• Advice You're Thankful for Contest

    Now that it's getting close to Thanksgiving, we're running a contest to hear advice you've received that you're most thankful for! This can be any type of advice and the advice with the most reactions will win!

    JOIN CONTEST

Is the grass greener in pain management than general anesthesiology?

Shouldawouldacouldas

Full Member
5+ Year Member
Oct 2, 2015
45
18
  1. Attending Physician
    Anyone gone from the practice of general anesthesiology to pain management? Is it worth switching now?

    My jobs have been mainly anesthesiology, but I also have provided both acute and chronic pain management services.

    An anesthesia management company is taking over our hospital soon, and this may be an opportunity to change directions.

    Thank you in advance for your responses. I will also post this same question in the anesthesiology forum.
     

    willabeast

    Full Member
    10+ Year Member
    Mar 7, 2011
    1,543
    411
    1. Attending Physician
      I switched anesthesia to pain. I did it in the 1990's so not much applicability to your situation. Looking back on it all, the best thing about the switch in terms of lifestyle was no nights or weekend call with pain, although i could have achieved the same thing in anesthesia at a full time job in a surgicenter.
      the best thing in terms of job satisfaction was that i called my own shots (literally) for years. But you could do this in anesthesia also in some academic centers. I really think it all comes down to what you like and whatever situation you wind up, so it is very variable and impossible to predict.
       
      • Like
      Reactions: 1 user

      neutro

      Full Member
      10+ Year Member
      Apr 8, 2009
      474
      274
      Pennsylvania
      1. Attending Physician
        I'm switching from a 100% pain and 20% anesthesia practice (currently it's my second, part time job), to a FT general anesthesia practice after my contract ends. The intention is to start an interventional only practice on the side and choose my referring physicians very carefully and build that up. I do not anticipate giving up anesthesia practice. I enjoy it a lot more than pain.
        Reasons for doing anesthesia:
        1) More time off. In most cases, more pay. If you compare the $amount/ effort, anesthesia wins easily. Cross coverage and back up is always available.
        2) literally no paperwork or notes, minimal administrative issues or prior auth. Actually more help around. CRNA supervision can be a good thing. I currently do 50% of my cases solo, but also work with CRNAs.
        3) No arguing with patients. Having long term relationship with a patient can be a good or a bad thing. Expectations from patients go up the longer you know them.
        4) Pain medicine is a dumping ground. Our PCPs don't even write for gabapentin or ibuprofen and that is becoming the trend elsewhere. They just "don't want to deal with it". Ortho/spine is the same. I have many patients who have stim explanted after 2 years, and have had 3 lumbar fusions and revisions. What can you do with that patient without having multimodal analgesics, and then opioids as part of their pain management plan? I end up becoming their PCP. I do not want that responsibility.
        5) very few chronic pain patients actually improve and the solution is not injections or medications or new and advanced stim or PRP. Perhaps it is a combined approach. A big part of pain management is treating the underlying cognitive dysfunction and teaching coping strategies as well as "PT for life". I am not a psychiatrist, and I do try my best - but its draining to constantly motivate these patients and keep them on the right track.
         
        • Like
        Reactions: 2 users
        About the Ads

        Ducttape

        Full Member
        Lifetime Donor
        10+ Year Member
        Oct 7, 2011
        11,102
        3,797
        1. Attending Physician
          im not understanding. are the below statements not in conflict with each other?
          The intention is to start an interventional only practice on the side.

          5) very few chronic pain patients actually improve and the solution is not injections or medications or new and advanced stim or PRP. .

          now this I agree completely with:
          Perhaps it is a combined approach. A big part of pain management is treating the underlying cognitive dysfunction and teaching coping strategies as well as "PT for life". I am not a psychiatrist, and I do try my best - but its draining to constantly motivate these patients and keep them on the right track.
           

          lobelsteve

          Full Member
          Staff member
          Volunteer Staff
          Lifetime Donor
          Verified Expert
          15+ Year Member
          May 30, 2005
          17,213
          7,433
          Canton GA
          www.stevenlobel.com
          1. Attending Physician
            Interventions for diagnostic/trial reasons ONLY. Repeat if helping. Patient's expectations need to be clarified from the start.

