Hello all,
Long-time lurker, first time poster here.
This post is long. I apologize. I am just really torn, and don't know what is or is not important to consider. I'm hoping to get a variety of opinions and input; thanks in advance for your help.
About me: I'm a PGY-3 PM&R resident, thinking about the next step, and wondering if a pain/interventional fellowship would make sense for me. Here's why I'm not yet convinced: I honestly don't have that much exposure to the field yet. I have some electives coming up where I can work with a few interventionalists, but right now most of my training has been inpatient with a few scattered outpatient and EMG months. Here's why I'm considering: I like the potential to be busy, productive, hands on, and not stuck seeing patients in 20 minute clinic slots every day.
The exposure I have had to interventional procedures has been neat, but I don't know if it matches reality going forward. As a med student I saw a handful of procedures, and even got to inject a knee and move a needle under fluoro (cool). As an intern, I did a two-week observational rotation with a private-practice anesthesia-background interventionalist who had a very efficient and very busy private practice. That place was a well-oiled machine. He must have had 15-20 staff for just one doc (reception, billing, practice managers, nurses, PAs). He didn't prescribe any narcotics and in 2 weeks there I only saw one new patient referral slip through the cracks that was obviously just drug seeking. If I can stay that busy, productive and (presumably) lucrative, it seems like a neat job. However, the time, effort and stress to set up that practice, combined with ongoing cuts, makes me think that reality is less and less likely. (FWIW, I think he initially came into someone else's practice and later ended up buying him out.)
Anyway, my dilemma is multi-factorial.
In PM&R, I like a lot of stuff and can honestly see myself pretty content with a variety of options. I don't think I'd be unhappy as an outpatient generalist. I might even consider inpatient if the call schedule was minimal (and I mean minimal), and the bureaucracy/administration not too onerous. I've liked my experiences at the VA so far, and often appreciate the slower pace though I'm sure I might get fed up with my inability to make things more efficient. Therefore, why do pain if I'd be happy with other things as well?
However, when I search for jobs, a lot of them seem to desire the pain/interventional training. Will this fellowship truly offer me more job opportunities? How much more could I make as an interventionalist than a generalist (accounting for reimbursement cuts on both spine and EMG procedures, overhead, etc). I know money should NOT be the ultimate goal, but if I work the same # of hours but make twice as much, that certainly is a consideration. And even without compensation as a goal, if an interventional job will get me to where I want to live location-wise, that would be awesome.
My husband gave up a 12-year career to move with me to residency where his current job options - to be honest - suck, and his skills are quickly atrophying. It's important to us that we both have fulfilling careers. Therefore, if interventional experience would allow me to go where we wanted to go, it would totally be worth it.
Additionally, my life outside of medicine is an extremely important consideration. We want to be close to the outdoors. We want a family. We don't want to be incredibly house-poor (if not, I would LOVE northern California). I honestly don't know if, long-term, I want to work full or part time. I'd like the income of full time, but I like the time to enjoy the money, too. I don't think I'd be happy working 60 hours/week, no matter what I do.
Finally, we want to start a family. Currently, baby #1 is on the way. He/she will be ~ 1yo when I start fellowship vs my first job. We'd like at least 2 kids, and if time permits, maybe up to 4. (My husband needs to be convinced about the >2, though.) I'm now 33, so these kids will have to be pretty close in age. I have NO idea how this plan will mesh with any fellowship/job I take.
Also, very importantly: should I even consider that much fluoro exposure when I'm expecting to be pregnant/breastfeeding?
What to do, what to do?
Thanks so much for making it through this LONG post.
Long-time lurker, first time poster here.
This post is long. I apologize. I am just really torn, and don't know what is or is not important to consider. I'm hoping to get a variety of opinions and input; thanks in advance for your help.
About me: I'm a PGY-3 PM&R resident, thinking about the next step, and wondering if a pain/interventional fellowship would make sense for me. Here's why I'm not yet convinced: I honestly don't have that much exposure to the field yet. I have some electives coming up where I can work with a few interventionalists, but right now most of my training has been inpatient with a few scattered outpatient and EMG months. Here's why I'm considering: I like the potential to be busy, productive, hands on, and not stuck seeing patients in 20 minute clinic slots every day.
The exposure I have had to interventional procedures has been neat, but I don't know if it matches reality going forward. As a med student I saw a handful of procedures, and even got to inject a knee and move a needle under fluoro (cool). As an intern, I did a two-week observational rotation with a private-practice anesthesia-background interventionalist who had a very efficient and very busy private practice. That place was a well-oiled machine. He must have had 15-20 staff for just one doc (reception, billing, practice managers, nurses, PAs). He didn't prescribe any narcotics and in 2 weeks there I only saw one new patient referral slip through the cracks that was obviously just drug seeking. If I can stay that busy, productive and (presumably) lucrative, it seems like a neat job. However, the time, effort and stress to set up that practice, combined with ongoing cuts, makes me think that reality is less and less likely. (FWIW, I think he initially came into someone else's practice and later ended up buying him out.)
Anyway, my dilemma is multi-factorial.
In PM&R, I like a lot of stuff and can honestly see myself pretty content with a variety of options. I don't think I'd be unhappy as an outpatient generalist. I might even consider inpatient if the call schedule was minimal (and I mean minimal), and the bureaucracy/administration not too onerous. I've liked my experiences at the VA so far, and often appreciate the slower pace though I'm sure I might get fed up with my inability to make things more efficient. Therefore, why do pain if I'd be happy with other things as well?
However, when I search for jobs, a lot of them seem to desire the pain/interventional training. Will this fellowship truly offer me more job opportunities? How much more could I make as an interventionalist than a generalist (accounting for reimbursement cuts on both spine and EMG procedures, overhead, etc). I know money should NOT be the ultimate goal, but if I work the same # of hours but make twice as much, that certainly is a consideration. And even without compensation as a goal, if an interventional job will get me to where I want to live location-wise, that would be awesome.
My husband gave up a 12-year career to move with me to residency where his current job options - to be honest - suck, and his skills are quickly atrophying. It's important to us that we both have fulfilling careers. Therefore, if interventional experience would allow me to go where we wanted to go, it would totally be worth it.
Additionally, my life outside of medicine is an extremely important consideration. We want to be close to the outdoors. We want a family. We don't want to be incredibly house-poor (if not, I would LOVE northern California). I honestly don't know if, long-term, I want to work full or part time. I'd like the income of full time, but I like the time to enjoy the money, too. I don't think I'd be happy working 60 hours/week, no matter what I do.
Finally, we want to start a family. Currently, baby #1 is on the way. He/she will be ~ 1yo when I start fellowship vs my first job. We'd like at least 2 kids, and if time permits, maybe up to 4. (My husband needs to be convinced about the >2, though.) I'm now 33, so these kids will have to be pretty close in age. I have NO idea how this plan will mesh with any fellowship/job I take.
Also, very importantly: should I even consider that much fluoro exposure when I'm expecting to be pregnant/breastfeeding?
What to do, what to do?
Thanks so much for making it through this LONG post.
