Starting a solo practice?

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Yo GabbaPentin

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So now that obamacare is right around the corner, would anyone advise against opening up shop? I have a little more than a years experience in PP and there are several areas around me which are pretty wide open right now. Thoughts?

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I'm doing it. Went to the bank, got the loan, going for it.
Am I worried about obamacare, you bet. That being said, everyone I know is, and My
Opinion is that hospital based anesthesia gigs may be in for some rough times with
Value based purchasing.
I found an area in need and I am going to try and develop that market.
We may take an income hit but overall I feel I can do reasonably well with M-F 8-5, no call or weekends.
After doing both pain and anesthesia in an anesthesia group, don't take lightly the ability to escape some of those politics and run your own show.
But yeah, I'm sweating bullets. But it seems everyone in medicine is right now, and I don't think the safety of hospital employed jobs are all that safe.
 
I'm doing it. Went to the bank, got the loan, going for it.
Am I worried about obamacare, you bet. That being said, everyone I know is, and My
Opinion is that hospital based anesthesia gigs may be in for some rough times with
Value based purchasing.
I found an area in need and I am going to try and develop that market.
We may take an income hit but overall I feel I can do reasonably well with M-F 8-5, no call or weekends.
After doing both pain and anesthesia in an anesthesia group, don't take lightly the ability to escape some of those politics and run your own show.
But yeah, I'm sweating bullets. But it seems everyone in medicine is right now, and I don't think the safety of hospital employed jobs are all that safe.

I'm with you guys as well. Let's see what happens.

I see the other hospital based employees that do Pain. They have nearly no incentive to work. I highly doubt that there will be enough Pain providers that will be able to accommodate the millions of folks coming into the system. Furthermore, those patients that have commercial insurance or the means, aren't going to wait 6mo to see a hospital based doc for a ESI...especially when you are in pain. I think other docs like PCPs and spine surgeons and the like may only be able to thrive by being hospital employeed......am I concerned. absolutely! But don't worry, I was going to hire SSDOC as my PA :)
 
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Members don't see this ad :)
I'm doing it. Went to the bank, got the loan, going for it.
Am I worried about obamacare, you bet. That being said, everyone I know is, and My
Opinion is that hospital based anesthesia gigs may be in for some rough times with
Value based purchasing.
I found an area in need and I am going to try and develop that market.
We may take an income hit but overall I feel I can do reasonably well with M-F 8-5, no call or weekends.
After doing both pain and anesthesia in an anesthesia group, don't take lightly the ability to escape some of those politics and run your own show.
But yeah, I'm sweating bullets. But it seems everyone in medicine is right now, and I don't think the safety of hospital employed jobs are all that safe.

Can you elaborate a bit? How much loan? What exactly does it take to get a practice running from the ground up?

Would also love if someone who has gone through this can chime in. Any specific info would be very helpful. Thanks.
 
I'm with you guys as well. Let's see what happens.

I see the other hospital based employees that do Pain. They have nearly no incentive to work. I highly doubt that there will be enough Pain providers that will be able to accommodate the millions of folks coming into the system. Furthermore, those patients that have commercial insurance or the means, aren't going to wait 6mo to see a hospital based doc for a ESI...especially when you are in pain. I think other docs like PCPs and spine surgeons and the like may only be able to thrive by being hospital employeed......am I concerned. absolutely! But don't worry, I was going to hire SSDOC as my PA :)

as a side note...

i am a hospital based physician. this office has a 2-4 week wait list for new evals, faster than at least 1/2 of the private practices in the county. Injections i typically schedule within a week of initial eval (unless they need MRI, etc.)

i have a lot of incentive, primarily because i want to keep the program running and financially beneficial, and as a hospital based physician i do have bonus clauses in contract.

maybe im an outlier....
 
I'm with you guys as well. Let's see what happens.

I see the other hospital based employees that do Pain. They have nearly no incentive to work. I highly doubt that there will be enough Pain providers that will be able to accommodate the millions of folks coming into the system. Furthermore, those patients that have commercial insurance or the means, aren't going to wait 6mo to see a hospital based doc for a ESI...especially when you are in pain. I think other docs like PCPs and spine surgeons and the like may only be able to thrive by being hospital employeed......am I concerned. absolutely! But don't worry, I was going to hire SSDOC as my PA :)

Pinch sigh

Clueless as usual.

Nobody has a 6 month wait list.

? Millions of patient? Millions?

Plenty of hospital docs are incentivized. The incentive is not as direct as in private practice,though.

Hire me? That might be your only chance......
 
Did my other post get sent to the private forums or something???
 
Pinch sigh

Clueless as usual.

Nobody has a 6 month wait list.

? Millions of patient? Millions?

Plenty of hospital docs are incentivized. The incentive is not as direct as in private practice,though.

Hire me? That might be your only chance......

