Starting a cash-based clinic can be an extremely profitable avenue to start a new phase in your anesthesiology career. There’s an estimated $400 billion market in the U.S. for spinal leak care due to reasons like a growing number of patients with spinal leaks being misdiagnosed and the outdated diagnostic tools – like lumbar punctures – many physicians continue to use. It’s one of the most lucrative fields for anesthesiologists wondering how to start a cash-based pain management clinic.
Any regional or obstetric anesthesiologist who has spent years in the hospital system has experienced moments of satisfaction like the fulfillment derived from providing near-instant relief to patients suffering from post-dural puncture headaches (PDPH) with epidural blood patches. You’ve also likely experienced frustration from dealing with bureaucratic red tape, the grueling work hours, and the limited time you spend with patients.
Tapping into the spinal leak care market with a cash-based clinic
Spinal leaks, from those caused by epidurals administered during labor to leaks caused by disc issues, occur more frequently than many realize, with over 2 million new cases of persistent iatrogenic spinal leaks estimated in the U.S. yearly. These leaks are often inadequately treated or misdiagnosed, creating a market of underserved patients willing to pay out of pocket for excellent care.
Many anesthesiologists are limited in their ability to apply epidural blood patches in a hospital setting, often due to other physicians failing to diagnose the condition and the low reimbursement rates offered by insurance providers. Reimbursement rates can be as low as $75 for an epidural blood patch, while patients at private practices spend as much as $750 cash per patch. This colossal disparity highlights how profitable starting a cash-based clinic can be, particularly with a subscription-based model.
Patients with spinal leaks can spend more than $24,000 annually on unnecessary treatments due to misdiagnoses and on conservative symptom management, like regular IV saline infusions with limited symptom relief. A subscription-based, cash-based clinic can allow anesthesiologists to be well-compensated for their time and expertise and for patients to spend significantly less per year as physicians provide effective treatment for about $4,000 annually per patient.
The mechanism behind epidural blood patches and the need for cash-based clinics
The immediate relief patients appear to feel after getting an epidural blood patch results from the tamponade effect, where the injected blood compresses the spinal cord and pushes cerebrospinal fluid into the head, temporarily lifting the brain. The relief is often transitory since the healing mechanism of an epidural blood patch is the blood clot that forms, encouraging fibroblast activity that heals the dura.
The timing of the blood patch after a puncture is important. Research has shown success rates for permanent relief from the epidural blood patch of only 50% when anesthesiologists give epidural blood patches within the first 24 hours, 65% between 24 and 48 hours, and 86% after the first 48 hours. Of note, this refers to permanent relief that involves the blood clot.
Patients may have immediate relief from the tamponade effect but not lasting relief unless the blood clots correctly at the spinal leak site. This means that a patient who had a lumbar puncture in radiology on Monday, appears in the ER on Tuesday about to collapse, and has an epidural blood patch that same day might experience immediate relief, but there is only approximately a 50% chance per research that this blood patch will clot correctly and hold.
Anesthesiologists in hospital settings tend to see patients only once and miss the opportunity to observe and learn from the long-term outcomes of their interventions. This lack of follow-up leads to misinterpreting the success rates of blood patches and the needs of patients with spinal leaks.
The immediate relief epidural blood patches deliver isn’t a measure of their success or failure. According to a leading article listed by the American Society of Anesthesiologists, a blood patch is successful when it provides long-lasting relief within 48 hours of being administered.
Why a cash-based, concierge spinal leak clinic makes sense
A cash-based, concierge care business model that focuses on spinal leaks and non-clinical work, like B2B community education, employee wellness projects, and consultations on the best practices for spinal leak care, offers anesthesiologists a unique way to transition from a hospital system into a lucrative, patient-centered practice.
Some of the reasons why starting a cash-based clinic might be the ideal opportunity to advance your anesthesiology career include:
1. High-competition, low demand
The market for treating chronic spinal leaks remains significantly underserved, with many patients receiving inadequate care and getting misdiagnosed. Many of these patients are willing to pay out of pocket for effective long-term treatment that addresses the root cause of their discomfort.
2. Revenue potential
A cash-based pain management clinic with a subscription model that charges $100 per month, $300 per quarterly visit, and $800 per epidural blood patch with an average of two blood patches needed per patient yearly would bring in $400,000 in revenue if it can retain 100 patients. Acquiring and retaining twice as many patients would bring its yearly revenue to $800,000.
3. Career fulfillment
Many anesthesiologists report high job satisfaction from administering epidural blood patches due to the immediate impact on a patient’s well-being. Running a cash-based clinic allows you to continue to enjoy high levels of fulfillment from witnessing the relief provided by the epidural blood patch and getting to guide patients’ long-term recovery.
4. Diverse revenue streams
Starting a cash-based pain management clinic allows you to diversify your income sources by providing non-clinical services like consultations on the best practices for spinal leak care, employee wellness programs, and community education. It allows you to advance your anesthesiology career by increasing your income and positioning yourself as a thought leader in a fast-growing field.
How to start a clinic: The pathway to independence and success
Leaving the hospital system and starting a cash-based clinic can be extremely rewarding for your anesthesiology career. Some of the ways you can separate your practice as a leader in your field include:
- Specialize in spinal leak care: You can differentiate your clinic by focusing on spinal leak treatment using advanced, non-invasive approaches to diagnosis like the Bern score, which is more effective and lower-risk than outdated diagnosis methods like lumbar punctures.
- Invest in training: Acquire new skills and certifications so you can administer epidural blood patches with increased precision. For example, use fluoroscopy for guidance to increase safety and observe blood flow to gather more data for clinical decision-making.
- Create a subscription-based model: Offering ongoing care through a subscription model ensures a consistent revenue stream while developing long-term relationships with patients.
- Expand your services: Diversify your income by providing B2B services that allow you to educate other healthcare professionals on spinal leak care and establish your clinic as a leader in the space while strengthening your revenue base and reducing your risk of burnout in a clinical-only role.
Starting a cash-based clinic offers a more rewarding anesthesiology career path
Positioning yourself as an expert in spinal leak treatment offers a fulfilling and financially rewarding career path for anesthesiologists considering how to start a cash-based clinic.
The concierge care, cash-based, subscription model allows you to leave the stress of the hospital environment behind, gain control over your schedule, and significantly impact the lives of patients seeking long-term spinal leak care.
With an estimated $400 billion market that remains largely untapped, opening a cash-based clinic can be a pathway to drastically increasing your income and career satisfaction.
