advice for an MS3?

[neurotrancer]

Hello,

I am currently a 3rd year med student, 1/2 way through his psych rotation.

I've been most interested in pain since shadowing a pain doc/anesthesiologist last summer in a rural town. I received a step I 214 (avg this year was 217).

Is anesthesiology going to be the way to go for me? What is the best route to a pain fellowship?

Is it too early to think about a pain fellowship?

Thanks!

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[DOctorJay]

http://www.nrmp.org/matchoutcomes.pdf

 

[neurotrancer]

the above link doesn't do anything to answer my questions regarding the route to obtaining a fellowship in pain management. Thanks for your input though.

Again, is anesth. the best way to pain?

Is it too early to think about fellowships?

Thanks!

 

[octrode]

Without igniting a flame session,
my plug is for PMR- certainly there are many a fine anesthesia trained pain doc, but for overall usefullness of training in residency-- i think i use more of my skills from my pmr residency than most anesthesia pain guys use from their anesthesia training in my everyday pain practice. It is probably easier to get a good, acredited anesthesia based pain fellowship spot (there are just so many of them) but many a PMR doc goes to an anesthesia program.
I decided PMR in my third year- and thought long a hard about anesthesia and surgery- I couldn't be happier with my decision.
Either way, a good choice.

 

[DOctorJay]

sorry neurotrancer, was just trying to help with input regarding your step 1 score (which is obviously a competitive score for Gas and PM&R). I'll let those in fellowship answer the specifics regarding obtaining fellowship.

good luck to you!
and I'm another one to plug for PM&R but others will certainly have excellent arguments for Gas

 

[neurotrancer]

no problemo.

I have to look into PM&R again. I shadowed the department chair once during 2nd year and didn't like it enough, but now I think I know a lot more than I did back then and it probably might be more attractive to me.

I'm not sure if aiming for a fellowship is such a good idea at this point.

I need to spend more time with an OR anesthesiologist also.

Sheesh...boards are over, I should be happy, but I find myself thinking, "It would be really great to know what I'm going to be going for so that I can finally put my mind at rest." I thought that's what the boards were supposed to be for. Oh well.

 

[C Fiber]

From what I have seen, you'll have an easier time getting into a fellowship if you do gas first. I am not saying that you'll be better trained or not. But just analyze the # of anesthesia programs and # PMR pain programs.....and count how many PMR fellows in anesthesia pain programs in each program.......odds are against PMR residents wanting to do pain. Some anesthesia paiin programs even refuse to take PMR residents(I won't name them). Do yourself a favor, increase your odds. Life is not fair. You can always do more rotations in PMR, ortho, neurology, neurosurgery during med school to make up for the training. A lot of PMR inpatient rehab stuff is kinda useless anyways. Good luck.

 

[drusso]

Good people who are well trained get good offers for fellowships regardless of their "specialty of origin." Programs that pass on highly qualified fellowship applicants from specialties outside of the sponsoring department in which the fellowship is based are only losing out on talent.

 

[C Fiber]

That's true. I agree, but if you do the math, the odds still favor the anesthesia residents. (Kinda like trying to get into medical school in California ) Let's just look at a few of the big pain programs: How many non-anethesia residents did Cleveland Clinic, MGH, BID, Mayo, UCSF, UCLA, Texas Tech take last year? MD Anderson is ahead of its time - 2/4, I think, were non-anesthesia fellows. In many incidences, the chairmans of the anesthesia departments forced the program directors to take anesthesia people, because these chairmans have no idea the direction that Pain Medicine is going. They just want to "keep it in the family". They want their own residents to have the few and precious positions. I know a few cases where the program directors had to fight with the chairman to admit non-anesthesia fellows. It is particularly sad for the psychiatry residents wanting to learn interventional stuff(I know only a few who has been fortunate enough to be allowed into the club). Life is not fair. I hope the day will come when we have a residency program dedicated to pain.

