Best fellowship in terms of future salary?

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afob100 said:
You do CT anesthesia because you enjoy the physiology/patients/echo/OR (not for more money than pain).
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And that's EXACTLY why people should do pain (or other fellowship), too, not for the money.

PP pain can be miserable, especially as an employee.
 
GandalfTheWhite said:
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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if you are looking for the easiest listed job to make X amount of money, pain is obviously the way to go. But those are not the good jobs in either specialty. There are far more lucrative opportunities in either area if you know the right people and can find the right gig.
 
Mman said:
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.
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How are the CT docs you're talking about pulling down the same kinda $ as the pain guys who have industry ties/own their suites etc.
 
vector2 said:
How are the CT docs you're talking about pulling down the same kinda $ as the pain guys who have industry ties/own their suites etc.
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get paid $120+ a unit and have a good payer mix (not a bunch of old medicare cabgs). Do some fancy valve work and you are getting more than 100 units per case.

Now obviously people who are industry ****** making 7 figures in essentially advertising revenue plus clinical pay are in another world of their own.
 
Mman said:
get paid $120+ a unit and have a good payer mix (not a bunch of old medicare cabgs). Do some fancy valve work and you are getting more than 100 units per case.

Now obviously people who are industry ****** making 7 figures in essentially advertising revenue plus clinical pay are in another world of their own.
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how do they get that level of advertising revenue? Is it mostly by publishing literature supporting the use of the products per se?
 
Tramadeezy said:
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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Where in Texas is this? Big city or Rural? San Antonio, Austin, Houston or Dallas-Fort Worth? Is it possible to hit this range in year 1? Seriously interested and willing to relocate.
 
gazzer said:
Where in Texas is this? Big city or Rural? San Antonio, Austin, Houston or Dallas-Fort Worth? Is it possible to hit this range in year 1? Seriously interested and willing to relocate.
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youre probably not going to hit that until year 4-5. to have that volume, you have to build your patient base and build referral networks. And likely also talking about rural/suburban (think abilene, lubbock, texarkana, etc...) The four placed you mentioned are major metros and will likely be 350 starting. Austin, expect less.
 
gazzer said:
Where in Texas is this? Big city or Rural? San Antonio, Austin, Houston or Dallas-Fort Worth? Is it possible to hit this range in year 1? Seriously interested and willing to relocate.
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you dont want to go out on your own - way easier to join an ortho/neurospine group that offers partnership.

you wont have to worry about any headaches of advertising and starting/running an office, and in 2-3 years youll likely be making 7 figures. thats what i would do.
 
Hoya11 said:
you dont want to go out on your own - way easier to join an ortho/neurospine group that offers partnership.

you wont have to worry about any headaches of advertising and starting/running an office, and in 2-3 years youll likely be making 7 figures. thats what i would do.
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7 figures? All before the decimal?
 
Agree that it's really not the fellowship per se but rather the opportunity for equal partner/ownership in a successful PP group. However, pain guys can crush it under the right circumstances and if they hustle hard.

The past 5 years as partner in my group (after a 2 year buy in) I've made at least 100k more per year more than my co-resident who did both CC and Cardiac fellowships who worked for an AMC. I did not do a fellowship.
 
anesthesiaman10 said:
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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Pain is a dying field.
 
GandalfTheWhite said:
Are people in less pain than before? Figured all these boomers will be a boon to pain in the next decade.
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Probably more so oversaturation, falling reimbursements, more payment denials.

"CRNAs independently practicing interventional pain has been going on for a while now.

A lot of non fellowship trained anesthesiologists and physiatrists practicing only interventional pain. Some family doctors and emergency room physicians attend weekend courses and conferences for fluoro and ultrasound guided blocks then call themselves pain specialists. Some of these courses are physician only. Some are not. I remember as a resident attending a very large name national annual pain conference and attending a few of the cadaver lab courses. Side by side with PAs/NPs who after speaking with them, want interventional only practices in rural areas.

“Even chiropractors and naturopaths are out practicing interventional pain with ultrasound and fluoroscopy, especially the regenerative medicine cash only stuff. Even know of someone who had left residency without finishing and just opened a pain clinic, state specific.

Not hard to buy or lease a c arm and ultrasound machine.

No they are not only doing minor blocks. Some are out doing radiofrequency ablations and spinal cord stimulators.

