Solo Practice Failures

[Orin]

I'm interested to see what happens if Medicare covers dentists, etc. I wonder if that'll change the coverage patterns and practice parameters for these cash-providers.

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[DOctorJay]

And they commit suicide at horrendous rates. No thanks.

Male dentists hold the highest suicide rate at 8.02 percent. Female dentists hold the fourth highest suicide rate at 5.28 percent. Physicians (7.87 percent), pharmacists (7.19 percent) and nurses (6.56 percent) also hold suicide rates much higher than the national average.

Mental Illness and Suicide in Dental School Fighting the Stigma

A review of author David Vann’s “Legend of a Suicide” shows the need of changing the perception and stigma of mental illness in the dental industry.

success.ada.org

 

[Pain Applicant1]

In response to OP, I just thought I would contribute my 2 cents.

I am currently in a solo practice situation, but I did not start my own practice. It is still up and running, so not a failure, but I am feeling some sense of burnout, and trying to figure out how I can manage things better (hence my earlier post on how to handle patient phone calls). There were other physicians initially when I joined, but for various reasons, others left, and I inherited the practice with no buy-in which is probably an incredibly rare situation and opportunity. There was a good reason for the no buy-in though, as the practice has it's challenges, spread out over few locations, so high overhead cost to inherit for one practitioner (we have downsized now to 2 main locations). I am not getting rich doing this, because that was never my priority. I could probably make more if I worked for a hospital, although the potential to make more is probably there, if I were to prioritize that. I agree with one of the other posters that running a private practice, especially if solo, would be a 5a-9p job. What makes my situation a little more manageable is that I have a non-physician business partner who handles all of the non clinical aspects of running a practice. If I took over his responsibilities, I could make more for myself (his salary would become mine), but I just don't have the aptitude for it, or the desire to do so, and I would be even more enslaved to my work. So the arrangement works for me. As to why I would not just go work for a hospital...in the end, I do value having some degree of independence from administrative bureaucracy, which allows for some flexibility in my schedule, and allows me more freedom to practice pain in a way that I feel is best for my patients.



Perhaps the best advice here. I find this to be very true.

Not good if my advice is the best one here, lol

If you want to ask specific questions I can try and help you. As I frequently post about, I started my practice from the ground up by myself so I've pretty much have done everything. My wife and children are my first priority so I haven't let the practice take over my life. It easily can but I've learned to make it fairly efficient. If you allow it, your practice will become a beast that will swallow up all of your time. It takes effort to not allow that to happen.

I created systems for different tasks to try to make everything run as smoothly as possible. My practice is busy and I have only one employee at this time. She multitasks everything, including operating my fluoro. What part of your practice is taking up your time? If you mention it, I can let you know how I handle my practice with respect to it if you want.

 

[plasma.]

Not good if my advice is the best one here, lol

If you want to ask specific questions I can try and help you. As I frequently post about, I started my practice from the ground up by myself so I've pretty much have done everything. My wife and children are my first priority so I haven't let the practice take over my life. It easily can but I've learned to make it fairly efficient. If you allow it, your practice will become a beast that will swallow up all of your time. It takes effort to not allow that to happen.

I created systems for different tasks to try to make everything run as smoothly as possible. My practice is busy and I have only one employee at this time. She multitasks everything, including operating my fluoro. What part of your practice is taking up your time? If you mention it, I can let you know how I handle my practice with respect to it if you want.

That’s really impressive!
Did you hire a radiology technician who is then able to also do the other tasks for you?

Is a rad tech even necessary? Could you train an MA or Nurse to operate the fluoro?

 

[Pain Applicant1]

That’s really impressive!
Did you hire a radiology technician who is then able to also do the other tasks for you?

Is a rad tech even necessary? Could you train an MA or Nurse to operate the fluoro?

Thx, I believe it depends on your state's law or in your case I guess in your provinces or territory, canuck. Where I am, my employee can move the fluoro but she can't take a picture. So, she moves it upon my direction but I step on the pedal to shoot the picture.

 

[jsaul]

I started my solo practice from the ground up. It's just me, one MA, one " insurance girl" and one part time receptionist.
It is hard but doable but I would not trade it for an employed position, especially hospital employed

 

[drusso]

Only 3 in 10 physicians remain independent. I can’t believe our profession had abandoned ship this way. Independence is precious and not to be taken for granted.

