In your opinion, how does IPM lifestyle compare to OR anesthesia?

[Nivens]

Hopefully the mods will tolerate me asking a related question on the Anesthesiology boards because I want to get the opinion of both groups.

How do you feel your lifestyle compares to that of OR anesthesia? Specifically, I'm wondering about how you weigh in your mind the increased administrative headaches of private practice, being beholden to your patient cohort, etc. , but with the relatively controllable appointments in pain, lack of call/nights/weekends vs the "once you're off, you're off" life in OR anesthesia, but with lack of true "control" over the OR schedule, call responsibilities, early mornings, late nights, weekends, unpredictability, etc.

I ask because it seems like many of my family friends who are older, IM-specialty PP docs refer to the lifestyle advantages of not owning patients- similar to ED- but then it seems widely accepted, at least on these boards, that pain docs have a better lifestyle than OR anesthesia. Obviously these are all opinions, but I want to hear it from the herd's mouth.

I am not referring to lack of perceived prestige or the headaches involved with caring for certain patient populations. I am asking about the nuts and bolts of the life-work interaction.

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[willabeast]

Hopefully the mods will tolerate me asking a related question on the Anesthesiology boards because I want to get the opinion of both groups.

How do you feel your lifestyle compares to that of OR anesthesia? Specifically, I'm wondering about how you weigh in your mind the increased administrative headaches of private practice, being beholden to your patient cohort, etc. , but with the relatively controllable appointments in pain, lack of call/nights/weekends vs the "once you're off, you're off" life in OR anesthesia, but with lack of true "control" over the OR schedule, call responsibilities, early mornings, late nights, weekends, unpredictability, etc.

I ask because it seems like many of my family friends who are older, IM-specialty PP docs refer to the lifestyle advantages of not owning patients- similar to ED- but then it seems widely accepted, at least on these boards, that pain docs have a better lifestyle than OR anesthesia. Obviously these are all opinions, but I want to hear it from the herd's mouth.

I am not referring to lack of perceived prestige or the headaches involved with caring for certain patient populations. I am asking about the nuts and bolts of the life-work interaction.

it is going to depend on your work environment.
example #1 - you could work exclusively in a surgery center doing outpatient anesthesia on patients who are all private pay 90% collection rate
(because a surgeon owns the surgicenter and will not operate otherwise). no nights or weekends, and if a patient goes sour, off the patient goes to a local hospital. but the patients will do fine, because by this particular surgicenter rules, you only do ASA 1 or 2 patients. no retirement package.
example #2 - you could work in a hospital that has a 60% collection rate, does a lot of emergency cases (like trauma and OB), has limited staff (so you are on call 24/7 every other weekend) and is owned by a hospital chain that always buys the worst anesthesia machines (because they also own a company that sells them). you could do an "emergency" c-section almost every morning at 0330 mainly because the obstetrician wants to get the baby delivered before he starts his clinic at 0900. it is a toss up for you to go home and take a shower/eat breakfast or stay at the hospital.
of course you will be working the rest of the day. no retirement package.
example #3 - you could be the only "pain" guy at an HMO, work 12 hour days but be paid a salary (which is supposed to reflect 10 hour days), be on call 24/7 7 days a week and get 2 hours of extra time paid for seeing a consult on weekends.
admin dislikes you because you have a 24 month waiting list for chronic pain. your schedule is always 100% booked. you have a great retirement package.
example #4 - you could be one of many "pain" guys at an HMO, work on salary 10 hour days, paid 10 hour days, no nights, no weekends, no emergencies, admin loves you because no back log and a great retirement package.
i have experienced all of these scenarios.
it is all going to depend on your work environment.

 

[SageCraft]

My only experience with Anesthesia lifestyle was during residency so it is biased. However, I can attest to the fact that nearly every attending I had the pleasure of working with was absolutely miserable. They were completely overworked, always exhausted, no morale and their vacation time was a joke because it was always a gamble if it would even be approved. Not to mention the weekends when they were annihilated with 48 hour straight call. But I digress. Plus this was a busy Level 1 trauma center so what do you expect. As willabeast mentioned, there are many different working environments for Anesthesia so it just depends.

Anyways, my current life in private practice is completely different compared to my Anesthesia colleagues. M-F, 8-4, no weekends, no call. In control of my schedule, vacation time, staff, etc. The patient population is a different story but you only wanted the "nuts and bolts" 😛

 

[Hoya11]

I did a pain fellowship and then PP pain for a year. Back to pure anesthesia for 2y now. I think I work less in OR anesthesia than I did in pain, but as other have said, it all depends on your setup. I work more in bulk in anesthesia and have more time off in bulk. I had lots of late nights consisting of marketing dinners/late clinic/late consults. Those are the things that keep you late in chronic pain. Also call is much better in IPM but more often and harder to leave town and get away from clinical responsibilities (there is inevitably someone making noise on the answering machine). Also, your employer is your boss in chronic pain unless you are independent which is rare. So it's the ortho group or anesthesia group who is telling you what to do and increasing your hours, you always have a boss.

