Combo Interventional Pain and O.R./Critical Care Anesthesia?

[RangerD]

I am wondering if anyone has observed a Pain Mgmt doc combining his practice with traditional OR anesthesia? For example, an MDA that sees Pain pts in clinic 2 days a week, does Pain procedures 1 day a week, and does traditional OR anesthesia 2 days a week. (or some variation of this) Does this type of combination practice occur? Or, is it typically all one way or the other?

I would think that by combining the 2 aspects of anesthesia, you could add some variety and enjoy the best of both worlds and not get burned out on either.

On the other hand, if someone is strictly Pain Management, say for 10 years, and then gets tired of dealing with the chronic pain patients, would it be easy for that MDA to get a position in a traditional OR anesthesia role? I would wonder if jobs would think he might be too rusty on that aspect of anesthesia...

Comments?

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[kickazzz2000]

from what ive seen this is common. one attending i worked with would do acute pain say, mondays and tuesdays, OR on wednesday through friday, and do pain office like 3 days a week every 4th week or something. keeps it interesting i guess.

 

[RangerD]

Originally posted by kickazzz2000
from what ive seen this is common. one attending i worked with would do acute pain say, mondays and tuesdays, OR on wednesday through friday, and do pain office like 3 days a week every 4th week or something. keeps it interesting i guess.

I'm glad to hear that. It does seem like it would keep in interesting. Personally, if I did only one or the other I think I would get burned out, but with the combination it would keep it interesting due to the variety.

The only Pain Docs I know personally are strictly Pain. They do clinic and related procedures, but they do not do any general anesthesia support for any of the OR's. And the MDA's I've seen in covering the OR cases were not Pain Management subspecialized. Glad to know it is different other places.

 

[Nikiforos]

Combining pain and OR anesthesia is definitely a possibility. IMHO, it is the way to go.

An anesthesiologist I trained under alternates weeks. One week in OR, one week in pain (2 days procedures, 3 days clinic). Another does procedures 1 day, clinic 2 days, and OR anesthesia 2 days. A friend of mine will combine cardiac anesthesia and pain!It gives them a good balance. Chronic pain patients are often emotionally needy and many are expert manipulators. It's nice to balance that with the physiology/pharmacology emphasis of the OR.

It would not be advisable to spend any significant period of time away from OR anesthesia if you think that you will one day want to do it again. Many colleagues feel "rusty" after they have been away for 2 weeks on vacation!

 

[Tenesma]

pain is becoming more and more its own specialty - very soon most pain divisions will become their own independent departments --- and to be a successful pain doctor and establish a reputation it almost dictates that you will have to become close to 100% pain. A lot of anesthesiologists I know have tried doing both, but in the end they usually end up choosing one or the other.... just like nikiforos said: after 2 weeks of vacation a lot of us feel rusty in the OR. I figure if you are doing it for the change of pace and the extra cash from procedures, then combining both is not a bad thing. But if you want to develop a strong referral base and set yourself apart in an increasingly competitive pain market (in the big metropolitan areas) you have to go 100%

 

[RangerD]

Originally posted by Tenesma
pain is becoming more and more its own specialty - very soon most pain divisions will become their own independent departments --- and to be a successful pain doctor and establish a reputation it almost dictates that you will have to become close to 100% pain. A lot of anesthesiologists I know have tried doing both, but in the end they usually end up choosing one or the other.... just like nikiforos said: after 2 weeks of vacation a lot of us feel rusty in the OR. I figure if you are doing it for the change of pace and the extra cash from procedures, then combining both is not a bad thing. But if you want to develop a strong referral base and set yourself apart in an increasingly competitive pain market (in the big metropolitan areas) you have to go 100%

I see your point. However, considering the types of patients you would see if you did 100% pain, I can see how that it might wear on you after a while. Personally, if I was in that situation, I could see that after 5-10 years of doing 100% pain, I would be ready for change of pace from the hectic clinical pain managment environment. To be able to step back into OR anesthesia when you are ready to slow things down a bit and are not as concerned about the extra money would be nice. However, if it had been 5 - 10 years since you were in OR anesthesia, that transition would be very difficult. How would you make that transition?

