Med student thinking about Pain...

[futurepaindoc234]

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Hey guys, M3 here and I was hoping I could get some insight from you all about Pain Management

I was pretty set on a Urology for most of med school; however, I seem to be having a change of heart. I do not love the OR as much as I thought I did... I like the OR.. I like doing procedures, but I am not a fan of some of the big cases in Urology. I am also concerned about what I've been hearing from a lot of Urology: it is not the "surgical lifestyle field" that it once was. Burnout is increasing, call burden is increasing significantly and pay has not increased enough to justify the increased demands. I don't really care about lifestyle in residency, but the thought of being in my 50's and having to come into the hospital in the middle of the night to place a catheter in someone because an incompetent nurse can't sounds horrible.

I was on my Anesthesia rotation and was able to work with the Pain management for a couple weeks. I can honestly say that I was shocked by how much I liked the field. Some really cool procedures and the patient population wasn't at all what I expected (besides a couple of nut jobs). All of the pain docs that I worked with were extremely happy and satisfied with their job. The type of day to day life and overall lifestyle that they had was what I have been hoping to find in medicine.

What I hope to find in a field
-good mix of procedures/clinic
-ability to work in private practice and/or start a practice
-manageable lifestyle (i.e not horrible call, etc)

From my understanding, it seems like the pay for Urology and Pain are relatively similar. The call in Pain is immensely better (i.e not much if any at all). I'm not sure what future of Pain looks like... Urology is in huge demand, but this may lead to an exacerbation of the problems I already listed.

Anyways, is it wise for a med student to go into Anesthesia with full intent of going into Pain? I enjoyed my Anesthesia rotation, so I am sure I could get through the residency. I would love insights on this, as well as thoughts on my dilemma above

 

[drusso]

Hey guys, M3 here and I was hoping I could get some insight from you all about Pain Management

I was pretty set on a Urology for most of med school; however, I seem to be having a change of heart. I do not love the OR as much as I thought I did... I like the OR.. I like doing procedures, but I am not a fan of some of the big cases in Urology. I am also concerned about what I've been hearing from a lot of Urology: it is not the "surgical lifestyle field" that it once was. Burnout is increasing, call burden is increasing significantly and pay has not increased enough to justify the increased demands. I don't really care about lifestyle in residency, but the thought of being in my 50's and having to come into the hospital in the middle of the night to place a catheter in someone because an incompetent nurse can't sounds horrible.

I was on my Anesthesia rotation and was able to work with the Pain management for a couple weeks. I can honestly say that I was shocked by how much I liked the field. Some really cool procedures and the patient population wasn't at all what I expected (besides a couple of nut jobs). All of the pain docs that I worked with were extremely happy and satisfied with their job. The type of day to day life and overall lifestyle that they had was what I have been hoping to find in medicine.

What I hope to find in a field
-good mix of procedures/clinic
-ability to work in private practice and/or start a practice
-manageable lifestyle (i.e not horrible call, etc)

From my understanding, it seems like the pay for Urology and Pain are relatively similar. The call in Pain is immensely better (i.e not much if any at all). I'm not sure what future of Pain looks like... Urology is in huge demand, but this may lead to an exacerbation of the problems I already listed.

Anyways, is it wise for a med student to go into Anesthesia with full intent of going into Pain? I enjoyed my Anesthesia rotation, so I am sure I could get through the residency. I would love I insights on this, as well as thoughts on my dilemma above

Honestly, I can't encourage you to pursue this field. "Pain Management" per se was sort of the dream of the '90's. The idea that a doctor would go and complete a fellowship and open a comprehensive/interventional pain center with an ASC and a multidisciplinary staff, etc. It's all been hacked away by insurance companies. Read the thread on vert/kypho. Stim is on the chopping block. The data for "Interventional Spine" is weak and insurance companies don't want to pay for it. Don't get me started on opioids. And, pain doctors have been lousy on the advocacy end of things. In my state, worker's comp flat out won't pay for RF or SCS.

The field needs psych-trained pain specialists to deal with the quasi-addicted chronic pain patients, but as a business activity you can be busy seeing those patients all day and still go broke.

The private practice model of pain management is an endangered species. That leaves "drilling teeth" as hospital employed MD trying to maximize your "enterprise value" to the admin to justify 50% MGMA total compensation. I would look at derm, oncology, or a surgical subspecialty.

 

[bronchospasm]

Opinion: A doctor's question: What has happened to medicine?

 

[drusso]

Opinion: A doctor's question: What has happened to medicine?

This: "Medicine, once the pursuit of individualists, once a profession of compassion and healing, is now a road of crushing student debt and soul-sucking rules and regulations where managers far outnumber clinicians."

