Job Market for Pain in Southern California

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WhateverMang

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Hey Everyone,

Current CA-2 at a midwest anesthesia program currently applying to pain. I am originally from Southern California and my goal is to get back there after fellowship.

I keep hearing about how saturated the job market is in Southern California for pain. The chairman from my medical school back home flat out told me not to do pain if I want to come back home for this reason. He said most pain fellows he sees end up doing general anesthesia because they couldn't get pain jobs. Obviously that's one opinion. I'd like to have more information on the subject. Being out in the midwest makes it difficult to know what's going on back home.

Bottom line question is, if I do a pain fellowship, will I have a difficult time getting a pain job in Southern California after I finish? Is it true that gas pays the same or less than pain out there? Ideally I would love to have a mixed practice with OR and pain but I really just want to know if doing the fellowship is worth it if my priority is coming back home. If I knew pain would not help my chances at landing a job, I would think twice about doing it because I still love OR.

Thanks in advance.

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the problem with forecasting job opportunities is that they can change 180 degrees in a few years. it is fun to make predictions however...
i am retiring next year, began medical school in 1975. (by way of forecasting skills).
my prediction - PMR will eventually dominate spine pain in California, spine is 90% of all pain, and PMR docs make a lot less money than Anesthesia pain, so pain reimbursement
is eventually going to fall to PMR levels. My advice in 1993 to anesthesiology residents looking for a job (and there were almost no anesthesia jobs in 1993) was to do a pediatric anesthesia fellowship. my reasoning is that every anesthesia group, no matter how small, can always use a pediatric anesthesiologist. IMHO the less pediatric cases they do, the more they need one, because skills atrophy if not used, and even a hospital or surgicenter that mostly operates on adults gets an emergency pediatric case once in a while.
besides, the kids are cute sometimes :) so if you want to be really marketable in Socal, do a pediatric anesthesia fellowship and learn to speak Spanish. Hasta La Vista.
 
I don't think it is so much related to what specialty is seeing the patients, as it is the procedural volume. Without the procedures, the collections are based on your E&M codes, just like primary care.

As it pertains to Southern CA, procedural volume will be low due to market saturation. Low procedure volume will make it difficult to support an in-office procedure room. Independent ASCs had a good run for about 10-15 years, but that is over due to due high managed care penetration, a series of cuts to Medicare and Worker's Comp reimbursement, and growing consolidation of hospital systems and provider networks, etc. Chances of starting your own ASC now, and having it be profitable, are slim.

You may have adequate procedural volume if you sign up with a well established group, but in a saturated market, the chances of being paid well, and/or having a chance at partnership which actually has some value is unlikely.

Alternatives are an academic job or Kaiser, with standard salary/benefits package.

It's not unique to pain doctors. Even new orthopedic surgeons have a hard time in CA. About half accept the struggle, and the other half leave for greener pastures after a couple of years.
 
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I'm a current pain fellow and if you want to come to California for a pain job, expect to make very little money and work harder. I'm in a California fellowship program and only one person has stayed in the state for pain in the last 3 years. A lot of people want to stay but aren't willing to sacrifice making less income and be taxed higher.

The Southern California market is saturated and be prepared to be offered 200-250k starting salary seeing 30 patients a day. Agree spine pain is PMR dominated and they are willing to take a lower salary compared to anesthesia pain.
 
here's your breakdown
- if you like anesthesia, and your objective is to come back southern cal, don't bother with a pain fellowship. you will get way more job opportunities in anesthesia than in pain. besides they would pay about the same
- if you like anesthesia, but you don't have to come back to southern cal, pick or choose either anesthesia or pain fellowship. you can go wherever you want to make a lot more money in either.
- if you hate anesthesia, and you still want to come back to southern cal, and you enjoy pain so much, do a pain fellowship and keep an open mind knowing you might have to do anesthesia anyway after spending a year in pain fellowship.
 
I still love anesthesia. I want to do fellowship to be more competitive for the SoCal job market but from what everyone is saying, it seems like pain won't help much. I am also considering critical care oddly enough. Sounds like cardiac and peds are the desirable ones everywhere though. Any one else have an opinion before I toss my pain application out the window?
 
you are looking at two very distinctly different subspecialties between pain and critical care, one is predominately office-based (could be private practice or employed by hospital) vs. purely hospital based. If you like anesthesia and wouldn't mind to do anesthesia, critical care would combine with anesthesia more organically than office-based pain management. on the other hand, general anesthesia will give you more job opportunities regardless in southern cal.
 
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Some wise person once told me - "There is always room at the top"

Also, cream always rises to the top.

Also, So Cal is super croweded with lots of people.

