Starting own Practice after Fellowship

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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 🙂
 
the ONLY down-side with doing your own practice from scratch out of fellowship is the HUGE amount of mistakes you will make the first year or two.... sometimes it is better to work for somebody else so that you can get a "super-fellow-ship" in the business aspect of things and get a better sense of what works and doesn't work in the real world...
 
specepic said:
I

Con: I have no idea what I'm doing 🙂
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misery love company...

hahhaa...find another person that also doesnt know what they are doing and you are all good.
 
Back in the Mesozoic Era, I went solo from the start, but with hospital support - they set up my office, I paid rent.

My chief points of advice:

Keep your staff to a bare minimum - they will be your biggest monthly expense in most cases. Don't keep incompetent people around, fire them quickly. Everyone gets 90 days probation at the start.

Market heavily but professionally - meet docs in the hospital lunch room or lounge, go to their office with a business card and a handout of what you do. Your job is to convince them you can do things better than your competition.

If you can swing it, get your own fluoro. It'll pay for itself quickly.

Billing and collections are key. Get as much training as you can in CPT/ICD coding. Bill everything you can, but don't commit fraud. Get the best billing and collection service you can. You can do it in house, but then you are assuming the person is good and competent. You are also at their mercy if they take time off or leave.

Collect all co-pays, deductibles and out-of-pocket expenses up front. It's much harder to collect them after the patient leaves the office.

Shop around for supplies. There can be huge differences - you may find some hidden gems at annual assemblies

If you use transcription, shop around again. There are many hungry people out there. You should expect 24-hour turn around time. 10 cents/line can be negotiated, and so can macros you use often.

Find a very good accountant who works for you, not Uncle Sam. Taxes can kill you.

Find a good lawyer to incorporate your business and protect your assets. Get the lawyer and accountant on the same page.

Be very wary of anyone who comes to your office with a smile and a handshake. They want something from you, usually your money.

Biggest thing - let no one touch your money but you. You go through all the mail before anyone. You record all incoming checks. You write all outgoing checks. You watch and manage direct deposits. You make the bank deposits. Have a system to make sure all money collected at the front desk gets recorded and receipts given. TRUST NO ONE.
 
Good advice. I started solo from fellowship, and billing and collections is key! I used www.dotmed.com to find a discounted C-arm.
I am struggling although with EMR...I may just continue with dictation/transcription which is more familiar.
 
Thanks a lot, you guys are very helpful and informative. I really appreciate it!
 
One other very important point...find a good banker who you can turn to for a line of credit/capital...unless you have deep pockets!
Shop around, create a business plan, and expect to be using the bank for the first 6 months or so for expenses...
 
Hmm...

Back in the 'day' you guys made bank when you set up shop.

Do you think in this day and age,with the reimbursements as they are right now that someone can start a solo practice and be profitable? especially in a major metropolitan city like LA, Chicago, Houston or NYC? or is it just too saturated?

ideas?
 
SleepIsGood said:
Hmm...

Back in the 'day' you guys made bank when you set up shop.

Do you think in this day and age,with the reimbursements as they are right now that someone can start a solo practice and be profitable? especially in a major metropolitan city like LA, Chicago, Houston or NYC? or is it just too saturated?

ideas?
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Breaking existing referral patterns is extremely difficult, so I would only consider setting up show in an area with limited competition. If you're fellowship trained, and good, it shouldn't be hard to out compete the local yokle who does blind facets and ESIs that don't work.
 
I started from scratch with no help from anybody in an area with a well-established pain group. It can be done, and when my last kid is out of the house I might do it again somewhere else.
 
i know people who have started practices in and around nyc in the last 2-5 years. private practice salaries at that level are about 450-500, with lots of hard work and definitely a sometimes not too kosher slant towards procedures.



SleepIsGood said:
Hmm...

Back in the 'day' you guys made bank when you set up shop.

Do you think in this day and age,with the reimbursements as they are right now that someone can start a solo practice and be profitable? especially in a major metropolitan city like LA, Chicago, Houston or NYC? or is it just too saturated?

ideas?
Click to expand...
 
