Referral Question

[houseofpain23]

Long time lurker, first time poster. I am one year out of fellowship and working in a single specialty group. I am considering starting a practice from scratch in an area with a population of about 250,000. There are two other practices each with only one pain doc. There is a large Ortho group with two pain docs. There are two hospitals with 2 pain docs each. In regards to referrals, I know having a relationship with Ortho/spine surgeons is important. One issue I see is that most, if not all, of the Ortho and spine surgeons are affiliated with the hospitals or the large Ortho group who all have their own pain docs. Needless to say, I have concerns about opening a practice when almost all of the surgeons are affiliated with groups with their own pain docs. Due to this, I'm assuming almost all of my referrals would be based based entirely on PCP and ED/urgent care referrals. Anyone have advice on how to obtain referrals from surgeons in this type of landscape?

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[RoloTomassi]

You can still develop a relationship. Those surgeons will want your referrals. They will give some to get some. A surgical referral is gold, make sure to follow up and have it reciprocated. Find out what they don't like about their pain docs. Don't advertise Vertiflex, mild, SI fusion, etc that would threaten their business.

They won't be the bulk of your business. PCPs are likely your best bet. And other specialties like neuro, rheum, though lower yield. Chiros can be a great source, but you need to develop those relationships. As you get busier you can focus more on direct to consumer.

ERs will likely keep in house. Urgent cares are usually a revolving door of midlevels who have little incentive to drive patients to you, so not the best ROI.

 

[Agast]

So there are already 8 pain doctors in that area? I don’t know if a population of 250,000 is enough to support 9 pain physicians if you move there.

I couldn’t find good data on what the number of specialists per person in an area is needed, but I found this table

Number of People per Active Physician by Specialty, 2021

The number of people in the U.S. per active physician in each of the 48 specialty categories featured in the 2022 Physician Specialty Data Report.

www.aamc.org

Basically an active pain physician is expected to take of 52,335 people. Based on this math it seems like your town should have quit after the 5th pain doctor, unless there are a lot of smaller surrounding towns where they are traveling to get medical treatment here.

 

[callmeanesthesia]

So there are already 8 pain doctors in that area? I don’t know if a population of 250,000 is enough to support 9 pain physicians if you move there.

I couldn’t find good data on what the number of specialists per person in an area is needed, but I found this table

Number of People per Active Physician by Specialty, 2021

The number of people in the U.S. per active physician in each of the 48 specialty categories featured in the 2022 Physician Specialty Data Report.

www.aamc.org

Basically an active pain physician is expected to take off 52,335 people. Based on this math it seems like your town should have quit after the 5th pain doctor, unless there are a lot of smaller surrounding towns where they are traveling to get medical treatment here.

Good point, but more important than city population is catchment area. My city is 80,000 and we have 4 pain doctors, but we are overwhelmed with business. However, there’s no one else for 3 hours north, east, or west, or an hour south.

 

[Agast]

Good point, but more important than city population is catchment area. My city is 80,000 and we have 4 pain doctors, but we are overwhelmed with business. However, there’s no one else for 3 hours north, east, or west, or an hour south.

If I set up shop 30 minutes south of you can I avoid all the fires

 

[callmeanesthesia]

If I set up shop 30 minutes south of you can I avoid all the fires

No such luck. All of California burns now.

 

[buddababa]

So there are already 8 pain doctors in that area? I don’t know if a population of 250,000 is enough to support 9 pain physicians if you move there.

I couldn’t find good data on what the number of specialists per person in an area is needed, but I found this table

Number of People per Active Physician by Specialty, 2021

The number of people in the U.S. per active physician in each of the 48 specialty categories featured in the 2022 Physician Specialty Data Report.

www.aamc.org

Basically an active pain physician is expected to take of 52,335 people. Based on this math it seems like your town should have quit after the 5th pain doctor, unless there are a lot of smaller surrounding towns where they are traveling to get medical treatment here.

have a population of around 250k and have like 20 pain docs

 

[cowboydoc]

Our metro of a bit under a million has 12-15, 4 have retired in past 3 years with only 1 new doc.

OP: most everyone on here has a strong opinion on PP vs employment, but in a saturated environment, it really helps to be tied in with the big players. If everyone has a motivation to refer elsewhere, you’ll have an uphill battle. Offer great service, but don’t compromise to eek out more referrals.

 

[Agast]

have a population of around 250k and have like 20 pain docs

So how are things? Good eatin’?

 

[BobBarker]

Just varies on your skills, personality, community presence, willingness to prescribe some medication, see tricare, Medicaid, Medicare advantage in no particular order.

 

[Laryngospasm]

Long time lurker, first time poster. I am one year out of fellowship and working in a single specialty group. I am considering starting a practice from scratch in an area with a population of about 250,000. There are two other practices each with only one pain doc. There is a large Ortho group with two pain docs. There are two hospitals with 2 pain docs each. In regards to referrals, I know having a relationship with Ortho/spine surgeons is important. One issue I see is that most, if not all, of the Ortho and spine surgeons are affiliated with the hospitals or the large Ortho group who all have their own pain docs. Needless to say, I have concerns about opening a practice when almost all of the surgeons are affiliated with groups with their own pain docs. Due to this, I'm assuming almost all of my referrals would be based based entirely on PCP and ED/urgent care referrals. Anyone have advice on how to obtain referrals from surgeons in this type of landscape?

This will definitely be an uphill battle. The hospitals keep patients within their groups so those surgeons will almost never send you anyone. Just my experience. I’m hospital now and that’s just how it is.. when I was private the only surgeons who sent me stuff were independent and this was in a large city not a smallish one like that. You will get dumped on a lot.. sending you the stuff their docs don’t want.