 

[futurepaindoc234]

Honestly, I can't encourage you to pursue this field. "Pain Management" per se was sort of the dream of the '90's. The idea that a doctor would go and complete a fellowship and open a comprehensive/interventional pain center with an ASC and a multidisciplinary staff, etc. It's all been hacked away by insurance companies. Read the thread on vert/kypho. Stim is on the chopping block. The data for "Interventional Spine" is weak and insurance companies don't want to pay for it. Don't get me started on opioids. And, pain doctors have been lousy on the advocacy end of things. In my state, worker's comp flat out won't pay for RF or SCS.

The field needs psych-trained pain specialists to deal with the quasi-addicted chronic pain patients, but as a business activity you can be busy seeing those patients all day and still go broke.

The private practice model of pain management is an endangered species. That leaves "drilling teeth" as hospital employed MD trying to maximize your "enterprise value" to the admin to justify 50% MGMA total compensation. I would look at derm, oncology, or a surgical subspecialty.

Thanks for your post. Do you think that the future of Pain is worse off than other fields (as @bronchospasm points out, there seem to be plenty in all fields)?

I have derm a shot but have no interest in it. I have not spent much time in oncology, but may check it out. When it comes to surgical subs, Urology and ENT were the only ones I spent substantial time with. Dislike ENT anatomy too much. Welp, looks like I may be veer back to Urology after all.

If it matters at all, I will be graduating med school with no debt if that is a relevant thing to consider when picking a field

 

[callmeanesthesia]

Anesthesia is very good as far as specialties go. Of course there’s the CRNA issue but there’s still no shortage of demand for anesthesiologists. You have good options for fellowships and they are all one year. You might even really enjoy something like cardiac anesthesia (although that always comes with call). One of my residency classmates didn’t match to urology, did a really malignant prelim surgery year, and ended up switching to anesthesia. He was really happy with that change. If avoiding call is a top priority for you though you may want to look for primary specialties that will allow that too. Something like ER offers shift work and lots of time off.

 

[futurepaindoc234]

Anesthesia is very good as far as specialties go. Of course there’s the CRNA issue but there’s still no shortage of demand for anesthesiologists. You have good options for fellowships and they are all one year. You might even really enjoy something like cardiac anesthesia (although that always comes with call). One of my residency classmates didn’t match to urology, did a really malignant prelim surgery year, and ended up switching to anesthesia. He was really happy with that change. If avoiding call is a top priority for you though you may want to look for primary specialties that will allow that too. Something like ER offers shift work and lots of time off.

Does doing a fellowship in anesthesia protect you from the CRNA issue?

 

[callmeanesthesia]

Does doing a fellowship in anesthesia protect you from the CRNA issue?

Somewhat. They are encroaching where ever they can, including pain, but it gives you a broader skill set.

 

[emd123]

Hey guys, M3 here and I was hoping I could get some insight from you all about Pain Management

I was pretty set on a Urology for most of med school; however, I seem to be having a change of heart. I do not love the OR as much as I thought I did... I like the OR.. I like doing procedures, but I am not a fan of some of the big cases in Urology. I am also concerned about what I've been hearing from a lot of Urology: it is not the "surgical lifestyle field" that it once was. Burnout is increasing, call burden is increasing significantly and pay has not increased enough to justify the increased demands. I don't really care about lifestyle in residency, but the thought of being in my 50's and having to come into the hospital in the middle of the night to place a catheter in someone because an incompetent nurse can't sounds horrible.

I was on my Anesthesia rotation and was able to work with the Pain management for a couple weeks. I can honestly say that I was shocked by how much I liked the field. Some really cool procedures and the patient population wasn't at all what I expected (besides a couple of nut jobs). All of the pain docs that I worked with were extremely happy and satisfied with their job. The type of day to day life and overall lifestyle that they had was what I have been hoping to find in medicine.

What I hope to find in a field
-good mix of procedures/clinic
-ability to work in private practice and/or start a practice
-manageable lifestyle (i.e not horrible call, etc)

From my understanding, it seems like the pay for Urology and Pain are relatively similar. The call in Pain is immensely better (i.e not much if any at all). I'm not sure what future of Pain looks like... Urology is in huge demand, but this may lead to an exacerbation of the problems I already listed.

Anyways, is it wise for a med student to go into Anesthesia with full intent of going into Pain? I enjoyed my Anesthesia rotation, so I am sure I could get through the residency. I would love insights on this, as well as thoughts on my dilemma above

It depends what you value. In my opinion the only good specialties are the ones where you don't work nights, weekends or holidays and are able to have a normal life. None of the others are worth doing, no matter how much money you make. By that criteria, Pain is and will always be a reasonably good field to be in, if you like it. It may not always be a good and high paying field. But it's not likely to ruin your life, like many of the sexier specialties do. Never forget that no area in Medicine is high paying enough, to compensate for you hating your life because it ruins the important things in life. That's my two cents.

