Pain Management Fellowship
Started by EmmaNemma
That makes sense. How are fellows selected for positions? How competitive is the process? Thanks.
You just apply to fellowship positions, go to interviews, then get offers. Fellowships are not super competitive now because most people go straight into private practice or academics. Unclear if this will still be the case in several years.
When you're a resident, your co-residents and people in your department will explain when and how to apply. I wouldn't worry too much about fellowships as a medical student-- just go to the best residency you can.
When you're a resident, your co-residents and people in your department will explain when and how to apply. I wouldn't worry too much about fellowships as a medical student-- just go to the best residency you can.
Umm, pain fellowships are quite competitive.
I think a lot of mid to lower tier IM programs place some people into GI and cards as well - that doesn't mean the opportunity is accessible to everyone.
I don't think it's as competitive as GI/cards fellowship is for IM, however. Nevertheless I think it's the most competitive anesthesia fellowship, and not everyone who applies gets one.
That's is way off. More and more are going into fellowships. 8 of our 11 residents in fact since the job market is not what it once was. And yes pain is relatively competitive.
Is it possible to go into private practice and do pain procedures without doing a fellowship?
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Friendly advice...from someone that did a pain fellowship
DONT GO INTO PAIN right now.
The future is very uncertain. Most people that did fellowships are doing 100% anesthesia or a very large portion -anesthesia.
food for thought..
Sometimes I dont understand if this is reality or sheer SDN 'doom n gloom' rumor
I'm finishing a pain fellowship now. Whether I do pure pain, pure anesthesia, or a mix, the fellowship has opened A LOT of doors for me in a competitive market in a desireable city. I'm not necessarily questioning this posters authenticity, but NONE of the pain fellows I've spoken with have regretted their decision.
Why? Specifics, please. I can think of many specialties with much worse lifestyles and much lower pay, even taking into account recent cuts in Pain reimbursement.
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That sounds ridiculous. Doing a fellowship will open up a ton of opportunities. Even if you don't end up joining a pain practice, it will improve your chances at any other practice, or make you appealing in academics. It also opens up a very appealing chance to practice both pain and anesthesia, definitely making your week more variable.
If i"m not mistaken, youre an ER doc, correct? I am not sure what ER docs make. Anesthesiologists can do quite well, without that extra year. Just remember, that one extra year, is lost income.
I've not seen a huge difference in starting incomes for someone that's doing 100% pain and someone that is doing 100% anesthesiology for their first year out.
With anesthesiology, surgeons bring patinets into the hospital, you provide the anesthesia.
In Pain, YOU have to bring that busines in. With the large influx of other specialties that have people going into Pain now, the actual number of patients that each provider can "bring in" is less.
Not trying to 'doom and gloom" but the young resident SHOULD realize that it's not the 'gravy train' it once was. Do it if you like it. Dont do it for $$$ especially in major cities. Trust me. I had offers that would pay me LESS to do 100% pain than to do 100% anesthesia !!
Just the 'other ' perspective .....
Can you give some more info? I have always heard the opposite of what you are saying. That is, pain management specialist can focus on doing pain procedures and have potential patients with chronic pain beating down the doors. Are you saying that the procedures just don't pay well or that there really aren't very many patients?
Depndig on your market. If you want to have 'patients beating on your door" who are all opioid renewal patients, you will be satisified.
Again,given the market currently, being given teh procedures all day long is very hard to come by. I would suggest asking around again. Primary Care, PMR and Rads (after doing procedures and maxing them out) love 'dumping' or atleast trying to dump opioid management onto the pain service.
How have you determined that it is a minority? My small sample suggests more of a majority.
1 extra year as a fellow = 150-200K AFTER taxes
1 whole year of your life and sanity
possibility you will not increase your salary
no inhouse call and being your own boss = PRICELESS
As it has already been said, don't do it for the money. There are better reasons.
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agree 100%
Being a Pain Physician does not equal doing 30 procedures every day.
That is called a needle monkey. Pain is about taking care of the whole patient- being able to examine, take a history, review the MRI with them, selecting the appropriate procedure, deciding when no procedure is appropriate, managing meds or at least making the decision for the PCP's, dictating what gets done in PT, clinical psych.
If you want to stick needles in people all day, go IR or don't waste time on a fellowship. It makes pain docs look bad.
This is a really good point that bears repeating. Pain docs are DOCTORS that have patients. You gotta take care of them. If you're not in to being someone's physician night and day 365 then it's irresponsible to the patients. These patients need docs who care about them and can care for them. It ain't for everybody--but if you got chronic pain, you want the real deal, not a needle jockey.
