The future of pain medicine

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Maverikk

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I'm an anesthesia resident thinking about pain medicine, I loved the multiple small procedures and bigger spine procedures performed. I want to know though: a lot of people, including pain attendings I've worked with, seemed uncertain what would happen to the field due to the lack of solid research in terms of being reimbursed for procedures. What do you think, I know everyones going to say: everybody's going to get a cut when the new law is implemented. But do you think their will be a radical change and if so how?
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Go into pain if you like taking care of pain pts, doing procedures, and feeling like a traditional doctor. It's more simple than people make it out to be. No one can tell what the future holds but if you do a pain fellowship you can always fall back on your anesthesia skills.
 
There have already been incremental changes that have made pain medicine much less attractive, with more of the insurance company axe falling on the specialty due to lack of cohesiveness of its practitioners, incursion of midlevels that are now practicing without any training at all, and the relatively easy money made without controlled studies demonstrating efficacy. This will continue, as the value of facet injections, epidural steroid injections, expensive overuse of stimulators, and lack of progression of the specialty due to FDA filing status of most new technologies in the 510K status- "investigational" rather than PMA filings. The future is not bright for many fields of medicine, but especially so for pain medicine.
 
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drusso said:
Unlike other specialties, the field has failed to "cumulate" a convincing evidence base for most of what we do.
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Pain medicine is not going to go away. There is a huge, even unmet, need for the specialty.
However, procedural or interventional pain medicine will shrink to a level more proportional to it's modest benefit.
 
101N said:
Pain medicine is not going to go away. There is a huge, even unmet, need for the specialty.
However, procedural or interventional pain medicine will shrink to a level more proportional to it's modest benefit.
Click to expand...

My newer line for patients:

1/3 of pain relief can come from any and all meds no matter what they are or what the dose, so the lower the better.

1/3 can come from all of my skills and tricks with needles, RF, wires, steroids.

1/3 comes from you the patient, by doing CBT, coping skills, TENS, exercise, PT, etc.
 
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The specialty is dying...

More specialties are also dying...

FP is doomed due to midlevel encroachment/walgreens clinics.

Ophthalmology is doomed due to optometrists.

Anesthesia is doomed due to CRNAs.

Radiology is doomed due to outsourcing and technology.

And we are ALL doomed due to government interference. So pick your poison. The MOST doomed specialty depends on which specialist you are speaking to.
 
lobelsteve said:
My newer line for patients:

1/3 of pain relief can come from any and all meds no matter what they are or what the dose, so the lower the better.

1/3 can come from all of my skills and tricks with needles, RF, wires, steroids.

1/3 comes from you the patient, by doing CBT, coping skills, TENS, exercise, PT, etc.
Click to expand...
Hopefully they don't know enough about probabilities to realize the cumulative probability of success is not 100%. It's about 70% (1-(2/3(3))).
 
His #'s are about right. The other 1/3rd are the addicts and folks with psychiatric problems
who we haven't been trained to diagnose or treat.

That important other 1/3rd now gets unnecessary opioids and useless procedures.
 
Yo GabbaPentin said:
The specialty is dying...

More specialties are also dying...

FP is doomed due to midlevel encroachment/walgreens clinics.

Ophthalmology is doomed due to optometrists.

Anesthesia is doomed due to CRNAs.

Radiology is doomed due to outsourcing and technology.

And we are ALL doomed due to government interference. So pick your poison. The MOST doomed specialty depends on which specialist you are speaking to.
Click to expand...

Even with all that doom and gloom, medical school applications are on the rise.
 
101N said:
His #'s are about right. The other 1/3rd are the addicts and folks with psychiatric problems
who we haven't been trained to diagnose or treat.

That important other 1/3rd now gets unnecessary opioids and useless procedures.
Click to expand...

oddly enough...
i took it that he was saying 1/3 of benefit for an individual patient will come from a particular type of therapy. it appears you are talking about groups of patients again.

he's talking individual, you are talking society.
 
Louisville04 said:
Even with all that doom and gloom, medical school applications are on the rise.
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With all the new schools popping up, pretty soon you will need about a 2.0 GPA and maybe spell your name right on the MCAT to get accepted into med school.

My other post was mostly sarcastic. The sky is falling over every specialty and each specialty thinks that they have it the worst.
 
the specialty is dying... I agree.
Medicaid in NY state will not pay for pain pumps for non-malignant or central pain as of this year.
Insurance are denying and precertifying everything. You have limits on facets and epidurals everywhere.
Patients have 2-5K deductibles.
health exchanges via ACA pay less than medicare.
good luck...
 
