When Medical Practice Dreams Meet Reality

Previously, I planned to build a part-time pain management practice as a financial engine to fuel entrepreneurial pursuits. This week, I'll share the major reasons I abandoned this plan.

Overhead

The primary problem was overhead. Some expenses, like clinic space and an x-ray machine, cost the same whether you use them six days per week or two.

Staffing is an even bigger challenge. It's difficult to hire in the current economic landscape, especially for part-time positions. But the real issue relates to an important rule of thumb I've learned: only hire people already competent at what you need them to do. Unfortunately, a pain clinic requires many different roles, leading to significant staffing overhead.

Staff Who Interact with Patients

A large pain practice typically employs the following staff members:

1. Schedulers: Part receptionist, they handle patient scheduling, cancellations, and appointment changes.

2. Medical assistants: Bring patients from the waiting room, check vitals, provide post-appointment instructions, and prepare rooms.

3. Nurses: Administer medications, assist with procedures, and address patient questions.

4. Radiologic technicians: Operate the x-ray machine needed for most pain procedures.

5. Practice manager: Ensures smooth operation of the practice.

That's at least five roles. Plus, you need backup staff to maintain efficiency and cover for sick days.

Successful solo pain doctors have found ways around this by cross-training staff to perform multiple roles. However, this training requires significant time and energy from the doctor – time that isn't compensated. It's one of the biggest challenges for modern doctors with private practices.

The complexity of these all-in-one jobs also means that many new employees don't make it past the probation period, exacerbating staffing problems.

Staff Who Don't Interact with Patients

The billing side of the practice presents even less scalable staffing challenges. A large organization typically hires separately for:

1. Coders: Ensure insurance is charged for the correct/optimal services.

2. Billers: Submit bills and follow up on initial problems and rejections.

3. Prior authorization specialists: Proactively address insurance company concerns about coverage.

4. Collections: Pursue payment from insurance companies and patients who haven't paid.

5. Revenue cycle management: Oversee the entire revenue process.

For a small private practice, scaling or outsourcing these jobs is problematic. You can allow a larger organization to handle these tasks, but you lose too much autonomy to truly call it your own practice.

Alternatively, you can hire multiple specialized services, but this is expensive and requires additional oversight to ensure quality.

Furthermore, despite how well a doctor might understand the billing system, they can't effectively cross-train employees to handle all these specialized roles. The complexity and daily nuances of each position mean that even the doctor themselves couldn't adequately fill in if an employee called out sick. These jobs require consistent, hands-on experience that a doctor, focused primarily on patient care, simply can't maintain. This makes it impractical for a doctor to train a single person to cover all these billing-related tasks in a small practice, unlike the more feasible cross-training for patient interaction roles.

You Didn’t See This Coming?

I envisioned eventually partnering with multiple doctors working at the practice with dozens of staff members, sharing overhead costs. This would have allowed me to scale back and explore non-clinical business opportunities.

However, building such a practice requires 5-10 years of very hard work, during which I'd likely earn less than I would as an anesthesiologist. Moreover, as an anesthesiologist, I'd have the option for a flexible, part-time schedule without the stress and responsibility of running my own practice. This makes the prospect of building a pain management practice less appealing from both a financial and lifestyle perspective.

Considering my age and career goals, investing a decade into building something that essentially results in a highly paid part-time job doesn't make sense. I need to take advantage of my peak years and build things that directly lead to the life I want, rather than serving as stepping stones towards it.