 

[drusso]

That's true. I agree, but if you do the math, the odds still favor the anesthesia residents. (Kinda like trying to get into medical school in California ) Let's just look at a few of the big pain programs: How many non-anethesia residents did Cleveland Clinic, MGH, BID, Mayo, UCSF, UCLA, Texas Tech take last year?

I think that if you survey this board you'll be surprised. Clearly, the composition of individual fellowship programs change with the underlying applicant pool, but every program that you've listed above has indeed had fellows from non-anesthesia backgrounds at one time or another. Moreover, given recent changes in the ACGME requirements for pain medicine fellowships, "the tide" is not with single-specialty programs.

 

[C Fiber]

I am just saying that the proportions of non-anesthesia fellows are still way less in these big programs than anesthesia fellows. I think Texas Tech has only taken 1 shining PMR fellow in the past. Maybe Dr. Shah can comment on this(sorry to put him on the spot). Anyone else out there besides me think that it's somewhat harder to get into an anesthesia fellowship if you are not anesthesia based?

 

[Ligament]

I'm PM&R trained in an anesthsiology run pain medicine fellowship. So is Dave, Mehul, BBBmd, and a couple others here.

I have to agree it is much easier to get a pain fellowship coming from anesthesiology. The anesthesiology pain fellowships understandably prefer their own (as I think they should, overall). Also, anesthesiologists can land their first job out of residency making a LOT of money so the incentive to spend another year in fellowship is less.

I interviewed at a lot of gas run pain fellowships last year and I can tell you the competition is VERY stiff if you are a PM&R applicant, and it was clear these fellowships would be taking only one or maybe no non-anesthesiologist fellows for my class. I got lucky. I know a lot of PM&R people that did not get a fellowship.

HOWEVER, I would not give up my PM&R residency training for anything. I feel VERY well prepared for a life in pain medicine. The thing I feel weakest in is with inpatient pain medicine consults. Other than that, I feel ideally suited as a pain doc.

I'm not berating anesthesiologist pain docs by any means here.

 

[lord_jeebus]

Hi, I'm another MS3 interested in pain.

I've seen a lot of very well articulated and persuasive arguments for the PM&R route on SDN, but I was wondering if there are any anesthesiology-trained pain docs here who can share how their training has helped them in their practice. Would you have gone that route if it was no more difficult to enter the field via PM&R?

 

[drrinoo]

It is tougher getting an anesthesiology pain fellowship, if not from the field of anesthesiology...no doubt.

But more and more PDs are receptive to this idea...

From my own personal standpoint...8 years ago, I walked around the PGA meeting in NYC, suit/tie and brief case full of CVs (PAZ and I are kindred spirits in this way)...tried to arrange a few lunches/breaktime conversations...

If you are interested in an anesthesiology based pain fellowship...engage those parties that will be relevant...go to ASIPP/ASRA/WIP/ASA meetings and identify PDs and talk to them...they are all human..


Do research in your anesthesiology department and join an anesthesiology society...see if there are research funds/corporate sponsors for your poster, so that you can go to this anesthesiology meeting ( I am being cognizant of the relative poverty of most residents)....

A human face on an applicant usually pushes those elitist anesth vs. pm+R debates to the backside....and use the opportunity to discuss your command of certain subjects in anesthesiology and pain....

Finally, current PMR fellows in pain fellowships should consider a career in academics, at least for a few years....then with your publications/presence at national meetings...the visibility of PM and R can only go up...and potentially make it easier for other physiatrists to secure fellowships in the future

 

[drusso]

It is tougher getting an anesthesiology pain fellowship, if not from the field of anesthesiology...no doubt.

But more and more PDs are receptive to this idea...

From my own personal standpoint...8 years ago, I walked around the PGA meeting in NYC, suit/tie and brief case full of CVs (PAZ and I are kindred spirits in this way)...tried to arrange a few lunches/breaktime conversations...

If you are interested in an anesthesiology based pain fellowship...engage those parties that will be relevant...go to ASIPP/ASRA/WIP/ASA meetings and identify PDs and talk to them...they are all human..


