This week I’m speaking with Dr. David Rosenblum about important topics in pain management. With a diverse career in pain management, Dr. Rosenblum is involved in a private practice in New York with an academic affiliation and has started several businesses that provide rich educational opportunities in the pain and anesthesia communities.
This week. I’m speaking with Dr. David Rosenblum about a handful of different topics. Dave has built a diverse career in pain management. He’s involved in a private practice in New York with an academic affiliation, and he’s also started several businesses on the side as ways to provide rich educational opportunities in the pain community, as well as anesthesia. Actually, I really enjoyed this episode, which Dave has cross posted on his own podcast pain exam as always thanks for tuning in this week. Hello and welcome to episode 57 of the anesthesia success podcast. I’m very pleased to be joined today by Dr. David Rosenblum. Dave is currently the director of pain medicine at he. He’s a medical center. He’s anesthesia pain, boarded trained at NYU, my neighbor to the North, just up 95. Thank you for being here this morning, Dave.
Dr. David Rosenblum (01:06):
Thanks a lot. Thanks for us.
So I first became exposed to some of the things that you’re doing out there on the internet, through your podcast, the pain exam podcast. So tell us a little bit about how did you get sort of in podcasting as a physician?
Dr. David Rosenblum (01:17):
Well, I was doing board review for quite a while and being online. And in that space, you kind of develop a little bit of a community. People always stay in touch with you. And I started to learn a lot about online marketing and business from another podcast, a smart, passive income podcast, which by now I’m sure a lot of you guys have already heard of Pat Flynn who does a great job. And I, I must have started listening to him about six, seven years ago, and I learned how to podcast based on his free tutorials. And I figured, you know what, let me just dabble with this. See what happens. And I did the pain exam podcast and realized, wow, there’s a lot of anesthesiologists out there and I do have an anesthesia and physiatry board review. So I figured out I’ll do the PMR exam and the anesthesia exam podcast and see how that goes. And the one thing I could talk about podcasts is you really need to stay dedicated and religious about producing. If you want to maintain a hump on, you know, in the Apple and Google plays radar. Yeah.
Yep. Yeah. And the funny thing is you have to do this thing. It’s very public, which is do a thing and push it out on the internet. And it has to suck for a long time, right before it stopped sucking. And you have to get through that in order to have an okay sounding podcast on the other side.
Dr. David Rosenblum (02:34):
It’s funny, you said that because my first few episodes are sound completely different than my more recent ones with the professional intro outro, et cetera.
Yup. As do mine, I listened back to those, some of those early interviews and I kind of cringe, but I leave them up there because you know what it keeps you humble. Right? Sure. Sure. So thank you for joining us early in the morning. This is actually, so we’re setting a record for the anesthesia success podcast right now, our record formerly held your colleague, Dr. Gary Schwartz for the earliest in the morning that we’re starting an episode.
Dr. David Rosenblum (03:03):
So we wake up early in New York. Yes.
Yeah. So I appreciate you making time. And I’m looking forward to hearing about some of the, you know, the educational content that you’ve built here and about your clinical practice, as well as some of your perspectives on industry collaboration, because I know a, and we’ll start with that last topic. First. This is something that in pain management, you know, the majority of the advances in science happen through partnering with Medtronic and Abbott and Boston and many others, which creates we’ll call it moral hazard. Whenever there’s economics introduced into medicine, as there necessarily always will be. And whenever the people advancing the science and make creating the inventions and doing the tests and all, and the trials and all that, whenever there’s economic interest involved, it can create challenges and remaining objective and in, you know, disclosing and all that. So I’m curious, you know, how did you first get started in industry collaboration knowing that in pain management, 70% of spending in R and D comes from companies themselves?
Dr. David Rosenblum (04:06):
Sure. Well, first of all, without industry, we would probably, you know, it would be a very different landscape of pain management. And I think it’s a, it’s a symbiotic, symbiotic relationship. They need us, we need them, but of course you need to do everything above board and ethical and not get yourself into trouble. I do. And I have collaborated with industry and I suppose being a podcast or, and someone with an online platform, it’s very different than your typical practitioner who may get paid by a company and then can be accused of using that company solely over the competitors. So having some other platform in which you’re providing a service, either to that company or to the doctors by education is different. For instance, in the past, I’ve worked with Boston scientific and what they actually wanted from my doctors was a survey answer.
