Thoughts of possible pain job opportunity

[painlove]

Hey Everyone,

I would love to have everyone's input on this opportunity. I will be finishing my fellowship soon and strongly considering starting off on my own. Here is the opportunity:

- Ability to buy-in to an ASC. The ASC obviously has c-arm, also has RFA. Won't be an issue to get time for procedure room or OR for advanced procedures.
- Ability to buy-in to anesthesia group in order to collect on the anesthesia fees for my procedures
- will start off with Time-share clinics a few times a week. This is all connected to the ASC
- Will need to hire one MA to start. Will hire more as the practice hopefully grows.
- Will need to market myself, figure out EMR, answering service, etc.

Since I will be on my own, 100% collections will be kept for me within my PLLC.

Please let me know your thoughts and anything I should keep in mind.

Thank you all! I don't usually post, but have been a long time lurker on multiple threads. Appreciate all input.

PainLove

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[painfree23]

Hey Everyone,

I would love to have everyone's input on this opportunity. I will be finishing my fellowship soon and strongly considering starting off on my own. Here is the opportunity:

- Ability to buy-in to an ASC. The ASC obviously has c-arm, also has RFA. Won't be an issue to get time for procedure room or OR for advanced procedures.
- Ability to buy-in to anesthesia group in order to collect on the anesthesia fees for my procedures
- will start off with Time-share clinics a few times a week. This is all connected to the ASC
- Will need to hire one MA to start. Will hire more as the practice hopefully grows.
- Will need to market myself, figure out EMR, answering service, etc.

Since I will be on my own, 100% collections will be kept for me within my PLLC.

Please let me know your thoughts and anything I should keep in mind.

Thank you all! I don't usually post, but have been a long time lurker on multiple threads. Appreciate all input.

PainLove

Salary? Referral base? ALL procedures at asc (do u collect any of the facility fee?)

 

[painlove]

Salary? Referral base? ALL procedures at asc (do u collect any of the facility fee?)

No salary. However, everything I bill for will be mine.
All procedures will be done at the ASC since I will be doing time-share for clinic, which is attached to the ASC. Since I will have part ownership into the ASC, I get a cut from that. Based on laws, you are not allowed to have a percentage of the facility of fee. Instead, all owners split profit equally based on your percentage owned.

As for referral base, I will have to market myself and find a referral base on my own. I may have to hire a marketing company for that, but unsure at this time. I am coming from a big name institution, so I am hoping that helps.

 

[neutro]

youre too green immediately after fellowship.
i would recommend atleast 1 year of hospital based or busy group practice to learn about yourself and how you practice independently, and knowing the flow of patients and managing a practice before you take a big financial risk and do it yourself.
dont give up anesthesia. you can always do locums anesthesia and start a pain practice on the side. that will be less risky.
i doubt any anesthesia group will allow you to just walk right in after fellowship and buy into the practice, or shares in ASC unless you can show to them that you are bringing in profits - which you wont have because you are just starting a practice...

 

[Taus]

youre too green immediately after fellowship.
i would recommend atleast 1 year of hospital based or busy group practice to learn about yourself and how you practice independently, and knowing the flow of patients and managing a practice before you take a big financial risk and do it yourself.
dont give up anesthesia. you can always do locums anesthesia and start a pain practice on the side. that will be less risky.
i doubt any anesthesia group will allow you to just walk right in after fellowship and buy into the practice, or shares in ASC unless you can show to them that you are bringing in profits - which you wont have because you are just starting a practice...

This. Unless you have the money saved to survive on your own for a while, I'd learn the private practice ropes in an established practice first before doing this.


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[drpainfree]

It doesn't sound like a "job opportunity" for you. More likely a potential source of income for the ASC, from both facility fee and timeshare rent. A lot of these ASC ownership things are set up to take advantage of small owners.

 

[painlove]

This. Unless you have the money saved to survive on your own for a while, I'd learn the private practice ropes in an established practice first before doing this.