Do research in your anesthesiology department and join an anesthesiology society...see if there are research funds/corporate sponsors for your poster, so that you can go to this anesthesiology meeting ( I am being cognizant of the relative poverty of most residents)....

A human face on an applicant usually pushes those elitist anesth vs. pm+R debates to the backside....and use the opportunity to discuss your command of certain subjects in anesthesiology and pain....

Finally, current PMR fellows in pain fellowships should consider a career in academics, at least for a few years....then with your publications/presence at national meetings...the visibility of PM and R can only go up...and potentially make it easier for other physiatrists to secure fellowships in the future

Sage advice. Plus, be humble and realistic about what skills you bring to the table. And, finally, focus your efforts on programs with a proven track record of training non-anesthesiologists.

 

[joseppi]

Sage advice. Plus, be humble and realistic about what skills you bring to the table. And, finally, focus your efforts on programs with a proven track record of training non-anesthesiologists.

Those who went the PMR route, can you comment on what it was that brought into the "inner circle" of gas & pain? What does one do to increase their chances?

Do fellowships still look at step1-3 scores as a criteria?

Finally the combination of DO/PMR wanting to do pain, any biases which the gas-based programs in that direction?

thanks-

 

[paz5559]

From my own personal standpoint...8 years ago, I walked around the PGA meeting in NYC, suit/tie and brief case full of CVs (PAZ and I are kindred spirits in this way)...tried to arrange a few lunches/breaktime conversations...

Why Dr R, didn't I get grief from you for that very practice on this board? Ironic ...

If you are interested in an anesthesiology based pain fellowship...engage those parties that will be relevant...go to ASIPP/ASRA/WIP/ASA meetings and identify PDs and talk to them...they are all human.

Herer Dr. Rinoo and Iare in complete agreement. When people post on here "how do I improve my chances of getting fellowship", the answer is always it depends on who the guy is running the individual fellowship, and what he/she is specifically looking for.

As for atending meetings, please do NOT waste your time going to he ASIPP meting - it is the least likely place to find a fellowship director, since it is almost all about generatin revenue and staying out of the DEA's crosshairs. It is a great meeting for the private pain practitioner, but is gonna be a low yield gathering for stumbling upon PD's.

 

[paz5559]

Going off on a tangent for a sec, I have seen a trend in PM&R-based fellowships to accept non-PM&R MDs, who can then get sub-specialty certified through the ABPM&R. To me, given the small number of PM&R fellowship positions, and the high ratio of applicants to positions even within PM&R, it seemed counter-intuitive to me.

Given that the converse logic applies to Anesthesia positions (they should consider us even if we are not "one of them"), how do members of the board feel about PMN&R fellowships acepting not only anesthesia/neuoro/psych applicants, but IM, FP, etc?

 

[drrinoo]

From my own personal standpoint...8 years ago, I walked around the PGA meeting in NYC, suit/tie and brief case full of CVs (PAZ and I are kindred spirits in this way)...tried to arrange a few lunches/breaktime conversations...

Why Dr R, didn't I get grief from you for that very practice on this board? Ironic ...


True, I did give you grief...but if it makes you feel any better...back then I was getting it from both sides and from a number of practitioners...

it was all to common to hear...go do an anesthesiology residency or physiatrists shouldn't be doing pain procedures and vice versa....pm+r folks were questioning my judgment about doing a pain fellowship...in the years 1997-2000, the number of non-anesthesiology folk in anesthesiology fellowships numbered 5-10...and of that there was a smaller subset of physiatrists..

as for ASIPP, a number of anesthesiology PDs do attend, as well as current and former faculty members of academic departments and former fellows( anesthesiology and non-anesthesiology)....furthermore the size of the meetings, lack of sprawl/lack of multiple tracks, historical choice of locations....make it very conducive to networking...

At the PGA meeting, I had to time my 'cold calls' to the start or end of a conference talk and literally wait outside the door...or lose the potential contact to a NYC broadway show...additionally, many PDs were scuttled away by their friends...or they could disappear into a parallel conference track.