Dr. David Rosenblum (04:59):
They had five questions that I would push out to my docs. They also probably wanted the contact info of these doctors and the doctors would answer them in exchange for a cheat sheet or some other type of service I could provide for them. And I think that the way you stay out of trouble is you basically, you know, it has no connection to the amount of spinal cord stimulators I do with that company over another. You know, you have to make it clear with that. And because showed the agreement that you, that you get into to a healthcare attorney and being involved with the New York state pain society, they have a great attorney. Who’s looked at some agreements that I’ve done with industry in the past and has given guidance and, you know, try to keep, keep you out of trouble. Yeah.
Would you say characterizes a really rewarding and productive relationship with one of those companies?
Dr. David Rosenblum (05:47):
First of all, they have to have a product you believe in, you know, there are, I mean, I’ve, I’ve worked with pharmacies also. So pharmacy is a pharmacy. I mean, obviously you want them to give good if you want to be associated with them, but in terms of biotech industry, you don’t want to be associated with an inferior product. Even if they’re paying you a lot, I’ve had the luck to be involved with great companies and the, I am kind of sells itself. If it’s a good product, you’re just another piece of the puzzle saying, listen, I’ve used this and I’m happy with it. Or they’re sponsoring this episode and it’s worth checking out or at least talking to them to see what’s what the deal is.
How has your access to these types of opportunities evolved over time? Talk about maybe coming out of fellowship. What was the landscape like? And as time progressed and your profile as a physician has been raised, and, you know, you have a busy, productive practice there in New York. How, how has that changed over time for you?
Dr. David Rosenblum (06:41):
Well, over time, I think I’ve, I’ve become a little bit smarter with respect to the whole online industry, community forming, tending to my newsletter. And, you know, those email lists are, are very valuable. I’ve been, people have asked to buy my email list. I can’t sell it. I don’t have that sort of agreement with my users. And I wouldn’t do that. But in terms of, you know, marketing on behalf, you know, first of all, you have to disclose that you’re an affiliate of this company and that you, that you have some sort of agreement with them that, or if you’re going to profit off of any sale made, but it’s not a majority of my income. It’s not, it’s not even a big part of my business. The biggest part of my online business is actually board review and providing a service to doctors.
Dr. David Rosenblum (07:27):
And when I first got into the space, or at least first, I first realized the advantage to partnering with academic societies, I realized a lot of these societies are not not-for-profit and the best and smartest thing I could do is to utilize my platform, to help these societies for free. So by partnering with them, I help them get exposure to my audience, get people to come to their meetings. And in exchange, they helped me with marketing and exchange. Maybe I get a table at their conference, or they I’m like what I’m doing with ACEP right now. We co market and collaborate on academic ventures.
Awesome. That’s a great idea. I got to try that with my,
Dr. David Rosenblum (08:08):
Yeah, you should. You should.
So talk a little bit about your current clinical practice.
Dr. David Rosenblum (08:12):
So we have a, basically we’re a 90% anesthesiology practice. We are the anesthesia group. That’s contracted to run the operating room at my mommy’s medical center, where we cover different ambulatory centers and private offices. In addition, we have probably about 30 or so partners, another 30 or so employees and a lot of residents and the pain practice is about right now. I think we’re about six docs and we cover the various boroughs in New York and including, including some of the West, the suburbs such as Westchester and long Island. And we’re very interventional. We try to minimize opiates, you know, each pain doctor as, as with most practices may or may not focus on different things. You know, some docs do more neuromodulation, some docs, stick more to the traditional bread and butter.
Yeah. As of the time of this recording, which is the end of June, it’ll be a few weeks until this is released. I’m curious, you know, how has your experience been during coronavirus? How have you guys been able to adapt and how, you know, how are things looking there? And I know New York has been a hotspot, obviously.
