Solo Practice Failures

[Tramadeezy]

Anyone out there start their own practice and abandon ship at some point? Ive been practicing for about 5 years and have given some thought about starting my own thing. I feel like if you put in the work and time it will eventually be successful; may take a while. Curious if anyone is willing share why their practice may have not worked out in the end. Feel free to PM me. Appreciate any insight.

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[drusso]

Anyone out there start their own practice and abandon ship at some point? Ive been practicing for about 5 years and have given some thought about starting my own thing. I feel like if you put in the work and time it will eventually be successful; may take a while. Curious if anyone is willing share why their practice may have not worked out in the end. Feel free to PM me. Appreciate any insight.

The practices I've seen fail are those where the owner doesn't want to commit the time to make it successful. Private practice is a 5-9 job.

 

[nvrsumr]

go for it

 

[Nodolor]

After 13 years of owning private practice about to join Dark side....My situation is one town hospital , refused to be bought out by hospital...they brought in competition, they control majority of referral sources, not worth the fight any more. Though I have a 5 year exit plan from medicine

 

[hyperalgesia]

I had a private practice for about 6 years. It was part time, in addition to my FT hospital job. I didn't need the extra money but just wanted to see what the perfect job was like so I made it in God's image. I only accepted cases I wanted and told referring docs to pound sand when they tried to "dump". No narcotics and no BS. I had some really great patients, mostly elderly, which is what I wanted.

This kind of practice requires marketing. Consults don't just roll in on a silver platter after you tell referring docs to pound sand. So, eventually it came down to either start hustling and marketing myself or enjoy the precious time that we have on this earth do do other things besides practice medicine and dance for insurance companies. So the consults dwindled and I shut it down.

I wouldn't call it a "failure". I made money and made a small difference and enjoyed the practice. Everything was done on a bare bones budget, shared office space, internal EMR, part-time malpractice, etc. My scheduler was a retired teacher who took calls from home and got paid per patient who showed up to their appointment.

 

[Ferrismonk]

My prior job was basically solo private practice with all the overhead stuff handled by an umbrella company. Obviously my experience cuts out much of what starting a practice entrails.

However, I agree with the people above that it's really a tough go to get a practice up an running if there is an competition in your market. Being the best doctor and doing the right thing isn't enough. I was surrounded by unscrupulous private doctors who gave obscene opiates along with in-house UDS, DME for everyone, and mandatory monthly injections (even if it's just trigger points). I also had several hospital systems nearby who only did interventional and for some reason all the patients wanted their procedures at the hospital but for me to write meds. If pain doctors around you write opiates, you'll be expected to if you want referrals. If you aren't part of the local hospital system, many referrals will be unavailable to you since there is major pressure to keep referrals in house. You'll also have to somehow pull away neurosurgical referrals from other established relationships. It's not impossible, but it's tough.

 

[drusso]

After 13 years of owning private practice about to join Dark side....My situation is one town hospital , refused to be bought out by hospital...they brought in competition, they control majority of referral sources, not worth the fight any more. Though I have a 5 year exit plan from medicine

That's terrible. And common.

 

[drusso]

Hustling is the name of the game. You've simply got to be willing to try harder, be more available, and offer better service than the HOPD-employed doctors or ortho-group needle monkey. It's non-stop networking, returning calls, rainmaking, etc. It really is 5 AM to 9 PM. My days usually start with a breakfast meeting or Zoom and end with the same. But, at the end of the day, you're different and people will notice. So, little by little a bird builds its nest.

 

[Agast]

It’s easier to be brave and bold if you don’t have financial pressures. If you’re the breadwinner with 2 kids and student loans to pay, you wear the golden handcuffs and take the job with benefits.

Even “solo practice docs” on this board who talk a big game, advertise hormone therapy and pellets prominently alongside their pain services.

 

[drusso]

It’s easier to be brave and bold if you don’t have financial pressures. If you’re the breadwinner with 2 kids and student loans to pay, you wear the golden handcuffs and take the job with benefits.

Even “solo practice docs” on this board who talk a big game, advertise hormone therapy and pellets prominently alongside their pain services.

HRT is an effective therapy, under-utilized, and safe--especially for women. It saved my wife's life.