Clearly your assumption is unsolicited. I'm not sure how you made the jump to saying that I was advocating for a 'needle monkey'.
I firmly believe that Pain Physicians need to evaluate and treat a patient based on their clinical judgement, including non interventional techniques. This is why I think radiologists should not be doing injections. THey have no experience with Physical Exam skills nearly for the entirety of their residency. Furthermore, they do not have clinics typically. All they do is usually just inject people and send them to the PCP to manage.
On the flip side. I see many Pain PHyscians getting dumped upon by these radiologists, and physiatrists. These guys do the injections and then dump the patient to have their opioids managed by Anesthesia Pain Docs. THat kind of practice is not viable for the pain doc. especially if he or she is from an anesthesiology background as they will be taking a huge pay cut when compared to doing OR anesthesia. Furthermore, their risk exposure is drastically increased without a commisurate compensation. It's sad, but anesthesiologists created Pain Medicine, and now will likely shy away from going into it.
Steve, you are a PMR doc. For guys like you, clearing say 150K or even 250K is pretty good. For anesthesiologists, that is very low. I doubt anesthesiologists would ever leave the OR if the pay was decreased to that amount. This is the point I'm conveying over to the residents here. They need to recognize this.
Dont jump to conclusions, read my posts more carefully next time.
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Please, show us the data (not just anecdote) the shows the average Pain Physician only makes $150-$250K. Show us data like MGMA or some legitimate industry survey that shows that (not rumor-mill stuff). If you're going to give residents and medical students potentially career course-changing advice, back it up. That average salary would make it one of the lowest paying specialties in all of medicine. Even peds, IM and family practice break $200K in some surveys. Yes, there have been cuts in reimbursement, but I think you've got some bad information.
Correct me if I'm wrong, but I think his point was that PMR make $150-250K if they stick in PMR, while anesthesia currently tends to make more if they stick in their field. So in the posters mind, it only makes sense for PMR physicians to do a pain medicine fellowship since they will see a larger % increase in salary.
However, as I stated before, it is not about money for a lot of us. You really couldn't pay me enough money to go back to the ORs for the rest of my career.
Then why did you decide on anesthesia?
There's other ways to landing that Pain fellowship, as stated above.
GabbaPentin-
THanks for READING my post. Guys like LOBELSTEVE like to troll on the Anesthesia forum and make assertions that are far from what I've stated. He likes to play "high and mighty" and does so even on the Pain forum. If you go to his website, he specifically states on the front page "Interventional Pain Medicine". The guy has ridden the 'gravy train" of Pain Medicine already, and now talks all this garbage. However, when the rest of us (anesthesiologists) talk about doing interventions he'll say one has to do more than interventions, blah blh. Believe me in real life, these PMR docs work closely with Neurosurgeons/Orthopods. They paint the anesthesia trained guy as the 'needle monkey' and tell the orthopods that they can offer all this extra stuff (msk, etc). In reality, once they get the referrals, they do the injections and then try to 'dumb' the patients onto the anesthesia pain physicians. Furthermore, more and more nowadays, Neurosurgeons/orthopods will hire a PMR guy to do the injections and then pay them less (200-250k), so they the neurosurgeons/orthopods can keep a greater chunk of the professional fee and the facility fees. Essentially, these guys are 'cheaper' labor.
Nonetheless, given STEVELobels lack of ability to read...he will resort to derogatory comments as he did.
Your above interpretation is what I was trying to convey. Having been on the interview trail recently,I can tell you that MOST places will offer you around 250k for doing 100% pain (guess what, most anesthesia gigs start you off at a lot higher than this or equal to this). Do places offer more than that starting..yes. But MOST places want to start you off at that or less. If you are in more 'rural' areas, you can add to that (but if you were doing aneshtesia only you would get paid more in a rural area as well).
Again, given the influx of other lower paid primary specialists (ie PMR, etc) going into pain, the market value has been driven down. To them, 250k is 'big money'. This is often times the reason that many of them have decided to go into Pain Medicine....
Again,from personal experience and talking to my colleagues, and I URGE you to ask your anesthesia attendings/friends and see if they would leave the OR completely to possibly make 250k. They'll likely tell you that they would rather have less headaches like managing a practice, getting referrals, etc. They will tell you that to just make that sort of money and possibly less stress, they would rather stay in the OR.