            Just stay in the OR. Your posts make it sound like you will never believe you're patient and will only do things to your own end.
             
            • Like
            Reactions: 1 user

            neutro

            Full Member
            10+ Year Member
            Apr 8, 2009
            474
            274
            Pennsylvania
            1. Attending Physician
              er, um, I was talking about your talking points, about how you are planning to do an intervention only practice, but realize that injections are only part of the solution.
              ummm, so thats it. i dont intend to be a "comprehensive pain doc" because that is too exhaustive and my temperament is not built for that. come and get an evaluation, ill do appropriate, evidence based injections if needed, then go back to your PCP/ candyman for further management.
              thats what Interventional Radiology does too. if it doesnt work, reevaluate and try again. but no long term follow up.
              Im happy with 80% anesthesia and 20% pain practice. i dont desire to be a hero for chronic pain patients.
               

              neutro

              Full Member
              10+ Year Member
              Apr 8, 2009
              474
              274
              Pennsylvania
              1. Attending Physician
                Just stay in the OR. Your posts make it sound like you will never believe you're patient and will only do things to your own end.
                Meh, thats certainly not the reality but I am not here to discuss that with you.
                Yes, OR is great. Thats why i did an anesthesia residency, i.e. actual medicine and real science. Glad to have it as a backup.
                 

                drpainfree

                Full Member
                10+ Year Member
                May 3, 2009
                1,102
                175
                1. Attending Physician
                  Meh, thats certainly not the reality but I am not here to discuss that with you.
                  Yes, OR is great. Thats why i did an anesthesia residency, i.e. actual medicine and real science. Glad to have it as a backup.


                  you have to realize you cannot be doing WELL in both specialties even if you try to. They are completely two different specialties requiring different mind set.

                  mean no offense, but I think based on what you described, you are meant to stay in OR.

                  you won't be able to build an injection only PRACTICE nowaday. At most you will get one or two inpatient consult a week from PCP and maybe do a little injections on the side of your anesthesia work. If you enjoy that kind of flow, great. Do realize though it's not a practice.
                   

                  neutro

                  Full Member
                  10+ Year Member
                  Apr 8, 2009
                  474
                  274
                  Pennsylvania
                  1. Attending Physician
                    you have to realize you cannot be doing WELL in both specialties even if you try to. They are completely two different specialties requiring different mind set.

                    mean no offense, but I think based on what you described, you are meant to stay in OR.

                    you won't be able to build an injection only PRACTICE nowaday. At most you will get one or two inpatient consult a week from PCP and maybe do a little injections on the side of your anesthesia work. If you enjoy that kind of flow, great. Do realize though it's not a practice.

                    It is true that to create this practice is hard but it does exist - it takes time to build, but it exists - just need to be careful with what type of patients you take on, and which referring physicians you choose to work with. it takes time. just last week, i had a podiatrist that i did anesthesia for, send me three referrals for lumbar SCS for diabetic neuropathy after i explained to him about my practice and what i can offer. Its all about marketing and making appropriate contacts.
                    I am also not looking to inject everyone. I *think* I am appropriately conservative in this regard. Focus is still on appropriate eval and safe interventions. If a candidate and if i can help - inject. If not, sorry. No long term follow up. its not for me.
                     

                    lobelsteve

                    Full Member
                    Staff member
                    Volunteer Staff
                    Lifetime Donor
                    Verified Expert
                    15+ Year Member
                    May 30, 2005
                    17,213
                    7,433
                    Canton GA
                    www.stevenlobel.com
                    1. Attending Physician
                      It is true that to create this practice is hard but it does exist - it takes time to build, but it exists - just need to be careful with what type of patients you take on, and which referring physicians you choose to work with. it takes time. just last week, i had a podiatrist that i did anesthesia for, send me three referrals for lumbar SCS for diabetic neuropathy after i explained to him about my practice and what i can offer. Its all about marketing and making appropriate contacts.
                      I am also not looking to inject everyone. I *think* I am appropriately conservative in this regard. Focus is still on appropriate eval and safe interventions. If a candidate and if i can help - inject. If not, sorry. No long term follow up. its not for me.

