Advice on Moving Forward

[pgy?]

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I was wondering if I could get some advice. I am currently a PGY4 anesthesiology resident however I am being asked to resign due to issues with substance abuse. I plan(ned) on a career in pain and was considering applying for non accredited pain fellowships. Do you believe this would be an issue in regards to practice, credentialing, and reimbursements? I have always planned on pain and am considering all options at this point. Is FP an option to go into pain? Any advice would be greatly appreciated.

 

[NOSfan]

So sorry to hear of your struggles.

In regard to some of your questions:

Credentialing --> you will be asked to disclose and likely either have to submit a letter or be asked to discuss in person some of the details surrounding your situation.

Reimbursement --> should NOT be impacted. Insurers cannot discriminate payments based upon this.

I would pray that you take care of yourself and can go on to be a successful physician!

 

[Papa Lou]

I was wondering if I could get some advice. I am currently a PGY4 anesthesiology resident however I am being asked to resign due to issues with substance abuse. I plan(ned) on a career in pain and was considering applying for non accredited pain fellowships. Do you believe this would be an issue in regards to practice, credentialing, and reimbursements? I have always planned on pain and am considering all options at this point. I was originally interested in pain through PMR and have an interest in PMR. Is FP an option to go into pain? Any advice would be greatly appreciated.
.

Have you seen the movie with Denzel Washington where he's an airline pilot? It's called Flight. Go watch it and pay careful attention to the last quarter of the film. Then take a lot of time for introspection.
I doubt you're ready to listen to this right now, but take a year off medicine. Anesthesiology and Pain Management are you kidding me? These are the fields of highest potential addiction / access to drugs. Stay away, sit at home and think about life deeply. Look into counseling. Otherwise, the chances that you die or ruin someone else's life in the process are VERY HIGH.
Don't play games.

I hope you take my comments to heart (and brain).

P.S.
There's so many non accredited spots scattered all around the states that just want a new guy to milk/train for a year, you won't have a problem in the future getting in even if you take a year off.

 

[ampaphb]

Louisiana has an entity called the physicians health foundation (http://www.phfl.org). While you may have already explored this route, there might be alternatives to resignation you have available. Don't assume just because your program says you are gone, that there aren't options.

Also, before you accept your program's pronouncement that they are kicking you to the curb, you might want to consult with an attorney to make sure they dotted all their i's, and crossed all their t's. I know you feel like crawling into a shell and just doing as you are told, but you have to recognize that what you have is an illness, a disability, and not a character flaw.

Make sure the ADA doesn't apply. Make sure your employee rights have not been violated. Maybe you can take a leave of absence. Residents think they are are easily replaceable, and that departments have all the power. Not necessarily.

 

[ampaphb]

Have you seen the movie with Denzel Washington where he's an airline pilot? It's called Flight. Go watch it and pay careful attention to the last quarter of the film. Then take a lot of time for introspection.
I doubt you're ready to listen to this right now, but take a year off medicine. Anesthesiology and Pain Management are you kidding me? These are the fields of highest potential addiction / access to drugs. Stay away, sit at home and think about life deeply. Look into counseling. Otherwise, the chances that you die or ruin someone else's life in the process are VERY HIGH.
Don't play games.

I hope you take my comments to heart (and brain).

P.S.
There's so many non accredited spots scattered all around the states that just want a new guy to milk/train for a year, you won't have a problem in the future getting in even if you take a year off. .

Who the F*&K are you to tell him or her they can't return to practice someday? Hell, we put former addicts BACK ON OPIOIDS! Clearly, the OP shouldn't practice pain RIGHT NOW. But five years from now? With counseling, and oversite, and good care? WTF not?

 

[bedrock]

Who the F*&K are you to tell him or her they can't return to practice someday? Hell, we put former addicts BACK ON OPIOIDS! Clearly, the OP shouldn't practice pain RIGHT NOW. But five years from now? With counseling, and oversite, and good care? WTF not?.

Who the hell puts former addicts back on opioids? I never would, outside of clearly defined terminal malignancy.

Just going through a recovery program and saying you're sorry, doesn't change the fact that you'll always be a higher risk to abuse and divert.