SSDOC "sigh"....I will now coin a term for you too.

just like your Democratic colleagues, I'm sure you didn't read the ACA that'll be instituted soon. Go figure:rolleyes:

21.3 MILLION new people will be coming into the 'system". http://obamacarefacts.com/obamacares-medicaid-expansion.php
 
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there are a LOT of incentives to work for hospitals. Right now, reimbursement for everything is increasing above outpatient because the government wants everyone to work for a hospital.
now that already 60% of all private practices have been bought out by hospitals, they will slowly start to decrease reimbursement to hospitals so hospitals will lower physician salaries. at that point, since doctors never unite and fight, we will have no leverage and take a large paycut while PA's, CRNA's, NP's all get pay raises. Look no further than the state of Hawaii, the most liberal state in the union. NP's/PA's/mid levels are treated as equals. reimbursement is already equal for mid levels on follow ups w medicare. wait for everything else to catch up
 
there are a LOT of incentives to work for hospitals. Right now, reimbursement for everything is increasing above outpatient because the government wants everyone to work for a hospital.
now that already 60% of all private practices have been bought out by hospitals, they will slowly start to decrease reimbursement to hospitals so hospitals will lower physician salaries. at that point, since doctors never unite and fight, we will have no leverage and take a large paycut while PA's, CRNA's, NP's all get pay raises. Look no further than the state of Hawaii, the most liberal state in the union. NP's/PA's/mid levels are treated as equals. reimbursement is already equal for mid levels on follow ups w medicare. wait for everything else to catch up

I can see a strategy for the strengthening of physician's leverage over time. Historically, physicians cannot legally unionize because they were considered management. As we are getting crushed is is obvious that we are no longer in control and thus as more physicians become employed the argument strengthens to allow unionization. I have wondered what the legal threshold is to allow the formation of a physician's union. Interns and residents have had a union for years. If pro athletes can make millions as "union workers" we could also do better. The only real enemy is us. The eternal specialist vs primary care fissure was successfully used to divide and conquer.
 
SSDOC "sigh"....I will now coin a term for you too.

just like your Democratic colleagues, I'm sure you didn't read the ACA that'll be instituted soon. Go figure:rolleyes:

21.3 MILLION new people will be coming into the 'system". http://obamacarefacts.com/obamacares-medicaid-expansion.php

I'm not sure how you feel about Medicaid expansion. That website presents very strong arguments for ObamaCare. It seems a little odd to make the case that millions of people getting access to health care is a bad thing; even if it results in longer wait times, surely people are better off with partial access and care that won't cause bankruptcies than no access at all.
 
I'm not sure how you feel about Medicaid expansion. That website presents very strong arguments for ObamaCare. It seems a little odd to make the case that millions of people getting access to health care is a bad thing; even if it results in longer wait times, surely people are better off with partial access and care that won't cause bankruptcies than no access at all.

Great. When you are done with your fellowship, I have a great idea for you. Take care of all those people. In fact do it for free! Forget about your school loan debt and other expenses. You my friend are of a higher calling than all of us here.
 
Pinch sigh

Clueless as usual.

Nobody has a 6 month wait list.

? Millions of patient? Millions?

Plenty of hospital docs are incentivized. The incentive is not as direct as in private practice,though.

Hire me? That might be your only chance......

"Nobody," eh? I personally had a 6 month wait list for 2 solid years at my previous job, employed physician in a large group of 150 physicians, 80% dependent on a specialized government insurance (USFHP). It was a great insight into what the marxist traitor King Obama will do to the rest of us when Obamanocare comes into play. USFHP dictates what care you get and WHEN.
 
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"Nobody," eh? I personally had a 6 month wait list for 2 solid years at my previous job, employed physician in a large group of 150 physicians, 80% dependent on a specialized government insurance (USFHP). It was a great insight into what the marxist traitor King Obama will do to the rest of us when Obamanocare comes into play. USFHP dictates what care you get and WHEN.

Did you try using that has leverage for a higher salary before leaving? Why did your group accept USFHP if the reimbursements are mediocre? Are they worse than Medicaid?
 
"Nobody," eh? I personally had a 6 month wait list for 2 solid years at my previous job, employed physician in a large group of 150 physicians, 80% dependent on a specialized government insurance (USFHP). It was a great insight into what the marxist traitor King Obama will do to the rest of us when Obamanocare comes into play. USFHP dictates what care you get and WHEN.
You know you're gonna get audited for this right?
 
Did you try using that has leverage for a higher salary before leaving? Why did your group accept USFHP if the reimbursements are mediocre? Are they worse than Medicaid?

USFHP was administered and delivered by the former group, so they were dependent on the government teet. Same payment as Medicare, nothing is worse than Medicaid.
 
I'm probably going to jail and my family murdered since I have an "Impeach Obama" bumber sticker on my non-electric powered car.

LOL. Ligament, I think you are second only to JPP for my favorite SDN posters.
 
Wow. Got it, this is not the forum to discuss health care policy. I'm very interested in learning about pain medicine from you experienced hands so I'll try not to antagonize you with my liberal coastal enclave ways.
 
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