What is your side gig?

[bravotwozero]

Maybe I'll set up my own snake oil ketamine cash clinic and get out of the rat race

That's the spirit man! If you can't beat 'em, join 'em! I don't know why the others on this thread just don't get it!

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[RustedFox]

That's the spirit man! If you can't beat 'em, join 'em! I don't know why the others on this thread just don't get it!

I gave up on the "nobility" of EM earlier this year. Anything that gets you out from under the rule of the suits is a good thing, so long as it does no real harm.

Eff "EM" as it currently stands.

 

[sloh]

Man, medicine sucks haha. Quite depressing. We can quibble on whether this is “snake oil,” but I think this whole discussion—being relegated to IV clinics, “regen” med (I’m PM&R
btw and would confidently say PRP/stem cells is grifting)—speaks to how the actual practice of medicine, its perverse incentives, and significant number of entitled patients who will not take even an iota of responsibility in their own health while acting like entitled children are a far cry from what we envisioned before med school and completing training.

Get that fu money asap doing the least harm possible and ride off into the sunset.

 

[Apollyon]

Man, medicine sucks haha. Quite depressing. We can quibble on whether this is “snake oil,” but I think this whole discussion—being relegated to IV clinics, “regen” med (I’m PM&R
btw and would confidently say PRP/stem cells is grifting)—speaks to how the actual practice of medicine, its perverse incentives, and significant number of entitled patients who will not take even an iota of responsibility in their own health while acting like entitled children are a far cry from what we envisioned before med school and completing training.

Get that fu money asap doing the least harm possible and ride off into the sunset.

Calling it "grifting" means that there is deception involved. If the doc says outright that there's no proof it works, that's not grifting.

The people clutching at their pearls, with all their righteous indignation, in this thread, are something to see. At that, why not keep going all the way, à la DrMcNinja, to doing nothing, as little of what we do is proven to work. There's salesmen in most of what we do.

People calling this "snake oil" are saying that this doc is a con artist. If he's saying that nothing is proven to work, all y'all need to choose a more accurate phrase.

 

[sloh]

Calling it "grifting" means that there is deception involved. If the doc says outright that there's no proof it works, that's not grifting.

The people clutching at their pearls, with all their righteous indignation, in this thread, are something to see. At that, why not keep going all the way, à la DrMcNinja, to doing nothing, as little of what we do is proven to work. There's salesmen in most of what we do.

People calling this "snake oil" are saying that this doc is a con artist. If he's saying that nothing is proven to work, all y'all need to choose a more accurate phrase.

It's not always clear when and how a product is sold drifts into the territory of grifting though. Physicians are generally more knowledgeable and intelligent than the general public; and the way benefits/risks/mechanisms are worded or downsides omitted can easily sway unsuspecting customers/patients while still remaining at best in the gray zone. Yes, this applies to many customer/vender interactions but I just think we physicians arguably should hold ourselves up to higher ethical/moral standards. To each their own though ‍:\

 

[RustedFox]

It's not always clear when and how a product is sold drifts into the territory of grifting though. Physicians are generally more knowledgeable and intelligent than the general public; and the way benefits/risks/mechanisms are worded or downsides omitted can easily sway unsuspecting customers/patients while still remaining at best in the gray zone. Yes, this applies to many customer/vender interactions but I just think we physicians arguably should hold ourselves up to higher ethical/moral standards. To each their own though ‍:\

Yet, the general public doesn't want to listen to what we have to say; sometimes often, and sometimes "not at all".
They just "google things" and think that it makes them experts.

Eff 'em. Let them have their poison. I'll give them my expertise; but that's where my "give a damn" ends.

 

[namethatsmell]

This "snake oil" talk requires a bit more nuance.

Setting up a ketamine clinic isn't in itself evil. Treated patients with legit refractory depression is reasonable. But giving ketamine repeatedly to any shmo who has the cash is slimy.

Regenerative medicine? If we're talking about anti-aging crap than yeah that's suspect. But if we're talking about it for msk purposes then it may have a role for some patients, but certainly not for widespread use until more data emerges.

Props to anybody who tries to start up their own practice.