In terms of time/efficiency for networking...St. Louis would trump Hawaii....do you really want to comb the beach to find a PD and interrupt them as they play with their children?

At ASIPP meetings, I have met a number of practitioners that can count both anesthesiologists and physiatrists as colleagues in their groups. This informal banter...could also benefit you the year following your fellowship when you look for jobs....colleagues are always coming up to me and asking if I have any fellows that are interested in jobs...

Personally, I believe anesthesiology background pain practitioners in private practice have historically been more open minded about incorporating physiatrists into their practices than academicians or for that matter, physiatrists incorporating anesthesiology pain guys. A number of colleagues in the late 1990s/early 2000s who did not secure pain fellowships, decided to accept job offers with anesthesiology pain groups in lieu of pursuing PASSOR fellowships

I would agree with PAZ on one point: I have not met a number of PDs from PMR fellowships (ACGME or non-ACGME) at ASIPP meetings, but I have met their fellows

There are a number of networking venues. I have only shared my personal experiences....if this info, helps...so be it....if it doesn't, so be it.

I suspect the ASRA/ASA meeting would useful to meet PDs...but you are probably going to be competing with a lot of anesthesiology residents and a competitive bunch at that and you will be in a minority as a physiatrist...if you do go to these meetings, be prepared to talk some anesthesiology/regional anesthesia...hence, the poster presentations present a viable alternative and major talking point to avoid the sensitive pm+r vs. anesthesiology debate!

Whatever you do....prepare a strategy!

 

[drusso]

Given that the converse logic applies to Anesthesia positions (they should consider us even if we are not "one of them"), how do members of the board feel about PMN&R fellowships acepting not only anesthesia/neuoro/psych applicants, but IM, FP, etc?

Well, look at it this way: If a PD has one slot left and has to choose between a stellar FP candidate with proven interest and motivation in Pain Medicine versus a mediocre PM&R candidate, who would you suggest that he or she pick?

I think that it is more about the individual candidate than "specialty of origin." Also, I think that a cadidate needs to have some baseline knowledge and skills in the field. If you've never even picked up a Touhy needle and are applying to pain fellowships how can you reasonably expect to be taken seriously? I think this is why you see so few psychiatrists in pain fellowship though they are allowed to apply. Psychiatry residents have a much harder time obtaining interventional pain training in their residencies than do physiatrists and neurologists.

The issue of certification is a different one altogether. I'm not thrilled that the ABPM&R will readily certify candidates from other specialties. I'm okay with an FP, IM, or pediatrician doing an ACGME-approved pain medicine fellowship and then sitting for the ABPM boards administered through AAPM. I am personally unaware of any physiatrists with PM&R sports-medicine training who were able to successfully sit for the subspecialty Sports Medicine board through the Family Practice board.

 

[drusso]

Those who went the PMR route, can you comment on what it was that brought into the "inner circle" of gas & pain? What does one do to increase their chances?

Do fellowships still look at step1-3 scores as a criteria?

Finally the combination of DO/PMR wanting to do pain, any biases which the gas-based programs in that direction?

thanks-

There are no secrets: Hard work, publications, seek out mentors in the field, get good letters of rec, go to conferences, get elective experiences, use vacation for additonal experiences related to the field. Make the most of your strengths and try to improve your weaknesses.

It's the total package. Everything is open to scrutiny: Board scores, letters of rec, Dean's letters, your CV, your extra-curriculars, your reputation, etc.

In every case, there will be things outside of your control. The people you meet and interview with will have biases for and against you. You can't please everyone...Just ask PAZ...

 

[paz5559]

In every case, there will be things outside of your control. The people you meet and interview with will have biases for and against you. You can't please everyone...Just ask PAZ...

Drusso's thinly veiled reference is to an event which took place after I was displaced by Katrina, and was emailing program directors across the nation to find a spot to finish my residency training. In that circumstance, with the clock ticking (we had to be back in a program a month after the storm), I pushed as hard as I could at virtually every program that responded to my initial inquiry.

