Moonlighting During Pain Fellowship?

[MaximusD]

Anyone moonlight in the OR during their pain fellowship?

Good experiences?

Bad experiences?

Pitfalls?

Rates?

Setting up a moonlighting gig for during my fellowship and would like to see how it has worked out for others who came before me.

Thanks!

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[Ducttape]

don't.
study, read. rest.

study for your primary boards, cause when you start working, you wont have a lot of time to study those because your spare time will be spent figuring out what the heck you are doing with your patients - in fellowship, its like a game and can be fun, because they aren't really yours. starting out, its much more stressful...


you may have an epiphany some time after about the value of studying. mine came while watching Dr. Stoeltling give opening statement during oral boards...

 

[lobelsteve]

I worked PT in fellowship. My PD got pissed when he foumd out. I was doing interventional cases at night for auto injury. Back in 2004.

 

[MaximusD]

Appreciate the input!

Had considered ~24-36 hrs of OR time per month, weekend-only. Just to keep up on anesthesia skillset and to earn some extra moolah for the fam.

 

[Tramadeezy]

Did it during my fellowship. 1 24 hr call a month @ 100 bucks an hr. Definitely worth it money-wise and keepin up on anesthesia for your oral boards. Didn't feel it cut into my study time etc.

 

[hyperalgesia]

Appreciate the input!

Had considered ~24-36 hrs of OR time per month, weekend-only. Just to keep up on anesthesia skillset and to earn some extra moolah for the fam.

I moonlighted at a hospital, just staffing inpatient call. I think it was an extended care facility if I remember - back in 2007.

I only did it a few times and then said forget it. I think it depends a lot on the gig and what kind of toll it takes on you and your sleep and satisfaction with life. At some point in the near future, the importance of money decreases as the importance of QOL increases.

 

[newbie04]

I agree with @Ducttape

My cofellow did anesthesia moonlighting and it sounded like a decent gig. Good luck!


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[drusso]

I did social security disability evals, DOT physicals, and MRO work through an Occ Med Clinic here and there. Easy, no stress work.

 

[bronchospasm]

If you don’t need the money, read and spend time with the family. You will thank yourself.

 

[kstarm]

I did SS disability evals...all computer cases. Also moonlighted doing call for inpatient rehab on the weekends. Flat rate for the weekend, really helped with the bills and not too stressful, but ultimately didn't like being away from the kids that much and quit part way through fellowship

 

[nvrsumr]

I wish I had thought of disability evals. Was always jealous of my gas co fellows making 2k for a day a month. Adds up.

 

[oreosandsake]

i worked weekends as a fellow

sometimes it really cut into my performance monday morning. I got yelled at during fellowship some days when i came in bleary eyed.. also when i had to take off a little early sometimes on friday to get to the airport.

 

[Ducttape]

i worked weekends as a fellow

sometimes it really cut into my performance monday morning. I got yelled at during fellowship some days when i came in bleary eyed.. also when i had to take off a little early sometimes on friday to get to the airport.

PDs and attending docs know what’s going on. And they don’t appreciate it.

 

[MaximusD]

i worked weekends as a fellow

sometimes it really cut into my performance monday morning. I got yelled at during fellowship some days when i came in bleary eyed.. also when i had to take off a little early sometimes on friday to get to the airport.

I don’t think that’s for me, but I think 1-2 12 hr shifts or one 24 hr shift per month is reasonable. Appreciate the feedback from everyone.

 

[oreosandsake]

PDs and attending docs know what’s going on. And they don’t appreciate it.

yeah... i definitely got an earful once or twice...

in retrospect? I wouldn't change much. I needed to do what I needed to do at the time.

 

[Blitz2006]

don't.
study, read. rest.

study for your primary boards, cause when you start working, you wont have a lot of time to study those because your spare time will be spent figuring out what the heck you are doing with your patients - in fellowship, its like a game and can be fun, because they aren't really yours. starting out, its much more stressful...


you may have an epiphany some time after about the value of studying. mine came while watching Dr. Stoeltling give opening statement during oral boards...

Sounds like solid advice.

I figure fellowship is only 12 months. Might as well learn as much as you can (cadaver workshops, attend conferences, read at night). Whats the point of making an extra 20k in fellowship if you struggle as an incompetent attending your first few years out...

 

[BobBarker]

Oreos,
Were you teaching courses as a fellow?
That seems like something they should have appreciated.

 

[MaximusD]

Sounds like solid advice.

I figure fellowship is only 12 months. Might as well learn as much as you can (cadaver workshops, attend conferences, read at night). Whats the point of making an extra 20k in fellowship if you struggle as an incompetent attending your first few years out...

