FM trained with Addiction Medicine Fellowship trained?

[markglt]

Any FM docs out there that do primarily addiction medicine, after doing a fellowship in addiction medicine that would like to share their experience...ie: life style, hours, salary, job satisfaction??

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[cabinbuilder]

Any FM docs out there that do primarily addiction medicine, after doing a fellowship in addiction medicine that would like to share their experience...ie: life style, hours, salary, job satisfaction??

If you practice in rural parts of the country it seems half of the patients are addicted to something anyway. These people really try your patience and don't really want to help themselves, only want the pills. Not sure why you would want to do a fellowship? After inheriting a practice where the narcotic of choice was methadone because it's cheap and that's what medicaid will pay for, I got the hell out of there quickly. Very scary place.😱

 

[ghost dog]

If you practice in rural parts of the country it seems half of the patients are addicted to something anyway. These people really try your patience and don't really want to help themselves, only want the pills. Not sure why you would want to do a fellowship? After inheriting a practice where the narcotic of choice was methadone because it's cheap and that's what medicaid will pay for, I got the hell out of there quickly. Very scary place.😱

I think we as docs need to take some responsibility for the iatrogenic factor here in scripting out narcs - we have some "skin in the game" starting a lot of these high risk pts on opioids.

Just say no.

On the flip side of this : an opioid maitenance program ( i.e. methadone or suboxone) can be very helpful for some pts. However, this population can be extremely challenging, particularly at the start of treatment. Their lives are a mess.

 

[cabinbuilder]

I think we as docs need to take some responsibility for the iatrogenic factor here in scripting out narcs - we have some "skin in the game" starting a lot of these high risk pts on opioids.

Just say no.

On the flip side of this : an opioid maitenance program ( i.e. methadone or suboxone) can be very helpful for some pts. However, this population can be extremely challenging, particularly at the start of treatment. Their lives are a mess.

I TOTALLY AGREE WITH YOU. There are far too few of us who will not use the word NO and are worried about losing patients. There will always be others and those who push. Some folks do very well and have to have pain mgmt since surgery is not an option but for many it's just a game to see how much they can get to supplement income by selling on the street.

 

[ghost dog]

I TOTALLY AGREE WITH YOU. There are far too few of us who will not use the word NO and are worried about losing patients. There will always be others and those who push. Some folks do very well and have to have pain magmt since surgery is not an option but for many it's just a game to see how much they can get to supplement income by selling on the street.

Yup.

This is a very challenging population, and not a "5 minute visit". However, they are typically a quick visit if opioids are dispensed.

I find people fall broadly into 3 (over simplified) categories:

1. Low risk, and opioid responders.

2. moderate risk, and " questionable responders." (i.e their written pain scores remain virtually the same on multi-dimensional pain assessment tools, yet they verbally state significant relief, and increased functional ability - but aren't working).

3. High risk, and opioid non-responders.

1 + 3 are no brainers for me. However, category 2 is where a lot of docs fumble the ball.

 

[markglt]

my plan...out west.. az, nevada, nm,....
urgent care and medical director of private rehab country club drug facility
s/p FM residency with a fellowship in addiction medicine..
anybody have expericnce doing anything like this..
lifetstyle...
slary...
thoughts, comments questions.....welcomed

 

[cabinbuilder]

my plan...out west.. az, nevada, nm,....
urgent care and medical director of private rehab country club drug facility
s/p FM residency with a fellowship in addiction medicine..
anybody have expericnce doing anything like this..
lifetstyle...
slary...
thoughts, comments questions.....welcomed

Disclaimer: I am not trying to be mean in my comment below. But you have no idea how many fights I have had with narcotic seekers and how many I have kicked out of my office for non-compliance and lying underhanded crap.

OMG, I am reading this today and I showed another colleague as we are doing urgent care here in West Texas. I honestly have to say that we both laughed. You will last maybe one day doing pain managment unless you don't have a conscience. The druggies will come out in droves with their anger, their rotting teeth, their guns, their knives. DOn't forget all the 20+ folks who claim back pain who want the marijuana card and disability so they don't have to work the rest of their lives. Maybe if you wanted to do something with the movie stars in Beverly Hills but currently the DEA is really cracking down on the amount of narcs that go against your DEA license. IMO, anyone who gets out of residency with the intent to go into addiction medicine is someone who won't be doing it very long.

 

[markglt]

well...im used to being laughed at in person, but over the internet...jeez.
anyways, i would be doing urgent care in one setting and then medical director of a private rehab at another location. i wont be a pain doc. i'll be an inpatient private pay medical director. hence, no druggies searching....
just patients wanting to get off drugs...

 

[cabinbuilder]

Sorry, don't mean to be such a bitch, just getting off of a 15 hr shift in urgent care where half of my day has just been stupid crap. I totally could not see doing drug addicts all day every day with their manipulative ways. Just saying. Of course my opinion is not yours and you should not take what anyone says as a reason for you to not do what you feel is right for you. Trust me I was laughed at plenty for want to be a doctor, being a mom, being in FP, etc etc etc. It never ends. Do what's best for you but I highly doubt you have many who will support your choice.

 

[markglt]

a medical director doesnt spend all day with drug addicts at a rehab facility.. they work them up and do medication managment. the clinical team is responsible for the majority of their care.

 

[F0nzie]

I'm a psych resident and even in psychiatry where a huge portion of our population are addicts, very few residents pursue a field in addiction.

I think it's a fascinating field. I can't imagine working with addicts without my psych training though. That's where your fellowship training will come in handy.

 

[simpler2]

It sounds like there is some confusion between patient's seeking addiction treatment and those seeking narcotics. Patient's looking for treatment for addiction can be challenging but are largely MUCH less annoying than those with dependence seeking narcotics. I will take a new consultation for Buprenorphine over chronic pain pt any day.

There is a good amount of addiction medicine going on in my area and very few fellowship trained docs providing it. If you want to provide this care a fellowship is definitely NOT necessary as you likely wont be competing too much for jobs. The fellows I have met do so more because the have passion for the research and learning about the neurotransmitters/pharmacology/etc behind the disease.

The providers at our area inpatient rehab/detox facility have a very relaxed schedule, 40hr max work week, can work hours that they please, get to work with learners, treat many somatic diseases as well. I didn't ask salary but I'm sure its on the low end 120-150s

 

[AddictionDoc]

I'm actually an addictions counselor close to finishing my masters degree, considering Addiction Medicine as a next step. I love this field, although it is very, very challenging working with addicts, I agree. There is a considerable difference working with people who are active in their addiction versus an individual in recovery or with some clean/sober time under their belt. Those who are active are going to be engaging in doctor-searching/drug-seeking behavior. It's just part of the symptomatology of the disease of addiction, as annoying as it can be.