 

[futurepaindoc234]

It depends what you value. In my opinion the only good specialties are the ones where you don't work nights, weekends or holidays and are able to have a normal life. None of the others are worth doing, no matter how much money you make. By that criteria, Pain is and will always be a reasonably good field to be in, if you like it. It may not always be a good and high paying field. But it's not likely to ruin your life, like many of the sexier specialties do. Never forget that no area in Medicine is high paying enough, to compensate for you hating your life because it ruins the important things in life. That's my two cents.

Thanks for your reply. How you define good specialties is similar to me. As an attending, I really would prefer not to work nights, weekends or holidays if possible. I wouldn't mind if it was home call where I normally would not have to come in, but it seems that even in a field which I thought this was possible (Urology), this hasn't been my experience. I understand it is a surgical subspecialty, but I thought that the life as an attending was much better than what I have been hearing/reading about.

Financially, I do not need to be slaving away as a NS or orthopod bringing in 700k a year as I have no med school debt, but I would like a job where it would be expected to make more than primary care specialties (~400k). I am not one of those people who "loves" medicine. I enjoy it, but in the end I understand that is a job. I am trying to find the best field for me where I can achieve my financial goals without recking my life outside of work.

 

[Ducttape]

Healthcare administrator would fit all your requirements. Or NIH researcher.

If you want the best fit, I’m sorry, but you really need to be in love with being a doctor to love your job.

I love being a doctor. I love taking care of people, hoping to get them better, whether it is in ER or pain.

If that isn’t your focus, then you should mitigate your exposure to needy self centered people who think you are at their beck and call. Some of those people will become “patients”...

If dead set on clinical pathway, think about derm, plastics, ortho sports, Maybe GI...

 

[SSdoc33]

i like medicine. i like my job. i dont love medicine or my job. but im pretty good at it. if i didnt get paid relatively well and if i didnt work reasonable hours, i would not be happy. the ability to have a nice lifestyle and life outside of work makes my situation sustainable.

if you LOVE what you do, then 70 hours a week isnt that big of a deal. personally, i think thats is insane and you wont have much time for your wife/kids/etc, but people do it.

i think you can have a career in medicine, but try to find a field where you dont have to interact as much with people. it sounds like that is what you are looking for.

 

[Agast]

If urology has lost its sheen you may prefer something like ENT. I feel like private practice docs can stick to the smaller cases if they wish, and it’s not really an area other practitioners can encroach on.

 

[futurepaindoc234]

@Ducttape - As @SSdoc33 said, just because I say that I treat medicine as a job does not mean I do not like it. Just because I say I don't "love" medicine, does not mean I am not fit to care for patients. I love taking care of people, it is the main reason I chose medicine (vs reasons such as enjoying science, etc). But just because I love caring for people does not mean I have to pick a field of medicine where I give up my whole life/time with family to do this. Sure, at certain points of my training and career this is required. I have no problem working hard, but I am trying to find a field of medicine that fits the lifestyle I hope to have when I am an attending (Good income, more office-style hours, procedure based).This is not a lazy medical student "what field of medicine can I go into and make a lot of money/not do any work" post.

I am a type A person who loves interacting with and helping people, but in the end I know that whatever field of medicine I go into will end up becoming routine and in the end is "just a job". I am trying to find one that fits what I am looking for and I thought that pain may be a good option

I have thought about GI, will probably look more into it. Someone mentioned no patient contact, but I could not do a field like Rads/Path as I am an extrovert and need the patient interaction.

 

[SommeRiver]

Financially, I do not need to be slaving away as a NS or orthopod bringing in 700k a year as I have no med school debt, but I would like a job where it would be expected to make more than primary care specialties (~400k). I am not one of those people who "loves" medicine. I enjoy it, but in the end I understand that is a job. I am trying to find the best field for me where I can achieve my financial goals without recking my life outside of work.

LOFL at putting a number value on how much you want to make...Do NOT become a pain doctor...I would love to know what information you used to select $400k as your goal.

 

[futurepaindoc234]

LOFL at putting a number value on how much you want to make...Do NOT become a pain doctor...I would love to know what information you used to select $400k as your goal.