You really believe this is true?

 

[oreosandsake]

Oreos,
Were you teaching courses as a fellow?
That seems like something they should have appreciated.

I started during my last year of residency. I think a lot of the staff and residents enjoyed it. i set up a course for the residents/faculty when i was in fellowship... but i still got crap for being bleary eyed monday mornings or having cofellows cover me the last hour of clinic on fridays (Q2 months)

my co fellows were all good with me so it's not like they were the ones complaining... and we had a HUGE fellowship class.

 

[MustangGtV894]

I wish I had thought of disability evals. Was always jealous of my gas co fellows making 2k for a day a month. Adds up.

How do you get these gigs doing disability evals?

 

[Blitz2006]

You really believe this is true?

100%.

Moonlighting is for short term gains. Being a phenomenal resident and/or fellow equates to long term gains.

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[MaximusD]

100%.

Moonlighting is for short term gains. Being a phenomenal resident and/or fellow equates to long term gains.

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That’s sort of a false equivalency argument though... (the two aren’t mutually exclusive).

Being an outstanding fellow who also moonlights on occasion is possible. It’s not like most fellows spend their whole weekend pounding the books.

Also, for me it’s not about short-term goals. I still intend to practice OR anesthesia when I’m done in addition to working in the pain clinic. I guess i should have clarified that point as a motivator for me. I want to not lose my skillZ in the OR.

 

[Blitz2006]

That’s sort of a false equivalency argument though... (the two aren’t mutually exclusive).

Being an outstanding fellow who also moonlights on occasion is possible. It’s not like most fellows spend their whole weekend pounding the books.

Also, for me it’s not about short-term goals. I still intend to practice OR anesthesia when I’m done in addition to working in the pain clinic. I guess i should have clarified that point as a motivator for me. I want to not lose my skillZ in the OR.

You confirmed my point.

"Most fellows". Exactly, you should strive to be the best, not among the herd.

My goal is to make pain my life for those 12 months, inside and outside the hospital. I'll worry about social life and $ after fellowship.

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[BobBarker]

You are over estimating how strenuous a pain fellowship is.

 

[Ducttape]

but I am not overestimating how strenuous boards are, oral and written, for primary specialty.

you will make plenty of money later... unless you fail boards

 

[Ronin1]

If you really need the money do it. If not enjoy the fellowship. Honestly it was the easiest year of my life since college

 

[Blitz2006]

but I am not overestimating how strenuous boards are, oral and written, for primary specialty.

you will make plenty of money later... unless you fail boards

Exactly.

Opportunity cost.

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[244913]

Exactly.

Opportunity cost.

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I couldn't have moonlighted during my fellowship if my life depended on it. It was "robust."

The bigger Q is how much Anesthesia do you see yourself doing as a pain guy? Moonlighting here and there in fellowship will keep you skilled enough to do a machine check and not goose the tube, but then after fellowship you really have to make a choice, I think. Are you a pain medicine physician or a **practicing** anesthesiologist?

They are two completely different specialties, two completely different mindsets. Pain suits me better and I feel like I do more good every day. I want to be the best I can be and this specialty is incredibly deep, complex, and intellectually challenging. It requires all of my mental and physical effort to perfect my craft.

I know some guys do it, straddling these two completely different specialties, but it is rare outside of academics and hospital systems. Not for me

- ex 61N

 

[Blitz2006]

I couldn't have moonlighted during my fellowship if my life depended on it. It was "robust."

The bigger Q is how much Anesthesia do you see yourself doing as a pain guy? Moonlighting here and there in fellowship will keep you skilled enough to do a machine check and not goose the tube, but then after fellowship you really have to make a choice, I think. Are you a pain medicine physician or a **practicing** anesthesiologist?

They are two completely different specialties, two completely different mindsets. Pain suits me better and I feel like I do more good every day. I want to be the best I can be and this specialty is incredibly deep, complex, and intellectually challenging. It requires all of my mental and physical effort to perfect my craft.

I know some guys do it, straddling these two completely different specialties, but it is rare outside of academics and hospital systems. Not for me

- ex 61N

Exactly.

I feel there is already so much to know in 12 months. I want to be able to do everything from pumps to kyphos to stims to PRP confidently after I'm done Fellowship

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[MaximusD]

I couldn't have moonlighted during my fellowship if my life depended on it. It was "robust."

The bigger Q is how much Anesthesia do you see yourself doing as a pain guy? Moonlighting here and there in fellowship will keep you skilled enough to do a machine check and not goose the tube, but then after fellowship you really have to make a choice, I think. Are you a pain medicine physician or a **practicing** anesthesiologist?

