Best fellowship in terms of future salary?

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anesthesiaman10

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I'm a third year resident at a mid-level anesthesia program looking to apply to fellowships. I was wondering which anesthesia fellowship will lead to the greatest increase in future salary?

Right now, I'm looking pain medicine and cardiothoracic. Which of these will lead to greatest future earning potential? I like both pain and CT and don't have any personal preference between the two so salary will be the deciding factor.

Thanks!

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For money, def CT. For less life or death ****, Pain. U dont do swan ganz in pain.
 
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Seems like someone asks this question every month. The fellowship that teaches you how to chug 60-80 hour work weeks for your entire career. That’s the one. Also, don’t get a fellowship in divorce, negative ROI there.
 
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Salary is the deciding factor between 2 COMPLETELY different careers/lifestyles?
 
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Have you spent a *significant* amount of time on a pain service? Those patients are rough. I only ask because CT and pain are 2 completely different careers. Pros and cons to both, but I personally could not do pain because of the patients, despite the procedures that I really liked. On the other hand, many cannot stand cardiac surgeons and the cardiac OR gauntlet which is also understandable.
 
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Pain has better potential, CT has better stability. side question, is CT the most marketable fellowship? I don't really see any "neuroanesthesia" jobs on gaswork etc. occasional pediatrics, though.
 
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I would also wonder about the reimbursement of pain procedures in the long run. Seems like low hanging fruit.

Have you spend a *significant* amount of time on a pain service? Those patients are rough. I only ask because CT and pain are 2 completely different careers. Pros and cons to both, but I personally could not do pain because of the patients, despite the procedures that I really liked. On the other hand, many cannot stand cardiac surgeons and the cardiac OR gauntlet which is also understandable.
 
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From what ive seen, whether you are in a per-unit compensation model or in academics, CT generally seems much more lucrative in 2020.
 
Pain. No other anesthesia fellowship will overtake pain income potential. Not even close. Especially if you compare hours worked to salary. Pain practices can be worth tens of millions of dollars. You start your own gig and the sky is the limit in pain.
 
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Pain. No other anesthesia fellowship will overtake pain income potential. Not even close. Especially if you compare hours worked to salary. Pain practices can be worth tens of millions of dollars. You start your own gig and the sky is the limit in pain.
Where? I genuinely wanna know. In ny we make significantly less than anesthesiology
 
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Seems like pain practices are more of a business. It’s like asking how much a restaurant owner makes. Is it a Denny’s in the desert or a Cheesecake Factory in Manhattan?
 
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Moreso than joints?

depends on if you are good enough to have 2 rooms. Either is great, but the outpatient side of sports ortho is good money and not so much work. That being said, i work with a total joint dude that bangs out 12 totals in a day easy. He crushes it and has every friday off.
 
Where? I genuinely wanna know. In ny we make significantly less than anesthesiology

maybe it depends on the practice model in Ny. If youre a busy doc part of a heavy interventional pain practice working for salary plus production bonus you should be making 400+ easy. Im in Texas. Guys in my area are 6-800k. Thats 40hrs a week no nights, call, or weekends. But you have to deal with pain pts...
 
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Makes btw 2.5 and 3/year (group makes their own inplants, own facilities and MRI/CT scanners, plus stipend from hoapitals)
 
OB
 
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pain revenue just depends on contracts. I am aware of a 5x different in reimbursement rate between groups for the same procedure in pain. In the OR, those differences are much smaller (think 25-50% difference at most).
 
As a CT anesthesiologist you will likely never own your own business or own part of your center.

As a pain doc you have multiple ancillary revenue streams you could access, including ASC ownership.

None of this is a guarantee. I would tell you to keep your mind open and go see what people out in the real world are doing every day.

I liked both as a resident. Did pain and halfway through fellowship had doubts. However I am now 5 years into pain practice and could not imagine doing anesthesia ever again.
 
