Will pain come back around?

[bedrock]

Stimulator pay is a joke for the risk you take with complications. As are many other procedures. Private insurance paid around 1000$ back in the oughts for an ILESI.

Yall need to remember this each time you put a stimulator in someone.

It is truly insulting how little we are paid for much of what we do now.

It used to be a badge of honor if you did all your trials and implants yourself. Nowadays, it just means you’re being taken advantage of….unless you’re HOPD paid in RVU.

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[bedrock]

Stimulator pay is a joke for the risk you take with complications. As are many other procedures. Private insurance paid around 1000$ back in the oughts for an ILESI.

Still the one that really burns me up are CESI. Only pays a bit over $100 in a facility for a medicare patient. Completely disproportionate to the risk.

 

[Ducttape]

and some pain doctors abused the practice of doing epidurals.

thats part of the reason we are in the boat we are in.

one of the U doctors would routinely - for every single patient - do 3 level bilateral TFESI. at the hospital. series of 3.

everyone wondered why his salary was well over $1.5 million.

you do the math.

(okay, the physician portion alone was $1800 per patient.)
(he would do 3 levels at the same time with the same obliquity, and only save the AP images)

 

[drrosenrosen]

Obviously this guy abused the system, but isn't the reason for drastic cuts in ESI billing because PCPs were billing them for blind in office sitting epidurals? I seem to recall that is why they bundled the fluoro

 

[Ducttape]

absolutely.

you give another good reason.

many docs abused the system, pain docs and those not qualified.

 

[Laryngospasm]

Not to mention the UDS and compound creme scandals if you want to call them that.. the reason no one pays for compound creams anymore

 

[NJPAIN]

The damage has been done to the field of pain medicine and I believe it’s irreversible. By taking the medical practice aspect out of pain medicine we turned our practice and procedures into an assembly line. You may think that performing 40 procedures a day makes you a superstar. Perhaps it does but it devalues what we do. As I have said before; if you treat a procedure with the same time, attention and respect that you treat a haircut, don’t complain when you are paid for a haircut.

 

[jsaul]

I remember taking an asipp cadaver course is the around 2007 and 1/3 of people there were internal med guys
It was wild to see them with the needle and flouro

 

[SSdoc33]

i have been hearing the doom and gloom since medical school. i still have been able to earn more every year for the last 15 years.

 

[jsaul]

i have been hearing the doom and gloom since medical school. i still have been able to earn more every year for the last 15 years.

that's because you are working harder and seeing more patients every year compared to previous, right?

 

[SSdoc33]

that's because you are working harder and seeing more patients every year compared to previous, right?

no comment....

we dont know how much i WOULD be making if things had stayed the same, that is true. but this grass is always greener stuff doesnt help anyone.

 

[NJPAIN]

Bending over and gripping your ankles likewise doesn’t help anyone; neither patient nor physician.

 

[nvrsumr]

Victim blaming. Bad apples everywhere always. Budget neutrality rules and your doctor buddies taking their piece of ur pie.

 

[cowboydoc]

Victim blaming. Bad apples everywhere always. Budget neutrality rules and your doctor buddies taking their piece of ur pie.

Partly true, but the real problem is the pie is relatively smaller, so everyone that is actually cooking is fighting for scraps.

 

[drusso]

i have been hearing the doom and gloom since medical school. i still have been able to earn more every year for the last 15 years.

Are you a HOPD doctor?

 

[drusso]

Bending over and gripping your ankles likewise doesn’t help anyone; neither patient nor physician.

This.

 

[dozitgetchahi]

So I think few people are doing pain for the money cause you can make more doing the OR or the same doing inpatient or subacute on the PMR side… still if you want a predictable work schedule with no real emergencies and light call responsibilities it’s hard to beat… outpatient neurology in My area is dead dead, Rheum is impossible sill like six pain practices

I’m curious how you feel that “rheum is impossible”?

Rheumatology job market is actually quite hot right now.

 

[bedrock]

I’m curious how you feel that “rheum is impossible”?