                      You are one big contradiction. Please stay in the OR. Or send me your explants. I think you are completely nuts.
                       
                      • Like
                      Reactions: 1 user

                      thecentral09

                      Full Member
                      2+ Year Member
                      Feb 8, 2017
                      277
                      87
                        It is true that to create this practice is hard but it does exist - it takes time to build, but it exists - just need to be careful with what type of patients you take on, and which referring physicians you choose to work with. it takes time. just last week, i had a podiatrist that i did anesthesia for, send me three referrals for lumbar SCS for diabetic neuropathy after i explained to him about my practice and what i can offer. Its all about marketing and making appropriate contacts.
                        I am also not looking to inject everyone. I *think* I am appropriately conservative in this regard. Focus is still on appropriate eval and safe interventions. If a candidate and if i can help - inject. If not, sorry. No long term follow up. its not for me.
                        Chronic pain by definition is chronic. If long term follow up for a chronic condition is not your thing, I would highly suggest not getting involved in the first place. All you will add is another care giver who is not all in, and who doesn't want to communicate with the other caregivers that patient will inevitably be dependent on if you are only doing procedures. Do the patient a favor and focus on where your heart is, in the OR doing anesthesia.
                         
                        About the Ads

                        Ducttape

                        Full Member
                        Lifetime Donor
                        10+ Year Member
                        Oct 7, 2011
                        11,102
                        3,797
                        1. Attending Physician
                          ummm, so thats it. i dont intend to be a "comprehensive pain doc" because that is too exhaustive and my temperament is not built for that. come and get an evaluation, ill do appropriate, evidence based injections if needed, then go back to your PCP/ candyman for further management.
                          thats what Interventional Radiology does too. if it doesnt work, reevaluate and try again. but no long term follow up.
                          Im happy with 80% anesthesia and 20% pain practice. i dont desire to be a hero for chronic pain patients.
                          so you want to be a needle jockey. 100%. all the time.

                          I *think* I am appropriately conservative in this regard.
                          so think the multitude of needle jockeys that do hundreds of "necessary" procedures and give pain management a bad name...




                          I think we have enough needle jockeys already...
                           

                          neutro

                          Full Member
                          10+ Year Member
                          Apr 8, 2009
                          474
                          274
                          Pennsylvania
                          1. Attending Physician
                            You are one big contradiction. Please stay in the OR. Or send me your explants. I think you are completely nuts.
                            haha, wow. Thank you for your input once again, stevelobel.
                            Since you foolishly continue to make personal comments despite not knowing me, my practice, or what service I provide - which is probably far more comprehensive than yours (besides bread and butter interventional pain, all sorts or non malignant pain, it includes inpatient pain coverage, OB pain, cancer pain and palliative care, peds pain, as well as addiction medicine for a hospital). And I have noticed, you are quite snippy towards anesthesiologists in general - I am going to say a few things that you may not like, but here it is.
                            It is clear to me that you are one big narcissist and a highly insecure man. Your posts do suggest that. And hungry for attention!
                            This thread is again an example of such non sense behavior. Acted like SDN Pain grandfather once again, came out of left field and contributed nothing. This is a thread comparing anesthesia and pain, since you have never practiced anesthesia (God, I hope not), you are pretty much disqualified in contributing in this thread.
                            If posting images of cards on SDN and arguing with Dr Candido trying to one-up him on social media, and jumping on whatever posts that are not in line with your philosophy as a physiatrist who has never been exposed to REALLY sick patients, taken real in house call, or deal with REAL emergency situations gets you through the day, then so be it. We get it, our patients walk in and out of clinic and you are done by 5 pm and weekends are off. Congrats. Good job. Just don't disrespect the discipline of anesthesia.
                            and FYI, I do not do implants of any kinds. but again, you do not know my practice. I just do trials and send them out only if the patient convinces me that they want this device and will take ownership of stim, otherwise no implant.
                            And dot worry, even if you were in my own department, I would not send you any patients with your attitude. We have a very strong anesthesia based pain group as part of a major hospital system 50 minutes north and south of me, and neurosurgeons - thats where my patients go.
                            Good luck to you though.