But yes, the market here sucks.

Get a pain fellowship - go work in Texas or one of those crappy middle states and save a ton of money - then come out to So Cal.
 
Am in SoCal; saturated and PPO pays less than medicare

I think the opportunity cost of doing a fellowship is too great if you are not going to benefit from it; try to get a job first, if you can't, then consider fellowship

I make more money doing anesthesia than I do pain

I dont think it matters how "good" or "nice" of a pain doc you are in saturated markets, everyone is "good" and "nice", I dont see it changing established referral patterns, which are often in place for economic reasons that wont change because you are the best. I think the best thing is to learn the business of medicine and build up capital somewhere else, learn how to see opportunities, and then create your own opportunity, don't look for a job, if you want to be in PP out here.
 
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Am in SoCal; saturated and PPO pays less than medicare

I think the opportunity cost of doing a fellowship is too great if you are not going to benefit from it; try to get a job first, if you can't, then consider fellowship

I make more money doing anesthesia than I do pain

I dont think it matters how "good" or "nice" of a pain doc you are in saturated markets, everyone is "good" and "nice", I dont see it changing established referral patterns, which are often in place for economic reasons that wont change because you are the best. I think the best thing is to learn the business of medicine and build up capital somewhere else, learn how to see opportunities, and then create your own opportunity, don't look for a job, if you want to be in PP out here.

It's too bad the medical school doesn't teach its graduates how to do this.
 
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Thanks for all the great input guys. I'm pretty much sold on NOT doing pain anymore based on what you all have said, which is basically what I have been hearing from everyone I talk to in real life also. For personal and family reasons, it is definitely more important to me to come back to SoCal than to do pain for a living... so taking a pain job in another state is off the table for me. Like I said, I do enjoy general anesthesia and would be happy getting a job doing that.
 
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here's your breakdown
- if you like anesthesia, and your objective is to come back southern cal, don't bother with a pain fellowship. you will get way more job opportunities in anesthesia than in pain. besides they would pay about the same
- if you like anesthesia, but you don't have to come back to southern cal, pick or choose either anesthesia or pain fellowship. you can go wherever you want to make a lot more money in either.
- if you hate anesthesia, and you still want to come back to southern cal, and you enjoy pain so much, do a pain fellowship and keep an open mind knowing you might have to do anesthesia anyway after spending a year in pain fellowship.

Is this still the case for Pain in California? CA2 here in similar situation considering Regional and Pain, but if pain is that bad in California, I'll likely continue with Regional or pursue a job in the state.

Thanks.
 
Dude, do what you will be happy doing. Get good at it. You will do well.

Jobs, market situations etc are all temporary.
 
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I have no idea what the SoCal market is like for pain and quite frankly I never understood why anesthesiologists go into pain. Gas seems to me to be a better way to go in general unless you are unlucky enough to wind up with a malignant call/ geographic restriction in terms of where you can live because of call situation. The hours of pain are better, yes, but the daily struggles of dealing with difficult patients and a crumbling insurance reimbursement makes up for the lifestyle. I work on the opposite coast and while I'm sure it's very different from cali, I can tell you that practice set up is key. I worked for a large multispecialty ortho group previously and I can tell you that success was entirely dependent on site of service and geography. NJ's major insurance carrier paid 30% more than PA and so if you were so lucky to work in NJ with an office based set up..you would just sit in the pocket and collect while doing very little work because you had a large referral base with strong insurance contract negotiation. But if you weren't so lucky you were surgi center or hospital based and did not get a site of service differential and worked like a dog for half the payout. It's all about your practice set up and while so cal is probably different, the key would be your contract and site of service. But, since you decided (wisely) to stay gas, none of this matters to you..haha..
 
Is this still the case for Pain in California? CA2 here in similar situation considering Regional and Pain, but if pain is that bad in California, I'll likely continue with Regional or pursue a job in the state.

Thanks.

If you like anesthesia and want to live in SoCal, I would stick with anesthesia. Many, many more job opportunities than pain and better pay as well.
 
The situation here in So Cal has not improved. There are TONS of very well trained and qualified pain medicine physicians competing hard for business. It's a tough market.
 
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Do you think it encourages people to be at the top of their game?

Hard to say. My impression is that some of the more successful groups tend to either bend the rules a little or are just completely unscrupulous. Referral patterns definitely are not tied to quality of care. It is saturated for all specialties. Referrals are a "you scratch my back, and I'll scratch your back" set up. I've also seen surgeons stop referring to better pain physicians in favor of lesser ones because they didn't want patients doing so well and not needing surgery. It's really dirty out here.
 
