Love pain but the job market and oversaturation

[A-poor-student]

Posting for an MS3 friend applying to anesthesia. "Very Interest in Pain. Considered PMR but decided that if I didn't get into pain Anesthesia will be better and more options I will enjoy.

My problem is I want to live in Texas or Florida. But I hear the Pain job market is oversaturated because of all the unaccredited fellowships. This forum is also a lot of doom and gloom.

How hard is it right now to get a job you win around 300-350 where you work around 50 hours. I know this in Anesthesia is very attainable but I enjoy pain but I don't want to be a drug dealer.

Do you think pain will be a viable career plan for the future? I am just starting won't be on the market for at least 6 years.

Or is the pain dream dead?"

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[Agast]

You can easily earn $300-350k at 50 hours a week without being sketchy. Even in Texas! The doom and gloom is most people well-established in their career expect to be making more than that.

 

[DrSpine]

Plenty of jobs to make that money in those states. Only difficult if you want Miami Beach or some ultra coveted area of Dallas. Also, you have the opportunity to open your own practice too.

 

[callmeanesthesia]

I think that’s a very reasonable expectation. If you join private practice you might start a little lower (2-300) but even in a competitive area I don’t think 350 would be hard to hit after 1-2 years. Hospital-employed you would easily start at that level.

A lot of the doom and gloom is from the old timers who made 7 figures for decades, or the more recent grads who heard those kind of salary numbers going in and are finding that’s no longer the case. In certain markets that’s still doable with a lot of hustle, but often involves some questionable practices.

 

[painfree23]

I mean 350 without much call is not bad, unlike anesthesia where u probably make a little more but have to spend the night in a hospital.

 

[gaseous_clay]

Current MS3 applying to anesthesia. Very Interest in Pain. Considered PMR but decided that if I didn't get into pain Anesthesia will be better and more options I will enjoy.

My problem is I want to live in Texas or Florida. But I hear the Pain job market is oversaturated because of all the unaccredited fellowships. This forum is also a lot of doom and gloom.

How hard is it right now to get a job you win around 300-350 where you work around 50 hours. I know this in Anesthesia is very attainable but I enjoy pain but I don't want to be a drug dealer.

Do you think pain will be a viable career plan for the future? I am just starting won't be on the market for at least 6 years.

Or is the pain dream dead?

Keep in mind that all this could change in 6 years.

 

[BobBarker]

Already applying to anesthesia so you have several years to decide to pursue pain. I don’t think you will have anything to worry about with pain and your stated salary goals.

 

[NJPAIN]

In my small town a half wit school superintendent with a masters degree (one school in district) makes 200k working < 40 hrs per week. A Union electrician or sheet metal worker working 50 hrs per week ( 10 hrs OT) makes more than 200k. All have health and retirement benefits 100x better than any group or hospital practice will give you.

Sorry, I just had to put this into perspective. Everyone else’s salaries are increasing while ours are on the steady decline. Long gone are the days when we are making 300k while everyone else is making 50k. Given the length of training, liability, etc is the juice worth the squeeze??

To OP -if you love it do it but don’t ever loose touch with your primary specialty. I wish I had not given up doing part time OR anesthesiology. It would be nice to fall back on that now without having to start with baby steps.

Pain medicine has become a free for all like no other field in medicine. I never made or expected to make any where near seven figures. I made a decent living practicing good medicine that I felt good about. You simply can’t do that anymore. You’re an assembly line worker using mid levels to make more cars. If the mid level leaves off a lug nut and a wheel falls off no one cares just keep making cars - crappy cars, as fast as you can. When the customer returns unhappy with the car, sell them more accessories.

 

[SSdoc33]

been hearing door and gloom ever since i entered the medical field 20 years ago. IMHO, little has changed. there will always be kvetchers

 

[Agast]

Pain medicine has become a free for all like no other field in medicine. I never made or expected to make any where near seven figures. I made a decent living practicing good medicine that I felt good about. You simply can’t do that anymore. You’re an assembly line worker using mid levels to make more cars. If the mid level leaves off a lug nut and a wheel falls off no one cares just keep making cars - crappy cars, as fast as you can. When the customer returns unhappy with the car, sell them more accessories.

I use zero midlevels. If you're really so busy you need a midlevel, bring on another physician. You still make a decent living and you're not a babysitter.

 

[NJPAIN]

I use zero midlevels. If you're really so busy you need a midlevel, bring on another physician. You still make a decent living and you're not a babysitter.

I don’t have a mid level but the declining reimbursement make spending the time to thoroughly evaluate a patient virtually impossible. I see many patients who have been seeing other docs, not just pain docs, and are frustrated by the lack of a logical diagnosis and response to treatment. Most are managed by a PA/NP in between surgeries or procedures. I don’t see docs adding partners just more midlevels.

 

[Ferrismonk]

I don’t have a mid level but the declining reimbursement make spending the time to thoroughly evaluate a patient virtually impossible. I see many patients who have been seeing other docs, not just pain docs, and are frustrated by the lack of a logical diagnosis and response to treatment. Most are managed by a PA/NP in between surgeries or procedures. I don’t see docs adding partners just more midlevels.