                            To the original poster. The landscape of pain management has changed drastically in the last 10 years. From when I became interested in pain medicine and cancer pain as a MS-3, to residency, to fellowship, to now. Im sure others will say it has changed since they started.
                            It would be a grave mistake if you let go of your anesthesia skill. Your training is anesthesia. Do pain part time and help where you can with appropriate needle based injections. Don't be an "ortho monkey" and "candyman" by being a pain physician. Also, the expectations from pain doctors have changed. You will almost be a primary care doctor to many pain patients - which at times, means opioid based pain management. Thats another can of worms but its not an easy thing to manage even if you are shielded by a hospital system.
                             

                            neutro

                            Full Member
                            10+ Year Member
                            Apr 8, 2009
                            474
                            274
                            Pennsylvania
                            1. Attending Physician
                              so you want to be a needle jockey. 100%. all the time.


                              so think the multitude of needle jockeys that do hundreds of "necessary" procedures and give pain management a bad name...




                              I think we have enough needle jockeys already...
                              you can call IR needle jockeys too. you can call dr. aprill needle jockey too then. The difference lies in ethics.
                              Needle jockeys do it for money. If i make $0 per year or 1/2 a mil it wont bother me as long as the right injection is done for the right patient for the right reasons. I will earn majority of my living doing anesthesia. Im happy with that.
                               

                              lobelsteve

                              Full Member
                              Staff member
                              Volunteer Staff
                              Lifetime Donor
                              Verified Expert
                              15+ Year Member
                              May 30, 2005
                              17,213
                              7,433
                              Canton GA
                              www.stevenlobel.com
                              1. Attending Physician
                                haha, wow. Thank you for your input once again, stevelobel.
                                Since you foolishly continue to make personal comments despite not knowing me, my practice, or what service I provide - which is probably far more comprehensive than yours (besides bread and butter interventional pain, all sorts or non malignant pain, it includes inpatient pain coverage, OB pain, cancer pain and palliative care, peds pain, as well as addiction medicine for a hospital). And I have noticed, you are quite snippy towards anesthesiologists in general - I am going to say a few things that you may not like, but here it is.
                                It is clear to me that you are one big narcissist and a highly insecure man. Your posts do suggest that. And hungry for attention!
                                This thread is again an example of such non sense behavior. Acted like SDN Pain grandfather once again, came out of left field and contributed nothing. This is a thread comparing anesthesia and pain, since you have never practiced anesthesia (God, I hope not), you are pretty much disqualified in contributing in this thread.
                                If posting images of cards on SDN and arguing with Dr Candido trying to one-up him on social media, and jumping on whatever posts that are not in line with your philosophy as a physiatrist who has never been exposed to REALLY sick patients, taken real in house call, or deal with REAL emergency situations gets you through the day, then so be it. We get it, our patients walk in and out of clinic and you are done by 5 pm and weekends are off. Congrats. Good job. Just don't disrespect the discipline of anesthesia.
                                and FYI, I do not do implants of any kinds. but again, you do not know my practice. I just do trials and send them out only if the patient convinces me that they want this device and will take ownership of stim, otherwise no implant.
                                And dot worry, even if you were in my own department, I would not send you any patients with your attitude. We have a very strong anesthesia based pain group as part of a major hospital system 50 minutes north and south of me, and neurosurgeons - thats where my patients go.
                                Good luck to you though.

                                To the original poster. The landscape of pain management has changed drastically in the last 10 years. From when I became interested in pain medicine and cancer pain as a MS-3, to residency, to fellowship, to now. Im sure others will say it has changed since they started.
                                It would be a grave mistake if you let go of your anesthesia skill. Your training is anesthesia. Do pain part time and help where you can with appropriate needle based injections. Don't be an "ortho monkey" and "candyman" by being a pain physician. Also, the expectations from pain doctors have changed. You will almost be a primary care doctor to many pain patients - which at times, means opioid based pain management. Thats another can of worms but its not an easy thing to manage even if you are shielded by a hospital system.

                                Glad i dont know you. You are what is wrong with our field. By your posts here alone i know enough. You do not sound like someone who is geared for an outpatient practice and your posts make it sound like you are in it for making money and providing false hope.
                                 

