Fellowships

[twoliter]

So after a month of agonizing (or so it seemed) self-debate between doing a fellowship in Pain Management or one in Cardiothoracic, I "decided" on Pain Management. Now, after I've sent off all my applications (before some programs are even accepting them) I'm back to having second thoughts.
The advice I've been given has been limited to attending from academia and fellow residents/fellows.
So do any of you in private practice have any insight? For those of you who have not done a fellowship, would you recommend doing one in either of those fields? Or if you did a CT or Pain fellowship, are you glad you took that route?
I know "it all depends on what you want to do," but choosing a fellowship in anesthesia is done with only limited exposure to each field. I actually wanted to do Pain since before I actually started anesthesia, but once I started CA-1 year, I fell in love with the OR part of anesthesia. So I don't want to give up on that, i.e., I still want to be in the OR 1-2 days per week. I also would love to be board certified in TEE. Both are reasons that point toward CT. But I also think the procedures that Pain docs have the opportunity to do are awesome. I like the idea of having my own clinic (probably one of the weaker reasons). I'm considering just going ahead and applying to a few CT programs and decide after interviews (and before the CT ROL is due).
I'll hang up and listen.

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[bonesmd]

If you do pain, you will probably have to decide between having your own clinic(if you mean owning a practice) and doing days in the OR. Owning your own pain practice vs. being in a group that provides pain and OR staffing.

 

[ssmallz]

These are great questions but at the heart of choosing pain vs cardiac you need to ask yourself a simple question. Where do you see yourself in 10 years? Do you want to be in the OR all the time or just some of the time? Do you like taking care of patients long term? Do you enjoy being a traditional diagnose, treat, reevaluate physician with varying degrees of success or do you like the instant gratification and minimal follow up of OR anesthesia? Do you need to have stable hours in your life or are you ok with long days and short days, nights weekends, and holidays? You should already have an idea of these questions based on your Ca-1 year in anesthesia and your med school/internship rotations rotating through clinics and IM.

Pain is way more like FP then anesthesia and you need to have the personality for it. One of the reasons med student choose anesthesia is because of the instant gratification and lack of follow up you can find in that specialty. BP down? Give pressor....bp up in 1 minute. Annoying patient? Give propofol, pt sleeping. Knee hurts? do a block, pain gone, pt home no longer your problem. Simple and reliable. Chronic pain is anything but that. You give drugs and procedures to patients that may or may not work. You will have way more failures than successes and the underlying disease can be very difficult to treat b/c of the significant psycho-social factors that contribute to chronic pain (E.g. Obesity or depression) and until your patient wants to get better you can't treat the root cause of their pain

In your original post you mentioned about how you wanted to own a clinic and that this is a weaker reason to go into pain. I disagree that this is a weak reason at all and feel it is an excellent reason to choose pain. As anesthesiologist you will have minimal opportunity to own much of anything and the environment is 24/7/365. Pain offers a much more stable lifestyle and is something to take into account when choosing between the 2. If your heart is set on being your own boss or owning a clinic, the OR may not be the right environment to spend the next 30 years of your life.

For me it was the right decision for my personality and skillset. I'm a much happier person now that I pursued a pain fellowship and feel I've finally found my professional calling. At the end of the day every person is different so I'd ask you or any perspective pain applicant to reread my first paragraph a few times. Write down the questions and answer them honestly. It should give you at least a starting point to figure out if you want to do traditional OR anesthesia or pursue a pain fellowship. Hope this helps

 

[BobBarker]

Pain. I'm going to start my fellowship in July. I'm a rural guy and rural hospitals actually want pain doctors. I will have a contract signed for a great gig months before I even start my fellowship.