How much money are walking about for start up cost. Is it hard to get financing with school debt?
 
start up cost... if you set up your own office with procedure suite you will need about 175k upfront and expect your cash-outflow for the first year to be close to 250-280k....

problem is with this economy -- most banks want collateral before they give a loan like that out... and usually they tie it to your AR --- which means, they may offer you 20k if you are totally new at this, which is totally useless.... or you can put your home or other possessions as collateral... i literally had to fight, whine and argue just to get a 100k line of credit recently even though they can see i generate good money....

cheapest is to have a local community hospital give you a "loan" or a "guaranteed income" that can be forgiven that you can ply into your practice --- or negotiate w/ your hospital where they pay the start-up costs, etc... depending on how rural you are you can probably have them do a LOT for you
 
Tenesma -That’s good to know-
I want to go back to my town <25k population- There have not been a neurologist and pain specialist since 1993 so the market is wide open. We do have a big hospital in town- Do I just show up and talk to the hospital administrators? What is the best protocol for working with the hospital and having them set up/loan you income?
 
1) great that there is no competition...
2) go directly to CEO - bypass the CFO or all other suits ---- i would start the conversation by emailing or writing the CEO about yourself and what you can bring to the community and the hospital: Large volume of money-generating procedures, Imaging, Physical Therapy, etc --- typically a hospital can create a profit of 1.5 million to 4 million per year off a pain doctor --- mention those numbers
3) ideally they would either give you a chunk of money (that will be forgiven as long as you stay in town for 2 years), next best is a guaranteed income (that will be forgiven as long as you stay in town for 2 years) or see if the hospital/physician community has a joint venture where they can set-you up by providing office space, staffing, billing/coding etc while you get started (least likely).
 
the reason i rec straight to CEO is that CEOs tend to be visionary and look 1 -3 years ahead and can see the benefits.... CFOs and others in the admin tend to be short-sighted and will just look at the next few months and will assume a financial loss and not want to get involved.

also, if the CEO is reticent then provide him with names of CEOs at other community hospitals that have opened up similar centers ---- you'll have to do some research...
 
This is not a friendly environment for getting startup business loans. The banks just aren't lending. Actually, many banks still seem to be teetering on the brink of failure and they don't want to part with any cash at all. The old joke about only qualifying for a loan if you can prove you don't need it is all too true right now.

I would also caution against going into debt during what could turn out to be a prolonged deflationary process since you'll be paying off your debt with stronger dollars.

Therefore, at the present time you might do better going the hospital route, much as I dislike and discourage it under less turbulent economic conditions. Let the hospital assume the risk while you focus on building referrals and learning the business angle. When the smoke clears go get a loan and venture out on your own.
 
we are going to be hitting massive inflation with these huge increasing deficits with the dollar losing its strength over time - if any time is a good time to take out a loan, now is the time...
 
How long does it take, generally, to establish contracts with private insurers in the area you want to set up practice in? How does that work exactly? Do you submit a schedule of your most frequently billed codes with your charges, and they send back the same schedule with what they're willing to pay?

If you're already set up with Medicare, say, in your former practice arrangement, does that translate to a new practice in or out of state?
 
1) medicare: if it is a different state then you have to go through the WHOLE mess all over again --- if it is the same state you need to make sure your benefits are re-assigned to you or your new group... either way, medicare makes it easy because you can see medicare patients and just hold the claims until you have all your numbers squared away --- usually takes about 3-5 months

2) private payers: they coudlnt' care less about your charges --- if they aren't swamped w/ pain docs in their HMOs they will offer you some crappy contract... you can try to negotiate which AT best will net you maybe 1-2% more per CPT based on original crappy contract - at which point you decide whether you want to be in-network or out-of-network... sometimes depending on the region and PCPs you may not have much of a choice initially... time delay is usually 4-10 months and you CAN'T see patients until you are in-network
 
If you aren't competing with another pain specialist, I don't see any benefit to joining HMOs and networks. The insurances still may not pay that much, but it's better than getting into the cage that they call a contract. Network contracts are insulting. HMOs are just plain demeaning.
 
Is this true of all private insurers? I used to hear stories of pain docs getting 3-4x medicare for injections, now I'm hearing that your lucky if you get 100% of medicare. Is this a regional thing, or is it everywhere?
 
hyperalgesia said:
If you aren't competing with another pain specialist, I don't see any benefit to joining HMOs and networks. The insurances still may not pay that much, but it's better than getting into the cage that they call a contract. Network contracts are insulting. HMOs are just plain demeaning.
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who ISNT competing with another pain specialist. I am competing with 10-15
 
powermd said:
How long does it take, generally, to establish contracts with private insurers in the area you want to set up practice in? How does that work exactly? Do you submit a schedule of your most frequently billed codes with your charges, and they send back the same schedule with what they're willing to pay?

