I've rotated in psych and pain and enjoy and can see myself going down either route. Will be doing a psych residency for now and and was wondering if it is financially worth it to do a pain fellowship in terms of salaries post-fellowship in comparison to psychiatry?
Is it financially worth it to do a Pain Fellowship?
- Thread starter moto_za
- Start date
- Joined
- Oct 31, 2017
- Messages
- 140
- Reaction score
- 422
Wait a minute... Financially worth it to do a Pain fellowship?
forums.studentdoctor.net
Financially worth it to do a Pain fellowship?
With MGMA data showing salaries close to 1 million for folks earning above the 75 percentile is it worth doing a Pain fellowship if you think you will enjoy it? Is it mostly because of interest in psychiatry that most psychiatry residents don't take this path?
forums.studentdoctor.net
- Joined
- Mar 21, 2019
- Messages
- 286
- Reaction score
- 298
Isn't pain very hard to land coming from psych?
- Joined
- Mar 13, 2013
- Messages
- 2,546
- Reaction score
- 4,274
It can be done.
- Joined
- Mar 21, 2019
- Messages
- 286
- Reaction score
- 298
What should one do to set themselves up on this path starting intern year?
- Joined
- Feb 24, 2010
- Messages
- 3,384
- Reaction score
- 6,903
Switch to Anesthesiology or PM&R?
But seriously, it will be a tough road to land Pain from Psychiatry unless at one of the places like CCF/Mayo/Hopkins which have Chronic Pain Rehab programs, and if they have their Pain fellows rotate through, that might be an in to the fellowship.
After doing 4 years of very limited hands on medicine, very limited imaging review, very limited general medical review it will be a rusty journey to get back into the swing of that thought process. Now, possibly you'll be a star for med management for the opioid maintenance of chronic opioids and spotting the addiction. Most pain docs hate the opioid clinic side of things and try to run from it to focus on just being a 'needle jockey.' Some out right refuse to do it. I really haven't seen pain management emphasize the non-opioid pain meds and psychotropic optimization, and if coming form psych you might have a leg up on this spend the time with patients doing so. However, if your goal is the higher salary, being a focused psychiatrist won't get you there, being in the procedure suite will.
Sadly, the country needs less pain management doctors as the field is currently structured and more pain psychiatrists like what you see at Mayo/Cleveland Clinic/Hopkins. These programs should be in every metro, sadly they are not.
Thanks for the responses. Will likely end up doing some more pain electives and see how it goes. Based on my research it can be done, but as mentioned has it's challenges. The website below shows a psych doc who does interventional pain and owns two clinics:
www.houstonpainandspine.com
Houston Pain & Spine | Pain Management Services in Houston and The Woodlands
Houston Pain & Spine are providing interventional pain management services in Houston and The Woodlands. Call to schedule an appointment (832) 680-4504
www.houstonpainandspine.com
- Joined
- Jan 5, 2002
- Messages
- 2,943
- Reaction score
- 3,017
You can do it, though the incentives really aren't there anymore. As people like @finalpsychyear shows, it's probably easier to make pain money doing a lot of psych than being a psych trying to make a lot of money by doing pain. You should only do pain if you are really interested in the procedures and don't want to practice psych anymore. I know a decent number of pain people through training. While it's much easier to crack 500k in pain, it's not trivial to crack 1M, and salary is coming down and people's schedules are very cramped. Frankly I think it's more likely to carve out a more derm like existence in psych than in pain.
- Joined
- Jun 4, 2010
- Messages
- 16
- Reaction score
- 4
You won't be competitive or knowledgeable. PM&R focuses on MSK causes of pain, anesthesia on the physiology and medical aspects, in psych you would be doing more pill management and it wouldn't be more lucrative. You won't get enough training in residency to be comfortable with the procedures.
- Joined
- Sep 1, 2008
- Messages
- 6,366
- Reaction score
- 6,169
Pain is quite lucrative, but the money is in procedures. Anything involving pills or general clinic is not.