Dr. David Rosenblum (09:19):
Yeah. It’s been crazy. We’ve done obviously a lot of telemedicine in terms of the anesthesia side. We couldn’t, you know, we were doing sedation rounds up until recently. Thank God. We don’t really have that anymore, but that may happen again, if there’s a second wave, which I am, I think there will be, I think it’s a matter of time, but I’d like to think we’re more prepared. Yeah.
How had the implementation of telemedicine? How did that go? Is that something that you guys had done a lot of before?
Dr. David Rosenblum (09:46):
It’s funny, you said that about a year ago, we realized we could do it with our EMR and we did some experiments. We tested it, tested it out in some patients, the big question was, were we going to be re reimbursed properly and we’d want to take those chances and, and you know, you do it, and then you realize you don’t get paid. So, so well, once this all happened and then, you know, we found out about the the rules of telehealth being lightened up, we we didn’t have a choice.
Yeah. So do you have, I’m curious with your practice, you know, there’s obviously there’s a lot of legislation happening right now about reimbursement for different types of procedures because of Kronos, you know, the, the waivers for paying for tele-health the same way as if somebody came into your office, do you have, who do you have in your practice that sort of keeps a finger on the pulse of like those types of things? It’s a pretty complex legal environment. I’m wondering, like it changes almost every day. It seems like.
Dr. David Rosenblum (10:40):
So we have a billing company, a huge billing company, which gives us guidance. We have an administrator who, who deals with them and we, you know, if we have questions, we’ll ask them directly. But the docs also, you know, the doctors in the group, we have a little group chat that we, you know, share ideas with and latest news and probably to keep each other updated.
Yeah. I know Dr. Schwartz and I first met or reconnected most recently at the practice management meeting in Asmara and that’s an area of acute interest for both of us. So sure. Talk a little bit about you know, as you’re thinking about the craziness of last couple of months, are there any stories that stand out, whether it’s a patient encounter or collaborating with one of your colleagues where it’s like, just something unusual, that’s a product of coronavirus that you might not experienced?
Dr. David Rosenblum (11:28):
Yeah, probably there’s a lot of stories. I mentioned one of these on my podcasts where my first day in the hospital during, you know, the, my, my whole thing was, you know, I, I said to my family, I said, look, I said, cause I’m a pain doctor. Mainly spending time in my office. I would normally do Monday pain rounds, but when the coronavirus start and they stopped elective surgeries, there was really not, we have mainly a acute pain service. That’s really regional base, not so much opiate management. And so when there was no elective orthopedic surgeries or other types of surgeries, there was, there was very few patients on the painless. And so the rounds were very short or nonexistent. Even I said to my family, I said, look, I said, you know, they didn’t want me to go to the hospital. Of course I said, I’m like a fireman.
Dr. David Rosenblum (12:14):
That’s not like, I’m, I can’t do it. You know, if I don’t do it. And given, yes, we have a very large group of anesthesiologists, but if I don’t do it, who’s going to do it. Yeah. So I when, when I, I had no problem going into the hospital to do the COVID rounds, which was on intubated patients. And it was very eyeopening because of you had nurses. And I mentioned to my podcast, my cousin, who’s a Florida nurse at my mom and he’s and you know, I walked up to her, said, hi, she, she didn’t recognize me. And the scary thing is she’s going to six or every day. It’s either six to nine patients that she’s caring for. She’s a regular floor nurse. I mean, it’s a cardiac floor, which she doesn’t do ICU, but she had all these intubated patients that she’s managing herself on, on Crestor’s on sedate sedatives.
Dr. David Rosenblum (13:04):
And she was she was overwhelmed. I mean, she didn’t look like she, she had together at work, but afterwards we texted and it, you know, it’s just sad that these nurses, they’re the ones who are really in the rooms all day long, watching them die. There’s no family members at the bedside to advocate for the patients. And, and it’s a very scary situation when you have overwhelmed people who are, who are trying their best to take care of these very sick patients and their support. But it’s not, as you know, there’s not enough eyes on the patients, his family members can’t be there. But then again, I understand that because that’s more dangerous. Yeah. So it’s just a tough situation that society has to deal.