                                neutro

                                Full Member
                                10+ Year Member
                                Apr 8, 2009
                                474
                                274
                                Pennsylvania
                                1. Attending Physician
                                  Glad i dont know you. You are what is wrong with our field. By your posts here alone i know enough. You do not sound like someone who is geared for an outpatient practice and your posts make it sound like you are in it for making money and providing false hope.

                                  oh, believe me, I'm actually quite glad I do not know you either, nor am I interested. I see nothing special in your conduct, posts, mannerisms or behavior. I remember posting once about a difficult cancer pain patient and you said "turf to hospice". That exemplifies everything. That is your caliber. Its laughable. I chucked then, and I chuckle now.

                                  FYI, as an anesthesiologist, no, I would not "turf to hospice". I would learn about the patient, call those who taught me and are more experienced than me, help the patient and give the sick patient my cell phone number along with his wife, and manage his meds and see him weekly, despite NOT knowing how to fully practice palliative care, nor it being my specialty but understanding the concept of "service" that anesthesia teaches you. Thats what I did until that poor man died 4.5 months after. And upon his passing, out of gratitude, his wife gave my newborn so many sets of clothes that he outgrew them before he could wear them all.

                                  Of course, I did not post a pic of that huge gift basket here like you.

                                  You make me laugh with your little shenanigans.

                                  Anyways, for the last time, I'm not here to make money or rip anyone off. Im employed and get a fixed salary and will get a fixed salary when I do anesthesia also.
                                  Please get that in your head IMMEDIATELY. My colleagues, admin, personal record, history and tax returns can attest to my record. There is nothing to hide.
                                  So please, kindly stop with the altruistic/ humble stance like you are some savior for chronic pain patient population and everyone else with an alternate opinion is living in a fool's world and here to cheat the patients.

                                  If you are a TRUE humanist, I urge you to quit your job tomorrow and go work for doctors without borders or many other services. In fact, I challenge you.
                                  How about volunteering two weeks a year and doing free service where they need it the most? I hear they're looking for help in Haiti, Syria, Kashmir, Sudan and Congo and Tanzania.

                                  ...but you wont.

                                  I now understand why pretty much 90% of pain attendings warned me about SDN. Its full of pretentious twats.

                                  Im done with SDN. What a waste of time.

                                  Good luck to everyone with their current and future endeavors.
                                   
                                  • Like
                                  Reactions: 1 user

                                  lobelsteve

                                  Full Member
                                  Staff member
                                  Volunteer Staff
                                  Lifetime Donor
                                  Verified Expert
                                  15+ Year Member
                                  May 30, 2005
                                  17,213
                                  7,433
                                  Canton GA
                                  www.stevenlobel.com
                                  1. Attending Physician
                                    oh, believe me, I'm actually quite glad I do not know you either, nor am I interested. I see nothing special in your conduct, posts, mannerisms or behavior. I remember posting once about a difficult cancer pain patient and you said "turf to hospice". That exemplifies everything. That is your caliber. Its laughable. I chucked then, and I chuckle now.

                                    FYI, as an anesthesiologist, no, I would not "turf to hospice". I would learn about the patient, call those who taught me and are more experienced than me, help the patient and give the sick patient my cell phone number along with his wife, and manage his meds and see him weekly, despite NOT knowing how to fully practice palliative care, nor it being my specialty but understanding the concept of "service" that anesthesia teaches you. Thats what I did until that poor man died 4.5 months after. And upon his passing, out of gratitude, his wife gave my newborn so many sets of clothes that he outgrew them before he could wear them all.

                                    Of course, I did not post a pic of that huge gift basket here like you.

                                    You make me laugh with your little shenanigans.

                                    Anyways, for the last time, I'm not here to make money or rip anyone off. Im employed and get a fixed salary and will get a fixed salary when I do anesthesia also.
                                    Please get that in your head IMMEDIATELY. My colleagues, admin, personal record, history and tax returns can attest to my record. There is nothing to hide.
                                    So please, kindly stop with the altruistic/ humble stance like you are some savior for chronic pain patient population and everyone else with an alternate opinion is living in a fool's world and here to cheat the patients.