I thought that was the point of doing a fellowship in pain though
- Joined
- Jun 4, 2010
- Messages
- 16
- Reaction score
- 4
Pain fellowships are one year and assume you come in with a large amount of knowledge on pain, procedures, radiology etc. It's more a numbers game. Yes they will supervise you doing procedures, but you would be lost without a good base beforehand. More-over, most fellows in pain have done extensive electives and research in pain prior to applying to be competitive. I would look more into who actually matches into pain before assuming it's a viable path for someone in psych despite the fact that technically you can apply from psych.
- Joined
- Jun 4, 2010
- Messages
- 16
- Reaction score
- 4
When I say numbers game- I mean doing a certain number of each procedure.
If you are looking to make money, why not do a forensics fellowship. If you do pain, maybe supplement income with expert witness work or do pain and forensics. I am not aware of any pain docs that did a forensics fellowship. You have to be a psychiatrist to do a forensics fellowship.
Go for it. Most non psych docs have no idea what psychiatrist training consists of. 40% of your board exam is neuro . You can have upto 1 year of residency made up of medicine. I did 9 months and was volunteered for every single available procedure. You are very much capable of doing pain management as a physician. If CRNA can do it, who have no basic science formal education, you can do it.
As for compensation that is different story. Psychiatrist will likely make more than pain management doc. 350k is average with 4 day work week. Private practice you will be making 6-800k. Throw in ketamine compensation will be significantly higher
As for compensation that is different story. Psychiatrist will likely make more than pain management doc. 350k is average with 4 day work week. Private practice you will be making 6-800k. Throw in ketamine compensation will be significantly higher
aren't there 1-2 pain fellowships that are psychiatric based? one option is to contact all the pain programs or do your residency where you plan on doing the pain fellowship. then you could somehow procedure-heavy electives or volunteer to observe pain procedures while you happen to have downtime during a call. I know some fellowships are flexible. another option is after residency work for a year as a psych consultant in a pain center and learn procedures off of fellow attendings. another idea is to do a combined neurology and psychiatry residency or FM/psychiatry residency. it is one extra year.
as an update to my post above, after you do your pain fellowship, you could make a lot of money getting involved in opioid litigation. you could opine both on the malpractice of a pain doc and the damages from the dependence standpoint. I have received a few cases that involved opioid dependence.
as an update to my post above, after you do your pain fellowship, you could make a lot of money getting involved in opioid litigation. you could opine both on the malpractice of a pain doc and the damages from the dependence standpoint. I have received a few cases that involved opioid dependence.
- Joined
- Oct 17, 2011
- Messages
- 363
- Reaction score
- 110
Pain attainable. Do it. You learn imaging and procedures. You are a physician and you can learn all of this with proper training.
As for salary, from experience, you make pretty good money, but you work much harder compared to psych. Imagine doing procedures from 7:30am to 7pm some days, and don’t forget you will be wearing a 10-20lb lead vest. It’s exhausting and wares on you.
Seeing pain in academic setting is totally different then doing pain in the real world. And if you want to do pain in an academic setting, then you won’t make lucrative amounts because you be seeing much less patients and doing less procedures . Basically, if you want to make lots of money, pain is a good field, but beware, it comes with lots and lots of work, high risk procedures at times(CESI), high malpractice insurance, mich high chance of getting sued, and orth and Neurosurg send you patients after they run out of surgeries.
But, I promise you, if Pain is your passion, it’s really rewarding and I am happy.
As for salary, from experience, you make pretty good money, but you work much harder compared to psych. Imagine doing procedures from 7:30am to 7pm some days, and don’t forget you will be wearing a 10-20lb lead vest. It’s exhausting and wares on you.
Seeing pain in academic setting is totally different then doing pain in the real world. And if you want to do pain in an academic setting, then you won’t make lucrative amounts because you be seeing much less patients and doing less procedures . Basically, if you want to make lots of money, pain is a good field, but beware, it comes with lots and lots of work, high risk procedures at times(CESI), high malpractice insurance, mich high chance of getting sued, and orth and Neurosurg send you patients after they run out of surgeries.
But, I promise you, if Pain is your passion, it’s really rewarding and I am happy.
