Pain and Anesthesiology?

[NightyNight]

Docs out there that still practice both anesthesia and pain? Do less pain and more anesthesia?

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[A Deep Breath]

I’m doing anesthesiology while my solo pain practice builds up, which seems to be common. Idealistically, I’d like to keep my anesthesia skills up for a long time. Realistically, I don’t personally know anyone who didn’t go full time pain within a few years in this scenario.

My own experience generally aligns with previous SDN consensus: outside of academia, these arrangements exist, but are somewhat uncommon. So, there may not be such a job posted in a particular geographic area.

If you’re willing to inhabit a middle ground between founding a practice and pure clinical employment, there are healthcare organizations out there who would love to have a pain doctor build up an in-house pain program. You might approach some to arrange an agreement with protected time for anesthesiology.

 

[willabeast]

I am retired now. Here is how I see it. Doing both Anesthesia and Pain is easy within 10-15 years post training. Then after 15 years it becomes increasingly difficult to keep up with both specialties. After 20 years of doing both I simply gave up the Anesthesia and went full time pain. Things got much easier after that. FYI I have time unlimited Anesthesia boards but pain recert is every 10 years. So I am thinking of having my future tombstone engraved "Still a Diplomate of the American Board of Anesthesiology".

 

[cowboydoc]

I am retired now. Here is how I see it. Doing both Anesthesia and Pain is easy within 10-15 years post training. Then after 15 years it becomes increasingly difficult to keep up with both specialties. After 20 years of doing both I simply gave up the Anesthesia and went full time pain. Things got much easier after that. FYI I have time unlimited Anesthesia boards but pain recert is every 10 years. So I am thinking of having my future tombstone engraved "Still a Diplomate of the American Board of Anesthesia".

Beats the heck out of “not meeting requirements,” though this would be an apt epitaph for me.

 

[NightyNight]

I am retired now. Here is how I see it. Doing both Anesthesia and Pain is easy within 10-15 years post training. Then after 15 years it becomes increasingly difficult to keep up with both specialties. After 20 years of doing both I simply gave up the Anesthesia and went full time pain. Things got much easier after that. FYI I have time unlimited Anesthesia boards but pain recert is every 10 years. So I am thinking of having my future tombstone engraved "Still a Diplomate of the American Board of Anesthesia".

Lucky you being retired. I still have 25 years. Right now, dumping anesthesia seems foolish. May change my mind when supervising becomes the norm

 

[BobBarker]

I would only do anesthesia nights and weekends for cash flow and focus on being the best pain doctor you can be.

 

[Status Sciaticus]

Docs out there that still practice both anesthesia and pain? Do less pain and more anesthesia?

It works well if you find a second person who wants to do a 50/50 split with you and effectively job share 0.5 FTE in each specialty

 

[willabeast]

I would only do anesthesia nights and weekends for cash flow and focus on being the best pain doctor you can be.

Working only nights/weekends = emergency surgery. When I was in the private pay world this would have meant low collection rates and the most high risk (for litigation) cases. OTOH when I was in the HMO world (paid by the hour) the income would have been fine, although still getting the worst cases. Worst two emergency cases I encountered doing anesthesia I was very lucky and did not get sued but I was truly lucky those two cases.

 

[BobBarker]

I mean just taking call at a low acuity place with pay per hour.

 

[agolden1]

Docs out there that still practice both anesthesia and pain? Do less pain and more anesthesia?

I'm presently in a job where I'm doing both in a priva-demic setting. In my general area (suburban northeast), I can think of four or five non-academic jobs that allow people to do both if they want and I've spoken with several of them at different times.

Some sweeping generalities. Typically, these jobs lean more towards anesthesiologists who have trained in pain who want to maintain some pain skill set rather than pain physicians who want to maintain an anesthesia skill set. What does this mean? The workload and culture of the group are more focused on anesthesia service than on the development of the pain service line. Some jobs are an even 50:50 split, mine is probably 60:40 anesthesia pain (possibly even 66:33), others are one day a week or one day every other week in the clinic.

Typically, these jobs are blended unit such that you aren't really incentivized to do excess work in the pain clinic/procedural side of things. You draw a straight salary, or can earn additional money by working late calls or weekends through anesthesia. There is not a wRVU or productivity model. This can keep things even between the physicians in the group, but doesn't incentivize you to work any harder than you need to.

Some groups tailor their expectations of you a bit more to your pain training or expect you to manage an acute pain service. Others will expect you to be able to mange all forms of cases depending on what the institution is doing.

In my example, I work at a level 1 trauma center with high risk OB and am technically responsible for all aspects of anesthesia and could be asked to run any room on any given day (vascular, thoracic, neuro anesthesia, orthopedics, OB, healthy pedi, trauma) except pedi < 2 and hearts. I take the same amount of call as the other anesthesiologists in the group. I have somewhere between 1 -4 clinic days a week that sort of shift around depending on the needs of the group and my late call and weekend call days. Work one weekend call a month doing anesthesia, one late shift for extra money a week. I do have to manage an acute pain service which sucks, but it could be worse.

The anesthesia group is heavily focused on filling operating rooms due to the ongoing anesthesia shortage. Pain is sort of the red headed step child of the group. We keep it running, but the group never figured out how to make the office profitable so there are no plans for expansion of services. I could be twice as busy as I currently am there at the moment, but the group is unwilling to incentivize me to work any harder so I would essentially be doing it for free.

I took this job as a need to escape a bad job situation I had in the past. I often joke if I put the blinders on, I could work like this for my career. However I know from this board and discussion with other anesthesiologists there are better pain and anesthesia jobs out there in general. I'll never make high end pain money, but $600 ish with eight weeks of vacation isn't awful for now.

You'll also likely have more time off with a job that incorporates some anesthesia than a private practice pain job. However, go rural enough and you may find a pain job which could let you live like anesthesia. A cofellow currently has a job with eight weeks of vacation and four days of clinic a week for a similar salary I am making now.

Let me know if you have other questions.