Currently in fellowship and hating it.....thoughts?

[stormtrooper123]

Hello all. It is not my intention to insult anyone here. I came to my pain management fellowship through anesthesia. It is not what I expected (or hoped, I guess). While I enjoy the procedures, especially SCS, there is so much of this fellowship I really don't like, including the tedious monotony of clinic (I hate doing H&P after H&P) and the chronic pain patients and their defeatist attitudes just bum me out.

I know some of the things I don't like about fellowship go away or get better after fellowship, (ie didactics, attendings contradicting/criticizing you, also most academic places see a disproponate number of medicaid/low income patient or patients with limited means where they can't afford the proper treatment and they are stuck in a semi-hopeless situation).

Sorry for the ranting, my question is does private practice pain get better? If so, is it that much better?
(This next question might be better suited for the anesthesia forum but...) has anyone here done a pain fellowship and just went right back to anesthesia? Does the fellowship make you a more attractive candidate for a GA job?

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[willabeast]

there are good jobs in pain and bad jobs in pain. same with anesthesia . your first job will probably be not that great unless you have some great connections.
the biggest change between fellowship+ residency vs. private world was that for me, coming from an upper middle class background, in PP i was seeing patients that i could relate to. this made all the difference in the world.

 

[Aether2000]

It depends on the practice. A high population of Medicaid or disability patients coupled with high dose opioids or polypharmacy of multiple sedating medications leads to a profoundly distasteful practice. On the other hand, a practice that does not prescribe opioids at all and has a steady stream of patients coming to you for diagnosis first (having had several faux diagnostic encounters) then treatment makes for a delightful practice. The H&P is no longer arduous or perfunctory. Armed with a large array of possibilities for each pain pattern, with the statistical knowledge of each diagnosis, and the physical exam with the nuances learned during training and honed during years of practice, pain medicine is more like solving a puzzle than drudgery. It is actually fun. The procedures become almost automatic because eventually you will learn so many tricks that it is rare you are unsuccessful in the delivery of the needle or leads, and for the most part are not really a challenge, nor are where I find the most satisfaction. Interacting with patients, engaging in expansive education with the use of models and illustrations, and arming them with knowledge about their own diagnosis is preventative of unnecessary, expensive, and failed procedures and surgeries. Developing a diagnostic/therapeutic algorithm on the initial visit for each patient becomes a roadmap for further visits and to help the patient understand the process. With the proper patient population, the joy of medical practice is sustained, and allows the doctor to tolerate a few extreme patients with significant and bizarre psychopathology, that becomes entertaining rather than oppressive.

 

[Stim4me]

Hello all. It is not my intention to insult anyone here. I came to my pain management fellowship through anesthesia. It is not what I expected (or hoped, I guess). While I enjoy the procedures, especially SCS, there is so much of this fellowship I really don't like, including the tedious monotony of clinic (I hate doing H&P after H&P) and the chronic pain patients and their defeatist attitudes just bum me out.

I know some of the things I don't like about fellowship go away or get better after fellowship, (ie didactics, attendings contradicting/criticizing you, also most academic places see a disproponate number of medicaid/low income patient or patients with limited means where they can't afford the proper treatment and they are stuck in a semi-hopeless situation).

Sorry for the ranting, my question is does private practice pain get better? If so, is it that much better?
(This next question might be better suited for the anesthesia forum but...) has anyone here done a pain fellowship and just went right back to anesthesia? Does the fellowship make you a more attractive candidate for a GA job?

Maybe, maybe, yes, and yes.... if you take a pain job via an anesthesia group you are likely to do less chronic management and split time in the OR. I think you will like that mix. Doesn't sound like you'd love solo pain and all it's challenges; patients and insurances...

 

[neutro]

there are good jobs in pain and bad jobs in pain. same with anesthesia . your first job will probably be not that great unless you have some great connections.
the biggest change between fellowship+ residency vs. private world was that for me, coming from an upper middle class background, in PP i was seeing patients that i could relate to. this made all the difference in the world.

?? what does upper middle class background have to do with understanding the pain patient? i would think the opposite is true in majority of the cases since the "at risk" population/ chronic pain sufferers are not from upper middle class. im curious, please explain.

 

[DrCommonSense]

Hello all. It is not my intention to insult anyone here. I came to my pain management fellowship through anesthesia. It is not what I expected (or hoped, I guess). While I enjoy the procedures, especially SCS, there is so much of this fellowship I really don't like, including the tedious monotony of clinic (I hate doing H&P after H&P) and the chronic pain patients and their defeatist attitudes just bum me out.

I know some of the things I don't like about fellowship go away or get better after fellowship, (ie didactics, attendings contradicting/criticizing you, also most academic places see a disproponate number of medicaid/low income patient or patients with limited means where they can't afford the proper treatment and they are stuck in a semi-hopeless situation).

Sorry for the ranting, my question is does private practice pain get better? If so, is it that much better?
(This next question might be better suited for the anesthesia forum but...) has anyone here done a pain fellowship and just went right back to anesthesia? Does the fellowship make you a more attractive candidate for a GA job?

I think you're experiencing the Medicaid and worst of the worst population.

I remember OB anesthesia where almost every woman was >320lbs in residency as well and wanted epidurals. It is what it is.

 

[DrCommonSense]

Hello all. It is not my intention to insult anyone here. I came to my pain management fellowship through anesthesia. It is not what I expected (or hoped, I guess). While I enjoy the procedures, especially SCS, there is so much of this fellowship I really don't like, including the tedious monotony of clinic (I hate doing H&P after H&P) and the chronic pain patients and their defeatist attitudes just bum me out.

I know some of the things I don't like about fellowship go away or get better after fellowship, (ie didactics, attendings contradicting/criticizing you, also most academic places see a disproponate number of medicaid/low income patient or patients with limited means where they can't afford the proper treatment and they are stuck in a semi-hopeless situation).

Sorry for the ranting, my question is does private practice pain get better? If so, is it that much better?
(This next question might be better suited for the anesthesia forum but...) has anyone here done a pain fellowship and just went right back to anesthesia? Does the fellowship make you a more attractive candidate for a GA job?

Also, every field has its major problems. In anesthesia that includes:

1) Disrespect from staff that don't really consider you a physician

2) Disrespect from CRNAs that think they can do your job without needing you and wonder why you even exist

3) Surgeons who push the envelope while taking sicker patients to the OR due to decreasing reimbursements to maintain their income. For instance, I was having to take 95 year old nursing home patients who were already immobile in wheelchairs to have TKR/THR by Ortho docs. These patients clearly weren't going to do well after surgery but the surgeons got them to the OR nonetheless. This is true of the critical AS patients, vasculopathic patients, uncontrolled BP patients, etc. Yeah in THEORY of anesthesia books you should "cancel" these cases but good luck with that if you want to remain employed long term. You can cancel a few of the really really egregious ones but you will have to continue forward with many others or lose your job while being on the hook for anything that goes wrong from a malpractice standpoint.