The University of Virginia, Temple, and Einstein, and EVMS took the bull by the horns, and gave me an offer by the end of the second week aftr the storm. For that I will be forever grateful, and if you are looking for programs with compassion, I strongly urge you to consider each of them.

Several other schools expressed a willingness to help, but had to work out the logistics of funding me for three months of training. In Mayo's case, I pushed hard because I thought it would be an excellent opportunity to be exposed to great teachers for three months.

As the ACGMEs deadline to resume training fast approached, and no definitive response forthcoming from places like Mayo and Kessler, I called the GME offices at those two institutions to address the issue directly, rathe4r than waiting for it to percolate through appropriate channels. I got a call back from Dr. Garstang who let me know they were moving heaven and earth to make things happen, but it might not be timely, so if I had a position in hand, I should go ahead and take it.

Mayo, on the other hand, took offence at the notion that I had not done things through proper channels and at their pace. In fact, I received a not so thinly veiled email from Dr. Moutvic letting me know that they would no longer consider me, and that perhaps my aggressive, pushy approach might not be a good fit for their more Midwestern “Mayo way”

The above is a long-winded way of saying don’t just go for the biggest name, regardless of reputation and prestige, pick a program that fits your personality best. It is 3-4 years, and even if I had pushed my way into Mayo’s program, and had the privilege of working with folks of their caliber, they are probably right that my personality might not have gelled well in their milieu. It took me about a day to recoil from the perceived insults I read into Dr. Moutvic’s letter, but in the end, I recognized she had done me a service, and I appreciated her candor, even if I was disappointed at her lack of compassion.

 

[Disciple]

Personally, I believe anesthesiology background pain practitioners in private practice have historically been more open minded about incorporating physiatrists into their practices than academicians or for that matter, physiatrists incorporating anesthesiology pain guys. A number of colleagues in the late 1990s/early 2000s who did not secure pain fellowships, decided to accept job offers with anesthesiology pain groups in lieu of pursuing PASSOR fellowships

Money knows no color (in this case specialty of origin).

Can't remember what movie I heard that in.


I think in academics (not just pain academics) it's often about ego, where as in private practice it's all about the bottom line.

 

[Mister Mxyzptlk]

This whole discussion misses the bigger picture, which is "Should you stay in medicine?" For the past 15 years we have been getting sliced and diced, and there is no end in sight. The reimbursement gets worse every year and you can't exercise any independent judgment except for Medicare patients.

My colleagues are selling their houses because they can't afford them any more. Practices are closing. One malpractice suit can put you out of business if the premiums go up so high that you can't afford coverage. One of my OB colleagues is now a Mary Kay rep.

It's too late for old farts like me (and probably Algos, who trails me by a couple of years) but you can still save yourself if you're a student. Get the medical degree - you've already come this far - and then get an MBA or law degree. By the time you're my age doctors will be working for corporations, either large groups like Kaiser or more likely a hospital, and they will be like school teachers - respected but poorly paid. Actually more like livestock - you'll be graded on your "production".

 

[Disciple]

It's too late for old farts like me (and probably Algos, who trails me by a couple of years) but you can still save yourself if you're a student.

What if you're a fellow?

 

[Mister Mxyzptlk]

There's a great future in plastics. Think about it. -- Ben McGuire, "The Graduate"

Plastic surgery is the only field left where you can charge what the market will bear, and if you are really good you can charge more than those who are not. Everyone else gets the same fee whether they are a killer or a priest.

The Baby Boomers are getting old and ugly. We might go softly into that gentle sleep, but we'll be damned if we go ugly. Lots of business to be had in plastic surgery (and incontinence appliances, walkers, scooters, blood sugar testing devices, etc). The other alternative is to do what some of my pain brethren have done and get into anti-aging clinics, prescribe some HGH, get a laser and zap some veins.

