Pain fellowship after Ortho Residency

samurai1

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    Currently an Ortho resident. I like it but I don't love it. I enjoy the shorter interventions more than the OR. Joint injections, vertebroplastys, US guided injections, etc. I know this is kind of an odd question and I'm absolutely serious about whether this is possible. Would it be possible to apply to a pain fellowship after completing my ortho residency?
     

    Agast

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      You don't need to be board certified in pain management to offer the above procedures. The only thing you're lacking right now would be epidural injection training. None of these short procedures reimburse anywhere near orthopedic surgeries. A pain doctor would have to work really hard or compromise some medical ethics to attain the same salary as an orthopedic surgeon who isn't breaking a sweat. Just something to keep in mind.
       
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      BobBarker

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        There is an ortho doc around these parts who does what you said you like you do, IME's for work comp, odds and ends related to spine an joint pain and never does real surgeries that I am aware of. He has a busy practice and seems happy.
         

        EtherBunny

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          Currently an Ortho resident. I like it but I don't love it. I enjoy the shorter interventions more than the OR. Joint injections, vertebroplastys, US guided injections, etc. I know this is kind of an odd question and I'm absolutely serious about whether this is possible. Would it be possible to apply to a pain fellowship after completing my ortho residency?

          Bad idea. It's normal to not love your specialty in residency. Crazy long hours, terrible pay, abuse by superiors, etc. Wait until you get out into practice before you explore any interventional pain avenues. Orthopaedic surgeons do very well financially and have a bright future in the current landscape of medicine. Stay the course. You'll be happy in the long run.
           
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          SSdoc33

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            go into hand.

            the hand guys i work with are in and out of cases in minutes. yeah, there is some trauma from time to time as well as call, but it is a good, high paying gig. also, you usually get to sit for your surgeries, which is a huge plus in my book.

            if you are really serious about disliking ortho, then switch residencies. it might be a little late in the game, as i dont know what year you are in. ortho is such a diverse field, however, that you should have plenty of options after finishing.
             
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            bedrock

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              To answer the OPs question. Yes you can do a pain fellowship after ortho. It's been done.

              As others have noted, being an ortho private attending is very different from being a resident. ortho private practice is one of the best jobs in medicine.

              I would just plan on taking an ortho job right out of residency, as you may want to skip spending another year on an ortho fellowship.

              Practice ortho for 1-2 years and if you're unsatisfied, then do the pain fellowship at that point.
               
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              Timeoutofmind

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                To answer the OPs question. Yes you can do a pain fellowship after ortho. It's been done.

                As others have noted, being an ortho private attending is very different from being a resident. ortho private practice is one of the best jobs in medicine.

                I would just plan on taking an ortho job right out of residency, as you may want to skip spending another year on an ortho fellowship.

                Practice ortho for 1-2 years and if you're unsatisfied, then do the pain fellowship at that point.
                This advice is golden. Residency is always terrible. I cannot even imagine an orthopedic residency.

                Stay the course.
                 

                Green Grass

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                  A lot of advice from people without any real Ortho knowledge. I know plenty of private practice Ortho guys who still work 60+ hours per week, take Q3 call long after residency, and if you live in a large city, make modest salaries (~$350k). If you are really questioning it, send me a message. I'd be happy to chime in.
                   

                  Disciple

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                    A lot of advice from people without any real Ortho knowledge. I know plenty of private practice Ortho guys who still work 60+ hours per week, take Q3 call long after residency, and if you live in a large city, make modest salaries (~$350k). If you are really questioning it, send me a message. I'd be happy to chime in.

                    I can see that. New Ortho, hospital employed, major metro area, on one of the coasts.

                    If it's $350 for Ortho, probably $170-200 for pain.
                     

                    DrCommonSense

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                      I can see that. New Ortho, hospital employed, major metro area, on one of the coasts.

                      If it's $350 for Ortho, probably $170-200 for pain.

                      According to MGMA stats, there is not a two times difference between the specialities. Its more around 10-20% difference in salaries between then two at the median number. This is nominal after the marginal tax rates are applied for higher earners.

                      Medscape shows an average difference around 50K as well on the salary level from their surveys.

                      This isn't taking into account work hours/stress/call/work environment/etc
                       
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                      cowboydoc

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                        According to MGMA stats, there is not a two times difference between the specialities. Its more around 10-20% difference in salaries between then two at the median number. This is nominal after the marginal tax rates are applied for higher earners.

                        Medscape shows an average difference around 50K as well on the salary level from their surveys.