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Just find a practice with fast surgeons

or be one
This all day. It's way more lucrative to work with a fast/efficient/busy ortho, urologist, or gen surgeon than one marginally busy CV service.
 
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Pain has better potential, CT has better stability. side question, is CT the most marketable fellowship? I don't really see any "neuroanesthesia" jobs on gaswork etc. occasional pediatrics, though.
Both are marketable to an extent, much like peds, CT offers the opportunity to be the person who can do CV and just about anything else, much in the sense of the "cardiac capable" generalist, the difference being you can wave your TEE certification like a flag.
 
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The truth can hurt sometimes

For OB (or everything in anesthesia) it all boils down to payer mix.... if you have a really good and busy OB department.

5000 deliveries/yr
80% insured = 4000 paying patients.
-15% who wants no epidurals.
3400 who would pay for epidurals.

The last time I checked, labor epidural ain’t cheap.
 
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depends on if you are good enough to have 2 rooms. Either is great, but the outpatient side of sports ortho is good money and not so much work. That being said, i work with a total joint dude that bangs out 12 totals in a day easy. He crushes it and has every friday off.



Before COVID, our sports Ortho guys were spending an inordinate number of Friday and Saturday nights at HS and college football games. It has to be your thing.
 
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Before COVID, our sports Ortho guys were spending an inordinate number of Friday and Saturday nights at HS and college football games. It has to be your thing.

Aren't you in san diego?? are they spending time doing intercostal blocks? :rofl:

RIP Tyrod Taylor's starting job. LOL
 
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Aren't you in san diego?? are they spending time doing intercostal blocks? :rofl:

RIP Tyrod Taylor's starting job. LOL


It’s funny. The high school and college kids get better doctors than the pros IMO.
 
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As a CT anesthesiologist you will likely never own your own business or own part of your center.

As a pain doc you have multiple ancillary revenue streams you could access, including ASC ownership.

None of this is a guarantee. I would tell you to keep your mind open and go see what people out in the real world are doing every day.

I liked both as a resident. Did pain and halfway through fellowship had doubts. However I am now 5 years into pain practice and could not imagine doing anesthesia ever again.

I gotta say man, I love your username
 
Aren't you in san diego?? are they spending time doing intercostal blocks? :rofl:

RIP Tyrod Taylor's starting job. LOL

Man, don’t gameday block anything with a pro athlete, or any competitive athlete.

Too many downsides for player.
They can get injured far worse if they are numb.

Or they can have a complication from the procedure itself.

I would think the culture at that level would be to get guys on the field no matter the cost, but it’s not good.

One of exception is a cortisone injection which would be days away from game day.

I was in high school and was looking forward to watch Jerome Bettis running over people, until he got a nerve block with a complication and couldn’t play.
So I saw Amos Zeroue and Chris Fumatu play that day.

Orthopedic Surgical procedure for a collegiate or pro athlete?
No block. Period.
 
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Man, don’t gameday block anything with a pro athlete, or any competitive athlete.

Too many downsides for player.
They can get injured far worse if they are numb.

Or they can have a complication from the procedure itself.

I would think the culture at that level would be to get guys on the field no matter the cost, but it’s not good.

One of exception is a cortisone injection which would be days away from game day.

I was in high school and was looking forward to watch Jerome Bettis running over people, until he got a nerve block with a complication and couldn’t play.
So I saw Amos Zeroue and Chris Fumatu play that day.

Orthopedic Surgical procedure for a collegiate or pro athlete?
No block. Period.
I totally remember that. A Bettis-less Steelers probably helped Brady get his for SB trophy
 
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Sounds like CT is a safe bet to make more $ on average, but pain has the outsize chance to make more $ if one sets up a successful practice. Is this about right?

How hard is it to set up a pain practice which makes more $ than the average anesthesiologist? What does it entail?
 
Sounds like CT is a safe bet to make more $ on average, but pain has the outsize chance to make more $ if one sets up a successful practice. Is this about right?

