did I make a mistake?

[scottpilgrim]

Hello

I will be starting a pain fellowship this July and am really having some regrets.
I see a lot of my co-fellows getting great jobs all starting around 300k, and simultaneously reading about how the future of pain is so bleak.
Am I just suffering from the "grass is always greener on the other side" issues?

is the job market really that bad?
I'm afraid with the weight of my med school loans, and being a single earner with a kid hanging over my head, perhaps this was not my best financial decision.

not having a good day.

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[lobelsteve]

Hello

I will be starting a pain fellowship this July and am really having some regrets.
I see a lot of my co-fellows getting great jobs all starting around 300k, and simultaneously reading about how the future of pain is so bleak.
Am I just suffering from the "grass is always greener on the other side" issues?

is the job market really that bad?
I'm afraid with the weight of my med school loans, and being a single earner with a kid hanging over my head, perhaps this was not my best financial decision.

not having a good day.

Yup. You made a huge mistake. As a doctor we decided to put caring for patients over financial gain. Go try Wall St.

Of course there are plenty of folks who afterca few years sell out gor millions. Then leave medicine.

 

[SSdoc33]

Relax. You are fine. Seriously

 

[drusso]

Hello

I will be starting a pain fellowship this July and am really having some regrets.
I see a lot of my co-fellows getting great jobs all starting around 300k, and simultaneously reading about how the future of pain is so bleak.
Am I just suffering from the "grass is always greener on the other side" issues?

is the job market really that bad?
I'm afraid with the weight of my med school loans, and being a single earner with a kid hanging over my head, perhaps this was not my best financial decision.

not having a good day.

Yes. I'll give it to without any BS: Pain is done.

There is still much pleasure to be gained by helping others get their life back from chronic pain. There can be nothing more gratifying than the sincere appreciation you'll get from a patient who you've helped get relief from a procedure or just a kind ear. But, let's be real, there are plenty of those moments to be had in other specialties too...

Pain specialists have all but shrugged their shoulders and walked away from their own specialty. We've let "meta-analyticians" and know-nothing/non-clinical Noctors dictate to us what the data mean instead of standing our ground as the real "content experts" in our field.

We refuse to enforce real training standards on fellowship programs.

We refuse to defend a legitimate "scope of practice." Come one, come all and practice Pain!! Gas, PM&R, Neuro, FP, Peds, OB/GYN, Psych, CRNA--no relevant prior experience required.

We refuse to act politically in our patient's best interest.

We can't get three of us in a room to agree on anything... I mean A-N-Y-T-H-I-N-G!

We don't fund our PAC's and then complain when our payment is cut.

We suffer from what the Germans might call fulminant der Handschuhschneeballwerfer (literally, a person who throws snowballs with gloves---criticizes from a safe distance).

I wouldn't do pain if I were you. Go back and do Derm or ENT...or Medical Genetics and job in industry would also be good bet...

 

[pmrmd]

The field of medicine is done, homie. Too bad you're too far along to turn back.

 

[nvrsumr]

The opportunity cost of a fellowship is very high unless you truly need the procedural skill set. Most of what i do i learned as a resident.

 

[Leo Aquarius]

Yes. I'll give it to without any BS: Pain is done.

There is still much pleasure to be gained by helping others get their life back from chronic pain. There can be nothing more gratifying than the sincere appreciation you'll get from a patient who you've helped get relief from a procedure or just a kind ear. But, let's be real, there are plenty of those moments to be had in other specialties too...

Pain specialists have all but shrugged their shoulders and walked away from their own specialty. We've let "meta-analyticians" and know-nothing/non-clinical Noctors dictate to us what the data mean instead of standing our ground as the real "content experts" in our field.

We refuse to enforce real training standards on fellowship programs.

We refuse to defend a legitimate "scope of practice." Come one, come all and practice Pain!! Gas, PM&R, Neuro, FP, Peds, OB/GYN, Psych, CRNA--no relevant prior experience required.

We refuse to act politically in our patient's best interest.

We can't get three of us in a room to agree on anything... I mean A-N-Y-T-H-I-N-G!

We don't fund our PAC's and then complain when our payment is cut.

We suffer from what the Germans might call fulminant der Handschuhschneeballwerfer (literally, a person who throws snowballs with gloves---criticizes from a safe distance).

I wouldn't do pain if I were you. Go back and do Derm or ENT...or Medical Genetics and job in industry would also be good bet...

This is disheartening.

Anyone else regret doing pain?

Anyone glad they did the 1 year fellowship?