Yeah. Are there any ways that you have changed or adapted or are preparing yourself for, you know, if, if, and when that kind of happens again, things that you use
Dr. David Rosenblum (13:52):
On a personal note? I’m taking lots of vitamins. I never was a vitamin person. I was always Holly, eat healthy and get my vitamins from the vegetables and whatnot. But yeah,
I got a big thing of those vitamin C gummies sitting on our counter downstairs,
Dr. David Rosenblum (14:05):
Right. The vitamin C. So we weren’t crazy. I mean, we have a friend who’s a nutritionist her husband’s anesthesiologists. He was actually one of my former residents. And you know, she’s at she, she’s one of those. No, it all people women, but she knows, she knows a lot. I’m not saying she doesn’t, but she, she always has some nutritional advice on every little thing. And us doctors, it’s like a, it’s like the gastroenterologist when it comes to nutrition or the pain doctors when it comes to physical therapy, we’re specialists, but we’re still might not be the best people to talk to about these stinks because of our nutrition training is, is way more limited maybe a month or two of med school. And that’s it. So I know a lot’s changed in the last 15, 20 years. So so I had selenium’s zinc, vitamin D vitamin D is a big thing which has been linked to improved outcomes or poor outcomes.
Dr. David Rosenblum (14:57):
If you have low vitamin D levels with COVID have all these other things in case you get sick, such as this thing called Russian immune, which is, I think that gets at one of those probiotics, but either way we personally to allow modifications. I knew a lot of friends who stopped smoking finally. And in terms of the practice, well, now that we’re ramping back up, we took chairs out of the waiting room. So we can only have limited number of people there stagger the appointments. We’re still doing tele-health, but with our patients who are on opiates, we’re telling them, you know, you need to come in for a drug screen, can’t keep doing video refills and not paying attention to these things.
Right? Yeah. It makes sense. Tell me a little bit about, you know, you mentioned right before we jumped on the call, just about how you define success for yourself as a physician and the way that you pursue a number of things as a, as a physician and as somebody who’s an educator and is contributing to the pain community and the body of knowledge for especially young clinicians. Tell me about how you think about that. How did that sort of come on your radar as something that you wanted to pursue and, and what does it currently look like for you?
Dr. David Rosenblum (16:07):
Sure. Well, so to go a little bit opposite where I told you before I remember being in NYU and I had an attending there who is back then making like a, I dunno, a base of, or a salary probably in the two hundreds. And he was telling me, he’s like, yeah, I don’t need to do private practice. He’s like, how much money do I really need? I’m like, you have a nice attitude. He’s not greedy or, or at least obsessed with money. But then when you think about living in Manhattan on 200 grand per year, if you live in Manhattan, you know, it’s not a lot of money. It sounds like a lot of money. It’s more than 99% of the country mates, but in New York city with a family
Yeah, a hundred of it makes it to your checking account.
Dr. David Rosenblum (16:50):
That’s right. It’s just not a lot of money. I mean, he probably made more than 200, but it’s still you know, with overtime and whatnot. But, but, but, but the point is I look at success as not a financial number. I need to be able to afford to live in a, in a, in a nice house and afford to be in a safe, nice neighborhood and educate my children in the way I see fit as well as afford retirement. And you know, the things you do in leisure is success is not a numbers game. I have a lot of friends who left New York probably make twice as much as I do. Are they any happier than me? I don’t think so. I get a lot of satisfaction from my job. I always said to myself, if I’m going to make a lot of money, which, you know, everybody wants to make a lot of money, but my goal wasn’t to do it by doing more procedures or seeing more patients or letting it be at the expense of my patients or my integrity or morals with respect to medicine and treating patients.