Sent from my iPhone using SDN mobile app

What would you consider "awhile" for being able to survive on my own?
Besides being new, what other barriers do you foresee? If I join a PP, I will be stuck with non-competes when I want to leave in a year. If I join a hospital based system, I will be stuck with having them run the show with how these are run and whatnot.

Thanks again for your input, Would love to know more what you or anyone else is thinking,.

 

[BobBarker]

The key questions are what will you ownership percentage be, how much will that cost, and how much would that percentage have payed off last year? Also, will you be filling a "need" among the other doctors or be competing directly with other ASC owners.

 

[nvrsumr]

U can do it. Skip the Asc and get loan for office procedure suite. Do part time gas til busy for extra income

 

[painfree23]

U can do it. Skip the Asc and get loan for office procedure suite. Do part time gas til busy for extra income

Office procedure suite is MONEY. Clinic procedures > part time asc in my opinion. U can see patients in between procedures, u can easily schedule same day procedures. Only thing is u have to provide fluoro, which can be expensive. Do those of u in clinic have rad techs? Or just have an MA operate the c arm?

 

[neutro]

What would you consider "awhile" for being able to survive on my own?
Besides being new, what other barriers do you foresee? If I join a PP, I will be stuck with non-competes when I want to leave in a year. If I join a hospital based system, I will be stuck with having them run the show with how these are run and whatnot.

Thanks again for your input, Would love to know more what you or anyone else is thinking,.

well, how many cervical ESIs and cervical medial branch blocks and RFAs have you done INDEPENDENTLY? i.e. without attending standing next to you. How long does it take you to do a stim trial? are you planning to manage pumps and implant stims? I doubt you will be 100% proficient in every aspect of interventional pain management despite being from a reputable place. It takes a good 6 months to a year to be comfortable with fluoro anatomy and looking at it yourself without help from attending. Heck, I would say it takes even longer to really know your patients well, and in my clinic, new patient evals are slotted for 45 minutes and I do not use my computer while the patient is in the room [i know it seems long, but my patients have not had any work up done]. Clinic visit is only for history, physical and plan. I document afterwards.
what is your clinic protocol for opioid management?
what are some of your weaknesses? strengths that you would like to build upon? what % mix do you want? what kind of patients you like seeing? which ones do you not want to see?

these are questions you need to answer to yourself before you venture into independent practice. Do not risk a paycheck not coming in while you are trying to figure out what kind of a doctor you are. every physician on SDN is different and so in real life. you can certainly learn as you go while starting solo, but that is a financial risk to you. And by the way, there is nothing wrong with being an "employee" for a while you are finding out answers to these questions at someone else's expense. learning about yourself and getting proficient in procedures and working on your skill is far more important to me, than the urge to start things in a chaos just to earn money...

Also, keep up your anesthesia skills so you can do locums. Pass your boards in the meantime.

I am personally in the process of getting the groundwork ready for independent practice in an area where i would like to live long term. I just obtained a license in that state. I have 10 months to plan a move.
I have been an employed physician since I finished my fellowship 2 years ago. It takes me 20-30 minutes to do a stim trial, 15-20 minutes for a lumbar RFA, 1-3 minutes for a LESI and 5-10 minutes for a CESI (only because I am super cautious). I am doing between 15-25 blocks on my procedure days. I have always been a solo, hospital based doctor without a department or other docs or midlevels - ofcourse, I seek guidance from my local pain docs, and affiliate hospital.

Yes, being employed has its downside, but I feel it is important to live through those downsides also and learn about them.

I could not have imagined going straight private practice one month after fellowship...you dont know much at that time...good luck.

