Anesthesia---to pain

[PAINISGOOD]

For those Pain fellows or attendings whose base residency was anesthesia, what made you want to go into pain? Did you miss seeing patients? DId you want your own cases?

In other words, what did you like more about Pain medicine than anesthesiology?

thanks,

PAINISGOOD

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[Aether2000]

1. Bored to death with the monotony of anesthesiology
2. Chained to an anesthesia machine after hours for as long as it would take an inept surgeon to finish a case that most surgeons would have completed in half the time
3. Performed 100 consecutive cases with exactly the same anesthetics in the same quantity without any difference in response or outcome
4. Found myself splitting a practice between liver transplant anesthesia and pain medicine out of boredom
5. Inability to plan for any kind of life due to OB anesthesia call
6. Incredibly poor reimbursement for OB Medicaid labor epidurals with obligatory in house call
7. Largely a technician rather than a diagnostician role- typically anesthesiologists do not make diagnosis of diseases...these are handed to the anesthesiologist by consultants, surgeons, and PCPs. Anesthesiologists act on symptoms that occur during anesthesia, but do not provide any long term input into disease management
8. Lack of appreciation by staff or patients for your services....an expected outcome is batting homeruns every time you step up to the plate...anything less is malpractice.
9. The perfunctory nature of the 2 minute preop visit and 17 second post op visit relegates the profession to a non-communication, non-interactive physician role, much like radiologists that rarely actually talk to patients
10. You can never make anyone better....you can only make people worse or the same.

 

[drusso]

Very interesting, indeed!

Any physiatrists or neurologists care to weigh in on the same question? I can see some similarities straight away from a physiatry POV:

Disclainer: If you can't appreciate sarcasm, please read no further!

1) Bored to death with inpatient rehab--another stroke, another spinal cord injury, another "grand-mother down."
2) Chained to a rehab unit late in the evening waiting for transfers from "only God knows where."
3) 100's of consecutive hospital consults with exactly the same PT/OT Rx with little or no difference in response or outcome.
4) Prospect of being a "table-setter" for an orthopod or spine surgeon for the rest of my life makes me depressed and suicidal.
5) Lack of appreciation by other services--ie seen solely as a disposition venue.
6) Competition from other disciplines and erosion of the "multidisciplinary team process" for which rehab is famous.
7) Poor reimbursement coupled with a sicker population leaves one feeling as if they are only doing "remedial internal medicine."
8) Perfunctory team conferences and family conferences that really revolve around securing a nursing home placement.
9) Paper work, paper work, paper work, and more paper work.
10) You can't polish a turd....you can only make some people worse or the same.

 

[Aether2000]

OMG ...too funny. I suppose anes and PMR gravitate into pain for virtually the same reasons

 

[PAINISGOOD]

1. Bored to death with the monotony of anesthesiology
2. Chained to an anesthesia machine after hours for as long as it would take an inept surgeon to finish a case that most surgeons would have completed in half the time
3. Performed 100 consecutive cases with exactly the same anesthetics in the same quantity without any difference in response or outcome
4. Found myself splitting a practice between liver transplant anesthesia and pain medicine out of boredom
5. Inability to plan for any kind of life due to OB anesthesia call
6. Incredibly poor reimbursement for OB Medicaid labor epidurals with obligatory in house call
7. Largely a technician rather than a diagnostician role- typically anesthesiologists do not make diagnosis of diseases...these are handed to the anesthesiologist by consultants, surgeons, and PCPs. Anesthesiologists act on symptoms that occur during anesthesia, but do not provide any long term input into disease management
8. Lack of appreciation by staff or patients for your services....an expected outcome is batting homeruns every time you step up to the plate...anything less is malpractice.
9. The perfunctory nature of the 2 minute preop visit and 17 second post op visit relegates the profession to a non-communication, non-interactive physician role, much like radiologists that rarely actually talk to patients
10. You can never make anyone better....you can only make people worse or the same.

OK, I can see why you bailed on anesthesia......but why do you enjoy pain medicine? Are you still happy with you decision to practice pain??

I guess I am asking what are the pros and cons of pain medicine, in your opinion?

Thanks for the insight!!