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Ducttape said:
oddly enough...
i took it that he was saying 1/3 of benefit for an individual patient will come from a particular type of therapy. it appears you are talking about groups of patients again.

he's talking individual, you are talking society.
Click to expand...

Ducttape 1
101N 0


Talking about how to get a patient better.
 
I think we'll survive, just have to adapt. Painful adaptations maybe, but we'll survive, somehow. It is definitely a time of great uncertainly, though.
 
Yo GabbaPentin said:
With all the new schools popping up, pretty soon you will need about a 2.0 GPA and maybe spell your name right on the MCAT to get accepted into med school.

My other post was mostly sarcastic. The sky is falling over every specialty and each specialty thinks that they have it the worst.
Click to expand...

Medicine has or will cease to be attractive to the " cream of the crop". As a result the quality of care will continue to fall. Who ever thought it would come to this?
 
OMG I can't read this crap! I just had a panic attack!! Please let's stay positive! I've got 30 more years of this **** and I have no other skillz..... seriously none!
 
I should have gotten my MBA, and made it 'rain' on wall street... at least my son will have more of a chance to be free of Dictator Obama's rule.
 
NJPAIN said:
Medicine has or will cease to be attractive to the " cream of the crop". As a result the quality of care will continue to fall. Who ever thought it would come to this?
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this is the truth. doctors will be more like lawyers, 4-5 tiers of law schools in the US.
it wont be like it was with the cream of the crop going to domestic MD schools, and the second tier going to DO schools and then the third tier going to foreign schools... there will be more than enough american MD spots for ANYONE to get into...

It will be interesting to see what the foreign/caribbean schools will do now that american schools will have more readily available spots and they wont be able entice poor students that dont have the grades to get into american schools to pay $60,000 a year for basically online medical education. A bunch of those have popped up recently. I know of a family friend that got tricked into a school in Mexico "NO MCAT required" that opend and closed within the 2 years he was there. out almost a 100k...sad.
 
docs will make a bit less, but the job security really is unparalleled. there is less top-end money, but it is a safer bet. you get an MBA, you could be rollin in it, or you could be unemployed.
 
Its essentially over. My practice is talking about "re-examining" our contracts to reflect a lower base bc our collections have been less this year compared to previous. The reimbursements are tanking like crazy and horizon insurance is back denying procedures that have already been carried out after pre-cert. The doom is most certainly here and the gloom is justified. My advice..marry rich (whether you are a man or a woman, it is 2013 after all)..and if you're already married..well..

Or..find another talent/skill and learn to live with much less as the years go by..
 
Dr. Ice said:
Its essentially over. My practice is talking about "re-examining" our contracts to reflect a lower base bc our collections have been less this year compared to previous. The reimbursements are tanking like crazy and horizon insurance is back denying procedures that have already been carried out after pre-cert. The doom is most certainly here and the gloom is justified. My advice..marry rich (whether you are a man or a woman, it is 2013 after all)..and if you're already married..well..

Or..find another talent/skill and learn to live with much less as the years go by..
Click to expand...

Suicide by pain physicians is under represented compared to many other specialties.

You can start now or wait for the falling sky to take you out.

I'm 8 yrs post-fellowship and this is my best year. I do not profit from any ancillary services including DME, UDS, my boutique creams, in house pharmacy, and a whole bunch of other stuff most of the scumbag pain docs are doing to make a buck.

Still happy to be at 80+ percent MGMA Anes pain.
 
its odd...

ive been in medicine a long time. i dont know if ive been in medicine as long as Dr. Ice or JCM800 or stim4u...

but ive heard this thread so many times. "reimbursements are gone". "its managed care now, you wont get paid under whats it called, an 'HMO'". "You med students arent as smart as mine" (thats a direct quote from a professor - in 1987).

theres a HUGE discrepancy in pay for physicians right now and that is killing Medicine. maybe those of us who are getting paid millions should not, and those not able to afford their student loans should be reimbursed enough so that they can.


there is no reason that the interventional pain doc down the road is literally making 5 times my salary, and im at 50% MGMA non-anesth pain.
 
Everyone's talking about % MGMA. Can someone remind me what 50% MGMA is. I forgot. Thought it was around 500k

Ducttape said:
its odd...

ive been in medicine a long time. i dont know if ive been in medicine as long as Dr. Ice or JCM800 or stim4u...

but ive heard this thread so many times. "reimbursements are gone". "its managed care now, you wont get paid under whats it called, an 'HMO'". "You med students arent as smart as mine" (thats a direct quote from a professor - in 1987).

theres a HUGE discrepancy in pay for physicians right now and that is killing Medicine. maybe those of us who are getting paid millions should not, and those not able to afford their student loans should be reimbursed enough so that they can.


there is no reason that the interventional pain doc down the road is literally making 5 times my salary, and im at 50% MGMA non-anesth pain.
Click to expand...
 