 

[drpainfree]

well, how many cervical ESIs and cervical medial branch blocks and RFAs have you done INDEPENDENTLY? i.e. without attending standing next to you. How long does it take you to do a stim trial? are you planning to manage pumps and implant stims? I doubt you will be 100% proficient in every aspect of interventional pain management despite being from a reputable place. It takes a good 6 months to a year to be comfortable with fluoro anatomy and looking at it yourself without help from attending. Heck, I would say it takes even longer to really know your patients well, and in my clinic, new patient evals are slotted for 45 minutes and I do not use my computer while the patient is in the room [i know it seems long, but my patients have not had any work up done]. Clinic visit is only for history, physical and plan. I document afterwards.
what is your clinic protocol for opioid management?
what are some of your weaknesses? strengths that you would like to build upon? what % mix do you want? what kind of patients you like seeing? which ones do you not want to see?

these are questions you need to answer to yourself before you venture into independent practice. Do not risk a paycheck not coming in while you are trying to figure out what kind of a doctor you are. every physician on SDN is different and so in real life. you can certainly learn as you go while starting solo, but that is a financial risk to you. And by the way, there is nothing wrong with being an "employee" for a while you are finding out answers to these questions at someone else's expense. learning about yourself and getting proficient in procedures and working on your skill is far more important to me, than the urge to start things in a chaos just to earn money...

Also, keep up your anesthesia skills so you can do locums. Pass your boards in the meantime.

I am personally in the process of getting the groundwork ready for independent practice in an area where i would like to live long term. I just obtained a license in that state. I have 10 months to plan a move.
I have been an employed physician since I finished my fellowship 2 years ago. It takes me 20-30 minutes to do a stim trial, 15-20 minutes for a lumbar RFA, 1-3 minutes for a LESI and 5-10 minutes for a CESI (only because I am super cautious). I am doing between 15-25 blocks on my procedure days. I have always been a solo, hospital based doctor without a department or other docs or midlevels - ofcourse, I seek guidance from my local pain docs, and affiliate hospital.

Yes, being employed has its downside, but I feel it is important to live through those downsides also and learn about them.

I could not have imagined going straight private practice one month after fellowship...you dont know much at that time...good luck.

I agree you should keep your anesthesia skill intact and get your boards out of the way (both anesthesia and pain boards).

Besides that I completely disagree with you need to take 1-2 years to start your own private practice just to be comfortable with your technical skills.

Being an employed physician gives you one thing, and one thing only that's transferable to solo private practice: money saved to get through downtime of PP. Other than that, you are just wasting your time. Really, what's more precious than time? You won't learn much about billing when you're an employed physician, even when you try to learn, it won't be same when you open your shop in a different area with different payer mix. You won't learn much about hospital credentialing, hiring your staff, paying payroll tax, etc, and etc. All these comes from actually learning in the trench, just a few examples.

Now, nobody cares about if you can do a trial in 20-30 minutes, or RFA in 15-20 unless you are employed and being monitored by someone for your productivity. In first few years of solo PP, you will be lucky to do a trial or RFA a few times a year, assuming you have the volume from enough referral sources. These are important skills, don't get me wrong, but you need much more than medical skills to survive in solo PP. And that, is not something you can learn without actually doing it.

 

[neutro]

I agree you should keep your anesthesia skill intact and get your boards out of the way (both anesthesia and pain boards).

Besides that I completely disagree with you need to take 1-2 years to start your own private practice just to be comfortable with your technical skills.

Being an employed physician gives you one thing, and one thing only that's transferable to solo private practice: money saved to get through downtime of PP. Other than that, you are just wasting your time. Really, what's more precious than time? You won't learn much about billing when you're an employed physician, even when you try to learn, it won't be same when you open your shop in a different area with different payer mix. You won't learn much about hospital credentialing, hiring your staff, paying payroll tax, etc, and etc. All these comes from actually learning in the trench, just a few examples.

Now, nobody cares about if you can do a trial in 20-30 minutes, or RFA in 15-20 unless you are employed and being monitored by someone for your productivity. In first few years of solo PP, you will be lucky to do a trial or RFA a few times a year, assuming you have the volume from enough referral sources. These are important skills, don't get me wrong, but you need much more than medical skills to survive in solo PP. And that, is not something you can learn without actually doing it.

