What's it really like to be a Pain Doc?

[hrmm]

Observing the specialty of Pain Medicine can be quite different when looking through the eyes of a resident vs. fellow vs. newly practicing.

For those already practicing Pain Medicine:

1. What type of practice are you at and what type of patients do you see?
2. What is your daily/weekly schedule like?
3. What parts of it do you enjoy/hate?
4. Anything you know now that you wish you knew before you ventured into the field?

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[emd123]

Observing the specialty of Pain Medicine can be quite different when looking through the eyes of a resident vs. fellow vs. newly practicing.

For those already practicing Pain Medicine:

1. What type of practice are you at and what type of patients do you see?
2. What is your daily/weekly schedule like?
3. What parts of it do you enjoy/hate?
4. Anything you know now that you wish you knew before you ventured into the field?

1-Multi-specialty private group. Shareholder and on board of directors of group.

2-Right now: 7:30-12:00 and 1:00-5:00, Mon-Fri. Pretty soon will go to 7:30-12:00 on Friday. In the past 2 years I haven't gone to the hospital once. I get about 1 after hours patient phone call per month, and have not had one after 8pm since I left fellowship. I never have to work a night shift, weekend or holiday shift for the rest of my life (which tortured me in my previous specialty).

3-I don't "hate" any of it. There's things I dislike. I like the procedures a lot. I like it when I've helped someone, who's thankful. It can be frustrating when you're unable, but not overwhelmingly so. It can be uncomfortable when someone with an addiction gets angry for me not prescribing them meds I think would be harmful, but it doesn't keep me down much or for long. It's much easier than telling a surprised family member their loved one has died, or watching someone die in front of you unable to help, which I used to have to do. The schedule is as good as Derm and that's a priceless thing and very hard to find in Medicine.

4- I wish I had known more about private practice and the business aspects. Also, I wish I had known how much change/controversy/worry there would be about 1-reimbursements and 2-the whole opiate abuse debacle.

I like Pain. It's not perfect but being able to have a normal life unlike most doctors makes it worth considering by itself. And if you have an intense screening protocol for patients and keep opiates as minimal as possible, it can be rewarding. I have lots of little old ladies on little or no opiates that are great, and very appreciative. I have enough to out balance the inevitable unappreciative, toxic patient.

 

[turnupthegas]

What does it take to match into Pain?

In-service scores and LOR's?

 

[Baller MD]

Also just to piggy back on turnupthegas' question, I know that there are normally two traditional routes to go into pain: anesthesiology and pmr. I also know that it's easier to match into pain if you do anesthesia first but how much more difficult is it to match into pain if you do a pmr residency? Is it an uphill battle?

 

[emd123]

Also just to piggy back on turnupthegas' question, I know that there are normally two traditional routes to go into pain: anesthesiology and pmr. I also know that it's easier to match into pain if you do anesthesia first but how much more difficult is it to match into pain if you do a pmr residency? Is it an uphill battle?

You're obviously a baller, so it shouldn't matter either way, should it?

 

[lobelsteve]

42% harder.

TWSS!!!!

 

[Baller MD]

^ Thanks for the laugh but I'm seriously curious with regards to my original question.

 

[bedrock]

Twice as hard but doable. Publish as a resident, work hard, get good letters and you'll land a pain fellowship.

Basically an average or good anesthesia resident can get a pain fellowship.
A good, (not just average) PM&R resident can get a pain fellowship.

 

[hrmm]

1-Multi-specialty private group. Shareholder and on board of directors of group.

2-Right now: 7:30-12:00 and 1:00-5:00, Mon-Fri. Pretty soon will go to 7:30-12:00 on Friday. In the past 2 years I haven't gone to the hospital once. I get about 1 after hours patient phone call per month, and have not had one after 8pm since I left fellowship. I never have to work a night shift, weekend or holiday shift for the rest of my life (which tortured me in my previous specialty).