You are a resident. You guys need to think about these thigns before choosing a field or spending an extra year of your life in a fellowship (which by the way is loss of income of one year as an attending). Remember, you have bills/school loans to pay. It's not "ALL" about the money, but you should be apprised of the economic potential or the lack thereof prior to pursuing a field. 👍
I know you are the best pain doctor in the world. 😍
Unsure why you're profile says attending while you are still a fellow. I trained in Pain at Emory. I do know a lot more than you do about the topic because I went through what you are doing now and then went back to teach before entering private practice. You make lots of assumptions based on NO clinical experience other than what you were fed in fellowship. You were probably offered $250k so you would go away when they met you at the time of an interview. Thanks for visiting my website. I may sell T-shirts from there to make up for my lack of ability to make mo money as a lowly PMR guy. How about "Series of 3" on the front and "PinchandBurn Fanboy" on the back" ?
So why did you do a Pain fellowship? Wanted to make less money? Go on...
And BTW, is PinchandBurn your real name? I'm pretty open about who I am and what I do- did you review my CV at the website? How many textbook chapters are under your name?
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Couple of things:
I am planning on working in a more 'rural' area. So as I stated above, I will be doing ok.
Secondly: I am doing a Pain Fellowship because I enjoy the autonomy and the ability to have a clinic and see patients. I enjoy anesthesiology, and feel that it prepares one the best for doing procedures, dealing with complications, and overall having a better grasp of pain medications. So dont get me wrong I like anesthesia, but Pain Management is what I enjoy more.
Also, when I was in residency and even up to last year, the starting salary for people coming out of a pain fellowship was significantly higher (yes it did change even in just one year!). The point of my posts were to let the upcoming residents know that things have changed. The 'gravy' train doesnt exist anymore. I'm sure that some residents would want to know this before doing a fellowship. Some will still go into pain, others will decide it isnt worth it. Nonetheless, they SHOULD hear both sides.
emd, out of curiosity, you are a ER doc right?
I am planning on working in a more 'rural' area. So as I stated above, I will be doing ok.
Secondly: I am doing a Pain Fellowship because I enjoy the autonomy and the ability to have a clinic and see patients. I enjoy anesthesiology, and feel that it prepares one the best for doing procedures, dealing with complications, and overall having a better grasp of pain medications. So dont get me wrong I like anesthesia, but Pain Management is what I enjoy more.
Also, when I was in residency and even up to last year, the starting salary for people coming out of a pain fellowship was significantly higher (yes it did change even in just one year!). The point of my posts were to let the upcoming residents know that things have changed. The 'gravy' train doesnt exist anymore. I'm sure that some residents would want to know this before doing a fellowship. Some will still go into pain, others will decide it isnt worth it. Nonetheless, they SHOULD hear both sides.
emd, out of curiosity, you are a ER doc right?
Let me preface by saying, I am not a pain doc and know little about the real world of that type practice.
I would seem to me, however, that a pain doc's income can be grown as his/her practice grows, unlike an OR anesthesiologist, such as myself, where income is, of course very very good, but relatively fixed.
For me, we do so very well financially, once you pay your debt off, you want to be doing work you enjoy, with time commitments that are comfortable and in balance for you and your family's physical, mental and spiritual health.
I would seem to me, however, that a pain doc's income can be grown as his/her practice grows, unlike an OR anesthesiologist, such as myself, where income is, of course very very good, but relatively fixed.
For me, we do so very well financially, once you pay your debt off, you want to be doing work you enjoy, with time commitments that are comfortable and in balance for you and your family's physical, mental and spiritual health.
"However, when the rest of us (anesthesiologists) talk about doing interventions he'll say one has to do more than interventions, blah blh. Believe me in real life, these PMR docs work closely with Neurosurgeons/Orthopods. They paint the anesthesia trained guy as the 'needle monkey' and tell the orthopods that they can offer all this extra stuff (msk, etc). In reality, once they get the referrals, they do the injections and then try to 'dumb' the patients onto the anesthesia pain physicians. Furthermore, more and more nowadays, Neurosurgeons/orthopods will hire a PMR guy to do the injections and then pay them less (200-250k), so they the neurosurgeons/orthopods can keep a greater chunk of the professional fee and the facility fees. Essentially, these guys are 'cheaper' labor."
-Pinchandburn
Ive seen this on my rotations as well...and after telling the PMR/Interventional Pain guy I was going into Anesthesia he says, "Anesthesia's cool...just dont do pain...90% of their practices are fraudulent." Guy just took orthopods clients in the afternoon, injected a new one every fifteen minutes with epidurals, and continued to blast Anesthesia Pain every chance he got with a "complete physical exam". "No evidence for SI or TP injections!" (Kind of like the sensitivity and specificity of Gaenslens and FABERs) All the while dumping the Axis II's/Chronic Painers and saying, "I just wont take them anymore." Understandable, since they are A LOT work without the inyeccion payoff, but he had me fooled that PMR/Psych were the only legit roads to pain until...