Well, while you're Employed...you Can learn The business side...you can get your volume of cases up
And give yourself confidence...lastly you can
Always have the 'option to
Go independent clause' negotiated, like I do. I can go
Independent tomorrow if I wanted...

Starting a private practice is like any other small business. Unless you are ready to invest and start a business, and are financially able to take a risk with a 7-8 month income already saved to run Your house , yes sure go for it.

In a competitive area, I doubt you
Will be able to beat out experienced physicians.

And of course it matters how fast you see patients and do procedures! Private practice is all
About volume! The faster and better you are, the more revenue you capture.

 

[neutro]

And what's there to learn about hospital credentialing? In the past two years, I have credentialed at 5 different facilities for anesthesia, pain and Asc work - all it requires is paperwork and possible interview and a urine? Unless I'm Missing something?

Billing, HCFA form, resubmission...you can also use billing company and give them
3%, like what we do...and learn the process and details yourself, like what i am doing

Of course we can do it ourselves but I don't anticipate it being too difficult or not learnable.

i have saved money from my current job. i have paid half of my med school loans in the last two years and significantly dropped the payments so i am mostly paying back the principal. I take anesthesia call so that brings me money also.

Yes being employed means not much control over decision making, and that is the reason I will be starting my own gig, but it does offer the benefit of no hassle, no overhead headache of putting logistics in place while you are planning the next move. the last thing i want to do when i am starting my own gig is not to be sure of basics. have this current experience has resolved all these issues.

 

[painlove]

This is all very helpful. Thank you everyone who has responded.

From other people I have spoken to at conferences, many of those who said they started on their own after fellowship said that they had some learning curves, but you sort of figure it out as you go along.
Some folks who joined a hospital group were usually the only pain provider, so essentially you are by yourself in terms of management and skills, but the hospital will take care of the billing, nursing staff, emr, etc.

My approach is that if I am able to have another income (wife), then it could be worth the risk trying to do it on my own especially if I can bill for anesthesia services and join an ASC.

I understand how some of you mentioned that most people are too green after fellowship. Is there anything you recommend that a fellow can do or wish you did as a fellow to better prepare you for private practice?

Again, any and all input is greatly appreciated.

 

[drusso]

Start your own practice after fellowship. Start lean and go slow. Learn as you go. Just as the rest of us did.

 

[drpainfree]

Well, while you're Employed...you Can learn The business side...you can get your volume of cases up
And give yourself confidence...lastly you can
Always have the 'option to
Go independent clause' negotiated, like I do. I can go
Independent tomorrow if I wanted...

Starting a private practice is like any other small business. Unless you are ready to invest and start a business, and are financially able to take a risk with a 7-8 month income already saved to run Your house , yes sure go for it.

In a competitive area, I doubt you
Will be able to beat out experienced physicians.

And of course it matters how fast you see patients and do procedures! Private practice is all
About volume! The faster and better you are, the more revenue you capture.

You are confusing speed with volume!
Again you're not in private solo PP, you don't know what you don't know, therefore you don't know what to prepare for what you don't know.
Again saving money to get through first couple of years of tough time in PP is the only reason you would take an employed position.
I would say about 80% of skills/info you acquire as an employed md is not transferrable to solo PP.

 

[deleted185747]

My recommendation is to get a job somewhere doing pain and after a year of experience start your own practice outside of the non-compete area. Keep your costs low by subleasing office space from several potential referral sources. Have web-based EMR so you are portable. Takes cases to ASC. Once volume picks up get your own place and own procedure suite and stop working for the initial guy.

 

[nvrsumr]

If you can land a part time gas gig you will be able to get a good start up bank loan, do not compete won't matter and can handle the early lean times.

Jumping thru hoops for the bank can be excellent discipline.

ASCs aren't magic. Have seen a lot of docs not make money and be stuck with their low return investment.