Testosterone therapy in women: Myths and misconceptions

Although testosterone therapy is being increasingly prescribed for men, there remain many questions and concerns about testosterone (T) and in particu…

www.sciencedirect.com

Ther Adv Endocrinol Metab

2021 May 27;12:20420188211015238.
doi: 10.1177/20420188211015238. eCollection 2021.

Low complication rates of testosterone and estradiol implants for androgen and estrogen replacement therapy in over 1 million procedures​

Gary S Donovitz 1 2
Affiliations expand

• PMID: 34104398
• PMCID: PMC8165877
• DOI: 10.1177/20420188211015238

Free PMC article

Abstract​

Background: Testosterone (T) deficiency (TD) in men and women and estrogen (E) deficiency (ED) in women increasingly affects the overall health and quality of life of patients. T implants have seen increased utilization over the past decade. We evaluated continuation rates and adverse events that occurred during T therapy by reviewing practitioner reported data on compressed human-identical T implants for the treatment of TD in both men and women collected over 7 years.

Methods: This was a retrospective review of data collected prospectively from men and women from 2012 and 2019. Men who had the clinical syndrome of TD received subcutaneous T implant therapy. Women who presented with symptoms of TD and/or ED underwent T implant and/or estradiol implant therapy. The clinics spanned multiple specialties including obstetrics and gynecology, internal medicine, family practice, and urology. Data were entered into a secure, custom tracking App, using Azure App Services and MS SQL Database integrated with a proprietary dosing site and industry-leading Pharmacy Dispensing software (BioTracker®).

Results: Over the 7 years, 1,204,012 subcutaneous implant procedures were performed for 376,254 patients; 85% of the procedures were performed in women. Of the women, 54% of were premenopausal, and 46% were postmenopausal. The overall continuation rate after two insertions was 93%. The overall complication rate was <1%. Most common secondary response reported was pellet extrusion, which was more common in men (<3%) than women (<1%).

Conclusions: This study is the largest reported retrospective study to evaluate the continuation and complication rates of T pellet implants. The safety of subcutaneous hormone pellet implants in men and women appears to be better than other routes of administration of bioidentical hormone replacement therapy. Further investigations on short- and long-term benefits of this modality are ongoing and could expand the overall utilization of this method.
Keywords: estradiol pellet implantation; pellet; sex hormone deficiency; testosterone pellet implantation.

 

[Agast]

Yeah, I wasn’t planning on naming names. If you think it makes sense for pain docs to be in charge of putting testosterone pellets in women’s’ butts when I can think of 3 other more appropriate medical specialties, we’re going to have to agree to disagree. Of course it’s just a coincidence that it’s cash pay.

You can’t hide a dollar from a pain doc. But according to this ASIPP lecture I’m listening to, we can expect our reimbursement to go down 6% *sad trombone* so maybe we should all be opening pellet clinics.

 

[Taus]

Hustling is the name of the game. You've simply got to be willing to try harder, be more available, and offer better service than the HOPD-employed doctors or ortho-group needle monkey. It's non-stop networking, returning calls, rainmaking, etc. It really is 5 AM to 9 PM. My days usually start with a breakfast meeting or Zoom and end with the same. But, at the end of the day, you're different and people will notice. So, little by little a bird builds its nest.

I know we have to agree to disagree….. but frankly that sounds terrible.

 

[Iamnew2]

Anyone out there start their own practice and abandon ship at some point? Ive been practicing for about 5 years and have given some thought about starting my own thing. I feel like if you put in the work and time it will eventually be successful; may take a while. Curious if anyone is willing share why their practice may have not worked out in the end. Feel free to PM me. Appreciate any insight.

It's hard if you are in a competitive market - larger cities are saturated with interventional everything. Out in the boonies, you get everything sure but people tend to lack insurance, good finances, making it as bad or worse option. Given the large massive groups these days in large cities in particular it's hard to compete - I thought about taking a job for one of the major pain groups here in my area, apparently they have 27 clinics - mostly in the nice wealthy suburbs - and apparently they opened one up about 10 minutes from where I live! But it would be impossible for me as an example to compete with that. I think it's hard. Reason why private practice - at least starting one in an internvetional field is so challenging these days. Buying one that's alreayd in business - that's a different story.

 

[nvrsumr]

I am solo straight interventional in a millennials paradise. 8-5 m-r, half days Friday. I take all insurance including caid.

