Is it common for Anesthesia Interventional Pain docs to also work 1-2 days in the OR?

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LebronManning

LebronManning

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Is this possible/common? You'd think it'd be a good idea for anesthesiologists to keep their OR skills by working a shift or two per week in case business goes bad with their pain practice.

Also is the future of interventional pain bleak and/or saturated? I tried to search some threads regarding this topic and only found answers during the Obama era when every one was scared about obamacare and eventual push toward single payer. I think much of those concerns have been alleviated even if ACA isnt completely gone. (S/O TRUMP).
 
LebronManning said:
Is this possible/common? You'd think it'd be a good idea for anesthesiologists to keep their OR skills by working a shift or two per week in case business goes bad with their pain practice.

Also is the future of interventional pain bleak and/or saturated? I tried to search some threads regarding this topic and only found answers during the Obama era when every one was scared about obamacare and eventual push toward single payer. I think much of those concerns have been alleviated even if ACA isnt completely gone. (S/O TRUMP).
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It is possible, I did it for 20+ years however let me tell you the downsides.
1. It is easy to keep up with the literature for first 10 years in both pain and anesthesia.
2. After 15 years or so it becomes very time consuming to keep current in both fields at the same time unless you are in academics, in which case it is probably easy.
3. I found that after 20 years of doing one day a week in the OR I could still do easy cases but that difficult cases (for example a pedi crani) were going to scare me. One day my chief came to me and said he wanted me to take regular OR anesthesia call. I told him it would not be safe. He insisted. I resigned my OR anesthesia privileges the next day. Life became much better for me. I no longer had to keep up with the new monitoring machines, or the anesthesia journals, or the latest anesthesia issues. I had enough time to keep up with all the current pain knowledge. Looking back, should have resigned my anesthesia privileges long ago.
4. one thing though - i have time limited pain ABMS, but my anesthesia was time un limited ABMS. Not sure how that fits into this.
 
willabeast said:
It is possible, I did it for 20+ years however let me tell you the downsides.
1. It is easy to keep up with the literature for first 10 years in both pain and anesthesia.
2. After 15 years or so it becomes very time consuming to keep current in both fields at the same time unless you are in academics, in which case it is probably easy.
3. I found that after 20 years of doing one day a week in the OR I could still do easy cases but that difficult cases (for example a pedi crani) were going to scare me. One day my chief came to me and said he wanted me to take regular OR anesthesia call. I told him it would not be safe. He insisted. I resigned my OR anesthesia privileges the next day. Life became much better for me. I no longer had to keep up with the new monitoring machines, or the anesthesia journals, or the latest anesthesia issues. I had enough time to keep up with all the current pain knowledge. Looking back, should have resigned my anesthesia privileges long ago.
4. one thing though - i have time limited pain ABMS, but my anesthesia was time un limited ABMS. Not sure how that fits into this.
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Thank you so much! Didn't even consider the part about staying up with anesthesia literature, seems like this would be the biggest limiting factor! Perhaps this would be alleviated by working 2-3 days in the OR and 2-3 days in the pain clinic but then maybe your pain clinic suffers. I guess it depends on how business is going in the pain clinic.

Any thoughts on the future of pain medicine now that the ACA and push to single payer isnt as strong? Is the competition in this field extensive or is the demand currently still outweighing this? I'd suspect the latter given the limited pain fellowship spots.
 
Pain is a full time job. If you have your own practice or even work for the hospital but don’t have a partner you have many employees that need you to be there working everyday so they can get their full time hours in.
 
BobBarker said:
Pain is a full time job. If you have your own practice or even work for the hospital but don’t have a partner you have many employees that need you to be there working everyday so they can get their full time hours in.
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I guess I'm thinking this would be a possibility if you joined an established pain practice and saw all your patients in a 3-4 day window and then worked in the OR the other day or two. Don't know if many pain practices would be down for this or whether many Anesthesia groups would want you for 1-2 days.
 