If you're already set up with Medicare, say, in your former practice arrangement, does that translate to a new practice in or out of state?
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2 - 6 mo to get established with private payor, IME. They give you a contract, you sign or don't. Unless you are in a big practice, there's really no negotiating - you have no power - take it or leave it. Often the contract will be accompanied by a schedule of what they pay for many common codes. Sometimes you have to ask for it, or try to work it out through RVUs. Sometimes they play games, and with every EOB, you get paid a different amount for the same thing.

For Medicare, it's easy to transfer, just filling out forms and such. Right now, I belive it is 30 - 60 days to get set up. you used to be able to hold on to bills until they finished your paperwkr, no that's not the case - I believe it's 30 days after.

powermd said:
Is this true of all private insurers? I used to hear stories of pain docs getting 3-4x medicare for injections, now I'm hearing that your lucky if you get 100% of medicare. Is this a regional thing, or is it everywhere?
Click to expand...

Very regional, and varies b/w payors.

E.g. BCBS pays me about 150% of Medicare of ASC injections, but abot 300% of Medicare for EMGs. Humana pays me more for injections, and less for EMGs.
 
neurochica said:
I am from a town <25k with no pain specialist. The closest one is more than 40 miles away!!!
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That's great for reimbursement issues but 25k is probably not enough people to support a person doing pain only. Neurology and Pain, possibly. If there is a spine surgeon in town, the equation changes. But most likely, you will need to be open minded, flexible and prepared to wear many hats for your patients.
 
i disagree --- a town of 25k can easily support a pain doctor especially if the nearest pain doc is 40 miles away - because then you add on the extra 10-20k people living outside of the town limits who will drive to you...
 
Tenesma said:
we are going to be hitting massive inflation with these huge increasing deficits with the dollar losing its strength over time - if any time is a good time to take out a loan, now is the time...
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You can't have inflation just by printing money. The money has to circulate in the form of credit expansion and we are in a period of credit contraction. Nobody wants to lend, nobody wants to borrow. The "velocity of money" has gone to almost zero. All that printed money is sitting in the closet.

If and when it comes out into circulation there will be inflation. Of course Bernanke says the Fed - which never saw this disaster coming - will be able to control the inflation when it happens. Right.

The only way I think we could have massive inflation without credit expansion is if there is a general loss of confidence in fiat money (or specifically in the dollar, which I think will be one of the last to go). I think the contagion will start in the Euro. Remember what happened when little Dubai cratered. Imagine what it will be like when one of the PIGS goes bust.

So: Inflation eventually, but deflation in the short term unless fiat currencies collapse. Of course, Japan has been stuck in deflation for about 2 decades now, so "short term" is kinda relative.
 
I was watching Kudlow recently and he was pointing out that inflation for 2009 was 4.9% --- now clearly there are different ways of measuring inflation - one of the other figures i saw was 2.7%.... so to have 2.7-4.9% inflation in 2009 when everybody is saying 2009 was a deflationary year, AND on top of that you have trillions of dollars lurking in the closet --- i can tell you inflation is going to be hell when those closets open up.

i noticed deflation initially early 2009 with the drop in energy prices --- but after that my grocery bills are going up, my lawyers are charging more, etc... so i am a bit concerned... initially i thought the EURO would be a safer hedge because of the attempt by quite a few OPEC countries to convert to euro for barrel purchases --- but with the idiots in Greece, Spain, Portugal and Ireland the Euro is going to teeter for a while longer... nobody is going to convert to petro-dollars because of the dubais of the middle east, so i agree the dollar is still the best currency to date....

i want to hedge against inflation --- and besides real estate, and consumer staples i don't know how else to do it --- and i think gold is way up in a bubble....ain't trusting gold either.
 
The inflation numbers are hard to interpret because they are massaged.

