Chronic and Acute Pain as an Attending

[Low Flow]

How feasible is it for a fellowship trained chronic pain attending to practice both chronic pain and acute pain? We have one attending at our academic institution who recently completed chronic pain fellowship and is now practicing both, but I was curious to hear if this arrangement has been made elsewhere.

I'm a CA2 applying to chronic pain fellowship now, but I really enjoyed my acute pain experience and think I would like to incorporate that into my practice. I still enjoy OR anesthesia, but I definitely like acute and chronic pain more.

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[Orin]

How feasible is it for a fellowship trained chronic pain attending to practice both chronic pain and acute pain? We have one attending at our academic institution who recently completed chronic pain fellowship and is now practicing both, but I was curious to hear if this arrangement has been made elsewhere.

I'm a CA2 applying to chronic pain fellowship now, but I really enjoyed my acute pain experience and think I would like to incorporate that into my practice. I still enjoy OR anesthesia, but I definitely like acute and chronic pain more.

It works in some academic models but is very much institution dependent and its a bit a money/politics issue.

In high volume places, the chronic faculty can't be doing all the perioperative blocks or catheters.
In high complexity places, the acute faculty aren't ideal for the inpatient/chronic management, fluoro-guided procedures, or cancer pain work.

In reality, you would probably just do chronic with a day or two of anesthesia, and ask to be part of the anesthesia team that utilizes regional techniques more like ortho or something, or just shoehorn blocks into whatever cases you're doing.

 

[deleted875186]

It works in some academic models but is very much institution dependent and its a bit a money/politics issue.

In high volume places, the chronic faculty can't be doing all the perioperative blocks or catheters.
In high complexity places, the acute faculty aren't ideal for the inpatient/chronic management, fluoro-guided procedures, or cancer pain work.

In reality, you would probably just do chronic with a day or two of anesthesia, and ask to be part of the anesthesia team that utilizes regional techniques more like ortho or something, or just shoehorn blocks into whatever cases you're doing.

I’ve seen this a couple times interviewing primarily when you’d like a chronic pain FTE position, but they don’t have the volume or space to accommodate a another FTE chronic pain doc.

 

[gaspasser127]

As has been mentioned, most of these acute-chronic combo jobs are mostly at academic centers where you do mostly chronic pain and then cover acute pain for a week at a time. That’s how it was during my residency and now during fellowship as well.

As I’ve interviewed for jobs though I think more hospital systems that are building their pain divisions are hoping to expand into acute pain management as well. The anesthesia groups contracted with the hospitals may be doing some acute pain already and while they like doing the peri-op blocks they have no interest in following these patients during the course of their admission. From a hospital system perspective I think they see it as an opportunity to keep potential chronic pain patients in-house.

 

[Ferrismonk]

Keep in mind that "Acute pain service" often doesn't mean regional for the OR. In my experience the Anesthesiologists in the OR will handle that. Acute pain often means doing intercostals on the rib fracture guy from the ER or managing all the post-op catheters and PCAs. Not fun.

If you're a chronic pain guy who wants to do some main OR anesthesia, if you express interest (depending on your OR size) they'll often let you be the block guy or at least put you in the ortho room.