I did half and half for a couple of years after full time pain for 20. It was a breath of fresh air. Around 15% of pain patients suck the oxygen from the room, are needy, unrealistic, self destructive, irrational, plot to remain on disability forever, are leaches to society and everyone in their lives, demanding narcotics endlessly, and can make your life hell in many ways. These 15% make it difficult at times to deal with the other 85% on a daily basis, therefore the OR can be a nice escape. In the OR, most patients want to get their surgery and get back on their feet as soon as possible. In the past, I believed pain should be a full time endeavor, but given the right circumstances, OR anesthesia/pain can provide an excellent balance of normals and nuts that can be career lengthening.
 
algosdoc said:
I did half and half for a couple of years after full time pain for 20. It was a breath of fresh air. Around 15% of pain patients suck the oxygen from the room, are needy, unrealistic, self destructive, irrational, plot to remain on disability forever, are leaches to society and everyone in their lives, demanding narcotics endlessly, and can make your life hell in many ways. These 15% make it difficult at times to deal with the other 85% on a daily basis, therefore the OR can be a nice escape. In the OR, most patients want to get their surgery and get back on their feet as soon as possible. In the past, I believed pain should be a full time endeavor, but given the right circumstances, OR anesthesia/pain can provide an excellent balance of normals and nuts that can be career lengthening.
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Very interesting. It has been about 10 years since I did any anesthesiology and in the preceding 8 years I only worked in an ASC.
What was it like going back after 20 years? I have recently been approached to do some anesthesia again. I feel like I would have a lot of catching up to do and would need to shadow someone for a few days at least to get my groove back and make certain I remember the drugs. I’m somewhat regretting allowing skills to lapse as the is a tremendous amount of anesthesia locums work out there.


Sent from my iPhone using Tapatalk
 
It was not as traumatic as I thought it would be. I started by going to conferences (PGA), doing CME online in anesthesiology, then signed up with a locums company to do outpatient non-peds anesthesia. After I became comfortable with that and in the process learned US guided anesthesiology blocks (that are quite different than US guided pain blocks), I transitioned into a hospital setting doing my own cases. After about 6 months, I began supervising some. I did more CME along the way and my colleagues were very helpful. At this time I do not do peds or hearts, but do everything else. The steepest learning curve was learning the idiosyncrasies of Cerner.
 
algosdoc said:
I did half and half for a couple of years after full time pain for 20. It was a breath of fresh air. Around 15% of pain patients suck the oxygen from the room, are needy, unrealistic, self destructive, irrational, plot to remain on disability forever, are leaches to society and everyone in their lives, demanding narcotics endlessly, and can make your life hell in many ways. These 15% make it difficult at times to deal with the other 85% on a daily basis, therefore the OR can be a nice escape. In the OR, most patients want to get their surgery and get back on their feet as soon as possible. In the past, I believed pain should be a full time endeavor, but given the right circumstances, OR anesthesia/pain can provide an excellent balance of normals and nuts that can be career lengthening.
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You got the part about the pain patient all wrong. Leeches. The rest is spot on. 🙂
 
Ligament said:
Really? The Anesthesiologists get a buttload of vacation time. I can take what I want but I loose the income.
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Some do, but they are compensated less, just like you. If they work for a hospital or AMC they are being compensated off time, not production. The gas men in real private practice don’t take much vacation. You are also forgetting the very large call burden. They may have a lot of vacation but they worked many weekends and overnights, perhaps with no pre/post call day off.
 
LebronManning said:
Is this possible/common? You'd think it'd be a good idea for anesthesiologists to keep their OR skills by working a shift or two per week in case business goes bad with their pain practice.

Also is the future of interventional pain bleak and/or saturated? I tried to search some threads regarding this topic and only found answers during the Obama era when every one was scared about obamacare and eventual push toward single payer. I think much of those concerns have been alleviated even if ACA isnt completely gone. (S/O TRUMP).
Click to expand...

It is definitely easier if you have at least one pain partner otherwise you will be doing multiple jobs. Having done some version of a mixed practice for twenty years I would recommend that you fully concentrate on Pain. I wouldn’t worry about the job market.
 
