200k to start - does that sound low?

 

[jsaul]

your brother finished a pain fellowship? the offer was only 200k to start - does that sound low?

that is not low

 

[Tenesma]

for anesthesia pain 200k is pretty low - average starting including decent benefits is between 250-300k for 1st year out.... california is weird because of their messed up system, but i know of 2 people starting in cali at 300k so it can't be all of california...

 

[HunterGatherer]

california is weird because of their messed up system...

Are you talking about medicare payouts?

 

[Tenesma]

medicare in california isn't the problem - it actually is pretty average if not a bit better... the problem is the managed care control of the market...

managed care sucks

 

[Disciple]

for anesthesia pain 200k is pretty low - average starting including decent benefits is between 250-300k for 1st year out.... california is weird because of their messed up system, but i know of 2 people starting in cali at 300k so it can't be all of california...

250K Would you say that holds true for the Bay area, OC or San Diego?

Can groups with a conservative philosophy generally pay that amount, or would you need to sign on with a group that is high volume procedurally.

 

[Tenesma]

bay area and san diego are hard pain markets to break into - so i would suspect people are willing to take lower starting salaries...

 

[preludexl]

your brother finished a pain fellowship? the offer was only 200k to start - does that sound low?

Yup 200k to start. The hours are good and he is only doing it since my sister in law is finishing her 1st year of residency there in the same hospital. He got better offers of around $250k in private firm with profit sharing of about 10%. I think the best offer was from a 1 man practice. He was going to give him the practice in 2 yrs when he retires at 62 but he wasnt dead set on the retirement date, not to mention it was a 2 hr drive back to hollywood. I asked about the $200k and he said it was pretty good considering the oversaturation in Cali. The anesthesiologists are making more than him but he said once a pain doc builds his practice he will surpass the anesthesiologist easily.

 

[mille125]

I was told by a resident in Texas "If you are an anesthesiology pain medicine doc, if you aren't making 1.2 million; you're doing something wrong."

That being said, I have seen posted salaries 700-800K on job listing boards at anesthesiology programs in Dallas, TX.

The 1.2 million figure seems a bit high for starting pay. But I expect if you go from general anesthesiology to pain management, I would guess you could at least double or triple the regular STARTING pay.

You need to realize that average salaries don't mean a lot. There is quite a bit of variation some based on location, how much you actually want to work, how good are your business skills, do people know you exist? Your reputation, your experience etc. Eg. I keep seeing average anesthesiology pay at ~226K,etc. But I also actually meet and talk with a lot of people who are starting at $450K, 300K, even 500K. (general anesthesiology)

you are misleading the readers of this forum.....700k is not the starting salary for pain management....there are very few pain management practitioners who are making that kind of money.....i am in private practice myself .....MGMA which is very reputable quotes average pain management salaries in the 300's.........500k is the 90th percentile........your figures are misleading and just downright wrong

 

[Tenesma]

pain salaries vary far more than anesthesia salaries - primarily due to extent of interventional component and volume generated... If you can figure out how to safely do 15-20 procedures/day in an office based setting with very low overhead, in a rural environment with very high private payors (insurance carriers) than 1-2 million is entirely plausible....

starting salary over 300k is usually indicative of a problem area or problem employer...

please don't make your decisions based on starting salaries

also remember that because of the ridiculous amount of internists, family practitioners, naturopaths, dentists etc doing interventional pain the insurance carriers are just responding by dropping the reimbursements - there is an active drive to reduce interventions by 20-40% and that will only get worse over time...not better...

so my guess is that within 2-5 years most pain guys will be lucky to make as much as anesthesiologists (unless they have diversified by then).

 

[ideas]

pain salaries vary far more than anesthesia salaries - primarily due to extent of interventional component and volume generated... If you can figure out how to safely do 15-20 procedures/day in an office based setting with very low overhead, in a rural environment with very high private payors (insurance carriers) than 1-2 million is entirely plausible....

starting salary over 300k is usually indicative of a problem area or problem employer...

please don't make your decisions based on starting salaries

also remember that because of the ridiculous amount of internists, family practitioners, naturopaths, dentists etc doing interventional pain the insurance carriers are just responding by dropping the reimbursements - there is an active drive to reduce interventions by 20-40% and that will only get worse over time...not better...

so my guess is that within 2-5 years most pain guys will be lucky to make as much as anesthesiologists (unless they have diversified by then).

I'm sorry, you mentioned a little about this already, but can you go into more detail about what it is to "diversify" in PM?