Nothing is stopping a family doc from buying bone marrow aspiration kits, a centrifuge, and opening up shop. Nothing is stopping a new grad from opening up a ketamine clinic that claims to cure anything under the sun. Some pain docs used to overtest every urine sample with their own lab and found this is far more lucrative than interventional procedures. These "pee mills" really gave insurances a tough time. Now the DEA is cracking down hard on such behaviors. Heck, even dermatologists are pushing PRP and microRFA for many conditions. All real examples. Not trying to start a flame war, just my experience.

I'm not writing this to discourage you if you want to pursue this path but know that it's a wide open mostly unregulated market and many people from all sorts of educational backgrounds want a piece of the pain management pie.

The current pain market is saturated. Unless you want to go to the underserved boonies, it will be hard to open something for yourself.

Reimbursement has been dropping. Likely from over utilization. Even one of the biggest names in spinal cord stimulation is says it's way overused and may not be a covered benefit in the future if changes aren't made.”

forums.studentdoctor.net

Chronic Pain Management and Midlevel Encroachment

Resident here- So I'm having a discussion a few months ago with a chronic pain doc about my future plans as a generalist, and she opined that current residents need to 'strongly consider' doing a fellowship for "job security" with all the common arguments we've heard before. She mentioned her...
forums.studentdoctor.net forums.studentdoctor.net
 
vector2 said:
How are the CT docs you're talking about pulling down the same kinda $ as the pain guys who have industry ties/own their suites etc.
Click to expand...

sloh said:
Probably more so oversaturation, falling reimbursements, more payment denials.

"CRNAs independently practicing interventional pain has been going on for a while now.

A lot of non fellowship trained anesthesiologists and physiatrists practicing only interventional pain. Some family doctors and emergency room physicians attend weekend courses and conferences for fluoro and ultrasound guided blocks then call themselves pain specialists. Some of these courses are physician only. Some are not. I remember as a resident attending a very large name national annual pain conference and attending a few of the cadaver lab courses. Side by side with PAs/NPs who after speaking with them, want interventional only practices in rural areas.

“Even chiropractors and naturopaths are out practicing interventional pain with ultrasound and fluoroscopy, especially the regenerative medicine cash only stuff. Even know of someone who had left residency without finishing and just opened a pain clinic, state specific.

Not hard to buy or lease a c arm and ultrasound machine.

No they are not only doing minor blocks. Some are out doing radiofrequency ablations and spinal cord stimulators.

Nothing is stopping a family doc from buying bone marrow aspiration kits, a centrifuge, and opening up shop. Nothing is stopping a new grad from opening up a ketamine clinic that claims to cure anything under the sun. Some pain docs used to overtest every urine sample with their own lab and found this is far more lucrative than interventional procedures. These "pee mills" really gave insurances a tough time. Now the DEA is cracking down hard on such behaviors. Heck, even dermatologists are pushing PRP and microRFA for many conditions. All real examples. Not trying to start a flame war, just my experience.

I'm not writing this to discourage you if you want to pursue this path but know that it's a wide open mostly unregulated market and many people from all sorts of educational backgrounds want a piece of the pain management pie.

The current pain market is saturated. Unless you want to go to the underserved boonies, it will be hard to open something for yourself.

Reimbursement has been dropping. Likely from over utilization. Even one of the biggest names in spinal cord stimulation is says it's way overused and may not be a covered benefit in the future if changes aren't made.”

forums.studentdoctor.net

Chronic Pain Management and Midlevel Encroachment

Resident here- So I'm having a discussion a few months ago with a chronic pain doc about my future plans as a generalist, and she opined that current residents need to 'strongly consider' doing a fellowship for "job security" with all the common arguments we've heard before. She mentioned her...
forums.studentdoctor.net forums.studentdoctor.net
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Here is my take. Pain was a lucrative field if you got in about a decade ago or more. You could set up your own practice, set up an in-house lab, set up industry ties, get speaking fees and make money off industry courses; basically you had several different avenues for generating income. If you were a shady MOFO the sky was the limit, and it still is in some areas of the country. Just be sure to have your jet fueled up for when the DEA comes knocking if you decide to go the shady route. As for those who choose to grind it out, insurance executives are not stupid and they realized that the easiest way to curtail spending in this area was to simply stop paying for procedures and create hurdles. deny deny deny. Now you are spending 30 minutes to an hour on a peer-to-peer call trying to get a lumbar epidural approved when in that same 30 minutes you previously could do 3 epidurals. Also as stated above everyone is a pain doc these days. Family med is the biggest joke (not counting the “pain trained”nurses) followed by ER. Take a weekend course in pain and try not to paralyze anyone, best of luck. 👍 I could write a book on how to make it in the pain game but it takes either luck (like someone I know who inherited a practice for instance) or grinding for a decade to have a profitable stable practice that compares to working in the OR.
 