Dr. David Rosenblum (17:47):
I wanted to be the best doctor I can, but I also have outside interests as a kid. I was always interested in creating music and being a musician, which of course never happened. But what I w I was also very creative. So as I remember being anesthesia resident in Bellevue, back in the day before, I-phones, we used to have Palm pilots, which if you don’t know, are these,
I’m a Palm pilot nerd alert. Yeah, exactly. I remember having a beeper, the code phone, a pump
Dr. David Rosenblum (18:16):
Pilot. I mean, ridiculous. This is, this is back in the day. And we’re talking about 1998 to 2002. I was in medical school. There were no smartphones. And I remember starting my anesthesia residency. I was in my first year, and it was still before the iPhone, probably 2003, 2004. And I was always thinking, well, you know, what could I do to innovate, to create some sort of, I don’t know, device product service. And I’d sit there in the anesthesia call room and I list ideas on my Palm pilot. And by the time I got to my pain fellowship, I had a very long list and I never had time to do any of these things. And I was in the pain first. I’m like, well, you know, I need to study for this pain exam, but wait, there’s, there’s nothing to study from. So that’s where the whole paintings and thing came from.
Dr. David Rosenblum (19:07):
And within a month or two, not only was it profitable, it made back all the money I invested in creating the whole thing, but it was in the top of Google organically, which is, you know, now is almost impossible to get so high organically with a, with a business or a, some sort of board review site or anything like that. And it happened because there was such a high need and there was nothing in the space. Yeah. And if I created pain exam, now, it probably wouldn’t have shots at the top so quickly. Right. But I’m getting back to your question with success, you know, having this whole podcast and be like, like you, you have in building a community online, or at least having people connecting online and getting value for your service. That to me is success. I’ve already achieved that goal. I’m very happy with what I’ve built. And I look forward to growing it even more in partnering with people like you, people like ACEP societies Nan’s EPA, et cetera, who have, who we basically build off of each other and help leverage each other.
Yeah. So for any listeners out there, if you go to anesthesia success.com/ 57, we’re going to put links in the show notes to be an exam. And all the content that Dr. Rosenblum has been working on a lot of great resources there that I definitely want to, if you didn’t already find it on Google, you can go to anesthesia success.com/ 57 and see what we’re talking about there,
Dr. David Rosenblum (20:30):
Which is a great show, by the way, I’m sorry to interrupt, but I was listening to the RVU episode this morning on my way to work. And I’m not, I’m not based on an RVU. My, my practice is we don’t use our views. And so I’ve actually know very little about it was, it was pretty eye opening and it just good to know in case I ever need to worry about it, or, you know, we, we change our model. Yeah.
I’m hoping to do another sister episode on doing percent of production. And so there’s obviously one of the reasons I have a job is because the way physicians get paid is so darn complicated.
Dr. David Rosenblum (21:00):
We’re not educated. Yeah.
Right. And there’s frankly, a lot of incentive to keep our hardworking physicians in the dark about the economics of these things. And that’s one of the missions of this show is to close that knowledge gap. Obviously we’re coming at it from different angles, but I very much see us as allies in that in that journey, which is a lot of fun. I appreciate you being with us this morning, Dr. Rosenblum. I want to close with a story of a you’re somebody who has a pretty prominent presence in the pain community. You’ve, you’ve given a lot, you’re a very well respected and reputed and someone to whom a lot of people look for just, you know, getting oriented. And I’m curious with all of the things that you’ve accomplished clinically through creating education content in your businesses and things like that. What’s something that you can look at and, and you feel like an accomplishment you’re proud of, or that really is something that you feel like has actualized your professional efforts
Dr. David Rosenblum (21:56):
Aside from my patients. And of course, helping my patients and seeing where people can get their lives back together, or people tell me, even you saved my life, which believe it or not has happened. Not just because I got them out of bed for pain problems, but sometimes you work them up and you find tumors that they get cured from. But in terms of my pain exam and side projects, I think when, when I get to meet the listeners and people who’ve passed my review to pass, use my review to pass the exam. When I meet you guys at conferences, or you email me to be honest, I started to get more excited over that. Then when I make a sale, it’s just a really nice feeling to know that I’ve helped somebody along their journey to become a board certified physician or anesthesiologist or any other clinician in their practice.
Awesome. Well, thank you for sharing that story. Thank you for joining us today on the anesthesia success podcast. Thank you, Justin. You heard this week head on over to anesthesia success.com, where you can find more content and free resources to help you build a successful career in anesthesiology and pain management. If you wanted to leave a review in iTunes, I would also really appreciate it. Thanks for using some of your valuable time to join me today on the anesthesia success podcast.