If you were coming out of residency right now with the current conditions, would you still choose pain?

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klumpke

klumpke

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I cant help but read all of these Anesthesia threads about how awful the field of pain is now. With rapidly declining reimbursements, expectations to see more patients, more saturated job market, and predatory private practices that exploit new grad without offering part owenership, its hard to really be excited about entering the field..

Do you feel like these are exaggerated claims by burnt out pain docs and speculation from people outside the field or are these real concerns that would deter you if you were in the place to go back and possible forego pain fellowship?
 
Pure lifestyle job with autonomy and ownership of patient care. Absolutely do pain again if I did anesthesia again.

Up to you to make the money work.
 
klumpke said:
I cant help but read all of these Anesthesia threads about how awful the field of pain is now. With rapidly declining reimbursements, expectations to see more patients, more saturated job market, and predatory private practices that exploit new grad without offering part owenership, its hard to really be excited about entering the field..

Do you feel like these are exaggerated claims by burnt out pain docs and speculation from people outside the field or are these real concerns that would deter you if you were in the place to go back and possible forego pain fellowship?
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Absolutely, I have always said, I'd rather make less money doing pain than doing OR anesthesia having to be at the will of the OR/hospital and surgeons. Granted I'm private practice and not owned by a hospital, multi-specialty group or PE. Can't beat the autonomy and the ability to work or not work when I want with no-one looking over my shoulder or monitoring my production and telling me how to practice medicine.
 
Pain is really easy compared to OR anesthesia. If your patient improves, you get to pat yourself on the back. If your patient doesn’t improve, well their spine was jacked anyways and you did what you could. Eventually the compensation for anesthesiology will go back to pre-covid levels when the shortages abate and people will remember why they chose Pain.
 
I would. I like what I do. It's not so much a task oriented field like anesthesia or radiology. It's more personal, trying to ease suffering and improve function. Less like "work" imo.
 
Absolutely. Pain beats anesthesia any day of the week. I’m doing less stressful work, working less hours, and getting paid significantly more than if I were doing anesthesia. Pain beats anesthesia in all 3 of those categories for me.
 
klumpke said:
I cant help but read all of these Anesthesia threads about how awful the field of pain is now. With rapidly declining reimbursements, expectations to see more patients, more saturated job market, and predatory private practices that exploit new grad without offering part owenership, its hard to really be excited about entering the field..

Do you feel like these are exaggerated claims by burnt out pain docs and speculation from people outside the field or are these real concerns that would deter you if you were in the place to go back and possible forego pain fellowship?
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Can you elaborate on this?
 
drusso said:
Can you elaborate on this?
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It just seems like whenever I talk to a lot of current attendings, other residents, or read online forums, the general consensus is that pain isn’t worth it anymore.

A lot of the sentiment is that there’s this huge trends toward declining reimbursements and less opportunity- be it available jobs or private practices where you have the reasonable ability to become a part owner in a practice. I can’t help but picture some future where I’m slaving away in the fluoro suite seeing 40-50 patients a day to maintain a ~400k salary. It’s like a recipe for burnout.

As a resident you never fully know the reality until you choose it and that’s why I was hoping you all could help clarify if it’s just the most pessimistic or least satisfied docs that happen to be the most vocal.
 
For an employed position, anesthesia pays much better currently. The anesthesia market is cyclical, and may not always be this way. The only way you'll come out ahead in pain at the moment is if you start your own practice, but even then there isn't a guarantee. Your success will depend on how well you can run a business.
 
truvida22 said:
For an employed position, anesthesia pays much better currently. The anesthesia market is cyclical, and may not always be this way. The only way you'll come out ahead in pain at the moment is if you start your own practice, but even then there isn't a guarantee. Your success will depend on how well you can run a business.
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Incorrect. Ask employed physicians.
 
As a hospital-employed wRVU farmer, I can currently make more doing pain while working banker's hours, than doing call-taking OR anesthesia.

And this is with significantly less than 40 patient encounters per day.
 
Why do you all think there are so many pain docs online pushing their story that they did pain, got burnt out/hated it/made less for worse hours what will you and then went back to OR full time? I feel like I see it all over the anesthesia reddit
 
Anesthesiologists don’t really like people. I don’t really either, but my tolerance is higher. For many, people asleep is better for them than those they have to talk to, ergo burnt out by the human interaction of pain
 
I know of a few pain physicians who went back to anesthesiology a few years into practice when they could not find non-sketchy jobs in the location of their choosing. My co-fellow for example.
 
klumpke said:
Why do you all think there are so many pain docs online pushing their story that they did pain, got burnt out/hated it/made less for worse hours what will you and then went back to OR full time? I feel like I see it all over the anesthesia reddit
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I have a feeling they were not able to be successful in pain, either in building their own practice or working as an employee. With OR anesthesia you don't need to be concerned about finding new patients. I've seen it with some folks where I am.
 
klumpke said:
It just seems like whenever I talk to a lot of current attendings, other residents, or read online forums, the general consensus is that pain isn’t worth it anymore.