What really got to me is that I have young kids, and the clinic schedule is relentless day after day, with any missed patients or off hours seen as lost revenue. So If I have clinic until 7pm on Tuesday, then a marketing dinner on Wednesday (as mandated by lovely employer) that means that I havent seen my kid since Monday night until Thursday evening. Thats what it was for me the constant consistent unrelenting days (which would be fine if not for late days 2-3 nights/wk with other BS) Whereas in anesthesia when I have a late night I have an early or post call or off day the next day. So I dont see kids one night, the next day IM with them alot and you rarely get streaks of not being home. To each their own, but that was my problem with the schedule.

 

[Nivens]

Wow, why such a disparity between PP pain experiences? Sage are you independent?

 

[BobBarker]

My schedule and lifestyle is essentially the same as sage. I work for the hospital.

 

[SageCraft]

I work in a group PP but am not the CEO (on the way to partnership). I have a say in all decisions but do not get the final word in the bigger ones. Either way it has worked out quite well for me because I'm not tied up in administrative duties and yet I have the flexibility to manage my own schedule within the practice.

 

[Taus]

I did a pain fellowship and then PP pain for a year. Back to pure anesthesia for 2y now. I think I work less in OR anesthesia than I did in pain, but as other have said, it all depends on your setup. I work more in bulk in anesthesia and have more time off in bulk. I had lots of late nights consisting of marketing dinners/late clinic/late consults. Those are the things that keep you late in chronic pain. Also call is much better in IPM but more often and harder to leave town and get away from clinical responsibilities (there is inevitably someone making noise on the answering machine). Also, your employer is your boss in chronic pain unless you are independent which is rare. So it's the ortho group or anesthesia group who is telling you what to do and increasing your hours, you always have a boss.

What really got to me is that I have young kids, and the clinic schedule is relentless day after day, with any missed patients or off hours seen as lost revenue. So If I have clinic until 7pm on Tuesday, then a marketing dinner on Wednesday (as mandated by lovely employer) that means that I havent seen my kid since Monday night until Thursday evening. Thats what it was for me the constant consistent unrelenting days (which would be fine if not for late days 2-3 nights/wk with other BS) Whereas in anesthesia when I have a late night I have an early or post call or off day the next day. So I dont see kids one night, the next day IM with them alot and you rarely get streaks of not being home. To each their own, but that was my problem with the schedule.

It certainly varies. I work M-F, 8a-5p, maybe once a week I'm there til 530 or 6. No nights, weekends, holidays, call by phone only 1-2 nights a month. Only evening events are academic-related. I'm in a large ortho group with an academic affiliation.

 

[Dr. Ice]

It certainly varies. I work M-F, 8a-5p, maybe once a week I'm there til 530 or 6. No nights, weekends, holidays, call by phone only 1-2 nights a month. Only evening events are academic-related. I'm in a large ortho group with an academic affiliation.

Hmm..a large ortho group employed an anesthesia trained pain doc in philly? That sounds quite unusual..

 

[Taus]

Hmm..a large ortho group employed an anesthesia trained pain doc in philly? That sounds quite unusual..

I'm pm&r. Anesthesia based fellowship.


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[drusso]

http://www.kevinmd.com/blog/2016/03/star-medical-student-feels-like-made-terrible-decision.html

 

[SeniorWrangler]

Very hard to combine pain and OR anesthesia outside of academics, in a teaching hospital you can combine outpatient pain, inpatient acute pain, and regional anesthesia and there's a good degree of overlap. Lifestyle is totally different between the fields, both are pretty stressful IMHO.

 

[clubdeac]

I did a pain fellowship and then PP pain for a year. Back to pure anesthesia for 2y now. I think I work less in OR anesthesia than I did in pain, but as other have said, it all depends on your setup. I work more in bulk in anesthesia and have more time off in bulk. I had lots of late nights consisting of marketing dinners/late clinic/late consults. Those are the things that keep you late in chronic pain. Also call is much better in IPM but more often and harder to leave town and get away from clinical responsibilities (there is inevitably someone making noise on the answering machine). Also, your employer is your boss in chronic pain unless you are independent which is rare. So it's the ortho group or anesthesia group who is telling you what to do and increasing your hours, you always have a boss.

What really got to me is that I have young kids, and the clinic schedule is relentless day after day, with any missed patients or off hours seen as lost revenue. So If I have clinic until 7pm on Tuesday, then a marketing dinner on Wednesday (as mandated by lovely employer) that means that I havent seen my kid since Monday night until Thursday evening. Thats what it was for me the constant consistent unrelenting days (which would be fine if not for late days 2-3 nights/wk with other BS) Whereas in anesthesia when I have a late night I have an early or post call or off day the next day. So I dont see kids one night, the next day IM with them alot and you rarely get streaks of not being home. To each their own, but that was my problem with the schedule.

You weren't in Nashville were you when in pain pp?