Orthopedic Surgery vs Interventional Pain

Panacea Financial Contract Review
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Ferrismonk said:
Don't listen to these guys about compensation. They're both machines.
Click to expand...
Bob is dramatically busier than me, but he’s right about compensation.
Members don't see this ad.
 
I don’t think it’s entirely genuine of people on here to castigate this young lad by not being “in love” with healthcare. I bet most of us are at the points in our career where we are bored, jaded, etc. I’m also sure it doesn’t help that he is running into people who are almost daily telling him they should have done something else. This happened to me. I was constantly encountering docs who were miserable. It didn’t paint a rosy picture in any speciality.

My advice would be, it’s a pretty expensive mistake to have made, so try to make the best of it and pick something that you can at least find yourself interested enough in to want to be proficient at.

When I was young and single, I used to not like going to work because it was a distraction from me doing something really fun like hanging out with friends or bar hopping. Now having young kids, going to work is a real joy and a break from real life..so you can always look at it that way
 
Members don't see this ad :)
Dr. Ice said:
I don’t think it’s entirely genuine of people on here to castigate this young lad by not being “in love” with healthcare. I bet most of us are at the points in our career where we are bored, jaded, etc. I’m also sure it doesn’t help that he is running into people who are almost daily telling him they should have done something else. This happened to me. I was constantly encountering docs who were miserable. It didn’t paint a rosy picture in any speciality.

My advice would be, it’s a pretty expensive mistake to have made, so try to make the best of it and pick something that you can at least find yourself interested enough in to want to be proficient at.

When I was young and single, I used to not like going to work because it was a distraction from me doing something really fun like hanging out with friends or bar hopping. Now having young kids, going to work is a real joy and a break from real life..so you can always look at it that way
Click to expand...
Thank you! This is more so what I was trying to say. Even some of the pain docs I shadowed told me it’s not a great field - the only docs that genuinely seemed happy was a pediatric heme/onc doctor I shadowed. I liked pain the most out of everything so that’s why I’m considering it still. I’m considering a neuro to pain route so I have all the subspecialties of neuro at my disposal if I lose interest in pain as well.
 
Another question I have is, does it feel like you guys lost most of your knowledge from your base residency when practicing pain full time? I feel a little worried at the fact that you have to go through 4 years of residency - just to practice mostly what you learned from a 1 year fellowship?
 
Bhargava Kolli said:
Another question I have is, does it feel like you guys lost most of your knowledge from your base residency when practicing pain full time? I feel a little worried at the fact that you have to go through 4 years of residency - just to practice mostly what you learned from a 1 year fellowship?
Click to expand...

Short answer is yes. I feel I could have just done the intern year and then straight to a one year pain fellowship.
I don’t feel that residency was required to be a competent pain physician.

That said, you should pick both a residency and fellowship you could live with practicing long term (Either one).
Once both completed most docs only practice their fellowship specialty but some decide to return to their residency specialty.

Better to have two options open to you than one, and a one year fellowship isn’t a big commitment in the grand scheme of 13 years of medical training.
 
Bhargava Kolli said:
Another question I have is, does it feel like you guys lost most of your knowledge from your base residency when practicing pain full time? I feel a little worried at the fact that you have to go through 4 years of residency - just to practice mostly what you learned from a 1 year fellowship?
Click to expand...
bedrock said:
Short answer is yes. I feel I could have just done the intern year and then straight to a one year pain fellowship.
I don’t feel that residency was required to be a competent pain physician.

That said, you should pick both a residency and fellowship you could live with practicing long term (Either one).
Once both completed most docs only practice their fellowship specialty but some decide to return to their residency specialty.

Better to have two options open to you than one, and a one year fellowship isn’t a big commitment in the grand scheme of 13 years of medical training.
Click to expand...
Agree you could get by with a 1+1 training pathway if you are primarily a needle jockey or pain surgeon. I've appreciated my background residency the more I do Pain. I think I consider more subtle things like CKD and med dosing, psychiatric overlay of pain, knowing when less is more, and risk/reward assessment just off the top of my head due to the experience of a full residency.

Yes you will gradually forget the core knowledge of your base residency unless you still practice it. If you really enjoy or value the knowledge component of it this can be mitigated with CME.
 
I appreciate every aspect of my training from Cornell gen surg to NYU PMR and then anesthesia pain. I use things from all almost every day
 
BobBarker said:
Probably less so than you think. I probably average 190-200 total encounters a week personally.
Click to expand...
I do around 500-600 month. I just don’t want to do more. My kids are 12 and 15 and we’re swamped with “stuff.” I was at 6500 last year. Half day Friday. Changing to Athena has negatively impacted this as well.

I should say, being in an ortho group my procedure rates per pt referral are extremely high, which is something to consider. If you’re swamped in crazy you’ll see tons of pts and be super busy in the clinic while your procedural numbers will be low.
 
GatorCHOMPions said:
Agree you could get by with a 1+1 training pathway if you are primarily a needle jockey or pain surgeon. I've appreciated my background residency the more I do Pain. I think I consider more subtle things like CKD and med dosing, psychiatric overlay of pain, knowing when less is more, and risk/reward assessment just off the top of my head due to the experience of a full residency.

