Pain management is a crucial medical field, yet massive care gaps persist worldwide, particularly in areas like cerebrospinal (CSF) leaks. Exploring pain management practices in top-care countries reveals stark differences in approaches, challenges, and opportunities for interventional pain physicians.
Countries like the United States and South Korea have contrasting healthcare models, providing insights for physicians in the U.S. considering starting pain management clinics.
Let’s take a closer look at the vastly different healthcare systems in the U.S. and South Korea:
The U.S. leads research and innovation in pain management relevant to medical devices. However, questions often arise about corporate involvement in healthcare rather than physician involvement. While Big Pharma is constantly discussed in the U.S., Big Tech and the sizable medical device manufacturing industry have quietly surpassed Big Pharma's cash flow and significantly impacted US healthcare.
An example is the role of the spinal cord stimulator (SCS) in pain management, where one manufacturing company’s CEO was jailed for selling fake devices to physicians for $16,000 with instructions to implant these in patients and bill Medicare for $18,000.
Are manufacturing companies guiding care, or are physicians? Another concern here is that some companies' approach is to sell expensive medical devices to physicians with only $2,000 as a possible profit margin due to $16,000 in overhead per device.
An article published at the end of 2023 in Interventional Pain Medicine noted why physicians had been the subject of malpractice lawsuits due to an SCS where spinal leaks due to lead migration and infection were common causes for patients suing. As of the time the article was written, the Food and Drug Administration (FDA) had noted approximately 80,000 injuries for spinal cord stimulators, making the device the third-most flagged device.
In the U.S., most pain management physicians are employed by hospital systems or other large organizations, limiting competition and hindering innovation. Those in private practice are often influenced by Big Pharma and/or medical device manufacturing companies rather than taking a step back, examining the science, determining what works, and advancing care according to gold standards, with physicians taking the lead.
It boils down primarily to the monopoly health insurance providers hold. Insurance-based care encourages adherence to outdated protocols, even when research shows that more effective options now exist. This culture of following the status quo is what often leads physicians into trouble, such as succumbing to high overhead on a pitch by manufacturing companies for how much insurance companies could pay out for implanting the third-most flagged device into patients.
A cash-based mentality would lead physicians to ask: “Would the patients value this so much that they would be willing to pay cash for it? What services are my competitors, like functional medicine doctors, offering patients that are comparable to the solutions my practice provides, like nutrition support for nerve pain? If all prices listed by me and my competitors were cash-based and transparent, would I have a competitive edge offering a spinal cord stimulator?”
Considering that patients are leading protests against spinal cord stimulators and horror stories from disabled patients fill social media groups, this likely would be a tough sell for cash-based patients.
In some cases, spinal leak patients have been offered a spinal cord stimulator after several blood patch attempts failed rather than the physicians examining why the patch attempts failed. Addressing pain does not solve the root issue, and a spinal cord stimulator is likely to cause more harm than good.
Another example of US physicians following the status quo rather than evidence-based practice is in the fact that many pain management specialists still perpetuate the myth that spinal leaks typically heal within seven to ten days despite research debunking the notion.
Meanwhile, Shin's (2022) leading meta-analysis summarizing current research for use by anesthesiologists in treating spinal leak cases goes unnoticed because keeping up-to-date on current research and adopting innovative approaches is considered “risky” to organizations run by boards of directors looking to maximize profits.
South Korea sharply contrasts with the United States’s healthcare system with its mix of national healthcare and entrepreneurial private practices. Its approach fosters healthy competition among pain management physicians, driving continuous learning, better patient outcomes, and higher satisfaction rates.
Pain medicine jobs in South Korea often involve providing adaptive, evidence-based care that aligns with patient needs.
While many South Korean physicians who specialize in interventional pain management still use outdated methods, such as lumbar punctures (which can lead to additional dural punctures), to diagnose spinal leaks, their overall strategies are driven by competition in providing customer service and quality care, making them a global leader in patient satisfaction.