 

[placeboy]

Hey guys,

Besides simply receiving dual certification, does anyone know if there are gas docs out there that practice both (critical care along with pain management)? I realize that dealing with critically ill patient requires a daily struggle and may be tough to do "a few times a week" (unless maybe you have a partner?). Is it possible to, say, go in half the day to the ICU and spend afternoons in a private pain clinic?
I'd appreciate any info anyone has with regards to the subject.

Thanks!

 

[placeboy]

Hey guys,

Besides simply receiving dual certification, does anyone know if there are gas docs out there that practice both (critical care along with pain management)? I realize that dealing with critically ill patient requires a daily struggle and may be tough to do "a few times a week" (unless maybe you have a partner?). Is it possible to, say, go in half the day to the ICU and spend afternoons in a private pain clinic?
I'd appreciate any info anyone has with regards to the subject.

Thanks!

Seriously everyone...I know this is a hot topic and all, but let's try to limit the feedback on this one...I can only take so much input at once

 

[WVmed]

I am interested in critical care anesthesia but also like the idea of being in a shared-practice or solo pain clinic. I understand most anesthetists work as hospital employees and thus don't have some of the freedoms which may (or may not) come with a "private" pain clinic. Do many anesthetists work in this high level of care? I assume anesthetists could also be valuable in sleep centers. Any insight into this exciting field ?

 

[Skip Intro]

I am interested in critical care anesthesia but also like the idea of being in a shared-practice or solo pain clinic. I understand most anesthetists work as hospital employees and thus don't have some of the freedoms which may (or may not) come with a "private" pain clinic. Do many anesthetists work in this high level of care? I assume anesthetists could also be valuable in sleep centers. Any insight into this exciting field ?

Well, first off, Critical Care is a one-year fellowship following four years of anesthesiology, and Pain is a one-year fellowship following four years of anesthesiology. If you want to get certified in both, you'd have to do two separate fellowships, unless there are combined programs I don't know about (anyone?). If you were suggesting an either/or scenario, then I think you could do pain fellowship and then set-up in an outside clinic and not be a "hospitalist" if you wanted to go that route. There is a big demand for pain specialists right now with commensurate compensation. Whether that continues will depend on how many enter the field over the next 5-10 years.

The pain guy I worked with actually had a sweet deal. The hospital he was working at was very interested in setting-up a pain service. So, they basically gave him an off-site clinic where he could see patients provided that he did all of his procedures in their ambulatory center. So, essentially, he gets to see patients in his office (that they pay for) but does all the procedures in their facility. This is win-win for both because he gets a free office and the hospital gets him to bring patients into their ambulatory center, which they get to bill for. The only downside, as I could see it, is that they required him to manage the in-hospital pain service (i.e., he had to round on all of the patients on PCA). Although, he usually just got a resident to do this part for him, collect the notes, review and sign-off, and then have a resident or student re-insert the notes in the chart. So, it wasn't that "painful" for him (pun intended ). Also, part of the deal was he covered the OR on Fridays if they needed an extra anesthesiologist.

-Skip

 

[militarymd]

Hey guys,

Besides simply receiving dual certification, does anyone know if there are gas docs out there that practice both (critical care along with pain management)? I realize that dealing with critically ill patient requires a daily struggle and may be tough to do "a few times a week" (unless maybe you have a partner?). Is it possible to, say, go in half the day to the ICU and spend afternoons in a private pain clinic?
I'd appreciate any info anyone has with regards to the subject.

Thanks!

I'm a BC CCM anesthesia guy, and I've worked with a bunch of Pain BC guys in a group.....I suppose you can do both, but I truly think that you would not be very good a both. Personalities and interests in each specialties are quite different, so I think most would be one or the other.