Are you happy in pain?

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med2928

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Copying the tread from the anesthesiology forum.

Are you happy working as an interventional pain specialist? (0-10)?
What was your reason for going into IPM in the first place?
Do you like your hours? Do you feel like you have enough time with your family/other interests?
Do you work in an academic center or private practice? Have you ever switched from one to the other, if so why?
Do you feel fairly compensated?
Would you choose pain again?
If you HAD to choose a different specialty, what would it be?
Anything else you'd like to share?

Thanks for your input!

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Copying the tread from the anesthesiology forum.

Are you happy working as an interventional pain specialist? (0-10)?
What was your reason for going into IPM in the first place?
Do you like your hours? Do you feel like you have enough time with your family/other interests?
Do you work in an academic center or private practice? Have you ever switched from one to the other, if so why?
Do you feel fairly compensated?
Would you choose pain again?
If you HAD to choose a different specialty, what would it be?
Anything else you'd like to share?

Thanks for your input!

These are the most important questions we need answers to, yet few people will give full and honest responses. I love that you posted this, but I imagine it will disintegrate into a "the sky is falling" thread within about 10 posts. I hope the attendings prove me wrong!
 
Copying the tread from the anesthesiology forum.

Are you happy working as an interventional pain specialist? (0-10)? 7-8 grass is always greener...
What was your reason for going into IPM in the first place? Liked internal Med and rads.
Do you like your hours? Do you feel like you have enough time with your family/other interests? Now I do. Building a practice was the most stressful thing in my life. Family time is much better year 5 into practice.
Do you work in an academic center or private practice? Have you ever switched from one to the other, if so why? Fellowship to pp. published in residency and fellowship but hated the passive aggressive types in academics...still do.
Do you feel fairly compensated? No. Medicare cut our fees 40% after 2009. Commercials follow. Need a capitalistic Hc system not socialized Hc. I had 500k in debt when I came out...plus pp loans 200+ k.
Would you choose pain again?yes. But you need to be confident and honest with patients. They will respect you when you tell them the limitations of health care...
If you HAD to choose a different specialty, what would it be?rads.
Anything else you'd like to share? If you like 9-5 stay in academics or work for an ortho or pcp group. If you are good with relating to the blue collar patients and have good skills, go out to pp. I believe the senior moderators like algos, gorback, etc reinforced this... Good luck.

Thanks for your input!

Are you happy working as an interventional pain specialist? (0-10)? 7-8 grass is always greener...
What was your reason for going into IPM in the first place? Liked internal Med and rads.
Do you like your hours? Do you feel like you have enough time with your family/other interests? Now I do. Building a practice was the most stressful thing in my life. Family time is much better year 5 into practice.
Do you work in an academic center or private practice? Have you ever switched from one to the other, if so why? Fellowship to pp. published in residency and fellowship but hated the passive aggressive types in academics...still do.
Do you feel fairly compensated? No. Medicare cut our fees 40% after 2009. Commercials follow. Need a capitalistic Hc system not socialized Hc. I had 500k in debt when I came out...plus pp loans 200+ k.
Would you choose pain again?yes. But you need to be confident and honest with patients. They will respect you when you tell them the limitations of health care...
If you HAD to choose a different specialty, what would it be?rads.
Anything else you'd like to share? If you like 9-5 stay in academics or work for an ortho or pcp group. If you are good with relating to the blue collar patients and have good skills, go out to pp. I believe the senior moderators like algos, gorback, etc reinforced this... Good luck.
 
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To be honest I've heard a lot of pain docs are just kinda MEH about their job. Not very fulfilled but like the lifestyle in terms of pay and hours. Alot are bleak about cuts. Im not sure if thats just people I've spoken with or a general consensus. I don't really care though I still want to do it just from a procedural stand point and interest.
 
Maybe I'd go into cosmetic plastics... Something that will always be paid for at market value. Other than that, all fields of medicine are under oppressive government control. The choice between specialties is like the choice between being the guy who puts the windshield on the car or the other guy who puts the doors on the car as it goes down the assembly line. I don't think any of us are fairly compensated if you consider the significance of the role we play in patients' lives.
 
