Starting own Practice after Fellowship

[SleepIsGood]

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no - no one cares where you trained or if you can offer something better. local politics is about who you know not what you know. if there is an exclusive contract at the hospital, you will not be able to get credentialed at that hospital.

interesting...cuz I've heard people even say. And it appears like common sense. If a patient had the option and wanted treatment. If their option was a guy from Univ of X or Harvard, Stanford, Texas Tech, etc....the patient would perceive a difference. I've been told that's where the marketability comes in. Apparently this also is true for the referring docs, they want their patients sent to who they believe is thebest. I suppose though, there's always the local 'politics' and schmoozing that will get you a good referral base.

 

[axm397]

interesting...cuz I've heard people even say. And it appears like common sense. If a patient had the option and wanted treatment. If their option was a guy from Univ of X or Harvard, Stanford, Texas Tech, etc....the patient would perceive a difference. I've been told that's where the marketability comes in. Apparently this also is true for the referring docs, they want their patients sent to who they believe is thebest. I suppose though, there's always the local 'politics' and schmoozing that will get you a good referral base.

most patients don't know that chiropractors and podiatrists didn't go to med school. ask anyone on the street where their doctor went to med school or residency and they likely won't know. The most effective way to get a patient is through word of mouth. if you made their friend better, then they trust you.

most referring docs could also care less where you trained. sure i tell them where i trained but that doesn't generate referrals. it's the "what can you do for me to make my life easier" factor that matters most.

name of institution matters in academic circles and that's about it.

 

[neurochica]

To follow up on her question...Dont MOST hospitals have pain physicians associated somehow with the hospital already in the competitive markets. If so,what's their incentive to give you a loan? I'm assuming if you trained somewhere amazing and can offer something better than the other, you've got it made?

There are no associated pain doctors with the hospital, or any pain doctors, in my town. Next pain doc is 40 miles away. But I still dont see what incentives hospitals have in offering a "loan" or a startup practice to a doc.

One of my co-residents have already contacted her hometown private-practice group- they've known her since she started undergrad. They have told her that she could specialize in what ever she wants and that she is welcome into their group. this group is the only group in town. Wouldnt that be nice.....?

 

[Disciple]

To follow up on her question...Dont MOST hospitals have pain physicians associated somehow with the hospital already in the competitive markets. If so,what's their incentive to give you a loan? I'm assuming if you trained somewhere amazing and can offer something better than the other, you've got it made?

That's correct. In competitive markets, there is generally no incentive for hospitals to give out loans. The establish practices generally want to stick with their surgery centers or procedure suites, so your in may be to offer to do all the inpt pain mgmt for the hospital.

The other problem is that in competitive markets, generally speaking, there is an abundance of physicians from good programs, in most specialties, who have been there for 10-15 years. What is boils down to is whether the medical community needs you, or you need them.

 

[Disciple]

i have found that those docs who haven't succeeded - typically had one thing in common: they all thought by opening up shop people would start lining up to kiss their feet - and none of them really went out and kissed some ass....

This is invaluable advice.

The more competitive the area, the more required.

 

[Mister Mxyzptlk]

In my area the pain docs are all invested in ASC's and specialty hospitals. A big box hospital might be interested in bringing in their own specialist. Most big hospitals don't see a pain doc as a huge asset though.

However, if it's a small town with no other pain docs, and it's a CON state so there are no doctor-owned facilities, then the prospect of generating new business should be very enticing for them.

 

[Pain Applicant]

interesting...cuz I've heard people even say. And it appears like common sense. If a patient had the option and wanted treatment. If their option was a guy from Univ of X or Harvard, Stanford, Texas Tech, etc....the patient would perceive a difference. I've been told that's where the marketability comes in. Apparently this also is true for the referring docs, they want their patients sent to who they believe is thebest. I suppose though, there's always the local 'politics' and schmoozing that will get you a good referral base.

I doubt the name of the place one trains at matters very much although I definitely wish it did.

 

[Tenesma]

where you trains matters

1) to a select few patients who research their doctors --- those patients tends to be highly educated themselves, are not necessarily the easiest of patients

2) to lawyers/juries

i agree that PCPs base their decisions on patient feedback --- if the choice is between Harvard trained and Carribbean trained, they will always choose the guy they like, who is available, who treats their patients with respect/understanding.

