Path to pain as a radiology resident

[hopefulraddaddypls]

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New R1 considering pain. Radiology is enjoyable but not wanting to join a mega group and would like to build a practice for myself (tough to do in DR). Is the best path to pain straight out of DR? Or would you guys recommend an IR, msk, or neurorads fellowship? I plan on doing independent contract work while running a pain clinic (current rates are like 250-400 an hour for 3-4 rvus on tele rads). Whats yalls recs?

Edit: *IR, msk, neurorads fellowship before doing pain. And would it be feasible to integrate some IR stuff into a pain practice?

 

[SSdoc33]

New R1 considering pain. Radiology is enjoyable but not wanting to join a mega group and would like to build a practice for myself (tough to do in DR). Is the best path to pain straight out of DR? Or would you guys recommend an IR, msk, or neurorads fellowship? I plan on doing independent contract work while running a pain clinic (current rates are like 250-400 an hour for 3-4 rvus on tele rads). Whats yalls recs?

Edit: *IR, msk, neurorads fellowship before doing pain. And would it be feasible to integrate some IR stuff into a pain practice?

slow down

slow the eff down

if you want to do just shots, go into IR.

if you want to, you know, talk to people go into pain.

but maybe do at least a little bit of clinical work before you decide which fellowships you will do 5 years from now.

 

[hopefulraddaddypls]

slow down

slow the eff down

if you want to do just shots, go into IR.

if you want to, you know, talk to people go into pain.

but maybe do at least a little bit of clinical work before you decide which fellowships you will do 5 years from now.

Just tryna get some career advice, the rad forum here is pretty dead

 

[lobelsteve]

Lots of guys do this. Complete auronomy.
Too many come out and inject everything and do advanced procedures.
Makes millions and then patients get stuck with bills and no relief.

 

[Dr. Ice]

Just tryna get some career advice, the rad forum here is pretty dead

The rad forum is dead cause they know they have a good gig..stay the course young padawan..all of medicine rests heavily on imaging. You made the right choice…

 

[hopefulraddaddypls]

The rad forum is dead cause they know they have a good gig..stay the course young padawan..all of medicine rests heavily on imaging. You made the right choice…

I actually love quick image-guided procedures. While on ped rads my favorite think to do was GJ tubes, on msk now and the joint/spine work is pretty enjoyable

 

[DOctorJay]

just do telerads from the beach in Puerto Rico and pay no income tax

 

[BobBarker]

Lots of guys do this. Complete auronomy.
Too many come out and inject everything and do advanced procedures.
Makes millions and then patients get stuck with bills and no relief.

I agree that they do all kinds of unusual stuff. But they are nearly universally oblivious to the financial reality of what they are doing. They do not adhere to lcd and the RAC will eventually recoup huge financial sums. Also, a lot of them are doing odd ball stuff out of hospitals where there is very limited financial upside. Classic example are kyphos done with ct only which they are doing frequently. One was talking about doing them with xray only. You know the physician from LinkedIn. I pm’d him trying to warn him and to get him to change what he was doing today to lower the harm to himself 3 years from now when the audit is done. He didn’t respond in a manner that makes me think he will take that advice.

 

[Taus]

I agree that they do all kinds of unusual stuff. But they are nearly universally oblivious to the financial reality of what they are doing. They do not adhere to lcd and the RAC will eventually recoup huge financial sums. Also, a lot of them are doing odd ball stuff out of hospitals where there is very limited financial upside. Classic example are kyphos done with ct only which they are doing frequently. One was talking about doing them with xray only. You know the physician from LinkedIn. I pm’d him trying to warn him and to get him to change what he was doing today to lower the harm to himself 3 years from now when the audit is done. He didn’t respond in a manner that makes me think he will take that advice.

Same guy who says closed fist percussion is better than MRI? And puts up images of multiple adjacent vert bodies without height loss stuffed to the gills with cement?

 

[BobBarker]

lol. That guy is shocked about his ongoing RAC audit. But I was thinking of another one. He is in CA and likes Nalu over the medial branches for post kypho pain.

 

[Taus]

lol. That guy is shocked about his ongoing RAC audit. But I was thinking of another one. He is in CA and likes Nalu over the medial branches for post kypho pain.

Ahhh… those pesky median branches

 

[BobBarker]

Yes, with big leaks. No shame.

 

[hopefulraddaddypls]

lol. That guy is shocked about his ongoing RAC audit. But I was thinking of another one. He is in CA and likes Nalu over the medial branches for post kypho pain.

What does this mean? And id rather not be known as a jacka## that gets audited or leaves patients with astronomical bills lol

 

[BobBarker]

Traditionally, Medicare will pay you after you do the case with no prior auth. After up to 5 years, they can choose to employ a third party Recovery Audit Contractor who will look over every kypho you do and make sure that you care adhered to the local coverage determination. They get a portion of every case they recoup. The patients will not get a bill. Whoever owns the practice will write a large check to Medicare.

 

[TIVAndy]

typical radiology behaviour i see is treating the image, not the patient.

Told a patient with multilevel old compression fracture don't do kyphos and don't let others convince you to do so. send to acupuncture. acupuncturist sends to local radiologist, his friend. patient comes back with multi level kypho and asks why it didn't help. I yelled at him "I told you so"

 

[Dr. Ice]

Sounds like I should be glad to just order PT on everyone, tee them up for someone else who will see them, do the procedure, and then get audited down the road…

 

[Taus]

Yes, with big leaks. No shame.

It really is odd for those to be posted publicly where he’s trying to show off/promote his work. We all get some leaks… But usually not that big and I most certainly would not post that on LinkedIn. Also, several with unilateral access with balloon not crossing the midline. Again, happens… but wtf would you post it?

 

[pastafan]

It really is odd for those to be posted publicly where he’s trying to show his work. We all get some leaks… But usually not that big and I most certainly would not post that on LinkedIn. Also, several with unilateral access with balloon not crossing the midline. Again, happens… but wtf would you post it?

The biggest danger in medicine are folks, MD/NP/PA/Chiro, that don't know what they don't know.

 

[nvrsumr]

Saw that a small local pp group has a couple interventional rads that are relatively recent hires. No pain fellowship.

Guessing angle is keeping asc fed with vascular cases as they have had a lot of md churn over the years in a competitive pain market. Not certain.