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I think there have been multiple like threads on this and I would imagine it will continue as this is "studentdoctor" network. Would I have chosen pain again? Probably not. I value the "lifestyle" although that's a loaded bracket. Not having to take ((call or work weekends is definitely nice...although how much do you love spending time with your wife and kids..haha ok I'll stop now. I'm sure the holier than thou who found their soulmates and whose kids are nobel lauriets already are getting ready to bash my **** in. I mostly agree with stim4me on most things actually. Would I have gone into pain if I could do it again..No. The patients are a pain in the ass. The insurance cuts suck. If you are stuck in the northeast, well, its just plain not financially worth it. I would have definitely done radiology if I were to do it all over again. However, there is something to be said about the small population of patients who you can help who will be eternally greatful and may name their kids/grandkids after you. Whoever said picking a specialty is like getting an arranged marriage (might have been this site) is right..you dont know what its gonna be like until youve been in it for a few years. To the original poster..pull up your big boy pants and pick something. No one on this site is gonna give you devine advice. There are too many variables and we dont know who you are as a person/doctor. If you choose incorrectly, deal with it or have the stones to start all over again. Over and out..
 
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I like to read these threads not to convince myself to pursue a career in pain but more out of curiosity and expectation management. Physicians who are 5, 10, 15 years out have an incredible wealth of knowledge and experience and passing some of that wisdom down to the next generation can be invaluable. I thank those that contribute honest answers in advance. Good thread.
 
I liken the treatment of pain to punching a ghost. That's how it feels with the majority of patients.

For the few that you can help, makes it worth while. I stress few.

Most of my patient population want an MRI and narcotics. I spend most of my day talking patients out of what they want, and into what they need. If you are okay with being a salesman or missionary, preachin' the gospel of lifestyle modification, core stabilization and all the other nebulous stuff we peddle after the patient fails a multitude of various injections, it's a great field.
 
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Are you happy working as an interventional pain specialist? (0-10)?
9/10 - I'm still starting out, but I'm starting to miss some of my base training diagnostic radiology work.

What was your reason for going into IPM in the first place?
Improve patient's quality of life. I also like hugs and tears of joy. My rationale for choosing radiology as a base field was that much of chronic pain is a diagnostic dilemma... figure out the problem (without relying on someone else to read your diagnostic studies - then target the treatment). Working out so far... I'd say I help more than a few patients, and I don't see that much in the way of narcotics or seekers (although in the first 2-3 months I saw a bunch because they heard a new guy was in town).

Do you like your hours? Do you feel like you have enough time with your family/other interests?
I'm M-F 8-5pm, no call, weekends or nights. Yes, hours are great. Not as good as most radiology, but still pretty good.

Do you work in an academic center or private practice? Have you ever switched from one to the other, if so why?
Private practice, never switched. I'm pseudo academic in that I teach in various settings around the country.

Do you feel fairly compensated?
"Fairly" is a word up for interpretation. I certainly think we take on a fair amount of risk with the procedures we do and the medications we prescribe and with that risk should come some increased compensation rather than our decreasing trend. I also feel we should be bonused by the government for getting patients off opioids or getting patients back to work. It would certainly make for a different health care system.

Would you choose pain again?
Absolutely. I still feel like I make a HUGE difference in patients' lives.

If you HAD to choose a different specialty, what would it be?
Nothing really. I loved my training and I'll probably return to doing some diagnostic rads work in the future, in addition to my pain practice.

Anything else you'd like to share?
Do what you love. This is not a field to go into because of the money. No money in the world is worth dealing with some of the patients we see day to day, but if you love pain and feel it would be the best way for you to make a difference, go for it. You'll love it.
 
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Copying the tread from the anesthesiology forum.

Are you happy working as an interventional pain specialist? (0-10)?
What was your reason for going into IPM in the first place?
Do you like your hours? Do you feel like you have enough time with your family/other interests?
Do you work in an academic center or private practice? Have you ever switched from one to the other, if so why?
Do you feel fairly compensated?
Would you choose pain again?
If you HAD to choose a different specialty, what would it be?
Anything else you'd like to share?

Thanks for your input!

