Doing Pain or Anesthesia?

[sd287]

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With inflation, reimbursement cuts, and staffing costs since pandemic has anyone practicing considered going back to Anesthesia? Some of these rates are undeniably great. I'm still young, when I decided to do my pain fellowship the market was hot for outpatient pain jobs, now I see a trend for Anesthesia jobs, there is a definite shift happening and I am wondering if many people who are in pain are considering switching back? And if you are not switching back is it because you haven't done the anesthesia part in a while or because you think pain is still financially lucrative?

 

[lobelsteve]

There are PMR jobs for inpt that are 400k .
See PMR forum...

 

[jsammi245]

I feel like anesthesiologist who switched to pain medicine have switched due to multiple factors not just money. It is just a different field. Better hours, better lifestyle, no emergencies, no call, more freedom are just some of the reasons why my colleagues would never go back to anesthesia even if they are paid lower.

 

[drrosenrosen]

Anesthesia and pain are extremely different. Quality of life/hours is a funny metric. If you don't mind irregular hours - sometimes very long, sometimes short, sometimes having weekends off, sometimes not - I can see where anesthesia hours are better for some people. You'll never take a weekday off in pain without using vacation/PTO/losing money. You may quite frequently have weekdays off as an anesthesiologist - post call, precall, worked til 8 last night and got off at noon today, etc. Anesthesia jobs also almost always come with more weeks of vacation, because for better and worse, you are a cog in the machine. 8 weeks is quite common and 12 isn't unheard of. You'll often be working your ass off in the other 40-46 weeks, though.

Pain, you'll do 8-5, 5 days a week (or 5-9, if you're running your own shop). In an employed position, I've never seen more than 6 weeks off offered. As an owner/pure PP, you take off as much time as you can afford to take off. On the other hand, you'll never have to come in to the hospital in the middle of the night, or spend all Sunday doing "emergency" cases.

Pay at least as much attention to schedule and QOL as you do money. Lots of $$ with poor quality of life will probably not make you very happy in the long run.

 

[vit8bsm]

A large portion of pain docs are pain docs because they wanna be "minimally invasive surgeons" or surgeon-lite, and not take call for similar pay.

Being the #2 in the room for work and being bitched around sometimes is a blow to the ego after doing over a decade of education to do what you do.

350k to be able to say you're doing procedures in the OR and be the "big boss" in the room and no call & tell people youre an *interventionalist* of the spine VS 400k to do arguably less work but be the #2 and get told to adjust the patients bed by a god complex surgeon... you'd be shocked how many people would take the 350k.

 

[DrMDAware]

A large portion of pain docs are pain docs because they wanna be "minimally invasive surgeons" or surgeon-lite, and not take call for similar pay.

Being the #2 in the room for work and being bitched around sometimes is a blow to the ego after doing over a decade of education to do what you do.

350k to be able to say you're doing procedures in the OR and be the "big boss" in the room and no call & tell people youre an *interventionalist* of the spine VS 400k to do arguably less work but be the #2 and get told to adjust the patients bed by a god complex surgeon... you'd be shocked how many people would take the 350k.

I’m pain. I’m not a surgeon.

Buuuuuut it does feel nice to be the one that brings in the money. That’s an income generating asset - not an expense that could be cut by a lower bidder.

I’m not the big boss. I have a huge team that helps me.

I think the patient interactions are intriguing. I enjoy the anatomy and detective work. I like the challenges of a procedure. I like staying up to date on new procedures, techniques, and meds. Taking away pain can be magical. Making patients feel heard and cared for is nice. Helping them avoid surgery or after a surgery is meaningful.

Oh and the future of pain has much more room for innovation than anesthesia IMHO.

And not to mention the upsides of doing medico legal work, owning shares in an ASC, offering some cash procedures, etc are a nice upside.

Sure the slow nurses, opioid seeking patients, Medicare cuts, and prior auths are terrible, though.

 

[drpainfree]

everything has dark side and bright side. pick which side you prefer, not love

 

[TIVAndy]

12:30 am i am up sending email to my marketer, have constant HR headaches etc.
it's rewarding but business aspect is also a headache. i sometimes envy my friends (despite some weekends/calls) able to take 10 weeks off per year and make good living. sometimes i need a day behind the curtain..

 

[lobelsteve]

12:30 am i am up sending email to my marketer, have constant HR headaches etc.
it's rewarding but business aspect is also a headache. i sometimes envy my friends (despite some weekends/calls) able to take 10 weeks off per year and make good living. sometimes i need a day behind the curtain..

Best HR guy.

 

[Ronin1]

I personally hated OB call and the middle of the night crap. It gets old especially if you plan on a longish career. I do miss taking 3 weeks off and checking out from the practice which I can’t do in the pain world. You can make plenty of money with a pain practice.

 

[MitchLevi]

Pain is great, and I'd do it again.

Nothing more satisfying to me than a 72 yo F after a great RFA.

 

[cowboydoc]

Pain is great, and I'd do it again.

Nothing more satisfying to me than a 72 yo F after a great RFA.

You need to get out more.

 

[deleted875186]

Anesthesia is probably a better option for many now. In my area many have done pain fellowship but choose to do anesthesia.

Anesthesia pay is better (my area most everyone is hosptial employed both pain and anesthesia), schedule not that different as noted above, youget post call days off, you get more vacation.

Pain comes with office schedule, but multiple headaches, opioids, prior authorization, and with more and more limitations on procedures and the CDC potentially rolling back opioid guidelines, think the future is bleak.

 

[MitchLevi]

Anesthesia is probably a better option for many now. In my area many have done pain fellowship but choose to do anesthesia.

Anesthesia pay is better (my area most everyone is hosptial employed both pain and anesthesia), schedule not that different as noted above, youget post call days off, you get more vacation.

Pain comes with office schedule, but multiple headaches, opioids, prior authorization, and with more and more limitations on procedures and the CDC potentially rolling back opioid guidelines, think the future is bleak.

Future has been bleak for a long time.

 

[agolden1]

With inflation, reimbursement cuts, and staffing costs since pandemic has anyone practicing considered going back to Anesthesia? Some of these rates are undeniably great. I'm still young, when I decided to do my pain fellowship the market was hot for outpatient pain jobs, now I see a trend for Anesthesia jobs, there is a definite shift happening and I am wondering if many people who are in pain are considering switching back? And if you are not switching back is it because you haven't done the anesthesia part in a while or because you think pain is still financially lucrative?

I'm not as certain about the financial benefits of one over the other. Plenty of people on this board doing extremely well in pain over what partnered anesthesia folks are making. The biggest benefit to anesthesia seems like it would be the additional time off. All of my former coresidents have 6-10 weeks off and have lots of plans to put two-three of their weeks together for bigger international trips.

Maybe instead of doing a full switch, consider a 50:50 pain:anesthesia job or an academic position? There were a surprising number of these 50:50 gigs I found in my area that gave you the ability to do pain some of the time while living like an anesthesiologist. This did mean call, but also the random days where you get out super early as well. Problem was, none of them seemed to reimburse you appropriately for pain work done (I would've just been paid a flat salary, no bonus or incentive), and there were limited to no partnership opportunities (super partners only).