PAINISGOOD

 

[PAINISGOOD]

1. Bored to death with the monotony of anesthesiology
2. Chained to an anesthesia machine after hours for as long as it would take an inept surgeon to finish a case that most surgeons would have completed in half the time
3. Performed 100 consecutive cases with exactly the same anesthetics in the same quantity without any difference in response or outcome
4. Found myself splitting a practice between liver transplant anesthesia and pain medicine out of boredom
5. Inability to plan for any kind of life due to OB anesthesia call
6. Incredibly poor reimbursement for OB Medicaid labor epidurals with obligatory in house call
7. Largely a technician rather than a diagnostician role- typically anesthesiologists do not make diagnosis of diseases...these are handed to the anesthesiologist by consultants, surgeons, and PCPs. Anesthesiologists act on symptoms that occur during anesthesia, but do not provide any long term input into disease management
8. Lack of appreciation by staff or patients for your services....an expected outcome is batting homeruns every time you step up to the plate...anything less is malpractice.
9. The perfunctory nature of the 2 minute preop visit and 17 second post op visit relegates the profession to a non-communication, non-interactive physician role, much like radiologists that rarely actually talk to patients
10. You can never make anyone better....you can only make people worse or the same.

OK, I can see why you bailed on anesthesia......but why do you enjoy pain medicine? Are you still happy with your decision to practice pain??

I guess I am asking what are the pros and cons of pain medicine, in your opinion?

Thanks for the insight!!

PAINISGOOD

 

[Aether2000]

Pros: You are your own boss, make your own schedule, run your own office the way you want it to be run, determine who works for you, determine what types of patient conditions and what insurances you will accept, can do something positive for patients to improve their functioning and existence in life, develop patient-doctor relationships that are long term and rewarding, determine how advanced you wish to be in procedures and minimally invasive spine surgery, and we have kewl toys to play with.

Cons: Many of the patients with chronic intractable pain are nuts and you have to try not to think too much about their idiosyncracies, drug addicts (true addicts that have no pain) will seek you out to treat them with narcotics, substance abuse problems in the pain population are ever present, dealing with police regarding drug diversion, overexpensive C-arms and office equipment....

I could not be happier doing exactly what I do as a full time comprehensive pain physician.

 

[Doctodd]

drrusso.....i didnt see that as sarcastic at all....all true points to some degree.

Basically i like the instant gratification of having a patient get up off the table with no pain from their L-HNP. Felt like all i did was write when it came to PMR....write scripts for this or that, but never actually did much hands-on for the patient. Gotta use the hands....fun to use the hands.

T

 

[bulletproof]

1. Bored to death with the monotony of anesthesiology
2. Chained to an anesthesia machine after hours for as long as it would take an inept surgeon to finish a case that most surgeons would have completed in half the time
3. Performed 100 consecutive cases with exactly the same anesthetics in the same quantity without any difference in response or outcome
4. Found myself splitting a practice between liver transplant anesthesia and pain medicine out of boredom
5. Inability to plan for any kind of life due to OB anesthesia call
6. Incredibly poor reimbursement for OB Medicaid labor epidurals with obligatory in house call
7. Largely a technician rather than a diagnostician role- typically anesthesiologists do not make diagnosis of diseases...these are handed to the anesthesiologist by consultants, surgeons, and PCPs. Anesthesiologists act on symptoms that occur during anesthesia, but do not provide any long term input into disease management
8. Lack of appreciation by staff or patients for your services....an expected outcome is batting homeruns every time you step up to the plate...anything less is malpractice.
9. The perfunctory nature of the 2 minute preop visit and 17 second post op visit relegates the profession to a non-communication, non-interactive physician role, much like radiologists that rarely actually talk to patients
10. You can never make anyone better....you can only make people worse or the same.

hey there Algosdoc, I have been reading on here and the anesthesiology forum for a while. Both are arenas extremely interesting to me as a third year med student. I think ultimately, I would like to do pain mngmt, with some pain research ( based on a four week clinical clerkship with an excellent pain doc). I guess my question for you is, given your stated aversion to the negatives of anesthesia, what do you feel is the best way to go about becoming a pain doc , short of establishing a pain medicine residency? ( ideal solution imho ). Would you go the anesthesia route again to end up in the position you are in now? Thanks so much for all your insight on this and other threads.

 

[Aether2000]

General Surgery Internship or surgery emphasis during first year
PM&R Residency with emphasis on injections and pain when possible
Anesthesia based pain fellowship

 

[Spine Specialist]

General Surgery Internship or surgery emphasis during first year
PM&R Residency with emphasis on injections and pain when possible
Anesthesia based pain fellowship

^^^^^

I am so glad i completed this route of training.