Australia’s healthcare system struggles with spinal leak care despite its reputation as one of the best worldwide. The country’s lack of anesthesiologists in private practice available for epidural blood patches often leads to people with spinal leaks facing prolonged delays when seeking diagnosis and treatment. Radiologists who monopolize spinal leak care require extensive, invasive testing while often administering blood patches incorrectly.
The Australian healthcare system’s struggles with spinal leak care highlight how the best medical systems can still fail at addressing niche medical issues.
The number of self-employed physicians in the U.S. has declined in recent years despite entrepreneurship and direct competition being the key to advancing patient care and achieving a healthy work-life balance. Some of the reasons why you should consider transitioning to private practice include:
Opening a private pain management clinic allows you to step away from outdated protocols and offer cutting-edge treatments. For example, you could use your experience working in interventional pain management physician jobs to launch a clinic specializing in spinal leak care, allowing you to tap into a trillion-dollar market.
Entrepreneurship opens doors that increase your earnings. Cash-based business models can be lucrative if paired with appropriate medical market research. For example, a spinal leak clinic that charges a $100 monthly subscription fee for access, $300 for each quarterly visit, and $800 per epidural blood patch (the standard treatment for dural punctures), with patients often needing two to three yearly, could bring in $800,000 annually with 200 patients.
Starting a business focused on advancing gold standards in care also opens up other opportunities, such as NIH business grants that provide more than $300,000 in Stage I funding. This could be helpful as an additional arm for a private practice clinic.
Focusing on researching and developing tools provides an additional revenue stream. The NIH supports physicians who take risks to advance a solid foundation. Physicians may look to something “new” for a more effective solution for CSF leaks than an epidural blood patch, even though blood patches are the gold standard. The idea is to innovate upon what works and learn ways to increase success rates.
Transitioning to a private practice specializing in pain management allows you to create a work schedule that is appropriate for you. Entrepreneurship puts you in control--whether you’d like to spend evenings with family or pursue your hobbies.
However, launching a successful practice requires more than clinical skills. Like any other business, physicians must also learn how to market their clinics effectively. For example, a clinic specializing in spinal leak care should highlight its unique expertise in marketing campaigns to build up its workforce and clientele while avoiding generic pitches like “pain management jobs in Boston.”
Clinics should avoid the assumption that all pain management physicians know how to provide spinal leak care and be more selective in hiring practices to evaluate past epidural blood patch experience.
South Korea’s medical system is successful because of its entrepreneurship culture. Some of the things U.S. physicians can learn from their Korean counterparts include:
South Korean physicians often focus on niches to gain competitive advantages against their peers. For example, they’re more likely to launch interventional pain management clinics specializing in spinal leaks instead of spending their entire careers working hospital jobs.
Patient education plays a vital role in South Korea’s healthcare system. Pain management physicians explain procedures, benefits, and potential outcomes to patients, building trust.
Adopting this approach in the U.S. through blog posts, social media, and webinars can position you as a thought leader in your niche.
While South Korea has an affordable healthcare system, U.S. physicians can adopt similar strategies by offering cost-transparent care. Marketing a service that people genuinely need is the key to running a successful pain management clinic using a concierge-based model.
Thinking about leaving the hospital system and launching a clinic? Here’s how to get started:
When identifying your niche, consider the care market gaps in your area to ensure there’s enough demand for the services you plan to offer. For example, spinal leak care is an underserved niche that can set your practice apart.
Starting a clinic is similar to starting any other type of business. Work with a marketing agency that specializes in healthcare to identify profitable niches, analyze your competition, and create a patient-focused campaign.
Calculated risks, backed by research and a solid business plan, can lead to financial and professional rewards. Start small and build confidence with structured learning. If you feel overwhelmed, don’t hesitate to hire professionals.
The global healthcare landscape highlights how entrepreneurship helps to advance care. U.S. doctors can increase innovation, enhance patient outcomes, and achieve their ideal work-life balance by learning from countries like South Korea.
Ready to take the next step? We specialize in helping physicians transition to private practice, find their niche, and attract the right patients. Contact us today to start building your future in pain management.