                                    If you are a TRUE humanist, I urge you to quit your job tomorrow and go work for doctors without borders or many other services. In fact, I challenge you.
                                    How about volunteering two weeks a year and doing free service where they need it the most? I hear they're looking for help in Haiti, Syria, Kashmir, Sudan and Congo and Tanzania.

                                    ...but you wont.

                                    I now understand why pretty much 90% of pain attendings warned me about SDN. Its full of pretentious twats.

                                    Im done with SDN. What a waste of time.

                                    Good luck to everyone with their current and future endeavors.

                                    Aww. I can't speak for others, but i will miss you. Nice long post, too.
                                     

                                    drpainfree

                                    Full Member
                                    10+ Year Member
                                    May 3, 2009
                                    1,102
                                    175
                                    1. Attending Physician
                                      oh, believe me, I'm actually quite glad I do not know you either, nor am I interested. I see nothing special in your conduct, posts, mannerisms or behavior. I remember posting once about a difficult cancer pain patient and you said "turf to hospice". That exemplifies everything. That is your caliber. Its laughable. I chucked then, and I chuckle now.

                                      FYI, as an anesthesiologist, no, I would not "turf to hospice". I would learn about the patient, call those who taught me and are more experienced than me, help the patient and give the sick patient my cell phone number along with his wife, and manage his meds and see him weekly, despite NOT knowing how to fully practice palliative care, nor it being my specialty but understanding the concept of "service" that anesthesia teaches you. Thats what I did until that poor man died 4.5 months after. And upon his passing, out of gratitude, his wife gave my newborn so many sets of clothes that he outgrew them before he could wear them all.

                                      Of course, I did not post a pic of that huge gift basket here like you.

                                      You make me laugh with your little shenanigans.

                                      Anyways, for the last time, I'm not here to make money or rip anyone off. Im employed and get a fixed salary and will get a fixed salary when I do anesthesia also.
                                      Please get that in your head IMMEDIATELY. My colleagues, admin, personal record, history and tax returns can attest to my record. There is nothing to hide.
                                      So please, kindly stop with the altruistic/ humble stance like you are some savior for chronic pain patient population and everyone else with an alternate opinion is living in a fool's world and here to cheat the patients.

                                      If you are a TRUE humanist, I urge you to quit your job tomorrow and go work for doctors without borders or many other services. In fact, I challenge you.
                                      How about volunteering two weeks a year and doing free service where they need it the most? I hear they're looking for help in Haiti, Syria, Kashmir, Sudan and Congo and Tanzania.

                                      ...but you wont.

                                      I now understand why pretty much 90% of pain attendings warned me about SDN. Its full of pretentious twats.

                                      Im done with SDN. What a waste of time.

                                      Good luck to everyone with their current and future endeavors.

                                      I don't think we're criticizing your choice between anesthesia and outpatient pain management. In fact, I completely understood what you are saying. I enjoyed doing anesthesia tremendously and frankly it's easy money if you know how to do anesthesia well and enjoy hands-on aspect of critical care medicine w/o all that non-sense BS in pain management paperwork. I completely gave up on anesthesia due to health-related reasons, but often scared of the regression of anesthesia skill and even have dreams of me forgetting some critical steps of anesthesia. Last night I had a dream where I was working with a resident on an open-heart case. Don't know why I have these dreams, but it reminds me how much fun I had when doing anesthesia back then.

                                      The outcome of trying to do both anesthesia and pain management is, you will naturally gravitate towards anesthesia simply because you like it and really it's easier than chronic pain management. The inevitable end point is you will want to stay in anesthesia instead of pain management. I have worked in probably 10 to 15 anesthesia departments in various setting. I have not seen a single anesthesiologist who can do well in both anesthesia and pain management. Each specialty has its advantage and disadvantages. What you are describing is really trying to cherry-pick the best of each specialty and not to be bothered with the disadvantages. Sorry, you can't pick it that way, unfortunately. If it's possible, you would have seen many anesthesiologist trained in pain management are doing what you are planning to do.

                                      You don't have to believe what I am saying here. Think back in 10 years, you will know what I mean.

                                      As for stevelobe, ignore him often, and don't take it personally.
                                       
                                      About the Ads

                                      Ducttape

                                      Full Member
                                      Lifetime Donor
                                      10+ Year Member
                                      Oct 7, 2011
                                      11,102
                                      3,797
                                      1. Attending Physician
                                        sorry to see you go...