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Hard to say. My impression is that some of the more successful groups tend to either bend the rules a little or are just completely unscrupulous. Referral patterns definitely are not tied to quality of care. It is saturated for all specialties. Referrals are a "you scratch my back, and I'll scratch your back" set up. I've also seen surgeons stop referring to better pain physicians in favor of lesser ones because they didn't want patients doing so well and not needing surgery. It's really dirty out here.

you guys are bumming me out!!!!!
 
Hard to say. My impression is that some of the more successful groups tend to either bend the rules a little or are just completely unscrupulous. Referral patterns definitely are not tied to quality of care. It is saturated for all specialties. Referrals are a "you scratch my back, and I'll scratch your back" set up. I've also seen surgeons stop referring to better pain physicians in favor of lesser ones because they didn't want patients doing so well and not needing surgery. It's really dirty out here.

Agree 100%. In my area of SoCal, of the pain doctors that I consider ethical, everyone is either 1. increasing non-pain work on the side, 2. leaving for greener pastures, or 3. about to retire.
 
potential employers would spend an hour on the phone discussing everything under the sun, but were not willing on paying for the travel for an interview in CA.

this also happened for my friend, an ivy league, fellowship trained ophthalmologist.
 
To the OP, if the location is that much a priority to you, why not consider Kaiser or academics.
 
To the OP, if the location is that much a priority to you, why not consider Kaiser or academics.

I work at Kaiser. We get a ridiculous number of applicants for each open pain position. Since I have been at my location, all anesthesiology hiring for full time positions is done from a pool of per diem physicians. The last pain physician that we hired had already worked per diem for more than 2 years. This is a Cornell residency and fellowship grad. My sister in law also worked per diem for 2+ years to get a full time Anesthesioogy position at Kaiser. She's not a slouch either. UCSF anesthesia residency and Stanford regional fellowship. It is brutally competitive everywhere.
 
I work at Kaiser. We get a ridiculous number of applicants for each open pain position. Since I have been at my location, all anesthesiology hiring for full time positions is done from a pool of per diem physicians. The last pain physician that we hired had already worked per diem for more than 2 years. This is a Cornell residency and fellowship grad. My sister in law also worked per diem for 2+ years to get a full time Anesthesioogy position at Kaiser. She's not a slouch either. UCSF anesthesia residency and Stanford regional fellowship. It is brutally competitive everywhere.

Yep. This what hospitals/large employers want...foster a sense of competition and employment scarcity among MD/DO's--erase all entrepreneurial opportunities or make the regulations so Byzantine that physicians are too intimidated to try to figure them out. They know that we'll kill each other if they just get out the way. They know our psychology better than we do.
 
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Yep. This what hospitals/large employers want...foster a sense of competition and employment scarcity among MD/DO's--erase all entrepreneurial opportunities or make the regulations so Byzantine that physicians are too intimidated to try to figure them out. They know that we'll kill each other if they just get out the way. They know our psychology better than we do.

When I last checked 3 years ago, there were 26 pain physicians in private practice within a 15 mile radius of my home. The employment scarcity and competition are killer.
 
Hard to say. My impression is that some of the more successful groups tend to either bend the rules a little or are just completely unscrupulous. Referral patterns definitely are not tied to quality of care. It is saturated for all specialties. Referrals are a "you scratch my back, and I'll scratch your back" set up. I've also seen surgeons stop referring to better pain physicians in favor of lesser ones because they didn't want patients doing so well and not needing surgery. It's really dirty out here.

Your competition in SoCal is Dr. Feelgood: http://www.latimes.com/local/lanow/...s-murder-overdose-verdict-20151030-story.html
This is the norm in that saturated market and once she got shut down I guarantee 3 others started goobling up these patients and referrals. You cannot make any legitimate pain/spine/msk practice work there. Same is probably true for any specialty there.
 
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You cannot make any legitimate pain/spine/msk practice work there. Same is probably true for any specialty there.

Quite a blanket statement -- when in reality, many have established legitimate (and ethical) pain/spine/msk practices in the heart of SoCal. While there are a lot of unethical physicians out there, they are nothing compared to the big hospital systems and insurance companies.

Starting in March of every year, we get calls from graduating fellows asking about job opportunities with salary expectations starting in the high 300's - When I first graduated from fellowship and started a practice, it took me almost 7 months before I was able to draw a salary! It takes a lot of hard work and sacrifice, but I wouldn't have it any other way.
 
When I last checked 3 years ago, there were 26 pain physicians in private practice within a 15 mile radius of my home. The employment scarcity and competition are killer.

