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Already matched advanced PM&R, possible opportunity in anesthesia, pain as final destination. Input appreciated!!
- Thread starter Dr. Spine
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I don’t know if other people’s experience is different, but 4 years out from fellowship I’d say if you’re looking for good work/life balance with good money, interventional pain is not it. Unless you get a unicorn of a job where patients don’t want narcotics and there are scores of privately insured patients who want procedures done by you and not the 30 other pain doctors in the area, you are going to have to hustle. If you’re already looking at not having to work hard in residency, you will flop miserably as a pain attending. I had a PM&R classmate in fellowship who couldn’t handle more than 5 clinic patients a day. Not surprisingly they are not loving life and sticking to academia.
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umm you're like barely 2 months out of med school doing a transitional year, not even a true intern-year(big difference in intensity) and you ready to bail for a chance, maybe, perhaps in Anesthesia. unless you hate PM&R you should probably focus on being a good intern learning medicine, managing conditions and reflect on the reasons you ended up 3 interviews total in medical school so you don't repeat those mistakes and end up with no fellowship or a bad job.
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Be very very careful with your discussions. If you have matched through the nrmp system, it is a violation for you to discuss or interview for another position while holding onto the position that you have. If your pmr program finds out you are courting, or discussing a position with a number program they can report you which can result in you losing your advanced position and being banned from future matches. It is a violation for him to discuss a position with you as well while you have your pmr spot.
As far as what’s the better path, up to you. Your step 1, and ite will open or close some doors depending on how they look. Also consider your home pmr program’s connections. Do they match someone every year into pain because the Pd is great friends with pain PDs? That could be your in. Do they never match pain? Try and find out why. If things look that bad, you could consider the anesthesia program you are working with, but it’s a dangerous game with no guarantees and you will have to go through a match again. Do you trust them 100% to give you a spot if you give up pmr?
As far as what’s the better path, up to you. Your step 1, and ite will open or close some doors depending on how they look. Also consider your home pmr program’s connections. Do they match someone every year into pain because the Pd is great friends with pain PDs? That could be your in. Do they never match pain? Try and find out why. If things look that bad, you could consider the anesthesia program you are working with, but it’s a dangerous game with no guarantees and you will have to go through a match again. Do you trust them 100% to give you a spot if you give up pmr?
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Assuming you want to do pain, I'd say stay in PM&R and do an anesthesia based pain fellowship. You get the best of both worlds that way.
You did not have many interviews, it seems very fortunate you landed a spot.
If you drop PM&R match you are not certain to have any residency position at all
If you think you may want to do anesthesia instead of pain, go anesthesia of course. General anesthetsia pays MUCH better, much more vacation, worse hours and higher stress. Group practice mentality. Coordinate your vacation time with 15 other partners. Deal with surgeon BS and CRNA infestation. Stuff like that.
If you want to do inpatient rehab, do PM&R. General and Inpatient PM&R is very easy, low stress, less vacation, much less money. Can be fairly independent even if working in an hospital setting. It is no longer possible to practice "general" Pm&R in an outpatient setting; pays nothing. EMGs pay nothing now. Office visits pay nothing. Only procedures pay, and you would not be doing much more than trigger point injections in general PM&R outpatietn practice. Unless you manage meds, then good luck that is a horrible life.
The two options could not be more different.
I personally think PM&R overall is a better background for an anesthesia based pain fellowship. You are not going to learn much MSK stuff in a pain fellowship or in an anesthesia residency. In practice you are going to see a TON of MSK stuff. Now, if you decide you only want to treat spine and nerve pain then no biggie, but you are throwing away a lot of business you could otherwise treat.
This is not to say PM&R docs make better pain doctors. I just think the background is overall better to set a good start for a pain practice. If you come from an anesthetsia residency you can learn the MSK stuff if you want, but it is a lot of info and difficult. If you come from a PM&R background you will learn some airway management and inpatient acute/malignant pain management and high complexity opoioid management but there is a high chance you will never use it again in your career.
You did not have many interviews, it seems very fortunate you landed a spot.
If you drop PM&R match you are not certain to have any residency position at all
If you think you may want to do anesthesia instead of pain, go anesthesia of course. General anesthetsia pays MUCH better, much more vacation, worse hours and higher stress. Group practice mentality. Coordinate your vacation time with 15 other partners. Deal with surgeon BS and CRNA infestation. Stuff like that.
If you want to do inpatient rehab, do PM&R. General and Inpatient PM&R is very easy, low stress, less vacation, much less money. Can be fairly independent even if working in an hospital setting. It is no longer possible to practice "general" Pm&R in an outpatient setting; pays nothing. EMGs pay nothing now. Office visits pay nothing. Only procedures pay, and you would not be doing much more than trigger point injections in general PM&R outpatietn practice. Unless you manage meds, then good luck that is a horrible life.
The two options could not be more different.
I personally think PM&R overall is a better background for an anesthesia based pain fellowship. You are not going to learn much MSK stuff in a pain fellowship or in an anesthesia residency. In practice you are going to see a TON of MSK stuff. Now, if you decide you only want to treat spine and nerve pain then no biggie, but you are throwing away a lot of business you could otherwise treat.