 

[neutro]

You are confusing speed with volume!
Again you're not in private solo PP, you don't know what you don't know, therefore you don't know what to prepare for what you don't know.
Again saving money to get through first couple of years of tough time in PP is the only reason you would take an employed position.
I would say about 80% of skills/info you acquire as an employed md is not transferrable to solo PP.

nope. not true. I dont have to jump off a 4000 foot cliff to know that it will result in death.
lets just agree to disagree.
"80% of skill is not transferrable", really? then what is? how exactly a lumbar TFESI that you do in your clinic is different than what I do at my hospital? am i missing something?
And no, you dont technically need to have money saved up to start a practice. I save money for myself and to invest, not to start a practice. you can always get a practice line of credit to finance your practice.

 

[drpainfree]

nope. not true. I dont have to jump off a 4000 foot cliff to know that it will result in death.
lets just agree to disagree.
"80% of skill is not transferrable", really? then what is? how exactly a lumbar TFESI that you do in your clinic is different than what I do at my hospital? am i missing something?
And no, you dont technically need to have money saved up to start a practice. I save money for myself and to invest, not to start a practice. you can always get a practice line of credit to finance your practice.

Lumbar TESI skill should be acquired as a fellow, not as employed. Technical skills should be acquired while you were in training and excelled during your LIFETIME of learning. It's why there are so many of us on this forum who have been in practice for a long time still debate and learn from each other on technical aspect of things. You will never finish learning, employed or not.

While you are employed, you will never learn things about marketing, you will never truly establish reliable networking with your referral sources, you will never know what your hospital will require you to have back-up coverage when you are on your own, you will never know much about payroll tax requirement, etc, you will never know where to get your materials and supplies at the most affordable rate, etc.

Starting a PP is not a cerebral process where you just THINK what you might need. It's a "doing" process, a logistic process that you need to get down and dirty and get things done, and running.

When you start your own solo PP, you don't FINANCE your practice, especially in today's healthcare economy. You use your own money, start lean and mean, and get things done with what you have, not with what you can borrow.

So looking at your last sentence, I am not quite sure if you are ready to start your PP. Maybe you do need more cerebral thinking to figure out to use line of credit to finance your practice is a risky move.

 

[Ducttape]

its always so fun to elevate oneself and to congratulate oneself in to doing something that is special.

forgive me if I am overreacting, but being employed and jumping in to PP seems not that different than being in a fellowship and jumping in to PP. one has to start somewhere with the "doing", as you call it. im not seeing a great difference between the two.

please do not make it seem like it is a curse being previously employed, that they are doomed to fail miserably if they choose to go in to PP. in fact, what are you advocating? that all non-PP docs need to join an established clinic and buy their way in?

at least, compared to those coming straight out of fellowship, they have some extra cash in their bank account...

 

[painlove]

@drpainfree and @drusso and anyone else!

What exactly do you mean by keeping things "lean"? I will have to pay an hourly wage to an MA, setup an answering service, fax line, PLLC, malpractice, marketing, and random expenses like office supplies and stuff. The nice thing is that the time-share will include electricity, computers, phones, etc. But I expect that I will have to take out a loan to help pay for these basic start-up costs? What other suggestions do you have and do you have further clarification on what you mean to start off "lean"?

Again, I appreciate everyone's insight. It's great to hear everyone's perspective.
Thank you!

 

[drusso]

Starting a PP is not a cerebral process where you just THINK what you might need. It's a "doing" process, a logistic process that you need to get down and dirty and get things done, and running.

This is spot on!

I would also add that it is a process of personal discovery--finding out what you roles you're really good at--management, HR, marketing, leadership, community relations, etc. You see many employed MD's move around a lot. Not so much for PP. You invest, create, and build something and you are more or less chained to the oars.

 

[drusso]

@drpainfree and @drusso and anyone else!

What exactly do you mean by keeping things "lean"? I will have to pay an hourly wage to an MA, setup an answering service, fax line, PLLC, malpractice, marketing, and random expenses like office supplies and stuff. The nice thing is that the time-share will include electricity, computers, phones, etc. But I expect that I will have to take out a loan to help pay for these basic start-up costs? What other suggestions do you have and do you have further clarification on what you mean to start off "lean"?

