Severe mid-life crisis...please talk me out of this.

[Nerveen]

Hello med students! Let me introduce myself I am a middle aged healthcare professional who is in the throes of a horrific mid-life crisis; it seems the only thing that gives me any relief are Quixotic thoughts of an ill advised bid at med school.

A little about me:
I have been performing clinical and surgical neurodiagnostics for about twenty years. I have the usual certificates to perform NCV's, EEG's, intraoperative neuromonitoring (IONM), evoked potentials of all kinds; and at one point I also held a sleep study certificate. I am a published sci-fi author (I have two books out with Harper Collins). I attained a bachelor's degree summa cum laude. I have started three neurodiagnostic firms one sold in very good deal to a much larger entity. I just founded my latest neuro-tech firm (once my non-compete from my previous sale was up). I am deeply familiar with the business side of medicine of course even more so in regard to neurodiagnostics. I have lost exact count, but over two decades I have logged thousands of hours in surgery and the same number of clinical studies. My latest firm is getting off to a great start, I have a few customers and I am leveraging my expertise to teach button pushers like myself to apply IONM to peripheral nerve cases, the supposed new frontier in the science. I am an ace (for a joe-blow button pusher) in neuroanatomy. This all sounds really good but for one problem: I feel like such a G** D*** failure at life.

Let's face it I am a physician extender and a button pusher. Without a physician attached to my work it really doesn't exist on paper. I show up at a clinic with my NCV and EEG machines, perform an NCV/EMG or EEG and most of the time I am asked my opinion on the data. My physician customer will agree with my assessment, sign his/her name and then collect more than 50% of the reimbursement. I'll be in the OR with my IOM rig, I'll see something alarming. I'll let the supervising physician know via the internet portal and will get back "I don't know what do you think?"
I don't have any bitterness against the physician here, the license they have provides them this lovely position. I blame ME for allowing myself to remain in this state and stature for so long. That's the main problem here, I have hit a dead end in this field. I have hit peak neurodiagnostician. This has been my career for twenty years. Though I have had great success as an author and writer you simply can't support yourself on those earnings. Aside from some kind of sudden bestseller streak for my books (this doesn't seem likely) I have one option to move up in my field and that is to go to medical school, pursue neurology and then resume my NCV/EMG clinics along with the rest the modalities I perform as my own man.

This idea is insane because 1. I am in my forties 2. I need to grab more than a few undergrad pre-reqs to be eligible, I have a BA in history and English for crying out loud. Yes I have thought about just going to business executive side and have more than a few options for MS style medical business degrees. But I'll tell you the business side of medicine without the thrill of solving difficult problems and discovering weird diagnosis is just the most boring thing you can do. The fact is that medicine as a business is unique (read dull). Sure I could be a business manager of neurology practices and to an extent I do that already. But that alone is just not exciting.

I'm really stuck here, I don't think med school is a wise choice in my situation but I can't think of anything else. I'm really here to get flamed, so I'll drop these fanciful delusional notions.

So I humbly ask you forum goers to talk me out of this and give a depressed button pusher some advice.

thanks

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[Blanky]

First find out what your cGPA and sGPA is without any retakes and then determine what classes you need etc. Also consider what your age will be when you are finished. Being too old for medical school is mostly a personal choice .

 

[deleted480308]

If you want to do it for the thrill of the chase and you can afford it, have at it.

If you're just worried about losing that 50% to a supervising doc, do a return on investment calculation and given your current incomes you might find it doesn't make sense mathematically

It's fine to do something that is bad math, but you need to know the math

 

[Blanky]

I would second sb247. This will almost surely be a loss of income in the longterm and must be something you go after not because of the "money."

 

[Nerveen]

First find out what your cGPA and sGPA is without any retakes and then determine what classes you need etc. Also consider what your age will be when you are finished. Being too old for medical school is mostly a personal choice .

Thanks for the reply, both of these would be north of 3.8 I graduated with a 4.0 with a history degree. The short answer is TOO OLD. But I could be a too old physician or a too old button pusher. I don't know I'm just not too happy with where I am at now. I thought I would go the creative route, I've had lots of that type of experience; two novels later and I still need a day job.

And look I'm going to sound like an ass here, but I'm good at this. I can knock out a ten patient clinic in less than a work day, take histories, present findings etc. I have been doing it for twenty years. I suppose I just feel like a failure since in the end it's button pusher work and even after all these years my title is still just "Mr. Tech."

****pulls out tarot cards (Just kidding!)

 

[Nerveen]

If you want to do it for the thrill of the chase and you can afford it, have at it.

If you're just worried about losing that 50% to a supervising doc, do a return on investment calculation and given your current incomes you might find it doesn't make sense mathematically

It's fine to do something that is bad math, but you need to know the math

You know it wouldn't be a loss really. I could be up and running doing EEG and NCV/EMG clinics and IONM supervision in a relatively short time. I mean I am doing these things now I just can't bill for the whole thing. The thing that sticks in my mind is if I am going to be doing this for a while, why would I not want to be benefiting from it 100%. It almost seems that the math beckons me toward this folly.