I would argue this is a problem in all of medicine (at least in the US). Every specialty is being squeezed.

Can you even imagine spending an hour with a patient, going through and explaining all the imaging, explaining all the potential diagnoses and the appropriate next diagnostic step on a complicated patient? I'm not primarily motivated by money, but when I can do 4-5 epidurals in the same amount of time, it's easy to see why people don't spend time in the clinic.

 

[Doctodd]

Pain Anesthesia if i had to do it over again. Maybe IR for the more complicated procedures and possible future procedures we were never trained to do.

 

[drusso]

In my small town a half wit school superintendent with a masters degree (one school in district) makes 200k working < 40 hrs per week. A Union electrician or sheet metal worker working 50 hrs per week ( 10 hrs OT) makes more than 200k. All have health and retirement benefits 100x better than any group or hospital practice will give you.

Sorry, I just had to put this into perspective. Everyone else’s salaries are increasing while ours are on the steady decline. Long gone are the days when we are making 300k while everyone else is making 50k. Given the length of training, liability, etc is the juice worth the squeeze??

To OP -if you love it do it but don’t ever loose touch with your primary specialty. I wish I had not given up doing part time OR anesthesiology. It would be nice to fall back on that now without having to start with baby steps.

Pain medicine has become a free for all like no other field in medicine. I never made or expected to make any where near seven figures. I made a decent living practicing good medicine that I felt good about. You simply can’t do that anymore. You’re an assembly line worker using mid levels to make more cars. If the mid level leaves off a lug nut and a wheel falls off no one cares just keep making cars - crappy cars, as fast as you can. When the customer returns unhappy with the car, sell them more accessories.

 

[drusso]

Current MS3 applying to anesthesia. Very Interest in Pain. Considered PMR but decided that if I didn't get into pain Anesthesia will be better and more options I will enjoy.

My problem is I want to live in Texas or Florida. But I hear the Pain job market is oversaturated because of all the unaccredited fellowships. This forum is also a lot of doom and gloom.

How hard is it right now to get a job you win around 300-350 where you work around 50 hours. I know this in Anesthesia is very attainable but I enjoy pain but I don't want to be a drug dealer.

Do you think pain will be a viable career plan for the future? I am just starting won't be on the market for at least 6 years.

Or is the pain dream dead?

Pain was the dream of the 1990s. The field has capitulated almost all meaningful advocacy, has a low professional profile/influence among policymakers, and more or less cannibalized itself over opioids, the scope of practice, and site of service issues.

 

[Ducttape]

i have done it over again.


out of the specialties I trained for and the specialties ive worked in, Pain has provided by far the best salary, best hours, and least amount of stress.



I don't save lives any more, but I am not waking up in the middle of the afternoon (ie sleep before night shift) with a nightmare that I missed something...

 

[SSdoc33]

Pain was the dream of the 1990s. The field has capitulated almost all meaningful advocacy, has a low professional profile/influence among policymakers, and more or less cannibalized itself over opioids, the scope of practice, and site of service issues.

see above comment re: kvetching

 

[drusso]

see above comment re: kvetching

Prove me wrong.

 

[SSdoc33]

Prove me wrong.

i can't, you Kvetch all the time!?!?

 

[The Last Ankibender]

I think pain will start to become less popular but it will always be a ok lifestyle field. At least I dont see it dying. Cause everyone is in pain. If the future of pain is a 250k salary is it really worth the fellowship? when you can easy make more as anesthesia or pmr. And make the same in IM with just three year instead of at least 5.

 

[sloh]

How hard is it right now to get a job you win around 300-350 where you work around 50 hours.

Even PM&R at Kaiser in SoCal makes just shy of 300k after making partnership. 300k isn't that much considering COL in SoCal though, especially if you have debt.

 

[painfree23]

Even PM&R at Kaiser in SoCal makes just shy of 300k after making partnership. 300k isn't that much considering COL in SoCal though, especially if you have debt.

300K after partner? What do they start at???

 

[sloh]

300K after partner? What do they start at???

For PM&R (not pain):

Year 1 = 228k
Year 2 = 252k
Year 3 = 266k
Year 4 (partnership) = 280k

This was the offer 2 years ago. Also have to keep in mind Kaiser comes with good benefits and pension. I no longer work for them because I can make a lot more with subacute work. Didn't like being a W2 much and inbox/phone call responsibilities (uncompensated) was like pouring salt on the wound.

 

[Laryngospasm]

I had an anesthesia offer for 350 with 26weeks vacation. Pain full time for 228? Uhhh no.

 

[nvrsumr]

I am amazed by the number of "interventional pain" docs on my linkedin feed. 15 years ago it seemed like a small field and that I almost knew everyone who was anyone. It feels oversaturated to me. On the other hand I am as busy as I have ever been....

 

[Laryngospasm]

Everyone has pain.. people only getting older. There will always be good jobs.. they just might not be where we would like them to be. They won’t be in Hawaii, Miami, Austin or San Diego.