Nearly half of physician practices owned by hospitals, corporate entities, report finds

Avalere found that independent doctors are becoming increasingly rare in the U.S., which should raise alarms, according to a coalition of state medical societies. It's urging Congress to act.

www.healthcaredive.com

 

[Iamnew2]

Only 3 in 10 physicians remain independent. I can’t believe our profession had abandoned ship this way. Independence is precious and not to be taken for granted.

Nearly half of physician practices owned by hospitals, corporate entities, report finds

Avalere found that independent doctors are becoming increasingly rare in the U.S., which should raise alarms, according to a coalition of state medical societies. It's urging Congress to act.

www.healthcaredive.com

I was chatting about this exact same thing with my SO today. I was telling him how more and more physicians are not in private practice, and that a lot of docs work in hospital based/equity backed type groups because not infrequently it's simply a better deal, for myself included and how it's become so challenging especially in saturated cities, to deal with your own practice. I work at a hospital, IC but with a significant director stipend from the hospital. I was telling SO how to get to this level of money it would be difficult if I were to branch out on my own. Is it bad? Not necessarily. I get a lot of say and independence in terms of admin stuff and almost complete independence in terms of clinical decision making. Not a bad deal at all for me. As a small business owner too I deal with the pressures and independence of owning such said business - and all that it implies. So while freedom is great, it can be very challenging to practice if you are a small private practice doc.

 

[hyperalgesia]

In my private practice vs my hospital job, I honestly felt like a prisoner in both. The hospital employed job for obvious reasons but the private practice I found to be equally oppressive because of insurance, medicare, hipaa, malpractice, etc. I did not find solo private practice to be a utopia of freedom by any stretch of the imagination.

OTOH, another business I was working on with software, was a COMPLETELY different story. It was funny because when I called medicare and pushed the button that says I'm a provider, I was transferred to the mill and treated like garbage. But when I called as a software vendor, I was transferred to the VIP - TOTALLY different experience. Ditto with private insurance.

Back to my original point, I find hospital employment to be about the same as private practice in terms of feeling like a burnt out prisoner.

 

[Agast]

I like being able to decide on a vacation at the last minute and have staff move my schedule around or close quickly for my own doctor appointments. You can only do that when you work for yourself. As soon as the new guy starts I’m going to 4 days a week. Play around with different schedules. I don’t think I could be an employee after this, I’m spoiled.

^^Did you really feel burdened by HIPAA @hyperalgesia ? Must have been some fancy schmancy patients. #freeBritney

 

[NJPAIN]

But the dentists were smart. They never went in on "managed care" contracts, etc.

So true. I just had a conversation with my dentist about this. He started off the visit asking “ how are things?” which opened the floodgates. Think about it… almost no solo practitioners in any medical specialty but still TONS of dentists, podiatrists and Chiros. We are definitely doing something wrong.

 

[Laryngospasm]

I like being able to decide on a vacation at the last minute and have staff move my schedule around or close quickly for my own doctor appointments. You can only do that when you work for yourself. As soon as the new guy starts I’m going to 4 days a week. Play around with different schedules. I don’t think I could be an employee after this, I’m spoiled.

^^Did you really feel burdened by HIPAA @hyperalgesia ? Must have been some fancy schmancy patients. #freeBritney

I disagree.. I’ve done both hospital and PP and currently hospital. I cancel for whatever reason I want whenever I want. Granted I try to be respectful to the patients and not do it haphazardly. I believe it depends on your hospital and how far up your butt they are.

 

[nvrsumr]

It seems nationally hospital jobs have gotten much better and the PP worse since I last took a look 10 years ago.

in my backyard I don’t believe hospital employed docs are making 750k with 12 weeks vacation like a lot of the folks on sdn but I’m not really in the loop. I see the local guys once a year at the state pain conference and that’s about it.

 

[buddababa]

I like being able to decide on a vacation at the last minute and have staff move my schedule around or close quickly for my own doctor appointments. You can only do that when you work for yourself. As soon as the new guy starts I’m going to 4 days a week. Play around with different schedules. I don’t think I could be an employee after this, I’m spoiled.