4) Selling out of most private practice groups to AMCs. This often happens while a new attending is on the partnership tract and never gets to see the golden land. PE/VC are on a warpath to lower salaries of anesthesiologists to pocket to the difference for investors.

5) Further attempts of the AANA to push for independence with a VERY MILITANT president of this organization largely saying "physicians are redundant" so they should go for a COLLABORATIVE model. This largely means the CRNA is equivalent to the physician with the physician getting the higher risk cases with minimal financial benefit. Imagine how the flood of these types of providers will change the salary structure in the future.


Pain has plenty of problems as well as you can see. However, you have to pick your poison in the future.

In the end of the day, both pain and anesthesia in the future will likely see significant decreases in salary compared to current levels.

So pick the one you can stand more.

 

[Taus]

See if you can spend a week or 2 with an alum of your fellowship at their private practice which aligns more with what you envisioned before starting fellowship.


I knew exactly what type of practice I wanted before fellowship. Fellowship gave me the skills I needed, but did not resemble the practice style I wanted.

Sent from my iPhone using SDN mobile app

 

[willabeast]

?? what does upper middle class background have to do with understanding the pain patient? i would think the opposite is true in majority of the cases since the "at risk" population/ chronic pain sufferers are not from upper middle class. im curious, please explain.

relate is not equal to understand. i understand the radical left in the USA, but i have difficulty relating to them. to put it another way - i belong to the Sierra Club. if i car pool with the Sierra Club i really have to watch out for all the discussion mines that could blow up - they are fervently anti - Trump for example and do not believe in dams on rivers for water storage. do not kid yourself - there are a lot of chronic pain patients in the middle class. after all, they are the ones with the insurance that gets them the back surgery that #$%&*&) them up to begin with.
relate

[ri-leyt]

• Synonyms
• Examples
• Word Origin

See more synonyms on Thesaurus.com
verb (used with object), related, relating.
1.
to tell; give an account of (an event, circumstance, etc.).
2.
to bring into or establish association, connection, or relation :
to relate events to probable causes.
verb (used without object), related, relating.
3.
to have reference (often followed by to).
4.
to have some relation (often followed by to).
5.
to establish a social or sympathetic relationship with a person orthing:
two sisters unable to relate to each other.

understand

[uhn-der-stand]

• Synonyms
• Examples
• Word Origin

See more synonyms on Thesaurus.com
verb (used with object), understood, understanding.
1.
to perceive the meaning of; grasp the idea of; comprehend:
to understand Spanish; I didn't understand your question.
2.
to be thoroughly familiar with; apprehend clearly the character, nature, or subtleties of:
to understand a trade.
3.
to assign a meaning to; interpret:
He understood her suggestion as a complaint.
4.
to grasp the significance, implications, or importance of:
He does not understand responsibility.
5.
to regard as firmly communicated; take as agreed or settled:
I understand that you will repay this loan in 30 days.
6.
to learn or hear:
I understand that you are going out of town.
7.
to accept as true; believe:
I understand that you are trying to be truthful, but you are wrong.
8.
to construe in a particular way:
You are to understand the phrase literally.
9.
to supply mentally (something that is not expressed).

 

[Timeoutofmind]

Hello all. It is not my intention to insult anyone here. I came to my pain management fellowship through anesthesia. It is not what I expected (or hoped, I guess). While I enjoy the procedures, especially SCS, there is so much of this fellowship I really don't like, including the tedious monotony of clinic (I hate doing H&P after H&P) and the chronic pain patients and their defeatist attitudes just bum me out.

I know some of the things I don't like about fellowship go away or get better after fellowship, (ie didactics, attendings contradicting/criticizing you, also most academic places see a disproponate number of medicaid/low income patient or patients with limited means where they can't afford the proper treatment and they are stuck in a semi-hopeless situation).

Sorry for the ranting, my question is does private practice pain get better? If so, is it that much better?
(This next question might be better suited for the anesthesia forum but...) has anyone here done a pain fellowship and just went right back to anesthesia? Does the fellowship make you a more attractive candidate for a GA job?

Stay the course.

Dont eval pain as a career choice until you have practiced for at least a year or two. Then, go back to the OR if you still dont like it.

See my thread on getting a good job in pain.

My current practice (first job out of fellowship) is totally different, in the most positive sense, from the type of practice setting of my fellowship. Biggest issue is: no/minimal narcs = reasonable people who want to get better. Narcs = a black hole of endless haggling with patients who never improve.

 

[Nivens]

It depends on the practice. A high population of Medicaid or disability patients coupled with high dose opioids or polypharmacy of multiple sedating medications leads to a profoundly distasteful practice. On the other hand, a practice that does not prescribe opioids at all and has a steady stream of patients coming to you for diagnosis first (having had several faux diagnostic encounters) then treatment makes for a delightful practice. The H&P is no longer arduous or perfunctory. Armed with a large array of possibilities for each pain pattern, with the statistical knowledge of each diagnosis, and the physical exam with the nuances learned during training and honed during years of practice, pain medicine is more like solving a puzzle than drudgery. It is actually fun. The procedures become almost automatic because eventually you will learn so many tricks that it is rare you are unsuccessful in the delivery of the needle or leads, and for the most part are not really a challenge, nor are where I find the most satisfaction. Interacting with patients, engaging in expansive education with the use of models and illustrations, and arming them with knowledge about their own diagnosis is preventative of unnecessary, expensive, and failed procedures and surgeries. Developing a diagnostic/therapeutic algorithm on the initial visit for each patient becomes a roadmap for further visits and to help the patient understand the process. With the proper patient population, the joy of medical practice is sustained, and allows the doctor to tolerate a few extreme patients with significant and bizarre psychopathology, that becomes entertaining rather than oppressive.

Just wanted to thank you for this post. Thumbs up.

 

[neutro]

relate is not equal to understand. i understand the radical left in the USA, but i have difficulty relating to them. to put it another way - i belong to the Sierra Club. if i car pool with the Sierra Club i really have to watch out for all the discussion mines that could blow up - they are fervently anti - Trump for example and do not believe in dams on rivers for water storage. do not kid yourself - there are a lot of chronic pain patients in the middle class. after all, they are the ones with the insurance that gets them the back surgery that #$%&*&) them up to begin with.
relate

[ri-leyt]

• Synonyms
• Examples
• Word Origin

See more synonyms on Thesaurus.com
verb (used with object), related, relating.
1.
to tell; give an account of (an event, circumstance, etc.).
2.
to bring into or establish association, connection, or relation :
to relate events to probable causes.
verb (used without object), related, relating.
3.
to have reference (often followed by to).
4.
to have some relation (often followed by to).
5.
to establish a social or sympathetic relationship with a person orthing:
two sisters unable to relate to each other.

understand

[uhn-der-stand]

• Synonyms
• Examples
• Word Origin

See more synonyms on Thesaurus.com
verb (used with object), understood, understanding.
1.
to perceive the meaning of; grasp the idea of; comprehend:
to understand Spanish; I didn't understand your question.
2.
to be thoroughly familiar with; apprehend clearly the character, nature, or subtleties of:
to understand a trade.
3.
to assign a meaning to; interpret:
He understood her suggestion as a complaint.
4.
to grasp the significance, implications, or importance of:
He does not understand responsibility.
5.
to regard as firmly communicated; take as agreed or settled:
I understand that you will repay this loan in 30 days.
6.
to learn or hear:
I understand that you are going out of town.
7.
to accept as true; believe:
I understand that you are trying to be truthful, but you are wrong.
8.
to construe in a particular way:
You are to understand the phrase literally.
9.
to supply mentally (something that is not expressed).