 

[emd123]

Relax. You are fine. Seriously

I agree with this. The doom and gloom is real in all fields but over blown. Sure if you had to start over, become a hedge fund guy or rock star. But Pain has its advantages too, compared to many specialties. Only you can decide if you made a mistake. Private message some of the doom and gloomers on here, find out what they earn per year with no call and it will give you a different perspective. There will be real challenges, but the sky is not falling. If you do the fellowship you have two specialties and that hedges your bets for the future, you can do whichever one ends up best/safest.

 

[lobelsteve]

I want to hear more about the Rock Star thingy. How do I transition away from clinical practice to musician. I am not a strong singer. Have electric guitar and a small amp. Using guitarsmith software but is it worth it? I haven't picked it up in 6 months. I'll put it an hour or two a week for a few weeks then get frustrated. I want to tour Europe and be a zillionaire.

 

[emd123]

I want to hear more about the Rock Star thingy. How do I transition away from clinical practice to musician.

I can't tell you. If I did, I'd have to kill you.

 

[Ducttape]

or be posting on some music forum.

 

[101N]

I want to hear more about the Rock Star thingy. How do I transition away from clinical practice to musician. I am not a strong singer. Have electric guitar and a small amp. Using guitarsmith software but is it worth it? I haven't picked it up in 6 months. I'll put it an hour or two a week for a few weeks then get frustrated. I want to tour Europe and be a zillionaire.

It all starts with some leather pants. You'll probably have to drive to Atlanta to get them.

 

[specepic]

Do Pain if you love it, don't if you Don't. If you are doing it for a salary bump it may not pan out, but you can still make a living IMO. There is no shortage of Pain pts! In the countries with socialized medicine, the docs either works for the government, doing primarily noninterventional work or if doing interventional, paid less with a long waiting list, others are practicing outside of socialized medicine as private practice, cash pay. There is so much spine and chronic pain, if you are good you will have a job. Diversified your training as much as possible, fluoroscopy, ultrasound, spinal manipulation, acupuncture, medication management, neuromodulation.

also keep in mind that the same regulatory bodies that seem to be attacking interventional pain, are also mandating hospitals to have services for inpatient and outpatient pain. Remember the "fifth vital sign", etc.

 

[Louisville04]

The field of medicine is done, homie. Too bad you're too far along to turn back.

Don't buy this garbage. There has been no drop in medical school applications with all the cuts and Obamacare.

http://www.bloomberg.com/news/artic...chool-applications-enrollment-rise-to-records

 

[hyperalgesia]

Hello

I will be starting a pain fellowship this July and am really having some regrets.
I see a lot of my co-fellows getting great jobs all starting around 300k, and simultaneously reading about how the future of pain is so bleak.
Am I just suffering from the "grass is always greener on the other side" issues?

is the job market really that bad?
I'm afraid with the weight of my med school loans, and being a single earner with a kid hanging over my head, perhaps this was not my best financial decision.

not having a good day.

It's definitely worth doing a pain fellowship. It's just 1 year investment and will open up the option of a private office based practice away from the OR. How many other single year investments of your life have returned that much? If you really like OR anesthesia, maybe forget it. Otherwise go for it.

 

[pmrmd]

Don't buy this garbage. There has been no drop in medical school applications with all the cuts and Obamacare.

http://www.bloomberg.com/news/artic...chool-applications-enrollment-rise-to-records

All this means is that younger people aren't paying attention. The medical students I have do not have a clue about the business side of medicine.

 

[emd123]

By the way, all the doom and gloom regarding Pain reimbursement in private practice has zero application whatsoever to hospital based Pain. The reimbursement in hospital settings is going up. Private practice may be threatened (I'm in PP and still think we'll survive) but hospital based hasn't been affected from what I can tell. We all may end up hospital employees (and I personally don't want that) but that doesn't mean the specialty ends. There are hospital employees on this board that make over MGMA average, last I checked.

 

[mille125]

Yes things have changed but ask these guys what they are making. If they are being honest they will tell you that they are making much more than 300K.

 

[Yo GabbaPentin]

It all starts with some leather pants. You'll probably have to drive to Atlanta to get them.

That is the exact same way my porn star career path began!

 

[EtherBunny]

The doom and gloom on this board about interventional pain is a bit ridiculous. Is the subspecialty confronting reimbursement issues right now? Absolutely. But so is every other specialist across the board (except for maybe the cash only plastics and derm folks out there). The truth of the matter is that medicine as a whole is under fire right now. It doesn't matter what specialty or subspecialty you go into, the same theme applies--more bureaucracy, more inefficiency, more hassles with insurance companies, and pay that doesn't keep up with inflation. Do you really think that interventional pain is unique in this respect?

