Considering a career in pain management

[L. Beethoven]

Hi, I'm a medical student considering going into pain medicine and I had a few questions for those practicing, particularly in regards to prescribing.

If I do Anesthesia or PM&R, I'd be going into the field with an interest especially in the interventional pain procedures. My main concern about pain management is the opioids, which have been covered ad naseum it seems. I've heard some people say that high incomes in a pain practice are only achieved by prescribing a bunch of narcotics to patients. I obviously won't post the MGMA numbers publicly here, but is it reasonable for a doc that practices ethically to reach the mean numbers for Anesthesia Pain after building up a practice? And how readily could you get referrals and do procedures if minimizing or reducing patients' opioid prescriptions?

I've worked in the pain clinic and really enjoyed it so far, but I want to make sure I have the full picture before planning for a career in the field. Thanks!

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[DODOCSS]

transfer to dental school (peri), it's not too late

 

[NJPAIN]

I think you might have a career in music.


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[L. Beethoven]

Just to make sure I was clear, I'm not at all saying I never want to write an opioid prescription, just asking if having a procedural practice is reasonable/financially sound while trying to follow good ethical standards. And I'm fine with working with difficult patients like I've seen in the pain clinic. At my institution, the interventional pain physicians routinely lower down narcotic doses, and they still have plenty of procedures being done. I wonder if it would be possible to get referrals like that outside of an academic setting.

 

[Ducttape]

in the future, you might not have the option towards prescribing a lot of opioids. if current trends go forward, it might be only palliative care that prescribes chronic opioid therapy (outside of cancer pain).

a greater concern might be the focus on interventional pain management. we might not critique needle jockeys as much as pill pushers, but there are issues with this practice type and there may be further salary correction. it seems like injections help, but very few procedures have strong EBM suggesting long term benefit.


you should not be going in to pain medicine purely to make money. you should love the work, even if it is hard (tho the lifestyle will probably always be good). that being said, you will indubitably make enough to be in the top 2% of US salary, unless you are a completely incompetent.

if you want to make money, go into ortho.

 

[Blitz2006]

in the future, you might not have the option towards prescribing a lot of opioids. if current trends go forward, it might be only palliative care that prescribes chronic opioid therapy (outside of cancer pain).

a greater concern might be the focus on interventional pain management. we might not critique needle jockeys as much as pill pushers, but there are issues with this practice type and there may be further salary correction. it seems like injections help, but very few procedures have strong EBM suggesting long term benefit.


you should not be going in to pain medicine purely to make money. you should love the work, even if it is hard (tho the lifestyle will probably always be good). that being said, you will indubitably make enough to be in the top 2% of US salary, unless you are a completely incompetent.

if you want to make money, go into ortho.

I agree with everything you said.

But does ortho actually make that much more than pain? Here on the east coast, numbers I hear, its relatively comparable in the private practice world...

 

[Agast]

The opioid epidemic means primary care physicians are moving away from prescribing. If you have up a sign that says “pain management” that leaves you as a prescriber. Of course you don’t have to prescribe anything you don’t want to. However like most specialists, we do depend on some referrals from primary care physicians and if you refuse to help them when someone else is willing to, you’re not going to be an attractive referral partner. Put it this way: if you practiced the way you are hoping to, you would make about the same or less than the average anesthesiologist and you would likely find yourself with less vacation time.