- Joined
- Oct 17, 2011
- Messages
- 363
- Reaction score
- 110
As a side note, I wouldn’t listen to the ones stating psych makes you less competitive. You can teach a monkey to do procedures, it’s not only about procedures. Yes, you’ll have a harder time initially, but who cares, everyone knows this(not a secret. Lol).
A good pain physician uses their brain and knows when NOT to do a procedure or when to STOP/abort a procedure: requires much more skill and training. Read the pain forum, I think it’s a good start.
A good pain physician uses their brain and knows when NOT to do a procedure or when to STOP/abort a procedure: requires much more skill and training. Read the pain forum, I think it’s a good start.
- Joined
- Nov 10, 2010
- Messages
- 1,191
- Reaction score
- 821
A few thoughts:
-unless you’re self-employed, don’t compare yourself to anesthesiology pain on the MGMA money report, compare yourself to non-anesthesia like PM&R docs. Still pretty good money
-you should really strive to learn some pain medicine, pain psychology, and addiction medicine in your residency. This is not that hard.
-try to find ways to spend time around pain, in clinic or going to rounds, doing electives, collaborating on articles and presentations
-get somebody to show you how to play with a needle and an ultrasound; most academic medical centers have simulation labs you can use. At this point, it doesn’t matter if you’re simulating a biopsy or a central line.
-if you really want to experience X-ray guided stuff, you can attend a pain procedure workshop a lot cheaper if you’re still in training and practice on cadavers. Don’t bother with this unless you’re very close to your goal.
-basically, you want to demonstrate that you’re really interested in pain and have already done a lot of the work, and that you're not just some guy who wants to make bank.
-unless you’re self-employed, don’t compare yourself to anesthesiology pain on the MGMA money report, compare yourself to non-anesthesia like PM&R docs. Still pretty good money
-you should really strive to learn some pain medicine, pain psychology, and addiction medicine in your residency. This is not that hard.
-try to find ways to spend time around pain, in clinic or going to rounds, doing electives, collaborating on articles and presentations
-get somebody to show you how to play with a needle and an ultrasound; most academic medical centers have simulation labs you can use. At this point, it doesn’t matter if you’re simulating a biopsy or a central line.
-if you really want to experience X-ray guided stuff, you can attend a pain procedure workshop a lot cheaper if you’re still in training and practice on cadavers. Don’t bother with this unless you’re very close to your goal.
-basically, you want to demonstrate that you’re really interested in pain and have already done a lot of the work, and that you're not just some guy who wants to make bank.
- Joined
- Jul 21, 2011
- Messages
- 532
- Reaction score
- 750
10 to 20 procedures before noon, then 10 to 20 procedures until 5. Wearing lead, getting zapped with fluoroscopy. 3 days a week. Another 2 days in clinic seeing pain patients all day.
Try it first if you can, shadow someone, because it's a jarring leap from psychiatry.
Starting salaries in competitive markets like SoCal is around $250 - $300K. Not that far off from Psych. You can hit $500K in less popular locations after 5 or 10 years in. Keep in mind reimbursements in pain have been coming down, while reimbursements in Psych have been going up.
Try it first if you can, shadow someone, because it's a jarring leap from psychiatry.
Starting salaries in competitive markets like SoCal is around $250 - $300K. Not that far off from Psych. You can hit $500K in less popular locations after 5 or 10 years in. Keep in mind reimbursements in pain have been coming down, while reimbursements in Psych have been going up.
100% false
- Joined
- Apr 8, 2003
- Messages
- 1,826
- Reaction score
- 369
It's FAR less neuro on the board exam. I think 6-9%
Lot of truth in this post -- though you don't need to put in 12 hour days on procedures if you don't want to.
At the current time, psychiatry is likely on par salary wise with pain management. Ten years ago, it was a different story.