You can do it. No butt pills required

 

[Agast]

I am solo straight interventional in a millennials paradise.

Hiking trails, beer gardens, cute brunch spots and trendy art installations?

 

[nvrsumr]

You’ve been here too?! Haha

 

[drusso]

Yeah, I wasn’t planning on naming names. If you think it makes sense for pain docs to be in charge of putting testosterone pellets in women’s’ butts when I can think of 3 other more appropriate medical specialties, we’re going to have to agree to disagree. Of course it’s just a coincidence that it’s cash pay.

You can’t hide a dollar from a pain doc. But according to this ASIPP lecture I’m listening to, we can expect our reimbursement to go down 6% *sad trombone* so maybe we should all be opening pellet clinics.

I think women's health issues get psychologized and medicalized and ultimately explained away. Some of those women land in pain clinics with "pelvic pain," dyspareunia, etc after OB/GYN's have said, "it's all in your head." And, PCP's do a terrible job of managing metabolic bone disease and osteoporosis especially in females with late menarche and early menopause. They never had a chance to build bone. If you got the skillset to tunnel a stim lead, do a kypho, or figure out how to dose and titrate coumadin to target INR, there's no limit to the number of women you can help with HRT. It's not rocket science. But, ignoring it is a great way to grow your DRG practice. Just place two leads and L1 and S2. Easy-Peezy.

 

[Tramadeezy]

Thanks for the insight. My current gig is great, 9-4 m-f, compensation is solid. There are a few things in the group that I dont like but for the most part I dont mind having a boss. An opportunity has come up with a good friend of mine in a large city a few hours from where im at now. He has about 8000 sqft of unused office space and we were throwing around the idea of starting a pain clinic/asc. I think it could be a great long term investment but obviously a lot of work.

 

[Ferrismonk]

Hustling is the name of the game. You've simply got to be willing to try harder, be more available, and offer better service than the HOPD-employed doctors or ortho-group needle monkey. It's non-stop networking, returning calls, rainmaking, etc. It really is 5 AM to 9 PM. My days usually start with a breakfast meeting or Zoom and end with the same. But, at the end of the day, you're different and people will notice. So, little by little a bird builds its nest.

I admire your gumption and agree that's what it takes to build a good business. However, I see your practice is just like all the old family doc offices that got shuttered when the old workhorse retired. Nobody else you bring in will work that hard and no one who may purchase your practice when you wish to retire will work the same way either.

 

[drusso]

I admire your gumption and agree that's what it takes to build a good business. However, I see your practice is just like all the old family doc offices that got shuttered when the old workhorse retired. Nobody else you bring in will work that hard and no one who may purchase your practice when you wish to retire will work the same way either.

That's right. It's a different mindset and a different level of commitment.

 

[hyperalgesia]

Thanks for the insight. My current gig is great, 9-4 m-f, compensation is solid. There are a few things in the group that I dont like but for the most part I dont mind having a boss. An opportunity has come up with a good friend of mine in a large city a few hours from where im at now. He has about 8000 sqft of unused office space and we were throwing around the idea of starting a pain clinic/asc. I think it could be a great long term investment but obviously a lot of work.

For me some would depend on the consequences of failure, ie supporting a family, debt, etc.

The most fun part for me is building the practice, proving you can do it, etc. Once you're fully in it and the novelty has worn off, that's when you get to find out if it was worth it.

 

[Orin]

No risk it, no biscuit.

Although in honesty, isn't there always a fall back plan even if you might not like it?

 

[DrSpine]

It’s easier to be brave and bold if you don’t have financial pressures. If you’re the breadwinner with 2 kids and student loans to pay, you wear the golden handcuffs and take the job with benefits.

Even “solo practice docs” on this board who talk a big game, advertise hormone therapy and pellets prominently alongside their pain services.

That first mentality is the worst and most depressing. I would flat out abandon medicine or would tell everyone to avoid such an indentured servitude. Guys with big balls take the big risks and come out the winners.

