Personal Injury Pain Doc

[Nonphysiologic]

Hey,
If a practice does primarily PI, what are the pros and cons?


What I have heard this far is that it can be very lucrative, you only see the patient for one thing or one procedure or something very specific?

Also I heard that while it’s very lucrative you don’t get paid until much later when the case is settled.

Anything else I should know? It seems like you have to deal with a lot of lawyers which is usually a bit of a red flag but idk docs out here make it seem like doing mostly PI cases is the way to go...


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[Doctodd]

i use trusted lawyers cuz plenty of lawyers rip you off. They usually own the diagnostic center also, so the easy money from the PIP policy gets eaten up by them. This varies state by state.

 

[244913]

Hey,
If a practice does primarily PI, what are the pros and cons?


What I have heard this far is that it can be very lucrative, you only see the patient for one thing or one procedure or something very specific?

Also I heard that while it’s very lucrative you don’t get paid until much later when the case is settled.

Anything else I should know? It seems like you have to deal with a lot of lawyers which is usually a bit of a red flag but idk docs out here make it seem like doing mostly PI cases is the way to go...


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I cannot imagine a worse job. Spend 15 years in training and school to be a fluffer for PI lawyers- the absolute scum of the earth.

Not worth it- no matter how many pieces of silver they dangle in front of you

- ex 61N

 

[painfree23]

I cannot imagine a worse job. Spend 15 years in training and school to be a fluffer for PI lawyers- the absolute scum of the earth.

Not worth it- no matter how many pieces of silver they dangle in front of you

- ex 61N

Other than ethically, financially is it worth it ?

 

[emd123]

Hey,
If a practice does primarily PI, what are the pros and cons?


What I have heard this far is that it can be very lucrative, you only see the patient for one thing or one procedure or something very specific?

Also I heard that while it’s very lucrative you don’t get paid until much later when the case is settled.

Anything else I should know? It seems like you have to deal with a lot of lawyers which is usually a bit of a red flag but idk docs out here make it seem like doing mostly PI cases is the way to go...


Sent from my iPhone using SDN mobile

Once I had an attorney call me and ask me to do some of this personal injury work on a "letter of protection" as they call it, which is essentially them promising to pay you for your work, once they win their personal injury case. After he explained it to me, and I talked to a guy I did fellowship with who did some, I didn't like the sound of any of it. It seemed shady. It seemed like the attorney was essentially trying to tempt me to do a bunch of unnecessary procedures to run up the medical bills so he could get a bigger award in the case (the greater the sum total of medical bills, the great damages the attorney can ultimately demand). Plus, you have to wait months, maybe years, to get your money, if you ever get it. So, right off the bat, it didn't set well with me, in many ways.

Then I talked a separate attorney, someone who knows about this kind of arrangement but doesn't do this kind of work currently, to get another opinion on it. He explained it to me, that if the lawyer doesn't win their case, or they move, or just generally want to be ruthless they may not ever pay you. And they you'd have to sue them to get the money. He made it sound like it's not rare for this to happen. His advice to me was that if I ever did this kind of work, its best to view it from the standpoint that you're doing a favor for the attorney, almost like a pro-bono kind of thing to help the attorney out and get his client treated and assist in the case, but by no means to view it as a money making opportunity or as anything I'd want to get heavily involved in or make a large part of my practice. Keep in my, this is a lawyer telling me this.

Everything about it turned me off, and it just seems to carry too much baggage with it, so I've decided not to get involved in any kind of work such as this.

 

[Agast]

I get a couple of these referrals. Usually what happens is the patient goes to the lawyer’s chiropractor of choice and doesn’t get better, then gets sent to the pain doctor of choice. The patient meets the pain doctor and gets weird vibes from how shady it seems (Nice to meet you, now lie down and get your shot) so they ask around and see me instead. From their anecdotes it seemed the pain doctors doing the injury injections were the ones who couldn’t find real jobs, either because of poor social and language skills or weak educational background. I don’t mind seeing those patients because they have real problems and want to get better.

You absolutely can bill these injections at a higher rate but I would not want this to be a cornerstone of my practice. I met a couple of slip-and-fall type lawsuit patients and I still feel the need to Purell my hands when I think of them.

