Pain AND Cardiac?

[WashMe]

Anybody here do both? I've been drawn in by Pain because of getting reconnected with the traditional doctor-patient relationship and I like the technical (albeit not always evidence-based) aspects. However I also love being in the operating room. I most enjoy big cases (open hearts, liver transplants, etc), big lines, and having a lot to do while in the room. I also want to be facile with echo. I know there are academic attendings who do part time Pain and part time OR anesthesia, but they typically do "basic" cases. Anyone here think it is possible to split time doing Pain AND Cardiac (after doing both fellowships)? Maybe 2 days of Pain clinic, 1 day of procedures, 2 days of Cardiac OR, and be in the general/cardiac call pool? An attending I respect told me he thinks it's not possible for someone to be good enough at both to provide the best care in either. What do you think, and have you seen it be done before?

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[medking]

People will likely say something like "you're crazy. Pain and cardiac are so different. You probably just don't know what you want to do".

Interestingly enough, I feel the same way as you. My ideal scenario would allow me to do 80% pain and 20% cardiac. That being said, the chances of that happening are close to none. And I realize this.

Your split is slightly different than mine, but I would have to agree with your attending in regards to their comment. Being able to keep up your skills/knowledge/clinical judgement in both to provide the best care in both arenas will be very difficult. Impossible? Nothing is impossible, but I don't think it's really realistic. Therefore, it will be pain for me.

Anyway, I'm glad there is someone else out there that has considered/is considering doing both. I thought I was a bit crazy for thinking this way.

 

[narcusprince]

You might fit in at a large quaternary facility like cleveland clinic, mayo, where you may be able to blend both worlds. Red-do sternotamies in the post-op post-discharge pain control regiments. You can carve a niche but its a tough road.

 

[GA8314]

Opportunity cost my man..... I've not heard of anyone doing this but, hey, that doesn't mean much about whether you should or shouldn't.

The problem is the JOBS that tend to pay well are PP pain jobs. They want you doing pain. The best paying PP Cardiac jobs want you doing cardiac (that's why they hired you). So, practically, while ANYTHING is possible, this doesn't seem to be too synergistic.

 

[mostwanted]

I had an attending who had done both fellowships and practiced both. He wasn't particularly good at either. And I echo the opportunity cost.

 

[nimbus]

We have a couple guys who do both. Both are echo and pain boarded. They are good. In a big enough practice, it can be done. Go for it!

 

[secants]

I actually thought about critical care and pain medicine as I feel those are a little more connected, anyone here know people both of these?

 

[deleted171991]

I actually thought about critical care and pain medicine as I feel those are a little more connected, anyone here know people both of these?

It's actually palliative and critical care that are more connected. Usually it's a CCM doc who ends up doing palliative, not the other way round. It's very rare though.

@WashMe, if you like the traditional doctor-patient relationship, do CCM instead of pain. CCM plus cardiac is a very strong combo.

 

[Man o War]

Just make sure you can get enough TEEs to maintain your advanced echo boards. Not sure what the requirements are for pain boards.

 

[Docuronium]

I actually thought about critical care and pain medicine as I feel those are a little more connected, anyone here know people both of these?

That would strike me as a fairly uncommon combination---don't see a scenario someone would do both unless they wanted to do a career switch up.

 

[notcool]

if you like the traditional doctor-patient relationship, do CCM instead of pain. CCM plus cardiac is a very strong combo.

Could you please elaborate? I like "thinking" and "doing" in medicine. CCM seems like a combination of both? (Edited for clarity.)

 

[deleted171991]

CCM is the best compromise for IM+anesthesiology lovers who hate clinic (plus/minus working in the OR).

On top of that, a cardiac fellowship should make the person highly sought-after (which is unfortunately not true for CCM-only, except indirectly - e.g. one applies the critical care knowledge to provide anesthesia for liver transplants).

Unfortunately, there isn't enough "medicine" in a good part of anesthesia either; that's why independent CRNAs can survive.

 

[2win]

Anybody here do both? I've been drawn in by Pain because of getting reconnected with the traditional doctor-patient relationship and I like the technical (albeit not always evidence-based) aspects. However I also love being in the operating room. I most enjoy big cases (open hearts, liver transplants, etc), big lines, and having a lot to do while in the room. I also want to be facile with echo. I know there are academic attendings who do part time Pain and part time OR anesthesia, but they typically do "basic" cases. Anyone here think it is possible to split time doing Pain AND Cardiac (after doing both fellowships)? Maybe 2 days of Pain clinic, 1 day of procedures, 2 days of Cardiac OR, and be in the general/cardiac call pool? An attending I respect told me he thinks it's not possible for someone to be good enough at both to provide the best care in either. What do you think, and have you seen it be done before?

What???
Do you want $$$$?
Make your mind.
You sound like a teenager ...
"best care" - what does it mean?
You sound that you don't like either one or you're afraid to commit.
Pathetic.