As for the OP, with counseling, going to back to medicine is doable, but pain medicine is not recommended as the final specialty.

 

[ampaphb]

Who the hell puts former addicts back on opioids? I never would, outside of clearly defined terminal malignancy.

Howard Heit is who I defer to when it comes to providing narcotics to those with prior abuse issues. http://www.prescriberesponsibly.com/pain-management-experts/howard-heit.

As for the OP, with counseling, going to back to medicine is doable, but pain medicine is not recommended as the final specialty.

Because ...

 

[Jitter Bug]

If you take your sobriety seriously, I would recommend a future specialty where you can practice without a DEA license and never dispense controlled substances. This would take pain physician off the table for you.

You can't ignore the high recidivism rate for substance abuse. Set yourself up for success. Get clean, and pick a specialty where you have limited to no access to pills, and no license to prescribe.

 

[Papa Lou]

Who the F*&K are you to tell him or her they can't return to practice someday? Hell, we put former addicts BACK ON OPIOIDS! Clearly, the OP shouldn't practice pain RIGHT NOW. But five years from now? With counseling, and oversite, and good care? WTF not?.

I'd like to see you talk that way to my face. You little internet troll piece of trash. My comments to him were meant to be caring and sweet because that's what he needs. I said literally that he could come back after taking a year off and get into medicine...even pain. Let alone five years as you stated. Dumb ass.

Huge risk of relapse without taking some serious introspection first. Even with it, the risk is high but I wouldn't deny him his dream on some silly post of mine. My advice is fairly impartial..I'm not taking a huge stance.

 

[Ligament]

Though I am a pain doc, and write for controlled substances, I almost never come into physical contact with them.

 

[pgy?]

Thanks for the advice guys...I am taking it all into consideration.

Im doing what all the professionals in the field of addiction tell me to do in regards to practicing medicine and what fields of medicine would be feasible. I am taking my recovery seriously and exploring all options at this point.

 

[SSdoc33]

he's already essentially completed an anesthesia residency. seeing outpatients in pain medicine will all of a sudden increase his risk of relapse? you gas passers have unfettered access to all the opioids in the world, if you want. depending on the substance of choice, it may be difficult to be surrounded by temptation all the time.

i dont see how a career in pain medicine is any different than a career in general anesthesiology. in fact, as a pain doc, you arent touching that virgin bottle of fentanyl a=or looking at all the goodies in the OR all the time...

 

[SSdoc33]

an Papa Lou, you gotta lighten up.

of your 20 posts, several have been pretty angry. we appreciate your take and your experience, but if you keep up with the angry posts, you will be banned by the moderators.

 

[Papa Lou]

it's the TRT...got me heated.
I only respond angrily when someone first attacks me rudely and in a manner unbefitting of a gentleman. Ban all or none. Respect man authoritey!
I do like contributing though. I benefit from reading these threads. So I am here to help.

 

[lord_jeebus]

I saw a patient who was a PM&R doctor that became addicted to opioids and benzos. He used his DEA license to prescribe to a friend and then bought the filled prescriptions from the "patient." There may be merit to the idea of finding a specialty that does not require a DEA license.

 

[drusso]

Pain managment, in particular, is a specialty that requires strong personal boundaries: There's something about seeing patients in the throws of pain, addiction, and suffering day in and day out that can be particularly stressful to a practitioner newly in recovery. You'd certainly want to surround yourself with a strong social network, keep in close personal contact with your sponsor, attend regular meetings, really "walk the talk," etc. You'd want to be transparent with your employers, partners, and colleagues about the disease of addiction, it's relapsing/remitting course, and its favorable trajectory under the right circumstances.

Otherwise, I'd think that your personal experiences would be a real asset to your patients.

 

[Ducttape]

id think that anesthesiology itself is a far worse career than pain medicine, but the temptations to "bargain" with patients, as they continuously bargain with you as the prescriber, would be a temptation that is not necessary. one of my memorable ER cases was a woman with a fairly significant head laceration requiring quite complicated suture repair. Substance abuse counsellor, who became one after getting sober from alcohol... she blew a 0.28. they found bottles in her desk, that she apparently got as "gifts" from clients giving up booze.

being an interventionalist only might be a "solution", but then one would have to make sure that controlled substances for sedation are not available - ie do them at an ASC.