 

[cyanide12345678]

It's not always clear when and how a product is sold drifts into the territory of grifting though. Physicians are generally more knowledgeable and intelligent than the general public; and the way benefits/risks/mechanisms are worded or downsides omitted can easily sway unsuspecting customers/patients while still remaining at best in the gray zone. Yes, this applies to many customer/vender interactions but I just think we physicians arguably should hold ourselves up to higher ethical/moral standards. To each their own though ‍:\

Remind me why we have to hold a higher ethical standard?

I mean everyone else seems to just f*** with us. When usacs had people out in 4 days, when team health decreased staffing significantly everywhere and now that numbers are starting to go up, they are finding excuses to not go back to essentially squeeze every dollar out of us.

Is higher ethical standard another way of saying we are supposed to be the sacrificial lamb?

 

[VA Hopeful Dr]

Remind me why we have to hold a higher ethical standard?

I mean everyone else seems to just f*** with us. When usacs had people out in 4 days, when team health decreased staffing significantly everywhere and now that numbers are starting to go up, they are finding excuses to not go back to essentially squeeze every dollar out of us.

Is higher ethical standard another way of saying we are supposed to be the sacrificial lamb?

Everyone has their limits as to how much they will compromise doing what is right with doing what is easy. I gave up fighting the good fight on antibiotics years ago but still keep a pretty hard line on opioids and benzos. That's my line. Some people think BS IV infusions cross a line, others don't. And that's OK.

It's why our licensing boards don't get involved in BS medicine as long as no one is getting hurt.

 

[bravotwozero]

Yet, the general public doesn't want to listen to what we have to say; sometimes often, and sometimes "not at all".
They just "google things" and think that it makes them experts.

Eff 'em. Let them have their poison. I'll give them my expertise; but that's where my "give a damn" ends.

 

[namethatsmell]

Remind me why we have to hold a higher ethical standard?

I mean everyone else seems to just f*** with us. When usacs had people out in 4 days, when team health decreased staffing significantly everywhere and now that numbers are starting to go up, they are finding excuses to not go back to essentially squeeze every dollar out of us.

Is higher ethical standard another way of saying we are supposed to be the sacrificial lamb?

Why we are held to a "higher standard" is a great question. People seem to define what this "standard" is, and when it applies, in too many different ways to count. Personally, I try to reconcile this by just focusing on my own standard for myself rather than societal/patient expectations of me. I've decided, in order, 1) I gotta practice in a way that lets me sleep well at night, 2) I deserve to be paid fairly, but my interest in medicine is not maximizing my ROI from it, and 3) I refuse to be taken advantage of by an employer.

So some questions...in what ways are we being made into a sacrificial lamb and is it avoidable? Can you create a business where neither you nor the patient becomes the lamb?

 

[EctopicFetus]

Must find outside sources of money. Can be a working spouse or other money making ventures. Some use their medical licenses. To me society has given EM docs (and many others) a big FU. We are stuck under the thumb of hospital noctors, CMG sell outs and they have taken our voice away. Proof is out there. See the Wahsington state doc who had the gall to ask for PPE.

Anyways, society wants us only when convenient for them, they offer us no protection from slimy PE backed corps. You want to feel bad about yourself. When your care bankrupts a patient you should feel bad. One of the magic things CMGs did is separate your work from the money it brings it. It allowed them to make a nice profit and you can see no evil as they commit it in your name and using your medical license.

I know many have no choice.. but that is false.. your choice is to GTFO. Snake oil, porn, ketamine clinics, regenrative medicine, med spas, Urgent Cares, etc.. whatever it takes.. do it.

 

[namethatsmell]

Must find outside sources of money. Can be a working spouse or other money making ventures. Some use their medical licenses. To me society has given EM docs (and many others) a big FU. We are stuck under the thumb of hospital noctors, CMG sell outs and they have taken our voice away. Proof is out there. See the Wahsington state doc who had the gall to ask for PPE.

Anyways, society wants us only when convenient for them, they offer us no protection from slimy PE backed corps. You want to feel bad about yourself. When your care bankrupts a patient you should feel bad. One of the magic things CMGs did is separate your work from the money it brings it. It allowed them to make a nice profit and you can see no evil as they commit it in your name and using your medical license.

