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I have the opposite take on pain. I am BC in Pain and was the chief fellow in a large well-known program. I was, like you are, very enthusiastic about pain. I went back to anesthesia in the OR and do not miss pain one bit. You can see from my posts in the pain forum that my attitude really took a 180 from when I was a fellow and early in my career as a PP pain attg.
The downside of pain is what you actually are doing day to day. Which, I now understand to believe, NOT helping people (in most cases) and exacerbating an opiate epidemic (in most cases) Yes you get weekends off (except for phone calls) and nights (except for sleazy marketing dinners/phone calls). But you get most of those off anyway in anesthesia. Like the above poster mentioned, even in a 1:4 model, you are still working only when scheduled which is 2-3 calls per month. I am out before 3pm in anesthesia 20% of the time, and am out before 6pm 95% of the time.
At least in anesthesia I am doing real good for real good people. Pain management is a man-made field. Keep the patients happy with opiates, keep the doctors/ascs happy with the procedures that they reluctantly agree to for secondary gain. Meanwhile your thousands of dollars of procedures and god knows how many opiate prescriptions are not helping the world. Insurance companies are paying those huge bills and premiums come back on GENUINELY sick people. "I lost my percocet" get out of here, I dont want to deal with those people. And yes you'll tell me your patient population is all angels, but when you do pain long enough you realize you are just handing out opiates, generating revenue with procedures, nobody gets better, and people end up getting in trouble or hurt from the opiates.
I think pain is in a boom right now due to ASCs. Anesthesiologists can suddenly be owners and get a piece of the facility fee by doing procedures at an ASC. Then generate huge revenue by seeing the patients in the office q2months for new opiates. All I can say is, it just cant continue. The people in the know will soon wise up to the sleazy street patients on their 12th injection on workers comp and oxycodone 30 q6h. We will stop paying for these losers and the "doctors" who are getting rich by enabling these parasites.
I think I could only tolerate a career in pain in a unique model like in academics or cancer only, even then though, why not just go to your PCP/Oncologist for meds? Because the blocks are going to make such a difference? OMG and this business with the stimulators and pumps makes me want to throw up - almostl completely useless are the stimulators, and pumps ARE completely useless. Total money makers for industry that is controlling the pain field, which if it were to go away completely, would be a good thing for medicine. No more enabled crazy opiate people, No more 20 cases in a day at an ASC for 1k/epidural, and just let guys like me (trained but no financial motivation to do procedures) do the procedures for healthy people who are actually good candidates, and let the PT guy do PT, the ortho guy and PMR guy diagnose and intervene. The only unique skillset pain fellowship brings is procedures. All the other stuff is just learning the nuts and bolts of other specialties and piecing it together.
So have fun writing your scripts and talking patients into procedures for your own benefit (again most of the time). Take that pretty fluoro picture and show your friends. Then fill out the disability paperwork and talk to the workers comp case worker and oh yeah how about CPS for the mom that ODd on her oxycodone while driving her son around. Maybe one day pain physicians will wake up to what they truly are: opportunists capitalizing and worsening a broken medical system. UGH - it just cant last, its a ridiculous field.
I'm gonna have to respectfully disagree with you on this one. I know several former pain physicians who decided to leave pain after a few years and transition into anesthesia. One did so because the compensation for pain in California was relatively crappy when compared to OR anesthesia. He was a very good doc. I would trust him with my family members. However, the other docs, without exception, were relatively bad physicians. Subpar bedside manner, questionable technical ability, poor diagnostic acumen, burnt out. They were very unhappy in interventional pain and I suspect it was because they just weren't particularly good at it.
Interventional pain isn't an easy field. You can't apply simple protocols, which is why it's hard for CRNAs to compete in any meaningful way with fellowship-trained interventional pain physicians. It doesn't rely very heavily on any of the skills acquired in anesthesiology residency. It has a skill set that straddles multiple specialty lines, which requires an enormous knowledge base that (frankly) only physicians possess. Every patient is unique and patient selection is absolutely essential for success with any intervention.
The notion that interventional pain procedures don't work is absurd. They do work, provided that you select patients correctly. Bad physicians do a sloppy evaluation and exercise poor judgment when they select particular patients for interventions. Obviously I wasn't in your practice. I never met your patients or observed your patient encounters. But if you noticed that the vast majority of your procedures didn't work, as your post would suggest, then you need to take a close look in the mirror before blaming the field as a whole. It wasn't because of the inherent lack of efficacy from interventional pain procedures, it's because of the patient selection (or your technique).
I have plenty of patients who do extremely well after interventional pain procedures. Pancreatic cancer patients with intractable pain despite being on high doses of systemic opioids...Guess what? I can eliminate their abdominal pain entirely with ONE procedure and get them off opioids. I've done it several hundred times. The patients think it's magical and they are VERY appreciative. Try telling one of them that pain procedures "never work." They would laugh out loud. Or what about patients with severe pain due to compression fractures to the point that they can't stand up or walk? Guess what? I can eliminate their pain with ONE procedure, too. I have TONS of these patients. The list goes on and on. I'm not sure how you left interventional pain with the idea that procedures don't work. I have hundreds of patients on my panel who would beg to differ. Are there treatment failures? Absolutely, but they are in the minority. Patient selection is key. My dad, who is a doctor, gets a transforaminal epidural steroid injection every year. He wasn't able to function before he starting getting the injections. If you told him that interventional pain procedures "never work" he would laugh in your face.
Do yourself a favor and don't spread so much venom and misinformation about interventional pain. The field accomplishes a tremendous amount of good, when it is performed by well trained, ethical, and competent physicians who actually give a crap about their patients. For all the jackasses out there injecting everything with two legs or distributing pills like a glorified drug dealer, I have zero respect for them. Their days are numbered and the color orange is in the not-so-distant future for many of them.
OR anesthesia is a great field, but don't fool yourself into thinking it's all peaches and cream. There are drawbacks to a career in interventional pain, but there are enormous problems on the horizon for OR anesthesia. One search on SDN is proof of that. The rise of mega-groups a that use and abuse new grads, lack of genuine respect (being called "anesthesia" instead of "doctor"), lack of ultimate control, in house overnight call, increasingly prevalent "independent" practice by CRNAs, no patients of your own, projected HUGE decrease in income if Medicare rates become commonplace with Obamacare, etc. I get to avoid all that crap in interventional pain. Not a bad gig, in my opinion. But one man's treasure is another's trash...