 

[ampaphb]

I'd like to see you talk that way to my face. You little internet troll piece of trash. My comments to him were meant to be caring and sweet because that's what he needs.

Going to ISIS in July - happy to chat with you then. Otherwise, you are welcome in New Orleans anytime. 🙂

 

[kstarm]

I don't see where the OP specified what substance was being abused. I think it matters to a certain extent (not that those details need to be shared). What you're going through gives you an interesting perspective on issues some of your patients may be going through, and if you can overcome this and move forward you may be able to partner with some of your patients in a unique way. You might be able to tell that story, and likely some program director/employer will appreciate that and give you a chance in the future. Everything else you do will have to be supporting of that of course.

Give yourself some time and get clean. This is more important than anything else. As you work through that it will become more clear what the best next step is for you.

 

[ampaphb]

ADA & Rehabilitation Act
The Americans with Disabilities Act (ADA) prohibits employment discrimination against employees and applicants with disabilities in organizations that employ 15 or more employees. The term "disability" means an individual has a physical or mental impairment that substantially limits one or more of his/her major life activities or there is a record of such an impairment or an individual is regarded as having such an impairment. The Equal Employment Opportunity Commission (EEOC) oversees application of the ADA. Section 503 of the Rehabilitation Act of 1973 also prohibits discrimination against qualified individuals with disabilities by contractors and subcontractors with the Federal government. The requirements regarding drug and alcohol use under the two laws are identical.

The ADA and the Rehabilitation Act of 1973 affect drug and alcohol policies. Individuals currently engaging in the illegal use of drugs are not "individuals with a disability" when the employer acts on the basis of such use. "Currently" means that the illegal use of drugs "occurred recently enough to justify the employer’s reasonable belief that involvement with drugs is an ongoing problem."

Some relevant issues include:

1) Employers may not discriminate against drug addicts who are not currently using drugs and have been rehabilitated or have a history of drug addiction.

2) Employers may not discriminate against drug addicts who are currently in a rehabilitation program. (The EEOC has clarified that a rehabilitation program includes inpatient or outpatient programs, Employee Assistance Programs, or recognized self-help programs such as Narcotics Anonymous.)

3) Reasonable accommodation efforts, such as allowing time off for medical care, self-help programs, etc., must be extended to rehabilitated drug addicts or individuals undergoing rehabilitation.

4) The ADA does not protect casual drug users; but individuals with a record of addiction, or who are erroneously perceived as being addicts, would be covered by the guidelines.

http://www.dol.gov/elaws/asp/drugfree/drugs/ada.asp

 

[joshmir]

There are also some programs where, depending on which substance created the challenge, may allow you join if you use the implantable burprenorphine; I know a program in my state that allowed an anesthesia resident to continue with this and they are doing well now; will PM you

 

[emd123]

it's the TRT...got me heated.
I only respond angrily when someone first attacks me rudely and in a manner unbefitting of a gentleman. Ban all or none.

Its normal around these parts. You'll get used to it.

 

[emd123]

I was wondering if I could get some advice. I am currently a PGY4 anesthesiology resident however I am being asked to resign due to issues with substance abuse. I plan(ned) on a career in pain and was considering applying for non accredited pain fellowships. Do you believe this would be an issue in regards to practice, credentialing, and reimbursements? I have always planned on pain and am considering all options at this point. I was originally interested in pain through PMR and have an interest in PMR. Is FP an option to go into pain? Any advice would be greatly appreciated.
.

The most important thing is to get your addiction treated. Submit fully. It could save your life. Without doing that, you have nothing.

Assuming you do that, your career should move on. They can't expect you to get treatment, recover, then be unemployed and homeless. You could say that Pain would be a bad field for a recovering addict, or is it good in the sense that a recovered addict knows the dangers of addictions best and can best help other stay off, and get off, addictive substances? I don't know, but it's something to ponder. Talk to your counselors about specialty choice, and do what they advise. But you need to put staying sober first.