I also recommend you consider buying stock in RV companies because that's what retired geezers do. The stocks have been hurt by high gas prices, but people forget that oil was below $20/barrel 10 years ago and all the Texans were selling their Colorado ski condos. Also bear in mind that terrorism has made flying and foreign travel less attractrive. Thor Industries has been very, very good to me since I bought it after 9/11/01. Winnebago less so but still pretty good.

 

[drusso]

Gorback, how about "conceirge" pain medicine? Sort of like what some of the FP/IM guys are doing: Limited practice size; retainers for patients to "join the practice" and 24/7 "access" to a pain physician!

 

[Mister Mxyzptlk]

I have thought about it, but the rich pain patients don't seem to be beating a path to my door. The boutique practices are geared towards busy affluent people who don't like to wait and who want special service.

A concierge practice requires you to make actuarial types of financial risk assessments like an insurance company. Basically you have to figure out what the average patient will cost you to treat and then how to set your fees to have a decent profit margin. A lot of doctors learned the hard way that they don't understand insurance types of risk assessment when they tried to do capitated contracts.

Pain is a more complex practice than family medicine because it is procedural as well. I don't know about you but I am not trained for that type of analysis, which is what insurance companies do for a living. When I start thinking about all the problems and permutations my eyes glaze over.

Where would you get your patients? Do you think the other docs drudging away with managed care contracts and Medicare will refer to you? Unlikely. So you'd advertise. I advertised when I first started out and I learned that the kind of people who respond to pain management ads are not the kind of people I want to treat.

I also would expect deterioration of the practice. Suppose someone answers your ad and all they want is meds. You make the same money whether they have procedures or not so what the heck? Why wear that heavy apron? Why struggle through a stim trial fishing for that sweet spot? Why expose yourself to xrays? Next thing you know you are sitting in the office writing scripts all day. It's the path of least resistance.

Suppose you're charging $200/month and writing for OxyContin 20 mg TID. The street value of the script is $1800/month. What sort of clientele do you think that style of practice attracts? And at what point have you crossed the line as a drug dealer with a prescription pad?

I've considered a 900 number where they can call me direct any time day or night for a hefty per-minute charge. I would probably toss in a free horoscope.

 

[Disciple]

I also would expect deterioration of the practice. Suppose someone answers your ad and all they want is meds. You make the same money whether they have procedures or not so what the heck? It's the path of least resistance.

What if you charge your monthly "membership" fee for the improved availability and service but charge medicare or their insurance carrier for any office visits or procedures?

Or is that in some way illegal?

 

[Mister Mxyzptlk]

A definite violation for Medicare and other government carriers like W/C. W/C will vary by state. Medicare allows charging for non-covered services but you have to get the patient to sign an advance beneficiary notice.

If you're out of network with private carriers you can do what you please. However, if you're in-network you can only charge separately for services not covered under the contract. Your contract will prohibit extra charges for covered services.

You can usually charge for non-covered things such as missed appointments (once again, Medicare requires an ABN) or filling out insurance forms.

If you are a cash-only / medication-only practice you could well end up sideways with the law or the state board. The DEA and other law enforcement agencies specifically look for practices that only accept cash and only prescribe meds.

 

[Mister Mxyzptlk]

Remember how I said doctors would end up working for hospitals? Check out the latest camel's nose in the tent. Some of the comments are extremely interesting, especially about how this will kill off solo practitioners.

As Ben Franklin said, "Sell not virtue to purchase wealth, nor Liberty to purchase power."

http://www.chron.com/disp/story.mpl/headline/biz/4226252.html

 

[salmonella]

I talked to a neurology resident the other day and he said pain management fellowships were very easy to get because no one wanted to deal with chronic pain patients, and that any neuro-trained resident should have no problem getting a fellowship....so this is not true? On average how many applicants compete for each pain fellowship spot?

 

[PainDr]

I talked to a neurology resident the other day and he said pain management fellowships were very easy to get because no one wanted to deal with chronic pain patients, and that any neuro-trained resident should have no problem getting a fellowship....so this is not true? On average how many applicants compete for each pain fellowship spot?