One of the main issues I have with pain, aside from the dysfunctional world of neurotic and personality disordered patients, is the large scale nefarious practice of the profession. The ethical and legal breeches seem to be pervasive, with my colleagues who are legitimate doctors having difficulty making ends meet unless they work an ungodly number of hours. Additionally, insurers see our profession as rife with graft and overcharging, with the resultant restrictions that stifle any innovation, and constrain treatments to a smaller and smaller box of tools available. Pressures exist on all sides of pain medicine, from unruly patients to financial to governmental and board regulatory impositions.
On the flip side, the treatment relationships you build with pain patients, especially those that are not singularly self-focused, is the sine qua non of medicine- that of being a doctor confronted with both the pathologies and sequelae of those pathologies while making prudent decisions on a course of treatment. The relationships developed in anesthesia are brief, and for the most part, patients will not remember you the next day. In anesthesia there is a much more limited toolbox that is operant in a timeframe of minutes to hours instead of months to years of pain medicine.
So much comes down to lifestyle choices. I am aware of three area pain physicians that died suddenly in the past year (no, I didn't off my competition). They were totally stressed about pain. So if you can't relax and enjoy your work, then either reduce the workload or find another avenue for self satisfaction. Life is short, live it well.
 
algosdoc said:
One of the main issues I have with pain, aside from the dysfunctional world of neurotic and personality disordered patients, is the large scale nefarious practice of the profession. The ethical and legal breeches seem to be pervasive, with my colleagues who are legitimate doctors having difficulty making ends meet unless they work an ungodly number of hours. Additionally, insurers see our profession as rife with graft and overcharging, with the resultant restrictions that stifle any innovation, and constrain treatments to a smaller and smaller box of tools available. Pressures exist on all sides of pain medicine, from unruly patients to financial to governmental and board regulatory impositions.
On the flip side, the treatment relationships you build with pain patients, especially those that are not singularly self-focused, is the sine qua non of medicine- that of being a doctor confronted with both the pathologies and sequelae of those pathologies while making prudent decisions on a course of treatment. The relationships developed in anesthesia are brief, and for the most part, patients will not remember you the next day. In anesthesia there is a much more limited toolbox that is operant in a timeframe of minutes to hours instead of months to years of pain medicine.
So much comes down to lifestyle choices. I am aware of three area pain physicians that died suddenly in the past year (no, I didn't off my competition). They were totally stressed about pain. So if you can't relax and enjoy your work, then either reduce the workload or find another avenue for self satisfaction. Life is short, live it well.
Click to expand...

Concierge and direct access for interventional pain services mitigate some of these issues. Taking care of people who are paying their own money makes for more satisfying relationships.
 
Yes, pain has it's stresses, but so does anesthesiology. I sometimes envy the anesthesiologist who covers my procedure days who goes home without bringing any work with him, but then I remember I don't have to do call, weekends, holidays, rotating shifts, or ridiculous anesthesia (I'm thinking prone jackknife spinals on obese men or 8-hour robotic steep trendelenburg nightmares). No call and a steady schedule is huge. My family (and my sleep) much appreciates it.

In my current practice, if a patient annoys me too much or doesn't follow the rules, they're gone. Pain doesn't have to be painful.

Only caveat, if you want to make a ton of money early on, anesthesia seems to be an easier way to go. Collect a fat paycheck and go home. Most of my high-paying offers right out of fellowship were 1/2 anesthesia & 1/2 hospital-based pain. Not what I wanted though.
 
LebronManning said:
Is this possible/common? You'd think it'd be a good idea for anesthesiologists to keep their OR skills by working a shift or two per week in case business goes bad with their pain practice.

Also is the future of interventional pain bleak and/or saturated? I tried to search some threads regarding this topic and only found answers during the Obama era when every one was scared about obamacare and eventual push toward single payer. I think much of those concerns have been alleviated even if ACA isnt completely gone. (S/O TRUMP).
Click to expand...
Reading this thread is interesting. I have been doing 100% pain for two years straight out of fellowship. I am going to start going back to the OR for one day a week starting soon here.
Because I have a no opioid practice, my volume is fair but I am never quite full. I thought it would just be one day less a week of business that I have to drum up. I also thought it might be nice to have a change of pace from time to time, as it is hard dealing with all the patients that never improve in a pain practice, or come back and tell you the procedure didn’t work, even if some of them do great. And all the psychopathology. And also I feel like the farther out I get from training, it will be less and less possible for me to come back to the OR.
But I negotiated it where it is essentially just office hours during the day. No call or evening or weekend or holiday OR work.
Hopefully this isn’t stupid! I will let you know how it goes!
My main concern is if I am going to be competent and safe. If I feel like it’s not a good idea I am going to back out.
 