 

[epidural man]

Absolutely do pain! I don't ever see any drugs. AND, I would love to practice pain without a DEA. In fact, the world would be a much better place if ALL pain physicians didn't have DEA licenses - they saw and consulted and recommended practices and then sent back to PCP. If I ever go to private practice as a pain guy, I have contemplated NOT getting a DEA license so I can't be bullied when I don't write for more percocet - it's a perfect situation. In my opinion, of the many tools in a pain physicians hand bag, if opioids are the most used and most relied on tool, you shouldn't be practicing pain. And if you can't practice pain without that tool, then - yes, you shouldn't be practicing pain.

Anyway, pain is a great field and with your current past and bright future, you will have a great perspective to share with patients.

I suggest that you look at the path of psychiatry to pain. That would really fit well with your current situation.

 

[epidural man]

Seriously, can some of you that don't think he/she should do pain explain in a more detailed way WHY that is a bad idea?

How many of you pain physicians actually handle scheduled medications? And if you do, why? What situation calls for that?

 

[pgy?]

Once again, thanks for the advice guys. I am submitting fully to recovery. It comes first and Im not making any rash moves or actions.

I think I may have been attracted to and excelled in my rotations in pain in the first place because I can relate to many of them. Im trying to look at this as an opportunity to be a better human and physician. Cliche and just words but hopefully an opportunity to accomplish these goals.

 

[drusso]

Seriously, can some of you that don't think he/she should do pain explain in a more detailed way WHY that is a bad idea?

How many of you pain physicians actually handle scheduled medications? And if you do, why? What situation calls for that?

It's not the physical handling of medications that I think is the primary concern (although in my clinic the MA's do pill counts and patients bring in their medications), but the risk of relapse related to the nature of the work. Again, most pain physicians (unless you're solely doing a by referral, interventional-only practice) are dealing directly with patients with sub-clinical or overt substance use disorders and chemical dependency. This can be stressful. I think that pain fellowships should do a little more "behavioral screening" and vetting of candidates for their suitability for a career in pain medicine: This job ain't for everyone.

 

[Ducttape]

Seriously, can some of you that don't think he/she should do pain explain in a more detailed way WHY that is a bad idea?

How many of you pain physicians actually handle scheduled medications? And if you do, why? What situation calls for that?

if he has any inpatient pain experience, like he would get at an ACGME accredited fellowship, he may be responsible for fentanyl or dilaudid based epidural pumps.

if he is ultimately in an office based practice, the office may have a supply of fentanyl and versed or propofol for sedation that he is responsible for.

he may be exposed to a population that might be willing to give him some of their medication in exchange for prescriptions.

he may be spending his entire career discussing the drugs that caused him to have addiction. (When i think about WoW, the temptation to load the game and sign on just to check it out is nearly overwhelming....)

 

[101N]

Wrong career choice.

 

[clubdeac]

I knew two pain guys in the same practice who both got messed up with meds. Both lost their DEA licenses and now practice non-opiate pain management. Pretty sweet deal

 

[epidural man]

if he has any inpatient pain experience, like he would get at an ACGME accredited fellowship, he may be responsible for fentanyl or dilaudid based epidural pumps.

if he is ultimately in an office based practice, the office may have a supply of fentanyl and versed or propofol for sedation that he is responsible for.

he may be exposed to a population that might be willing to give him some of their medication in exchange for prescriptions.

he may be spending his entire career discussing the drugs that caused him to have addiction. (When i think about WoW, the temptation to load the game and sign on just to check it out is nearly overwhelming....)

some good points.

However, he can choose not to have those medications in his office - or set it so it requires extreme oversite to get them out of the locked cabinet (two keys, finger prints, whatever..)

Next, talking about it daily would help him - showing how others are pinned by their addiciton. Isn't that what AA and NA do?

As far as being exposed to a population willing to give him some meds - that is ANY job in medicine except maybe pathology.

 

[Ducttape]

true, but would it be wise to have an alcoholic work in a liquor store, or a brittle diabetic work in a candy store?

if a patient attempted to bribe me by offering me some of their meds, id throw them out of the office without even a first thought. this temptation might be the straw for someone who is an addict...

 

[epidural man]

OP,

You should go into IR.