However, if it costs $200K to buy a house that used to cost $400K, that is deflation. if you can buy a car for 25% less than 2 years ago, that's deflation. If you can buy IBM for half what it used to cost, that's deflation.
When I can buy 20 Faberge' eggs each worth $2500 for only $300 each, that is deflation. (I plan to make a lot of money on those some day.)

Oil is denominated in dollars so when the dollar weakens prices rise and vice-versa.

If people continue to default on their loans and continue to avoid borrowing as is currently the case, there will be more deflation. When the closets open up that will be inflationary, but for now nobody is either lending or borrowing so it sits on the shelves. Japan has been stuck in this rut for 20 years and always seems to be on the brink of disaster. However, in the investing world betting against Japan is called "the widow-maker" because they just never seem to blow up.

OTOH, if the debt bomb explodes then paper money will be worthless and you will wish you owned some physical gold. I think any one of Greece, Portugal or Spain could trigger the explosion with a default. As we speak the EU is trying to prop up Greece.

Whether we will have more deflation or start to have inflation is a hot topic right now. There is a good video floating around showing a debate between Robert Prechter (deflationist) and Peter Schiff (inflationist). Both have been very good at calling things over the past few years. Prechter has been mind-boggling. He predicted the crash and went short, then reversed his position in February just before the March 2009 bull run. He is now 200% short the market.

Right now there is a compelling case to have cash in case of deflation and gold in case of inflation. As Marc Faber said recently, “If I am right about further monetization and further government debt growth, the risk is really not to own any precious metals at all”.

FWIW, I also went short on China recently (FXP).
 
i now get all my financial info from these threads. Gawdamn you guys know a lot of about finances/investing/money stuff...
I am in awe. Im just a back woods country pain doctor, you know..
 
so how much capital do we need to start a Pain Clinic. If or example, myself and a buddy are planning on opening a practice up?

If we fronted 150K, then with our good credit,etc would we be able to get 300K. Would that be a good starting point?
 
it is easier to get a loan for that amount from a hospital than it is from a bank..... i just increased my line of credit to 100k w/ my local bank... this is the most they would give me even though my actual AR is way over that amount... and they use the AR as collateral...

so unless you have some collateral you better start negotating deals w/ the local community hospital
 
You need to meet with some bankers (and hope that they have not read about the pending SGR 21% cut). You will need to show them a business plan. This would include startup expenses (rent, staff, etc), projected patient load, projected revenue per patient, and projected cash flow (mainly, when you expect to see money come in). You need to figure in what you will live on while waiting for collections to ramp up. I would allow 3 months for collections to level out - assuming you have Medicare numbers and are on insurance panels on day 1. I think you can start billing Medicare right away but the checks won't come in until you have your numbers set up.

You will need to figure out delays in getting patients or reimbursement due to getting on insurance plans and so on. That can really take a long time and sometimes the panels are closed. If you're the only game in town you could possibly get by on out-of-network status as a permanent situation. It depends on state insurance regs whether or not you can pull this off. I dropped Aetna years ago and still see the PPO patients out of network - for more money than when I had a contract.

If you put up $150K the bank will definitely be more receptive, especially if you set it up as a line of credit that you would draw on if and when your cash was exhausted instead of a loan.

You should call your local medical society for guidance. A lot of societies have services available that can walk you through all this.
 
Mister Mxyzptlk said:
You need to meet with some bankers (and hope that they have not read about the pending SGR 21% cut). You will need to show them a business plan. This would include startup expenses (rent, staff, etc), projected patient load, projected revenue per patient, and projected cash flow (mainly, when you expect to see money come in). You need to figure in what you will live on while waiting for collections to ramp up. I would allow 3 months for collections to level out - assuming you have Medicare numbers and are on insurance panels on day 1. I think you can start billing Medicare right away but the checks won't come in until you have your numbers set up.

You will need to figure out delays in getting patients or reimbursement due to getting on insurance plans and so on. That can really take a long time and sometimes the panels are closed. If you're the only game in town you could possibly get by on out-of-network status as a permanent situation. It depends on state insurance regs whether or not you can pull this off. I dropped Aetna years ago and still see the PPO patients out of network - for more money than when I had a contract.

If you put up $150K the bank will definitely be more receptive, especially if you set it up as a line of credit that you would draw on if and when your cash was exhausted instead of a loan.