Happy New Year Mike! 26 pain physicians, maybe half of them legitimate. That's not a lot for orange county with a population of over 3.2 million people. The LA Metro, OC and San Bernadino areas combined have a population of approximately 20 million. This can support a fair amount of pain specialists.
 
I see that most of the replies are geared towards the market in the LA area, but could anyone comment on how the market is in the San Diego county? I hear that most of the area is controlled by strong HMO's. Thnx...

-ML
 
I see that most of the replies are geared towards the market in the LA area, but could anyone comment on how the market is in the San Diego county? I hear that most of the area is controlled by strong HMO's. Thnx...



-ML

It's worse than LA
 
I work at Kaiser. We get a ridiculous number of applicants for each open pain position. Since I have been at my location, all anesthesiology hiring for full time positions is done from a pool of per diem physicians. The last pain physician that we hired had already worked per diem for more than 2 years. This is a Cornell residency and fellowship grad. My sister in law also worked per diem for 2+ years to get a full time Anesthesioogy position at Kaiser. She's not a slouch either. UCSF anesthesia residency and Stanford regional fellowship. It is brutally competitive everywhere.

2 year try-outs required for the privilege. Awesome.
 
Ive been in san diego on and off since 2010, been in PP last couple years here; it took me 4 years of networking before i felt i had the opportunities to make a go at it. I have to live here for family reasons, dont really have a choice. It is really impossible here. There are too many 500lb gorillas in the backyard- kaiser, UCSD, navy and the HMOs. Lots of big contracts which have panels which have been closed for years, so you gotta try to work under someone else. There have been some crooks who have built big practices here. I agree with the poster above: the population in LA is so gigantic compared with SD it makes sense to go there. Many SD docs have half their practice in LA. Doesnt matter how nice you are or how good of a doctor you are if you cant get on contracts. Also, because its tough to enforce non-competes in CA, people are wary to bring you on, prefer PAs. But if you love to surf, this is a great place to be. A couple spine surgeons have started doing their own ESIs and stims, if that continues i dont know what is going to happen. Lol join the navy? I agree with poster above; make your money elsewhere, then move to socal
 
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Hard to say. My impression is that some of the more successful groups tend to either bend the rules a little or are just completely unscrupulous. Referral patterns definitely are not tied to quality of care. It is saturated for all specialties. Referrals are a "you scratch my back, and I'll scratch your back" set up. I've also seen surgeons stop referring to better pain physicians in favor of lesser ones because they didn't want patients doing so well and not needing surgery. It's really dirty out here.

A little disheartening, but not really surprising. With market saturation, things shunt towards shadiness instead of excellence. Unless you want to call it business excellence.

Wonder if this is region specific? Anyone care to provide comparisons to Manhattan, Miami, others?
 
Ive been in san diego on and off since 2010, been in PP last couple years here; it took me 4 years of networking before i felt i had the opportunities to make a go at it. I have to live here for family reasons, dont really have a choice. It is really impossible here. There are too many 500lb gorillas in the backyard- kaiser, UCSD, navy and the HMOs. Lots of big contracts which have panels which have been closed for years, so you gotta try to work under someone else. There have been some crooks who have built big practices here. I agree with the poster above: the population in LA is so gigantic compared with SD it makes sense to go there. Many SD docs have half their practice in LA. Doesnt matter how nice you are or how good of a doctor you are if you cant get on contracts. Also, because its tough to enforce non-competes in CA, people are wary to bring you on, prefer PAs. But if you love to surf, this is a great place to be. A couple spine surgeons have started doing their own ESIs and stims, if that continues i dont know what is going to happen. Lol join the navy? I agree with poster above; make your money elsewhere, then move to socal

Highly accurate.

However, innovation occurs in CA that doesn't happen elsewhere. If you have a penchant for it, it's the place to be.
 
A little disheartening, but not really surprising. With market saturation, things shunt towards shadiness instead of excellence. Unless you want to call it business excellence.

Wonder if this is region specific? Anyone care to provide comparisons to Manhattan, Miami, others?



Second that, would be interesting to hear about miami and manhattan. But they likely have non-competes. Florida does
 
Ive been in san diego on and off since 2010, been in PP last couple years here; it took me 4 years of networking before i felt i had the opportunities to make a go at it. I have to live here for family reasons, dont really have a choice. It is really impossible here. There are too many 500lb gorillas in the backyard- kaiser, UCSD, navy and the HMOs. Lots of big contracts which have panels which have been closed for years, so you gotta try to work under someone else. There have been some crooks who have built big practices here. I agree with the poster above: the population in LA is so gigantic compared with SD it makes sense to go there. Many SD docs have half their practice in LA. Doesnt matter how nice you are or how good of a doctor you are if you cant get on contracts. Also, because its tough to enforce non-competes in CA, people are wary to bring you on, prefer PAs. But if you love to surf, this is a great place to be. A couple spine surgeons have started doing their own ESIs and stims, if that continues i dont know what is going to happen. Lol join the navy? I agree with poster above; make your money elsewhere, then move to socal