Because it was in between 350 and 450k... or 300 and 500k. Who cares, it was an arbitrary number that is above primary care level. Seriously, I do not know why everyone freaks out if there is any mention of salary or considerations of lifestyle/practice set ups. These are important considerations

 

[SommeRiver]

Because it was in between 350 and 450k... or 300 and 500k. Seriously, I do not know why everyone freaks out if there is any mention of salary or considerations of lifestyle/practice set ups. These are important considerations

You feel that way bc you're in training and completely naive to the real world. No matter how much money you make you'll never be happy if money is what drives your decisions. After 6 or 7 paychecks the novelty wears off and you're just going to work every day. Pain is NOT for you if you're looking for a lifestyle gig. The pt population doesn't allow that, and I would encourage you to explore other options like radiology. If you want to do procedures, do interventional radiology.

 

[futurepaindoc234]

You feel that way bc you're in training and completely naive to the real world. No matter how much money you make you'll never be happy if money is what drives your decisions. After 6 or 7 paychecks the novelty wears off and you're just going to work every day. Pain is NOT for you if you're looking for a lifestyle gig. The pt population doesn't allow that, and I would encourage you to explore other options like radiology. If you want to do procedures, do interventional radiology.

IR has a brutal lifestyle from my understanding and I would rather be a surgeon working 80+ hours a week then sit in a dark room all day like Radiology (contradictory to my posts about lifestyle but I could never do that).

Everyone mentions the patient population in pain. I understand I am completely naive about this, but from working with pain for a couple weeks on my rotation these patients seem to be outliers. Most were genuinely good people who exhausted other options and wanted some relief. Opioids rarely used.

Is the reason you describe pain as not a "lifestyle gig" merely because of the patients?

 

[SommeRiver]

IR has a brutal lifestyle from my understanding and I would rather be a surgeon working 80+ hours a week then sit in a dark room all day like Radiology (contradictory to my posts about lifestyle but I could never do that).

Everyone mentions the patient population in pain. I understand I am completely naive about this, but from working with pain for a couple weeks on my rotation these patients seem to be outliers. Most were genuinely good people who exhausted other options and wanted some relief. Opioids rarely used.

Is the reason you describe pain as not a "lifestyle gig" merely because of the patients?

One of my best friends does IR and has a great QOL. He does a procedure on a pt and moves on, frequently never to see them again.

Pain pts generally don't get better so you're not necessarily treating them and releasing them. You have to be okay with small improvements and frequent failures. They will ask you why your intervention failed, and you'll tell them they have problems you can't fix. So unlike my ortho colleagues, pts don't come in and get fixed by me. They come in and we make small improvements that are temporary. This doesn't describe a lifestyle gig where you're the hero repeatedly throughout the day, and everyone loves you.

You have to really like pain to do the job, and absolutely do NOT consider it if you're looking around for subspecialties with no call and good income as a criteria for pursuit.

You're talking about your life...Money means nothing...

Put $400k out of head...Instead look for what you LIKE to do.

Also - I take no call, don't do weekends, and take several weeks off per year. That's a great gig, but here's the reality of the situation - I am ACTUALLY on call 24-7. I don't get called at night, but if I put a stimulator in someone or I do something to them it is me that will fix it. I get a wet tap on a pt and they have a dural puncture headache I am the one that will meet them in the ED for their blood patch. I've been called one time after hours, but the possibility is always there. I fix my own problems, which is the only way to do it IMO. Patients don't want some other doctor, they want you...

 

[drusso]

Thanks for your post. Do you think that the future of Pain is worse off than other fields (as @bronchospasm points out, there seem to be plenty in all fields)?

I have derm a shot but have no interest in it. I have not spent much time in oncology, but may check it out. When it comes to surgical subs, Urology and ENT were the only ones I spent substantial time with. Dislike ENT anatomy too much. Welp, looks like I may be veer back to Urology after all.

If it matters at all, I will be graduating med school with no debt if that is a relevant thing to consider when picking a field

I think that the future of pain is worse off than other specialties. Pain physicians have not been effective at advocating for higher reimbursement or more autonomy. Ask the pain physicians here how many of them have given money to PainPAC, ASIPP-PAC, or other groups that lobby for our secure future and a seat at the table? Very few. Pain doctors are not well organized, energized, or oriented toward their own self-preservation compared to other specialties...

Moreover, treating pain is a very individualized and personalized service: That kind of personalized medicine approach to patient care is not in step with the dominant collectivist/population-based health care delivery model. The thrust by government payers and workers comp is to "de-medicalize" pain so that it is not even a medical problem...it's a perceptual problem or a character foible and therefore outside the realm of requiring any medical treatment whatsoever. Interventional modalities get replaced by "Mu-shoo Medicine" like acupuncture, Yoga, and chiropractic. It doesn't matter if those things don't work, because if pain is imaginary, or at least not biologically grounded, (socially constructed as they say), then imaginary treatments work fine for imaginary problems! All anyone needs is a "stern talking too" about their pain...some version of "knock that **** off..."