You should call your local medical society for guidance. A lot of societies have services available that can walk you through all this.
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Thanks for your insight. As I stated, a friend of mine and are still trying to figure out if we should just both start a practice right out of residency or work for someone else.

With the economy the way it is and people so up in the air about pain, sometimes it seems the 'easy' way (join a practice) is better. However, we both are 'hungry' and have the drive. So...
 
SleepIsGood said:
Thanks for your insight. As I stated, a friend of mine and are still trying to figure out if we should just both start a practice right out of residency or work for someone else.

With the economy the way it is and people so up in the air about pain, sometimes it seems the 'easy' way (join a practice) is better. However, we both are 'hungry' and have the drive. So...
Click to expand...

after interviewing this year (i've taken a pretty good job in academics doing both pain/anes. and i NEVER saw myself staying in academics, i was all about PP) and seeing what it means to go work for someone else (granted in a very saturated and competitive area) i would say - if you and your friend have the drive and the time: start your own practice.

"someone else" will still be there (to take advantage of you) if you don't like being on your own.
 
I have known about 6-8 people who have tried starting practices in the past 3 years or so - only 1 is still trying but he also has a part time academic appointment to fund the rest of his efforts. the rest have joined or are looking to join groups.

One of them specifically told me that after he interviewed with a bunch of pain groups, he felt that there were glaring inefficiencies and poor business practices in those groups and that he could do better. he had been an attending for a few years so he had some $$ saved up and he was married to another doctor so he didn't have to worry about supporting the household. Unfortunately, after all the loans/debt x almost a year, he still has not seen a single patient. He's doing anesthesia moonlighting to support his loan payments.

Pain medicine, unlike other healthcare entrepreneurial efforts (like chiro), require a lot of overhead - medical supplies, personnel, etc. there are also legislations and area politics that you have to consider.
 
he hasn't seen a single patient??!?!?!?!? there is a problem there....

it requires a good business plan, a good understanding of the field, the ability to shake hands and kiss babies, the ability to befriend all the referring docs in the community and to provide customer service that goes beyond your competition

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.... when i started my practice i basically spent a full day every day just driving from practice to practice, bring along powerpoint slides for the staff, spine models and needles to show what it is i do... and every week i would see PCPs in larger and larger concentric circles... etc..
 
Tenesma said:
he hasn't seen a single patient??!?!?!?!? there is a problem there....

it requires a good business plan, a good understanding of the field, the ability to shake hands and kiss babies, the ability to befriend all the referring docs in the community and to provide customer service that goes beyond your competition

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.... when i started my practice i basically spent a full day every day just driving from practice to practice, bring along powerpoint slides for the staff, spine models and needles to show what it is i do... and every week i would see PCPs in larger and larger concentric circles... etc..
Click to expand...

Ditto, and don't forget to bring the deli platter. Although I don't personally make marketing calls any more, I have found that periodically sending my office manager around works well. A lot of referrals are directed by the staff so a nice plate of sandwiches and a chat between "the girls" really helps.

If you do gas try to get assigned the ortho and spine procedures and get a conversation going.

Three A's: able, available, affable
 
Regarding the economy, I would still be very cautious and consider a hospital venture. Here is a fable that illustrates my concern:

Once upon a time there was a rich country with a great economy. In the interest of additional growth, it deregulated its financial markets and began lowering interest rates. Companies grew and the use of debt skyrocketed.

Unfortunately, at the same time, real estate values began to waver, people realized that the entire financial system was a house of cards leveraged against collateral that either didn't exist or wasn't properly assessed in the first place. And the stock market cratered.

Companies that were considered rock stable began defaulting on loans and many went out of business entirely. Individuals couldn't repay their debts. Real estate values fell dramatically. People simply walked away from their mortgages.

At the same time all of this was happening, deflation set in. Lower prices meant lower profit margins. Lower margins meant lower production and the need for lower production, in turn, created the need for smaller work forces. Unemployment rose to previously unthinkable levels.

Thus began Japan's "Lost Decade". The Nikkei is currently at about 20% of its peak in 1989.

We are also looking at a possible 5-year Medicare fee freeze (at best) or perhaps a 21% cut (which could be a blessing in disguise). If we do get inflation it will eat your lunch with a 5-year freeze on fees. If deflation continues then you might not have many people with insurance and your commercial debt repayment will be relatively increased as the dollar strengthens.

