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PostPosted: Sun Nov 13, 2016 5:35 pm 
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Is there a need for another Suboxone doctor in the Dallas area? I am seriously considering expanding to Dallas. Here is a short background:

Earlier this year, I took the plunge and expanded my services to provide Suboxone treatment in Tulsa. With the research I conducted on Suboxforum, I was able to make a very successful start and overcome so many fears I initially had. I can not express how the positive feedback I received motivated me to give a 100% and has been surprisingly a great decision.

For those patients familiar with my office, they have experienced direct access to me through my personal cell phone 24/7, office hours to 10 PM and weekend hours to make their treatment as convenient as possible. Sometimes, I wondered if I was crazy for doing so. However, I am thankful that my patients never abused the access. I've prescribed antidepressants, benzodiazepines, and even taken on a handful of patients who were truly suffering from chronic pain as their main issue. In a nutshell, the decision to provide outpatient based opioid treatment has changed so many lives including my own. Now, I am working towards transitioning to addiction medicine full time and considering expanding my services to another city. Realistically, I am approaching the final 15 years of my career and need to settle in an area that I will consider home for the next 15+ years.

Since I travel to Frisco, TX 2 - 3 weekends per month, opening a weekend clinic in Dallas would fall in line with my monthly travels and I could expand that to weekdays once it is full. However, I want to make sure that I would be providing the help that people desire and the convenience they can't obtain right now. Looking at the Sahmsa website lists a large number of providers. Is there a need for another Suboxone doctor in Dallas right now and can the need keep me busy?

Thanks for the feedback.


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PostPosted: Sun Nov 13, 2016 7:21 pm 
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Hey Dr. Tulsa. Welcome back. A couple questions first to try to see what you are offering.

Your website markets to addicted healthcare professionals. Is this your preferred patient demographic? Or are you open to anyone?

DFW is a huge area. Is this office based only or is telemedicine a part of your offer? If telemedicine is a part, how are UA's managed?

It looks like you prescribe Suboxone only and no other buprenorphine/naloxone, buprenorphine only products? Prices matter for self pay. Any plans for the implant or the not yet approved depot injection?

I notice you offer 7 day, 30 day and 90 day Suboxone detoxes as well as some long term maintenance. Do you inform your patients on the low 10% success rate w the shorter times? I reread Amy's post to you on your prior thread and hope you take it to heart as well as what's written here in this forum.

Wishing you my best! Pelican

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Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


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PostPosted: Sun Nov 13, 2016 9:13 pm 
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My website is being replaced with a new one that will be under http://www.frugaldoctor.com

I realized that my original website gave the wrong impression that I am only treating health professionals, and fortunately that is not the case. The new website will demonstrate the fact that everyone is welcomed. Healthcare professionals account for 1 or 2 of my patients.

I treat patients with a combination that may include Suboxone, Subutex, Vivitrol, Gabapentin, Lamictal, Clonazepam, Clonidine, SSRI, Memantine and Amitriptyline. My pain patients are typically treated with Fentanyl patches, Oxycodone, Subutex, and Methadone. My strict pain patients are minimal, probably 10 at most. They were kicked to the curb by other physicians who just didn't feel comfortable prescribing very high morphine equivalents.

I have no experience with telemedicine and have no plans to offer it as of yet. But I will look into it. If I do offer a telemedicine service, it will be for the stable maintenance patients who will have their UAs collected and processed at a local lab of my choosing. The goal is to help people become successful and minimize the obstacles.

As for cost, you are completely correct that this is a major factor. Currently, close to half of my patients do not have insurance. I've had to work very hard to minimize their costs to make treatment accessible. That includes treating their psychiatric illnesses as well as their chronic medical conditions (hypertension, etc.) I hear it all of the time that I am the cheapest provider in town. I hope to have the same reputation in Dallas too. My Suboxone clinic is not my main source of income and thus I can provide that service at significantly less cost. Most likely I will find an office in North Dallas where I have visited monthly for the past 13 years.