They are two completely different specialties, two completely different mindsets. Pain suits me better and I feel like I do more good every day. I want to be the best I can be and this specialty is incredibly deep, complex, and intellectually challenging. It requires all of my mental and physical effort to perfect my craft.

I know some guys do it, straddling these two completely different specialties, but it is rare outside of academics and hospital systems. Not for me

- ex 61N

This is the bigger question that I am attempting to answer for myself. I really enjoyed Pain and feel like I am well-suited for it, but I do like anesthesia as well.

Really helpful post. I guess I have some soul-searching as it is not my intent to be a mediocre pain doc, but I dislike the idea of the decision being made for me due to lack of foresight. Put bluntly, a year is a long time to have done no OR work if you have any desire to continue practicing anesthesia competently.

 

[BobBarker]

Pain is a full time job. The only way it isn’t in private practice is if you have a partner or don’t prescribe medication.

 

[MaximusD]

Pain is a full time job. The only way it isn’t in private practice is if you have a partner or don’t prescribe medication.

Thanks for your input.

 

[MaximusD]

You confirmed my point.

"Most fellows". Exactly, you should strive to be the best, not among the herd.

My goal is to make pain my life for those 12 months, inside and outside the hospital. I'll worry about social life and $ after fellowship.

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We may have different values, which is OK. Sounds like you will absolutely excel in whatever you do. Props!

 

[Blitz2006]

We may have different values, which is OK. Sounds like you will absolutely excel in whatever you do. Props!

Just want to be competent and provide the best possible evidence based pain medicine!

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[244913]

Just want to be competent and provide the best possible evidence based pain medicine!

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don't do pumps then and learn how to taper patients off opioids during fellowship. Learn addiction medicine

 

[Blitz2006]

don't do pumps then and learn how to taper patients off opioids during fellowship. Learn addiction medicine

I want to learn pumps for cancer patients...right?

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I want to learn pumps for cancer patients... but yes, I am going to be closely monitoring the 90 meQ limits as well...but also want to provide adequate pain relief in those who require Greater than 90...

 

[MaximusD]

I want to learn pumps for cancer patients...right?

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I want to learn pumps for cancer patients... but yes, I am going to be closely monitoring the 90 meQ limits as well...but also want to provide adequate pain relief in those who require Greater than 90...

“Require” is certainly an interesting concept in this statement. I’m not convinced anyone requires >90 mEqs. Doesn’t mean they may not benefit from it in a multimodal regimen in certain conditions... but require is strong nomenclature! I digress.

Back to the question at hand... maybe the question I should be asking is: does anyone here practice both anesthesia and pain Medicine, and if so, are you happy doing it?

 

[BobBarker]

No body requires more than 90meq. They are just used to it.

 

[Ronin1]

“Require” is certainly an interesting concept in this statement. I’m not convinced anyone requires >90 mEqs. Doesn’t mean they may not benefit from it in a multimodal regimen in certain conditions... but require is strong nomenclature! I digress.

Back to the question at hand... maybe the question I should be asking is: does anyone here practice both anesthesia and pain Medicine, and if so, are you happy doing it?

I have done both pain and anesthesia for 20 years. With the right group and the right pain partner you can do it:however, that combo is not always available. It was certainly more common coming out of fellowship to do both in rhe nineties. That being said, I do enjoy the occasional anesthesia day, it's seems very laid back compared to a day in the office!

 

[oreosandsake]

No body requires more than 90meq. They are just used to it.

Vitamin D-ilaudid Deficiency!

 

[MaximusD]

Gonna do it! Thanks for the discussion... love being a part of this community.

 

[oreosandsake]

Gonna do it! Thanks for the discussion... love being a part of this community.

good luck

post your thoughts in 6 months

it wont take long to figure out if it works for you

 

[Biohazard685]

I did some anthesia shifts during fellowship. If you can study for your boards then go for it.

 

[unchockey21]

Gonna do it! Thanks for the discussion... love being a part of this community.

Late to the party but for what it’s worth I made an extra $70k during fellowship moonlighting in the OR at a community hospital. I’d do one weekend per month. Got to hospital about 6pm Friday and left Monday morning in time to get to clinic. $5500 per weekend. No trauma, no hearts, no vascular, no thoracic. It was extremely light call and I had far more time to study than I would’ve had at home. Every moonlighting gig and every fellowship is different. Some can coexist and some can’t. If it doesn’t work out, you can always stop taking shifts. Good luck. Hope it works out for you