I'm considering pain medicine, but...

[Leo Aquarius]

So I'm a resident who is thinking about expanding my skill set to include pain medicine. But then you read something like this and you're left wondering about doom and gloom:

http://www.painphysicianjournal.com/2014/january/2014;17;E11-E19.pdf

Is the future bright for pain medicine or is it looking troublesome? Thanks for any replies in advance.

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[drusso]

So I'm a resident who is thinking about expanding my skill set to include pain medicine. But then you read something like this and you're left wondering about doom and gloom:

http://www.painphysicianjournal.com/2014/january/2014;17;E11-E19.pdf

Is the future bright for pain medicine or is it looking troublesome? Thanks for any replies in advance.

Yep. Pain Medicine is a great field, but we've let external stakeholders call the tune. If you join this field, you have to anticipate being involved in advocacy work.

 

[ampaphb]

I wouldn't be overly concerned. The article's lead author still generated several million dollars in revenue last year

 

[bedrock]

I wouldn't be overly concerned. The article's lead author still generated several million dollars in revenue last year

Several million? So mainly his ASIPP revenue?

 

[Ligament]

Thus, we welcome 2014, with issues related to SGR (24-26), multiple regulatory burdens of the Affordable Care Act (29), the expected International Classification of Disease (ICD) transition (30,31), exploding Medicaid managed care, expanded Health Insurance Portability and Accountability Act (HIPAA) compliance (32), re- imbursement tied to Physician Quality Reporting Sys- tem (PQRS) and outcomes (14,33), multiple LCD issues, meaningful use of electronic medical records (EMRs) (34,35), and highly limited coverage policies from Af- fordable Care enrollees and private insurers (11,36).

 

[emd123]

The great upside of Pain is that you can do it with Derm like hours, if you want. That's gold in Medicine. The reimbursement issue is a threat but seems a little less threatening than last year. You can never be sure which specialty is on the chopping block, which year.

Do you really want to be suffering in some hospital at 3am working horrendous shifts and have nurses & administrators manipulate you and control you all the time?

Pain allows outpatient work that avoids that if desired.

You will have the albatross of a certain amount of addicts trying to lie/manipulate to get meds, but you just learn to say, "No." Also, you deal with the same in ortho, primary care, ER, Spine and others.

I would do Pain again, over anything that has nights/weekends/holidays/call/shift work.

I get to have normal life and always get a good nights sleep. Though not a perfect specialty, that's what I love about Pain.

 

[jsaul]

The great upside of Pain is that you can do it with Derm like hours, if you want. That's gold in Medicine. The reimbursement issue is a threat but seems a little less threatening than last year. You can never be sure which specialty is on the chopping block, which year.

Do you really want to be suffering in some hospital at 3am working horrendous shifts and have nurses & administrators manipulate you and control you all the time?

Pain allows outpatient work that avoids that if desired.

You will have the albatross of a certain amount of addicts trying to lie/manipulate to get meds, but you just learn to say, "No." Also, you deal with the same in ortho, primary care, ER, Spine and others.

I would do Pain again, over anything that has nights/weekends/holidays/call/shift work.

I get to have normal life and always get a good nights sleep. Though not a perfect specialty, that's what I love about Pain.

spoken like a true burnt out ER doc

 

[specepic]

we are heading in the direction of universal health care (in kind of a CMS passive agressive manner but nevertheless), if you look at countries that have this "pain" as a speciality is often not covered or very rationed. I am very happy in my specialty but do worry about the future.

 

[EtherBunny]

I'm an interventional pain physician in private practice (employed by a hospital actually) and I love my job. I would absolutely go into pain medicine again.

Are there downsides to interventional pain? Of course. Every field in medicine has drawbacks. There really isn't a "holy grail" specialty out there. You just have to pick your poison wisely.

For me, interventional pain is a great field for a variety of reasons...
-Tons of fun procedures
-Absurdly great schedule (M-F, 8-4ish, no weekends, no nights, call is a joke)
-Outstanding compensation
-You get to sleep in your own bed every night when you're "on call" (and you rarely, if ever, get awakened in the middle of the night)
-Autonomy (especially when compared to OR anesthesia) with the power to control your schedule
-Strong relationships with patients
-Nice mix of diagnostic work in clinic (which can be fairly challenging from an intellectual standpoint requiring a fairly broad skill set that only physicians possess) and procedural medicine
-Low stress field in general with virtually no emergencies and very reasonable medical liability
-Perfect for the "entrepreneurial spirit" in medicine, as you can start your own practice
-Lots of very cool technology on the horizon
-Viewed as a revenue generator by hospitals instead of a liability (a busy interventional pain physician can generate millions of dollars in revenue for a hospital. It really is crazy. I was blown away the first time I saw the numbers.)

 

[emd123]

spoken like a true burnt out ER doc

From burned out ER doc, to "chilled out" Pain doc

 

[miamidoc2b]

OP, this is a PAIN DOC forum. Hence, the answers will obviously be biased.

Do a rotation or two. Only way to really know. Do it because YOU like it - not b/c of what you read or what others are saying/predicting...

 

[Leo Aquarius]

OP, this is a PAIN DOC forum. Hence, the answers will obviously be biased.

Do a rotation or two. Only way to really know. Do it because YOU like it - not b/c of what you read or what others are saying/predicting...

Thanks miamidoc and all the others. I did a pain rotation in med school and an anesthesiology rotation where they did tons of US-guided nerve blocks and really liked both experiences. Now I'm in psychiatry residency which is great, but I miss procedural medicine and would like to incorporate the two.

 

[clubdeac]

Psych will really help you for all the somatization d/o, depression/anxiety, personality d/o and malingering patients you will see. Very smart! However it will be harder to get into a fellowship and you'll have a bit of a steeper learning curve your fellowship year. Good luck

 

[Leo Aquarius]

Psych will really help you for all the somatization d/o, depression/anxiety, personality d/o and malingering patients you will see. Very smart! However it will be harder to get into a fellowship and you'll have a bit of a steeper learning curve your fellowship year. Good luck

Thanks. I am willing to work very hard and frankly am excited about it all.

I appreciate the vote of confidence. I've learned how to deal with personality disorders and malingerers daily so I hope that will come in handy.

 

[nvrsumr]

BWH has a psychiatrist pain attending in the anesthesia dept who does implants etc..