non interventional pain

[WHOIZME]

Hello,

I have an interest in non-interventional pain.
Are there any fellowships that focus more on this aspect?
Also, how is the job market for this? I couldn't find too many jobs when I tried to google it.

Thanks for your help.

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[Aether2000]

Probably not. Most docs just want to stick needles in people. Pays 10 times as much per hour.

 

[specepic]

Hello,

I have an interest in non-interventional pain.
Are there any fellowships that focus more on this aspect?
Also, how is the job market for this? I couldn't find too many jobs when I tried to google it.

Thanks for your help.

There are fellowships that deemphasize procedures (Michigan?)

You can def find a job as groups would love to have someone who can handle complex pain in clinic (including our group as we are now looking for a non-interventional PMR/Pain to support my practice)

I disagree with above post re: financial side of it. In PP maybe (though 10x more I think is hyperbole) but in many environments the pay is not that much worse and RVU/hr pretty similar (hosp jobs)

Good luck

 

[knoxdoc]

Probably not. Most docs just want to stick needles in people. Pays 10 times as much per hour.

I'm moving to Indiana ASAP.

 

[Aether2000]

A pain doc in my city makes 10 times as much...it is not hyperbole. I have seen the insurance payment data for this. For most docs it is only 4 times more.

 

[hyperalgesia]

Hello,

I have an interest in non-interventional pain.
Are there any fellowships that focus more on this aspect?
Also, how is the job market for this? I couldn't find too many jobs when I tried to google it.

Thanks for your help.

There is a market for it but you will be billing (or your employer will be) exactly the same as a family doctor. Medicare and insurances have a code for "New patient evaluation" and that's the same code for surgeons and for psychiatrists and every other doc. What makes the pay unique among specialties, are the OTHER codes they are qualified to bill for. Any doctor can bill the new and return visit codes. But only a few can perform (and therefore bill for) a craniotomy. But if you really like non-interventional pain, you will probably be good at it and you could potentially establish a cash model and your pay will then reflect the demand for your services.

Sorry if this is too basic, but the OP avatar says pre-med and I had no idea about any of this when I was pre-med.

 

[specepic]

A pain doc in my city makes 10 times as much...it is not hyperbole. I have seen the insurance payment data for this. For most docs it is only 4 times more.

I think a typical rather than outlier example would provide the most useful advice? MGMA median for PMR vs PMR/Pain are not very far apart at all. Aneth Pain is too much more either. I'm there are some block jocks in your area rocking it out but that info is not the norm

 

[PinchandBurn]

I think a NON interventional pain doc actually would be a HUGE asset. I can tell you that my hospital is looking for one right now. I think if you have a background or training in addictionology, it would even be of greater asset.

Plus, I don't think it would be too hard. It's just you need to have policies and procedures in place. And then strictly be able to enforce things and monitor meds,etc.

 

[Aether2000]

It is the norm in my area. Medicare pays around 56 dollars for a level 3 visit and a transforaminal epidural in an office pays around 200. A transforaminal in a surgery center in-network pays around 370 and a transforaminal in a non-network ASC pays up to $1500. This is all for 15 min work. These are real numbers in my area. No matter how you slice it, interventional pain procedures bring in much more per hour than the non-interventional pain procedures. Now the question is, what is the venue and what number of procedures are being performed every day.....that is the determinate of net income. Per 15 minute interval, sticking a needle in a person pays a hell of a lot more than taking care of a fibromyalgia patient. That is one of the main drivers of people into interventional pain. If they paid the same, then it is unlikely there would be even a small fraction of the number of procedures being done that we see today.

 

[specepic]

I think a NON interventional pain doc actually would be a HUGE asset. I can tell you that my hospital is looking for one right now. I think if you have a background or training in addictionology, it would even be of greater asset.

Plus, I don't think it would be too hard. It's just you need to have policies and procedures in place. And then strictly be able to enforce things and monitor meds,etc.