Wonder where they got those numbers and who represents non-anesthesia. Does non-anesthesia include FP's, psych, med mgt only docs. If so, then I'd understand the discrepancy. If it's guys also doing interventional pain then I don't see why they're making so much less. I consider myself as interventional as about any anesthesia guy out there. I also spend a lot of time with patients in my clinic, particularly during their initial visit. I guess we'll see where I fall after a few more months. Hmmmm
 
Jcm800 said:
MIDWEST
Anesthesia: $601,026
Nonanesthesia: $319,826

when i see these numbers i begin to think what am i doing wrong...if 600k is AVERAGE!!!!!

i dont know anyone making that money, maybe the scumbags, and i dont talk to them...
Click to expand...

it gets averaged out. you are holding up the bottom half of the curve! :D

as a side note, the interventional pain doc in this area making ALL the money was the highest paid physician in this and the surrounding 3 counties. he gives interventional pain such a bad name... i was talking to one of his non-pain co-workers who stated point blank that interventional pain made too much money(he forgot i changed to pain).
 
Southern -mean
Anesthesia: $483,902
Nonanesthesia: $356,085

As steve is "making 80% of MGMA", he must be pulling in about 650-700K.

That sounds a far cry from the 275K salary Steve posted about in the past, which made him immune from financial pressures to do more procedures.

I guess he renegotiated his contract.
 
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clubdeac said:
Wonder where they got those numbers and who represents non-anesthesia. Does non-anesthesia include FP's, psych, med mgt only docs. If so, then I'd understand the discrepancy. If it's guys also doing interventional pain then I don't see why they're making so much less. I consider myself as interventional as about any anesthesia guy out there. I also spend a lot of time with patients in my clinic, particularly during their initial visit. I guess we'll see where I fall after a few more months. Hmmmm
Click to expand...

non-anesthesia is a big group. Much of it is composed of what you mentioned FP, etc doing med management. Also PMR-pain, which tends to do less of the big ticket procedures than anes-pain.
 
All specialists that work hard and have higher volume are at the top of the bell curve. Medicare and the CMS comparative committees don't care about that fact. They are taking a blunt hatchet and destroying the fee for service system. They would rather have higher paying procedures spread over many doctors and nurses..... that fixes nothing and leads to more fraud, more health costs, and resentment.
 
bedrock said:
Southern -mean
Anesthesia: $483,902
Nonanesthesia: $356,085

As steve is "making 80% of MGMA", he must be pulling in about 650-700K.

That sounds a far cry from the 275K salary Steve posted about in the past, which made him immune from financial pressures to do more procedures.

I guess he renegotiated his contract.
Click to expand...

I meant 08%. :rolleyes:

My starting salary was $150 and it was that way for 4 years. I was changed over to $300 2 years ago to make it easier to pay bonuses. Bonuses went from quarterly to monthly as well.
Less out of the payroll account all at once. And I still see less patients and do fewer procedures than most who post here.
 
lobelsteve said:
I meant 08%. :rolleyes:

My starting salary was $150 and it was that way for 4 years. I was changed over to $300 2 years ago to make it easier to pay bonuses. Bonuses went from quarterly to monthly as well.
Less out of the payroll account all at once. And I still see less patients and do fewer procedures than most who post here.
Click to expand...

can you post your SS# and your ATM pin number also...
 
Kudos for posting your base salary...... But we still don't know the bonus. 50k or 500k?
 
SSdoc33 said:
Kudos for posting your base salary...... But we still don't know the bonus. 50k or 500k?
Click to expand...

I'm whispering this...

self-righteous: convinced of one's own righteousness especially in contrast with the actions and beliefs of others : narrow-mindedly moralistic

bore: One that is wearingly dull, repetitive, or tedious.
 
SSdoc33 said:
Kudos for posting your base salary...... But we still don't know the bonus. 50k or 500k?
Click to expand...

I can just post my 1040 from 2012....


Not you SSdoc33, but perhaps others....

*****: Posting all over the internet and hiding behind a username to remain anonymous while attacking your peers.
 
Well I for one, appreciate the disclosure of real info. We are all too freaking timid, myself included. But I would probably only disclose in pvt forum setting. Seems like every other person these days is an activist 99 percenter. I have come to fear envy.
 