Talk to specialists in other fields and I'm sure you'll hear the exact same gripes about the "decline of medicine." All doctors are on the chopping block these days, so to speak. Sad but true.

Nonetheless, don't lose perspective. A career in interventional pain is still a very sweet gig. No question about it. Great pay, great hours, low stress, low medicolegal liability, great mix of clinic and procedures, and TONS of job opportunities (chronic pain is EXTREMELY common in the general population. That's job security...).

I'm a fellowship trained, interventional pain physician in private practice. I don't have a single regret regarding my decision to go into interventional pain. It's a great field. Don't pay attention to all of the doom and gloom folks on this board. They must be depressed or something.

 

[mille125]

Ditto

The doom and gloom on this board about interventional pain is a bit ridiculous. Is the subspecialty confronting reimbursement issues right now? Absolutely. But so is every other specialist across the board (except for maybe the cash only plastics and derm folks out there). The truth of the matter is that medicine as a whole is under fire right now. It doesn't matter what specialty or subspecialty you go into, the same theme applies--more bureaucracy, more inefficiency, more hassles with insurance companies, and pay that doesn't keep up with inflation. Do you really think that interventional pain is unique in this respect?

Talk to specialists in other fields and I'm sure you'll hear the exact same gripes about the "decline of medicine." All doctors are on the chopping block these days, so to speak. Sad but true.

Nonetheless, don't lose perspective. A career in interventional pain is still a very sweet gig. No question about it. Great pay, great hours, low stress, low medicolegal liability, great mix of clinic and procedures, and TONS of job opportunities (chronic pain is EXTREMELY common in the general population. That's job security...).

I'm a fellowship trained, interventional pain physician in private practice. I don't have a single regret regarding my decision to go into interventional pain. It's a great field. Don't pay attention to all of the doom and gloom folks on this board. They must be depressed or something.

 

[Dr. Ice]

Hello

I will be starting a pain fellowship this July and am really having some regrets.
I see a lot of my co-fellows getting great jobs all starting around 300k, and simultaneously reading about how the future of pain is so bleak.
Am I just suffering from the "grass is always greener on the other side" issues?

is the job market really that bad?
I'm afraid with the weight of my med school loans, and being a single earner with a kid hanging over my head, perhaps this was not my best financial decision.

not having a good day.

Pain is done. Agreed. Although, I dont really know what "done" means to the people on here. Ive been practicing for 5 years, granted in the northeast part of the country. Let me just say that I wouldnt be complaining if I was making 300k. I see all the same whinny chronic pain/fibro/disability seekers that everyone else sees and if I was making that much, I would be pretty content. But alas.. My advice..go out west or down south if you wanna practice pain.

 

[EtherBunny]

Pain is done. Agreed. Although, I dont really know what "done" means to the people on here. Ive been practicing for 5 years, granted in the northeast part of the country. Let me just say that I wouldnt be complaining if I was making 300k. I see all the same whinny chronic pain/fibro/disability seekers that everyone else sees and if I was making that much, I would be pretty content. But alas.. My advice..go out west or down south if you wanna practice pain.

The Northeast is pretty crappy across the board for physicians--it doesn't matter what specialty you're in. The cost of living is high. The reimbursement is equivalent to other parts of the country, where the cost of living is considerably lower. Physician density is high.

I practice in the South, which is a COMPLETELY different atmosphere for medicine when compared to the Northeast. High compensation, low cost of living, low physician density (with a few notable exceptions).

No regrets here.

I don't think pain is "done." Not even close. It's a young subspecialty that desperately needs high quality research to elucidate the underlying mechanisms of chronic pain and improve patient selection for various therapies. From my perspective, the field is very much in a "preparadigmatic" state. The future of this field is bright. There will ALWAYS be a need for pain specialists. Why? Because there are tens of millions of people in the United States who suffer from chronic pain and are horribly mismanaged by overworked, overextended primary care physicians and physician extenders. Compounding the problem is a MASSIVE prescription opioid epidemic. Expertise in chronic pain management is a valuable skill in this society and will remain so for a long time (unless, of course, chronic pain mysteriously disappears and primary care providers suddenly develop a thorough knowledge of how to manage chronic pain and, just as important, the time to do so).

 

[Ducttape]

i live in the NE too.

perhaps you are currently in a very competitive and oversaturated part of the region? seems that most salaries outside of NYC are at least $250K. there is a practice in Boston listed in gaswork offering $320, a RI at $250-300K, and a Valhalla NY $330-475K. in contradistinction, one located in NYC is $150-270 and another in Queens at $210K...