                                        but just as i hate to have referrals from docs who are just doing opioids, i do not like referrals from docs that only stick needles in to patients. yes, most IR are needle jockeys, but they do have a purpose (particularly for those complicated stents and the like, in which the primary referring service not only does not have the requisite skills but there is no way for these skills to be taught to them; ergo an interventional specialist is required).

                                        we have way too many "pain doctors" out there who think they are doing it only for the good of their patients, but express no interest in really helping patients - develop coping skills/ cognitive behavioral therapy, or teach basic home exercise or even c0nsider alternative therapies - either in person or referring out, who are only interested in generating millions of dollars in a fee for service world. Many still do series of 3. MBBx2 followed by FJI followed by RFA, all under sedation. ad infintum.


                                        the only caveat is if you are the proceduralist for a group that practices multimodal pain management, and you supplement their care as they do not want to perform procedures.


                                        setting up a practice to only do injections only sounds circumspect, esp when you post "go back to your PCP/ candyman for further management." and it seems like practices like this always start out benign, until people realize how much money they can make...
                                         

                                        Dr. Ice

                                        Attending
                                        15+ Year Member
                                        Oct 10, 2003
                                        737
                                        302
                                        1. Attending Physician
                                          To piggyback this..how many of you in a pp setting employ a pain psychologist and is it cost effective? While I appreciate that cbt and "teaching" a coping mechanism are great, I do not believe my patient population would do it and certainly wouldn't seek out a separate outside provider for this. It would be wonderful if people really wanted to help themselves but that's not quite reality is it...
                                           
                                          • Like
                                          Reactions: 2 users

                                          drusso

                                          Full Member
                                          Moderator Emeritus
                                          Lifetime Donor
                                          Verified Expert
                                          Nov 21, 1998
                                          11,043
                                          5,080
                                          Over the rainbow
                                          1. Attending Physician
                                            To piggyback this..how many of you in a pp setting employ a pain psychologist and is it cost effective? While I appreciate that cbt and "teaching" a coping mechanism are great, I do not believe my patient population would do it and certainly wouldn't seek out a separate outside provider for this. It would be wonderful if people really wanted to help themselves but that's not quite reality is it...

                                            Very hard to make a PhD/PsyD pencil out; they are also kind of PIA's to work with. It is possible to incorporate Master's level clinicians; they are good followers. I have two. LCSW and a Drug and Alcohol Counselor. It's almost impossible to practice ethical pain medicine without integrated behavioral health on the premises.
                                             
                                            • Like
                                            Reactions: 2 users

                                            drusso

                                            Full Member
                                            Moderator Emeritus
                                            Lifetime Donor
                                            Verified Expert
                                            Nov 21, 1998
                                            11,043
                                            5,080
                                            Over the rainbow
                                            1. Attending Physician

                                              Because of the co-morbidities: 1/3 of patients with a chronic pain diagnosis have undiagnosed mental health issues. 2/3 of litigated industrial medicine claims have psychosocial barriers to functional restoration. Depending upon criteria, 1 in 8 to 1 in 4 patients on opioids longer than 90 days meet criteria for opioid use disorder. These are very time consuming and nuanced issues to dissect and unravel. I find it easier to front-load that work with on-site and integrated behavioralists and then circle back to the "pain management" issues once the big boulders are smashed.

                                              Our health care system doesn't adequately resource that work done by physicians. It can be resourced and paid for using allied health and non-traditional providers.
                                               
                                              • Like
                                              Reactions: 2 users

                                              ateria radicularis magna

                                              Full Member
                                              5+ Year Member
                                              Apr 6, 2016
                                              630
                                              296
                                                Because of the co-morbidities: 1/3 of patients with a chronic pain diagnosis have undiagnosed mental health issues. 2/3 of litigated industrial medicine claims have psychosocial barriers to functional restoration. Depending upon criteria, 1 in 8 to 1 in 4 patients on opioids longer than 90 days meet criteria for opioid use disorder. These are very time consuming and nuanced issues to dissect and unravel. I find it easier to front-load that work with on-site and integrated behavioralists and then circle back to the "pain management" issues once the big boulders are smashed.