 

[emd123]

true, but would it be wise to have an alcoholic work in a liquor store, or a brittle diabetic work in a candy store?

if a patient attempted to bribe me by offering me some of their meds, id throw them out of the office without even a first thought. this temptation might be the straw for someone who is an addict...

This actually happens not infrequently amongst the docs who end up arrested for inappropriate prescribing. Some are getting pill kickbacks to feed their own addiction

 

[miamidoc2b]

papa lou - send me a pic stat. TRT is where it's at...what are you benching?

 

[pgy?]

Reviving this thread.

I was forced out of residency with the threat of opening a case and facing jailtime. Im grateful to not be in jail however I now have a decision to make. Its been about a year clean now with no issues. I have done work in the OR in another aspect of medicine surrounded by the old meds without a problem. I am now at a crossroads. Do I repeat residency?

I am going to sign up with major medical insurers and have found a niche in personaly injury practicing some pain medicine as I had planned all along. I am strongly considering forgoeing residency as training for another four years of my life for board certification to get a fellowship in pain is not ideal for my life plans. I feel SOMEWHAT well versed in interventional procedures after a few months in pain medicine. Am I at the level of a board certified fellowship trained pain doc? No, but I had nearly finished my anesthesiology training before being diagnosed with a well documented disease that Ive sought treatment for and been involved in recovery with for almost a year and feel that I am prepared to start my career and not lose four years of starting a life because of a disease.

A few of my friends from residency are doing pain fellowships and we have talked about opening a pain clinic when they are done. Really my question is what issues am I going to face? I have already received malpractice coverage and have begun signing up with BCBS, United, etc. and get reimbursed by the auto insurers for the treatments and evaluations I provide. I will basically learn from my former coresidents on the more invasive spinal procedures as right now I am planning on doing epidurals and triggers only without any narcotic management.

 

[drusso]

PGY? As you know addiction is a relapsing/remitting disease. While you might be strong in your recovery now, your old cravings and habits could be problematic in the future. You should establish a strong and enduring relationship with a sponsor--preferably a physician or similar health care provider you can check in with on a periodic basis...

These days I think that performing interventional pain procedures without a fellowship will leave you vulnerable in the event of a malpractice claim or negligence tort. I am not certain that I can recommend that path. Gone are the days where one could (or should) be apprenticed in interventional pain procedures.

You will want some kind of ABMS certification to facilitate paneling, credentialing, and contracts. How about occupational medicine? It's basically a two year clinical experience and a 1 year classroom MPH. It would be a good fit for personal injury/workers comp type work. You could still do basic interventional MSK type procedures within your scope of practice.

 

[pgy?]

What paneling, credentialing and contract problems am I likely to face if I open my own clinic and perform all procedures in house?

 

[ampaphb]

Regardless of credentialing, you need to be better trained. Like the guys who hang up a shingle straight out of residency, you don't know what you don't know. Sure, you can do a simple epidural, but what about the hard ones? Where do you go when the patient has had a fusion? When there is metal in the way? When you get into a vascular tangle, and cant seem to get out of it? Do you know what levels to be scared of, an where to look for that faint wisp of arterial flow? etc. etc. etc.

Sign up for every SIS (formerly known as the International Spine Intervention Society) course offered. Spend several one week observations with experts. Get into trouble as many times as you can WHILE SOMEONE IS WATCHING, so you can figure out how to get out of trouble.

I never had a wet tap in fellowship. Used to think I was bulletproof. Have had my share in practice. First time it happened, patient had a bifid spinus process, with no ligamentum flavum to speak of, so the first loss I felt was the thecal sac. Lesson learned. You have LOTS of these lessons ahead of you. I wish you well..

 

[drusso]

I have a sponsor. He is a doctor. If I relapse (which I certainly wont with the intense monitoring program I am on for at least five years) it will be on alcohol and the way I see it doing interventional pain offers as much "exposure" to drugs as any other field.

What paneling, credentialing and contract problems am I likely to face if I open my own clinic and perform all procedures in house? i am already getting paid for the work I was trained to do by the auto insurers and am confident in my ability to build a patient base through PI.