                        This isn't taking into account work hours/stress/call/work environment/etc

                        The MGMA and similar data is sometimes misleading IMO. Who is reporting? Accuracy/honesty? Inclusion of benefits? Also, there is far more variety in Ortho regarding reimbursement/practice type/hours than in pain. Most pain practices are relatively homogeneous beyond a minor variation of scope of procedures. Otherwise it's mostly determined by volume. An outpt. hand surgeon's practice probably doesn't compare to a trauma surgeon or a hip/knee specialist.

                        FWIW, I work with 10 ortho MDs, mostly general, a hand guy, foot/ankle guy and 2 hip/knee guys. As a moderate volume MSK physician doing two 1/2 days of fluoro time, I make about 30% less than the least productive surgeon and the busiest guy makes almost triple what I do. To paraphrase what someone recently said in another thread, if the Pain doc is making ortho money, there are likely some questionable practices happening...


                        All that said, agree with bedrock. Stay the course, get board certified, carve out your niche thereafter. Then, in the long run, making ~$300k and having decent hours/job satisfaction beats the pants off making >$500k and hating your life.
                         
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                        Dr. Ice

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                          Geography geography geography. Makes a huge difference. On the coasts at least the northeast, there isn't much of a comparison between ortho and pain. Ortho is easily 1.5 to 2x pain. But yes of course they have call and many of them from what I see hate their lives. There are so many factors though. Practice size being one, academic affiliation, ancillaries, real estate all can impact passive income as an ortho. I know some moderately busy pp ortho guys making 1 mill in net collections/year so after their overhead their take home is probably around 5-600k. And this is in the northeast. Large corporate physician employed practices skew this number slightly bc they emphasize how great their insurance contracts are and so their employment agreements are different. Of course we could also get into the salary differential between pmr "spine" for whoever wants to call it and anesthesia "pain"...but that's another story...
                           

                          DrCommonSense

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                            The MGMA and similar data is sometimes misleading IMO. Who is reporting? Accuracy/honesty? Inclusion of benefits? Also, there is far more variety in Ortho regarding reimbursement/practice type/hours than in pain. Most pain practices are relatively homogeneous beyond a minor variation of scope of procedures. Otherwise it's mostly determined by volume. An outpt. hand surgeon's practice probably doesn't compare to a trauma surgeon or a hip/knee specialist.

                            FWIW, I work with 10 ortho MDs, mostly general, a hand guy, foot/ankle guy and 2 hip/knee guys. As a moderate volume MSK physician doing two 1/2 days of fluoro time, I make about 30% less than the least productive surgeon and the busiest guy makes almost triple what I do. To paraphrase what someone recently said in another thread, if the Pain doc is making ortho money, there are likely some questionable practices happening...


                            All that said, agree with bedrock. Stay the course, get board certified, carve out your niche thereafter. Then, in the long run, making ~$300k and having decent hours/job satisfaction beats the pants off making >$500k and hating your life.

                            Good point but an anecdotal story doesn't give me sufficient information compared to larger salary surveys such as Medscape and MGMA.

                            Medscape is probably more accurate take in terms of take home SALARY numbers vs MGMA which is "total" compensation rather than just salary. I think both give you a good amount of information.

                            Also, remember take rates in Cali/NYC are through the ROOF.

                            If one person is making 400k vs another making 500K, the difference after takes is only about 40K or so due to >50% tax rate (federal, state, city, real estate,etc) are literally astronomical on the coasts.

                            The best method for top dollar is a top MBA with making partner salaries at Mckinsey or Goldman or making a lateral move into industry where VPs at Blue Cross are making >1 million dollars while just going to meetings mostly.
                             

                            Green Grass

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                              No one comes out of Ortho residency/fellowship and miraculously falls into only sports or only hand. You'll take general call, fill your clinic with trauma followup and a few elective cases. Over 5-10 years you develop a reputation, get more elective cases in your office, hopefully scale back call. And there ya go - ~15 years post residency you finally have the life you desired.


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                              DrCommonSense

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                                No one comes out of Ortho residency/fellowship and miraculously falls into only sports or only hand. You'll take general call, fill your clinic with trauma followup and a few elective cases. Over 5-10 years you develop a reputation, get more elective cases in your office, hopefully scale back call. And there ya go - ~15 years post residency you finally have the life you desired.


                                Sent from my iPhone using SDN mobile

                                Very true.

                                They are looking at mid career salaries for SUCCESSFUL ortho docs in SPECIALTY fields with GOOD reputations.

                                Also, with the changes in healthcare, all "specialist" physicians will likely be cut to about 30-50% more than PCP when it's all said and done.

                                Wouldn't trust salary data for ANY field of medicine at this point outside of direct pay models such as Cosmetic Plastic Surgeons who have great reputations.
                                 
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