 

[drusso]

You're betting on the come. It's treacherous work. You might not get paid. Plus, you spend a lot of time talking to lawyers...

Basically, if you want to do PI work you have to get screwed a few times before you learn what you're doing. There are no short-cuts. And, lawyers are very good at screwing doctors.

 

[Doctodd]

Depending on the state, auto insurance pays more than anyone else. PI can pay your full charges. You want to accept the patients who still have auto insurance medical benefits, so your staff can find that out before seeing the patient. If benefits exhausted, you MAY bill their private insurance and/or get an LOP. The LOP is an IOU of sorts, is the last resort, and is a legal document. If you are only taking LOP's from all PI, then you might get frustrated. Most lawyers who do PI also do auto and workmans comp. You take the good with the bad.

 

[101N]

A “fluffer” who used to post a lot here had this type of practice. He killed one of his PI referrals during a CESI.

No thanks.

 

[nvrsumr]

Look around in ur state for “funding companies”. They basically buy the lien from u. Pay u immediately but get a big cut.

The attorney is never going to pay u full boat and will always ask for a haircut in the end so the funding cos aren’t a bad deal.

First time you don’t say patient needs ongoing medical care forever and is fully disabled this work will dry up fast...

 

[Ducttape]

don't worry, if you are a new pain doc in town and they are looking, they will find you and feel you out to see how you will practice.

I was an unwitting participant in this. within the first 6 months of starting, I had 2 separate PI practices set up a full 1 hour session to "discuss a client" and, in retrospect, asked me pretty loaded questions. (things like "would you feel comfortable testifying in court?", "so do you feel that these patients can have lifelong pain that should be appropriately compensated?" "don't we always go to bat for the patient, right?")

like an idiot, I answered truthfully... and I haven't heard back from those guys since then.

 

[emd123]

A “fluffer” who used to post a lot here had this type of practice. He killed one of his PI referrals during a CESI.

No thanks.

How the hell did he do that?
Doing it at C1/2?
Particulate into the vertebral?

 

[101N]

Sedation with aspiration in a setting that wasn't - he was PM&R - prepared to handle that complication.

 

[emd123]

Sedation with aspiration in a setting that wasn't - he was PM&R - prepared to handle that complication.

Yikes. Not good.

 

[101N]

To be clear I'm not picking on PM&R, I'm PM&R. I'm picking on his ethics.

 

[Agast]

Sedation with aspiration in a setting that wasn't - he was PM&R - prepared to handle that complication.

There wasn’t an anesthesiologist/CRNA providing the sedation? I would never hold the proceduralist accountable for the aftermath of an aspiration event.

 

[101N]

Bull s*it. You book an unnecessary procedure on a PI patient and they die, it's on you not your CRNA or anesthesiologist.

 

[Biohazard685]

What state are you in?

 

[nvrsumr]

we know for certain the cesi wasn't indicated? doubtful.

Its a tragedy and other than a imagined personal vendetta against an anonymous blogger cant imagine what there is to learn as it relates to PI business. Seems to say more about the current poster than the "fluffer"

 

[emd123]

we know for certain the cesi wasn't indicated? doubtful.

Of course it wasn't indicated. It was an injection.















(purple = sarc font)

 

[Disciple]

Bull s*it. You book an unnecessary procedure on a PI patient and they die, it's on you not your CRNA or anesthesiologist.

Do you know the specifics of the case?

 

[lobelsteve]

Do you know the specifics of the case?

I know all of the details of the case as I was able to review the entire chart. That being said I'm not going to discuss it on a public or private forum. When you see me at sis or other meetings I'll be happy to discuss in person.

 

[Disciple]

That's what I'm saying. Maybe we shouldn't be hurling accusations around here.

 

[drusso]

It's very unprofessional behavior--and grounds for a complaint to the medical board for such--to discuss privileged, confidential, or litigated case information in public. At the very least, someone should be spanked in public for doing so. NO ONE wants others to complain to their human resources managers either.

 

[axm397]

I think the OP got enough feedback about this line of work. Closing thread.