                                                Our health care system doesn't adequately resource that work done by physicians. It can be resourced and paid for using allied health and non-traditional providers.

                                                Do you have multiple docs in your practice? Do the people you employ for behavioral health "pay for themselves"? Is it difficult to recruit this type of person?
                                                 

                                                drusso

                                                Full Member
                                                Moderator Emeritus
                                                Lifetime Donor
                                                Verified Expert
                                                Nov 21, 1998
                                                11,043
                                                5,080
                                                Over the rainbow
                                                1. Attending Physician
                                                  Do you have multiple docs in your practice? Do the people you employ for behavioral health "pay for themselves"? Is it difficult to recruit this type of person?

                                                  3 MD/DO's, 3 PA's, 2 RN's, 2 behaviorists. Yes, it's hard. Most mental health specialists have a very poor understanding of chronic pain and finding a drug and alcohol counselor who does not have addiction him- or herself is rare...Again, depending upon the mix of the practice you can squeak by paying for a master's level clinician easier than a PhD.
                                                   

                                                  SSdoc33

                                                  Full Member
                                                  10+ Year Member
                                                  Apr 23, 2007
                                                  9,448
                                                  3,487
                                                  1. Attending Physician
                                                    It is true that to create this practice is hard but it does exist - it takes time to build, but it exists - just need to be careful with what type of patients you take on, and which referring physicians you choose to work with. it takes time. just last week, i had a podiatrist that i did anesthesia for, send me three referrals for lumbar SCS for diabetic neuropathy after i explained to him about my practice and what i can offer. Its all about marketing and making appropriate contacts.
                                                    I am also not looking to inject everyone. I *think* I am appropriately conservative in this regard. Focus is still on appropriate eval and safe interventions. If a candidate and if i can help - inject. If not, sorry. No long term follow up. its not for me.

                                                    3 stim trials for diabetic neuropathy, and you dont do implants, and you wont follow these patients in clinic.....

                                                    do you see nothing wrong with this scenario?

                                                    nobody is crapping on anesthesia. im not sure why you are getting defensive about it. the practice you are describing is untenable and certainly borders on unethical
                                                     
                                                    • Like
                                                    Reactions: 1 user

                                                    jsaul

                                                    Member
                                                    15+ Year Member
                                                    Sep 27, 2005
                                                    1,182
                                                    273
                                                      3 stim trials for diabetic neuropathy, and you dont do implants, and you wont follow these patients in clinic.....

                                                      do you see nothing wrong with this scenario?

                                                      nobody is crapping on anesthesia. im not sure why you are getting defensive about it. the practice you are describing is untenable and certainly borders on unethical


                                                      agree with this. This has nothing to do with anesthesia or lobel. It has to do with you neutro. Everything you have said leads one to believe in the statements lobel said about you
                                                       

                                                      clubdeac

                                                      Full Member
                                                      10+ Year Member
                                                      Aug 16, 2007
                                                      4,231
                                                      1,347
                                                      1. Attending Physician
                                                        Yeah you can't say these things in the same paragraph and honestly think you're giving your patients your best. You're completely contradicting yourself. Just stick with anesthesia. In fact, I wish I would've done anesthesia as my primary specialty.

                                                        "The intention is to start an interventional only practice on the side...Pain medicine is a dumping ground...What can you do with that patient without having multimodal analgesics, and then opioids as part of their pain management plan....very few chronic pain patients actually improve and the solution is not injections or medications or new and advanced stim or PRP. Perhaps it is a combined approach. A big part of pain management is treating the underlying cognitive dysfunction and teaching coping strategies as well as "PT for life"


                                                        WTH? :smack:
                                                         
                                                        About the Ads
                                                        This thread is more than 4 years old.

                                                        Your message may be considered spam for the following reasons:

                                                        1. Your new thread title is very short, and likely is unhelpful.
                                                        2. Your reply is very short and likely does not add anything to the thread.
                                                        3. Your reply is very long and likely does not add anything to the thread.
                                                        4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
                                                        5. Your message is mostly quotes or spoilers.
                                                        6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
                                                        7. This thread is locked.