I'd rather shoot pellets than be a dog for an administrator or private equity guy mindlessly doing unnecessary procedures otherwise my RVUs will "drop" and I'm not being a "team player" by refusing to cycle patients in/out of the never ending hospital procedure carousel or PE shady business scam. Legit, I feel bad for those patients. PCPs from Hospital PGs are told to refer endlessly with patients - to encourage referrals and imaging - and those referrals then serve to generate endless procedures. "Hi 50 year old guy with GERD, OA, Back Pan, HTN...here's your referrals to GI, Ortho, Spine/Pain, Cardiology. Enjoy the Endoscopy, THA, LESI x3, and cardiac tests." No wonder why the US overdoes everything, and our healthcare costs are through the roof. This was the goal of Obamacare and "integration/streamlining of healthcare."

 

[DrSpine]

Hustling is the name of the game. You've simply got to be willing to try harder, be more available, and offer better service than the HOPD-employed doctors or ortho-group needle monkey. It's non-stop networking, returning calls, rainmaking, etc. It really is 5 AM to 9 PM. My days usually start with a breakfast meeting or Zoom and end with the same. But, at the end of the day, you're different and people will notice. So, little by little a bird builds its nest.

Sounds like the talk of a successful guy who is master of his own destiny, provides the best care for his patients, and doesn't take crap from anyone. Kudos to you dude.

 

[DrSpine]

It's hard if you are in a competitive market - larger cities are saturated with interventional everything. Out in the boonies, you get everything sure but people tend to lack insurance, good finances, making it as bad or worse option. Given the large massive groups these days in large cities in particular it's hard to compete - I thought about taking a job for one of the major pain groups here in my area, apparently they have 27 clinics - mostly in the nice wealthy suburbs - and apparently they opened one up about 10 minutes from where I live! But it would be impossible for me as an example to compete with that. I think it's hard. Reason why private practice - at least starting one in an internvetional field is so challenging these days. Buying one that's alreayd in business - that's a different story.

"It's hard due to saturatation." Do me a favor, call your local specialist Physician in any city, let me know when you can see the PHYSICIAN and not the NP/PA. I'm not sure why we get scared away with that saturation statement. Doctors, primarily specialists, are IMPOSSIBLE to get an appointment with. Somehow we're oversaturated? We're not Starbucks Baristas here, we're ultra niche highly trained guys. Every physician I meet, nearly 95%, who own a practice in a major metropolitan city, I ask if they're doing miserable and regret it. The answer is 95% of the time, "nope, I don't know why I didn't do this before...first year was brutal, after that I'm doing good." The issue comes down to how many hours and time one is willing to put in.

 

[Iamnew2]

"It's hard due to saturatation." Do me a favor, call your local specialist Physician in any city, let me know when you can see the PHYSICIAN and not the NP/PA. I'm not sure why we get scared away with that saturation statement. Doctors, primarily specialists, are IMPOSSIBLE to get an appointment with. Somehow we're oversaturated? We're not Starbucks Baristas here, we're ultra niche highly trained guys. Every physician I meet, nearly 95%, who own a practice in a major metropolitan city, I ask if they're doing miserable and regret it. The answer is 95% of the time, "nope, I don't know why I didn't do this before...first year was brutal, after that I'm doing good." The issue comes down to how many hours and time one is willing to put in.

I don't know where you practice, but in my area, there are specialists of every kind in every variety, everywhere.

 

[hyperalgesia]

"It's hard due to saturatation." Do me a favor, call your local specialist Physician in any city, let me know when you can see the PHYSICIAN and not the NP/PA. I'm not sure why we get scared away with that saturation statement. Doctors, primarily specialists, are IMPOSSIBLE to get an appointment with. Somehow we're oversaturated? We're not Starbucks Baristas here, we're ultra niche highly trained guys. Every physician I meet, nearly 95%, who own a practice in a major metropolitan city, I ask if they're doing miserable and regret it. The answer is 95% of the time, "nope, I don't know why I didn't do this before...first year was brutal, after that I'm doing good." The issue comes down to how many hours and time one is willing to put in.

in my city, you can get to see any number of bc, fellowship trained pain docs in less than 2 weeks. you will eventually be seeing an np for all your narcotic refills though.

 

[Iamnew2]

in my city, you can get to see any number of bc, fellowship trained pain docs in less than 2 weeks. you will eventually be seeing an np for all your narcotic refills though.

Same where I did fellowship.