Thank you for your condescending and elitist reply and copy/pasting dictionary definitions from the first search you click on web. I fully understand now. How foolish of me to not understand the meaning of these basic words.
I'm not sure why Trump jumped into the conversation, but ok. Whatever floats your boat.
Congratulations on your upper middle class patients. Now from tomorrow onwards, go and also try to relate to the less fortunate ones.

 

[stormtrooper123]

Thanks everyone for their replies. I am encouraged. I spoke to a private practice guy who graduated from our fellowship and his experience is so different and awesome, I'm feeling a lot better. Willabeast, I get what you're trying to say, thank you. Have a great day everyone!!!

 

[lonelobo]

Thank you for your condescending and elitist reply and copy/pasting dictionary definitions from the first search you click on web. I fully understand now. How foolish of me to not understand the meaning of these basic words.
I'm not sure why Trump jumped into the conversation, but ok. Whatever floats your boat.
Congratulations on your upper middle class patients. Now from tomorrow onwards, go and also try to relate to the less fortunate ones.

Don't worry about him (Willi), he is cranky, tired, retired man

 

[EtherBunny]

Hello all. It is not my intention to insult anyone here. I came to my pain management fellowship through anesthesia. It is not what I expected (or hoped, I guess). While I enjoy the procedures, especially SCS, there is so much of this fellowship I really don't like, including the tedious monotony of clinic (I hate doing H&P after H&P) and the chronic pain patients and their defeatist attitudes just bum me out.

I know some of the things I don't like about fellowship go away or get better after fellowship, (ie didactics, attendings contradicting/criticizing you, also most academic places see a disproponate number of medicaid/low income patient or patients with limited means where they can't afford the proper treatment and they are stuck in a semi-hopeless situation).

Sorry for the ranting, my question is does private practice pain get better? If so, is it that much better?
(This next question might be better suited for the anesthesia forum but...) has anyone here done a pain fellowship and just went right back to anesthesia? Does the fellowship make you a more attractive candidate for a GA job?

My best advice to you is to take a job right out of fellowship that involves both anesthesia and pain medicine, then you can decide which direction to take with your career.

Unfortunately, chronic pain patients are a royal PITA to deal with on a daily basis. They gradually suck the life out of you. Catastrophizing and psychiatric disorders are rampant (to an annoying degree), but of course these patients have zero insight and they have no desire to actually tackle these issues. Many of them simply will not get better regardless of what you do. Arguments about opioid management are common and a source of burnout, especially if your clinical practice is truly evidence based (as there is a mounting body of evidence against the use of long term opioid therapy for chronic, nonmalignant pain). Good luck convincing patients to taper down or off opioids, after some jackass in the community put them on ridiculous doses. Get used to the lovely combo of benzos and opioids--the majority of referrals will be on both--which is yet another lovely conversation with patients about the danger (and stupidity) of concurrent use of these drugs. Expect to have that conversation several times a day. That gets old really fast.

Let's see, what are some other bad features of private practice...

--The documentation requirements are absurd, especially with Medicare and the wonderful rollout of MACRA/MIPS. As a fellow you're insulated from these things for the most part because your income doesn't depend on them. That changes completely when you become an attending.
--Insurance companies will become the bane of your existence. They literally dictate just about every aspect of your clinical practice. Local coverage determinations for procedures are arbitrary and constantly in flux. Deny, deny, deny is the name of the game. It's an absurd dynamic in which doctors try to milk the system anyway possible (to maintain their income in an era of declining reimbursement) and insurance companies try to boost their bottom line by restricting coverage.
--Sketchy/unethical practices are disturbingly common but hard to identify on the interview trail.
--failure rates for treatment are excessively high compared to your experience as an anesthesiology resident. In anesthesia you know that your anesthetic will go as planned 99.9% of the time; you know that your blocks will work nearly every time. Interventional pain is a different ball game. Good luck getting your success rates for procedures to the same level as OR anesthesia. If you're accustomed to success in clinical practice, the treatment failures can start to get to you after a while.

The positives?
--the sky is the limit on compensation. You can make as much money as you want, but you may have to compromise your sense of ethics if you want to earn in the 7 figure range.
--amazing/banker hours
--no in house call
--revenue generators for hospitals which gives you more leverage
--you have your own patients which can be a good thing


Just my two cents. Obviously I'm a bit burnt out from private practice, but I'm not alone. Many of my colleagues in interventional pain have decided to transition back to the ORs for these reasons, including one of my cofellows.

 

[epidural man]

Sounds like you are feeling better about fellowship.

I have trained a few fellows - and I become pretty good friends with most of them. And most of them - around this time - want to quit. It is an interesting phenomenon.

And most of them, stay, are glad - and end up doing 100% pain. All of them (that came from anesthesia) often have your question and think they will probably go back to anesthesia.

I think the practice you end up in will be a big decider.

In the end - don't quit. Get the skill. Get the piece of paper. That gives you higher ground to make decisions. That is always the goal, right?

 

[Hoya11]

Hello all. It is not my intention to insult anyone here. I came to my pain management fellowship through anesthesia. It is not what I expected (or hoped, I guess). While I enjoy the procedures, especially SCS, there is so much of this fellowship I really don't like, including the tedious monotony of clinic (I hate doing H&P after H&P) and the chronic pain patients and their defeatist attitudes just bum me out.

I know some of the things I don't like about fellowship go away or get better after fellowship, (ie didactics, attendings contradicting/criticizing you, also most academic places see a disproponate number of medicaid/low income patient or patients with limited means where they can't afford the proper treatment and they are stuck in a semi-hopeless situation).

Sorry for the ranting, my question is does private practice pain get better? If so, is it that much better?
(This next question might be better suited for the anesthesia forum but...) has anyone here done a pain fellowship and just went right back to anesthesia? Does the fellowship make you a more attractive candidate for a GA job?

PP gets worse. I liked my fellowship year. It was a super easy schedule and great procedures. Pain patients are pain patients. Whatever class they are from you have depressed, pathetic people. Id say I had basically the same folks in poor academic setting and rich PP setting.

