Pain vs Anesthesia....Salary???

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ravanbj

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I am planning to start a pain fellowship this summer but am curious about the field of pain vs anesthesia. I know a lot about pain and think I will enjoy taking care of chronic pain patients, actually enjoy speaking with them, like the procedures, and want to eventually open my own pain practice. However, I am also tired of residency and really burned out from being a "student". I am ready to start making some money now and find it hard to continue to delay my gradification. I loved anesthesia residency, enjoy OR work and find it exciting and rewarding. I do not like being called :anesthesia" and the lack of respect we get from nurses and surgeona. Although I hear it gets a little better in private practice...


so my question.....what is the salary difference. I can never get any real figuers or answers about this and it is an important factor in my situation. What are private pain docs making. I know what anesthesia is making and it is preety nice. I want to hear from private pain docs in practice or fellows who recently got jobs. I am happy to discuss this in private if people do not want to post on the fourm. I just want to hear some actual $$$ figuers for pain docs. I mean it sound slike anywhere from $150-1 million. I would like an average. Thanks
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Starting salary will vary depending on where you are going to work. Academics the fellowship may only bring you $25-40K extra per year over general anesthesia, but over the course of a career that difference can really add up.
In the private world the groups doing exclusively pain may give you a lower starting salary $220K as a "buy-in" for a year or two before you are partner. It seems that starting salary $300-400K is possible with some heavy negotiating. In a private practice with a good interventional mix, working reasonably hard, you can earn $500-600K. Sure there are guys making over $1 million but that would be heavy interventional, working long days, and probably owning your own practice (which means taking on $200K in debt up front and making nothing for 6months to a year).
Some pain docs do a mix of anesthesia and pain because they do love the OR and want to keep those skills up, in addition to providing some start-up capital as they transition into owning their own practice.
As an OR anesthesiologist you have little control over your schedule, little control over your payor mix (Medicare=$16 dollars every 15 minutes), overnight call in-house, etc. I strongly feel that the field of general anesthesiology is going to take a major dump in the next 10-15 years with the expansion of CRNAs and continued cuts by medicare.
In pain you can be your own employer (major tax benefits and control over your schedule), no in-house call, more control over your payor mix as you build your practice (i.e. we are no longer accepting Medicaid or BWC), and have the option to add mid-level providers and additional services (psych, PT, etc.) as means of adding cash flow. Eventually you may own your building and equipment as well, whereas in anesthesiology when you retire as a partner in a group there usually aren't any assets to sell.

I think doing the fellowship is worth it...you can always consider doing some locums during your fellowship year to relieve that pressure to earn some extra cash. Plus you may be able to snag a signing bonus when you start interviewing in october/november/december. Just be sure you love the work because if you hate it you will be miserable.
Hang in there!
 
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I agree with the previous post as far as compensation. If you are looking at private practice, I do not feel that pain would add many more dollars to your pocket especially when compared to private partnership anesthesiology groups.


Reasons to do the fellowship:

1) Return of a traditional patient/physician relationship (some better than others)

2) Opportunity to control your schedule, payer mix, etc (as previously mentioned)

3) Opportunity to partner with other surgeons/doctors in ASC's, MRI centers, PT clinics, etc.

4) Opportunity to sleep in your own bed every night (as previously mentioned)

5) Big community presence/more prestige: As a neurosurgeon told me in the OR when I wouldn't give his patient an overdose on mannitol, "Patients come here to see me, not to see you"


If none of these things are important to you, then continue to pass gas and dont give the fellowship a second thought. If you endgame is strictly money, pass gas and at least have one less year as an indentured servant.


just my 2 cents......
 
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Wondering if there is any update on the job market, regional differences, etc?
 
Silent Cool said:
Just saw this on Gaswork. Would someone comment on how reasonable this is?

http://www.gaswork.com/post/147866
Click to expand...
100% Pain Management
Exceptional earnings possible
Several Locations open due to new Partnership agreements
Grow your own Practice
7 figure earnings possible

Ongoing building of the practice - several Ohio, MI, KY, WV locations available

That's not a job, it's a career! And the same thing is going on in 4 states. It's an empire....
 
7 figures jobs are a dime a dozen. i see no reason to be skeptical.
 