 

[emd123]

To do well in Pain I think it helps to make and build your own job. If you're expecting someone to hand you MGMA average or higher, it's going to be an uphill battle in doctor-toxic regions. An honest and ethical 300k+ is very doable where I'm at (Southeast) once established.

 

[Dr. Ice]

i live in the NE too.

perhaps you are currently in a very competitive and oversaturated part of the region? seems that most salaries outside of NYC are at least $250K. there is a practice in Boston listed in gaswork offering $320, a RI at $250-300K, and a Valhalla NY $330-475K. in contradistinction, one located in NYC is $150-270 and another in Queens at $210K...

Are you talking about base salaries? 250k anywhere near NYC seems pretty good as a base. Guess it's all relative. I just left a job with a very large established ortho group with lots of ancillaries and high volume which also meant extremely high overhead that the docs inadvertently paid for without it being explicitly stated. I also quite frankly have never really known how do make money. Some of my cohorts are making a killing off this pain cream bs which I just didn't get into..dunno felt dirty to me. Of course now I'm kicking myself but at least I sleep relatively well at night...

 

[lord_jeebus]

To do well in Pain I think it helps to make and build your own job. If you're expecting someone to hand you MGMA average or higher, it's going to be an uphill battle in doctor-toxic regions. An honest and ethical 300k+ is very doable where I'm at (Southeast) once established.

I would add that it's a very good field for building your own practice from scratch compared to most specialties. You don't need a lot of specialized equipment (can use an ASC or hospital C-arm) unlike many specialties. Call obligations are minimal. Good opportunities for chart review for side income while getting started. If you're an anesthesiologist, you can do some anesthesia on the side also. Not to mention relatively high demand for the treatments we provide, unless you're in an oversaturated area.

 

[Ducttape]

the lower numbers (or the only number) are what are listed as minimum salary on gaswork.

 

[epidural man]

i know two pain guys - who practiced for a long time - who recently went back and did a mini fellowship in anesthesia to get reacquinted so they could do that. It's weird that I know two - in the last year. Before this, I had never heard of even one person ever doing that.

 

[Leo Aquarius]

What's a mini fellowship in anesthesia?

 

[epidural man]

Oh....it isn't a real fellowship - just using the term. They are just doing some anesthesia cases under supervision until they feel comfortable again. Being away from anesthesia for a while...it takes a real toll.

 

[Leo Aquarius]

Ah, got it.

 

[yancantcook]

what was their reasoning for doing anesthesia after doing pain for so long? was it reimbursement decrease or job dis-satisfaction?

 

[epidural man]

what was their reasoning for doing anesthesia after doing pain for so long? was it reimbursement decrease or job dis-satisfaction?

Pain has dark, thunderous clouds looming off in the distance. Sometimes building thunderstorms disperse and blow away - sometimes they bring a horrible storm. I would guess that has something to do with it.

 

[yancantcook]

I guess they are buying an insurance policy in case the doom and gloom is real

 

[SeniorWrangler]

I want to hear more about the Rock Star thingy. How do I transition away from clinical practice to musician. I am not a strong singer. Have electric guitar and a small amp. Using guitarsmith software but is it worth it? I haven't picked it up in 6 months. I'll put it an hour or two a week for a few weeks then get frustrated. I want to tour Europe and be a zillionaire.

At least they probably don't post on forums wishing they had gone into pain management instead... nobody wishes that.

 

[deleted682700]

Just do the fellowship, you are investing in educating yourself. I am 15 years out of anesthesia residency and now want to get back into a fellowship. It's going to be hard when you get older. Honestly you are lucky. Grit your teeth and finish despite all the quick temptations.

 

[314117]

Epidural man-
Read any forum in this website. Everyone seems to think that their field has "dark, thunderous clouds looming off in the distance."

Do you think that anesthesiologists don't? Read their forums.

More likely that these guys you "know" wanted a change or got tired of pain patients.

 

[epidural man]

Epidural man-
Read any forum in this website. Everyone seems to think that their field has "dark, thunderous clouds looming off in the distance."

Do you think that anesthesiologists don't? Read their forums.

More likely that these guys you "know" wanted a change or got tired of pain patients.

I doubt that. Pain patients are the most caring, kind, and understanding patients. The chronic pain makes them that way...teaches them patience.

 

[314117]

Haha

 

[Ducttape]

to be honest, us pain doctors arent called "Hey Anesthesia" by other professionals...

 

[Yo GabbaPentin]

Pain has dark, thunderous clouds looming off in the distance. Sometimes building thunderstorms disperse and blow away - sometimes they bring a horrible storm. I would guess that has something to do with it.