Ferrismonk said:
I sometimes envy the anesthesiologist who covers my procedure days who goes home without bringing any work with him
Click to expand...

So how much pain can a non pain fellowship trained anesthesiologist practice? I doubt he/she would be able to compete with fellowship trained in opening their own practice but will hospitals or other established practice still let them perform some procedures?
 
Ferrismonk said:
Only caveat, if you want to make a ton of money early on, anesthesia seems to be an easier way to go. Collect a fat paycheck and go home. Most of my high-paying offers right out of fellowship were 1/2 anesthesia & 1/2 hospital-based pain.
Click to expand...

Interesting. Surely pain has more benefits compared to anesthesia than just more money on average but can a productive/busy partner in a large anesthesia group rake in almost just as much as busy partner in a pain practice?
 
The OR anesthesia schedule is not so monolithic in all practices. I am full time anesthesia, no nights, no call, no weekends, no holidays. My pain practice residual is on the weekends. The kinds of stress are quite different between the twi areas of medicine.
 
LebronManning said:
So how much pain can a non pain fellowship trained anesthesiologist practice? I doubt he/she would be able to compete with fellowship trained in opening their own practice but will hospitals or other established practice still let them perform some procedures?
Click to expand...
Maybe I wasn't clear. I have an anesthesiologist that comes in to do the sedation for my pain procedures. End of day he just goes home. I dictate, deal with messages, etc.
 
LebronManning said:
So how much pain can a non pain fellowship trained anesthesiologist practice? I doubt he/she would be able to compete with fellowship trained in opening their own practice but will hospitals or other established practice still let them perform some procedures?
Click to expand...

Depending on your group or hospital system's setup, you may catch a lot of flack as the "pain guy" doing OR because you don't have the same call burden, weekends, nights. I've seen it breed a lot of resentment amongst the full time Anesthesiologists, not that it should matter what they think..but.

I do full time pain, but if I did ever step back into the OR I would be expected to do weekends, take night trauma call, do OB- you get the idea. Almost impossible to have a functional pain practice and do that sort of thing.
 
Ferrismonk said:
Maybe I wasn't clear. I have an anesthesiologist that comes in to do the sedation for my pain procedures. End of day he just goes home. I dictate, deal with messages, etc.
Click to expand...
What are you doing that requires an Anesthesiologist to sedate for your procedures?
 
lobelsteve said:
2004 Donzi Enclosed Bridge Power Boat For Sale - www.yachtworld.com
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Lol, I wish. I'm employed in a group, so contracted anesthesia (no relationship to my company) came built in before I signed on. Nowadays, I've come to appreciate it more for spreading the liability and making my job simpler. I want to be focused on the patient/procedure, not on their sedation. One less thing to worry about.

To be clear, patient's are not asleep. It's conscious sedation or MAC. I try to do almost everything without sedation, but it's available if patient requests. Only time I recommend some sedation, and even that is not absolute, is during SCS trial, RFA, and geniculars.
 
Timeoutofmind said:
Reading this thread is interesting. I have been doing 100% pain for two years straight out of fellowship. I am going to start going back to the OR for one day a week starting soon here.
Because I have a no opioid practice, my volume is fair but I am never quite full. I thought it would just be one day less a week of business that I have to drum up. I also thought it might be nice to have a change of pace from time to time, as it is hard dealing with all the patients that never improve in a pain practice, or come back and tell you the procedure didn’t work, even if some of them do great. And all the psychopathology. And also I feel like the farther out I get from training, it will be less and less possible for me to come back to the OR.
But I negotiated it where it is essentially just office hours during the day. No call or evening or weekend or holiday OR work.
Hopefully this isn’t stupid! I will let you know how it goes!
My main concern is if I am going to be competent and safe. If I feel like it’s not a good idea I am going to back out.
Click to expand...

