Is Pain a good choice in 2016?

[Dawkter]

Anesthesia resident looking to get some advice from the folks practicing full time pain management. I am debating between this fellowship or pediatrics and having difficulty deciding. Here are my thoughts:

Pros- Great skill set outside of the OR, may have diversity of practice if you split time between the OR and pain, fun procedures, patient contact, no call/weekends, great pay

Cons- Unknown future with reimbursements, difficult patients, may lose OR skills if practicing 100% pain, midlevel encroachment

I enjoy being in the clinic setting and appreciate that pain gives you an avenue to practice medicine outside of an OR setting if you feel like changing up the pace and being your own boss. My concerns are primarily possible frustration with the patient population and lack of success with interventional approaches.

Would you recommend going into pain given the current market in 2016?

Thanks in advance

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[deleted185747]

setup a poll on SDN

 

[pastafan]

Anesthesia resident looking to get some advice from the folks practicing full time pain management. I am debating between this fellowship or pediatrics and having difficulty deciding. Here are my thoughts:

Pros- Great skill set outside of the OR, may have diversity of practice if you split time between the OR and pain, fun procedures, patient contact, no call/weekends, great pay

Cons- Unknown future with reimbursements, difficult patients, may lose OR skills if practicing 100% pain, midlevel encroachment

I enjoy being in the clinic setting and appreciate that pain gives you an avenue to practice medicine outside of an OR setting if you feel like changing up the pace and being your own boss. My concerns are primarily possible frustration with the patient population and lack of success with interventional approaches.

Would you recommend going into pain given the current market in 2016?

Thanks in advance

Everything is turning to stool. Do what you enjoy most as the other variables are unpredictable and will change. Be aware that the decision that you make at age 30 may not be
the the one that best fits you 20 years later. Whichever way you choose live below your means and go with your passion.

 

[willabeast]

off hand i would say go with anesthesia pediatrics as you will be more marketable, be able to practice in more locations, lots of + reinforcement from happy parents, watch the kids grow up (i gave an anesthetic to a nephew i have seen almost every year at XMAS for >25 years now). but...anesthesia has some serious downsides also - for example - do i do a roth or not, how do i explain i make more $$ than a general surgeon (seriously the night/weekend call can kill you when you are over 55 yo).

 

[Ducttape]

im fascinated by how pediatric anesthesia will change over the next few decades. it appears that more data suggests that general anesthesia may have potential long term harm when given to children. while the % of kids in the general population overall will be less (the population is aging), there will still be more total kids in the future than right now, so you wont be lacking work. it will be a very interesting field.

but not interesting enough for me to go into it...

 

[Disciple]

Anesthesia resident looking to get some advice from the folks practicing full time pain management. I am debating between this fellowship or pediatrics and having difficulty deciding. Here are my thoughts:

Go into pain if you can stomach long-term face-to-face management of the patient population. The high volume procedure model while rarely seeing the patients will not be around much longer.

By the time MIPS rolls out in a few years, it may primarily be a loss prevention type specialty.

 

[Dawkter]

Thanks for the advice, much appreciated!

 

[drusso]

Go into pain if you can stomach long-term face-to-face management of the patient population. The high volume procedure model while rarely seeing the patients will not be around much longer.

By the time MIPS rolls out in a few years, it may primarily be a loss prevention type specialty.

Do you think putting an MD/DO fellowship-trained pain specialist in front of patients is efficient use of resources or could it be pushed down to other providers?

I keep hearing ACO's/CCO's/population-based health planners talk about how important "care teams" and "team models" of care are in our new system.

 

[Baritonebass]

Do you think putting an MD/DO fellowship-trained pain specialist in front of patients is efficient use of resources or could it be pushed down to other providers?

I keep hearing ACO's/CCO's/population-based health planners talk about how important "care teams" and "team models" of care are in our new system.

Interviewing in the people's republic of Boston, the land that birthed the ACA and ACO. The Pain/spine teams value is keep the patients from going under the knife while increasing and capturing spinal pathologies til they need/meet criteria for surgery. Limiting inappropriate spine surgery was a significant source of savings. Several places felt the days of 5 surgeons to 1 pain guy is over and the ratio will reverse over time.

 

[Disciple]

Do you think putting an MD/DO fellowship-trained pain specialist in front of patients is efficient use of resources.

For a large health system? No.

For personalized, more expensive care? Maybe.

I think you either take care of patients, or you take care of "the people".

 

[hyperalgesia]

I keep hearing ACO's/CCO's/population-based health planners talk about how important "care teams" and "team models" of care are in our new system.

For some reason "Health Care" is a breeding ground for bureaucrats. Every new "model" employs thousands more baby bureaucrats. Many of these 'cratlings will find themselves unemployed within their first few years. But the ones who quickly learn to hide in the crevices of the system will grow to be strong, full blown bureaucrats.