This is not to say PM&R docs make better pain doctors. I just think the background is overall better to set a good start for a pain practice. If you come from an anesthetsia residency you can learn the MSK stuff if you want, but it is a lot of info and difficult. If you come from a PM&R background you will learn some airway management and inpatient acute/malignant pain management and high complexity opoioid management but there is a high chance you will never use it again in your career.
Im Anes based and would personally go the Anes route. I think doing pain which is already getting saturated will be much more saturated by the time you graduate and that doesn't mean you won't find a job but what it does mean is you have much less bargaining power and you'll be easy to promise partner too in two years and after 1.5 years fired after you've max out collections for your partners and another " you " is brought in. Ive never done this but know people that do and its common.
If you want to maximize billing being an anesthesiologist is a great way to do it bc your comfortable with sedating people and if you need to leave the field of pain, Anes is extremely in demand and pays very very well. Also if your looking for side income while your doing pain and getting it going being behind the drape in the OR chatting with ortho docs is a great referral source. they are always doing add ons on the weekends. Make a few K on a Saturday and build a referral network.
If you want to maximize billing being an anesthesiologist is a great way to do it bc your comfortable with sedating people and if you need to leave the field of pain, Anes is extremely in demand and pays very very well. Also if your looking for side income while your doing pain and getting it going being behind the drape in the OR chatting with ortho docs is a great referral source. they are always doing add ons on the weekends. Make a few K on a Saturday and build a referral network.
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Think about what aspects of each specialty you actually enjoy doing on a day-to-day basis. Do you enjoy the OR? Do you enjoy being in the hospital? Do you like MSK, neurological diseases, etc? Or, do you prefer physiology, cardiopulmonary, etc over biomechanics, orthopedics, etc.
I was interested in anesthesia, PM&R, and neurology. I settled on physiatry because I enjoyed the broader orientation of the field. Anesthesia seemed too "applied" and too "service-oriented." I felt like I was more of a "technician" on my anesthesia rotations, but I loved the gadgets...Neurology was literally too "cerebral" for me...brain, brain, brain all day....
From an income perspective, probably more flexibility to moonlight and make extra money in gas. PM&R was very competitive this year I heard. So, relinquishing your spot to someone who is truly passionate about the field would be a nice Mitzvah.
I was interested in anesthesia, PM&R, and neurology. I settled on physiatry because I enjoyed the broader orientation of the field. Anesthesia seemed too "applied" and too "service-oriented." I felt like I was more of a "technician" on my anesthesia rotations, but I loved the gadgets...Neurology was literally too "cerebral" for me...brain, brain, brain all day....
From an income perspective, probably more flexibility to moonlight and make extra money in gas. PM&R was very competitive this year I heard. So, relinquishing your spot to someone who is truly passionate about the field would be a nice Mitzvah.
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I did PMR but think I could’ve found better more lucrative jobs had I been anesthesia trained. I did luck out though and landed a low opioid, interventional spine job that pays well. It took several years of trial and error. I don’t think it would’ve been this hard had I an anesthesia background. I could be wrong
Anesthesia is one of the most cerebral jobs out there. The reason you felt like a technician on a rotation is because like most people on an away rotation you dont even know what you dont know and all those people can be trusted with are technician jobs. We can tell you to turn the yellow or purple knob a few cm's to the left. any everything is usually still ok.
You should stick with PMR here. You're high risk of not matching and you wouldn't know until after the fact. The bird in hand is something something...
You can be very pharm/physiology focused as a physiatry resident and work towards pain/spine stuff. PM&R programs vary but some are integrated with their neurology departments, and others with surgical departments, but all in all, if you're gunning for a pain fellowship, stick with the residency you have and foster the relationships you're building in anesthesiology.
Likely, by the time you are applying for fellowship, some of those people will be pain fellows/faculty elsewhere and can vouch for you as a person, which goes a long way. Also, there will likely be more pain fellowships that are not anesthesia based by then.
Nothing is 100%, but based on a historical relationship with such pd this I am beyond just a doubt about such chances. I know its a dangerous game, however to answer your questions, there is a chance to do pain in-house as they have their own PMR pain fellowship
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think how happy you were when you were offered the PMR residency.
you are thinking the grass is greener on the anesthesia side. you will work harder in anesthesia than you will in pain. back in 2013, some data was posted that showed that anesthesia residents worked 61.5 hours per week vs. 54.2 for PMR.
you are not guaranteed anything with anesthesiology. and your endpoint is a pain fellowship, and there is imo insufficient benefit of risking it all for the possibility that the anesthesiology program will have an opening that they can backdoor you in for a anesthesiology residency.
heres a side question - did you ask whether there is a slot open for this next year for anesthesiology? if you go through and try to get into anesthesiology, wont you have to repeat your internship/first year? would you have to do that with PMR?
you are thinking the grass is greener on the anesthesia side. you will work harder in anesthesia than you will in pain. back in 2013, some data was posted that showed that anesthesia residents worked 61.5 hours per week vs. 54.2 for PMR.
you are not guaranteed anything with anesthesiology. and your endpoint is a pain fellowship, and there is imo insufficient benefit of risking it all for the possibility that the anesthesiology program will have an opening that they can backdoor you in for a anesthesiology residency.
heres a side question - did you ask whether there is a slot open for this next year for anesthesiology? if you go through and try to get into anesthesiology, wont you have to repeat your internship/first year? would you have to do that with PMR?
