Leaving Anesthesiology residency for PM&R.

[distracted]

Hi,

I'm currently a pgy-2 anesthesia resident in my 4th month and am seriously considering trying to rematch into PMR. I haven't liked anesthesiology since the beginning of my training, but was hoping it would get better as I got more accustomed to the OR and my new program. It hasn't. I loved my pain management rotation and understand that I could just stick it out to get into a pain fellowship, but there are only 3 months of Pain during the three years of residency and it makes me incredibly anxious thinking about completing all of the highly stressful OR months that are coming. I think my personality would be a much better fit for PMR. I know that I have to get moving on the application if I'm going to do this.

Just wondering if anyone out there has made the same switch and what their experiences have been. I searched for other topics but didn't find anything specifically. If I missed any, please point me in the right direction.

Thanks in advance for any advice, thoughts, or help.

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[oreosandsake]

I have heard of a few people doing this.

A girl in my program switched after CA1 year. She did well at a highly regarded anesthesiology program, but did not enjoy the work. she's much happier now. has no regrets, and is looking at a career in inpatient rehabilitation

 

[Paddington]

If you want to do all interventional pain, you might not be much happier in PM&R either, as most residencies only have a few months of such training and a great many have little to no interventional pain/spine training. The pathway to pain fellowships - particularly accredited ones - is still easier from Anesthesiology, IMO. However, the overall MSK training is much better in PM&R.

If I were you I would stick it out in Anesthesiology and go for a pain fellowship. If you get electives, do them in Sports Medicine or a good outpatient PM&R if such is available. Switching into PM&R would be a loss of at least 1 year and maybe 2. And you might not be happy doing 12-18 months of inpatient PM&R and consults either.

 

[kentuckydr]

I just made the switch from Anesthesia to PM&R and I couldn't be happier.

With regards to attaining a pain fellowship: coming from PM&R, I may or may not decide to do it. The great thing about PM&R is all the options it provides aside from pain, many of which are interesting and enjoyable fields.

 

[Doctodd]

No way would I get out of anesthesia to do pain. There is no future job security in pain. It also depends on some details.....what do u hate about anesthesia? Can you modify it or overcome it? I like to use my hands....I'm not a cerebral guy, and I like instant gratification(from a block). PMR wasn't a perfect fit but i stuck it out. I disliked all the writing, meetings, general inpatient care. Pain was a perfect fit for me. So figure out what fits for you....but be aware Pain has a bleak future.

 

[lejeunesage]

No way would I get out of anesthesia to do pain. There is no future job security in pain. It also depends on some details.....what do u hate about anesthesia? Can you modify it or overcome it? I like to use my hands....I'm not a cerebral guy, and I like instant gratification(from a block). PMR wasn't a perfect fit but i stuck it out. I disliked all the writing, meetings, general inpatient care. Pain was a perfect fit for me. So figure out what fits for you....but be aware Pain has a bleak future.

Can you please elaborate?
Why do you think so? Are there scheduled reimbursement cuts? Will the switch to bundled payments make procedures less profitable?

 

[Baritonebass]

Major cuts for epidurals and spinal cord stimulator occurred Jan 1

 

[lejeunesage]

Major cuts for epidurals and spinal cord stimulator occurred Jan 1

What's a "major cut"?

30%, 50%, 70%?

And after those cuts, what is to stop providers to migrate towards other procedures where there was either no cut or a smaller cut in reimbursement?

I've always thought that people were overreacting a bit when declaring a field dead. It doesn't necessarily happen consciously, but in the aggregate, people who want to make money always find a way to justify moving away from less lucrative procedures and towards more lucrative ones.

Now if there was to be across-the-board cuts in everything... that would be a different story. But I'm assuming physicians have enough political clout to prevent that from occurring.

 

[Baritonebass]

So ESI are bread and butter procedures, it would be very unlikely you would be the go to guy for stims and pumps immediately. Second you don't start a pain management treatment plans with pumps or stims that's more like the end. MBB and SI joint inject are for other pain generators so you can substitute them for ESI for spinal stenosis, diskogenic pain or radicular sx... My understanding is that cervical epidurals pay only little more than a blind knee inject with greater risk, time and equipment need. U/S guided inject May be equal or more.... Long story short their will always be a need for Pain but you may also have to practice your primary specialty

 

[Baritonebass]

CMS cut were like 50% for SI and spinal cord stim trial now pay $0. See the pain forum for more detail on practices closing and the outlook

 

[lejeunesage]

Wow.... that's what you call cutting deep!

 

[SSdoc33]

baritone's facts are wrong. you should know what you are talking about on these boards, or people may actually believe your nonsense. there have been cuts. see the pain forum for details.

 

[lejeunesage]

So, what actually happened? I tried to read the pain forums and all I could find were people freaking out.

 

[SSdoc33]

Read some more. Or check ASIPP

 

[kentuckydr]

 

[Disciple]

Long story short their will always be a need for Pain

Of course there will be. There will be a need for any specialty where a lot of the patients are elderly.

However, need does not equate to reasonable compensation.

 

[Disciple]

But I'm assuming physicians have enough political clout to prevent that from occurring.

 

[Xardas]

Rule of thumb if you have come this far into medicine... do what you want to do because you like it, not because it offers more money.

A lot of guys I know in residency chose the pain route.. I know they hated pain. I don't know what they are going to do now. But the other older wiser posters are right.. pain is getting hammered. EMG's have gotten hammered. A lot more things in the future will likely get hammered.

I truly believe the future will be a situation where there will be one physician to about 3-5 mid levels.

Chasing money in medicine or any investment for that matter is a recipe for failure. Doing something you are interested or passionate in is a much better marker for future professional success and personal happiness.

 

[Disciple]

Rule of thumb if you have come this far into medicine... do what you want to do because you like it, not because it offers more money.

A lot of guys I know in residency chose the pain route.. I know they hated pain. I don't know what they are going to do now. But the other older wiser posters are right.. pain is getting hammered. EMG's have gotten hammered. A lot more things in the future will likely get hammered.

I truly believe the future will be a situation where there will be one physician to about 3-5 mid levels.

Chasing money in medicine or any investment for that matter is a recipe for failure. Doing something you are interested or passionate in is a much better marker for future professional success and personal happiness.

Agree.

Medical students generally go into Physiatry because of an interest in neurorehabilitation or musculoskeletal care. In general, Physiatrists go into "pain" because of the procedures. Some have interest in the Physiatric model of chronic pain management, i.e. the functional restoration program (analogous to inpatient rehab), but this is few and far between. The typical pain practice model of volume opioid scripts and injections is not a Physiatric construct. Now that the procedural reimbursement is rapidly disappearing, what it left? Opioid clinic?

The key is balance between interest in what you're doing and having an income adequate to support your lifestyle.

The beauty in the ambiguity of Physiatry is that it allows you to morph your practice as you see fit, oftentimes without the change appearing strange or out of place to the general public and referring physicians.

I know many Physiatrists are planning on giving up their primary board certification when it comes up for renewal, and keeping only their subspecialty certification.

Not a smart move in my opinion.

Especially in these times.