 

[bbbmd]

1) Bored to death with inpatient rehab--another stroke, another spinal cord injury, another "grand-mother down."
2) Chained to a rehab unit late in the evening waiting for transfers from "only God knows where."
3) 100's of consecutive hospital consults with exactly the same PT/OT Rx with little or no difference in response or outcome.
4) Prospect of being a "table-setter" for an orthopod or spine surgeon for the rest of my life makes me depressed and suicidal.
5) Lack of appreciation by other services--ie seen solely as a disposition venue.
6) Competition from other disciplines and erosion of the "multidisciplinary team process" for which rehab is famous.
7) Poor reimbursement coupled with a sicker population leaves one feeling as if they are only doing "remedial internal medicine."
8) Perfunctory team conferences and family conferences that really revolve around securing a nursing home placement.
9) Paper work, paper work, paper work, and more paper work.
10) You can't polish a turd....you can only make some people worse or the same.

David--> This is hilarious!!! Loved #10. I had to share this with the others in my program going into pain. As much as I love being a physiatrist, there are just some things I can't stand and you were right on target (in a sarcastic way).

B

 

[drusso]

David--> This is hilarious!!! Loved #10. I had to share this with the others in my program going into pain. As much as I love being a physiatrist, there are just some things I can't stand and you were right on target (in a sarcastic way).

B

I'm just here to help...

 

[Disciple]

Especially 1,2,5,7&8.

Thanks.

It's great when someone in your position can say things the rest of us are afraid to.

At least until the end of June that is.

 

[PAINISGOOD]

Algos,

Can you explain how call works as a pain physician who does implantable techniques.....I would think you would need to be "on call" albeit from home 24/7 for possible complications? Is this correct?

If true, then your argument about not being able to plan for a life in anesthesia would also hold true for pain.

PAINISGOOD

 

[Doctodd]

You choose to do implants only if you want. When you get busy enough you have a PA or NP take first call. Otherwise, dont schedule any pumps on a friday and cross your fingers for an easy call.

T

 

[Spine Specialist]

Very interesting, indeed!

Any physiatrists or neurologists care to weigh in on the same question? I can see some similarities straight away from a physiatry POV:

Disclainer: If you can't appreciate sarcasm, please read no further!

1) Bored to death with inpatient rehab--another stroke, another spinal cord injury, another "grand-mother down."
2) Chained to a rehab unit late in the evening waiting for transfers from "only God knows where."
3) 100's of consecutive hospital consults with exactly the same PT/OT Rx with little or no difference in response or outcome.
4) Prospect of being a "table-setter" for an orthopod or spine surgeon for the rest of my life makes me depressed and suicidal.
5) Lack of appreciation by other services--ie seen solely as a disposition venue.
6) Competition from other disciplines and erosion of the "multidisciplinary team process" for which rehab is famous.
7) Poor reimbursement coupled with a sicker population leaves one feeling as if they are only doing "remedial internal medicine."
8) Perfunctory team conferences and family conferences that really revolve around securing a nursing home placement.
9) Paper work, paper work, paper work, and more paper work.
10) You can't polish a turd....you can only make some people worse or the same.

There was a period in the history of medicine when physiatrists were called 'Glorified Physical therapists'.....the day is not far when physiatrists are going to be called 'Un-Glorified Minimally invasive spine surgeons'. I cant wait for that wonderful day in my life time.

 

[paz5559]

There was a period in the history of medicine when physiatrists were called 'Glorified Physical therapists'.....the day is not far when physiatrists are going to be called 'Un-Glorified Minimally invasive spine surgeons'. I cant wait for that wonderful day in my life time.

If you are foolish enough to characterize yourself as a spine SURGEON, you had best be ready for attorneys to hold you the the level of expertise of a residency trained surgeon. We are interventional pain management specialists, or spinal interventionists, but I, for one, know better than to ever use the word 'surgeon' to describe what I do

 

[paindefender]

"Surgeon wannabe", at the best.

 

[Spine Specialist]

If you are foolish enough to characterize yourself as a spine SURGEON, you had best be ready for attorneys to hold you the the level of expertise of a residency trained surgeon. We are interventional pain management specialists, or spinal interventionists, but I, for one, know better than to ever use the word 'surgeon' to describe what I do

Read my post again. I never mentioned physiatrists are gonna be spine SURGEONS. Physiatrists are just going to be compared with spine surgeons for their quality of spine work in future. UnGlorified Spine Surgeon is an overstatement. Yep. I am a fool with a goal. We are gonna be players in this field for a very long time. Let us discuss about this again in 2010.
May be we can talk about robotic assisted percutaneous discectomy and stim placement performed by physiatrists then.

 

[lobelsteve]

If you are foolish enough to characterize yourself as a spine SURGEON, you had best be ready for attorneys to hold you the the level of expertise of a residency trained surgeon. We are interventional pain management specialists, or spinal interventionists, but I, for one, know better than to ever use the word 'surgeon' to describe what I do

I noticed when you cosign your notes your tagline says Surgeon: and not Physician:.

But I'll fix that in July.

Just fun to pick on the little guys...