 

[10KHertz]

Until site of service payments are equalized , hospitals and their minions will control healthcare volume in all regions. You may be lucky and with amazing skills, an efficient staff, and a large patient population . But these unicorn private practices are hard to replicate and compete with… take home message : reverse SOS injustice.

 

[bedrock]

in my city, you can get to see any number of bc, fellowship trained pain docs in less than 2 weeks. you will eventually be seeing an np for all your narcotic refills though.

Exactly. You can definitely start your own practice in BFE, or in a small-medium town.
But if you want to live in one of the top 10 metros in the US, it is far harder to start your own practice and keep it viable.

 

[DrSpine]

Until site of service payments are equalized , hospitals and their minions will control healthcare volume in all regions. You may be lucky and with amazing skills, an efficient staff, and a large patient population . But these unicorn private practices are hard to replicate and compete with… take home message : reverse SOS injustice.

Isn't that happening right now? If I am not mistaken, isn't HHS implementing this, and despite the AHA's attempt to sue, was upheld by circuit court? I heard they're trying for Supreme Court, but unlikely to get there. I imagine if it stands as is, private insurers will follow CMS/Medicare. If Outpatient visits become site neutral, isn't that hopefully a start for procedures as well, etc?

 

[Sushirolls]

"It's hard due to saturatation." Do me a favor, call your local specialist Physician in any city, let me know when you can see the PHYSICIAN and not the NP/PA. I'm not sure why we get scared away with that saturation statement. Doctors, primarily specialists, are IMPOSSIBLE to get an appointment with. Somehow we're oversaturated? We're not Starbucks Baristas here, we're ultra niche highly trained guys. Every physician I meet, nearly 95%, who own a practice in a major metropolitan city, I ask if they're doing miserable and regret it. The answer is 95% of the time, "nope, I don't know why I didn't do this before...first year was brutal, after that I'm doing good." The issue comes down to how many hours and time one is willing to put in.

Saturation is real, and there are different types. I'm Psych and I'm swimming in a sea of ARNPs next to an ARNP pill. I'm still growing, slowly, and won't ever go back to Big Box shop. A Sleep Medicine doc I have subleasing from me has their own type of saturation from the Big Box shops. This person only gets referrals from the private independent PCPs (or random patients who used insurance directory). As PCPs are slowing being bought up by Big Box shops and this person also has other Sleep Medicine competition, their growth rate is just as slow as mine. Yet, this doc also has tasted freedom and won't ever go back to Big Box shop despite the big hit to income.

In summary, saturation can be a thing, so try to look for a healthy percentage of independent private PCPs, overall, they will refer to other independent groups when they have the choice over the large Big Box shop entities.

Don't be afraid to think outside of the box either. Perhaps its pellets? Or perhaps its hiring a psychologist and starting a chronic pain group therapy. Or perhaps learning basic CBT and doing it yourself? The sleep doc who subleases from me does their own CBTi and is a big niche and generating a lot of referrals just for that - which at times helps to fuel some sleep studies. Yes, a pain doc could drop a therapy 90833 add on code and get paid for it, but you need to document it well (own topic for another day). I've got pain docs in my metro pushing Ketamine on psych patients.

 

[10KHertz]

Isn't that happening right now? If I am not mistaken, isn't HHS implementing this, and despite the AHA's attempt to sue, was upheld by circuit court? I heard they're trying for Supreme Court, but unlikely to get there. I imagine if it stands as is, private insurers will follow CMS/Medicare. If Outpatient visits become site neutral, isn't that hopefully a start for procedures as well, etc?

CMS director looking to capitate everything. ..
Basically, robot cookie cutter medicine for all.

 

[au bon pain]

Or perhaps learning basic CBT and doing it yourself? The sleep doc who subleases from me does their own CBTi and is a big niche and generating a lot of referrals just for that - which at times helps to fuel some sleep studies. Yes, a pain doc could drop a therapy 90833 add on code and get paid for it, but you need to document it well (own topic for another day).

Any high-yield resources you'd recommend for a pain doc interesting in learning basic CBT?

 

[au bon pain]

in my city, you can get to see any number of bc, fellowship trained pain docs in less than 2 weeks. you will eventually be seeing an np for all your narcotic refills though.

The area where I trained had two groups doing exactly this. They'd move mountains to make room on their schedule for new patient appointments and procedures with the doc. Oh you want to follow up? That'll be 8 weeks at 5:38am with NP#572. But you want to see the doc for follow-up? Sure, the next available doc follow-up appt is in 34 weeks lolz.