Again, I appreciate everyone's insight. It's great to hear everyone's perspective.
Thank you!

Put all your IT "in the cloud" using subscription-based services. Eat it and pay a competent billing company a percentage for the first few years and then re-evaluate bringing everything in house as you grow. Keep your leases as short as possible even you need to pay a premium. You can get probably get a credit line from smaller local banks/lenders.

 

[drpainfree]

its always so fun to elevate oneself and to congratulate oneself in to doing something that is special.

forgive me if I am overreacting, but being employed and jumping in to PP seems not that different than being in a fellowship and jumping in to PP. one has to start somewhere with the "doing", as you call it. im not seeing a great difference between the two.

please do not make it seem like it is a curse being previously employed, that they are doomed to fail miserably if they choose to go in to PP. in fact, what are you advocating? that all non-PP docs need to join an established clinic and buy their way in?

at least, compared to those coming straight out of fellowship, they have some extra cash in their bank account...

Here're my points,

- yes, work for someone else right out of fellowship is NOT a bad idea, but earning extra cash is the priority, not so much to prepare you to move onto your own solo PP.
- I'm not saying once you're employed, you cannot go onto open your own shop, solo PP. I'm just saying employment position does not give you more advantage.
- If time is the most valuable commodity in life, I would argue to save the time and invest it in your OWN practice.

 

[EtherBunny]

It's interesting that a few people on this forum are strongly advocating for private practice. Is it still a worthwhile pursuit these days with declining reimbursement, increasing overhead, and site of service differential in reimbursement between hospital and office based? When I talk to physicians in other fields who are in private practice, I hear the same thing over and over again--declining revenue, rising overhead, and problems with health care consolidation. So many private practices are selling out to hospitals or many people in private practice seem to be abandoning it for hospital employment.

What do the guys in private practice interventional pain think about these trends nowadays? I'm in private practice but I'm not a partner yet, so I haven't had to struggle with the financial aspects of private practice relative to employment. But it's something I worry about as I get closer to the possibility of partnership, with a hefty financial buy-in.

 

[Dr. Ice]

What kind of practice are you in? Pain practice or surgical practice? Makes a big difference. The worry will never end if you are in a surgical practice as you will never make as much as them. The elephant in the room would always be that you aren't pulling your weight as partner. If I had to do it all over again I would have found someone else who wanted to start a practice and would have just started a two man group and seen where it went. Hindsight is 20/20...

 

[drusso]

It's interesting that a few people on this forum are strongly advocating for private practice. Is it still a worthwhile pursuit these days with declining reimbursement, increasing overhead, and site of service differential in reimbursement between hospital and office based? When I talk to physicians in other fields who are in private practice, I hear the same thing over and over again--declining revenue, rising overhead, and problems with health care consolidation. So many private practices are selling out to hospitals or many people in private practice seem to be abandoning it for hospital employment.

What do the guys in private practice interventional pain think about these trends nowadays? I'm in private practice but I'm not a partner yet, so I haven't had to struggle with the financial aspects of private practice relative to employment. But it's something I worry about as I get closer to the possibility of partnership, with a hefty financial buy-in.

It sucks $hit. But, the alternative is worse.

 

[Disciple]

It's interesting that a few people on this forum are strongly advocating for private practice. Is it still a worthwhile pursuit these days with declining reimbursement, increasing overhead, and site of service differential in reimbursement between hospital and office based? When I talk to physicians in other fields who are in private practice, I hear the same thing over and over again--declining revenue, rising overhead, and problems with health care consolidation. So many private practices are selling out to hospitals or many people in private practice seem to be abandoning it for hospital employment.

What do the guys in private practice interventional pain think about these trends nowadays? I'm in private practice but I'm not a partner yet, so I haven't had to struggle with the financial aspects of private practice relative to employment. But it's something I worry about as I get closer to the possibility of partnership, with a hefty financial buy-in.

Those trends are accurate.

Depends what would make you more depressed, being a drone or being a hustler. To each his own.