 

[deleted480308]

You know it wouldn't be a loss really. I could be up and running doing EEG and NCV/EMG clinics and IONM supervision in a relatively short time. I mean I am doing these things now I just can't bill for the whole thing. The thing that sticks in my mind is if I am going to be doing this for a while, why would I not want to be benefiting from it 100%. It almost seems that the math beckons me toward this folly.

Do the math of 4yrs lost salary while digging a hole with tuition, then a mediocre salary while interest stacks up, then paying off the loans.....figure out how many years to break even to where you would be if you had kept your current gig

 

[Nerveen]

Do the math of 4yrs lost salary while digging a hole with tuition, then a mediocre salary while interest stacks up, then paying off the loans.....figure out how many years to break even to where you would be if you had kept your current gig

Yeah hell, it seems I'll need to get some more "Mr. Tech" monogrammed scrubs, thanks gentlefolks I needed a dose of that hard stuff.

Adieu! And good luck.

 

[Goro]

Hello med students! Let me introduce myself I am a middle aged healthcare professional who is in
I'm really stuck here, I don't think med school is a wise choice in my situation but I can't think of anything else. I'm really here to get flamed, so I'll drop these fanciful delusional notions.

thanks

Trying to become a doctor because you don't like your current job is one of the worst reasons to become a doctor.

 

[Nerveen]

Trying to become a doctor because you don't like your current job is one of the worst reasons to become a doctor.

Yep I agree, I'm thoroughly talked off the ledge here.

 

[Ad2b]

My physician customer will agree with my assessment, sign his/her name and then collect more than 50% of the reimbursement.

Physicians don't collect the reimbursement, the clinic or hospital does LONG after the physician has charted the service, provided the dx and signed the chart. The clinic, if lucky, will get reimbursed less than 50% based on whatever fee schedule the latest/greatest insurance company has decided is appropriate and whatever negotiator for the clinic agreed to.

Physicians, at least the ones I've worked for (very large, very disparate multi-specialty in many states of the great USA), get paid salary + bonus based on metrics of meeting Medicare metrics, patient encounters/day, etc etc etc.

By the time the reimbursement comes, if at all, the physician has already been, sometimes months prior. In fact, the physician gets paid whether or not (!!) the clinic/hospital gets reimbursed at all. It's this little thing that gets lost on many people:

Why do clinics lose money when the docs are paid so well? So often what gets screamed by people who don't know, "DOCS MUST BE PAID LESS MONEY..." ahem, it's the insurance companies everyone. Medical facilities lose money because insurance companies use every little ability to say, "Nah, we're not paying that code cost at all" or "we're not paying that code cost, we're gonna pay you this instead"... if you appeal, things get lost in the paperwork. Insurance company wins, medical facility loses money.

Wanted to clarify that for you. 🙂

I'm 53. 30 years serving the healthcare industry (finance, IT, revenue cycle, salary negotiations, credentialing, insurance side, STAT/GAAP, EMR - GE, Epic).

 

[Nerveen]

Physicians don't collect the reimbursement, the clinic or hospital does LONG after the physician has charted the service, provided the dx and signed the chart. The clinic, if lucky, will get reimbursed less than 50% based on whatever fee schedule the latest/greatest insurance company has decided is appropriate and whatever negotiator for the clinic agreed to.

Physicians, at least the ones I've worked for (very large, very disparate multi-specialty in many states of the great USA), get paid salary + bonus based on metrics of meeting Medicare metrics, patient encounters/day, etc etc etc.

By the time the reimbursement comes, if at all, the physician has already been, sometimes months prior. In fact, the physician gets paid whether or not (!!) the clinic/hospital gets reimbursed at all. It's this little thing that gets lost on many people:

Why do clinics lose money when the docs are paid so well? So often what gets screamed by people who don't know, "DOCS MUST BE PAID LESS MONEY..." ahem, it's the insurance companies everyone. Medical facilities lose money because insurance companies use every little ability to say, "Nah, we're not paying that code cost at all" or "we're not paying that code cost, we're gonna pay you this instead"... if you appeal, things get lost in the paperwork. Insurance company wins, medical facility loses money.

Wanted to clarify that for you. 🙂

I'm 53. 30 years serving the healthcare industry (finance, IT, revenue cycle, salary negotiations, credentialing, insurance side, STAT/GAAP, EMR - GE, Epic).

.

No true in my case I work with private practices. I participate in the claim submissions and the accounting of the EOBs. What you are saying is simply not true in this case.
7% is left on the table for billers all else is split there is no other mouth to feed in this case. This is not an OPP scenario.

 

[Nerveen]

.

No true in my case I work with private practices. I participate in the claim submissions and the accounting of the EOBs. What you are saying is simply not true in this case.
7% is left on the table for billers all else is split there is no other mouth to feed in this case. This is not an OPP scenario.

Anything not paid at at least Medicare
Fee schedule is appealed immediately.

