Pain Management- why such an increase in pay?

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Paradox

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After speaking with PGY-3 in the operating room the other afternoon, he told me about a pain management fellow that was offered a starting salary of $825 K! I recognize my ignorance concerning the field and that this example may be extreme, but why is there such an astronomical difference in pay? How does a one year fellowship after an anesthesia residency simply increase your starting salary by half a million dollars in this case? Anyone in a pain fellowship or in the know for that matter, I would be much obliged. Thanks.

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It's pretty simple- pain is a procedural specialty, and if you line up the procedures very efficiently, for example, doing lots of blocks and stimulator implants, the $$$ add up VERY quickly. I know of a practice in Las Vegas where the docs are making over $1M each. Apparantly they do a lot of stimulator implants. This kind of financial success isn't possible everywhere, but it is possible.
 
I would think that $825 K to start is pretty unheard of. The average starting salary (according to the head hunters I've talked to) is more like $300 K. Of course, after a couple of years in practice the compensation gets much better, but it's not easy money! The patients are needy, the DEA is always looming in the background and drug seekers are always trying to scam you. It's certainly not for everyone.
 
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