How hard is it to set up a pain practice which makes more $ than the average anesthesiologist? What does it entail?

im not going into pain, but from what I understand, the job market for pain doc in large cities in east coast is terrible for new fellowship grads.
 
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im not going into pain, but from what I understand, the job market for pain doc in large cities in east coast is terrible for new fellowship grads.
The main problem is, stupid people talk about “opening a pain practice and making $1 million a year” as if it’s like opening a burger king or some ****. On average, CT anesthesiologists make more than Pain
 
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Sounds like CT is a safe bet to make more $ on average, but pain has the outsize chance to make more $ if one sets up a successful practice. Is this about right?

How hard is it to set up a pain practice which makes more $ than the average anesthesiologist? What does it entail?

The great ability to hustle. And sometimes make hard business decisions rather than clinical decisions.
 
The great ability to hustle. And sometimes make hard business decisions rather than clinical decisions.
Do you know anyone who has successfully started a lucrative practice in the past 5 years?
 
Do you know anyone who has successfully started a lucrative practice in the past 5 years?

Depends on how you define lucrative.

Depends if you’re a general anesthesiologist who is being hired to do their pain cases.

Depends if you count expanding foot print, ( > 1 office) and service expansion (aesthetic and wellness) as a marker of being lucrative.

I consider being a good hustler~~> good businessman
 
The main problem is, stupid people talk about “opening a pain practice and making $1 million a year” as if it’s like opening a burger king or some ****. On average, CT anesthesiologists make more than Pain

disagree.

maybe in the middle of manhattan during covid that is true..

but joining a busy ortho group and making partner is very very doable, and you are at 700->1million easy with bankers hours... CT anesthesia you are typically killing yourself for 500-600max - thats been my experience here in the burbs

i interviewed for pain at several groups where this was the gig: 350k plus incentive for the first 2-3 years. Then partner in the ortho/neuro group.

They have tons of patients, they need someone to just come in and skim off the top and do epidurals and RFs , its easy and big money for the ortho/neuro group. They need someone to manage the failures and medical therapy only patients. All those office visits generate money. Not TONS of board certified pain docs in my area, esp anesthesia based.. i think pain makes more
 
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disagree.

maybe in the middle of manhattan during covid that is true..

but joining a busy ortho group and making partner is very very doable, and you are at 700->1million easy with bankers hours... CT anesthesia you are typically killing yourself for 500-600max - thats been my experience here in the burbs
Which metro area is this? (Serious question. Because Im currently in fellowship and looking for Pain jobs right now for July 2021)
 
Which metro area is this? (Serious question. Because Im currently in fellowship and looking for Pain jobs right now for July 2021)

Look at large private ortho/neuro groups in the MA/CT area (not right near the cities though)

Join an ortho/neuro group doing pain on partner track.

Make partner and enjoy. The group just feeds you softballs and you hit them.

But PS your doing this at a bad time, hopefully in year or two things will be normal again
 
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Pain. If you join a set up that gives you a productivity bonus you make more if you do more .... during business hours.

for CT, you only make more by taking more call, which sucks.
 
Go pain. I am a new grad doing pain in a large ortho group/hospital employed - 2 months in and my injections days are filled up with direct referrals from the surgeons for bread and butter injections. And yes, I can make more money DURING BUSINESS HOURS by working harder/seeing more clinic patients or doing more injections (base salary + RVU production bonus). And my hours are 8a to 4-430p with no weekend/nights/holidays ever again. CT anesthesia cannot touch the lifestyle/hourly pay of pain.

I always chuckle inside when I think back to my CT anesthesia rotation of arriving at the hospital at 5am.
 
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CT anesthesia cannot touch the lifestyle/hourly pay of pain.

pay is so dependent on different factors that it is not comparable although pain has better hours. Pay depends on things far different than what fellowship someone did. I am sure I know docs with CT fellowships making more than double what you make.
 