A lot of the sentiment is that there’s this huge trends toward declining reimbursements and less opportunity- be it available jobs or private practices where you have the reasonable ability to become a part owner in a practice. I can’t help but picture some future where I’m slaving away in the fluoro suite seeing 40-50 patients a day to maintain a ~400k salary. It’s like a recipe for burnout.

As a resident you never fully know the reality until you choose it and that’s why I was hoping you all could help clarify if it’s just the most pessimistic or least satisfied docs that happen to be the most vocal.
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Have you tried going out for coffee with a real private practice pain doc or shadowing one for a morning instead of relying on secondhand reports? Seeing is believing.
 
lobelsteve said:
Incorrect. Ask employed physicians.
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Former pain employed physician. If you speak with most new grads entering the job market, pain jobs are starting anywhere from 250k-500k base, with some rvu/production component, 5-8 weeks vacation. Anesthesia jobs are starting 450k-700k base, with extra compensation for call and overtime, 8-12 weeks vacation. The anesthesia market has drastically changed. There are new grad anesthesiologists making 7 figures. There are only a few HOPD employed pain docs I've met that can do those numbers and that's after a few years of building up a practice. Private practice can do better than both, but depends on how well you can run a business
 
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truvida22 said:
Former pain employed physician. If you speak with most new grads entering the job market, pain jobs are starting anywhere from 250k-500k base, with some rvu/production component, 5-8 weeks vacation. Anesthesia jobs are starting 450k-700k base, with extra compensation for call and overtime, 8-12 weeks vacation. The anesthesia market has drastically changed. There are new grad anesthesiologists making 7 figures. There are only a few HOPD employed pain docs I've met that can do those numbers and that's after a few years of building up a practice. Private practice can do better than both, but depends on how well you can run a business
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I agree that as a new grad, anesthesia has a higher starting salary, but pain management has a much higher earning potential, even for employed physicians. No calls, no weekends. Some pain docs, like me, work 4days a week, Monday to Thursday, 8 AM to 5 PM, with Fridays off. If you do the math, that’s about 10–11 weeks off per year, not even counting weekends. Now, think about how much you’d generate if you worked the same schedule with no calls, no weekends.
 
so55b said:
I agree that as a new grad, anesthesia has a higher starting salary, but pain management has a much higher earning potential, even for employed physicians. No calls, no weekends. Some pain docs, like me, work 4days a week, Monday to Thursday, 8 AM to 5 PM, with Fridays off. If you do the math, that’s about 10–11 weeks off per year, not even counting weekends. Now, think about how much you’d generate if you worked the same schedule with no calls, no weekends.
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Depends on where you’re searching. My employed pain gig offered $750k guarantee starting out of the gate, that was 2 years ago, but even still I know of another employed pain job also offering $750k starting.

Also, exactly correct on the number of days worked. I work 4 days a week, including my vacation time off I work 183 days a year and am off 182 days. You aren’t going to find an anesthesia job with that much time off that also pays close to the same ($950k-1 mil for me as employed with productivity bonus). You would have to take a lot of undesirable call shifts to make that in anesthesia.
 
mdo1738 said:
Depends on where you’re searching. My employed pain gig offered $750k guarantee starting out of the gate, that was 2 years ago, but even still I know of another employed pain job also offering $750k starting.

Also, exactly correct on the number of days worked. I work 4 days a week, including my vacation time off I work 183 days a year and am off 182 days. You aren’t going to find an anesthesia job with that much time off that also pays close to the same ($950k-1 mil for me as employed with productivity bonus). You would have to take a lot of undesirable call shifts to make that in anesthesia.
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but that 182 days off, would be better if those weeks could be taken consecutively; but then again having a 3 day weekend every week is winning
 
In contrast with Agast’s experience above, I find that almost all anesthesia patients get what they want and are grateful. Pain patients are more often disappointed by what we do and even those who get good results are often glass half empty types. Most pain docs will say they aren’t especially bothered by this.

My vote for most people without a stronger pull to one or another is for pain. Weekends and call suck. Pain gives the option to own a practice. You’re slightly less replaceable. Anesthesiology is more draining than it seems per hour.

However, anesthesiology enables types of freedom that pain cannot. If you want the option to take big blocks of time off or move about the country with relative ease, it may be a better choice.
 
A Deep Breath said:
In contrast with Agast’s experience above, I find that almost all anesthesia patients get what they want and are grateful. Pain patients are more often disappointed by what we do and even those who get good results are often glass half empty types. Most pain docs will say they aren’t especially bothered by this.

My vote for most people without a stronger pull to one or another is for pain. Weekends and call suck. Pain gives the option to own a practice. You’re slightly less replaceable. Anesthesiology is more draining than it seems per hour.

However, anesthesiology enables types of freedom that pain cannot. If you want the option to take big blocks of time off or move about the country with relative ease, it may be a better choice.
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Well… most patients are grateful to their surgeon, but unfortunately, not so much to the anesthesiologist. They just hope nothing goes wrong with the anesthesia, so even if we do a great job, it goes unnoticed and unappreciated. No patient really notices if an anesthesiologist is good or not, and hardly anyone specifically seeks out a particular anesthesiologist.