Making money in pain is like anything else. Ownership matters. I know of a guy who graduated from my program who was a mediocre resident but a great businessman. He bought up a bunch of pain practices in his area and sold his empire at the end of his career for 8 figures. Another person I know is in a partnership with a bunch of surgeons, bought into the surgery center and gets a portion of the facility fees as well as anesthesia fees.

If you can cherry pick your patients and cases, pain is a great way out of the OR.
 
ToKingdomCome said:
Crit care boost in salary ?
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None generally. Do it because CCM is interesting and anesthesiologists get no respect. Maybe some locations and job opportunities open up (but, foolishly imo, some opportunities definitely close from pp when they see that on your CV)
 
I got a nice salary boost doing CCM only because of Covid. Some PP groups around the country are starting to value CCM. But otherwise I agree with other posters : do CCM because of your interest in the field and genuinely feeling like a doctor. I love the OR but at this point I could not do it 100% of the time.
 
DrZzZz said:
CCM is a money loser. You generally make less than you would doing 100% anesthesia.
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I hear that CCM could open up tele-ICU opportunities in the future. Conceivably one could get paid to sit at home looking at monitors for a bunch of distant ICUs, directing on-site midlevels to be your monkey-hands.

Seems like there's a lot of potential there, though I don't know if I could stand the helplessness of watching a midlevel mess up a procedure on a monitor, it's hard enough to watch them mess up in person where I can physically step in.
 
Im CCM and cadiac trained. Can’t speak to salary, but I felt baited and switched by anesthesia training. Absolutely hated how I was treated. CCM made a lot of that better, but it’s probably because I’m there at 2 in the morning slugging it out with the patients alongside the surgeons long after the anesthesia team went home.

Their respect comes at a cost.
 
Nivens said:
Im CCM and cadiac trained. Can’t speak to salary, but I felt baited and switched by anesthesia training. Absolutely hated how I was treated. CCM made a lot of that better, but it’s probably because I’m there at 2 in the morning slugging it out with the patients alongside the surgeons long after the anesthesia team went home.

Their respect comes at a cost.
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Quoted for truth
 
GandalfTheWhite said:
Are people in less pain than before? Figured all these boomers will be a boon to pain in the next decade.
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No.

But consider that MRI's have increased about 700% in the last 10 years.

Injections 1000%.

And population has only increased a small amount - maybe 5%?

Clearly what we are doing isn't working.
 
epidural man said:
Pain is a dying field.
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Lol, you clearly are not in the field of pain management. I beg you to tell me a field expanding as quickly as pain medicine. Within the last five years the scope of practice has expanded significantly to include Vertiflex, Intracept, New RF and SCS technologies, Peripheral Nerve Stim…the list goes on. You clearly are clueless, ignorant or just plain stupid.
 
Paincrusher said:
Lol, you clearly are not in the field of pain management. I beg you to tell me a field expanding as quickly as pain medicine. Within the last five years the scope of practice has expanded significantly to include Vertiflex, Intracept, New RF and SCS technologies, Peripheral Nerve Stim…the list goes on. You clearly are clueless, ignorant or just plain stupid.
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Do you actually get these new procedures approved? Intacept is the new IDET, vertiflex is the new Xstop and these procedures were never paid for by the vast majority of insurance companies.
 
Paincrusher said:
Lol, you clearly are not in the field of pain management. I beg you to tell me a field expanding as quickly as pain medicine. Within the last five years the scope of practice has expanded significantly to include Vertiflex, Intracept, New RF and SCS technologies, Peripheral Nerve Stim…the list goes on. You clearly are clueless, ignorant or just plain stupid.
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Take it easy my dude. @epidural man is actually a pain physician that has been around for a while.
 