3-I don't "hate" any of it. There's things I dislike. I like the procedures a lot. I like it when I've helped someone, who's thankful. It can be frustrating when you're unable, but not overwhelmingly so. It can be uncomfortable when someone with an addiction gets angry for me not prescribing them meds I think would be harmful, but it doesn't keep me down much or for long. It's much easier than telling a surprised family member their loved one has died, or watching someone die in front of you unable to help, which I used to have to do. The schedule is as good as Derm and that's a priceless thing and very hard to find in Medicine.

4- I wish I had known more about private practice and the business aspects. Also, I wish I had known how much change/controversy/worry there would be about 1-reimbursements and 2-the whole opiate abuse debacle.

I like Pain. It's not perfect but being able to have a normal life unlike most doctors makes it worth considering by itself. And if you have an intense screening protocol for patients and keep opiates as minimal as possible, it can be rewarding. I have lots of little old ladies on little or no opiates that are great, and very appreciative. I have enough to out balance the inevitable unappreciative, toxic patient.

Thanks for the reply. It was pretty interesting seeing the view of an actual practicing attending and their day-to-day. Does anyone else have any insight?

 

[clubdeac]

Observing the specialty of Pain Medicine can be quite different when looking through the eyes of a resident vs. fellow vs. newly practicing.

For those already practicing Pain Medicine:

1. What type of practice are you at and what type of patients do you see?
2. What is your daily/weekly schedule like?
3. What parts of it do you enjoy/hate?
4. Anything you know now that you wish you knew before you ventured into the field?

1. Private practice: 1/2 older medicare legit patients, 1/4 pain patients with drug seeking tendencies 1/4 pain patients that are plain cra cra
2. 8:30-5:30-6pm
3. I love it when patients return after an ESI, stim, kypho, RFA, LFCN block etc. and tell me they feel great. Also love it when I find something that no one else has found especially when I can then treat it and fix it. i.e. had a lady s/p fusion with horrific anterolateral thigh pain x 1 year. The PA at her last pain practice told her it was arachnoiditis and she couldn't do anything about it. I did an US guided LFCN block and it's resolved. She's now my patient for all of her pain needs
4. Hmmm... that some private practices will **** you so make sure your contract is air tight so you aren't on the receiving end

 

[ctts]

Twice as hard but doable. Publish as a resident, work hard, get good letters and you'll land a pain fellowship.

Basically an average or good anesthesia resident can get a pain fellowship.
A good, (not just average) PM&R resident can get a pain fellowship.

That sounds about right. There are more anesthesia pain fellowships out there, but there are some that are run by PM&R programs. So if you choose the PM&R route, know that the PM&R programs probably will give preference to PM&R residents. Of course, that doesn't make them easy to get into, because there are as many of them...

If you are doing residency at a program that also has a pain fellowship, then you may have a leg up on outside applicants, but your co-residents will surely be interested also, so either way, you need to find a way to be a little better than the rest.

I take it if you are asking the question, you are not doing residency yet... I am biased, being PM&R, but you will generally have better musculoskeletal training in PM&R and that is a very useful tool.

1. What type of practice are you at and what type of patients do you see?
Private. Office based, no hospital work. Minimal opioids. Most drug seekers are screened out by my office staff when scheduling appointments, before they even walk in the door.

2. What is your daily/weekly schedule like?
Mon-Fri 8-5ish, but I tend to stay late to finish documentation... Off every other Friday for now. No partners at the moment, so on call 24/7, but even that is not a big deal, as I rarely get calls. Other partners left, so I basically own the practice now. However, even before they left, I have 6 weeks vacation (I don't use all of it), and have great flexibility in my schedule, to take a day or half-day off here there as needed when I need to be somewhere for my kids for example. This is great.

3. What parts of it do you enjoy/hate?

4. Anything you know now that you wish you knew before you ventured into the field?
The advice from others sounds good. So long as you get decent experience during your training, you should be able to make an educated guess as to whether the field is right for you. All the reimbursement and political stuff...its everywhere, and for the most part you can't do much about it, so I don't let it get to me too much.

 

[Jcm800]

What does it take to match into Pain?

In-service scores and LOR's?

Why would LOSS OF RESISTANCE get you into pain?