The biggest thing for me that made me leave pain now that I look back on it is waking up in the morning with a sense of "how much can i make today and when can i get home". Is it Friday yet? Very rarely did i feel that i was doing something worthwhile medically. And that would probably be starting someone on neurontin with good effect. Small potatoes. Many times i felt that i was enabling terrible people. I think the idea of solving the mystery diagnosis with slick physical exam/diagnostic skills is just not a reality. Patients come to you for opiates and injections. Follow up with someone else.

I used to have the mindset of who cares what i do as long as i make a lot of money, this is a job.... but as corny as it sounds doing anesthesia makes me feel good inside and gives me a sense of purpose and authenticity that i didnt feel in pain, or i should say that pain made me appreciate. Is this what you went to med school for? Is this how you want to leave your mark?

 

[Timeoutofmind]

PP gets worse. I liked my fellowship year. It was a super easy schedule and great procedures. Pain patients are pain patients. Whatever class they are from you have depressed, pathetic people. Id say I had basically the same folks in poor academic setting and rich PP setting.

The biggest thing for me that made me leave pain now that I look back on it is waking up in the morning with a sense of "how much can i make today and when can i get home". Is it Friday yet? Very rarely did i feel that i was doing something worthwhile medically. And that would probably be starting someone on neurontin with good effect. Small potatoes. Many times i felt that i was enabling terrible people. I think the idea of solving the mystery diagnosis with slick physical exam/diagnostic skills is just not a reality. Patients come to you for opiates and injections. Follow up with someone else.

I used to have the mindset of who cares what i do as long as i make a lot of money, this is a job.... but as corny as it sounds doing anesthesia makes me feel good inside and gives me a sense of purpose and authenticity that i didnt feel in pain, or i should say that pain made me appreciate. Is this what you went to med school for? Is this how you want to leave your mark?

My experience of pain is totally different.

I just do what I think is right for patients period. What I would do if a family member came in.

I talk people out of stims and pumps even when they are sent for that if I don't think it's appropriate.

Sometimes our tools are not optimal, and we can't fix everyone or everything but I never feel shady or like it's all about the greenbacks.

If people just need psychosocial, weight loss, smoking cessation, wean opioids, get some exercise...I tell them that. I don't give those people opioids or injections.

Rarely any opioids. No disability.

I see less patients so that I can actually do a good job, and make less money.

I try to shoot the breeze with patients when I have time.

I don't enable anyone. I challenge a lot of people to help themselves.

I will wean anyone that comes in if they are willing, and once I take meds over it is a non optional wean we both agree to.

I take care of cancer patients.

I do educational talks for pcps. On hospital commitee that deals with perioperative morbidity. Helped set up lido infusion protocol.

I diagnose stuff every day that pcps miss. I clean up the messes that orthos make trying to manage pain. Patients are very grateful.

All other docs mostly suck at treating and diagnosing chronic pain.

I read all the time because it's a huge and challenging field.

Geniculars, SCS, even neuropathic meds are game changers for people.

U should tried a different practice setting before jumping ship.

 

[BobBarker]

Yes, I catch things all the time missed by PCPs. Late onset muscular dystrophy, epidural abscess, disc extrusions, and most recently a pheo.

 

[Ligament]

If you can be selective of the patients that are allowed to schedule with you, pain can be fantastic. I really like my job.

No disability, No medicaid, no controlled substances unless I personally start them (which is rarely), no attitude with staff or schedulers.

The worst part of my job is the government trying to snuff my business out at every turn in favor of the hospitals and insurance companies. Hopefully Trump will change that. Maybe...we'll see.

 

[Stim4me]

Private practice pain medicine offering comprehensive care and owning ones own business is the best gig in the world... maybe in the near future some of you will have the chances we had coming out of fellowship.

 

[Hoya11]

My experience of pain is totally different.

I just do what I think is right for patients period. What I would do if a family member came in.

I talk people out of stims and pumps even when they are sent for that if I don't think it's appropriate.

Sometimes our tools are not optimal, and we can't fix everyone or everything but I never feel shady or like it's all about the greenbacks.

If people just need psychosocial, weight loss, smoking cessation, wean opioids, get some exercise...I tell them that. I don't give those people opioids or injections.

Rarely any opioids. No disability.

I see less patients so that I can actually do a good job, and make less money.

I try to shoot the breeze with patients when I have time.

I don't enable anyone. I challenge a lot of people to help themselves.

I will wean anyone that comes in if they are willing, and once I take meds over it is a non optional wean we both agree to.

I take care of cancer patients.

I do educational talks for pcps. On hospital commitee that deals with perioperative morbidity. Helped set up lido infusion protocol.

I diagnose stuff every day that pcps miss. I clean up the messes that orthos make trying to manage pain. Patients are very grateful.

All other docs mostly suck at treating and diagnosing chronic pain.

I read all the time because it's a huge and challenging field.

Geniculars, SCS, even neuropathic meds are game changers for people.

U should tried a different practice setting before jumping ship.

Ive been in lots of different clinics. All injections, no injections, loose with opiates, no opiates. Posh and ghetto. There are some unavoidable common threads. No type of setup is as enjoyable to me as anesthesia is. Even a heavy block clinic, I just dont find it engaging. Giving old folks temporary relief from an inevitable disease? Not what Im looking for. More like something I would do part time if I retired. Different strokes for different folks and if the OP is feeling this way already (and clearly there is a significant subset of those who do a pain fellowship who then develop these feelings) then I would personally advise to finish the fellowship and look for a job with 100%anesthesia or a heavy anesthesia to pain mix. Even with an anesthesia gig a pain opportunity will present itself most likely even if only part time or rarely. Then as time goes on do as much or as little pain as you want. I definitely wouldnt leave the fellowship unless it was abusive to you which few are.

 

[DrCommonSense]

Ive been in lots of different clinics. All injections, no injections, loose with opiates, no opiates. Posh and ghetto. There are some unavoidable common threads. No type of setup is as enjoyable to me as anesthesia is. Even a heavy block clinic, I just dont find it engaging. Giving old folks temporary relief from an inevitable disease? Not what Im looking for. More like something I would do part time if I retired. Different strokes for different folks and if the OP is feeling this way already (and clearly there is a significant subset of those who do a pain fellowship who then develop these feelings) then I would personally advise to finish the fellowship and look for a job with 100%anesthesia or a heavy anesthesia to pain mix. Even with an anesthesia gig a pain opportunity will present itself most likely even if only part time or rarely. Then as time goes on do as much or as little pain as you want. I definitely wouldnt leave the fellowship unless it was abusive to you which few are.

So how often do you find all those fusion back surgeries that you do anesthesia for whereby those patients will be on high dosages of narcotic medications for life make you feel?

Or all those ortho surgeons who take the nursing home patients in to get knee/hip replacements despite being in a wheel chair?

How about all those anesthesia cases you do for arthroscopic knee surgeries or rotator cuff repairs?