Paincrusher said:
Lol, you clearly are not in the field of pain management. I beg you to tell me a field expanding as quickly as pain medicine. Within the last five years the scope of practice has expanded significantly to include Vertiflex, Intracept, New RF and SCS technologies, Peripheral Nerve Stim…the list goes on. You clearly are clueless, ignorant or just plain stupid.
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He/she is probably trying to reduce the number of people (competition) by swaying them away from pain. /s
 
Nivens said:
Im CCM and cadiac trained. Can’t speak to salary, but I felt baited and switched by anesthesia training. Absolutely hated how I was treated. CCM made a lot of that better, but it’s probably because I’m there at 2 in the morning slugging it out with the patients alongside the surgeons long after the anesthesia team went home.

Their respect comes at a cost.
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baited and switched? what does that mean?
 
PainDrain said:
Do you actually get these new procedures approved? Intacept is the new IDET, vertiflex is the new Xstop and these procedures were never paid for by the vast majority of insurance companies.
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Medicare is paying for Vertiflex in my state. I think procedures are way UP vs a few years ago.
 
Getting a fellowship in PAIN is much harder these days due to all the specialties allowed in. ER/EM, Physical Medicine and Rehab, Psychiatry and Anesthesiology just to name a few. The EM people are really looking hard at their options and about 1/4 of them want to get out of EM with quite a few wanting that PAIN fellowship.
 
epidural man said:
No.

But consider that MRI's have increased about 700% in the last 10 years.

Injections 1000%.

And population has only increased a small amount - maybe 5%?

Clearly what we are doing isn't working.
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For generating revenue for the provider PAIN is indeed working quite well. But, looking at the results they are no better than 10-15 years ago in terms of patient satisfaction.
 
With the ANTI-OPIOID sentiment in the USA Pain is very lucrative (still). Cardiac is still THE fellowship to do for PP. Longer term (10 years out) CCM will pay better than anesthesia due to very low Medicare reimbursement for anesthesia.

Nivens has set himself up quite well for the next 25 years by completing Cardiac/Critical Care fellowships. The "generalist" in anesthesia is NOT where you want to be down the road.
 
BLADEMDA said:
Getting a fellowship in PAIN is much harder these days due to all the specialties allowed in. ER/EM, Physical Medicine and Rehab, Psychiatry and Anesthesiology just to name a few. The EM people are really looking hard at their options and about 1/4 of them want to get out of EM with quite a few wanting that PAIN fellowship.
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It’s actually not that hard if you’re a US grad. Based on the most recent 2021 data, there were 238 total US grad applicants for 349 positions. Including foreign grads, there was a total of 395 applicants for those 349 positions. In my residency program there were a bunch of pretty average residents that matched pain. But there were stellar residents that failed to match cardiac.
 
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BLADEMDA said:
With the ANTI-OPIOID sentiment in the USA Pain is very lucrative (still). Cardiac is still THE fellowship to do for PP. Longer term (10 years out) CCM will pay better than anesthesia due to very low Medicare reimbursement for anesthesia.

Nivens has set himself up quite well for the next 25 years by completing Cardiac/Critical Care fellowships. The "generalist" in anesthesia is NOT where you want to be down the road.
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Eh we are short as are a lot of groups around us and I know locums people are doing well.
 
sevo00 said:
It’s actually not that hard if you’re a US grad. Based on the most recent 2021 data, there were 238 total US grad applicants for 349 positions. Including foreign grads, there was a total of 395 applicants for those 349 positions. In my residency program there were a bunch of pretty average residents that matched pain. But there were stellar residents that failed to match cardiac.
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At least, at my program, there is definitely more self-selection for applying to cardiac vs pain.
 
BLADEMDA said:
The "generalist" in anesthesia is NOT where you want to be down the road.
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Thats funny because my friends group that that hires cardiac and peds docs, and general docs, They are flush with cardiac and peds applicants but general docs ( those who do everything) are lacking. General docs are not applying.
 
Aheadbyacentury said:
Thats funny because my friends group that that hires cardiac and peds docs, and general docs, They are flush with cardiac and peds applicants but general docs ( those who do everything) are lacking. General docs are not applying.
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same with my group. Currently have 9 open spots for generalists. The rest of us woking like dogs to cover all the call shifts
 
Aheadbyacentury said:
Thats funny because my friends group that that hires cardiac and peds docs, and general docs, They are flush with cardiac and peds applicants but general docs ( those who do everything) are lacking. General docs are not applying.
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I agree the greatest need is for generalists. If you have peds and cardiac folks who don’t mind giving up their subspecialty, then it’s not a problem.
 
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