Can you imagine proposing that we talk people out of their tumor? Or, talk them out of their broken bone? Or talk them out of their basal cell carcinoma? Crazy, right? But, in pain medicine, we confront peer reviewers who insist that discs don't hurt, that facet arthropathy is just "wrinkles of the spine," that CRPS is from bad parenting, etc... You think I'm exaggerating? Read this:

Home - Dr. Kevin Cuccaro
PNE Review II: Mentally "Buffing" Chronic Pain Patients - Regenexx Blog
https://sciencebasedmedicine.org/ba...g-quackery-for-opioids-for-medicaid-patients/
https://sciencebasedmedicine.org/in...-crisis-promote-medicaid-funding-acupuncture/

I am a terminally-differentiated private practice pain physician. It's too late for me, but I would encourage you to apply yourself and seek greener pastures---pathology, dermatology, radiology, genetics, even rheumatology (own your own infusion center), radiation oncology, orthopedics (with a fellowship in sports, hand, or ankle/foot), plastics, general surgery with an eye toward bariatrics or varicose vein treatment, etc. Pick something with some "meat to it" that still lets you be autonomous, independent, and entrepreneurial. Arrange to do a pain rotation at a health-system based "structured opioid refill clinic" and imagine that model spread out across the nation where your role as the titular "pain specialist" amounts to rubber-stamping compliance plans...

Take it from me, in pain the days are long but the years are short. Don't settle for a second tier specialty with poor advocacy and limited ROI.

 

[Ducttape]

The point remains.

Do what you love, not what you think will give you the best lifestyle with the most money... and the rest will be gravy.

If you like medicine and like taking care of people but there is nothing you love, then definitely choose a “lifestyle” subspecialty - ER, sports med, derm maybe, research, even path...

It’s just my opinion clocking in a job that you like but not love is just never as fulfilling as really being interested in something and being willing to dedicate yourself to it, and then making a commitment to cut back on it later for the sake of family...

(Hence my posting at 6:50 pm...)

 

[IkeBoy18]

job prospects in pathology arent good, and even rad onc. I used to work in path at MD Anderson. they need 2 fellowships to find a job and the market is super tight. starting at MDA 10 years ago $169k. Dermatopath is a different story.

 

[Dr. Ice]

IR has a brutal lifestyle from my understanding and I would rather be a surgeon working 80+ hours a week then sit in a dark room all day like Radiology (contradictory to my posts about lifestyle but I could never do that).

Everyone mentions the patient population in pain. I understand I am completely naive about this, but from working with pain for a couple weeks on my rotation these patients seem to be outliers. Most were genuinely good people who exhausted other options and wanted some relief. Opioids rarely used.

Is the reason you describe pain as not a "lifestyle gig" merely because of the patients?

Where do you want to live? You might be able to pull 400k in Georgia starting but 250k in the northeast or Cali. It doesn’t matter anyway, once we are single payor subtract 40% from whatever you want to make.

 

[SSdoc33]

One of my best friends does IR and has a great QOL. He does a procedure on a pt and moves on, frequently never to see them again.

Pain pts generally don't get better so you're not necessarily treating them and releasing them. You have to be okay with small improvements and frequent failures. They will ask you why your intervention failed, and you'll tell them they have problems you can't fix. So unlike my ortho colleagues, pts don't come in and get fixed by me. They come in and we make small improvements that are temporary. This doesn't describe a lifestyle gig where you're the hero repeatedly throughout the day, and everyone loves you.

You have to really like pain to do the job, and absolutely do NOT consider it if you're looking around for subspecialties with no call and good income as a criteria for pursuit.

You're talking about your life...Money means nothing...

Put $400k out of head...Instead look for what you LIKE to do.

Also - I take no call, don't do weekends, and take several weeks off per year. That's a great gig, but here's the reality of the situation - I am ACTUALLY on call 24-7. I don't get called at night, but if I put a stimulator in someone or I do something to them it is me that will fix it. I get a wet tap on a pt and they have a dural puncture headache I am the one that will meet them in the ED for their blood patch. I've been called one time after hours, but the possibility is always there. I fix my own problems, which is the only way to do it IMO. Patients don't want some other doctor, they want you...

I disagree with most of this post

it is fine, natural, and normal to think about money and lifestyle.

you seem to be asking the right questions. trust your instinct, and you will do fine. there is a lot of bad information/misinformation on this board and in any of your brief rotations.