For me, this is the worst part of anesthesia and the main reason I chose to go into pain management, though I still practice a little anesthesia to maintain my skills.
 
A Deep Breath said:
In contrast with Agast’s experience above, I find that almost all anesthesia patients get what they want and are grateful.
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“Why am I getting a bill for anesthesia? I didn’t have any” “there was no anesthesiologist in my surgery”

I’ve heard stuff like this many times over
 
Anesthesia market ebbs and flows. Just 8 years ago in residency the market was … ok, at least in Washington. Just do what you find enjoyable.
 
Know your pain market!

If contemplating fellowship, talk to junior physicians in the area you want to practice. Did they have an easy time identifying a job opportunity? Do the jobs require you to see a volume of patients you are comfortable with?

If there’s few opportunities, or the jobs are scuzzy, maybe don’t move forward with the fellowship. If folks have good luck securing an outstanding position and there may be one available close to graduation, then go for it!
 
agolden1 said:
Know your pain market!

If contemplating fellowship, talk to junior physicians in the area you want to practice. Did they have an easy time identifying a job opportunity? Do the jobs require you to see a volume of patients you are comfortable with?

If there’s few opportunities, or the jobs are scuzzy, maybe don’t move forward with the fellowship. If folks have good luck securing an outstanding position and there may be one available close to graduation, then go for it!
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100%.

The answer to this question is very heavily location-dependent.

And FWIW...

When I started as an Attending, I had a hybrid Pain/Anesthesia position at a large academic center. There were some weeks where I would be the solo Anesthesiologist at the ASC in Room 2 on some Tuesdays, and nobody gave a **** about me or lifted a finger to try to help transport and induce the patient.

When I showed up to Room 2 on Wednesdays as the Pain guy, there were banners and fanfare everywhere. Or at least it felt that way.
 
klumpke said:
I cant help but read all of these Anesthesia threads about how awful the field of pain is now. With rapidly declining reimbursements, expectations to see more patients, more saturated job market, and predatory private practices that exploit new grad without offering part owenership, its hard to really be excited about entering the field..

Do you feel like these are exaggerated claims by burnt out pain docs and speculation from people outside the field or are these real concerns that would deter you if you were in the place to go back and possible forego pain fellowship?
Click to expand...
If it makes you feel any better, I graduated from my fellowship in 2010, and I heard the exact same arguments back then. I agree that it feels like the environment has changed since then but at the same time it also feels that the more things change, the more they stay the same.
 
Lol, actually I think I graduated residency in 2010 and fship in 2011 🤣
 
There is and will always be very strong demand for pain management
  • People will always suffer from pain
  • People will always have different emotional needs that need to be met to help them deal with it
As long as the demand is there, there will always be opportunity. You just have to figure out what those opportunities are for whatever respective environment you're dealing with at that point in time. If you can't figure it out, someone else will, but the opportunity will be there.

It's not much different than any other industry. All industries constantly shift, cycle, and evolve. That hasn't changed. What's changed is the lockdown physicians held on the market.
 
Pain Applicant1 said:
There is and will always be very strong demand for pain management
  • People will always suffer from pain
  • People will always have different emotional needs that need to be met to help them deal with it
As long as the demand is there, there will always be opportunity. You just have to figure out what those opportunities are for whatever respective environment you're dealing with at that point in time. If you can't figure it out, someone else will, but the opportunity will be there.

It's not much different than any other industry. All industries constantly shift, cycle, and evolve. That hasn't changed. What's changed is the lockdown physicians held on the market.
Click to expand...
Optimist: the glass is half full and there’s a refreshing rain.

Pessimist: the glass is half empty, the weather is crap and I’m all wet.

Pain App: I need to buy heavy equipment and massive plumbing infrastructure to catch all this free rain to build a water park!
 
Meyer-Overton said:
sounds like doing a pain fellowship is still the move
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If applications to pain fellowships are down, it probably would be a good time to apply. That means you'll have less competition when you start practicing a few years down the road as the older folks start dropping out.
 
mdo1738 said:
Depends on where you’re searching. My employed pain gig offered $750k guarantee starting out of the gate, that was 2 years ago, but even still I know of another employed pain job also offering $750k starting.

Also, exactly correct on the number of days worked. I work 4 days a week, including my vacation time off I work 183 days a year and am off 182 days. You aren’t going to find an anesthesia job with that much time off that also pays close to the same ($950k-1 mil for me as employed with productivity bonus). You would have to take a lot of undesirable call shifts to make that in anesthesia.
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Dahum nice work. Are you in the rural Midwest? I’m in a large, very competitive eastern market but still do pretty good as an employed doc. Not that good though
 
Pain is 100% the move if you are not dumb enough to work in an extremely saturated market if looking at it from a financial and work-life balance standpoint. It is possible to carve out a survivable living in LA, Austin, Boston, etc but you are going to be working extremely, extremely hard just to stick around.
 
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