 

[mille125]

pain salaries vary far more than anesthesia salaries - primarily due to extent of interventional component and volume generated... If you can figure out how to safely do 15-20 procedures/day in an office based setting with very low overhead, in a rural environment with very high private payors (insurance carriers) than 1-2 million is entirely plausible....

starting salary over 300k is usually indicative of a problem area or problem employer...

please don't make your decisions based on starting salaries

also remember that because of the ridiculous amount of internists, family practitioners, naturopaths, dentists etc doing interventional pain the insurance carriers are just responding by dropping the reimbursements - there is an active drive to reduce interventions by 20-40% and that will only get worse over time...not better...

so my guess is that within 2-5 years most pain guys will be lucky to make as much as anesthesiologists (unless they have diversified by then).

Tenesma,

Your reply is giving me tenesmus. Private practice pain salaries and private practice partner anesthesiology salaries are very similar, especially when you factor in the value of vacation time, etc. There are a few practitioners that earn seven figures. However, this is the exception and is certainly not the rule. I am in private practice and I knew how the figures shake out. The pain practitioners who are doing extremely well often have ownership in an ambulatory surgical center which helps suppliment income. To say that the very majority of pain practitioners are making one million dollars or more is ridiculous.

 

[PainDr]

To say that the very majority of pain practitioners are making one million dollars or more is ridiculous.

Absolutely agree. The only people who make that kind of money are the ones running block shops.

 

[Tenesma]

mille.... read my post again please...

i said that >1 million is entirely plausible based on the situation that i described (high volume procedures in a rural area with low overhead and high non-managed care payers)...

i would say that most pain guys make on average about 20-25% more than most anesthesiologists.... but the kicker is that most pain guys work far more hours.... I make about 80k more than my anesthesia buddy but i have 3 weeks of vacation and he has 17 wks of vacation.... and i am technically always on call (solo practice)...

 

[Mister Mxyzptlk]

Absolutely agree. The only people who make that kind of money are the ones running block shops.

I think we are being treated to a nice description of one right here.

 

[mille125]

mille.... read my post again please...

i said that >1 million is entirely plausible based on the situation that i described (high volume procedures in a rural area with low overhead and high non-managed care payers)...

i would say that most pain guys make on average about 20-25% more than most anesthesiologists.... but the kicker is that most pain guys work far more hours.... I make about 80k more than my anesthesia buddy but i have 3 weeks of vacation and he has 17 wks of vacation.... and i am technically always on call (solo practice)...

i did read your post....sure 1 million can happen but all salary sources quote 656K as 95th percentile. If you are doing better than that, congratulations. By simple statistics you can figure out how many people are actually making that kind of money (one million).

i am also in sole practice pain. there are definitely pluses and minuses as you have eluded to. I have the following things to add to what you said previously,

1) Yes, technically you are on call every day, but how many times are you actually called (i would guess very few). You never have to leave your house to take call. Your anesthesia collegues do. Your call is nowhere close to their call in terms of acuity.

2) Yes, a tradeoff to solo practice is less vacation. However, if you choose to take more your can. You will lose income during this time, but you do have a choice. Your anesthesia collegues do not. On the same note, you can choose WHEN you want to take vacation. Your anesthesia collegues have to go through a group to decide.

3) You have ultimate control over every aspect of your practice. Your anesthesia collegues do not. You can invest into an ASC or imaging center if you choose. You can do mostly pumps and stims or no pumps and stims. You can work seven days a week or you can work 4 days a week. To me this is by far the biggest plus to solo practice. Also you can incorporate you practice and get tax benefits. You can contribute up to 45k for retirement. Ask your anesthesia collegues if they get these perks.

4) Other minuses include having no income if you are sick, on leave, or disabled. Also being unable to bounce ideas of off collegues.


To me the pluses outweigh the minuses.

 

[PainDr]

.

 

[Tenesma]

1) call: i get about 3-4 phone calls per week (after hours/weekends) - out of those phone calls only about 1-2 are actually inpatient consults... those I have to leave the house (but i do a full medical record eval online from home first, that way i can just sit w/ the patient, do an exam, make a decision, dictate and then head back home - which consumes about 1-1.5 hours)... it doesn't pay to do them, but the PCPs love it...

2) a LOT less vacation - yes, i am the boss and therefore have a lot of lattitude, but as a solo practitioner taking vacation is very difficult to do and every day that I don't work I am losing a lot of money ...

3) control: the best thing about being the boss....

i agree that the pluses far outweigh the minuses - otherwise i'd be a fool to be doing this instead of anesthesia....

what kills me is the time i spend doing paperwork (both clinical and business related)....