 

[SSdoc33]

I think that the future of pain is worse off than other specialties. Pain physicians have not been effective at advocating for higher reimbursement or more autonomy. Ask the pain physicians here how many of them have given money to PainPAC, ASIPP-PAC, or other groups that lobby for our secure future and a seat at the table? Very few. Pain doctors are not well organized, energized, or oriented toward their own self-preservation compared to other specialties...

Moreover, treating pain is a very individualized and personalized service: That kind of personalized medicine approach to patient care is not in step with the dominant collectivist/population-based health care delivery model. The thrust by government payers and workers comp is to "de-medicalize" pain so that it is not even a medical problem...it's a perceptual problem or a character foible and therefore outside the realm of requiring any medical treatment whatsoever. Interventional modalities get replaced by "Mu-shoo Medicine" like acupuncture, Yoga, and chiropractic. It doesn't matter if those things don't work, because if pain is imaginary, or at least not biologically grounded, (socially constructed as they say), then imaginary treatments work fine for imaginary problems! All anyone needs is a "stern talking too" about their pain...some version of "knock that **** off..."

Can you imagine proposing that we talk people out of their tumor? Or, talk them out of their broken bone? Or talk them out of their basal cell carcinoma? Crazy, right? But, in pain medicine, we confront peer reviewers who insist that discs don't hurt, that facet arthropathy is just "wrinkles of the spine," that CRPS is from bad parenting, etc... You think I'm exaggerating? Read this:

Home - Dr. Kevin Cuccaro
PNE Review II: Mentally "Buffing" Chronic Pain Patients - Regenexx Blog
https://sciencebasedmedicine.org/ba...g-quackery-for-opioids-for-medicaid-patients/
https://sciencebasedmedicine.org/in...-crisis-promote-medicaid-funding-acupuncture/

I am a terminally-differentiated private practice pain physician. It's too late for me, but I would encourage you to apply yourself and seek greener pastures---pathology, dermatology, radiology, genetics, even rheumatology (own your own infusion center), radiation oncology, orthopedics (with a fellowship in sports, hand, or ankle/foot), plastics, general surgery with an eye toward bariatrics or varicose vein treatment, etc. Pick something with some "meat to it" that still lets you be autonomous, independent, and entrepreneurial. Arrange to do a pain rotation at a health-system based "structured opioid refill clinic" and imagine that model spread out across the nation where your role as the titular "pain specialist" amounts to rubber-stamping compliance plans...

Take it from me, in pain the days are long but the years are short. Don't settle for a second tier specialty with poor advocacy and limited ROI.

this is utter nonsense and mid-life crisis drivel

 

[Dr. Ice]

I think that the future of pain is worse off than other specialties. Pain physicians have not been effective at advocating for higher reimbursement or more autonomy. Ask the pain physicians here how many of them have given money to PainPAC, ASIPP-PAC, or other groups that lobby for our secure future and a seat at the table? Very few. Pain doctors are not well organized, energized, or oriented toward their own self-preservation compared to other specialties...

Moreover, treating pain is a very individualized and personalized service: That kind of personalized medicine approach to patient care is not in step with the dominant collectivist/population-based health care delivery model. The thrust by government payers and workers comp is to "de-medicalize" pain so that it is not even a medical problem...it's a perceptual problem or a character foible and therefore outside the realm of requiring any medical treatment whatsoever. Interventional modalities get replaced by "Mu-shoo Medicine" like acupuncture, Yoga, and chiropractic. It doesn't matter if those things don't work, because if pain is imaginary, or at least not biologically grounded, (socially constructed as they say), then imaginary treatments work fine for imaginary problems! All anyone needs is a "stern talking too" about their pain...some version of "knock that **** off..."

Can you imagine proposing that we talk people out of their tumor? Or, talk them out of their broken bone? Or talk them out of their basal cell carcinoma? Crazy, right? But, in pain medicine, we confront peer reviewers who insist that discs don't hurt, that facet arthropathy is just "wrinkles of the spine," that CRPS is from bad parenting, etc... You think I'm exaggerating? Read this:

Home - Dr. Kevin Cuccaro
PNE Review II: Mentally "Buffing" Chronic Pain Patients - Regenexx Blog
https://sciencebasedmedicine.org/ba...g-quackery-for-opioids-for-medicaid-patients/
https://sciencebasedmedicine.org/in...-crisis-promote-medicaid-funding-acupuncture/

I am a terminally-differentiated private practice pain physician. It's too late for me, but I would encourage you to apply yourself and seek greener pastures---pathology, dermatology, radiology, genetics, even rheumatology (own your own infusion center), radiation oncology, orthopedics (with a fellowship in sports, hand, or ankle/foot), plastics, general surgery with an eye toward bariatrics or varicose vein treatment, etc. Pick something with some "meat to it" that still lets you be autonomous, independent, and entrepreneurial. Arrange to do a pain rotation at a health-system based "structured opioid refill clinic" and imagine that model spread out across the nation where your role as the titular "pain specialist" amounts to rubber-stamping compliance plans...