On top of doing anesthesia on many patients whose surgeries will be neutral at best, you have a large segments of CRNAs who think you are a crook as an anesthesiologist and are strongly overpaid.

Most CRNAs consider you a crook that is getting paid for unnecessary supervision where they can do an equal job for less money. They consider you to use monopolistic practices to keep your salaries high due to crooked behavior.

Guess it's all in the eye of the beholder.

(Not to mention the 97 percent of stents for stable cad and vast majority of anesthetics for a fib ablations for stable afib patients)

 

[Aether2000]

I agree with DrCommonSense that anesthesia is primarily a necessary but technician job that provides the means for surgeons and endoscopists to provide procedures that may be unnecessary or have long term harms associated. Pain medicine involves a far wider array of diagnosis and therapies, and yes, is used to temporarily relieve suffering- one of the major reasons many of us became doctors. Both have their merits.

"We all must die. But that I can save him from days of torture, that is what I feel as my great and ever new privilege. Pain is a more terrible lord of mankind than even is death himself" Albert Schweitzer

 

[Stim4me]

So how often do you find all those fusion back surgeries that you do anesthesia for whereby those patients will be on high dosages of narcotic medications for life make you feel?

Or all those ortho surgeons who take the nursing home patients in to get knee/hip replacements despite being in a wheel chair?

How about all those anesthesia cases you do for arthroscopic knee surgeries or rotator cuff repairs?

On top of doing anesthesia on many patients whose surgeries will be neutral at best, you have a large segments of CRNAs who think you are a crook as an anesthesiologist and are strongly overpaid.

Most CRNAs consider you a crook that is getting paid for unnecessary supervision where they can do an equal job for less money. They consider you to use monopolistic practices to keep your salaries high due to crooked behavior.

Guess it's all in the eye of the beholder.

(Not to mention the 97 percent of stents for stable cad and vast majority of anesthetics for a fib ablations for stable afib patients)

Don't forget those late term D/c 's Gyns and anesthesia directors try to make you do during residency. That's eye opening ... apparently the Jewish residents and attending are immune . Yeah It happens

 

[DrCommonSense]

Don't forget those late term D/c 's Gyns and anesthesia directors try to make you do during residency. That's eye opening ... apparently the Jewish residents and attending are immune . Yeah It happens

Lets be honest here with Hoya who is pretending he is some high and mighty moralist that got into anesthesia due to ethics.

Lets check out the reality:

1) Anesthesiologists are literally the BITCH of the surgeons. So you will do the cases the surgeons will demand or you will be fired in the vast majority of cases (unless there is an extremely egregious case of medical problems). I remember plenty of very questionable cases where surgeons pushed me to take people to the OR where there was significant AS on ELECTIVE cases that should have never have gone. Plenty of anesthesiology colleagues performed these cases due to fear despite medical ethics. With decreasing reimbursements, surgeons are going to push the envelope and anesthesiologists will follow

2) Performing Anesthesiology for MANY cases whose procedures won't benefit the patient and will most likely make the patient worse. How many second and third fusion surgeries are you performing anesthesia for that will make the patient a CHRONIC narcotic using train wreck so that you can get paid? Where do you think so many of these narcotic train wrecks come from?

How many "ethical" anesthesiologists like Hoya are stepping up to avoid these cases and demanding the hospitals avoid taking them to the OR knowing full well that this is just going to get the surgeon money while the patient will be far worse off? Never seen them.

This is true for countless meniscus surgeries, arthroscopic surgeries, rotator cuff surgeries, ablations for Afib that is stable, etc where patients are literally exposed to toxic anesthesia (make no mistake, anesthesia is a TOXIN and not healthy to be exposed to, see all the studies on pediatric anesthesia) so that you can make extra money for the surgeons (and yourself) despite knowing FULL well that you will not be helping that patient. How many multiple hour prostate surgeries are you performing anesthesia for when long term studies show there is no benefit to the procedure in terms of mortality benefit for prostate CA?

I vividly remember the countless nursing home patients who were literally wheelchair bound with no hope of recovery getting THR/TKR while being exposed to anesthesia in their late 70s and up. Wonder the ethics in that.

You still did the cases because you wanted to get paid and didn't want to piss off the surgeons.

3) CRNAs claiming in 9 different studies (don't take my word for it, look at the AANA website that is pushed by the PRESIDENT of the AANA) that there is NO DIFFERENCE in outcomes between Anesthesiologists and CRNAs.

By this logic, Anesthesiologists are crooks that are abusing the CRNAs to literally just do phony supervision while taking half of the anesthesia payment for each case. They form a monopolistic cabal that artificially increases their wages to absurd levels on the back of CRNAs.

Don't believe this is being said? Just read the comments on ANY article discussing the issue from CRNAs:

http://www.crainsdetroit.com/articl...s-doctors-nurses-at-odds-over-anesthesia-care

http://www.freep.com/story/opinion/.../nurse-anesthetist-debate-continues/72187942/

Here is an article written in the HILL political journal about how Anesthesiologists are basically crooks who are gaming the system:

http://thehill.com/blogs/congress-blog/healthcare/309183-anesthesiologists-are-gaming-the-system


As to the "ethics" complaints against pain, lets look at them:

1) You aren't curing anything but just managing people temporarily: Where in medicine is anything being "cured"?

Does the Rheumatologist cure RA? Does the Neurologist cure MS? Does the cardiologist "cure" anything but putting stents in stable CAD, managing statins, ACE-Is, etc? Does the PCP cure diabetes?

Do the back surgeons "cure" anyone when they do fusion surgeries for spinal stenosis?

I can go on forever covering almost all disease states in medicine. Most of medicine isn't "curative"

The vast majority of physicians ultimately manage most conditions while never "curing" them. Maybe one day with regenerative medicine, we will be able to "cure" things as the science develops further. But make no mistake, the vast majority of physicians doesn't "cure" anything in ANY field.

2) "Pill Mills" are clearly ethically problematic (just like all the ethically problematic stuff that is going on in Anesthesiology), so we should be attempting to clamp down on these unscrupulous people. I think this has been going in the right direction. Many of the "pill mills" in Florida were run by PCPs, OB/GYNs, etc as well just to give perspective. The PCPs also still write the vast majority of narcotic meds in the country. IPM pain docs should be on the forefront towards attempting to minimize narcotic usage in the future and use alternative methods to manage patients

3) Procedures are "hit or miss": Newsflash, procedures are "hit or miss" in almost all of Orthopedics (outside of THR/TKR on HEALTHY MOBILE patients that are relatively young), very "hit or miss" for back surgeries with many getting far worse requiring high dosages of narcotic medications after surgeries, "hit or miss" when it comes to stents for CAD (97% of them with no evidence of mortality benefit), ablations of A-fib, the vast majority of CABGs for patients with normal EF, the insane number of C sections performed, etc.

