General vs Interventional Pain

[rax]

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Hi,

I am currently an Anesthesiology resident and I am trying to make some tough decisions. I would appreciate your advice.

So far I have enjoyed my OR work and I don't see myself getting sick of it or anything. At the same time, I really enjoyed my pain rotation. I am fine with the clinic time, being a bit of a people person in general, but I have especially enjoyed the procedures.

It seems that a lot of the older residents and young attendings I meet are really pushing the idea of a fellowship. They feel it helps land a job and provides long-term job security against the cRNA encroachment.

Would you recommend a pain fellowship for someone like me?

How would doing a pain fellowship affect future career potential/salary/hours/etc versus doing general? (I am really not too interested in moving to the midwest or anything, if that information is useful.)

And which area has a brighter future ahead (obviously speculative, but still curious) with the healthcare changes on the horizon?

Thanks!

 

[pastafan]

The future looks discouraging for us all. This is a difficult decision and the pro/cons would take hours to list. Find what area you believe will make you happiest and pursue your choice. Good luck to you...

 

[rax]

Thanks for your reply.

I appreciate the reminder to "do what you love" because I agree that is the most important thing. That is also why I am the most confused because my enjoyment really is the same between these areas. I think other factors would be helpful to consider to make my decision, but I feel very naive about the real world of each of these fields and how they compare. Any additional ideas shared here would be very appreciated.

 

[gasattack3]

Picking whether to do a fellowship and then which fellowship can be tough. I'm currently a CA2 who was going to do CT but now plan on applying to Pain. I've also been, frankly, on the fence about doing a fellowship in the first place. I don't really plan on being in a major "urban center" and thus there are what I think good jobs still in those places.

I don't think our future needs to be looked upon as grimly as some here do.

Back to fellowships, while it's an important decision, it's not going to kill you if you do one and have some minor regrets. After all you don't NEED to get pigeonholed into that supspecialty. At the very least you'll acquire some additional skills and comfort level doing those types of cases.

I have determined that fellowships are way more important in tough, mature/saturated markets where you need to jump through hoops to get a job. This is not the case IMO if you are willing to live in an area which is less "popular". Those less popular places don't even need to be "less desirable" and can even be quite nice but, yeah, it's probably a lesser populated area etc.

I'm steering towards smaller communities with an emphasis on what I think are good lifestyle things which may differ from what others feel they want to have in their life. Everyone's priorities are different.

I'm also getting sick of being pulled towards Ivory Tower thinking which can be compelling if you don't take a step back and reassess what's really important. I'm getting to the point where, aside from securing a good job in PP (and +/- fellowship), I'm unwilling to continue playing the Ivory Tower game of credentialing for this and that while mid-levels continue making advances without that opportunity cost and additional credentials. When is enough enough? To me, it's liberating that I don't feel I'll die without a fellowship and I can argue that it's certainly not for everyone. I'll probably do one, accredited or not, just to gain some extra skills in Pain however. I'm not, however, going to do sh.t like take a year off and do some research and then reapply if I don't get one this time around. What I will do is move forward with my life and start earning and then probably take on some sort of leadership position with a smaller group in an area where I'll not be a little fish in a big pond as is the case in many more populated areas and certainly the Ivory Tower. I digress.......

Edit: In fairness, CT, Pain, CC, and Peds are important if you want to do the full spectrum of those subspecialties and work in places with large volumes of patients requiring those skills. So, I'm not marginalizing a fellowship. Don't want to come off that way.

 

[rax]

Thanks so much for your response. You really make a lot of good points and your post is really helpful.

In my case, I am hoping to live within 1.5 hours of one of the most saturated coastal cities. I am not sure how a 1.5 hour radius will play out (is that far enough out to become "less popular" or is that still stuck in a low pay/limited opportunity zone?). There are days when I think, the heck with it I need to go where the opportunity is geographically. But really I can't imagine living anywhere else but around that city, since that is my home and my family is there.

Can you give some examples of places that are "less popular" while not "less desirable"? I really am curious to know what places fall into this category.

Thanks again!

 

[gasattack3]

Thanks so much for your response. You really make a lot of good points and your post is really helpful.

In my case, I am hoping to live within 1.5 hours of one of the most saturated coastal cities. I am not sure how a 1.5 hour radius will play out (is that far enough out to become "less popular" or is that still stuck in a low pay/limited opportunity zone?). There are days when I think, the heck with it I need to go where the opportunity is geographically. But really I can't imagine living anywhere else but around that city, since that is my home and my family is there.

Can you give some examples of places that are "less popular" while not "less desirable"? I really am curious to know what places fall into this category.

Thanks again!

I can only speak to my state, but suffice it to say that larger urban areas and tertiary care centers aren't the only places to work. Plenty of smaller hospitals and hospital systems which are off the beaten track a bit, but which can offer a smaller town feel (cause they are smaller towns...), perhaps more laid back, more personable, more bread and butter oriented, and with PP partnerships which may still be attractive over the next 5-10 years depending on how things go.

Everyone's practice ideal will be different. Priorities change along with the times. It's true I'd not want to go work for an endo suite or ASC right out of the bat, but I don't think I'll die not doing hearts, livers and level I traumas even though I do enjoy the types of really big cases you only see at the major hospitals. Everyone is different and I think you can keep up your general skills just fine in a smaller community setting. They call it bread and butter for a reason. Also, for pain, you don't need to be near the large Children's center or Heart institute etc.

Again, these are all very personalized decisions. I can say I've changed outlook over the past year. To each his own and this is one of the neat things about anesthesia. Practice settings can be very diverse and you can have some control over that if you are least not super tied to a 30 mile radius of places to settle down.