Yes, happy. Much of that has to do with my employment situation. I am a partner in a no-narc, almost entirely interventional practice with two other fair-minded guys. Three of us share two jobs, so lots of vacation time. Much of my happiness is attributable to our generally pleasant and appreciative patient base. We see good outcomes all the time. Very different from what some other guys here on the board talk about. Our office has two other docs to interact with, as well as 5 PTs, and a wonderful pain psychologist. This creates a nice collegial atmosphere. We see a wide variety of problems leading to some interesting diagnostic challenges.
Went into IPM with a goal of using more of what I felt I brought to the table as a physician than I thought I was using as an anesthesia resident. I liked the idea of learning and using musculoskeletal medicine, psychology/psychiatry, neurology, surgical knowledge, etc.
Work hours are great, but that's largely a function of the practice I chose. No nights or weekends was important to me in any specialty.
I feel fairly compensated, but the threat of declining reimbursements leads to insecurity for the future.
Hard to answer the question of whether or not I'd choose pain again. At the time it was the right choice. I can say that given the reimbursement climate, I wouldn't recommend it to medical students or residents. The grass always looks greener somewhere else. If I had to choose an alternate specialty I might consider ortho, plastics, but I doubt I could deal with long operations, night, and weekend work.
 
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Are you happy working as an interventional pain specialist? (0-10)?
7/10. I'm an odd case though. In order to get my Green Card (on an H1b Visa), I need to work in an under-serviced area. Therefore, I see around 95% Medicaid. Think about that for a second. Once I move to an area with a better payer mix I'm confident my satisfaction will improve.

What was your reason for going into IPM in the first place?
I trained in Anesthesiology but was missing the patient interaction and could not stand the call/weekends/nights. Not to mention I was fascinated with Pain Psychology as an undergrad. I still find a considerable draw in being able to alleviate someones pain with a challenging procedure that the patient "assumed they'd have to live with their entire lives". Having someone with "zero faith in injections" walk out of their wheelchair can be pretty phenomenal.

Do you like your hours? Do you feel like you have enough time with your family/other interests?
This is a huge factor for me and probably one of the main reasons I haven't returned to Anesth. I work Mon-Fri, 8-4. No weekends, no nights, no call. I find I have more than enough time to enjoy my life outside of work. I take every weekend as a mini vacation.

Do you work in an academic center or private practice? Have you ever switched from one to the other, if so why?
Private practice. Simply based on the opportunity I was able to find given my Visa situation.

Do you feel fairly compensated?
I feel as though I should say "no" given how well Pain docs were compensated not long ago. However, given the hours that I work, the wonderful staff I have and the joy of performing procedures I'd say I'm fairly content. Could I do better? Absolutely. Could I do worse? Yep.

Would you choose pain again?
Given the alternatives, I'd say yes. I have no doubt that once I'm able to convert my 95% Medicaid load to <5%, my patient base will become more palatable.

If you HAD to choose a different specialty, what would it be?
Emergency Med or Rads. I have an ED colleague who works 15 days out of every 30 and makes more than I do; gets to travel all the time. Get in, get out, no follow up. The night-shift would suck though.

Anything else you'd like to share?
It's all about balance and adaptation. Every specialty has its headaches. My biggest initial stressor was realizing that most Medicaid patients simply do not care about getting better. They don't want to lose weight, exercise, stop smoking, work for a living, cut out fast food, etc. All they want is opioids, benzos, a welfare check and a recliner to which to permanently attach themselves. Once I accepted this, I set clear boundaries for all of my patients which I follow to a T. All I can do is try my best and do "what's right for the patient". If they're not having any of it, than "I'm sorry but that is all I have to offer". The patients I actually DO get through to are simply icing on the cake. Hope this was helpful.
 
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Anything else you'd like to share?
It's all about balance and adaptation. Every specialty has its headaches. My biggest initial stressor was realizing that most Medicaid patients simply do not care about getting better. They don't want to lose weight, exercise, stop smoking, work for a living, cut out fast food, etc. All they want is opioids, benzos, a welfare check and a recliner to which to permanently attach themselves. Once I accepted this, I set clear boundaries for all of my patients which I follow to a T. All I can do is try my best and do "what's right for the patient". If they're not having any of it, than "I'm sorry but that is all I have to offer". The patients I actually DO get through to are simply icing on the cake. Hope this was helpful.
 
Are you happy working as an interventional pain specialist? (0-10)?

10/10. Only negatives are the government meddling in my business, reducing pay, increasing overhead.

What was your reason for going into IPM in the first place?

My dad died of Non-hodgkins with primary tumor in his lumbar spine. Had a painful death. Could have been much much more comfortable with a v-plasty and maybe intrathecals, but he was offered none of it despite being at a good private hospital. I found out about IPM after his death. My very first patient as a pain attending had a lumbar body tumor causing his pain. I like working with my hands. I don't like surgeons hours. I hate lab work.

Do you like your hours? Do you feel like you have enough time with your family/other interests?

