Financially worth it to do a Pain fellowship?

[mymembernames]

With MGMA data showing salaries close to 1 million for folks earning above the 75 percentile is it worth doing a Pain fellowship if you think you will enjoy it? Is it mostly because of interest in psychiatry that most psychiatry residents don't take this path?

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[TexasPhysician]

It is a much harder route to land a pain fellowship from psychiatry. If you are pre-residency, you would be better off starting in anesthesia.

Financially it would be rewarding if only comparing apples to apples, but there are psychiatrists that earn more per hour.

 

[psyguru]

Financially forensics is a good option. Find a low volume salaried clinical job and do forensic cases on the side. Forensics, when you do get work, pays 2 to 3 times per hour wht you would get clinically.

If you do go the pain route, consider doing expert witness work which would pay more.

I think there r 2 psych based pain fellowships.

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[Drrrrrr. Celty]

Can a psychiatrist who does a pain fellowship do procedures though? Like spinal anesthesia or nerve blocks? Or is essentially a drug management specialty for them?

 

[Stagg737]

Can a psychiatrist who does a pain fellowship do procedures though? Like spinal anesthesia or nerve blocks? Or is essentially a drug management specialty for them?

Legally yes. Technically a psychiatrist can legally perform open heart surgery as they're a licensed physician. The ethics and practicality is a completely different argument, but I'd guess that if their fellowship trained them in it they could practically do those procedures.

 

[Drrrrrr. Celty]

Legally yes. Technically a psychiatrist can legally perform open heart surgery as they're a licensed physician. The ethics and practicality is a completely different argument, but I'd guess that if their fellowship trained them in it they could practically do those procedures.

I mean practically though? Like can they get certified and bill for it? And would they be really trained for it?

 

[Stagg737]

I mean practically though? Like can they get certified and bill for it? And would they be really trained for it?

You don't need to be certified. If you can open up your own practice you could certainly bill for it. The practicality of doing it in an employed setting would depend on the training though, which would require the answer to your last question (which I don't know).

 

[TexasPhysician]

I mean practically though? Like can they get certified and bill for it? And would they be really trained for it?

Yes. This is partially why psych has a very hard time getting into the field. We are very behind procedurally. A good applicant should find a way to do electives with a procedural field or volunteer with other fields, etc.

 

[FlowRate]

Can a psychiatrist who does a pain fellowship do procedures though? Like spinal anesthesia or nerve blocks? Or is essentially a drug management specialty for them?

One of our residents got into our (typically anesthesia) pain fellowship a few years back. I'm pretty sure he learned all the same procedures.

 

[SeniorWrangler]

If you do an ACGME pain fellowship, then you're expected to do procedures just like every other fellow, and there may be some things that you just don't want to do (some pain procedures -- the really lucrative ones -- are basically small neurosurgical procedures). You still have to deal with prejudice against psychiatrists in an anesthesia-dominated field. If you are interested in this kind of thing, it is highly recommended to spend some time doing pain-related care (acute pain service, pain procedures, rehab) and doing reading ahead of time, and if at all possible get some practice time (on simulators or cadavers, not patients) before you start. Buying beers for current pain fellows may help.

Also, note that MGMA compensation for pain is about 100K higher for anesthesia than all non-anesthesia, which still includes PM&R, the other big pain specialty.

 

[dl2dp2]

It is a much harder route to land a pain fellowship from psychiatry. If you are pre-residency, you would be better off starting in anesthesia.

Financially it would be rewarding if only comparing apples to apples, but there are psychiatrists that earn more per hour.

This is a salient point. I rotated in a outpatient pain clinic as part of my training. They do a lot of procedures, but depending on the context a subspecialist in psychiatry may get paid more, and this would not be an unusual situation, especially on a per hour basis. And it's much less repetitive imho. So the original question is difficult to answer.

 

[mymembernames]

This is a salient point. I rotated in a outpatient pain clinic as part of my training. They do a lot of procedures, but depending on the context a subspecialist in psychiatry may get paid more, and this would not be an unusual situation, especially on a per hour basis. And it's much less repetitive imho. So the original question is difficult to answer.

Is this for all psych subspecialties? Specific one?

 

[dl2dp2]

Is this for all psych subspecialties? Specific one?

This is asked on the forum frequently. Most bang for your buck fellowship is child, followed by addiction/forensics. Sleep is also mentioned, though lately that field is suffering somewhat on the reimbursement side. However, if you do any of these fellowships for money it'll be pretty stupid. A lot of child trained psychiatrists don't do any child. A lot of child psychiatrists get paid squat for working in public settings.

Depending on what type of applicant you are (i.e. top school/top grade etc) vs. average vs. lower tier, psychiatry residency placement often has more effect on salary, though even that intuition comes with lots of caveats. The main difference in psychiatrist pay is ownership structure and schedule. I'd say as a run of the mill applicant, choosing the two fields (psych/anesthesia) based on pay would be unwise, because if you work the same amount the pay may be similar. At the high end, I think high end cash pp subspecialty psych is much more of a lifestyle specialty than general anesthesia (have good friends in this field), even pain (which is in itself considered more lifestyle within anesthesia). Group pain practices, for example, often require call. Though I suspect the ceiling is higher in pain--kind of like derm has a lower ceiling but is probably more of a lifestyle specialty than pain.

As a general rule in medicine, highest ceiling salaries deal with procedure specialties that carry high overhead/facilities fee/ownership and passive income (large teams, larger billings, etc). Best lifestyle specialties deal with very small niche populations that are usually well off and small clinical teams.

 

[mymembernames]

This is asked on the forum frequently. Most bang for your buck fellowship is child, followed by addiction/forensics. Sleep is also mentioned, though lately that field is suffering somewhat on the reimbursement side. However, if you do any of these fellowships for money it'll be pretty stupid. A lot of child trained psychiatrists don't do any child. A lot of child psychiatrists get paid squat for working in public settings.

Depending on what type of applicant you are (i.e. top school/top grade etc) vs. average vs. lower tier, psychiatry residency placement often has more effect on salary, though even that intuition comes with lots of caveats. The main difference in psychiatrist pay is ownership structure and schedule. I'd say as a run of the mill applicant, choosing the two fields (psych/anesthesia) based on pay would be unwise, because if you work the same amount the pay may be similar. At the high end, I think high end cash pp subspecialty psych is much more of a lifestyle specialty than general anesthesia (have good friends in this field), even pain (which is in itself considered more lifestyle within anesthesia). Group pain practices, for example, often require call. Though I suspect the ceiling is higher in pain--kind of like derm has a lower ceiling but is probably more of a lifestyle specialty than pain.

As a general rule in medicine, highest ceiling salaries deal with procedure specialties that carry high overhead/facilities fee/ownership and passive income (large teams, larger billings, etc). Best lifestyle specialties deal with very small niche populations that are usually well off and small clinical teams.

Thanks! I’m leaning towards just doing general psych (no fellowship)


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[SmallBird]

One of our residents got into our (typically anesthesia) pain fellowship a few years back. I'm pretty sure he learned all the same procedures.

One of my co-residents did the same. They had to work hard, but got competent at all the procedures. They were much better than the anesthesia residents at history taking and writing notes, which helped a little it seems. They make a lot of money now!