The days of just opening your own clinic and bypassing credentialing requirements are waning. Many health plans want even office-based MD/DO's to maintain privileges at a nearby hospital. I'm not saying it is right, but it is a hurdle. I spend countless hours per year fulfilling various hospital requirements, doing committee work, etc solely for paperwork attestation purposes.

Some kind of ABMS certification will be favorable to you moving forward---if not pain related, another specialty. Just something to think about...

 

[emd123]

Reviving this thread.

I was forced out of residency with the threat of opening a case and facing jailtime. Im grateful to not be in jail however I now have a decision to make. Its been about a year clean now with no issues. I have done work in the OR in another aspect of medicine surrounded by the old meds without a problem. I am now at a crossroads. Do I repeat residency?

I am going to sign up with major medical insurers and have found a niche in personaly injury practicing some pain medicine as I had planned all along. I am strongly considering forgoeing residency as training for another four years of my life for board certification to get a fellowship in pain is not ideal for my life plans. I feel SOMEWHAT well versed in interventional procedures after a few months in pain medicine. Am I at the level of a board certified fellowship trained pain doc? No, but I had nearly finished my anesthesiology training before being diagnosed with a well documented disease that Ive sought treatment for and been involved in recovery with for almost a year and feel that I am prepared to start my career and not lose four years of starting a life because of a disease.

A few of my friends from residency are doing pain fellowships and we have talked about opening a pain clinic when they are done. Really my question is what issues am I going to face? I have already received malpractice coverage and have begun signing up with BCBS, United, etc. and get reimbursed by the auto insurers for the treatments and evaluations I provide. I will basically learn from my former coresidents on the more invasive spinal procedures as right now I am planning on doing epidurals and triggers only without any narcotic management.

To your credit, you're getting treatment for your addiction. That's commendable and not easy to do. However, I sense severely impaired judgement and very bad choices independent of any addiction disease.

You've been kicked of residency. Whatever you did was bad enough to "face jail time." Yet, you want to avoid finishing residency. You want to skip fellowship. You want to skip your primary board certification. You want to skip Pain Subspecialty certification, yet move forward working as if you've done all these things. You also say, "I won't relapse, because ..." even though all odds are that addiction is a relapsing remitting disease where the great majority do relapse despite the great minority not thinking they will or wanting to relapse. What I'm hearing are lots of short cuts, rationalizations and denial.

What you should do, the right thing and the honorable thing, is to find a way to finish residency (hopefully without repeating an entire residency.) Get board certified in your primary specially. Apply for ACGME fellowships in Pain. If accepted, become board certified in Pain. If not, apply again the next year while working to become a stronger applicant. This should all be done with a primary focus on staying sober (because not doing so could leave you dead or in jail) and doing the right thing. Shortcuts, denial and more rationalizations will just send you down the same rabbit hole that very nearly ruined your life and career. Take it for what it's worth.

 

[epidural man]

I have to agree with emd.

Take the head of the ASA as an example - who was a CRNA for years, and decided to take the hard road to become a physician then anesthesiologist. Imagine having a great job, paying well - but having the ability to recognize that there was an issue (she wanted to be as safe as an anesthesiologist and as well trained), then realizing the huge amount of crap she had to go through to get there - and then having the fortitude to GO DO IT. Ugh...that would suck so bad.

You need to do residency I think. If you really want to do a pain fellowship - pick one of these residencies. IM, FP, Psychiatry, PM&R.

 

[pgy?]

To your credit, you're getting treatment for your addiction. That's commendable and not easy to do. However, I sense severely impaired judgement and very bad choices independent of any addiction disease.

You've been kicked of residency. Whatever you did was bad enough to "face jail time." Yet, you want to avoid finishing residency. You want to skip fellowship. You want to skip your primary board certification. You want to skip Pain Subspecialty certification, yet move forward working as if you've done all these things. You also say, "I won't relapse, because ..." even though all odds are that addiction is a relapsing remitting disease where the great majority do relapse despite the great minority not thinking they will or wanting to relapse. What I'm hearing are lots of short cuts, rationalizations and denial.