Had a patient today who works for a big construction company. Were shooting the ****. They cant fill their consturction positions. He mentioned that:

US welders in Canada at oil sands are making 190K with incredible benefits-2 weeks on 1 off and free flights.

US carpenters in Perth, Australia are making 300k with similar benefits.

Only docs feel bad about making $$. Sad. I dont.
 
I dont get a bonus, but I make roughly $3,000,000 a year. This is my winnings on Tiger woods golf... but still
 
nvrsumr said:
Had a patient today who works for a big construction company. Were shooting the ****. They cant fill their consturction positions. He mentioned that:

US welders in Canada at oil sands are making 190K with incredible benefits-2 weeks on 1 off and free flights.

US carpenters in Perth, Australia are making 300k with similar benefits.

Only docs feel bad about making $$. Sad. I dont.
Click to expand...

Why can't they fill their Canadian positions with Canadians, ditto for Australia? Everybody speaks English in all these countries, and welding/carpentry aren't exclusive US skills.

Agree that we gotta stop feeling bad about making $. We all worked our butts off and scraped by with minimal funds for 13 years to get here. None of us should feel bad about living in nice house and driving a nice car, and taking fun vacations.

Things are fine now financially, but I live with anxiety regarding the future.

I will be very angry if in 10 years physicians make less than carpenters and welders, who learned their skills on the job in 6 months, many of which didn't even finish high school.
 
nvrsumr said:
Had a patient today who works for a big construction company. Were shooting the ****. They cant fill their consturction positions. He mentioned that:

US welders in Canada at oil sands are making 190K with incredible benefits-2 weeks on 1 off and free flights.

US carpenters in Perth, Australia are making 300k with similar benefits.

Only docs feel bad about making $$. Sad. I dont.
Click to expand...

This sounds like an urban legend. Maybe a carpenter who's also an executive...
 
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bedrock said:
Why can't they fill their Canadian positions with Canadians, ditto for Australia? Everybody speaks English in all these countries, and welding/carpentry aren't exclusive US skills.
.
Click to expand...

I'm sure there are places where doctors can make a very high salary.....but do you want to live in some remote area like North Dakota or Montana?
 
its an unfortunate duality of taking care of people and getting paid for it. But thats life. If you take care of A LOT of people, you will get paid A LOT more. This concept is the same virtually everywhere in the world. If you do ANYTHING and get paid for it, if you do more of that thing, your will get paid more.

We do feel guilty making money, because we ALL (almost all) want to help people and feel bad, guilty for taking money for it.

We have now entered and entitlement era, where life, liberty, food, housing, car, healthcare, and cell phones are a RIGHT. Therefore we should not be paid handsomely for giving people their rights.

Im all for making less money, give me back 10 years of my life, and a couple hundred thousand dollars in loan money, and expect no nights and weekends, and expect to be treated like a car at the shop...
 
Ligament said:
I will say again if you support and vote for the socialist Obama, you are a traitor to our profession!
Click to expand...

Yes I want my profession to fail....you are delusional.
you need to stay off the Hippy Cabbage
 
I have patients who have merely a high school diploma, work at the docks and make 300-500k. My wife's ex was a ny/nj port authority cop. Was making close to $200k directing traffic at Lincoln tunnel. So dumb when they divorced had to teach him how to write a check. Been on faked disability for more than 10 years making 60% of his salary. Unbelievable medical benefits. He already collected more than I have in my pension plan and he is only 53! Wtf is wrong with this picture? And don't tell me he deserves it because he puts his life on the line. I'm at more risk as a pain mgmt doc.
 
NJPAIN said:
I have patients who have merely a high school diploma, work at the docks and make 300-500k. My wife's ex was a ny/nj port authority cop. Was making close to $200k directing traffic at Lincoln tunnel. So dumb when they divorced had to teach him how to write a check. Been on faked disability for more than 10 years making 60% of his salary. Unbelievable medical benefits. He already collected more than I have in my pension plan and he is only 53! Wtf is wrong with this picture? And don't tell me he deserves it because he puts his life on the line. I'm at more risk as a pain mgmt doc.
Click to expand...

and for every one of those patients who are dockworkers making 300-500K, there are probably 9999 that are making $26,000. there is probably a dock worker out there that made $1.

similarly, unless you are the 1%, you arent making 1.5 million doing pain this past year. i do know that that person exists however, as it was reported in the news. did you actually see your dockworker's W2?

there is also worries re. salary reimbursement for Port Authority policemen. that great salary you are quoting might be more due to "ill gotten gains" than you might expect.

Report: Port Authority police earn far more than counterparts in region
 
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