Well doesn't say anything about interventional pain, just "Pain Management" cash business pill mills could probably provide with a 7 figure salary
 
lobelsteve said:
100% Pain Management
Exceptional earnings possible
Several Locations open due to new Partnership agreements
Grow your own Practice
7 figure earnings possible

Ongoing building of the practice - several Ohio, MI, KY, WV locations available

That's not a job, it's a career! And the same thing is going on in 4 states. It's an empire....
Click to expand...
Seems too good to be true. Probably is.
 
emd123 said:
Seems too good to be true. Probably is.
Click to expand...

Well that's what I figured, but I see a decent number of gigs like that on gaswork. I keep scratching my head each time......
 
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ravanbj said:
I am planning to start a pain fellowship this summer but am curious about the field of pain vs anesthesia. I know a lot about pain and think I will enjoy taking care of chronic pain patients, actually enjoy speaking with them, like the procedures, and want to eventually open my own pain practice. However, I am also tired of residency and really burned out from being a "student". I am ready to start making some money now and find it hard to continue to delay my gradification. I loved anesthesia residency, enjoy OR work and find it exciting and rewarding. I do not like being called :anesthesia" and the lack of respect we get from nurses and surgeona. Although I hear it gets a little better in private practice...


so my question.....what is the salary difference. I can never get any real figuers or answers about this and it is an important factor in my situation. What are private pain docs making. I know what anesthesia is making and it is preety nice. I want to hear from private pain docs in practice or fellows who recently got jobs. I am happy to discuss this in private if people do not want to post on the fourm. I just want to hear some actual $$$ figuers for pain docs. I mean it sound slike anywhere from $150-1 million. I would like an average. Thanks
Click to expand...

The pay for interventional pain medicine physicians is highly variable. In general you can expect a starting compensation (base salary + bonus) right out of fellowship of $250K-$450k. How benefits are structured is a separate issue entirely. Partnership tracks are generally 3 years and partner income is $450k to $650k or so.

There are people making more but they are exceptions to the rule--"super partners" in large groups, owners of ancillary services out the wazoo, or shady physicians (pill mills or block shops).
 
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Those incomes $400-$600K aren't going to last. I wouldn't look at some people making that now and have an expectation of getting that 5 years from now, when we're deep into Obamacare.
 
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For those who suggest there are positions available for $400 - 450K straight out of fellowship, I would challenge you to post such a position. I have seen one in 10 years, and it was in Scottsbluff, NE (i.e. BFE)
 
ampaphb said:
For those who suggest there are positions available for $400 - 450K straight out of fellowship, I would challenge you to post such a position. I have seen one in 10 years, and it was in Scottsbluff, NE (i.e. BFE)
Click to expand...

Really?!?! Scottsbluff aint' that far from where I grew up. They still offering . At this point I'd take it. Gotta be better than seeing 100+ patients a week for table scaps
 
I took a job in this range right out of fellowship and I interviewed at 3 other jobs with starting compensation in this range. They're definitely out there--they're just not advertised.
 
EtherBunny said:
I took a job in this range right out of fellowship and I interviewed at 3 other jobs with starting compensation in this range. They're definitely out there--they're just not advertised.
Click to expand...
Did u find these unadvertised 500K jobs from alumini? How can the rest of us find these hidden 500K jobs?
 
clubdeac said:
Really?!?! Scottsbluff aint' that far from where I grew up. They still offering . At this point I'd take it. Gotta be better than seeing 100+ patients a week for table scaps
Click to expand...
Remember you wanted that. You left the spa for that
 
My co-fellow took a job for 450k plus student loan payoff. That was two years ago. Hospital employee with a 30%+ medicaid payor mix.

Very rural Appalachia. ... I wouldn't take that job for twice that.
 
bedrock said:
Did u find these unadvertised 500K jobs from alumini? How can the rest of us find these hidden 500K jobs?
Click to expand...

"Awww, come on guys, it's so simple maybe you need a refresher course. Heyya! It's all ball bearings nowadays."
 
Think I'm going back to the spa!
 
agree fletch, but manure? i thought the scene is where he is wearing buck teeth pretending to be a plane mechanic looking at Alan's plane....
 
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