The Kyphoplasty controversy really brought it to a head for me. I have definitely seen older patients who were taking narcotics/had a back brace/etc have almost instant relief of pain after the procedure was done while coming off narcotic meds for vertebral fractures. I have seen plenty of my patients doing well with SCS after failed back surgeries that has allowed them to reduce narcotic usage.

True, there are unethical practitioners in ALL of medicine with many procedurally oriented docs doing unnecessary stuff for money. It's the nature of the game in "fee for service".


In conclusion, it is very possible to have a fulfilling life and remain an ethical practitioner of medicine in pain.

 

[nimbus]

Lets be honest here with Hoya who is pretending he is some high and mighty moralist that got into anesthesia due to ethics.

Lets check out the reality:

1) Anesthesiologists are literally the BITCH of the surgeons. So you will do the cases the surgeons will demand or you will be fired in the vast majority of cases (unless there is an extremely egregious case of medical problems). I remember plenty of very questionable cases where surgeons pushed me to take people to the OR where there was significant AS on ELECTIVE cases that should have never have gone. Plenty of anesthesiology colleagues performed these cases due to fear despite medical ethics. With decreasing reimbursements, surgeons are going to push the envelope and anesthesiologists will follow

2) Performing Anesthesiology for MANY cases whose procedures won't benefit the patient and will most likely make the patient worse. How many second and third fusion surgeries are you performing anesthesia for that will make the patient a CHRONIC narcotic using train wreck so that you can get paid? Where do you think so many of these narcotic train wrecks come from?

How many "ethical" anesthesiologists like Hoya are stepping up to avoid these cases and demanding the hospitals avoid taking them to the OR knowing full well that this is just going to get the surgeon money while the patient will be far worse off? Never seen them.

This is true for countless meniscus surgeries, arthroscopic surgeries, rotator cuff surgeries, ablations for Afib that is stable, etc where patients are literally exposed to toxic anesthesia (make no mistake, anesthesia is a TOXIN and not healthy to be exposed to, see all the studies on pediatric anesthesia) so that you can make extra money for the surgeons (and yourself) despite knowing FULL well that you will not be helping that patient. How many multiple hour prostate surgeries are you performing anesthesia for when long term studies show there is no benefit to the procedure in terms of mortality benefit for prostate CA?

I vividly remember the countless nursing home patients who were literally wheelchair bound with no hope of recovery getting THR/TKR while being exposed to anesthesia in their late 70s and up. Wonder the ethics in that.

You still did the cases because you wanted to get paid and didn't want to piss off the surgeons.

3) CRNAs claiming in 9 different studies (don't take my word for it, look at the AANA website that is pushed by the PRESIDENT of the AANA) that there is NO DIFFERENCE in outcomes between Anesthesiologists and CRNAs.

By this logic, Anesthesiologists are crooks that are abusing the CRNAs to literally just do phony supervision while taking half of the anesthesia payment for each case. They form a monopolistic cabal that artificially increases their wages to absurd levels on the back of CRNAs.

Don't believe this is being said? Just read the comments on ANY article discussing the issue from CRNAs:

http://www.crainsdetroit.com/articl...s-doctors-nurses-at-odds-over-anesthesia-care

http://www.freep.com/story/opinion/.../nurse-anesthetist-debate-continues/72187942/

Here is an article written in the HILL political journal about how Anesthesiologists are basically crooks who are gaming the system:

http://thehill.com/blogs/congress-blog/healthcare/309183-anesthesiologists-are-gaming-the-system


As to the "ethics" complaints against pain, lets look at them:

1) You aren't curing anything but just managing people temporarily: Where in medicine is anything being "cured"?

Does the Rheumatologist cure RA? Does the Neurologist cure MS? Does the cardiologist "cure" anything but putting stents in stable CAD, managing statins, ACE-Is, etc? Does the PCP cure diabetes?

Do the back surgeons "cure" anyone when they do fusion surgeries for spinal stenosis?

I can go on forever covering almost all disease states in medicine. Most of medicine isn't "curative"

The vast majority of physicians ultimately manage most conditions while never "curing" them. Maybe one day with regenerative medicine, we will be able to "cure" things as the science develops further. But make no mistake, the vast majority of physicians doesn't "cure" anything in ANY field.

2) "Pill Mills" are clearly ethically problematic (just like all the ethically problematic stuff that is going on in Anesthesiology), so we should be attempting to clamp down on these unscrupulous people. I think this has been going in the right direction. Many of the "pill mills" in Florida were run by PCPs, OB/GYNs, etc as well just to give perspective. The PCPs also still write the vast majority of narcotic meds in the country. IPM pain docs should be on the forefront towards attempting to minimize narcotic usage in the future and use alternative methods to manage patients

3) Procedures are "hit or miss": Newsflash, procedures are "hit or miss" in almost all of Orthopedics (outside of THR/TKR on HEALTHY MOBILE patients that are relatively young), very "hit or miss" for back surgeries with many getting far worse requiring high dosages of narcotic medications after surgeries, "hit or miss" when it comes to stents for CAD (97% of them with no evidence of mortality benefit), ablations of A-fib, the vast majority of CABGs for patients with normal EF, the insane number of C sections performed, etc.

The Kyphoplasty controversy really brought it to a head for me. I have definitely seen older patients who were taking narcotics/had a back brace/etc have almost instant relief of pain after the procedure was done while coming off narcotic meds for vertebral fractures. I have seen plenty of my patients doing well with SCS after failed back surgeries that has allowed them to reduce narcotic usage.

True, there are unethical practitioners in ALL of medicine with many procedurally oriented docs doing unnecessary stuff for money. It's the nature of the game in "fee for service".


In conclusion, it is very possible to have a fulfilling life and remain an ethical practitioner of medicine in pain.

You guys are seriously doing total joints on immobile nursing home patients? What part of the country is this? 98 percent of our total knees and hips are walking on POD 0 or POD 1.

 

[SSdoc33]

Don't forget those late term D/c 's Gyns and anesthesia directors try to make you do during residency. That's eye opening ... apparently the Jewish residents and attending are immune . Yeah It happens

care to elaborate on that inflammatory racist remark?

 

[Stim4me]

care to elaborate on that inflammatory racist remark?

Only a troll like you would call a simple comment racist. Jewish residents typically defer on d/c surgeries for religious reasons. What's does your feeble mind not comprehend?
Best not to post when you have nothing to add. Ultimately that's your problem...

 

[lonelobo]

Funny how a lot of Surgeons' Bitches on these threads have bashed PMR.....

 

[Stim4me]

Funny how a lot of Surgeons' Bitches on these threads have bashed PMR.....

lmao, Robbin just showed up...

 

[lonelobo]

lmao, Robbin just showed up...

If there was any confusion you were one of those it was directed at " Surgeon Bitch"

 

[BobBarker]

Geez. You guys need to chillax.