Hours in IPM are very good. Hours in IPM combined with being the business/clinic owner are very long. I'm always working on either patient care in the AM, or website, business stuff in PM. Currently working on Local SEO optimization and heat mapping my website, as well as getting all my office locations accurately listed with the major data aggregators. Have no idea what this means? That's what you need to do in private practice.

Do you work in an academic center or private practice? Have you ever switched from one to the other, if so why?

Private practice. Have not switched.

Do you feel fairly compensated?

No. I am under compensated and get compensated less ever year I am in business, though I work harder every year.

Would you choose pain again?

Yes. It is a wonderful job. I get to really make an impact in patient's lives.

If you HAD to choose a different specialty, what would it be?

I'm not saying I would be competitive, but maybe opthy, derm.

Anything else you'd like to share?

Its a great field. All of medicine is getting worse every year for physicians.
 
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Anything else you'd like to share?
It's all about balance and adaptation. Every specialty has its headaches. My biggest initial stressor was realizing that most Medicaid patients simply do not care about getting better. They don't want to lose weight, exercise, stop smoking, work for a living, cut out fast food, etc. All they want is opioids, benzos, a welfare check and a recliner to which to permanently attach themselves. Once I accepted this, I set clear boundaries for all of my patients which I follow to a T. All I can do is try my best and do "what's right for the patient". If they're not having any of it, than "I'm sorry but that is all I have to offer". The patients I actually DO get through to are simply icing on the cake. Hope this was helpful.

I'm kind of curious what the boundaries are... you can PM me if you want. I have some of the same feelings with my medicaid population, though some are truly worth giving the charity care I provide for them. I see a lot more medicaid than I thought I would.
 
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Are you happy working as an interventional pain specialist? (0-10)?
9

What was your reason for going into IPM in the first place?
You actually get to be the Doctor, patient relationships are nice (even in pain), schedule, reimbursment, I like doing procedures, I like running a business

Do you like your hours? Do you feel like you have enough time with your family/other interests?
7am to 4pm m-th, no call, no nights, every weekend is along weekend, I would still love to be more involved in hobbies, but that's on me - and partially on the wife for ball-busting

Do you work in an academic center or private practice? Have you ever switched from one to the other, if so why?
PP, I love being my own boss, controlling my own destiny, nobody tells me what to do. I am in my 30's and can retire (modestly) if I wanted to, loans paid off, life isn't that bad. Academics is a pissing match, I went to top programs, published, top board scores, but don't need someone to pat me on the back and tell me I am the "God" of some esoteric subject nobody really give a sh** about anyways. Props to those who love academics, maybe that will be my retirement, holing up in some academic program, taking lots of vacation while the residents and fellows do the heavy lifting.

Do you feel fairly compensated?
See above. Once you pay your loans off, save for your kids college, and have a nice retirement stash - a big load is off your back. Being in PP I can control my own destiny. Any specialty that allows you to hit those benchmarks in your 30's is great in my books.

Would you choose pain again?
Yes, see above

If you HAD to choose a different specialty, what would it be?
Maybe a whack job Hedge Fund manager a la Dr. Burry??? Chances of success are not that great, though. Once you HAVE a lot of money, you find that the joy of helping others is actually much greater than the joy of spending a load of cash on designer clothes, exotic cars etc.

Anything else you'd like to share?
If pain is played right, it can be reminiscent of medicine back in the 80's. Staff and patients respect you (if you treat them right - and pick the right population to set your practice up in). Hours are great, no call, no weekends, ancillaries still pay well, you can incorporate anesthesia, therapy, and other specialties into your practice etc. etc. Sorry for farting sunshine, but pain has treated me pretty well.
 
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Currently working on Local SEO optimization and heat mapping my website, as well as getting all my office locations accurately listed with the major data aggregators.

My Web-developer offered to do this for me, but for the non-tech-savvy, how hard is it to do this yourself?
 
If you have access to your website source code, there is a place in the header where you can list keywords like "spine", "epidural", "soma" (jk).

The search engines will find you.
 
Bump. Just wondering if any of the people who posted here feel any different from how they did two years ago.
 
Bump. Just wondering if any of the people who posted here feel any different from how they did two years ago.

Due to the extreme political climate and QOL I decided to go back to radiology. Specifically, ER rads. I work nights 9 on 11 off, but I see my kids all the time, go to every school event, daytime class, bday party, etc. I have a great life outside of medicine which I wasn't enjoying when I was practicing pain. I also despised prescribing opioids for patients when they didn't need it and was obligated in order to appease my larger practice. I no longer wanted to play that game and the practice refused to hire an NP or PA.