I know many have no choice.. but that is false.. your choice is to GTFO. Snake oil, porn, ketamine clinics, regenrative medicine, med spas, Urgent Cares, etc.. whatever it takes.. do it.

This is all truth.

As for the bolded, I've been a broken record about this for the last few years now. It's totally true.

For anybody contemplating leaving a CMG or a different style of predatory group, consider that their biggest score isn't what they profit off you in a given year...it's planting the idea in your mind that "well, this is just how it is now" and working for them in perpetuity.

And there's nothing a CMG would rather do than reinforce the notion that you can't do anything other than work for them in an ED. Welllllllll...

That's. Just. False.

 

[cyanide12345678]

I know many have no choice.. but that is false.. your choice is to GTFO. Snake oil, porn, ketamine clinics, regenrative medicine, med spas, Urgent Cares, etc.. whatever it takes.. do it.

Speaking of porn, my fully automated dropshipping adult e-commerce store is starting to get decent traffic and beginning to gain rank on Google

 

[BAM!]

Why are we discouraging entrepreneurial risk taking by calling it snake oil? So what if there's no obvious benefit to the IV hydration? I'm pretty sure the last time i pushed Tpa, there was only questionable benefit as well.

Firstly: Put down your straw man argument. No one's bashing business. And the best businesses solve problems instead of preying on the ignorant.

Secondly: Of course it's snake oil. Do you really think a 5 second half hearted disclaimer is changing any paying customers' minds? No, the idiots paying for that garbage are already sold. And the clinic owner knows it. That's what makes the sale deceptive.

Thirdly: If you know you're selling snake oil, own it. Be honest. The most disgusting part is rationalizing it.

 

[EctopicFetus]

Simply know what your doing and be honest with yourself. No shame there. When my hospital said they wanted to cut ed visits and admits I said why. Our job is to see people in the ed. I have no interest in sending them to noctors to get mistreated then coming to the ed. It’s easy to point out how the noctors can save money. A large number of people we see in the ed would have the same outcome if they didnt come to the hospital. 1/3 of ab pain visits to the ED get no specific diagnosis. It’s higher for the younger folks. For that 1/3 all those tests led to no change in outcome or management. Sure you would miss the appy, cancer ectopic etc.

We have to advocate for ourselves. No one else is doing it.

 

[beebermd]

Firstly: Put down your straw man argument. No one's bashing business. And the best businesses solve problems instead of preying on the ignorant.

Secondly: Of course it's snake oil. Do you really think a 5 second half hearted disclaimer is changing any paying customers' minds? No, the idiots paying for that garbage are already sold. And the clinic owner knows it. That's what makes the sale deceptive.

Thirdly: If you know you're selling snake oil, own it. Be honest. The most disgusting part is rationalizing it.

just checked back in and wow! lol. didn't expect to see such a backlash. that escalated quickly. I suppose you don't have to agree, but the vitrol is a bit surprising. I suppose that if the patients have already made up their mind regardless of what I have to say, then from a sheer business point of view, then i guess im just filling a niche. A fellow EM doc has his own line of multivitamin and supplements. everyone seems to applaud his entrepreneur spirit despite the fact there is little evidence to support their benefit. Maybe this model offends you as well, who knows. The problem is that while I am approaching this in what I feel is the most medically and ethically responsible way, there are lot of BAD ACTORS in this field, and trying to seperate myself from the stigma they have created has been a challenge. The knee jerk reactions here only reinforces that. I never thought that a doctor having an honest conversation with a patient about possible risks and benefits would be seen as a bad thing. lol. Ive talked quite a few patients out IVs because of unreasonable expectations . I have no problem with discussing anything, but the fact that this is was labeled as "preying on the ignorant", and my patient encounters are automatically assumed to be "a half hearted 5 sec discalimer", means you've probably already made up your mind and sent me down the river of damnation. Im also pretty sure that telling my patients that the only evidence that shows benefit is anecdotal at best, is the definition of "being honest and owning it." To set the record straight, the ethical comparison I made with regards to the ED was in no way shape or form a "rationalization" for anything. It was a broader statement that EM is not free from ethically ambigious situations. with the CMGs, admin, PG, and other metrics that actually could be a harm to patients, and that non compliance puts our jobs at risk, we do a balancing act every day on what we find acceptable with regards to what we are ethically ok with. having to seperate the buisness from the medicine can be difficult, especially when the the progress of one comes at the expense of the other. Find a ratio that is the best for your practice, your patients and your consience. But yes, if the evil IV infusion industry goes belly up, its good to know that I can always turn to drug trafficking, ponzi schemes, reverse mortgages and penis enlargement pills, without any change in the direction of my moral compass. haha