 

[Stim4me]

If there was any confusion you were one of those it was directed at " Surgeon Bitch"

Whatever you say life sciences ... I don't think most of the PMR memebers on this forum would consider you a paragon of their profession.

 

[SSdoc33]

Only a troll like you would call a simple comment racist. Jewish residents typically defer on d/c surgeries for religious reasons. What's does your feeble mind not comprehend?
Best not to post when you have nothing to add. Ultimately that's your problem...

i have no idea what you are talking about with this comment. are you saying that jews dont like to take part in d/cs? jews are by and large "against" abortion? if so, thats news to me.

 

[Stim4me]

i have no idea what you are talking about with this comment. are you saying that jews dont like to take part in d/cs? jews are by and large "against" abortion? if so, thats news to me.

Yes, yes(strict Jewish persons), and yes a lot of things are news to you. That's why it's best to keep quiet , otherwise your meathead-troll tends to sabotage and close threads...

 

[lonelobo]

Disagree with Stim Nonsense=Troll

 

[neutro]

Being or not being a surgeon's bitch is completely dependent on the type of anesthesiologist and a person you are.
I know anesthesia doctors who are collaborative, respectful, and great with CRNAs - and will wiggle when they can and have to, and not wiggle when not and make sure that the surgeon understands it.
This is where knowledge, competence, and being able to defend your position becomes very important. Its not different in Anesthesiologist vs. surgeons, vs. Pain doctors vs. difficult patients.

 

[SSdoc33]

Yes, yes(strict Jewish persons), and yes a lot of things are news to you. That's why it's best to keep quiet , otherwise your meathead-troll tends to sabotage and close threads...

yeah. uh.... never learned that in hebrew school. maybe i should ask the rabbi. also im pretty sure i have a better handle on judaism than you.

you can be an angry troublemaker if you want, but dont expect to remain silent when you spout off your BS

 

[Hoya11]

Lets be honest here with Hoya who is pretending he is some high and mighty moralist that got into anesthesia due to ethics.

Lets check out the reality:

1) Anesthesiologists are literally the BITCH of the surgeons. So you will do the cases the surgeons will demand or you will be fired in the vast majority of cases (unless there is an extremely egregious case of medical problems). I remember plenty of very questionable cases where surgeons pushed me to take people to the OR where there was significant AS on ELECTIVE cases that should have never have gone. Plenty of anesthesiology colleagues performed these cases due to fear despite medical ethics. With decreasing reimbursements, surgeons are going to push the envelope and anesthesiologists will follow

2) Performing Anesthesiology for MANY cases whose procedures won't benefit the patient and will most likely make the patient worse. How many second and third fusion surgeries are you performing anesthesia for that will make the patient a CHRONIC narcotic using train wreck so that you can get paid? Where do you think so many of these narcotic train wrecks come from?

How many "ethical" anesthesiologists like Hoya are stepping up to avoid these cases and demanding the hospitals avoid taking them to the OR knowing full well that this is just going to get the surgeon money while the patient will be far worse off? Never seen them.

This is true for countless meniscus surgeries, arthroscopic surgeries, rotator cuff surgeries, ablations for Afib that is stable, etc where patients are literally exposed to toxic anesthesia (make no mistake, anesthesia is a TOXIN and not healthy to be exposed to, see all the studies on pediatric anesthesia) so that you can make extra money for the surgeons (and yourself) despite knowing FULL well that you will not be helping that patient. How many multiple hour prostate surgeries are you performing anesthesia for when long term studies show there is no benefit to the procedure in terms of mortality benefit for prostate CA?

I vividly remember the countless nursing home patients who were literally wheelchair bound with no hope of recovery getting THR/TKR while being exposed to anesthesia in their late 70s and up. Wonder the ethics in that.

You still did the cases because you wanted to get paid and didn't want to piss off the surgeons.

3) CRNAs claiming in 9 different studies (don't take my word for it, look at the AANA website that is pushed by the PRESIDENT of the AANA) that there is NO DIFFERENCE in outcomes between Anesthesiologists and CRNAs.

By this logic, Anesthesiologists are crooks that are abusing the CRNAs to literally just do phony supervision while taking half of the anesthesia payment for each case. They form a monopolistic cabal that artificially increases their wages to absurd levels on the back of CRNAs.

Don't believe this is being said? Just read the comments on ANY article discussing the issue from CRNAs:

http://www.crainsdetroit.com/articl...s-doctors-nurses-at-odds-over-anesthesia-care

http://www.freep.com/story/opinion/.../nurse-anesthetist-debate-continues/72187942/

Here is an article written in the HILL political journal about how Anesthesiologists are basically crooks who are gaming the system:

http://thehill.com/blogs/congress-blog/healthcare/309183-anesthesiologists-are-gaming-the-system


As to the "ethics" complaints against pain, lets look at them:

1) You aren't curing anything but just managing people temporarily: Where in medicine is anything being "cured"?

Does the Rheumatologist cure RA? Does the Neurologist cure MS? Does the cardiologist "cure" anything but putting stents in stable CAD, managing statins, ACE-Is, etc? Does the PCP cure diabetes?

Do the back surgeons "cure" anyone when they do fusion surgeries for spinal stenosis?

I can go on forever covering almost all disease states in medicine. Most of medicine isn't "curative"

The vast majority of physicians ultimately manage most conditions while never "curing" them. Maybe one day with regenerative medicine, we will be able to "cure" things as the science develops further. But make no mistake, the vast majority of physicians doesn't "cure" anything in ANY field.

2) "Pill Mills" are clearly ethically problematic (just like all the ethically problematic stuff that is going on in Anesthesiology), so we should be attempting to clamp down on these unscrupulous people. I think this has been going in the right direction. Many of the "pill mills" in Florida were run by PCPs, OB/GYNs, etc as well just to give perspective. The PCPs also still write the vast majority of narcotic meds in the country. IPM pain docs should be on the forefront towards attempting to minimize narcotic usage in the future and use alternative methods to manage patients

3) Procedures are "hit or miss": Newsflash, procedures are "hit or miss" in almost all of Orthopedics (outside of THR/TKR on HEALTHY MOBILE patients that are relatively young), very "hit or miss" for back surgeries with many getting far worse requiring high dosages of narcotic medications after surgeries, "hit or miss" when it comes to stents for CAD (97% of them with no evidence of mortality benefit), ablations of A-fib, the vast majority of CABGs for patients with normal EF, the insane number of C sections performed, etc.

The Kyphoplasty controversy really brought it to a head for me. I have definitely seen older patients who were taking narcotics/had a back brace/etc have almost instant relief of pain after the procedure was done while coming off narcotic meds for vertebral fractures. I have seen plenty of my patients doing well with SCS after failed back surgeries that has allowed them to reduce narcotic usage.

True, there are unethical practitioners in ALL of medicine with many procedurally oriented docs doing unnecessary stuff for money. It's the nature of the game in "fee for service".