Now I make 25% more but work less than half the hours (from home) and I teach. I think there are great pain practices out there but I wasn't able to find the unicorn "procedure only, efficient, no opioids, well staffed/supported, great payer mix but completely ethical" practice.

I think the field is going to move more to cash only as time goes on. There will be a divide in pain care between the haves and have nots. It's how chiros have survived and it's how pain will survive.
 
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Wow. What a loss for pain medicine. You had a unique background. Glad you are happy
 
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Bump. Just wondering if any of the people who posted here feel any different from how they did two years ago.
I'm still happy. I think things might even better in the future, since opiates are becoming less emphasized. Pain isn't perfect, but it's pretty special to carve out a niche in Medicine where one doesn't have to work nights, weekends, holidays or be on call. It may not be perfect and it may not be for everyone, but there are more positives than negatives, in my opinion. I'm also fortunate enough to be the only Pain MD in a primary care practice, so I run my show how I want and deem appropriate, not how anyone else pressures me too. Having enough autonomy to practice the way you feel is best, and are most comfortable, cannot be emphasized enough.
 
I'm still happy. I think things might even better in the future, since opiates are becoming less emphasized. Pain isn't perfect, but it's pretty special to carve out a niche in Medicine where one doesn't have to work nights, weekends, holidays or be on call. It may not be perfect and it may not be for everyone, but there are more positives than negatives, in my opinion. I'm also fortunate enough to be the only Pain MD in a primary care practice, so I run my show how I want and deem appropriate, not how anyone else pressures me too. Having enough autonomy to practice the way you feel is best, and are most comfortable, cannot be emphasized enough.

I think this is a great model. Pain MD embedded in large multi-specialty non surgical group. You get to be the gatekeeper and refer to the surgeons instead of the other way around. I am trying to make this happen in my health system by energetically lobbying the PCP's, but it is slow going because they are very set in the old referral patterns. Any MSK complaint --> ortho referral --> sees NP/PA, gets blind "joint" injection, maybe PT ---> surgeon for butchery. Same with NSGY, except instead of blind injection they get an opportunistically read MRI and then a fusion depending on the insurance status.

What I want to know- how are you salaried? How do the PCP's feel about you as the Pain guy not taking call and making 1.5 X more than them? What is the expectation regarding opioid mgmt? At least initially, I would expect a lot of pressure in this type of setup to "take over" the xanax-oxycodone zombies created and nurtured by well meaning but misguided PCP's.
 
Left pain medicine altogether and now am 100% anesthesiology- far happier now. Pain medicine was once a noble calling in the 1990s and early millennium, but insurance control, risk of litigation, dealing with drug addicts and substances abusers, reduced reimbursement, increased documentation, a decreasing scope of insurance paid practice, pain physicians getting into the far fringes of the profession for financial enhancement without little scientific proof of efficacy, pill mills, and injection mills have all made it far too unsavory for me. Kudos to those that stayed the course, and I wish you well.
 
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I went into pain thinking epiduroscopy, adhesiolysis, and IDET were the miraculous treatments they claimed to be...

If you look at the profession of medicine as a whole, the reality is that humanity has precious little, in terms of meds and procedures that actually improve human physiology/anatomy. We educate people and use our primitive tools the best we can.
 
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I'm happy to have stuff things I can try, but I can't say I am happy with the data to back up what I can offer. This field, or perhaps it's just the disease, sucks for fixing things.

Overall though, yeah. I can't complain. It beats the gulag!
 
I would probably not have gone into medicine if I could do it all over again. If I were to go into it for some reason, would have probably picked cards or GI. People in general value their guts and tickers more than their muscles and nerves..
 
Everytime I think about going back into anesthesia, be it for more money, time off, etc, I remember how much I hated being woken up at 2AM for an emergent thoracotomy/Ex-lap s/p GSW after an already long day at work. I remember placing an IJ cordis in trendelenburg under sedation on someone with an EF of 10%. I remember having to choose to spend either Thanksgiving or Christmas with my kids. I'll stick with Pain Management thank you very much.
 
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im relatively happy. i dont wake up excited to go to work, but i dont wake up dreading it. i get paid well, and never think about the office when i leave work.
 
