Man, if I ever leave EM...it won't be to a pain clinic. Chronic pain is one of the things I don't like about EM! Maybe it's different when you have the tools to actually help.
Clearly, it's not for everyone, but I must say, it's worked out great for me. The only reason I didn't post about is sooner, like 4-5 years ago, is because even I wasn't sure that it would work out in the beginning. My posts on this forum had a lot of influence at that time (or seemed to) so I didn't to really endorse anything until I was sure it would even work out for me. I also didn't want to blab too much about it early on, while interviewing and starting a practice, mainly for anonymity during that time, not knowing if I'd get a fellowship, where/if I'd get a job and if I might even go back to EM. I took a bit of a leap of faith in doing a Pain fellowship, with the idea that if I didn't like it, I could bail out at any time, even after a month of two if I wanted, and go right back to my old job in EM. But as it worked out, I haven't work a day in the ED, since I left. I've had no desire, whatsoever.
I had a lot of fun in my more than a decade in the ED, but it absolutely beat me down after a while. 90% of that burnout was the circadian rhythm effects on my life, attitude and well being. I got to a point where I just wanted a normal life, and I wanted to feel rested, and not jet lagged every day of my life. I got to the point that I swear to God, I'd lay brick in a Louisiana swamp 40 hrs per week, if I could just sleep at night, feel well rested all the time and have a normal life with my family and make 2/3 of what I made as an EP. No code, interesting case or life saved was enough override the emotional exhaustion. Add to that the relentless pace over time, growing Press Ganey insanity and being expected by administration to do the impossible, meet unattainable time goals and save the ED overcrowding crisis single-handedly every shift, it became time to try something new. By "new," I wanted something 180 degrees different, not just a job that would be 5 or 10% better, for a year or two, until the contract got dumped.
So I applied to, and completed an ACGME accredited Pain fellowship (interventional focus), side by side with anesthesiolgists and physiatrists. After 5 years, I can honestly say its worked out great, for me. I'm not telling anyone else to do it, but I like it and it's an option for EP's now (Pain fellowship + sub-specialty board certification.) I'm happy about that, having been at the forefront of the process to push that through nationally. I'm proud to have taken a role in bringing a new sub-specialty to EM, however how large or small that role was and is.
I like the procedures. I just scheduled a kyphoplasty, which I love doing. It's cool stuff. This is stuff only interventional rads, ortho spine and neurosurgeons get to do.
Unless, you're a ACGME Pain Fellowship trained and ABMS Pain board certified EM physician. I think that's pretty cool. Spinal cord stimulators are pretty cool to do, also. I do a lot of lumbar and cervical epidural injections, nerve blocks (some spine, some peripheral, imaging-guided), plus tons of ortho type stuff such as intra-articular hip injections, shoulder injections. There's radiofrequency facet joint nerve ablations for axial spinal pain. Lumbar sympathetic chain blocks, for (legit) RSD. The list goes on.
Yes, there are the clinic days. They key is to focus as much on non-opiate treatment options as possible (some pain doctors prescribe zero opiates.) There's a whole laundry list of options you have to empower yourself with much greater control over weeding out and dealing with the worst system abusers in a non-ED non-EMTALA setting, but I won't bore you with the details unless someone wants them. You just do the right thing, use opiates as little as possible and be as strict as you can with prescribing tools, monitoring, drug screens, etc, when you do think a patient will benefit from them. Can difficult patients get irritating some times? Yes. But all things considered, I can honestly say my stress is 90% less than it was in the ED and working 4 1/2 days per week at my office ( about 40 hr) is infinitely easier on me, than working my ED schedule was. I feel like my career and life expectancy both, are probably 5 years longer as a result.
I can't tell you how great I felt, when I got that phone call with my fellowship offer and I accepted it, knowing that would I have to work another night weekend or holiday the rest of my life (except for a rare few during the fellowship year), feel rested and refreshed again, and
be able to truly live a normal life again. That being said, I absolutely would not have been able to appreciate what a great thing I have, if I hadn't gone through what I did in 10 yrs in EM. I likely would not have been happy or interested in doing what I'm doing now, if I hadn't had the chance to do the things I did, see the things I saw and ride the rodeo that is the ED for 10 years. I don't regret my time in EDs at all. In fact, I wouldn't change it for the world, but I don't want to go back.
It's all just amazing how it worked out. I'm very lucky and much happier.