In conclusion, it is very possible to have a fulfilling life and remain an ethical practitioner of medicine in pain.

There is definitely some genuine good done in IPM and by IPM docs. And though some are unethical, I certainly dont think all are (of course definitions may vary). You have to admit though that there are many board certified pain docs who voluntarily left it behind for the OR with similar feelings to myself and the OP. Are they all just confused and need to read your essay above? I think you need to recognize that OPs feelings are common and legitimate. If you are not really loving your pain fellowship then I wouldnt do 100% pain. I would definitely keep the door open to anesthesia with a mix if any pain. All Im trying to say is, do what makes you happy. If your not happy doing pain in fellowship, you probably feel like me and some others, so get back in the OR and do what works for you. It doesnt mean the guys who stay and do pain are sleazy, its just not for me.

 

[neutro]

There is definitely some genuine good done in IPM and by IPM docs. And though some are unethical, I certainly dont think all are (of course definitions may vary). You have to admit though that there are many board certified pain docs who voluntarily left it behind for the OR with similar feelings to myself and the OP. Are they all just confused and need to read your essay above? I think you need to recognize that OPs feelings are common and legitimate. If you are not really loving your pain fellowship then I wouldnt do 100% pain. I would definitely keep the door open to anesthesia with a mix if any pain. All Im trying to say is, do what makes you happy. If your not happy doing pain in fellowship, you probably feel like me and some others, so get back in the OR and do what works for you. It doesnt mean the guys who stay and do pain are sleazy, its just not for me.

yeah, but i planned my life in a way which allows me to drop off my kids to school in the morning before i go to clinic if i wanted, come back home on my own time, be my own boss and never be on call, and have weekends off for similar, if not more pay.
they both have different challenges. anesthesia just has a higher burn out rate.
intubation in ICU and epidurals on 400 lb patients at 2 am vs. Cervical Epidurals for pain - meh, they can be both challenging/annoying...but i would pick pain injections and crazy outpatient patients any day because its done on my time and totally under my control without ay pressure. and honestly, once you know and understand the pain patient and have a treatment plan in place - its really not that hard to follow up and adjust your treatment plan.
Thats what it boils down to - for me, the autonomy and some sort of control over my life was the deciding factor vs. being told which day and weekend i would be on call.

to each his own.

 

[Stim4me]

yeah. uh.... never learned that in hebrew school. maybe i should ask the rabbi. also im pretty sure i have a better handle on judaism than you.

you can be an angry troublemaker if you want, but dont expect to remain silent when you spout off your BS

Really, because we had a lot of issues with d & c' s and Jewish attendings and residents willing to do cases. But I guess you know everything about anesthesia training, surgical cases, and residency issues.

My guess is that you and meathead and carribean boy have no clue how complex and challenging the field of anesthesia is. To call anesthesiologists surgical bitches is ridiculous and asinine. You and your following of two have no idea what you lack in knowledge and that's scary... even worse is that you make your peers and field look pathetic.

 

[lobelsteve]

https://www.google.com/url?sa=t&sou...KV0DzNGoJ7mBDf7pQ&sig2=1V5roKYyL7FQNTSfpJkVvA


Your comment appeared more anti semitic than factual. Dont go there.

 

[Stim4me]

https://www.google.com/url?sa=t&sou...KV0DzNGoJ7mBDf7pQ&sig2=1V5roKYyL7FQNTSfpJkVvA


Your comment appeared more anti semitic than factual. Dont go there.

Your post doesn't address orthodox Jewish anesthesiologists refusing elective d/e procedures. What It does show is that most gyns are anti abortion, and gyns tend to be
much more liberal than anesthesiologists in terms of women's rights to reproductive care. So imagine a major academic anesthesia department with many conservative Orthodox Jews reassigning cases to avoid ethical conflict. Not so say this can't happen in an extremely catholic academic anesthesia department as well. There is no racist tone here, I love Jewish people, it's just a real issue anesthesia has to deal with that 2-3 rogue PMR bloggers just cant understand. Won't even delve into euthanasia/death penalty and anesthesia.

As for Orthodox Jews and rabbis and abortion , read up, interesting stuff. Trend is to more conservatism .... we see this in medicine as well.

http://www.slate.com/articles/news_...thodox_jews_think_about_abortion_and_why.html

 

[Hoya11]

yeah, but i planned my life in a way which allows me to drop off my kids to school in the morning before i go to clinic if i wanted, come back home on my own time, be my own boss and never be on call, and have weekends off for similar, if not more pay.
they both have different challenges. anesthesia just has a higher burn out rate.
intubation in ICU and epidurals on 400 lb patients at 2 am vs. Cervical Epidurals for pain - meh, they can be both challenging/annoying...but i would pick pain injections and crazy outpatient patients any day because its done on my time and totally under my control without ay pressure. and honestly, once you know and understand the pain patient and have a treatment plan in place - its really not that hard to follow up and adjust your treatment plan.
Thats what it boils down to - for me, the autonomy and some sort of control over my life was the deciding factor vs. being told which day and weekend i would be on call.

to each his own.

no argument there. pp pain definitely has an easier schedule and less pressure.

 

[Stim4me]

no argument there. pp pain definitely has an easier schedule and less pressure.

Depends on if youre actually running the practice, contract negotiating, managing HR, accounting, disputes, appeals, etc. actually more work than academics in a lot of ways. Not 9-5 as some think.

 

[Stim4me]

https://www.google.com/url?sa=t&sou...KV0DzNGoJ7mBDf7pQ&sig2=1V5roKYyL7FQNTSfpJkVvA


Your comment appeared more anti semitic than factual. Dont go there.

"Magic temple" a racist comment based on your definitions? Quick to support friends aren't we?

 

[Ducttape]

we really should not be denigrating each other. as a profession, we should be supporting each other and embracing the differences we all bring to this profession of pain. each primary specialty adds something unique and advantageous to the overall practice.

but just ask yourself - how many of you would willingly undergo an invasive surgical procedure - regardless of type, whether it is a fusion, knee surgery, appy, mastectomy, fracture stabilization/reduction - without an anesthesiologist, and just some surgeon who took a weeknight course on moderate sedation....

 

[Stim4me]

we really should not be denigrating each other. as a profession, we should be supporting each other and embracing the differences we all bring to this profession of pain. each primary specialty adds something unique and advantageous to the overall practice.

but just ask yourself - how many of you would willingly undergo an invasive surgical procedure - regardless of type, whether it is a fusion, knee surgery, appy, mastectomy, fracture stabilization/reduction - without an anesthesiologist, and just some surgeon who took a weeknight course on moderate sedation....

Well said. Truce ..

 

[Disciple]

care to elaborate on that inflammatory racist remark?

Sounds like he's saying that based on his experience, Jewish attendings/residents are often given leeway to decline to participate in late term D&Cs, where others are not.

Don't know whether that's true or not, but don't think it's a racist statement.