Yes, agree, we are also looking for one. I think as more docs are hosp employed and with ACOs/ACA non-interventional pain will pay similar and in demand

From an RVU perspective you could make the same income, or very close.

 

[Louisville04]

These were the comments earlier in the year when there was a non interventional pain job advertised on the pain management job listing forum:

SSdoc33: Translation: we need your DEA number to assume all risk and pad our bottom line by dispensing copious amounts of opioids. Pediatricians, pathologists, and geneticists welcome.

Jcm800: this sounds like a great job. I can be an internist, but not do any internal medicine. I can "treat" patients pain "medically" and then refer them to get interventions done by the interventional guys in the practice. I will take this job if i can write ZERO narcotics? Do you think they will take me? do ya

Ducttape: sounds like they couldnt find a midlevel that they want to hire...

 

[Jcm800]

what is non-interventional pain? to me, it is opioids. we can say multi-modal, blah blah all day, but the long and short of it, this is an opioid prescription doctor. do you think they would hire a "non-interventional doc" that doesnt write narcotics? i can see writing narcotics in instances where you (the pain doc) feels that it is appropriate, but when you are the non-interventional guy, they will assume you will take over narcs on ALL patients, and the push will not be to prescribe meds to the APPROPRIATE patient (which in my opinion is so low, that this whole non-interventinal doc thing to me doesnt make any sense anyway) but to AS MANY patients as possible.

lets be honest a "stable med patient" is gold mine. every month or whenever your feel f/u is appropriate, 5 minute visit, UDS makes a little money here an there... there is a reason these are handled by mid levels... but again, i dont think there are too many truly "stable" pain patients on opiates long-term, so either they are being mis-managed by given meds they dont need or shouldnt have, or their issues have been placed in a box that is treated "effectively" by whatever re-fill they get monthly in their 5 minute visit...a reason why i dont have too many stable med patients. I have some, and my NP does see them 2-3 out of every 4 visits, but i still see them. this is not a big number for me...

so yeah, i dont get it. a pain doc should do procedures as necessary, and write meds as necessary. when we separate these two completely, each one will do whatever at high volumes as they lack perspective and likely understanding about the patient.

 

[painj]

From what I have seen--in the employment sector--quite a few hospitals and large multi-specialty groups are starting to see the need and hiring non-interventional pain specialists-expecially over the course of the past year----this would typically someone with a pain background--or one of the primary specialties co-inciding with it along with a strong understanding or background in addiction medicine. This allows the group or department to funnel patients that are not helped by-or have an issue with any type of procedural pain options. The physician working in this capacity is able to determine long term needs for the patient and work in a stronger role with the PCP's. Some of the major factors with this type of employment situation is that it is typically a salaried, employment base role--no incentives as far as production or any other determining factor. Some hospitals require a 15-20 minutes session with each patient--this allows--they feel-- the pain physician ample time to assess and prescribe appropriately and to determine the long term affects of the medication.
I guess on a profit standpoint--it frees up a lot of time for the remainder of the pain group or department in not having to deal with the time that it takes for each of these patients to be seen appropriately.
It seems to be working better than those facilities that are hiring mid-levels to take on this type of responsibilities.
Of course-these positions would NEVER be showcases in your pain job board section on this forum--posters would be crucified without being able to explain it correctly.

 

[hyperalgesia]

The majority of "non-interventional pain" is misdirected substance abuse. Pts and their complicit docs who are using pain as the easiest avenue to feed their addictions and appease their pts. When we hear this from a student or other clinical person, we are less skeptical than if we hear it from an employer or broker. Many of us are seeing red all the time because of the scams and abuse that debase the medical specialty that we care about. It's nothing personal.

 

[fj25]

The trouble is that pain fellowships tend not to choose the individuals that dont come from an interventional residency so it becomes hard to get good pain training. I have a non-interventional background (psychiatry) from a great hospital and applied to pain fellowships but received almost all rejection letters. The pain docs at my hospital wouldnt even let me shadow them so I never got a chance to get a solid base of LORs.