- Joined
- Oct 17, 2011
- Messages
- 363
- Reaction score
- 110
I know I am very late with this response, as I am not a frequent poster on this forum. I just want to give the OP some reassurance from all the negativity. I am a psych trained pain management physician. I also know several of us who are both in academics and in private practice (though few, we are here!) People are correct in that is hard to get into fellowship. But more and more programs are open to accepting well rounded candidates as we shift to a multidisciplinary approach to pain. That being said, you will come out of fellowship knowing what you need to start practice. The learning curve is steep but completely doable and programs that are willing to hire a psychiatrist understand that. I am proficient in procedures coming from a nonprocedural background and can stand my own with my anesthesia pain partners in our practice. Please don't be discouraged, you have a lot to offer coming from your background.
- Joined
- Jun 23, 2006
- Messages
- 509
- Reaction score
- 255
How does pay compare in pain versus standard psychiatry jobs in your experience?
- Joined
- Jan 5, 2002
- Messages
- 2,943
- Reaction score
- 3,017
I don't know about that. I think for facilities jobs, pain pays at least 50-100k more. For PP, the max is maybe similar but the distribution is totally different. The median for psych in PP for owners' profit including labor is probably around 300-350k, but the median for pain is likely > 500k. Making 600-800k a year as a PP psychiatrist is not rare, but also not typical.
That said, it is plausible that the median PP psychiatrist is living more of a sweet low key lifestyle, especially if u r cash. For one thing, hours are vastly more flexible in a typical PP psych set up. Overhead is way lower. You really do need to seriously fill those hours in the fluoro suite if you want to make money.
It really depends on on location and ownership structures, etc. But for the most part, the days of a 500k median salary in pain are largely over with unless someone has significant ownership in ASCs, etc.
Pay is similar to PMR/Neuro colleagues doing pain. Reimbursements have gone down, but if you have a thriving private practice then there really isn’t that much of a discrepancy in my opinion
- Joined
- Jun 1, 2013
- Messages
- 170
- Reaction score
- 84
You will make as much in pain as you want. So to your question yes Pain has massive potential to be "Worth" spending another year doing training. Work surgeon hours with heavy emphasis on procedures and you too can make 500-900k a year as a PP doc (sounds like a living hell to me). Try to be both a Pain doc and a "pain psychiatrist" and, expect to make a little more than the average psychiatrist (because you do have a half day or two of procedures), working regular life hours.
I am planning to do an addictions and a pain fellowship. My hope is to be the latter of the two choices above, doing a nice mix of pain procedures, pain psych, gen psych, and addiction psych/medicine. I anticipate I will make 15-30% more than the average psychiatrist with a mix of procedures/therapy/med management. Yes will I be taking a proverbial "Hit"? Sure! I could go all procedures all day, with clinic appointments who's goal is to always generate more procedures, but that's not the life I want. I'm looking to enjoy what I do, not get burnt out, and work a sustainable schedule that will allow me to be in a carrier that will last well past "retirement age" because realistically, if I still enjoy what I'm doing why stop when I'm 65 or 70?
Also as above noted. You don't make more because of what specialty your come from to get to pain, you make more based on billing more and getting more RVU's. The psych trained pain doc who lives in the flouro suite and does SCS as often as possible with 70 hours weeks, will always make more than the anesthesiologist colleague who does a 4.5 day week with 1/2/3 half days of procedures.
I am planning to do an addictions and a pain fellowship. My hope is to be the latter of the two choices above, doing a nice mix of pain procedures, pain psych, gen psych, and addiction psych/medicine. I anticipate I will make 15-30% more than the average psychiatrist with a mix of procedures/therapy/med management. Yes will I be taking a proverbial "Hit"? Sure! I could go all procedures all day, with clinic appointments who's goal is to always generate more procedures, but that's not the life I want. I'm looking to enjoy what I do, not get burnt out, and work a sustainable schedule that will allow me to be in a carrier that will last well past "retirement age" because realistically, if I still enjoy what I'm doing why stop when I'm 65 or 70?
Also as above noted. You don't make more because of what specialty your come from to get to pain, you make more based on billing more and getting more RVU's. The psych trained pain doc who lives in the flouro suite and does SCS as often as possible with 70 hours weeks, will always make more than the anesthesiologist colleague who does a 4.5 day week with 1/2/3 half days of procedures.