It's just not a good time to take financial risk so I would let the hospital take the risk instead. Things will be clearer by March 1 when the temporary SGR suspension ends but unless there is a COLA provision on fees (don't hold your breath), it's looking grim.
 
i agree w/ sending the girls around --- but nothing beats face to face w/ the doctors... I try hard to create friendly relationships w/ as many referring docs as possible - go fishing, raquetball games, sushi outings, playdates w/ kids --- beyond making friends you also want to cement your referral patterns.
 
I agree, although maybe it wasn't clear in my post. The initial relationship has to be with the doctor, but subsequent iterations can be with the staff.

I don't cultivate social relationships with my referral sources. I just schmooze in the cafeteria at lunch time or in the surgeon's lounge, but everyone has their own style that works for them.
 
Mister Mxyzptlk said:
You will need to figure out delays in getting patients or reimbursement due to getting on insurance plans and so on. That can really take a long time and sometimes the panels are closed. If you're the only game in town you could possibly get by on out-of-network status as a permanent situation. It depends on state insurance regs whether or not you can pull this off. I dropped Aetna years ago and still see the PPO patients out of network - for more money than when I had a contract..
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Would you then suggest to negotiate a salary witht the hospital for the first 1 to 2 yrs? Hence, this will allow the doc to settle down financially. True?
 
options

1) Salary --- most hospitals don't like that because data shows that doctors slack off when they are on salary and are difficult to manage

2) Guaranteed Income --- kind of like a salary, but you pay it back with the collections you make.... so the harder you work the more likely you will have money above and beyond your guaranteed income ... typically desperate hospitals will forgive the amount owed if you stay in the community a couple of years - however you will owe taxes on whatever is forgiven

3) A loan - where they write you a check for 100k (for example) and you have to pay it back but it is usually at 0% interest and usually is forgiven if you stay in the community a couple of years - and you owe tax on the amount forgiven (just like you'd owe tax on any income).
 
I think a lot of the failure was financial - loans that didn't come through, too ambitious (i.e. expensive) of a clinic setting with the best furniture and accessories, etc.

Many of the failures were in competitive markets where the market was already saturated, referral patterns were already set, and overall the economy was slowing down. My friend did go market - he was probably the biggest shmoozer i knew - but I don't know if he had anything different to offer a refering doc.

I am part of a group but I hit the pavement HARD and still do. When I started, I was going on a lunch meeting almost every other day. I took about a week or two to go on serial visits for 1/2days at a time. After a while I started to figure out what the PCPs wanted from a spine/pain person. Most of them surprisingly didn't want their patients on narcotics (many complained that pain groups in the area routinely would put patients on higher dose opioids and do a crap load of procedures on them then the patient's insurance would change or the patient would be unhappy with the group (or didn't want to go through any more procedures) , and they would bounce back to the PCP for med refills). They also wanted notes/communication in a timely fashion. (I usually call my referring docs for at least the first couple patients from them and make sure they get my notes within 2-3 days)
 
Tenesma said:
options

1) Salary --- most hospitals don't like that because data shows that doctors slack off when they are on salary and are difficult to manage

2) Guaranteed Income --- kind of like a salary, but you pay it back with the collections you make.... so the harder you work the more likely you will have money above and beyond your guaranteed income ... typically desperate hospitals will forgive the amount owed if you stay in the community a couple of years - however you will owe taxes on whatever is forgiven

3) A loan - where they write you a check for 100k (for example) and you have to pay it back but it is usually at 0% interest and usually is forgiven if you stay in the community a couple of years - and you owe tax on the amount forgiven (just like you'd owe tax on any income).
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Great discussion-
Now, what is the hospital incentive to keep you around/give you a loan, assuming you are the only pain doc in town, if once you go solo you’ll be collecting all the revenue?….Do they get a share, even after , you pay them the loan and your practice is up and going?
 
neurochica said:
Great discussion-
Now, what is the hospital incentive to keep you around/give you a loan, assuming you are the only pain doc in town, if once you go solo you'll be collecting all the revenue?&#8230;.Do they get a share, even after , you pay them the loan and your practice is up and going?
Click to expand...

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?
 
Last edited:
SleepIsGood said:
I'm assuming if you traine somewhere amazing and can offer something better than the other, you've got it made?
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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.
 
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