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I wake up excited for work 80-90% of the time. I ditched football practice (coaching 8th grade) to spend time doing online EBM course for upcoming SIS meeting. Totally worth it. Had to fire a guy's meds at 750am, rebound with SIJ pain after kitty litter lifting incident in a 77 y/o at 8AM. Then RF for a few folks. Got my 2.35 mi lunch walk in, ate an Rx bar, and ready for 15 follow ups to finish my week before heading to Chicago.
 
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I'm happy with my job. Unlike many others here, I have a recent comparison of working in anesthesia, and I am so much happier with work after switching over to full time pain. Like Ferrismonk said, no calls in the middle of the night, no deciding which holiday(s) I'm going to be working, no on call looming over me all weekend. Also, no surgeon's bs, no living on someone else's schedule, no trying to figure out how to shoehorn add-on cases onto the board, etc.
I like what I do. I like seeing patients and helping them. I like interacting with my staff. I like getting days to do procedures to mix up the clinic routine. Money is great for how much I put into it. Do others in medicine and other fields make more than me? Sure. Do I make enough to feel really fortunate? Yep.
 
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Left pain medicine altogether and now am 100% anesthesiology- far happier now. Pain medicine was once a noble calling in the 1990s and early millennium, but insurance control, risk of litigation, dealing with drug addicts and substances abusers, reduced reimbursement, increased documentation, a decreasing scope of insurance paid practice, pain physicians getting into the far fringes of the profession for financial enhancement without little scientific proof of efficacy, pill mills, and injection mills have all made it far too unsavory for me. Kudos to those that stayed the course, and I wish you well.

Algos,

What became of your burgeoning Regen Med. practice from a few years back?
 
I would probably not have gone into medicine if I could do it all over again. If I were to go into it for some reason, would have probably picked cards or GI. People in general value their guts and tickers more than their muscles and nerves..

for me it would've been derm or plastics because people come to you expecting procedures and know they will have to pay $$ for it.
at this stage in my career I'm admin more than clinical and am much happier. so much of pain was trying to talk people out of their opiates to try something else (injection, exercise, diet & lose weight, CBT, love their spouse, go back to work!) over and over and over and not getting through to them
 
Bump. Just wondering if any of the people who posted here feel any different from how they did two years ago.

One's happiness in pain is directly proportional to one's control over their environment. If you're expected to be the clinic pill guy, or the in-house ortho needle monkey, or the health-system appointed opioid compliance lackey, then you're going to be miserable because you're going to be pigeon-holed into doing things and having relationships that would otherwise risk your integrity and pride. Instead, find opportunities where you are able to cultivate your own niche, groom your referring providers, and offer services that others don't offer. That is the key to being prosperous in pain.
 
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One's happiness in pain is directly proportional to one's control over their environment. If you're expected to be the clinic pill guy, or the in-house ortho needle monkey, or the health-system appointed opioid compliance lackey, then you're going to be miserable because you're going to be pigeon-holed into doing things and having relationships that would otherwise risk your integrity and pride. Instead, find opportunities where you are able to cultivate your own niche, groom your referring providers, and offer services that others don't offer. That is the key to being prosperous in pain.

this is indeed key. if you're working in an environment where management changes that can completely upset this balance.

that said I'm happy I went into pain for all the reasons mentioned by colleagues above.
 
Are you happy working as an interventional pain specialist? (0-10)?
10 (for the profession itself, not the business or insurance aspect)

What was your reason for going into IPM in the first place?
I like doing procedures but not surgeries. I wanted to be a quality of life physician. I like the huge variety of pathology seen. Lifestyle is great compared to other specialties. Relieving people of pain is a true blessing.

Do you like your hours? Do you feel like you have enough time with your family/other interests?

Hours as solo private practice business owner: hate it. Work 24/7 Do not have any time for family or other interests.
Hours as employed physician in past: 10/10. Had plenty of time for family or other interests. But hated being managed by lemmings and MBAs.

Bottom line is the business of medicine sucks on both ends. Just depends if you want to work your ass off in private practice, or sell your ass out to MBAs in a hospital.

Do you work in an academic center or private practice? Have you ever switched from one to the other, if so why?
Private Practice

Do you feel fairly compensated?
No, I want more. Work 7 days per week in clinic or on business, reimbursement less every single year without fail.

Would you choose pain again?

If I stayed in medicine, yes. But I probably would not enter medicine again.

If you HAD to choose a different specialty, what would it be?

Lasik surgery specialist. Huge quality of life for patients, very technical, nice lifestyle.