I've detox only one patient. I don't believe detox is a viable option in 99% of patients. However, this particular patient came to me insisting on it because she didn't want buprenorphine in her system for her pregnancy despite my advice. I remind EVERY patient that approximately 13% of patients abstain from opiates a year after ending MAT and that most will relapse within the first month. Thus, I encourage patients to consider addiction as the chronic disease that it is characterized by frequent relapses. I don't kick patients out for relapsing and work with them to achieve sobriety. I don't kick them out for abusing other drugs, instead we work together to minimize those drugs and eventually abstain from ALL drugs. Surprisingly, my patients are brutally honest about the drugs they use.

Once several months of sobriety has been achieved, we taper to the lowest effective dose IF and when the PATIENT request it. I'm placed in a very hard situation because it appears that I have a conflict of interest. I appears that I am trying to keep patients on a medication to garner revenues. It's just not the case. There are always patients on the waiting list if that was all I wanted. But I remind them that the Suboxone prevents the cravings and withdrawals, so they may work on behaviors to be functional and law abiding.

I am certified to place the implant but have not had any request from patients for the Probuphine product.

I hope I answered all of the questions. By the way, Amy's advice was dead on. It helped me be much more effective.


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PostPosted: Mon Nov 14, 2016 12:01 am 
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I can't tell you how glad I am to know that this forum has helped you in your bid to help addicts. Any small part I've played becomes amplified as knowledge spreads. A doctor who is willing to listen to others is worth his weight in gold.

Let us know the details as they come, OK?

Amy

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PostPosted: Mon Nov 14, 2016 12:48 am 
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Dr. A OK. What you now describe is far different from your old website and its suggested medical practices.

Welcome here and hope you refer your patients here.

Wish I'd found bup and this site sooner. I'm 5.5 yrs off bup after an accident led to pain pills rapidly accelerating into addiction w real life losses. Lots of crappy crap crapolla in between till I found bup - Bup was my wonder drug. It turned my life around. Everything I got back, which is alot, is bc of it. I came here on a whim -- and ended up learning forgiveness for myself and for all those involved. Which means I now understand why I totally failed multi abstinence attempts. Yep, I came here and learned I'm not a failure. So grateful.

Hope you are open to generic bup/nx SL tabs bc are often a bit cheaper.

What is your definition of N Dallas? Used to live in Dallas. Been years tho but used to be less expensive space at preston and Hillcrest /LBJ corners. Depends on how far south you want to commute.

My understanding for telemedicine lab work - the Dr. chooses the lab provider - Labcorp, Quest, etc which have walk in labs nationwide. Dr. either emails the patient to print out or Dr. orders via the lab provider web portal to the walkin lab location of patient convenience. I know a person who is able to vary their lab draw locations as they travel for work across the US. Obtaining cheap UA rates that your Pts can afford may be the challenge. Pt's pay via credit card (no cash or check) at lab visit.

Likely their is opportunity for you in N Dallas...and you sound like you have the right approach. Wishing you my best! Pelican

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Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


Last edited by Pelican on Wed Jun 28, 2017 10:32 pm, edited 2 times in total.

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PostPosted: Mon Nov 14, 2016 10:02 am 
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Pelican,

I'm so glad to hear more of your story. You may have told your story at some point, but I don't remember seeing it.

I always appreciate your point of view because you have such intelligent things to say. What I didn't know is that you came here feeling like a failure, but found a home here among so many of us who have been through the same struggles. I'm grateful that you landed here. :D

Amy

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PostPosted: Mon Nov 14, 2016 12:05 pm 
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Thanks Amy! P

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Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


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PostPosted: Tue Nov 15, 2016 12:12 pm 
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Hello Tulsa Doc,
My practice is quite geographically diverse. It will be much more convenient if you can limit the area you serve and still be at the patient count you want.
I think I am dealing now with over 30 different pharmacies, 6 benefit companies and I have no idea how many different insurance plans. Transportation for many, particularly in the winter, can be an issue.
The way you describe your practice I would think you should be filling up. Do you plan to expand to the 275 cap or stay at 100? My clinic does not meet the criteria for expansion so I am staying at 100. Ironically, my colleague that is board certified in addiction, in the same clinic, is going to the 275 cap.
You are quite correct about how much this site has to offer us.
PAX


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PostPosted: Mon Nov 28, 2016 1:36 pm 
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I want to expand to 275 at some point and accept insurance. However, I will need to hire office staff just to deal with the insurance contracts and reimbursements. Right now with 30 and soon to be 100 patients, it is not feasible to add that much overhead.