This is my main issue. Practicing full time pain really does not give the option to do any shadowing in terms of time. I wonder how I would even get my feet wet in terms of doing some anesthesia? Do I take a couple of weeks off from pain and shadow in the OR??
 
call your old residency program. see if any of your fellow residents took a full time gig there. talk to them and the program director. ask if you can shadow someone for a couple of weeks.


go back to your old stomping grounds for a week, catch up with old friends, see the old surgical suite, talk to the nurses still there, have fun... relearn anesthesiology.
 
I did 100%, physician-owned private practice pain in my first job out of training, for about two years. Turns out the place was a disaster of personal problems between the partners, so I did not want to join them. Then retreated to a university setting where I could do pain plus some anesthesia. I worked one day a week in the OR for three years. Then I came to this job where I've been doing 50/50 for about 2.5 years, until recently. I was a full member of the anesthesia group as far as call, weekends, holidays, etc. There are certainly pros and cons to both practices. As I've mentioned several times here, the other guy who was doing pain at this practice moved on recently, so for the past six weeks or so I've been back to full time pain. I actually am surprised how much I like it. I do miss the occasional call off days, or having a post-call day free, or being finished with my cases at 2pm and leaving. I also miss hanging out with some of my surgeon buddies. Most of us are in the same multispecialty group, and there are a few guys who I genuinely can't wait to work with for a nice busy productive day. I don't miss working the evening swing shift, nights, weekends, and holidays, coming in from home to do an epidural on an obese 40 year old G4P3 at 3am. I don't miss doing disaster cases like the nec fasc to the chest wall in a BMI 50 guy, who got his sternum cracked for the debridement.

I had thought when I took over the pain practice that I would be eager for them to recruit a new guy and for me to be able to go back to my 50/50. I had a nightmare/stress dream last night about being asked to come back to the OR. I think I might stick to this pain thing...

Also, agreed that it's hard to keep up with CME/ read the journals in two such disparate specialties.
 
How do you Interventional Pain physicians feel the general public feels about your specialty respect wise? How does it compare to anesthesiology?
 
LebronManning said:
How do you Interventional Pain physicians feel the general public feels about your specialty respect wise? How does it compare to anesthesiology?
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One of the reasons I wanted to do a fellowship at the end of my residency is that I got tired of "not feeling like a doctor". It is at the bottom of my list of concerns now. As a physician, your career is more respected than most, and whether this specialty or that is "more respected" is really starting to split hairs.
 
Two questions.

Is interventional pain saturated in general?

Do non anesthesia interventional pain physicians get paid less than anesthesia for the same procedures? For example Neurology trained and then interventional pain.
 
LebronManning said:
Two questions.

Is interventional pain saturated in general?

Do non anesthesia interventional pain physicians get paid less than anesthesia for the same procedures? For example Neurology trained and then interventional pain.
Click to expand...

Depends on what saturated means to you. I have two other guys in the same building and probably another 7-10 within one mile from me. I’m saturated with a 3 week wait for new evals. Pay your dues and put in the time wherever you go and you will be busy. Have empathy and talk to your patients and they will come.

Can’t answer to number two. But fee schedules should be the same.
 
Is it possible for someone to start their own private practice right after graduating fellowship or do you think a couple years in an established practice to learn the business would be necessary?
 
LebronManning said:
Is it possible for someone to start their own private practice right after graduating fellowship or do you think a couple years in an established practice to learn the business would be necessary?
Click to expand...

I think it really all comes down to how risk averse you are. Are you comfortable not making any money for a year and taking on practice debt?
You definitely have a lot to learn clinically and business wise but here is no guarantee you will get this by joining an established group
 
Pain medicine is saturated with needle jockeys.

It is also saturated with glorified drug pushers and narc dealers.



It is not saturated with multidisciplinary pain physicians who will use a multitude of varied treatments to improved be patient functioning.

Don’t go back into pain if all you can envision is stabbing ppl with needles to generate oodles of money.
 
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