 

[bronchospasm]

Everything is turning to stool. Do what you enjoy most as the other variables are unpredictable and will change. Be aware that the decision that you make at age 30 may not be
the the one that best fits you 20 years later. Whichever way you choose live below your means and go with your passion.

Words of wisdom here.

 

[mid|ine]

I enjoy my practice, but am seriously concerned about its short term future and would have a hard time recommending anyone do a fellowship now. Pain is getting hit hard with cuts and seems to have a target painted on it...

 

[mountainDOc09]

If you like being in the OR, stay in the OR. My non-pain residency buddies are all making more than me. People I know who did peds fellowships all have amazing jobs in the cities they want to be in, and are making huge salaries with reasonable call schedules. If you don't like being in the OR, and like pain medicine, do pain medicine, then do pain, but definitely not for the money. It isn't what it used to be. My guess is that as procedure reimbursements go down, fellowships will become less competitive. If you need a career change later in life you can always go back and do a fellowship. Good luck.

 

[Doctor4Life1769]

off hand i would say go with anesthesia pediatrics as you will be more marketable, be able to practice in more locations, lots of + reinforcement from happy parents, watch the kids grow up (i gave an anesthetic to a nephew i have seen almost every year at XMAS for >25 years now). but...anesthesia has some serious downsides also - for example - do i do a roth or not, how do i explain i make more $$ than a general surgeon (seriously the night/weekend call can kill you when you are over 55 yo).

Lolwut?

 

[Gauss]

the way it's going, in 5-10 years get out of medicine entirely. maybe sooner when hillary takes over

 

[willabeast]

i think docs are currently in a sweet spot $$ wise. the "plan" was top keep docs incomes steady, then inflate the currency until docs incomes are about what other white collar workers make. the problem is that the dollar is not inflating. so docs are making way more $$ than expected. this is of great concern to the democrats, because docs give a lot of $$ to conservative politicians. to cut off the conservative political contributions the democrats have to somehow cut healthcare $$.
https://www.opensecrets.org/industries/indus.php?Ind=H

 

[Ducttape]

i think that is a bit presumptuous to believe that democrats specifically target doctors salaries.

at the least, it is giving democrats too much credit for being able to manipulate physician salaries, when they cant even manipulate their own party...

 

[willabeast]

i think that is a bit presumptuous to believe that democrats specifically target doctors salaries.

at the least, it is giving democrats too much credit for being able to manipulate physician salaries, when they cant even manipulate their own party...

i suspect it, i do not believe it. just as i suspect the IRS likes to audit conservative groups.

 

[clubdeac]

Curious, what do most anesthesia peds guys make?

 

[101N]

More than you

 

[emd123]

Anesthesia resident looking to get some advice from the folks practicing full time pain management. I am debating between this fellowship or pediatrics and having difficulty deciding. Here are my thoughts:

Pros- Great skill set outside of the OR, may have diversity of practice if you split time between the OR and pain, fun procedures, patient contact, no call/weekends, great pay

Cons- Unknown future with reimbursements, difficult patients, may lose OR skills if practicing 100% pain, midlevel encroachment

I enjoy being in the clinic setting and appreciate that pain gives you an avenue to practice medicine outside of an OR setting if you feel like changing up the pace and being your own boss. My concerns are primarily possible frustration with the patient population and lack of success with interventional approaches.

Would you recommend going into pain given the current market in 2016?

Thanks in advance

I'm bullish on pain at the moment, mainly because of lifestyle. Get into a good outpatient only interventional job and it's good. Salaries may or may not hold but if you control your spending and lifestyle you'll be fine. You could jump into some other specialty and that one may get hit with cuts, so you never know with that. The one premium thing in Medicine most docs don't have but all wish they had, is normal hours and a normal life with little (or no) nights, weekends, holiday's or call. After years of awful call in medical school and residency, then insane rotating shift work in the ED constantly feeling miserably sleep deprived due to destroyed circadian rhythms, and missing 1/2 of holidays, weekends and family/social events, a boring 7:30-12, 1pm-4:30 job is something I feel very, very, very fortunate to be able to have. It's a rarity in Medicine and makes dealing with some very tough patients more than worth it. I used to deal with the worst of the worst of patients at 3am (those kicked out of Pain practices, drunk, high on coke, under arrest, violent, etc) while also having to deal with traumas, MIs and seizures and critical peds at the same time, plus with crushing and unrealistic administrator time pressure and patient satisfaction goals overhanging it all.

What's a difficult chronic pain patient at 2pm on a Tuesday with no actual sick or dying people to also manage at the same time?

What it is, is a very good deal. I consider us lucky.