What you should do, the right thing and the honorable thing, is to find a way to finish residency (hopefully without repeating an entire residency.) Get board certified in your primary specially. Apply for ACGME fellowships in Pain. If accepted, become board certified in Pain. If not, apply again the next year while working to become a stronger applicant. This should all be done with a primary focus on staying sober (because not doing so could leave you dead or in jail) and doing the right thing. Shortcuts, denial and more rationalizations will just send you down the same rabbit hole that very nearly ruined your life and career. Take it for what it's worth.

Stealing drugs from the hospital or stealing anything from the hospital is grounds for jailtime. My program simply does not take residents back after treatment if they don't have to and stealing drugs was their trump card for dismissal as otherwise I would have been protected by the ADA. They used to let residents come back (and other programs do allow their OWN residents to finish, have not had luck in finding another program to accept me, even as a CA2 repeating a year of residency). I dont WANT to skip fellowship, I dont WANT to skip primary board certification but this is the hand I was dealt. A 90 day treatment program, weekly drug tests, weekly meetings with a monitoring agency and daily aa meetings gives the monitoring group nearly a 90% five year success rate in preventing relapse. Anything I say that does not include finishing residency and fellowship could be looked upon as a rationalization and/or shortcut. I have done hundreds of epidurals, nerve blocks, and airways throughout my three and a half year career as a resident so yes I want to move forwards and not backwards 3-5 years (depending on when I can even start another residency program). Crippling debt with an added $30,000 for treatment and approx 10k/yr in monitoring costs has me thinking of alternatives to the career path I was a year and half away from starting. I looked back in this thread a little bit and what you said is basically what happened. I went to treatment, "recovered" (I understand its a lifelong process and not a 90 day process), and was basically told resign or be fired via opening an investigation with the pharmacy, which could lead to a DEA investigation, which could lead to things being even worse.

By the way I am reapplying for residency through advanced positions in other fields so Im not being close minded about repeating residency but it is unpalatable.

I have reached out to some programs and spots that have opened up who, once I open up about drugs, basically hang up the phone.

 

[pgy?]

The days of just opening your own clinic and bypassing credentialing requirements are waning. Many health plans want even office-based MD/DO's to maintain privileges at a nearby hospital. I'm not saying it is right, but it is a hurdle. I spend countless hours per year fulfilling various hospital requirements, doing committee work, etc solely for paperwork attestation purposes.

Some kind of ABMS certification will be favorable to you moving forward---if not pain related, another specialty. Just something to think about...

This is my primary concern. Thanks.

 

[hyperalgesia]

PGY? As you know addiction is a relapsing/remitting disease. While you might be strong in your recovery now, your old cravings and habits could be problematic in the future. You should establish a strong and enduring relationship with a sponsor--preferably a physician or similar health care provider you can check in with on a periodic basis...

These days I think that performing interventional pain procedures without a fellowship will leave you vulnerable in the event of a malpractice claim or negligence tort. I am not certain that I can recommend that path. Gone are the days where one could (or should) be apprenticed in interventional pain procedures.

You will want some kind of ABMS certification to facilitate paneling, credentialing, and contracts. How about occupational medicine? It's basically a two year clinical experience and a 1 year classroom MPH. It would be a good fit for personal injury/workers comp type work. You could still do basic interventional MSK type procedures within your scope of practice.

Occupational Medicine is an outstanding idea. I personally think there should be no shortcuts here. Just go back and do it right. You don't want to compound prior mistakes with more mistakes/short cuts.

 

[pgy?]

Occupational Medicine is an outstanding idea. I personally think there should be no shortcuts here. Just go back and do it right. You don't want to compound prior mistakes with more mistakes/short cuts.

Easier said then done.

I am interested in the SIS training courses though. Thanks for the tip.