Oh please. Spend 5 minutes on the anesthesia forum and you'd think that the specialty has been paying minimum wage with 140 hr work weeks for the past 10 years. I've never seen clouds as dark as the clouds in that forum. CRNAs, anesthesia management companies, hospital admin, zero respect/autonomy, collapse of the specialty, etc, etc, etc, etc. Those are the common complaints all over that forum.

 

[epidural man]

Oh please. Spend 5 minutes on the anesthesia forum and you'd think that the specialty has been paying minimum wage with 140 hr work weeks for the past 10 years. I've never seen clouds as dark as the clouds in that forum. CRNAs, anesthesia management companies, hospital admin, zero respect/autonomy, collapse of the specialty, etc, etc, etc, etc. Those are the common complaints all over that forum.

Nice imagery, though...right?

 

[Aether2000]

as well as surmised above, the major issues affecting pain medicine evolved from the lack of autonomy and simultaneously the lack of agreement on virtually everything. The ethics of pain medicine are all over the map. Some doctors believe it is perfectly acceptable to charge patients twelve hundred dollars for an epidural steroid that is out of network of their insurance and collect that much over a period of years for a procedure that lasts two months. Similarly the charges for medial branch blocks x 6 repeated in 2 weeks followed by a radio-frequency even though with the initial medial branch block there was no functional assessment and no pain assessment can total $8000 if you own your own surgery center. some unscrupulous doctors are even charging Medicare patients $500 upfront in cash for doing a medial branch block injection in their clinic even though this is clearly fraud. without an agreement and ethics then we could agree on nothing else as pain physicians. We have the lowest of the low practicing among us.

 

[SSdoc33]

as well as surmised above, the major issues affecting pain medicine evolved from the lack of autonomy and simultaneously the lack of agreement on virtually everything. The ethics of pain medicine are all over the map. Some doctors believe it is perfectly acceptable to charge patients twelve hundred dollars for an epidural steroid that is out of network of their insurance and collect that much over a period of years for a procedure that lasts two months. Similarly the charges for medial branch blocks x 6 repeated in 2 weeks followed by a radio-frequency even though with the initial medial branch block there was no functional assessment and no pain assessment can total $8000 if you own your own surgery center. some unscrupulous doctors are even charging Medicare patients $500 upfront in cash for doing a medial branch block injection in their clinic even though this is clearly fraud. without an agreement and ethics then we could agree on nothing else as pain physicians. We have the lowest of the low practicing among us.

are we really worse than the GI docs who scope everybody? the spine surgeons who fuse anybody with a pulse? the neurologists who order a sleep study on 3/4 of their patients?

people are people. with fee-for-service, this type of shenanigans is difficult, if not impossible to avoid. we'd like to think that docs always do what is best for their patients, but reality and human nature would argue otherwise....

 

[314117]

I don't think we are "the lowest of the low". Every specialty has things like this that go on. As a matter of fact, so does every profession and business.

 

[emd123]

are we really worse than the GI docs who scope everybody? the spine surgeons who fuse anybody with a pulse? the neurologists who order a sleep study on 3/4 of their patients?

people are people. with fee-for-service, this type of shenanigans is difficult, if not impossible to avoid. we'd like to think that docs always do what is best for their patients, but reality and human nature would argue otherwise....

Agree. The dog poop always looks and smells worst in your own back yard, especially of you're the one stepping in it and having to clean it up. Some perspective goes a long way.

 

[Aether2000]

Not what I said....I said the lowest of the low are practicing among us. Not that our profession is the lowest of the low. I stand by my statement based on a professional lifetime of watching overt pathetically poor practices of pain medicine that have but one motivation: to extract the maximum amount of dollars for those who suffer, by not telling them the truth about how long the procedures are expected to last, about their unscrupulous billing policies that have resulted in hundreds of bankruptcies in a small town, and how procedures will be performed (SCS, RF) regardless of whether there is zero relief (noted in the physicians own charts) with trials or MBB.

 

[Disciple]

are we really worse than the GI docs who scope everybody? the spine surgeons who fuse anybody with a pulse? the neurologists who order a sleep study on 3/4 of their patients?

Perception of our specialty is worse because of the of prescription opioid epidemic.

 

[lobelsteve]

Perception of our specialty is worse because of the of prescription opioid epidemic.

But there are guys out there injecting repeatedly for no legitimate medical purpose. Teens with normal mri, 80 yo with 2/10 pain, a single 40 y/o 3 years after mva with nl mri of neck and back gets 4 cesi,4 lesi,rfa b/l c4-7, L3-S1, and sij, and a few gtbs over 4 months.