Hello. I was wondering if anyone can give me some advice on switching back to anesthesia from pain medicine. I graduated from fellowship last year and have been practicing 100% pain for almost 2 years. I was thinking of switching back but really nervous about making the switch and I feel stuck. I am board certified but feel that my anesthesia skills have severely diminished. I was thinking of asking new jobs to see if any anesthesiologists were willing to shadow me until I get back into things; however, I feel that it would raise red flags. Any advice can help. Thank you in advance.
Advice switching back to anesthesiology from pain medicine
- Thread starter JD786
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Made the switch years ago, also after a couple years of 100 percent pain. Best decision I ever made. Never looked back. Like riding a bike- put in ‘easy’ rooms for a couple weeks, then full force shortly thereafter. Find a job that will make a small accommodation for you in order to help with your transition, like being proctored for a bit, or shadowing, etc. Shouldn’t be too hard to find as the market is wide open.
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Why was it the best decision of yojr life?
The practice and situation I was in was awful. I love Pain, but couldn’t find a good setup (I’m sure they exist) and decided that since I also liked anesthesia, I was willing to make the sacrifice. Probably not unlike others who left the field.
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Weird. The pain guys I know are banking out. I guess it depends on surgicenter ownership and practice setting
Making bank is unfortunately a thing of the past. I mean, you can do well, but it requires high volumes (think of ophthalmologists who continue to have to do more cataracts in order to maintain income due to continual declination of reimbursement…). The oil change guy gets paid more than some of those pain procedures. And you’re right- surgical center ownership and good payor mix is key.
You don’t need proctoring nor shadowing. You need a laid back small hospital with no trauma no OB and simple cases and as you feel more comfortable can take on whatever. There are plenty of jobs and it’s a good time to be all rounder. Please don’t stop pain practice, somehow manage to keep those skills. I wish I were in your shoes with pain experience.
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What? I think pain people are very good at Ob.
I switched back after 1 fellowship year and 1 PP year. Agree that you do not need any supervision or shadowing, dont even ask or bring that up. If they require it they will set it up. If you have any big or tough cases at first just ask a senior attending. It is indeed like riding a bike. I have been much happier doing anesthesia for the last 8 years. You are not stuck. In this job market more than ever there are groups willing to take you on without any concern. Leave the crazies and the pills behind and come back to real medicine!
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I know several who made the jump back from pain. They are all happy. Pain is great, but it is not for everyone and it certainly is not getting any easier to manage all of the hoops you have to jump through.
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I would echo the other posters about the current job market. If you're going to switch, now's the time, as jobs are more plentiful than in the past. Plentiful jobs mean future partners would be more accommodating toward your need for a little bit of extra reorientation (which, BTW, I think is totally reasonable and shows some self-awareness).
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Not to derail this thread but I'm doing a CCM fellowship in a few weeks. Was it super easy to transition back to anesthesia after a full year?
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Agreed you need a fostering environment with low acuity cases. We have had people come from purely pain backgrounds that we have kindly asked to leave before because they just couldn’t cut it.
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Critical care is very similar to anesthesiology, unlike pain medicine. I would think there would be no issue.
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I made the switch back after 20 years practicing pain full time and have zero regrets about the transition. Anesthesia is a different mindset- do the job, then go home and live. There are no calls in the middle of the night begging for narcotics when they claim their dog ate them or they fell from their pocket while on a roller coaster, etc. There are no diagnostic dilemmas at 2 in the morning, determining if they have an epidural abscess, discitis, meningitis, or epidural hematoma and no intrathecal pumps that have migrated. It is much less challenging than pain medicine, but at some point during a career, that can be beneficial. I suggest working in a lower acuity center for a couple of months, then jump back into the hospital setting if that floats your boat. You definitely do not need proctoring and shadowing is useful for about 2 cases. You have the knowledge base, it is just the mechanics that are rusty.
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What made u switch back. I don’t miss the nights and weekends of an anesthesia practice and went to full time pain after 20 plus years of a mixed practice
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Weekends are easy but the nights can be hard on you after age 50-55. IMHO, doing weekends was harder when my kids were school age but now that they are out of the house I don't mind the weekends much if I get compensatory time off during the week. But, the nights are hard as I get older no doubt about it but still doing some because it's part of the job.