 

[epidural man]

Stealing drugs from the hospital or stealing anything from the hospital is grounds for jailtime. My program simply does not take residents back after treatment if they don't have to and stealing drugs was their trump card for dismissal as otherwise I would have been protected by the ADA. They used to let residents come back (and other programs do allow their OWN residents to finish, have not had luck in finding another program to accept me, even as a CA2 repeating a year of residency). I dont WANT to skip fellowship, I dont WANT to skip primary board certification but this is the hand I was dealt. A 90 day treatment program, weekly drug tests, weekly meetings with a monitoring agency and daily aa meetings gives the monitoring group nearly a 90% five year success rate in preventing relapse. Anything I say that does not include finishing residency and fellowship could be looked upon as a rationalization and/or shortcut. I have done hundreds of epidurals, nerve blocks, and airways throughout my three and a half year career as a resident so yes I want to move forwards and not backwards 3-5 years (depending on when I can even start another residency program). Crippling debt with an added $30,000 for treatment and approx 10k/yr in monitoring costs has me thinking of alternatives to the career path I was a year and half away from starting. I looked back in this thread a little bit and what you said is basically what happened. I went to treatment, "recovered" (I understand its a lifelong process and not a 90 day process), and was basically told resign or be fired via opening an investigation with the pharmacy, which could lead to a DEA investigation, which could lead to things being even worse.

By the way I am reapplying for residency through advanced positions in other fields so Im not being close minded about repeating residency but it is unpalatable.

I have reached out to some programs and spots that have opened up who, once I open up about drugs, basically hang up the phone.

Well said. You are in a tough spot.

I think getting a job that pays is not a terrible idea - especially if you can't get a residency. I wish you had a good friend that was a program director. You shouldn't be treated poorly for falling so hard. The cool thing is you are trying to get back up. I hope it goes okay.

 

[bedrock]

Not sure if SIS will accept you at their courses if you've been removed from your residency.

I agree with the above posts that you must stop choosing shortcuts to happiness in life and that even if you are able to work right now, the day will come soon enough that all insurance companies will require board certification.

You might be okay for 3-6 years then permanently out of a job after the enivitable insurance crackdown comes on docs who haven't finished residency or become board certified.

I would suggest you go ahead and work PI for the next 12-18 months, pay your debts, while demonstrating you're clean for an extended period. Then again apply for new residency and for pgy2-3 spots, but you can't be picky at all, you have to be ready to accept a crappy IM or similar residency, occ med, FP in the rural Deep South or rural Midwest. After ACGME residency and with your prior anesthesia training, you could land a low tier pain fellowship, but you would be much better trained to serve your patients and also much better protected against changing insurance policies for the next 30 yrs.

 

[epidural man]

Kids, don't do drugs.

 

[pgy?]

Not sure if SIS will accept you at their courses if you've been removed from your residency.

I agree with the above posts that you must stop choosing shortcuts to happiness in life and that even if you are able to work right now, the day will come soon enough that all insurance companies will require board certification.

You might be okay for 3-6 years then permanently out of a job after the enivitable insurance crackdown comes on docs who haven't finished residency or become board certified.

I would suggest you go ahead and work PI for the next 12-18 months, pay your debts, while demonstrating you're clean for an extended period. Then again apply for new residency and for pgy2-3 spots, but you can't be picky at all, you have to be ready to accept a crappy IM or similar residency, occ med, FP in the rural Deep South or rural Midwest. After ACGME residency and with your prior anesthesia training, you could land a low tier pain fellowship, but you would be much better trained to serve your patients and also much better protected against changing insurance policies for the next 30 yrs.

This is why I would do a residency again to avoid problems down the line. I completed 4 years of MD school, chose the long hours of anesthesia, did over 1500 cases in residency, hundreds of epidurals, a hundred nerve blocks of varing types, hundreds of a lines, probably a hundred central lines and fifty PA catheters. I was in the top half to top third of anesthesia residents in the country in my board and in training exams I havent been taking shortcuts to pain (shortcuts to happiness sure but not professionally whatsoever) but now I am definitely being told to take the scenic route after breaking my leg (and hobbling on one for awhile) in the last mile of the marathon. Im going to see where Im at financially and the opportunities available before jumping into implanting spinal cord stims however after entering the real world now as a licensed MD I see PAs and ARNPs doing nerve blocks and epidurals and I imagine my training is more advanced then theirs.

I believe there are now 20,000,000 more insured patients on the docket after Obamacare has been enacted. I dont think that insurers are going to increase their training requirements for providers the way ABMS boards have increased requirements and training then again I could be very wrong and that is the risk I would have to be willing to take. Like I said Im applying to redo residency in another field. Would a hospital be more likely to credential me to perform interventional pain procedures as an FP?