What was your first job out of fellowship?

[TrailRun]

Current fellow trying to get an early start on thinking about academic vs private practice (or maybe less likely the VA). Wondering what people's first job out of fellowship was and whether you stayed or switched settings. I guess my thinking is academic may generally have better lifestyle, private practice better income, but I'm sure there's a lot of variability

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[gaspasser127]

HOPD setting
Medium to large sized city in an area I was familiar with
$400k base
$63/RVU in excess of base
Part of a neurosurgery practice
Bread and butter procedures + SCS/PNS (can do your own perms as well)
Not allowed to do anything more “advanced” (MILD, Vertiflex, MM, SIJ fusion, Intracept, etc)

Average 16-20 patients a day in clinic
Max 12 bread and butter procedures in half a day

I left because you learn quickly in the real world whether you’re willing to be the surgeon’s b**** or not and I was not.

Hospital system inefficiencies limited my productivity so it’s unrealistic to expect to do more than 700 RVUs a month

 

[BobBarker]

I think it is great to take a medium sized hospital job. Somewhere small enough they can notice your positive financial impact but big enough they aren’t dependent on you. My first job was at a smaller hospital and they were really dependent on me for many years to stay afloat and I felt that burden at times.

 

[thecentral09]

HOPD setting
Medium to large sized city in an area I was familiar with
$400k base
$63/RVU in excess of base
Part of a neurosurgery practice
Bread and butter procedures + SCS/PNS (can do your own perms as well)
Not allowed to do anything more “advanced” (MILD, Vertiflex, MM, SIJ fusion, Intracept, etc)

Average 16-20 patients a day in clinic
Max 12 bread and butter procedures in half a day

I left because you learn quickly in the real world whether you’re willing to be the surgeon’s b**** or not and I was not.

Hospital system inefficiencies limited my productivity so it’s unrealistic to expect to do more than 700 RVUs a month

Similar except small hospital/rural.
Worked my butt off with minimal staff, at the volume/demand to generate 800 to 1000 RVs per month, however, I had a hard time getting above 700 consistently due to inefficiencies that I had no control over. Mainly that was staffing, and being forced to do all procedures in the hospital OR at a critical access hospital, where they made megabucks off of facility fees.

4.5 years later, started private practice, after working around noncompete clause for one year, now with 2.5 PAs, 14 employees, two sites, and seeing around 300-350 patients per week.

 

[mdo1738]

HOPD in small, rural town
$750k base
Quarterly productivity bonus at about $63/RVU once I exceed ~3k RVU/quarter
System is such that I’m able to hit just over 1k RVU a month currently as I’m closing my 1st year without having to excessively grind. I expect to get that up to about 1500 a month over the next year without too much difficulty
1 day per week procedures, 3 days clinic
Seeing about 25-35 patients per day currently
Other than bread and butter, I do SCS, kypho, SI fusion, Vertiflex, Minuteman, and PNS. No ortho/neuro spine doc at the hospital nor within about 45 minutes so no turf wars about what procedures I can do
All procedures done at hospital other than in-office joint injections

I took Bob’s old job. Overall has been pretty good in a small hospital, while they may heavily rely on your productivity that has also meant they have been very responsive to any issues I’ve needed them to fix

 

[drusso]

I've only ever had one job since my fellowship. I guess that makes me a PGY-25. Joined a practice, then bought it. Can't be fired and also completely unemployable. The rest is history.

 

[thecentral09]

I've only ever had one job since my fellowship. I guess that makes me a PGY-25. Joined a practice, then bought it. Can't be fired and also completely unemployable. The rest is history.

I like your picture

 

[nvrsumr]

Joined a solo pmr doc who didn’t do any interventions just med management. Built an office suite from scratch which at the time was probably the first in the state. Left after a year but got to the location i wanted and still reside

Owner currently enjoying his third year in federal prison

 

[stsa84]

HOPD as well, medium city in Southeast. 3 years out of fellowship. Had guaranteed salary of $400k per year for 18 months, then changed to entirely RVU based, $65/RVU. Work M - Th, 8am - 4pm. Half clinic, half procedures. Currently have about 1.5 PA's, and I get paid $18 per chart of theirs I sign, I think it works out to around $50k per year. I'm about as efficient as I can be at this point working 4 days a week, and am on track for low $700's this year. I could make more with longer hours or working Fridays, but I make plenty and incredibly enjoy being home at 4:30 and off Fridays, spending time on things that I find more important and fulfilling.