I hope to be near the Addison area. If I had a tracking collar on me every time I was in DFW, it would concentrate in an area between Addison, Richardson and Frisco. Today, I start looking for my office space options and hopefully have something secured within the next few weeks.

Docm2, I hope to keep my Suboxone practice to just those 2 locations (Tulsa & Dallas). Right now, I have patients driving to me within a 3 hour driving radius and at one time had one driving 5.5 hours each way. I guess having a first appointment costing $150 made the drive tolerable. So, having an office in Dallas will alleviate some of the burden for at least 3 of my patients and hopefully many others in Southern Oklahoma. In 2017, I will focus my attention on passing that ABA exam to become board certified. Who knows when they will decide to have it.

Pelican, thanks for the advice on the locations in DFW. I will definitely look at those places. It was also great to hear your story. I commend you for your recovery. I do prescribe the generic buprenorphine but I am quite hesitant. I would say 20 - 25% of my patients are on it. I prescribe it when the patient has trouble affording treatment and I am comfortable that the patient will not abuse it. Of course, I can never be sure.


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PostPosted: Wed Nov 30, 2016 11:24 am 
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doc2, you and I are in similar positions. I'm at a time in life where I look forward to slowing down a bit, but the new law is frustrating, and seems to be more-motivated by medical politics than by health concerns. For readers who are not familiar with it, doctors who are boarded in addiction medicine-- a relatively small number of people, since addiction is a 'secondary board'--- can go to 275 patients regardless of how they run their practices. But other doctors like myself (boarded in psychiatry and in anesthesiology, with a PhD in neurochemistry) must be 'approved practices', which requires using electronic medical records, accepting insurance plans under the Affordable Care Act, using a 'team practice approach', etc. I complained about it on my blog: http://suboxonetalkzone.com/congress-acts-on-opioid-dependence-ugh/

Tulsa, it is good to see docs getting more involved. Your situation is also ridiculous-- that you can only have 30 patients the first year, then 100, etc. How crazy that a new doctor treating cancer, or doing brain surgery, is considered a 'success' when business grows, and doctors using one of the safer medications in buprenorphine are limited to 30 patients! And in an era of an epidemic of overdose deaths!

Also Tulsa, I'm sure you've noticed that the SAMHSA web site for buprenorphine docs is woefully outdated. The vast majority of the docs listed on that site for my area are no longer practicing, and many never opened buprenorphine practices at all.

Good luck!


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PostPosted: Wed Nov 30, 2016 4:46 pm 
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Quote:
But other doctors like myself (boarded in psychiatry and in anesthesiology, with a PhD in neurochemistry) must be 'approved practices', which requires using electronic medical records, accepting insurance plans under the Affordable Care Act, using a 'team practice approach', etc. I complained about it on my blog: http://suboxonetalkzone.com/congress-ac ... dence-ugh/


It's stuff like that that's turned me into a Republican in my mid-60's. The Federal bureaucracy reminds me of that cult classic with Steve McQueen from the 1950s. The Blob. It just keep expanding, and eating everything in its path. If we're not vigilant enough, it might just gobble us all. It just might do it anyway.

I also want to say what a pleasure it is to see fine, dedicated physicians doing their best to serve an urgent need. There's no scarcity of treatment in the Boston area, which is to be expected. I'm about 20 miles south of the city and there are at least 2 clinics within 20 minutes of my house.. I've not had any trouble getting an appointment.

Much more expensive than Tulsa. First time visit fee is 300 for one of them I believe. Also as to be expected, the phone book is full of addiction psychiatrists in private practice. One charges $650 for a first time visit! I'd say the average is about 400 for first timers. But that's something of a guess.