Yes you will gradually forget the core knowledge of your base residency unless you still practice it. If you really enjoy or value the knowledge component of it this can be mitigated with CME.
Click to expand...
A good pain fellowship will teach what you need to know for private practice.

Note that I did include internship in my 1+1 training paradigm. I learned plenty about CKD and med dosing in internship.

I learned about psych overlay of pain and risk reward assessment in fellowship.

I’m not suggesting the residency has no value, but I’m stating that I place a higher value on not losing 3 years of my 20s over what I learned in residency.
 
Last edited:
Members don't see this ad :)
Bhargava Kolli said:
Thank you! This is more so what I was trying to say. Even some of the pain docs I shadowed told me it’s not a great field - the only docs that genuinely seemed happy was a pediatric heme/onc doctor I shadowed. I liked pain the most out of everything so that’s why I’m considering it still. I’m considering a neuro to pain route so I have all the subspecialties of neuro at my disposal if I lose interest in pain as well.
Click to expand...
What if you lose interest in neuro as well
 
bedrock said:
Short answer is yes. I feel I could have just done the intern year and then straight to a one year pain fellowship.
I don’t feel that residency was required to be a competent pain physician.
Click to expand...
Man if this was the pathway then pain would suddenly be the most competitive field amongst med students
 
bedrock said:
Sorry to say, but maybe you should pursue a career outside of medicine?

Better to make that decision now, compared to after 5 years of residency when you are even more locked into a medical career.
Click to expand...
With the way the market is now, don't think this is wise. All my friends in rads, anesthesia, pmr, and derm have views similar to those of OP. Better to see it as a med student than be an idealist and do something like gen surg only to get jaded later....
 
GlowInTheDark said:
You’ll make a great radiologist.
Click to expand...
Hate to hijack the thread, but what about an msk or neurorad going into pain? Is it a good idea to add another year (7 years total) to do a pain fellowship if the goal is to own and run a clinic then get one of those 7on/14off swing rads jobs too?
 
Ronin1 said:
You guys see a lot of patients. I only see about 5000 a year total with my NP. Maybe I should try harder lol
Click to expand...
My PA sees 20 per day on avg, and I don’t count his numbers as part of my own.
 
It not enough patients to sustain the head count. Even in HOPD. The doc might not be able to keep up in the real world after being in that job for a few years.
 
That’s a good number. Assuming the NP’s wrvu’s are separate from that. You have to be doing a lot of RFA’s to reach those numbers with so few office visits which the hospital does great on.
 
The anesthesiology to pain path would provide freedom I suspect you’d appreciate.

There was a poster years ago who documented his journey to match ortho. He ended up a radiologist. In a reflective post, he said he’d go back and try for another surgical subspecialty instead because ortho works so hard.

Still, I recently had an ophthalmologist tell me the only job in medicine she recommends to her kids is anesthesiologist/CRNA. There’s not much opportunity to escape the grind of 4-6 days per week plus call. The anesthesiology market will have its ups and downs, but the availability of schedule flexibility is as good as it gets in medicine.

Since you me mention concerns about ortho training, if you’re competitive for ortho, you should be able to land a prestigious and humane anesthesiology residency.

Maybe you’re someone who definitely plans to bust tail until retirement. Per hour worked, pain seems more draining than ortho for most people, but pain doesn’t have to work nights and weekends.

Although ortho reimbursement seems more secure, I still know several orthopods who were fed up with the system and did / are doing whatever it takes to go to a cash practice.

Another one of many reasons I’m more optimistic about the future of ortho is that it’s much more respected. But no one can predict the future. Things mostly stay the same. Change is usually just a slow erosion.
 
BobBarker said:
That’s a good number. Assuming the NP’s wrvu’s are separate from that. You have to be doing a lot of RFA’s to reach those numbers with so few office visits which the hospital does great on.
Click to expand...
PA used to be attached to the physician’s overhead in our group, but not any longer. They are in a giant pool, and I am happy about that. Mine collects around 35k per month total, and that’s ancillaries and clinic and everything in an aggregate.
 
BobBarker said:
You should fire your nurse practioner. That is less than 24 patients per day. (5000/48) x 4.5
Click to expand...
In my practice, NPs and docs see max 24 patients a day. NPs and docs are 4-ish days per week. We're not running around like crazy and get a real hour lunch. Still make good money, but not what you make obviously.
 
They are seeing 24 for one doc and one np. So 14 for the doc and 10 for the np. Not enough to pay the NP’s salary.
 
Ronin1 said:
i managed to log over 10,000 wrvu pellets a year with the old values. Should hit 12k or so with new values and the g code. Time >money after a certain income. I’m not going to back to the real world….
Click to expand...
my goal is also 3.5 days, but how many are you seeing per day with those numbers?
 
You must log in or register to reply here.

Similar threads

T
Non-interventional vs Interventional Pain
Replies
37
Views
3K
SeniorWrangler
SeniorWrangler
Status Sciaticus
SCS Trial vs Implant pain relief?
Replies
18
Views
2K
Ducttape
D
specepic
Pain APP $ per RVU vs salary
Replies
16
Views
1K
BobBarker
BobBarker
drusso
  • Poll Poll
Trump 2.0 vs Obama's Second Term: Implications for Pain?
2
Replies
69
Views
4K
Pain Applicant1
Pain Applicant1
C
Pain Block Trays
Replies
15
Views
699
Ferdog27
F
Top