 

[William Sparrow]

Private practice. 4 years out now. First gig I joined a large multidisciplanary group in a small city adjacent to a large metropolitan area. Found that it was mainly a dumping ground for pill seekers that PCP's didn't want to deal with. Left after 2 years. Then joined an ortho group in the city, still private practice. Heavily interventional, mostly bread and butter procedures. Made partner after a year and now make between $800-900k. I generate around 12-13,000 wrvu's per year. I love being an owner now instead of an employee.

 

[agolden1]

First job was private practice in a small town. Practice had been in place for 20 years with two senior physicians looking to retire in the next 4-5 years. Promise of equal partnership with buy in after 3 years. Starting $265 with three weeks vacation, productivity after that. Initially, had some issues building a patient base even with going door to door and shaking hands. About three months in, three PAs/NPs out of four left the practice and I inherited most of the med management they had been doing. Every fourth patient was high MME with concurrent benzo and/or medical marijuana. EtOH Utoxs were advised to be overlooked by partner physicians or not documented. I was unable to discharge patients without running them by one of the senior physicians, and was advised not to insist they come off benzodiazepine or rotate to Buprenorphine. I also essentially served as a PA/NP for one of the partner docs seeing their procedure follow ups as they didn't want to see them after injection.

In addition, C-arm time was limited to a half day a week as they had one xray tech between three locations and the senior docs needed to do their procedures first. Was commuting an hour twice a week to a satellite location.

I bailed as soon as I could line something up (seven-ish months).

 

[Doctodd]

joined a busy practice in Boynton Beach and did 30 procedures a day with 2 PA's. Lots of Oxycontin patients i didnt really have to deal with. Left after a year and the owners started suing each other. Joined a chiro practice in Mami that didnt last. Went solo and bought my first c-arm and worked part time at Boynton Beach practice again during their court battle and receivership. Then was approached by Health South to start a pain practice and that took off. Took my practice out of Health South and here i am. Still have my office manager from back then.

 

[sloh]

joined a busy practice in Boynton Beach and did 30 procedures a day with 2 PA's. Lots of Oxycontin patients i didnt really have to deal with. Left after a year and the owners started suing each other. Joined a chiro practice in Mami that didnt last. Went solo and bought my first c-arm and worked part time at Boynton Beach practice again during their court battle and receivership. Then was approached by Health South to start a pain practice and that took off. Took my practice out of Health South and here i am. Still have my office manager from back then.

Why were the owners suing each other?

 

[Doctodd]

Why were the owners suing each other?

The usual….money and control

 

[cowboydoc]

I've only ever had one job since my fellowship. I guess that makes me a PGY-25. Joined a practice, then bought it. Can't be fired and also completely unemployable. The rest is history.

Sounds great, but I hear the boss can be a real A-hole.

 

[SSdoc33]

Sounds great, but I hear the boss can be a real A-hole.

he will never love you back

 

[Ducttape]

back? BACK?

he never loved you in the first place.

well, except for the greenbacks you brought in.

wait. i meant petrodollars...

 

[po_boy]

Private practice. 4 years out now. First gig I joined a large multidisciplanary group in a small city adjacent to a large metropolitan area. Found that it was mainly a dumping ground for pill seekers that PCP's didn't want to deal with. Left after 2 years. Then joined an ortho group in the city, still private practice. Heavily interventional, mostly bread and butter procedures. Made partner after a year and now make between $800-900k. I generate around 12-13,000 wrvu's per year. I love being an owner now instead of an employee.

how much marketing did you have to do?

 

[William Sparrow]

how much marketing did you have to do?

I was out shaking hands and kissing babies for a good 8 months. It was a grind, but ended up paying off nicely as I began to break even productivity-wise about 6 months in. I still do a little here and there, but not as often now that my practice is busier.

 

[drrosenrosen]

I was out shaking hands and kissing babies for a good 8 months. It was a grind, but ended up paying off nicely as I began to break even productivity-wise about 6 months in. I still do a little here and there, but not as often now that my practice is busier.

I knew I wasn't supposed to kiss hands and shake babies...