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I don't think you guys understand the amount of ancillary revenue you can make doing pain. You can serve as a consultant for spinal cord stimulators (Boston Scientific, etc), teach at SCS courses, have ownership in ASCs, and make way more money than any OR anesthesiologist.

For example, Tim Deer MD (pain doc in WV) made $1.8 million last year from industry alone - forget about money from his actual clinical work. Obviously this is not typical at all, but to say " I know docs with CT fellowships making more than double what you make " is a little short sighted.

Physician Profile - Open Payments Data - CMS | CMS Open Payments Data

I AM NOT advocating for selling your soul to industry, but if money is solely your goal, pain will get you more $ while sleeping in your own bed.
 
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I don't think you guys understand the amount of ancillary revenue you can make doing pain. You can serve as a consultant for spinal cord stimulators (Boston Scientific, etc), teach at SCS courses, have ownership in ASCs, and make way more money than any OR anesthesiologist.

For example, Tim Deer MD (pain doc in WV) made $1.8 million last year from industry alone - forget about money from his actual clinical work. Obviously this is not typical at all, but to say " I know docs with CT fellowships making more than double what you make " is a little short sighted.

Physician Profile - Open Payments Data - CMS | CMS Open Payments Data

I AM NOT advocating for selling your soul to industry, but if money is solely your goal, pain will get you more $ while sleeping in your own bed.
Exactly. Plus its likely a 40ish hr work week.
 
For example, Tim Deer MD (pain doc in WV) made $1.8 million last year from industry alone - forget about money from his actual clinical work. Obviously this is not typical at all, but to say " I know docs with CT fellowships making more than double what you make " is a little short sighted.

I will just say that you don't know what you don't know and I know docs making that kind of money in both pain and CT. I'm not saying totally easy and I'm not saying common, but the random employed pain doc bragging about their incentive pay has no idea how much cash they are leaving on the table nor has any idea about how much money some places make in the OR.
 
Go pain. I am a new grad doing pain in a large ortho group/hospital employed - 2 months in and my injections days are filled up with direct referrals from the surgeons for bread and butter injections. And yes, I can make more money DURING BUSINESS HOURS by working harder/seeing more clinic patients or doing more injections (base salary + RVU production bonus). And my hours are 8a to 4-430p with no weekend/nights/holidays ever again. CT anesthesia cannot touch the lifestyle/hourly pay of pain.
I don't think you guys understand the amount of ancillary revenue you can make doing pain. You can serve as a consultant for spinal cord stimulators (Boston Scientific, etc), teach at SCS courses, have ownership in ASCs, and make way more money than any OR anesthesiologist.

For example, Tim Deer MD (pain doc in WV) made $1.8 million last year from industry alone - forget about money from his actual clinical work. Obviously this is not typical at all, but to say " I know docs with CT fellowships making more than double what you make " is a little short sighted.

Physician Profile - Open Payments Data - CMS | CMS Open Payments Data

I AM NOT advocating for selling your soul to industry, but if money is solely your goal, pain will get you more $ while sleeping in your own bed.

This. Dont listen to the clowns telling you that CT makes more money than pain. Look at the $$$/hour worked. You can have a CT anes making 500k/year and a pain doc making 400k/year, but closer inspection will show you that its a 60 hour/week vs 40 hour week with CT taking more frequent calls vs no calls and no weekends. A no call taking CT anes will make significantly less.
 
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I will just say that you don't know what you don't know and I know docs making that kind of money in both pain and CT. I'm not saying totally easy and I'm not saying common, but the random employed pain doc bragging about their incentive pay has no idea how much cash they are leaving on the table nor has any idea about how much money some places make in the OR.

Of course a hospital pain doc is leaving money on the table but they also aren't dealing with the business side/headaches of running a practice.

For the OP/average Joe anesthesia resident, doing pain fellowship will open more doors to earning a higher income with less work than CT anesthesia. You do CT anesthesia because you enjoy the physiology/patients/echo/OR (not for more money than pain).
 
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