Or work from home radiologist. Sounds fantastic, though I know it is tough work. I'd live in Japan or something make a lot of money and have fun.

Anything else you'd like to share?

If you do the full range of pain practice, it can be very interesting.
 
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Left pain medicine altogether and now am 100% anesthesiology- far happier now. Pain medicine was once a noble calling in the 1990s and early millennium, but insurance control, risk of litigation, dealing with drug addicts and substances abusers, reduced reimbursement, increased documentation, a decreasing scope of insurance paid practice, pain physicians getting into the far fringes of the profession for financial enhancement without little scientific proof of efficacy, pill mills, and injection mills have all made it far too unsavory for me. Kudos to those that stayed the course, and I wish you well.

why did u stop regenerative medicine? It changed my practice and it is incredibly satisfying. This week i did some free BMAC's and PRP for established patients because they had little money and i wanted them to feel better.
 
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why did u stop regenerative medicine? It changed my practice and it is incredibly satisfying. This week i did some free BMAC's and PRP for established patients because they had little money and i wanted them to feel better.
Cmon man..you are obviously a greedy, money hungry unethical fool who doesn’t read ebm and is only out to line your pocket at the expense of poor misguided and uninformed patients. Oh wait you did the treatment for free...cause you believe in it and have seen that it makes a difference in the lives you of your patients...
 
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why did u stop regenerative medicine? It changed my practice and it is incredibly satisfying.

Right, a few years ago Algos was supposed to show us the way.:laugh:
 
What I want to know- how are you salaried? How do the PCP's feel about you as the Pain guy not taking call and making 1.5 X more than them? What is the expectation regarding opioid mgmt? At least initially, I would expect a lot of pressure in this type of setup to "take over" the xanax-oxycodone zombies created and nurtured by well meaning but misguided PCP's.
We all function on our own independent profit and loss sheet. It's 100% eat what you kill. You can make as much or as little as you want, based on your billing and production. I've never picked up on any resentment regarding salary, because there's not really any "salary," per se, and instead each keeps what he generates. Overhead is taken out of that revenues steam, but the formula is the same for everyone. You buy a vial of saline, it comes off the top of your revenue. You bill a patient, it goes to your pay stream and no one else's. I do a kypho, I get all the $ from it, they get none. But they also don't have to pay a penny for my GE 9900 fluoro; I'll pay every cent of that. I do definitely make more than them, but I think they're mostly just happy that my presence means they have less opiate Rx's to prescribe.

Some of them that have expected me to take over opiobenzosomaaadderal zombies don't refer to me anymore. The ones that are good docs and have real patients to send me, do refer the good patients to me and send the train-wrecks out of the practice. When I decided to demand all opiate patients taper off benzos, most of whom got their benzos from the PCPs (none from me) there was some grumbling as we weaned people, but surprisingly little, and in the end, they seem happier that we've lowered the risk profile and painfulness of our mutual patient population. As far as call goes, the PCPs couldn't care less if I take call or not, because they don't really take call either. They all have hospitalists do their admits. It's a pretty sweet set up, for all involved. In the end, I'm sure we probably don't make as much money as some groups, but the lifestyle setup is very good and sustainable.

Also, a plus is that PCPs tend to be easier to work with than surgeons and they view what you say with more weight since they consider you a "specialist" with more knowledge than them in your area. That's as opposed to surgeons, who generally want you to do what they want you to do, when they want you to do it and always think they know best about everything. The downside is that the average PCP's patient stream has a lower % of patients needing a Pain MD, than your average neurosurgeon or ortho spine doc. So, I'll never be the guy with a line of patients out the door; I have busy times and slow periods, and I'm okay with that. But I'm not starving, and the upsides make it more than worth it.
 
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I did PRP but did not have the results I anticipated. As for stem cell treatments, I never found a treatment that had enough scientific support, and the FDA continues their gyrations as to what is acceptable. With the permanent blinding from stem cells, I expect the FDA will become more stringent. Stem cells have tremendous potential but I do not think injecting cellular debris and undesirable cells is in the patient's best interest- limitations imposed by the FDA.
 
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Yet you were thinking about/planning on setting up a stem cell clinic in Bimini? Sounds like a complete 180. What am I missing?
 