 

[emergentmd]

If you want to get out of the rat race, become a boss and make your own decisions. Don't sit back and let the years fly by then look back on your lost opportunities.

Start a business, Own a UC (You can make $$'$$) if you find the right spot b/c the overhead is so low, get rentals. Heck, save your $$$ and put it in some dividend stocks that pays you quarterly.

But do something and take a risk.

It feels really good when you can make a decision that can affect so many people. Christmas bonus time is coming and the docs literally pick an amount to give to our staff without anyone looking over our shoulders.

 

[Splenda88]

If you want to get out of the rat race, become a boss and make your own decisions. Don't sit back and let the years fly by then look back on your lost opportunities.

Start a business, Own a UC (You can make $$'$$) if you find the right spot b/c the overhead is so low, get rentals. Heck, save your $$$ and put it in some dividend stocks that pays you quarterly.

But do something and take a risk.

It feels really good when you can make a decision that can affect so many people. Christmas bonus time is coming and the docs literally pick an amount to give to our staff without anyone looking over our shoulders.

I would go for dividend index fund (like VYM) instead of individual stock...

 

[Groove]

1) Has anybody thought of getting an x-waiver to prescribe buprenorphine and/or practice addiction medicine on the side? I see a lot of part time jobs for addiction docs in clinics and I also see a bunch of telemedicine gigs where you are basically refilling Suboxone prescriptions for people. One job paid from $150-250/hr. Anybody doing this? Many of the jobs don't require fellowship, only the x-waiver.

2) Anybody doing "collaborative physician" gigs where you sign off and/or review charts for NP/PAs in your state that require physician supervision? Some require a small amount of on site involvement. Any idea about the malpractice risk for something like this?

In case it wasn't obvious...I just came off another string of nights and am flipping to days then flipping back to nights again next week...racking my sleep deprived and circadian shell shocked brain about anything else I could be doing right now...

 

[bravotwozero]

2) Anybody doing "collaborative physician" gigs where you sign off and/or review charts for NP/PAs in your state that require physician supervision? Some require a small amount of on site involvement. Any idea about the malpractice risk for something like this?

No, but I don't have to do this gig to tell you and the other EPs to RUN. RUN FAR FAR AWAY FROM THIS.

Do not touch this with a 100 foot pole.

Not worth the money, wayy to much liability, and they won't even cover your malpractice.

Don't take the hit for incompetent PLPs who you're not even supervising in person.

 

[deleted77919]

…

 

[Birdstrike]

I am 10 days into fellowship (different field from addiction medicine) and honestly - I haven’t been this happy in years.

Good for you.

 

[deleted77919]

…

 

[The Knife & Gun Club]

1) Has anybody thought of getting an x-waiver to prescribe buprenorphine and/or practice addiction medicine on the side? I see a lot of part time jobs for addiction docs in clinics and I also see a bunch of telemedicine gigs where you are basically refilling Suboxone prescriptions for people. One job paid from $150-250/hr. Anybody doing this?

2) Anybody doing "collaborative physician" gigs where you sign off and/or review charts for NP/PAs in your state that require physician supervision? Some require a small amount of on site involvement. Any idea about the malpractice risk for something like this?

In case it wasn't obvious...I just came off another string of nights and am flipping to days then flipping back to nights again next week...racking my sleep deprived and circadian shell shocked brain about anything else I could be doing right now...

At least with a DEA and Xwaiver you can do addiction counseling and decide if it’s right for you.

addiction counseling actually pays (about as much as a central line) if you start the person on buprenorphine from the ED. Just something to think about.