 

[Ad2b]

Anything not paid at at least Medicare. Fee schedule is appealed immediately.

Awesome for you. It's always nice to hear the insurance companies don't screw over everyone; just the large multi-specialty clinics.

 

[Nerveen]

Sorry I didn't mention my invoices are derived from actual EOBs so I'm not taking from anything not there.
Risk free for a practice that previously did not have a diagnostic service.

 

[Ad2b]

Sorry I didn't mention my invoices are derived from actual EOBs so I'm not taking from anything not there. Risk free for a practice that previously did not have a diagnostic service.

I didn't think you were; but you might be thinking I'm stupid and don't understand clinic billing/revenue cycle or the RVUs, bonuses, salary and contract negotiations with providers and insurance companies. You'd be wrong. Both sides.

It appears you work mostly with private practice/small physician groups who can easily appeal insurance denials and submit all the stuff Medicare wants you to for reimbursement.

If reimbursement were so easy to handle for the large groups, there'd be no need for a McKesson outsourcing group, or an Indian off-shore group to take medical records from US clinics and submit/appeal denials. 🙂

Trying to become a doctor because you don't like your current job is one of the worst reasons to become a doctor.

I completely concur with Goro.

You seem to enjoy the business side; MHA is a great avenue; opens lots of doors, pays you big bucks especially given your already well versed background.

 

[LingoLaine]

I don't think med school is a wise choice in my situation.

Agreed.

 

[QofQuimica]

Trying to become a doctor because you don't like your current job is one of the worst reasons to become a doctor.

This.

OP, I'm all in favor of you quitting a job (or career) you don't like and reinventing yourself. I'm middle aged too, and I've done it a couple of times myself now. So I feel comfortable in saying that your age is not an issue. Your knowledge is not an issue. Your scope of practice is not an issue. Your ego *is* an issue, but only in your own mind. The fact that you have not yet once said that you have any desire to take care of sick people, well, *that* is the main issue. You have no business (pun intended) going to medical school for the motives you've given, and if you do it for the wrong reasons in spite of me telling you not to, you will likely regret it. The greenness of this grass is definitely relative to the observer and not absolute.

It sounds to me like you need to change jobs, or even change careers. I don't know what your financial situation is like, but if you can afford to quit your job and go write FT (or whatever else you enjoy doing), maybe you should. And if you can't afford to do it, maybe you should think about what you can live without that will decrease your expenses enough so that you can afford it. There's more than one way to skin a cat when it comes to escaping a job you hate, and frugality works pretty darn well as a strategy for creating the average middle class millionaire. Just another thought to consider as you ponder various "ill-advised paths."

On a somewhat related note, are your sci fi books any good? I'm always looking for new titles.

Oh, and for the record, you greatly overestimate the sense of self-worth and self-esteem that one gets from being a doctor. I say this as someone who is a doctor twice over. :-/

 

[SpartanWolverine]

Trying to become a doctor because you don't like your current job is one of the worst reasons to become a doctor.

Basically this (and now that I've read the rest of the thread, what @QofQuimica says, too).

There's a lot more to being a neurologist than knowing anatomy and doing whatever testing it is you do. And it sounds like your plan is to basically become a physician just to put a couple of letters after your name and then resume the same work you do now. So... No. Don't do it.

 

[Crayola227]

This.

OP, I'm all in favor of you quitting a job (or career) you don't like and reinventing yourself. I'm middle aged too, and I've done it a couple of times myself now. So I feel comfortable in saying that your age is not an issue. Your knowledge is not an issue. Your scope of practice is not an issue. Your ego *is* an issue, but only in your own mind. The fact that you have not yet once said that you have any desire to take care of sick people, well, *that* is the main issue. You have no business (pun intended) going to medical school for the motives you've given, and if you do it for the wrong reasons in spite of me telling you not to, you will likely regret it. The greenness of this grass is definitely relative to the observer and not absolute.

It sounds to me like you need to change jobs, or even change careers. I don't know what your financial situation is like, but if you can afford to quit your job and go write FT (or whatever else you enjoy doing), maybe you should. And if you can't afford to do it, maybe you should think about what you can live without that will decrease your expenses enough so that you can afford it. There's more than one way to skin a cat when it comes to escaping a job you hate, and frugality works pretty darn well as a strategy for creating the average middle class millionaire. Just another thought to consider as you ponder various "ill-advised paths."

On a somewhat related note, are your sci fi books any good? I'm always looking for new titles.

Oh, and for the record, you greatly overestimate the sense of self-worth and self-esteem that one gets from being a doctor. I say this as someone who is a doctor twice over. :-/

QFT. Everything said here.

OP, I would really reiterate that a Mother Teresa-like love of caring for the sick is really what the it takes to be really happy as a physician. The sacrifices won't be worth it, otherwise.

 

[Dr.J.D]

You'll be finished by 50ish, that is if you actually make it to medical school But if you do make it, and live to 90ish you've got 20-40 years of practice 🙂 or you might die tomorrow