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2 years? That's not a big deal if you were a decent resident. If you sucked at anesthesia as a CA-3 then you will be even worse now. Any senior attending worth his/her salt would be happy to mentor you for a week to get back in the game. We are all short staffed right now so I agree that Now is the time to make the switch back and stop worrying about "feeling stuck" as the job market is wide open.
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I do no weekends and no nights, except for a rare weekend call (my choice) at a local hospital. Some hospital groups and almost no surgery centers work nights and weekends.
I did this and switched back to anesthesia.
Still not sure what the true compensation for pain is. It varies a lot.
Also, for pain Mgt the real money is in having your own practice, having ancillary services and surgery center ownership. Working for a hospital or a group means you’ll be capped and they will enjoy fruits of your labor. Think psychiatry practice. The pain patients are typically complicated and if you want to provide a good service, you have to manage them well and safely. It may mean less patients - which means less money.
The math I did, and for the lifestyle I was looking for, pain practice didn’t make sense to me.
I also don’t want to manage an office, staff or have people on my payroll. I didn’t want to worry about vacation coverage or notes at home.
Also for a little while CRNAs were dominating market and still do, but more and more hospitals are realizing the need and value of anesthesiologists. This is reflected in competitive job market for us.
At our hospital, we are noticing that the cost difference between a crna and anesthesiologist is not that much, and in fact docs bring in more value because they don’t start crying after their 8 hour shift is done and require a lot less management and ‘professionalism reminders’. We find that doctors tend to be far more loyal.
Anyways, You can still do pain management by doing inpatient consults at your hospital once in a while, or do locums covering vacations for pain docs.
Or you can do 4 days Anesthesia and one day pain etc. get your own malpractice and work as 1099. Bigger groups will try to employ you for anesthesia but keep declining. If you want to have control of schedule, don’t be an employee of any big group. Don’t sign anything that has a non-compete. In the writing have an arbitration clause.
Locums is also an option but best is to be independently credentialed at multiple hospitals through groups. Locums to me is less reliable and many groups don’t like using locums companies.
Infact after I purchased my own malpractice insurance last fall, so many doors opened up for me that my schedule is full. I work when I want depending on my availability.
I work full time for an anesthesia practice, and provide locums/prn coverage for both anesthesia and pain to different facilities under my LLC during my time off.
It really depends on what you want. I find that if you have a clean record and boarded and have case logs, there’s a lot of opportunity.
Still not sure what the true compensation for pain is. It varies a lot.
Also, for pain Mgt the real money is in having your own practice, having ancillary services and surgery center ownership. Working for a hospital or a group means you’ll be capped and they will enjoy fruits of your labor. Think psychiatry practice. The pain patients are typically complicated and if you want to provide a good service, you have to manage them well and safely. It may mean less patients - which means less money.
The math I did, and for the lifestyle I was looking for, pain practice didn’t make sense to me.
I also don’t want to manage an office, staff or have people on my payroll. I didn’t want to worry about vacation coverage or notes at home.
Also for a little while CRNAs were dominating market and still do, but more and more hospitals are realizing the need and value of anesthesiologists. This is reflected in competitive job market for us.
At our hospital, we are noticing that the cost difference between a crna and anesthesiologist is not that much, and in fact docs bring in more value because they don’t start crying after their 8 hour shift is done and require a lot less management and ‘professionalism reminders’. We find that doctors tend to be far more loyal.
Anyways, You can still do pain management by doing inpatient consults at your hospital once in a while, or do locums covering vacations for pain docs.
Or you can do 4 days Anesthesia and one day pain etc. get your own malpractice and work as 1099. Bigger groups will try to employ you for anesthesia but keep declining. If you want to have control of schedule, don’t be an employee of any big group. Don’t sign anything that has a non-compete. In the writing have an arbitration clause.
Locums is also an option but best is to be independently credentialed at multiple hospitals through groups. Locums to me is less reliable and many groups don’t like using locums companies.
Infact after I purchased my own malpractice insurance last fall, so many doors opened up for me that my schedule is full. I work when I want depending on my availability.
I work full time for an anesthesia practice, and provide locums/prn coverage for both anesthesia and pain to different facilities under my LLC during my time off.
It really depends on what you want. I find that if you have a clean record and boarded and have case logs, there’s a lot of opportunity.
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