Why won't this work?

[Axehandler]

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Thanks in advance for all who offer suggestions. I am a board certified Emergency Physican who is back in fellowship after ten years of nights/weekends/holidays, contract group headaches, hospital administrator bullying and missed birthday parties.

I am doing a fellowship in Pain and Palliative medicine. I am doing 2 elective months with the interventional pain fellowship at my institution and will have performed > 50 esi's, >30 tfesi's, >30 medial branch blocks and rfs in addition to the hundreds of LPs, joint injections and nerve blocks from my previous life in the ED.

I have a vision for a solo practice; medical and interventional office based pain and symptom management for cancer(prefered) or chronic non-cancer patients. I am not interested in stims or pumps, those I will refer. Refer for psych, addiction screening, pt/ot/at.

I have relationships with tons of pmds, orthopods and spine surgeons not to mention what will be a flood of patients from the three EDs where I still do clinical time.

I plan on seeking ABPM certification and ABIPP after that.(I am not eligible for interventional pain fellowship)

I wan't to know where I am going wrong with this idea and why it will fail. I appreciate all opinions.

 

[SSdoc33]

Thanks in advance for all who offer suggestions. I am a board certified Emergency Physican who is back in fellowship after ten years of nights/weekends/holidays, contract group headaches, hospital administrator bullying and missed birthday parties.

I am doing a fellowship in Pain and Palliative medicine. I am doing 2 elective months with the interventional pain fellowship at my institution and will have performed > 50 esi's, >30 tfesi's, >30 medial branch blocks and rfs in addition to the hundreds of LPs, joint injections and nerve blocks from my previous life in the ED.

I have a vision for a solo practice; medical and interventional office based pain and symptom management for cancer(prefered) or chronic non-cancer patients. I am not interested in stims or pumps, those I will refer. Refer for psych, addiction screening, pt/ot/at.

I have relationships with tons of pmds, orthopods and spine surgeons not to mention what will be a flood of patients from the three EDs where I still do clinical time.

I plan on seeking ABPM certification and ABIPP after that.(I am not eligible for interventional pain fellowship)

I wan't to know where I am going wrong with this idea and why it will fail. I appreciate all opinions.

if you are interested in chronic cancer/non-cancer pain and are willing (dare i say eager?) to prescribe opioids, you should have no lack of business. most people on this board are bigger fans of the procedures than with medication management b/c in general, that means more $$ and less headaches (not to mention the fact that many people dont really "believe" in opioids for chronic non-malignant pain). you may be looking at some big up-front costs, and there are other threads which detail what you might expect.

i would thing long and hard about how you feel about narcotics and what you envision feeling comfortable with in the future. running your own office is not like the ER. you dont have as much shielding from the hospital and these will become YOUR patients with whom you'll need to follow and monitor, unlike what you were doing in the ER.

also, i get the feeling that you'd be seeing ER patients and, in essence, self-referring to your office practice for "pain" care. i havent heard of that model before, but it does seem like a way to get a lot of patients (although maybe not the ones you'd want). might want to check to make sure that is legal -- also, i wouldnt think you could personally bill for 2 separate consultations/new pt evals on the same patient. thus, you'd be seeing a lot of f/u that dont generate as much.

 

[Axehandler]

Self referral is a big no no. My fellow ed physicians are dying for a place to send legitimate pain patients. I am no longer a partner in the group, I am still employed by them however.

Eager is probably not routinely applicable, few would argue we should not use combination therapies including opiates in the case of widely metastatic malignant disease. Chronic low back pain with normal imaging, unwilling to do adjunctive agents or treatments or participate in a care plan, lost my prescriptions and my last doc won't see me anymore.........not so much.

Thanks for your response, I appreciate it.

 

[paindoc2]

I'm not sure if this "self-referral" is any different than a consulting physician following up with his patient in the office. If you see a patient in the ER and you feel you can offer additional services in a private office, assuming there are no non-compete issues with the hospital, not sure there's a problem. If you have the will, the financial resources (c-arm suite is $$expensive$$), the referral base, and some reasonable community acceptance, this is an absolutely attainable goal. You will save yourself a lot of headache if you come up with an algorithm to treat non-malignant pain. Consider what you will do when a high-volume referring physician sends you a patient with no objective pathology and asks you to take over the oxycontin after pt was found with THC in his urine. Then let me know how to deal with that! But your goal is realistic and can work if you get all your ducks in a row beforehand. Go for it!