Take it from me, in pain the days are long but the years are short. Don't settle for a second tier specialty with poor advocacy and limited ROI.

I actually agree with most of this. Maybe I’m having a premature midlife crisis..

 

[drusso]

this is utter nonsense and mid-life crisis drivel

How much money have you given to our PAC's, etc to support our specialty's interests? Our specialty is invisible when it comes to standing up for our practice and patients.

 

[swamprat]

This thread is full of crap. ER is not a life style specialty. I am an ER physician. Pain is way more life style. ER pay is very good currently. Head over to the ER forum and look at all the people worried about declining reimbursements. Go to another forum, another specialty and you will see similar doom and gloom. I think too many ppl on medicine are jaded. I’m relatively new to pain but I think it’s a great field. The patients can suck tho OP despite what u have seen. You have to roll with it or you won’t survive. GL

 

[SSdoc33]

How much money have you given to our PAC's, etc to support our specialty's interests? Our specialty is invisible when it comes to standing up for our practice and patients.

granted, not as much as I should.

but you paint a portrait of a hospital based pain practice that is really not reality in most instances, and a practice environment that is nowhere near as bad as it really is (IMHO).

 

[244913]

A mature pain practice with good patients = best job in Medicine. A pain practice with bad patients, in a saturated market...sure you'll be off weekends but M-F the pain will be brought upon you, and brought hard

 

[SommeRiver]

I disagree with most of this post

Which parts specifically?

 

[SSdoc33]

Which parts specifically?

you advised not to consider pain as a specialty with no call and good income. I have no call. I have a good income. I think most of us are in that boat

400k for a sub specialist isn't unreasonable

I agree that we are typically managing a chronic process, but there are lots of instances when you get a patient through an acute phase (hot radic) and they love you for it. RFs are very satisfying when they work well.

also, if you want to avoid the wet taps, just do transforaminals

 

[Piebaldi]

You feel that way bc you're in training and completely naive to the real world. No matter how much money you make you'll never be happy if money is what drives your decisions. After 6 or 7 paychecks the novelty wears off and you're just going to work every day. Pain is NOT for you if you're looking for a lifestyle gig. The pt population doesn't allow that, and I would encourage you to explore other options like radiology. If you want to do procedures, do interventional radiology.

Radiology and Interventional radiology have brutal lifestyles. The last thing that they are are lifestyle specialties. They require 24/7 coverage, nights, holidays. Every specialty has its pros and cons. I would say pain despite its challenges is likely better than others.

 

[Piebaldi]

This thread is full of crap. ER is not a life style specialty. I am an ER physician. Pain is way more life style. ER pay is very good currently. Head over to the ER forum and look at all the people worried about declining reimbursements. Go to another forum, another specialty and you will see similar doom and gloom. I think too many ppl on medicine are jaded. I’m relatively new to pain but I think it’s a great field. The patients can suck tho OP despite what u have seen. You have to roll with it or you won’t survive. GL

Would agree with this. EM seems sexy at first but I can see why EM docs have brutal burnout. One of the fellows were I will be doing Pain fellowships is an EM doc. Hours seem awful and the brutality of the ED seems brutalizing. Ugh. Every specialty has pros and cons.

 

[chudat]

dermatology

 

[SommeRiver]

you advised not to consider pain as a specialty with no call and good income. I have no call. I have a good income. I think most of us are in that boat

400k for a sub specialist isn't unreasonable

I agree that we are typically managing a chronic process, but there are lots of instances when you get a patient through an acute phase (hot radic) and they love you for it. RFs are very satisfying when they work well.

also, if you want to avoid the wet taps, just do transforaminals

Choosing to be a pain physician simply based off hours and money is a very foolish proposition. You take on medical risk for elective procedures in a population of pts that can be completely unreasonable and litigious, and the medical risk is poorly supported by data.

Thanks for the advice about TFESI - I didn't know that.

 

[SommeRiver]

Radiology and Interventional radiology have brutal lifestyles. The last thing that they are are lifestyle specialties. They require 24/7 coverage, nights, holidays. Every specialty has its pros and cons. I would say pain despite its challenges is likely better than others.

Yes, pain is better than "others," but not better than many. I only know my friend has a great lifestyle as IR guy and there are PLENTY of pain jobs that take call.

 

[Piebaldi]

Yes, pain is better than "others," but not better than many. I only know my friend has a great lifestyle as IR guy and there are PLENTY of pain jobs that take call.