 

[lonelobo]

Heard they same arguments 15 yrs ago out of training.

Painlove don't listen to the naysayers here, if you are comfortable heard straight to PP since that is what you are planning on.
Sounds like you understand the risks associated with this and that is what you want to do.

Could an employed position make you more money the 1st couple years , Maybe?
Does it prepare you for private practice...unlikely.

There will be hiccups along they way, but that is part of the learning process. Many don't have the risk tolerance for PP, but
I think overall you will sleep better knowing that you succeed/fail based on your own merits and not worrying about possibly being a hospital administrator's bitch.

 

[BobBarker]

Calling employed physicians drones or bitches is a little offensive.

 

[lonelobo]

Calling employed physicians drones or bitches is a little offensive.

Not per say calling Employed physicians "bitches", sorry if I offended.
What I meant is that more of the urban dictionary phrase

Someones bitch
Someone who does everything for you, not very loved by the person you are doing stuff for. If you are someones bitch you are their slave, someone who they need to clean up for them; someone who doesnt mean alot to a significant other.

 

[Ducttape]

we prefer the term "proles"

 

[DOctorJay]

just don't call me a provider

 

[solopain]

Heard they same arguments 15 yrs ago out of training.

Painlove don't listen to the naysayers here, if you are comfortable heard straight to PP since that is what you are planning on.
Sounds like you understand the risks associated with this and that is what you want to do.

Could an employed position make you more money the 1st couple years , Maybe?
Does it prepare you for private practice...unlikely.

There will be hiccups along they way, but that is part of the learning process. Many don't have the risk tolerance for PP, but
I think overall you will sleep better knowing that you succeed/fail based on your own merits and not worrying about possibly being a hospital administrator's bitch.

Thanks for the great post! Yes, I understand the risks of starting my own PP. The thought of grinding it out and making it work is a challenge I am willing to take.

My biggest concern is declining reimburments. I read somewhere that expect about 50% of your earnings to go towards overhead..any idea how many patients I will need to see and procedures done on average in a given week to even have some sort of decent income (~200k)?? With reimbursemts declining I am concerned that I won't even make a decent amount.

Any thoughts are appreciated!

This tread has been great and has given me more perspective on starting a PP. thank you all!

 

[Disciple]

Thanks for the great post! Yes, I understand the risks of starting my own PP. The thought of grinding it out and making it work is a challenge I am willing to take.

My biggest concern is declining reimburments. I read somewhere that expect about 50% of your earnings to go towards overhead..any idea how many patients I will need to see and procedures done on average in a given week to even have some sort of decent income (~200k)?? With reimbursemts declining I am concerned that I won't even make a decent amount.

Any thoughts are appreciated!

This tread has been great and has given me more perspective on starting a PP. thank you all!

You can make 200K if you're busy and get at least Medicare rates on most of your contracts. Could be difficult if you're getting primarily med management referrals.

 

[thecentral09]

You can make 200K if you're busy and get at least Medicare rates on most of your contracts. Could be difficult if you're getting primarily med management referrals.

This as compared to a hospital employee. I am a graduating fellow and just interviewed with multiple hospitals (>5) for employed positions who offered 400k-550k as base salary guaranteed out of fellowship. Sure, these locations may not be the most desirable locations, but it is guaranteed money that could be earned and saved while you are also learning the specifics of billing/staff management/ reimbursement etc. Then after three to five years start your own private practice with your own money.

 

[BobBarker]

You will never be able to afford a $6500 chair at $200k/year "maybe if you are busy".

 

[Ligament]

Drone or Hustler is about right. Either required to survive in their respective environment.

 

[solopain]

This as compared to a hospital employee. I am a graduating fellow and just interviewed with multiple hospitals (>5) for employed positions who offered 400k-550k as base salary guaranteed out of fellowship. Sure, these locations may not be the most desirable locations, but it is guaranteed money that could be earned and saved while you are also learning the specifics of billing/staff management/ reimbursement etc. Then after three to five years start your own private practice with your own money.

