Reality of private practice skull base

[Guest]

People always talk about these "side hustles" however when you look on open payments website they guys dont seem to be raking in much extra cash. Is there money changing hands that isnt disclosed? I thought that was illegal

[Guest]

Maybe They all have onlyfans sites…

[Guest]

It's wildly overblown. You can see everything on Open Payments (and disclosures are required by law). Basically only a handful of spine and endovascular folks make lifestyle-changing money, usually from royalties by being on a design team. The people making tons of money basically pioneered a widely used device (like Juan Uribe with XLIF, or Mike Wang with DePuy MIS TLIF, or Foley with METRx/Stealth), plus a small handful of other people like Chris Ames. You can look at each company separately and see who the top payees are. The vast majority of academic neurosurgeons (including full professors, chairs, and presidents of sections) do not make a lot of money from companies. Look it up and see for yourself.

People also wildly underestimate how much work this stuff involves. My PD did work for Stryker and you have to travel to a bunch of random places to give talks/teach courses on the weekends, sit in a bunch of meetings, for like 15-20K. Unless you make it all the way to the top (which takes decades), it's rarely worth the time. If you're an open cranial surgeon this isn't even an option, unless you're Spetzler and you get royalties from your bipolars.

[Guest]

Lots of drs own rental properties, restaurants, hotels, etc. The relatively stable/high income makes it ideal for long-term investments. Of course such investments require intelligence, and some drs have that too.

[Guest]

Its also important to answer OP by reiterating the distinction between private practice (a practice owned by the physician or physicians) and hospital employment. All too frequently on this site, people throw the term "private practice" around loosely to refer to any non-academic practice which is incorrect.

Plenty of people do skull base work as employed physicians but in a true private practice setting it is extremely difficult for a variety of reasons. When it comes down to it, you need a big team to do skull base and the volume to support a practice -- volume which is frequently referred to Universities.

[Guest]

Why is it so much easier to get an academic spine job? Is it just because it's a worse financial deal, since you're subsidizing the other fields, so fewer people want to do it?

[Guest]

Yes. You hit it the nail right on the head.

[Guest]

Also the number of spine positions as a whole is larger because more people have spine pathologies for which there are no non-surgical options. Whereas the number of people who need skull base procedures is appreciably smaller

[Guest]

The core of academic spine and nonacademic spine are very similar: mostly clinical focus since your primary job—unless you’ve already made a name for yourself—is to pay the bills. You subsidize skull base as well as other specialties, admin buildings, the CEO’s bonus, and many other things. If you want true academics and you are called to research, you get grants and write on your own time. Kind of a shitty deal to get paid worse for the same work while being expected to do extra because you’re academic.

[Guest]

In addition the majority of research in spine is clinical. So that means you don’t really need a university to fund a wet lab etc. That means large private groups can essentially do the clinical research just as easily and without sacrificing your autonomy, salary, etc.