And plenty of pain jobs that don't. It's entirely up to you if you choose to think IR is so fabulous. Just bc your friend might have a good gig does not mean that all IR gigs are like that. It seems naive at best.

 

[SommeRiver]

And plenty of pain jobs that don't. It's entirely up to you if you choose to think IR is so fabulous. Just bc your friend might have a good gig does not mean that all IR gigs are like that. It seems naive at best.

The irony of this statement is not lost on me.

 

[DODOCSS]

dentistry, specifically endodontics

 

[futurepaindoc234]

Where do you want to live? You might be able to pull 400k in Georgia starting but 250k in the northeast or Cali. It doesn’t matter anyway, once we are single payor subtract 40% from whatever you want to make.

I am from the midwest and would like to live here in the future. Cities like Indianapolis, Milwaukee, Columbus, Cincinnati, Detroit, etc. No plans to live in Cali or the East Coast, hence why I thought making 400k as a subspecialist was reasonable and was surprised I got called out for quoting that number



Thanks to everyone for contributing to this thread. The discussion on here as been helpful and has given me a lot to think about.

It seems that no matter what field of medicine you pick, there are always the people who say that the sky is falling, life isn't good, etc.

I appreciate all your comments and perspectives. It is good to hear that some of you don't think the sky is falling in Pain and that it can still be a great specialty. I am planning on reaching out to more docs in my area and see what their thoughts are.

 

[chudat]

Outpt IR doing comestics....

 

[Dr. Ice]

I am from the midwest and would like to live here in the future. Cities like Indianapolis, Milwaukee, Columbus, Cincinnati, Detroit, etc. No plans to live in Cali or the East Coast, hence why I thought making 400k as a subspecialist was reasonable and was surprised I got called out for quoting that number



Thanks to everyone for contributing to this thread. The discussion on here as been helpful and has given me a lot to think about.

It seems that no matter what field of medicine you pick, there are always the people who say that the sky is falling, life isn't good, etc.

I appreciate all your comments and perspectives. It is good to hear that some of you don't think the sky is falling in Pain and that it can still be a great specialty. I am planning on reaching out to more docs in my area and see what their thoughts are.

Midwest is good. Don’t think 400k is unreasonable there at all. And I doubt you will be paying anywhere near 18-24k in property tax just to live in a house like I would have to. I guess once we all are assembly line workers through democratic single payor, you will still be ok in the Midwest because your cost of living will not be high.

 

[Ferrismonk]

Midwest is good. Don’t think 400k is unreasonable there at all. And I doubt you will be paying anywhere near 18-24k in property tax just to live in a house like I would have to. I guess once we all are assembly line workers through democratic single payor, you will still be ok in the Midwest because your cost of living will not be high.

I'm in near Detroit. When I was looking a couple years ago jobs were somewhere between 200K and 400K. Anesthesiologists are the ones making near 400k, but they are expected to take Anesthesia call as well. In my experience, if you want greater than 400k you either own the ASC/lab/DME stuff, or you are doing a ton of call.

 

[Piebaldi]

I'm in near Detroit. When I was looking a couple years ago jobs were somewhere between 200K and 400K. Anesthesiologists are the ones making near 400k, but they are expected to take Anesthesia call as well. In my experience, if you want greater than 400k you either own the ASC/lab/DME stuff, or you are doing a ton of call.

Are you really serious? 400K plus is the most standard salary pain wise in the Midwest and many other parts of the nation. 200K? Not even PCPs get so little these days.

 

[BobBarker]

I'm in near Detroit. When I was looking a couple years ago jobs were somewhere between 200K and 400K. Anesthesiologists are the ones making near 400k, but they are expected to take Anesthesia call as well. In my experience, if you want greater than 400k you either own the ASC/lab/DME stuff, or you are doing a ton of call.

I think you are probably settling for much less than you are worth and not guessing correctly what others are making.

 

[Ferrismonk]

Perhaps I wasn't clear in my post above. These are starting salaries after fellowship. After you build up your client base, you can make more.

 

[Piebaldi]

Perhaps I wasn't clear in my post above. These are starting salaries after fellowship. After you build up your client base, you can make more.

If someone is offered 200k as a fellowship trained physician and they take it, they are idiots. PCPs and FM grads make more than that

What a joke

 

[SSdoc33]

If someone is offered 200k as a fellowship trained physician and they take it, they are idiots. PCPs and FM grads make more than that

What a joke

A. in cities most people want to live in, salaries are much lower. who is the idiot? the doc making 275K in manhattan, or the doc making 500K in wichita,kansas?

PCPs and FM grads fo not all make more than 200

 

[BobBarker]

Dude. He lives in Detroit. A dying, cold city.