Fellowships are not "very easy to get"...it's an extremely competitive applicant pool. Most programs are run by anesthesiology and favor their own. However, for programs eager to have multidisciplinary fellows it is somewhat easier for neurologists simply because there aren't that many of us interested in the field. The trick is finding the programs interested in becoming multidisciplinary. You should have a sincere interest in the specialty and apply widely. I had a long standing committment to the field, research, mentors and elective interventional rotations every year beginning in med school. I applied to 25 programs but received only 8 interviews. I ended up matching at my top choice, but do believe I was incredibly lucky. It's not as easy as some would have you believe. Regarding ratios, at my program we interviewed approx. 60 applicants for 4 positions.

 

[spinal]

That neurology resident that you talked to is out of touch with reality. He has no clue. Becareful who you talk to.

 

[Disciple]

A definite violation for Medicare and other government carriers like W/C. W/C will vary by state. Medicare allows charging for non-covered services but you have to get the patient to sign an advance beneficiary notice.

If you're out of network with private carriers you can do what you please. However, if you're in-network you can only charge separately for services not covered under the contract. Your contract will prohibit extra charges for covered services.

You can usually charge for non-covered things such as missed appointments (once again, Medicare requires an ABN) or filling out insurance forms.

If you are a cash-only / medication-only practice you could well end up sideways with the law or the state board. The DEA and other law enforcement agencies specifically look for practices that only accept cash and only prescribe meds.

www.wnj.com/Concierge_JRM.html

Hmmm....

Looks difficult, but doable.

 

[lobelsteve]

Conceirge pain medicine = drug dealer. No way about it.

 

[Ligament]

Conceirge pain medicine = drug dealer. No way about it.

why? this does not make a lot of sense. Just because you take cash does not mean you have to sell out your ethics...

 

[lobelsteve]

why? this does not make a lot of sense. Just because you take cash does not mean you have to sell out your ethics...

You can say that, but the prosecutor and the DEA think differently than you do. My recommendation is that if anyone is considering this type of pain practice, consult your local DEA for guidance prior to seeing your first VIP patient.

 

[Mister Mxyzptlk]

You can argue this all you want but we are not the people you will have to answer to. I know a lot of drug cops, both state and federal, as well as a few prosecutors. I have been to their educational meetings, most recently at DEA headquarters here in Houston. Cash-only narcotic practices are one of the profiles they are specifically taught to look for.

You can beat the rap but you can't beat the ride. If you are arrested on suspicion of drug dealing your license will probably be suspended so you can't practice. The DEA will most likely pull your narcotics ticket. There goes your income.

So now you're trying to survive without income and you are also paying a lawyer. Expect to pay in the low to mid six figure range for your defense. That's not the end of it. They may very well try to freeze your assets or even confiscate them as assets obtained by drug-dealing.

Your name is splattered all over the paper and TV. The DA may even display your mug shot like a prize trophy. Won't your spouse and children be thrilled?

If you win - and most prosecuted docs do not - you will emerge bankrupt with a terminally stained reputation. The DEA doesn't have to give you your narcotics license back so you'll have another legal battle for that before an administrative law judge - if you still have money for a lawyer.

See www.weitzelcharts.com for an example of how the nightmare can unfold. I don't think Franz Kafka could have thought up this story. I know Dr. Weitzel personally. Even though he won on appeal (after serving 6 months for murder before he got out) he has not been able to get his license back and he has been unable to practice for the past 7 years.

The DEA will NOT provide guidance for your practice. You will just be quoted the standard line about prescribing for a "legitimate medical purpose". They can't give you advice.

If you still want to do this I suggest you talk to Jennifer Bolen (legalsideofpain.com). Another resource would be Dr. Joel Hochman, a psychiatrist who has survived legal scrutiny of his medication-only practice (but he did get hounded out of NM). (www.paincare.org)

If you get a chance to hear either Art Jordan or Roger Cicala talk at an ASIPP meeting, do so.