Rheumatology job market is actually quite hot right now.

As far as I know, both rheum and neurology are in high demand.

I don’t know how either specialty is doing financially, but job market is strong for both.

 

[drusso]

As far as I know, both rheum and neurology are in high demand.

I don’t know how either specialty is doing financially, but job market is strong for both.

You can be busy all day and still go broke.

 

[cowboydoc]

I’m curious how you feel that “rheum is impossible”?

Rheumatology job market is actually quite hot right now.

Rheum is impossible to get into as a patient in my market. University bought up most of the PPs. Could definitely get a job in rheum locally. If you had an infusion center associated with the practice, one could probably do fairly well.

 

[drusso]

Rheum is impossible to get into as a patient in my market. University bought up most of the PPs. Could definitely get a job in rheum locally. If you had an infusion center associated with the practice, one could probably do fairly well.

That's exactly right. The payment model for Rheum commoditized the professional fee into the site of service (infusion center). All those employed university rheumatologist are just little biotches turning the crank on the SOS machine for their employers.

PP rheum + infusion center = entrepreneur

employed rheum + employer-owned infusion center = infusion monkey.

 

[Ronin1]

No one denies the SOS inequality but the individual doc can take advantage of it to maximize his/her personal income. Just this last week alone between my partner and I, we did 3 Intracept 2 stim trials 10 RFAs and about 40 other basic fluro procedures. The hopd loves us. I don’t think we are even that busy compared to a lot of the other posters out there

 

[drusso]

No one denies the SOS inequality but the individual doc can take advantage of it to maximize his/her personal income. Just this last week alone between my partner and I, we did 3 Intracept 2 stim trials 10 RFAs and about 40 other basic fluro procedures. The hopd loves us. I don’t think we are even that busy compared to a lot of the other posters out there

"They will never love you back." Let that sink in.

 

[DoYouEvenLiftBro]

Workers comp typically continues to go up in reimbursement

Work smarter not harder!

 

[BobBarker]

@Ronin1 no office fluoro?

 

[Bostonspine]

Rheum is impossible to get into as a patient in my market. University bought up most of the PPs. Could definitely get a job in rheum locally. If you had an infusion center associated with the practice, one could probably do fairly well.

Clarification it is impossible to get an appointment for outpatient Rheum or Neurology 3-6 month wait... one could start a practice with lower overhead and add ancillaries, So these are other specialties outpatient based with predictable schedules.

 

[SSdoc33]

Clarification it is impossible to get an appointment for outpatient Rheum or Neurology 3-6 month wait... one could start a practice with lower overhead and add ancillaries, So these are other specialties outpatient based with predictable schedules.

or, maybe neuro/rheum could stop being such pansies and see >1 pt/hr.

these docs move like molasses in the wintertime

 

[cowboydoc]

or, maybe neuro/rheum could stop being such pansies and see >1 pt/hr.

these docs move like molasses in the wintertime

The pp rheum people around here see OA and fibro q30 or better. The academics see 1/hour with a resident or 2 and fellow helping.

Some Neuro take 60-90 min!

 

[SSdoc33]

The pp rheum people around here see OA and fibro q30 or better. The academics see 1/hour with a resident or 2 and fellow helping.

Some Neuro take 60-90 min!

the HOPD rheum and neuro are the worst. no sense of urgency at all. while its true that these can be complex patients -- what are we doing here. why is there a 10 page note? why do you need to do the mental mental masturbation with a 2 page list of ddx? why are you ordering every blood test under the sun?

one good thing about our job is that we actually DO something. rather than just psychobabble

 

[callmeanesthesia]

the HOPD rheum and neuro are the worst. no sense of urgency at all. while its true that these can be complex patients -- what are we doing here. why is there a 10 page note? why do you need to do the mental mental masturbation with a 2 page list of ddx? why are you ordering every blood test under the sun?

one good thing about our job is that we actually DO something. rather than just psychobabble

Are you kidding? I love those types of consultants. When you have a patient with some sort of weird underlying disease vibe, send to them for the million dollar workup. Let them spend 2 hours of uncompensated time and handholding so I don’t have to.