Wow...This really sucks!!! I thought one would have a better chance of establishing if you move away from LA, but your point on huge population density makes total sense. I'm also looking into moving to California for family reasons, but I'm not bounded by a certain geographic location as long as I move to an area within driving distance of my brother's family who are looking into moving to East bay of SFO Bay area as we already have other family members living in the San Jose area. I will maybe do some research into the East bay area to open my own shop with my wife, my brother, and his wife who are all physicians from different specialties. Thank you very much....

-ML
 
will maybe do some research into the East bay area to open my own shop with my wife, my brother, and his wife who are all physicians from different specialties. Thank you very much....

sounds like a wonderful idea.

unless you are gonna botox divorcees, and offer chemical peels and laser hair removal, this plan is doomed.
 
sounds like a wonderful idea.

unless you are gonna botox divorcees, and offer chemical peels and laser hair removal, this plan is doomed.

I disagree.

San Francisco is popular but there are more options for pain physicians in the Bay Area and surrounding communities than SoCal.

I've been watching job postings in California for over a year. You hardly ever see jobs advertised in LA/San Diego, but you regularly see jobs listed for San Francisco and nearby areas.
 
sounds like a wonderful idea.

unless you are gonna botox divorcees, and offer chemical peels and laser hair removal, this plan is doomed.
It looks like you can't win for losing in California if you are a physician.

Your comments on botox, chemical peels, and laser hair removal would have made sense in case of LA, but I'm not sure that is the case with the Bay area.

I will do my due research before I decide on this. Any suggestions from anyone on this forum would be greatly appreciated. Thank you very much....

-ML
 
different specialties under the same roof? in the same family? overhead will be different for each type of doc, as will the billing, contracts, etc. hey, by all means, go for it. i dont have all the facts, but this is not a standard practice set up, and things can get ugly when you do business in the family. especially in-laws.
 
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different specialties under the same roof? in the same family? overhead will be different for each type of doc, as will the billing, contracts, etc. hey, by all means, go for it. i dont have all the facts, but this is not a standard practice set up, and things can get ugly when you do business in the family. especially in-laws.

I didn't realize from your earlier post that your concern was about doing business with family members. I totally understand your concern. Starting a PP with fellow docs in my family is just one of many thoughts. I'm still trying to figure out if there are any other ways of transplanting to California without opening a PP because I know that it takes a lot of commitment, effort and initial financial burden to start a PP.

If I do end up opening a PP with family members, then we just have to make sure everything is discussed upfront and things are written out in a very detailed and clear manner so that there are no issues later on. I'm sure things will popup as the PP matures, but as long as we can sit down and discuss issues on a frequent basis, I think this is a doable option. We are a family of Indian origin. Nuclear families with multiple family members running the family business is quite common in India though we have not done it in our family. So, I'm hoping that this cultural engraving works here in setting up the PP.
 
if you want to work in San Diego or LA - best bet is to work inland in a crappy town and commute. For example, drive to Lancaster to work. It's about an hour outside LA.
 
I met a fellow looking for a job in a similar situation to mine. He said that most Ca practices were pretty low paying no partnership so he ended up in Las Vegas in a sweet gig.

What is the going rate for a new pain fellow in LA if you can get a job? I've seen some on gaswork for ~300k but not sure if that's common or not.
 
I met a fellow looking for a job in a similar situation to mine. He said that most Ca practices were pretty low paying no partnership so he ended up in Las Vegas in a sweet gig.

What is the going rate for a new pain fellow in LA if you can get a job? I've seen some on gaswork for ~300k but not sure if that's common or not.

My first job out of fellowship back in 2010 paid $185,000.
 
I regret not coming directly out of fellowship to the sticks of wherever to make as much money as possible for 3-4 years...
 
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Kaiser in SoCal (I forget exactly which one) offered to fly me out to an interview because I was planning on leaving my first job. I asked them if I could have a ballpark salary figure. The guy said, let's see... PM&R... Fellowship trained... BE/BC in Pain... Salary starts at $130k.
 
In fairness to Kaiser, I interviewed for a job in San Bernardino in 2013 and they quoted me around 230K starting salary for 4.5 days/week of pain. The schedule was something ridiculous like one injection q30min and one new patient consult per hour. No med management, only procedures and consultations about procedures. They told me that the unionized staff would not allow them to be any busier.
 
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