jmj11

Depending on the venue, it was from $500- $3000 per hour of talk. Once I spent a couple of hours on a talk, I could give it 10 times or more without much prep.

I was a spoke person for several pharmaceutical companies. It was good and easy money, but I quit when I was told what I had to say by one. In the beginning, I could create my own talks.

I've spent most of my career in neurology. You know the two, psychiatry and neurology used to have the same boards. But with that said, I don't think the adjustment would be harder or easier. You would bring some things to the table that those in surgery or FP wouldn't have and FP would bring some things to the table that you may not have. I don't see much advantage to having a surgery background unless it was neurosurgery. If it is your desire, you could navigate toward those disorders that have comorbidities of psych and neuro, such as dementia. I focused my career on headache, but also covered epilepsy, dementia, and a little stroke in my career. Headache disorders has a lot in common with psych. Not that psychological issues cause the headaches (a bad sterotype) but because it, like psych, is a disorder without a lot of objective findings and requires a very good history, great listening, and a lot of chronic management (like mood disorders). Neurology is such a broad area, if it were possible, I would pick 2-3 sub-specialties of neuro to focus on and try to know those very, very well.

I see that you didn't have any responders here. I owned a practice for 5 years, and it has been three years since we closed so I will give some general comments. My mentor told me (a PA who had owned a successful practice for 10 years), and I didn't listen, but I should have, to do my business plan the best I could and then cut in half my expected income and double my expected expenses. The hard lessons I learned were (and this does not correspond to your numbered questions); 1) Insurance companies drove me crazy and constantly looked for reasons to not pay us. It is a false notion to believe that if you just bill correctly you will get paid. For example, our business building did not have a mail box so we had to use a PO Box. It took six months to find out that no insurance company will pay for a visit that was seen in a practice that uses a PO Box (it is in their very, very fine print). We lost 65 K right up front and it could not be re-billed. I had to go to war with my landlord over this (he didn't want mail boxes in the building) which took a huge amount of energy and distraction. 2) Unless you are really lucky, personnel will disappoint you. I had five did different billers over 5 years, each one starting out doing a fantastic job and then doing a lousy job. 3) While suing injust insurance companies (who withhold payments for no reason) would make a good Hallmark movie, in reality, they are bullies. You can sue them, but it would cost you about 250K and you may get very little in return even if you win. 4) I had about 10% cash paying patients, most from Vancouver, BC. I loved them, because cash made it so easy. 5) I strongly recommend that you run a very frugal practice (based on what my mentor told me) until you are clearly doing well. My software because very expensive and failed us horribly. Between Kaiser rejecting payments (and it was ultimately based on the fact that I was a PA who owned the practice) and the software contract (which failed to bill correctly) I choose to close my doors although I was overwhelmed with demand. My fear, going into this, that there would not be enough demand but that fear was not realized.

It has been over 25 years ago when I had my short stent in student health and that may have been a different time. My memory may have been skewed as well. I had a terrible SP during that job and why I only stayed a year. It seems like there were several parents that called, but I do remember one couple from Chicago, both lawyers, who bugged the hell out of me when I would not give their daughter antibiotics for her cold. They were very angry and ended up calling my worthless SP, who completely folded and came down and screamed at me for not giving the students what they wanted. Otherwise, I would have loved the work.

I provided student health services at Michigan Tech U for 1 year. Pros: I liked being back around a university setting and most students were really nice. Cons: The social dynamics were more complex than I had anticipated. For example, I had several girls come in for, basically post rape, check out for sexually transmitted diseases, yet, they did not want to go to authorities for the typical reasons (afraid of being scorned by other students, or "it was my fault because I went to the party and drank too much, not knowing that five boys would have sex with me while I was unconscious"). These stories kept me awake at night as I tried to end this abuse. Others included, suicide prevention, addiction issues and these issues also kept me awake at night. But, the most frustrating problem, which happened over and over, was a student coming in with a URI, wanting antibiotics. When you don't provide antibiotics, then mommy or sometimes daddy calls from out of state, mad as hell and demands to speak to you. They tell you how important and rich they are and how their private doctor in Chicago or wherever, always gave them what they wanted. Then, when you don't cave in to them, your (nonsupporting boss, SP) comes in to scream at you after their parent calls them.

Dealing with insurances never makes sense. After fighting with them for 5 years when I owned my own practice, I had to go live in a cave in Malta to recover, seriously. They eventually put me out of business despite overwhelming demand for services. But issues like the one you are describing, almost drove me mad. I would buy a drug for $100 per dose and give it, and they would reimburse at $3. Anyway.

For years I've fought with insurance companies as a provider. Then, this year as a patient, with more than 800K in bills, we still only had to pay our max out-of-pocket of $2000. I am deeply grateful for that.

I'm not sure if I fully understand the question, but if it is un-credentialed physicians billing under the credentialed physicians name, who didn't render the service, then this article may be helpful:

I got to meet a lot of great PAs at the Seattle Cancer Care Alliance this summer. They are the bread-n-butter of the out patient program. It is interesting that on the inpatient side (bone marrow transplant program) the primary care-givers were NPs. I don't know why that model works best for them (PAs-out patient and NPs-inpatient).

I will add a question to yours. Does "going generic" have the same meaning as it once did? I've seen our (migraine management) meds go generic (eg. dihydroertogamine, sumatriptan), then the manufacturer of the brand drug, enters into an agreement with generic makers, for them (the generic companies) to not make it and allow the brand manufacturer make the generic for a price that is very close to the original branded drug. So, unlike in the old days, when you would see an 80% + drop in price, I'm skeptical that these changes would make a lot of difference. I hope I'm wrong. For example, Revlamid. It is a drug that I may have to be on. I just listened to Tom Brokaw's (who also has Multiple Myleoma) book and he describes a colleague with MM who retired, losing his private insurance, and suddenly he had to personally pay 100K per year for Revlamid. I suspect the generic will not be a lot cheaper.

I do believe that there is space for redemption. I've seen ex-KKK members, who now fight for the rights of minorities and against the KKK. However, I do think patients were hurt. You can't have his attitude toward minorities and still give them excellent care. I worked with two different doctors in my career, that both hated patients. They hated all patients and would say so. They demeaned almost every patient that they saw (they weren't racist as far as I know). I also observed what horrible care they delivered. It wasn't because they didn't know better (at least one of those two was very smart) but was because they didn't give a damn. Both said they went into medicine for the money. So, my point is, your attitude does effect the care you give. Now, this guy in the video, maybe he could go through some type of deprogramming treatment and save his career, but I would take a lot of work.

https://www.ebay.com/itm/2005-Icd-9-cm-Volumes-1-2-3-Hcpcs-Level-Ii-Ama-Cpt-2005-by-n/312484552830?epid=46470267&hash=item48c187e07e:i:312484552830

If he is correct that the Docs did the same, all their asses should be fired. Some of you work for Team Health, I would assume (at least for liability issues, not to mention the ethical) they would have zero tolerance for this.

Yeah, as a man I've grown weary of the mythological "locker room talk." It is a sorry excuse. I've been in many locker rooms and have never heard men talking this way. But an ER is not a locker room, and this "talk" should not be acceptable even in a locker room.