There were scientific articles early on that pointed to the potential of stem cell therapies, but some later studies were more subdued. Ultimately I did not find enough scientific advances to support wholesale adoption of stem cells as viable therapies, especially given the massive proliferation of stem cell use in the US. Bimini was to be a cultured stem cell operation with pure stem cell lines used in co-culture with a patient's healthy cells to produce a template for stem cells. But when there are a gazillion docs injecting garbage into patients in the US and marketing them as stem cells, it is likely naive patients would not know the difference between those operations and co-cultured differentiated stem cells.
 
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One of the things I like about pain is the mix of procedures and talking with patients. 80% of the time, it doesn't seem like work to me. There aren't too many specialties that are as balanced. Plus, we get paid relatively well so that doesn't hurt. The thing I don't like is the lack of support/evidence for most of our procedures. If (hopefully when) we have more effective treatments, this would be the ultimate specialty IMO.
 
There were scientific articles early on that pointed to the potential of stem cell therapies, but some later studies were more subdued. Ultimately I did not find enough scientific advances to support wholesale adoption of stem cells as viable therapies, especially given the massive proliferation of stem cell use in the US. Bimini was to be a cultured stem cell operation with pure stem cell lines used in co-culture with a patient's healthy cells to produce a template for stem cells. But when there are a gazillion docs injecting garbage into patients in the US and marketing them as stem cells, it is likely naive patients would not know the difference between those operations and co-cultured differentiated stem cells.

Discussed at EAC meeting at SIS. Saw your name on cover sheet. Hoping to see you again. A review of regmed is underway.....
 
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We all function on our own independent profit and loss sheet. It's 100% eat what you kill. You can make as much or as little as you want, based on your billing and production. I've never picked up on any resentment regarding salary, because there's not really any "salary," per se, and instead each keeps what he generates. Overhead is taken out of that revenues steam, but the formula is the same for everyone. You buy a vial of saline, it comes off the top of your revenue. You bill a patient, it goes to your pay stream and no one else's. I do a kypho, I get all the $ from it, they get none. But they also don't have to pay a penny for my GE 9900 fluoro; I'll pay every cent of that. I do definitely make more than them, but I think they're mostly just happy that my presence means they have less opiate Rx's to prescribe.

Some of them that have expected me to take over opiobenzosomaaadderal zombies don't refer to me anymore. The ones that are good docs and have real patients to send me, do refer the good patients to me and send the train-wrecks out of the practice. When I decided to demand all opiate patients taper off benzos, most of whom got their benzos from the PCPs (none from me) there was some grumbling as we weaned people, but surprisingly little, and in the end, they seem happier that we've lowered the risk profile and painfulness of our mutual patient population. As far as call goes, the PCPs couldn't care less if I take call or not, because they don't really take call either. They all have hospitalists do their admits. It's a pretty sweet set up, for all involved. In the end, I'm sure we probably don't make as much money as some groups, but the lifestyle setup is very good and sustainable.

Also, a plus is that PCPs tend to be easier to work with than surgeons and they view what you say with more weight since they consider you a "specialist" with more knowledge than them in your area. That's as opposed to surgeons, who generally want you to do what they want you to do, when they want you to do it and always think they know best about everything. The downside is that the average PCP's patient stream has a lower % of patients needing a Pain MD, than your average neurosurgeon or ortho spine doc. So, I'll never be the guy with a line of patients out the door; I have busy times and slow periods, and I'm okay with that. But I'm not starving, and the upsides make it more than worth it.

Approximately what % of your revenue is paid in overhead in your setup?
 
There were scientific articles early on that pointed to the potential of stem cell therapies, but some later studies were more subdued. Ultimately I did not find enough scientific advances to support wholesale adoption of stem cells as viable therapies, especially given the massive proliferation of stem cell use in the US. Bimini was to be a cultured stem cell operation with pure stem cell lines used in co-culture with a patient's healthy cells to produce a template for stem cells. But when there are a gazillion docs injecting garbage into patients in the US and marketing them as stem cells, it is likely naive patients would not know the difference between those operations and co-cultured differentiated stem cells.

What kind of QC were you going to do on the cultured cells to ensure no mutations, etc?
 
Discussed at EAC meeting at SIS. Saw your name on cover sheet. Hoping to see you again. A review of regmed is underway.....

As usual the SIS blowhards doing a “review”. How about some real research.
 
Mutations can occur with protracted repeated cell line divisions so limiting the number of iterations to 3 to 4 days solves that issue. Of more concern is the utilization of a growth media that contains foreign DNA. There are now gross mediums available that are free of xeno cellular material.
 
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