^^Did you really feel burdened by HIPAA @hyperalgesia ? Must have been some fancy schmancy patients. #freeBritney

I'm hospital employed and I have full control of my schedule as such. Basically I can work as little hours as I want and take as many days off as I wanted and vice versa

 

[cowboydoc]

I disagree.. I’ve done both hospital and PP and currently hospital. I cancel for whatever reason I want whenever I want. Granted I try to be respectful to the patients and not do it haphazardly. I believe it depends on your hospital and how far up your butt they are.

This! I tell my nurse I’m not working Friday. Deuces! My impetus is to not burden pts. with last minute changes, no other pressure. If I’m gone, not worried about staff getting paid to do nothing, etc. It’s not all bad. YMMV!

 

[hyperalgesia]

I feel MUCH more free to move pts around, take time off, etc from my hospital job than I ever did in private practice. I tell my staff I'll be gone for an hour, period. In my small practice in a highly competitive market, I was always nervous a pt would not be satisfied and move right on. If you're not worried about it, that's great.

For hipaa, I was using my own cloud emr and mostly worked out of a home office since it was just a part time deal. But faxing records and notes just added another worry. My hospital has a whole department for that.

I think in any business, if you get to the point where you can hire staff to take care of all your needs, get you coffee in the am, etc, then you basically WIN. But I don't see that very much in medicine unfortunately.

 

[Ducttape]

Buddy of mine is an endodontist. He’s got a brand new 911 turbo S and an E63 AMG. Turned in an Audi R8 V10 to get the 911.

love how one person who probably is still living in moms basement but has nice cars is an example of what all of them make.

fwiw, an endodontist is a specialist. kind of like you and I. and would do 12-13 years of "training" (which I guess you included 4 years of undergrad).

for similar amount of schooling:

https://www.ziprecruiter.com/Salaries/Endodontist-Salary

Endodontist Salary | Salary.com

The average Endodontist salary in the United States is $196,501 as of March 26, 2024, but the salary range typically falls between $176,264 and $221,364.

www.salary.com

that would be crappy salary for a pain doc, wouldn't it...

 

[RoloTomassi]

Dental specialists can make bank and have cush hours. Orthodontics, periodontists, implants, cosmetics, etc. Residency is 2-3 years, no fellowship. I think a lot of salary sites like that are employed positions. Most I know are owners, work in plush highrises with nice views and cash only. The work itself is not for me, but I don't think it's that different from what we do--procedures in small spaces requiring a lot of accuracy and attention to detail. Patients aren't excited to have to see us either. Don't understand all the suicide stats--maybe old data or not an accurate picture. I'd rather do that than half of MD specialties like inpatient rehab, PCP, Medicaid, etc.

 

[Iamnew2]

Dental specialists can make bank and have cush hours. Orthodontics, periodontists, implants, cosmetics, etc. Residency is 2-3 years, no fellowship. I think a lot of salary sites like that are employed positions. Most I know are owners, work in plush highrises with nice views and cash only. The work itself is not for me, but I don't think it's that different from what we do--procedures in small spaces requiring a lot of accuracy and attention to detail. Patients aren't excited to have to see us either. Don't understand all the suicide stats--maybe old data or not an accurate picture. I'd rather do that than half of MD specialties like inpatient rehab, PCP, Medicaid, etc.

Do you think there are endless numbers of people who pay for these services with thousands of dollars to throw at their dental specialties?

 

[RoloTomassi]

Do you think there are endless numbers of people who pay for these services with thousands of dollars to throw at their dental specialties?

In my area, big city, I've been to several of these specialists, usually booked 1 month out. Doctors let insurance take over our field, dentists didn't. We have to play by their rules now. This isn't plastics, tons of people need gum grafts, bone grafts, implants for teeth falling out, orthognathic surgery. Not being able to eat solid food is a big deal, people prioritize.