*** Incentive for hospital to give you a loan or help start up your practice --- if you present to the hospital that you are definitely going to be in their community NO MATTER what then they have NO incentive.... If you tell them that you are interested in coming to their community (and by the way you will generate 1.5 million in profit your FIRST year for the hospital based on procedures, imaging, PT, ancillaries), but you are evaluating your options at other hospital, you'd be surprised... in fact, most hospitals mission is to get good doctors to take care of their community and provide services--- the "loan" is typically peanuts compared to what they will generate off of you so for them it is a no-brainer....

also, you can't really negotiate a start-up salary--- they will typically pay you a % of MGMA for a start-up practice 1st year.... don't expect much over 275k the first year from the hospital --- at least it helps when you get a mortgage that you can show that you have a set income... most banks will laugh if you show up for a mortgage and you have some AR to show them..

 

[hyperalgesia]

interesting...cuz I've heard people even say. And it appears like common sense. If a patient had the option and wanted treatment. If their option was a guy from Univ of X or Harvard, Stanford, Texas Tech, etc....the patient would perceive a difference. I've been told that's where the marketability comes in. Apparently this also is true for the referring docs, they want their patients sent to who they believe is thebest. I suppose though, there's always the local 'politics' and schmoozing that will get you a good referral base.

Nobody cares where you train unless you are actively seeking an academic appointment. The patient may smile and be reassured because you did undergrad at Johns Hopkins, never mind that you majored in economics and then went to dental school in North Korea. Referring docs are even less interested. They have absolutely no idea that there is such a place as Texas Tech. They probably don't even remember the good training programs for their own specialty. Good training will serve your patients well and that is saying a lot. But that's where its utility ends.

 

[knoxdoc]

....he still has not seen a single patient. He's doing anesthesia moonlighting to support his loan payments.

I would recommend he put up a large sign reading, "Pain Management: Cash Only" and place it somewhere along a busy road in Florida.

 

[TX PAIN DOC]

also, you can't really negotiate a start-up salary--- they will typically pay you a % of MGMA for a start-up practice 1st year.... don't expect much over 275k the first year from the hospital

Do group practices also use MGMA data to base first year compensation? I would think so, but some do not have the resources of a hospital. I would think that the economy and unknown Obamacare changes would make a group ignore MGMA numbers. Should we still use the MGMA numbers for negotiation?

 

[SleepIsGood]

Do group practices also use MGMA data to base first year compensation? I would think so, but some do not have the resources of a hospital. I would think that the economy and unknown Obamacare changes would make a group ignore MGMA numbers. Should we still use the MGMA numbers for negotiation?

Please do..

Work for a good compensation. the more people that go in workign for less, the more employers will think they can hire for less in the future..which effects all of us.

 

[AnybodyWantAPeanut?]

I finish fellowship this summer and am currently doing the leg work to start my Pain practice essentially from the ground up. When I say 'essentially' I am joining a hybrid private practice/hospital based group but I will be the only pain doc and they have not previously had pain services.

pro: I have more say/control.

Con: I have no idea what I'm doing 🙂

Hi,

I was wondering if you were able to setup a practice immediately after fellowship, I plan on doing this as well and was wondering what headaches you discovered doing this?

 

[AnybodyWantAPeanut?]

Hello everyone,

I also would like to start a private practice right after fellowship (hopefully I will be able to obtain a pain fellowship), just wondering. If I do have plans to start a private practice and work any amount of hours to do this, in addition to learning management aspects of medical management which I have been doing. Would it be better to work 1-2 years with a group to see what works/doesnt work for me and then branch out? However, what about non-compete clauses, can you not sign one of these knowing you are going to leave in a year or two? In addition, does anyone know of pain clinic with in house x-ray, does it make financial sense to have this? I would assume everyone will need plain films, however, I had a procedure on myself with the physician only going off the text report and never looking at the image. I dont think I would feel comfortable putting a needle in someone's spine without looking at the images myself as I have worked hard on radiology interpretation of the spine for this reason. Thanks.