 

[SSdoc33]

Are you kidding? I love those types of consultants. When you have a patient with some sort of weird underlying disease vibe, send to them for the million dollar workup. Let them spend 2 hours of uncompensated time and handholding so I don’t have to.

im just consistently underwhelmed with their performance.

but oh yeah: peripheral neuropathies, polyarthalgias, weird stuff? sure. buh bye

 

[cowboydoc]

Are you kidding? I love those types of consultants. When you have a patient with some sort of weird underlying disease vibe, send to them for the million dollar workup. Let them spend 2 hours of uncompensated time and handholding so I don’t have to.

That’s what mayo is for. It’s usually easier to get a mayo pan-consult than a Neuro specialty clinic appt.

 

[NJPAIN]

That’s what mayo is for. It’s usually easier to get a mayo pan-consult than a Neuro specialty clinic appt.

It’s nowhere near as easy as you think. Referrals are very closely scrutinized and patients who have failed extensive treatment elsewhere are not infrequently treated honestly and told that they have exhausted their treatment and an appointment is not scheduled.

Think about it. Is the gap between community care offerings in interventional pain medicine and tertiary care pain medicine really that great. Certainly not what you see in other specialties. I think the biggest difference is the time taken in workup and pulling together the data. The fact of the matter is that patients referred for tertiary care pain medicine have already had the “kitchen sink” thrown at them in a community setting… in desperation and/or $$$.

 

[Dr. Ice]

It’s nowhere near as easy as you think. Referrals are very closely scrutinized and patients who have failed extensive treatment elsewhere are not infrequently treated honestly and told that they have exhausted their treatment and an appointment is not scheduled.

Think about it. Is the gap between community care offerings in interventional pain medicine and tertiary care pain medicine really that great. Certainly not what you see in other specialties. I think the biggest difference is the time taken in workup and pulling together the data. The fact of the matter is that patients referred for tertiary care pain medicine have already had the “kitchen sink” thrown at them in a community setting… in desperation and/or $$$.

This is quite true. So glad to have left a tertiary care type setting. Now once I’m done I’m happy to give out the name of my former employer 😆

 

[Laryngospasm]

Agree, I have sent them a few I couldn’t figure out that have had an exhaustive work up and tried multiple treatments and they have been rejected.

 

[Ronin1]

@Ronin1 no office fluoro?

Our office is in HOPD. We have 2 dedicated procedure suites in the same area

 

[BobBarker]

Units or cash?

 

[Ronin1]

Units or cash?

Wrvu pellets

 

[gaseous_clay]

Betsy Grunch. Neurosurgeon. Tiktok.

What a joke! She used to have a good reputation, but filming videos all day has to come at the expense of being a decent clinician. I doubt she cares as she likely makes more money from it than her doctor salary.

 

[lobelsteve]

What a joke! She used to have a good reputation, but filming videos all day has to come at the expense of being a decent clinician. I doubt she cares as she likely makes more money from it than her doctor salary.

I have not seen good outcomes with her cases. She did a neck and back fusion on a 44 y/o meth addict then doped him up for a few months. No better from pain or functional standpoint. Got him clean and off meds. Nice guy with an addiction problem. Imaging wasn't bad either.

 

[drusso]

Our office is in HOPD. We have 2 dedicated procedure suites in the same area

You're making someone very, very rich.

 

[Ronin1]

You're making someone very, very rich.

True but it’s a good hourly rate for my 30 hours or so a week. Better than 5-9. At least at this point in my life

 

[gaseous_clay]

I have not seen good outcomes with her cases. She did a neck and back fusion on a 44 y/o meth addict then doped him up for a few months. No better from pain or functional standpoint. Got him clean and off meds. Nice guy with an addiction problem. Imaging wasn't bad either.

She fused an NP I used to work with, basically ruining her life. Can’t take her seriously as a clinician any more.