 

[DOctorJay]

love how one person who probably is still living in moms basement but has nice cars is an example of what all of them make.

fwiw, an endodontist is a specialist. kind of like you and I. and would do 12-13 years of "training" (which I guess you included 4 years of undergrad).

for similar amount of schooling:

https://www.ziprecruiter.com/Salaries/Endodontist-Salary

Endodontist Salary | Salary.com

The average Endodontist salary in the United States is $196,501 as of March 26, 2024, but the salary range typically falls between $176,264 and $221,364.

www.salary.com

that would be crappy salary for a pain doc, wouldn't it...

hahahahaha

my buddy has a gigantic house, owns the practice with his friend from dental school and that dude drives a Lambo. perhaps they're the exception but it's not unheard of.

your point is taken regarding the N of 1, well 2 in this case

 

[Iamnew2]

hahahahaha

my buddy has a gigantic house, owns the practice with his friend from dental school and that dude drives a Lambo. perhaps they're the exception but it's not unheard.

I think we should all become endodontists

 

[drusso]

Do you think there are endless numbers of people who pay for these services with thousands of dollars to throw at their dental specialties?

It took me 6 weeks to see my periodontist for a gum graft. It was a 15 min procedure and he got paid $2K and he did it in his office.

 

[Ducttape]

and I recently went in to my dentists office reeking of garlic.




actually, I didn't. because she is really cute. but I digress.

 

[hyperalgesia]

It took me 6 weeks to see my periodontist for a gum graft. It was a 15 min procedure and he got paid $2K and he did it in his office.

Identical experience. It's a great field imo.

 

[sloh]

The grass isn't always greener. You guys should go to the dental forums and see the threads on their dismal job market and job offers.

 

[Iamnew2]

Identical experience. It's a great field imo.

I think that while some people dish out money to do things like this there are limited numbers of people w access to this type of money. I do prp for hair loss for example I recently had a client come and say you are my new prp person from now on! I said why? She’s like well the dermatologist wants to charge me $700 per treatment I can’t afford that! Lots of people just simply don’t have the monies. You two likely do. You two are prob pain docs making 400k plus. Most people are not like u two.

 

[cowboydoc]

I think that while some people dish out money to do things like this there are limited numbers of people w access to this type of money. I do prp for hair loss for example I recently had a client come and say you are my new prp person from now on! I said why? She’s like well the dermatologist wants to charge me $700 per treatment I can’t afford that! Lots of people just simply don’t have the monies. You two likely do. You two are prob pain docs making 400k plus. Most people are not like u two.

There's a corporate owned franchise doing "restorative" health near me. They had PCPhysicians and now NPs doing O and P shots (google it), vampire facials (think PRP in botox targets), etc. They had people lined up around the block paying $750-1000 per treatment. People spend a lot of their money on stupid stuff.

 

[drusso]

There's a corporate owned franchise doing "restorative" health near me. They had PCPhysicians and now NPs doing O and P shots (google it), vampire facials (think PRP in botox targets), etc. They had people lined up around the block paying $750-1000 per treatment. People spend a lot of their money on stupid stuff.

My wife got the Vampire facial a couple of times with micro-needling. I've got to say, the results are not like plastic surgery, but noticeable...it only lasts a few months though. It really is more of a "medi-spa" treatment...

Again, if you comfortable cannulating pedicles and shoving spine jacks in people, and tunneling stereo cable under people's skin-- all these procedures are suitable to an interventional pain doctor's core skill set. It's all cash and no one complains.

 

[Agast]

hahahahaha

my buddy has a gigantic house, owns the practice with his friend from dental school and that dude drives a Lambo. perhaps they're the exception but it's not unheard of.

I had double-check the username to see if this was another “Fatima and Joe” story lol

 

[drusso]

I had double-check the username to see if this was another “Fatima and Joe” story lol

Fatima and Joe would not buy a Lambo. MAYBE an Audi-etron...

 

[Laryngospasm]

Porsche taycan

 

[Iamnew2]

There's a corporate owned franchise doing "restorative" health near me. They had PCPhysicians and now NPs doing O and P shots (google it), vampire facials (think PRP in botox targets), etc. They had people lined up around the block paying $750-1000 per treatment. People spend a lot of their money on stupid stuff.

I am fully aware what P and O shots are, and I do "vampire" facials also. Most people are not willign to pay that kind of money. Some yes. Most no. Not sure where you are geographically, but here in a pretty big city, tons of regenerative/salon/spas have gone out of business and struggle.