Since they are offering you that much, they must also be profiting off you as well. So to justify that guaranteed salary, you must be generating a lot of revenue for them.
How many patients do they expect you to see and how many procedures do they expect you to perform?
Bc reimbursements shouldn't be different if you're on your own in PP except that you get to keep 100% of your collections.

I would love to know more about that. Bc it seems then my previous statement of at least making 200k is much more doable that anticipated. Please correct me if I am wrong.

Thank you again for the post. I appreciate it!

 

[BobBarker]

I think you are really a bit oblivious if you think $200k is even close to reasonable. Look at the ASIPP fee schedule. 99204 is about $166. If you work say 48 weeks a year, 4 days a week, and see 10 new patients a day, and none of them ever return for anything it is $318,000.

 

[Disciple]

I think you are really a bit oblivious if you think $200k is even close to reasonable. Look at the ASIPP fee schedule. 99204 is about $166. If you work say 48 weeks a year, 4 days a week, and see 10 new patients a day, and none of them ever return for anything it is $318,000.

And at 50% overhead that's $160,000.

 

[drpainfree]

I think you are really a bit oblivious if you think $200k is even close to reasonable. Look at the ASIPP fee schedule. 99204 is about $166. If you work say 48 weeks a year, 4 days a week, and see 10 new patients a day, and none of them ever return for anything it is $318,000.

10 new patients a day? wow!!!!

 

[BobBarker]

Why would you have that much overhead? You need one exam room, malpractice, pen, paper, and one $10/hour receptionist or maybe your Aunt Betty would do it for free. Lease the copy machine. No medical supplies needed. Take your own vitals.

10 new patients is just a very easy, doable example. You could spend 45 minutes with each one if you wanted.

 

[Ducttape]

That's assuming you get 100% of collections...

And you can find a market with such a high need and essentially no pain presence now....

And that you have such a great marketing strategy - other than "new pill mill in town" that you can get that many new patients...


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[EtherBunny]

That's assuming you get 100% of collections...

And you can find a market with such a high need and essentially no pain presence now....

And that you have such a great marketing strategy - other than "new pill mill in town" that you can get that many new patients...


Sent from my iPhone using SDN mobile

Definitely true. It's easier said than done to recruit good patients into a new private practice, especially in a competitive market. Good luck getting 10 new patients a day. You'll be lucky if you get 1-2 new patients a day for several months. Hospital based practice is very different from private practice. The former is like drinking from the fire hydrant with new patient referrals--you can be full within 3 months. The latter is a painfully slow growth process.

 

[BobBarker]

2/day? Ok, agree to disagree. But I challenge anyone to look at the fee schedule and determine it is possible for anyone in full time practice to only clear 200k.

 

[drpainfree]

That's assuming you get 100% of collections...

And you can find a market with such a high need and essentially no pain presence now....

And that you have such a great marketing strategy - other than "new pill mill in town" that you can get that many new patients...


Sent from my iPhone using SDN mobile

agree. I'd be lucky to hit 2 new patients a day, consistently day in an day out.

 

[EtherBunny]

2/day? Ok, agree to disagree. But I challenge anyone to look at the fee schedule and determine it is possible for anyone in full time practice to only clear 200k.

I thought my experience in private practice would be similar to my time as a hospital employee. Boy was I wrong. They are sooooo different. It takes a really long time to build up a solid patient base in private practice, if you practice ethically in a competitive market. At least 2 years, or so it seems.
I typically get 1-2 new patients a day.

Hospital employment? Completely different animal. I was up to my eyeballs in patients after 3 months. 10 new patients a day in that setting was very plausible. Hospital employment can really skew a person's perspective on practice growth. Private practice is more challenging in this respect.

I agree that an ethical doc in private practice, with a full schedule and no ancillary revenue streams, can definitely clear $200,000/yr. Probably close to $350,000/yr. You need ancillary revenue streams and access to facility fees to push the income substantially higher than that though.