 

[drusso]

Saturation is real, and there are different types. I'm Psych and I'm swimming in a sea of ARNPs next to an ARNP pill. I'm still growing, slowly, and won't ever go back to Big Box shop. A Sleep Medicine doc I have subleasing from me has their own type of saturation from the Big Box shops. This person only gets referrals from the private independent PCPs (or random patients who used insurance directory). As PCPs are slowing being bought up by Big Box shops and this person also has other Sleep Medicine competition, their growth rate is just as slow as mine. Yet, this doc also has tasted freedom and won't ever go back to Big Box shop despite the big hit to income.

In summary, saturation can be a thing, so try to look for a healthy percentage of independent private PCPs, overall, they will refer to other independent groups when they have the choice over the large Big Box shop entities.

Don't be afraid to think outside of the box either. Perhaps its pellets? Or perhaps its hiring a psychologist and starting a chronic pain group therapy. Or perhaps learning basic CBT and doing it yourself? The sleep doc who subleases from me does their own CBTi and is a big niche and generating a lot of referrals just for that - which at times helps to fuel some sleep studies. Yes, a pain doc could drop a therapy 90833 add on code and get paid for it, but you need to document it well (own topic for another day). I've got pain docs in my metro pushing Ketamine on psych patients.

Describe what it felt like working for the Big Box shop?

 

[Sushirolls]

Any high-yield resources you'd recommend for a pain doc interesting in learning basic CBT?

Best CBT Manuals

What are the manuals you use when you conduct CBT? I still have some CME funds to burn and am looking to put them to good use.

forums.studentdoctor.net

 

[Sushirolls]

Another niche is Hypnosis for pain. There is PhD at UW I believe who focuses a lot on Ericksonian hypnosis for pain.

Get some basic training here: American Society of Clinical Hypnosis > Home

Majority of insurance won't pay for hyponsis so it would be an OON cash based modality

 

[Agast]

If I tried to hypnotize my patients

I'd probably put myself to sleep

 

[drusso]

Another niche is Hypnosis for pain. There is PhD at UW I believe who focuses a lot on Ericksonian hypnosis for pain.

Get some basic training here: American Society of Clinical Hypnosis > Home

Majority of insurance won't pay for hyponsis so it would be an OON cash based modality

Hypnosis and interactive guided imagery work well for people who understand how their minds work. Sometimes helpful for the somatically focused.

 

[Iamnew2]

Hypnosis and interactive guided imagery work well for people who understand how their minds work. Sometimes helpful for the somatically focused.

If people don't even want to pay for co-pays how many do you think will pay for hypnosis?

 

[drusso]

If people don't even want to pay for co-pays how many do you think will pay for hypnosis?

You have to show your outcomes, testimonials, patient ambassadors, seminars, etc.

 

[Iamnew2]

You have to show your outcomes, testimonials, patient ambassadors, seminars, etc.

Don't think you'd cover your expenses even if you had to pay a hypnotherapist. Not thinking it's worth it.

 

[drusso]

Don't think you'd cover your expenses even if you had to pay a hypnotherapist. Not thinking it's worth it.

Just have patients pay cash.

 

[Pain Applicant1]

For me some would depend on the consequences of failure, ie supporting a family, debt, etc.

The most fun part for me is building the practice, proving you can do it, etc. Once you're fully in it and the novelty has worn off, that's when you get to find out if it was worth it.

That first mentality is the worst and most depressing. I would flat out abandon medicine or would tell everyone to avoid such an indentured servitude. Guys with big balls take the big risks and come out the winners.

I'd rather shoot pellets than be a dog for an administrator or private equity guy mindlessly doing unnecessary procedures otherwise my RVUs will "drop" and I'm not being a "team player" by refusing to cycle patients in/out of the never ending hospital procedure carousel or PE shady business scam. Legit, I feel bad for those patients. PCPs from Hospital PGs are told to refer endlessly with patients - to encourage referrals and imaging - and those referrals then serve to generate endless procedures. "Hi 50 year old guy with GERD, OA, Back Pan, HTN...here's your referrals to GI, Ortho, Spine/Pain, Cardiology. Enjoy the Endoscopy, THA, LESI x3, and cardiac tests." No wonder why the US overdoes everything, and our healthcare costs are through the roof. This was the goal of Obamacare and "integration/streamlining of healthcare."