 

[Iamnew2]

My wife got the Vampire facial a couple of times with micro-needling. I've got to say, the results are not like plastic surgery, but noticeable...it only lasts a few months though. It really is more of a "medi-spa" treatment...

Again, if you comfortable cannulating pedicles and shoving spine jacks in people, and tunneling stereo cable under people's skin-- all these procedures are suitable to an interventional pain doctor's core skill set. It's all cash and no one complains.

They are simple to do indeed. Drawing blood - which I really had only done once maybe as a med student - was one of the biggest concerns for me, but practiced on the finance before any actual paying customers and he got much needed PRP for free! and actually got good hair growth. Far easier than any spine procedure.

 

[Ligament]

They are simple to do indeed. Drawing blood - which I really had only done once maybe as a med student - was one of the biggest concerns for me, but practiced on the finance before any actual paying customers and he got much needed PRP for free! and actually got good hair growth. Far easier than any spine procedure.

What concentration of PRP and how much volume do you inject?

 

[lobelsteve]

Some one already has your market plan and menu dialed in.

 

[Iamnew2]

Some one already has your market plan and menu dialed in.

Again I don't see a lot of people dishing out $$ for these type of services.

 

[sloh]

Again I don't see a lot of people dishing out $$ for these type of services.

Gotta come to Beverly Hills

 

[drusso]

Some one already has your market plan and menu dialed in.

Those prices would be 10X higher in an HOPD or hospital pharmacy. Guarantee it.

Hospitals mark up drugs by 479%: 6 report findings

On average, hospitals mark up prescription drugs by 479 percent, according to a new report from PhRMA, the drug industry's main lobbying group.

www.beckershospitalreview.com

 

[Ducttape]

most hospitals wont offer this type of treatment. so moot point.

 

[Iamnew2]

Gotta come to Beverly Hills

Sure I'm sure that in Beverly Hills people certainly pay for that kind of stuff. I'm thinking of transferring my small cosmetic business to Texas - maybe Austin/Houston - people here where I'm at tend to be on the cheaper side and want everything "on sale" - it does get exhausting.

 

[drusso]

most hospitals wont offer this type of treatment. so moot point.

Wrong. My wife had to have a series of IV infusions with a long-established generic drug. Her hospital-employed PCP ordered it at the HOPD infusion and it cost $1250 for the infusion and $350 for the drug. I got an EOB and showed it to the PCP and said, "Look, F*ck this $h*T!"

I had my RN do the next ones in my office. Pro fee for the infusion $125. The drug cost $105.

 

[cowboydoc]

Wrong. My wife had to have a series of IV infusions with a long-established generic drug. Her hospital-employed PCP ordered it at the HOPD infusion and it cost $1250 for the infusion and $350 for the drug. I got an EOB and showed it to the PCP and said, "Look, F*ck this $h*T!"

I had my RN do the next ones in my office. Pro fee for the infusion $125. The drug cost $105.

What did you actually say?

What does the neighborhood ND charge?

 

[Ducttape]

so what drug was it?

what was your payment after insurance covered?

I looked at lobel's pics and none of those "treatments" are done at any of the local hospital infusion centers.

 

[drusso]

What did you actually say?

What does the neighborhood ND charge?

Ring, Ring...

I said, "Hi, Janet, we got the EOB for the infusion you ordered for Jess, come on, really? Do you know how much your employer charges for a 30-minute infusion? It's like twelve-hundreds bucks. I mean WTF? Jess could this done in my office for like a tenth of the price"

And then she like, "I don't know. Since I sold to the hospital, I'm out of the loop on the finances. I'm more or less just punching the clock these days...Is your daughter playing Lacrosse this year? We need to figure out the carpool."

And then I'm like, "Look, I don't like how Tom lines up the girls on offense. I've spoken with him about this. He's been playing 2-2-2 forever and all the other teams know all his tricks. He's phoning it in. We had a good chance with Brack as a coach but we pissed it away. And, the practice schedules and away game commitments are just too much. I don't know, I think she wants to focus on dance instead."

She's like, "Our backfield is weak. And, I liked your daughter on defense."

And I'm like, "Sure, she's aggressive; she likes to charge, but still needs to dial in her stick skills work on clears. Oh, BTW, It was great seeing Mike at graduation. I gave him a fist pump as he crossed the stage. You and Geroge must be proud..."