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PostPosted: Fri Jan 13, 2017 2:50 pm 
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I know this thread is a month or two old but I was absolutely blown away and had to comment. My husband and myself are first time Suboxone users and r currently on day 3. We had planned to quit a 13 year Methadone habit of 140mgs a day pretty much cold turkey, with only a couple of days tapered to 70mgs then a couple more tapered to 20mgs then none. Needless to say, it didn't work but we couldn't get back on Methadone or he'd have lost his job so we were stuck hurting. We live in a small town in East Texas of about 5,600 people but it had the one Methadone clinic and we don't have health insurance. There was only one Dr listed as doing the Suboxone but that was the same Dr from the Methadone Clinic and she couldn't see us because of a 'conflict of interest' because the clinic didn't offer Suboxone, only at her personal office. So we were stuck. Literally. The counselor from the clinic was a Godsend who brought up the Suboxone and worked like crazy to help find a place that wouldn't have a waiting list. In the beginning of MMT, we had to drive 2 hours, one way, 6 days a week to the closest Methadone clinic but we did it and eventually had the maximum number of take homes.
By day 4 of having absolutely nothing, we were already desperate. Between me and the counselor, we called every Dr and clinic that we could find and yes, most of the ones on the website were no longer even available. We were begging for some kind of help. Most of the ones that we called said it'd b MONTHS! I was about to give up and do Crystal meth for the first time ever just to get some kind of relief. Thanks to persistence (actually worrying the hell outta 'em & begging) we were able to find the only other Dr in our town that did Suboxone and squeezed us in so we only had to wait another 3 days. Seven days total with nothing but 2 Norco on day 4 (I think) was HELL!! I would've LOVED to find a Dr as caring as the ones on here r. I know that you are doing everything that u can and that y'all's hands r tied about accepting more patients and such but almost everyone that I talked to that offered Suboxone was so blasé. Like waiting weeks and months (hell, I felt like I couldn't wait one more day!) Was no big deal.

I absolutely commend the Drs on here. I believe a caring Suboxone clinic in Dallas would probably b a Godsend but I don't know about the demographics and whatnot. As u can see, I have nothing to offer about what you should do. I just had to say 'Thank you're to the Docs and professionals out there that actually, honestly, genuinely CARE about helping addicts.


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PostPosted: Fri Jan 13, 2017 3:16 pm 
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Mom, I am so sorry that you've had such a hard time finding a suboxone doctor. I hope that with your husband's new CDL job that you will have insurance. Under the Affordable Care Act insurance companies are required to pay for addiction medication. They might make you switch from Suboxone to Zubsolv, like I had to, but usually they will pay for a good portion of your medication. One thing that is unfortunate for consumers is that many doctors only take cash.

In fact, the very caring doctor, Dr. Junig, who started this forum only takes cash. He charges a reasonable $200 for a half hour appointment once a month and he is a psychiatrist, so he is well-versed in treating co-occurring mental disorders as well. I'm remembering from my studies that at least 50% of addicts have another mental disorder like depression, anxiety, bipolar, etc. I have heard from a couple of Dr. Junig's patients that he is thoughtful and kind and they are extremely pleased with his level of care. I wanted to give you his example so you can see that there are plenty of doctors who are not in it for the money.

It looks like the Affordable Care Act will be repealed and who knows what will end up in its place. I'm hoping that it will still require insurance companies to cover addiction, pre-existing conditions, and young adults on their parent's insurance, but right now it's a question mark.

There will always be some doctors who care and some who care more for other things besides their patients. The doctor who started this thread is in addiction medicine for all the right reasons. He hasn't updated us on his practice (and I hope he will), but there are very good professionals around.

I hope that your current doctor turns out to be wonderful. If you look at the top of this page you will see a tab that says "Find Suboxone Doctors". We try to help people find good doctors by networking as well. Also, please click on the TalkZone tab at the top where you can read Dr. Junig's many articles about topics related to Suboxone and similar issues. You can learn a great deal by reading his articles which are informed by scientific research.

Amy

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