 

[The Last Ankibender]

Everyone has pain.. people only getting older. There will always be good jobs.. they just might not be where we would like them to be. They won’t be in Hawaii, Miami, Austin or San Diego.

Exactly. Jobs will not be great it will be like any specialty with mid pay

 

[Peterluger]

For PM&R (not pain):

Year 1 = 228k
Year 2 = 252k
Year 3 = 266k
Year 4 (partnership) = 280k

This was the offer 2 years ago. Also have to keep in mind Kaiser comes with good benefits and pension. I no longer work for them because I can make a lot more with subacute work. Didn't like being a W2 much and inbox/phone call responsibilities (uncompensated) was like pouring salt on the wound.

With that kind of salary, you can live comfortably in one of the gang neighborhoods in Culver City.

 

[painfree23]

I had an anesthesia offer for 350 with 26weeks vacation. Pain full time for 228? Uhhh no.

Seriously? 26 weeks off??? Where?? North Dakota?

 

[Peterluger]

Seriously? 26 weeks off??? Where?? North Dakota?

No, i actually saw one of these jobs in the NYC metro area. 350k, night shifts, 26 weeks a year.

 

[painfree23]

No, i actually saw one of these jobs in the NYC metro area. 350k, night shifts, 26 weeks a year.

Oh missed the night shifts part. Never mind, never want to spend another night in a hospital unless I’m dying

 

[BobBarker]

I wouldn’t call that 26 weeks vacation. That is 7 on 7 off 12 hour nocturnist work.

 

[The Last Ankibender]

I wouldn’t call that 26 weeks vacation. That is 7 on 7 off 12 hour nocturnist work.

Literally almost the same pay

 

[Laryngospasm]

my offer was day work. But every other day call for the week. No trauma, interventional radiology. Rarely called in. Midwest.

 

[The Last Ankibender]

my offer was day work. But every other day call for the week. No trauma, interventional radiology. Rarely called in. Midwest.

if you are rarelly call in, the job aint bad. 350k and 26week vacay its nice for anesthesia

 

[au bon pain]

I wouldn’t call that 26 weeks vacation. That is 7 on 7 off 12 hour nocturnist work.

Flipping from days to nights like that is bad for your health and even worse for your soul. People tend to underestimate how useless you are the first day or two you have off after a stretch of nights. People who do this should be paid at least 1.5x what people make during the day.

 

[wendalltwolf]

Another factor for the future is how profitable those CRNA interventional fellowships become...

 

[SSdoc33]

Oh missed the night shifts part. Never mind, never want to spend another night in a hospital unless I’m dying

If you are dying, the last place you should be is in a hospital

 

[The Last Ankibender]

Another factor for the future is how profitable those CRNA interventional fellowships become...

pain patients are difficult. I dont think midlevel are stupid enough to open up to lawsuit. And as a patient I would totally want a untrained midlevel doing procedure on me.

 

[NJPAIN]

I think pain will start to become less popular but it will always be a ok lifestyle field. At least I dont see it dying. Cause everyone is in pain. If the future of pain is a 250k salary is it really worth the fellowship? when you can easy make more as anesthesia or pmr. And make the same in IM with just three year instead of at least 5.

No, it won’t be worth the fellowship.

 

[bedrock]

With that kind of salary, you can live comfortably in one of the gang neighborhoods in Culver City.

Basically,

Other than Culver City has gentrified significantly lately and is much more expensive due to Silicon Beach influence. You have to go even further inland these days for cheap housing.

 

[gazzer]

any info on the austin area job market?

 

[bedrock]

any info on the austin area job market?

Very tough. A doc on every block.

 

[Status Sciaticus]

Very tough. A doc on every block.

How about SA and Houston?

 

[painfree23]

How about SA and Houston?

Same

 

[10KHertz]

Radiology, neurology , physiatrist, anesthesia, pcp, urgent care, nursing opioid clinics, hospice clinic , chiro Med clinics , orthofast clinics, methadone clinics, suboxone clinics , all want a piece of pain.... Yes it’s oversaturated ...

 

[drusso]

Radiology, neurology , physiatrist, anesthesia, pcp, urgent care, nursing opioid clinics, hospice clinic , chiro Med clinics , orthofast clinics, methadone clinics, suboxone clinics , all want a piece of pain.... Yes it’s oversaturated ...

 

[mxis512]

Very tough. A doc on every block.

Is that the same for OR anesthesiologists in Austin too? Just wondering if doing one or the other makes more sense if I want to live in Austin.

 

[mid|ine]

If you want money, listen to the sage advice in House of God. The best money right now may be in private practice GI, as long as you have an ASC and infusion center, they can clear $2m/yr.

 

[drusso]

If you want money, listen to the sage advice in House of God. The best money right now may be in private practice GI, as long as you have an ASC and infusion center, they can clear $2m/yr.

What's the over/under on that set-up versus an ASC, tox lab, and physician-owned distribution (POD) franchise?