She's like, "Awww. So, sweet. Thank you. We'll see what his brother can pull off."

And I'm like, "So, I'm just going to order these next three infusions through my office and copy you the notes. Are you good with that? It'll save me a thousand bucks a pop."

She's like, "Do whatever you want..."

And I'm like, "K-bye."

She's like, "Bye."

 

[Iamnew2]

Ring, Ring...

I said, "Hi, Janet, we got the EOB for the infusion you ordered for Jess, come on, really? Do you know how much your employer charges for a 30-minute infusion? It's like twelve-hundreds bucks. I mean WTF? Jess could this done in my office for like a tenth of the price"

And then she like, "I don't know. Since I sold to the hospital, I'm out of the loop on the finances. I'm more or less just punching the clock these days...Is your daughter playing Lacrosse this year? We need to figure out the carpool."

And then I'm like, "Look, I don't like how Tom lines up the girls on offense. I've spoken with him about this. He's been playing 2-2-2 forever and all the other teams know all his tricks. He's phoning it in. We had a good chance with Brack as a coach but we pissed it away. And, the practice schedules and away game commitments are just too much. I don't know, I think she wants to focus on dance instead."

She's like, "Our backfield is weak. And, I liked your daughter on defense."

And I'm like, "Sure, she's aggressive; she likes to charge, but still needs to dial in her stick skills work on clears. Oh, BTW, It was great seeing Mike at graduation. I gave him a fist pump as he crossed the stage. You and Geroge must be proud..."

She's like, "Awww. So, sweet. Thank you. We'll see what his brother can pull off."

And I'm like, "So, I'm just going to order these next three infusions through my office and copy you the notes. Are you good with that? It'll save me a thousand bucks a pop."

She's like, "Do whatever you want..."

And I'm like, "K-bye."

She's like, "Bye."

That was a little painful to read however I hope Jess is feeling better!

Ring, Ring...

I said, "Hi, Janet, we got the EOB for the infusion you ordered for Jess, come on, really? Do you know how much your employer charges for a 30-minute infusion? It's like twelve-hundreds bucks. I mean WTF? Jess could this done in my office for like a tenth of the price"

And then she like, "I don't know. Since I sold to the hospital, I'm out of the loop on the finances. I'm more or less just punching the clock these days...Is your daughter playing Lacrosse this year? We need to figure out the carpool."

And then I'm like, "Look, I don't like how Tom lines up the girls on offense. I've spoken with him about this. He's been playing 2-2-2 forever and all the other teams know all his tricks. He's phoning it in. We had a good chance with Brack as a coach but we pissed it away. And, the practice schedules and away game commitments are just too much. I don't know, I think she wants to focus on dance instead."

She's like, "Our backfield is weak. And, I liked your daughter on defense."

And I'm like, "Sure, she's aggressive; she likes to charge, but still needs to dial in her stick skills work on clears. Oh, BTW, It was great seeing Mike at graduation. I gave him a fist pump as he crossed the stage. You and Geroge must be proud..."

She's like, "Awww. So, sweet. Thank you. We'll see what his brother can pull off."

And I'm like, "So, I'm just going to order these next three infusions through my office and copy you the notes. Are you good with that? It'll save me a thousand bucks a pop."

She's like, "Do whatever you want..."

And I'm like, "K-bye."

She's like, "Bye."

 

[drusso]

That was a little painful to read however I hope Jess is feeling better!

A Hospital Charged More Than $700 For Each Push Of Medicine Through Her IV

A college student never learned the cause of intense pain that drove her to an ER, but her bill totaled $18,735.93. She and her mom, a nurse practitioner, were outraged after dissecting the charges.

www.npr.org

"Total Bill: $18,735.93, including two $722.50 fees for a nurse to "push" drugs into her IV, a process that takes seconds. Anthem's negotiated charges were $6,999 for the total treatment. Anthem paid $5,578.30, and the Lang-Rees owed $1,270.45 to the hospital, plus additional bills for radiologists and other care. (Claire also anted up a $150 copay at the ER.)"

 

[Ducttape]

imagine the cost if there was universal emergency healthcare coverage for everyone....