Right and right.

I started my practice after fellowship and am going on for about 10 years now. It was a lot of work at the beginning but now that I'm established I only work 22 hours per week and consider myself semi-retired. I don't do the pellet thing but I would if I wanted to. One of the best things about medicine is what your license allows you to do. If you're slow in your primary specialty you can always learn other things to add to your practice. I did my fellowship in pain but I started doing suboxone a few years out and I like it better. Never let haters stop you from doing anything.

Autonomy is also one of the best parts of my job. I would accept less of an income to have my independence and I can't imaging going to useless hospital meetings at this point. Fortunately, in medicine, you can have independence and a high salary.

 

[plasma.]

When starting a solo practice, is it reasonable to limit your practice to certain patients such as spine / joint / peripheral pain etc? Given patients with chronic headache / abdo / pelvic pain usually require a multidisciplinary approach and we may not have the necessary personnel to treat these patients effectively (in house psychologist, physiotherapist etc).

 

[Pain Applicant1]

When starting a solo practice, is it reasonable to limit your practice to certain patients such as spine / joint / peripheral pain etc? Given patients with chronic headache / abdo / pelvic pain usually require a multidisciplinary approach and we may not have the necessary personnel to treat these patients effectively (in house psychologist, physiotherapist etc).

Of course you can do whatever you'd like but I wouldn't recommend it. I would work on filling up the schedule. I would take all patients and all payers. Once you're busy you can start skimming off the top.

 

[plasma.]

Of course you can do whatever you'd like but I wouldn't recommend it. I would work on filling up the schedule. I would take all patients and all payers. Once you're busy you can start skimming off the top.

Once you start accepting all patients, does it become more difficult to be selective in the future? Because the referring doctors will expect you to see everyone at that time? Versus if you are more selective, it'll take longer to build up the practice but you could build an ideal practice over time? I'm just starting fellowship this year so very new to thinking about all this

 

[Pain Applicant1]

Once you start accepting all patients, does it become more difficult to be selective in the future? Because the referring doctors will expect you to see everyone at that time? Versus if you are more selective, it'll take longer to build up the practice but you could build an ideal practice over time? I'm just starting fellowship this year so very new to thinking about all this

No way. Once the patients like you they will send to you because you become a reflection of the referring provider. I'm solo in a place where the local university hospital owns nearly everthing, including 99% of primary care and specialists. I have several competitors now but I'm still around.

I only accept medicaid for suboxone and for nothing else. I accept medicaid for suboxone because I choose to do that for my community since the town I live in has been very good to me. I'm at the point where I don't depend on any one referral source and word of mouth is probably enough to keep me busy. I don't really care if anyone would stop referring to me at this point.

The most important thing is to make the patients love you. The most important thing to make this happen is to be kind and caring to them. It really is that simple.

Contrary to what you may want to believe, fellowship, acgme, ivy league, etc. means very little once you're established. I have all of those things and my diplomas are sitting on the bottom of a shelf somewhere. No one cares. But they do care if you give their father who is dying from cancer your cell phone number so you can help him die in peace and not in pain.

 

[plasma.]

No way. Once the patients like you they will send to you because you become a reflection of the referring provider. I'm solo in a place where the local university hospital owns nearly everthing, including 99% of primary care and specialists. I have several competitors now but I'm still around.

I only accept medicaid for suboxone and for nothing else. I accept medicaid for suboxone because I choose to do that for my community since the town I live in has been very good to me. I'm at the point where I don't depend on any one referral source and word of mouth is probably enough to keep me busy. I don't really care if anyone would stop referring to me at this point.

The most important thing is to make the patients love you. The most important thing to make this happen is to be kind and caring to them. It really is that simple.

Contrary to what you may want to believe, fellowship, acgme, ivy league, etc. means very little once you're established. I have all of those things and my diplomas are sitting on the bottom of a shelf somewhere. No one cares. But they do care if you give their father who is dying from cancer your cell phone number so you can help him die in peace and not in pain.

This is excellent advice and really reassuring. I agree, being available for patients and providing good and empathetic care should be a priority. Appreciate your guidance!