I go on my Anesthesia Pain rotation...see them doing the epidurals for the same reason, not DUMPING/REFUSING new patients (and not just injecting them for no reason nor being a needle for hire for ortho/neuro), and basically taking care of the "whole patient" just as much if not moreso than Mr. PMR. Surprise! Patients actually came back to these guys and even called in to thank them the next day. 3 patients out of the whole month were "druggies" but at least these guys didnt just say FU, they forced them to go to psych. I know Ive only done two months of pain but I think its pretty obvious it doesnt matter which road you took, it only matters who knows when to holster the needle.
-Pinchandburn
Ive seen this on my rotations as well...and after telling the PMR/Interventional Pain guy I was going into Anesthesia he says, "Anesthesia's cool...just dont do pain...90% of their practices are fraudulent." Guy just took orthopods clients in the afternoon, injected a new one every fifteen minutes with epidurals, and continued to blast Anesthesia Pain every chance he got with a "complete physical exam". "No evidence for SI or TP injections!" (Kind of like the sensitivity and specificity of Gaenslens and FABERs) All the while dumping the Axis II's/Chronic Painers and saying, "I just wont take them anymore." Understandable, since they are A LOT work without the inyeccion payoff, but he had me fooled that PMR/Psych were the only legit roads to pain until...
I go on my Anesthesia Pain rotation...see them doing the epidurals for the same reason, not DUMPING/REFUSING new patients (and not just injecting them for no reason nor being a needle for hire for ortho/neuro), and basically taking care of the "whole patient" just as much if not moreso than Mr. PMR. Surprise! Patients actually came back to these guys and even called in to thank them the next day. 3 patients out of the whole month were "druggies" but at least these guys didnt just say FU, they forced them to go to psych. I know Ive only done two months of pain but I think its pretty obvious it doesnt matter which road you took, it only matters who knows when to holster the needle.
If you see PMR guys doing this crap, post their names or PM me.
We can cut them off at the knees (insurance/CMS/DEA/State Medical Board).
Just ask for help when doctors are misbehaving and there are folks that will help alleviate the problem through appropriate channels.
😎
Snitches get stitches.
Just so the PMR guy doesnt look like a total ahole. He did see his own patients in the mornings, do a complete MSK exam (but rarely inject these patients and simply prescribe PT), and also do some IME's and NCV's in between. But in the afternoon he was no doubt a needle for hire. No exams, only injections. He was speaking out of both sides of his mouth when he decided to villify anesthesia and describe himself as an angel compared to them.
Just so the PMR guy doesnt look like a total ahole. He did see his own patients in the mornings, do a complete MSK exam (but rarely inject these patients and simply prescribe PT), and also do some IME's and NCV's in between. But in the afternoon he was no doubt a needle for hire. No exams, only injections. He was speaking out of both sides of his mouth when he decided to villify anesthesia and describe himself as an angel compared to them.
I'm sorry, but I feel terrible for anyone going into pain now. It's like you've showed up at 1:50, but the buffet closes at 2:00.
Really? Tell me more? 🙄
I decided on anesthesia for the many reasons that most new fourth year med students with very little true anesthesia experience do. Procedures seemed cool and saving patients from the jaws of death seemed like an exciting way to spend my time. The usual phys and pharm interests, as well as some pretty slick private practice mentors. Starting residency I had ZERO clue that I wanted to go into pain.
The answer regarding why I decided to get away from anesthesia is more complicated. There are two main aspects of the field that I can not tolerate. Keep in mind that these are my OPINIONS and in no way am I trying to discourage anyone from entering the field.
Aspect 1. - The job. The truth is, a good number (NOT ALL) of our attendings and elder anesthesiologist have sold out the profession. I can say with 100% certainty that my attendings were directly responsible. The result of the massive sell out and absurd laziness of my attendings has resulted in surgeons treating the entire profession like it is the practice of nursing. And I can not blame them. Nurses are doing most of their work while they sit in the lounge and drink coffee. It is embarrassing and I can see why CRNAs think they can go out on their own after dealing with lazy, out of practice attendings whose only goal is to leave the hospital ASAP. I did not go through the amount of training that I have to be treated like a nurse. Of course respect has to be earned, but after watching EVERYONE in our department get run over by surgeons AND administration, I'm not sure it is a problem that can be fixed. Why learn about anesthesia if I'm just going to do whatever the surgeon tells me to, regardless of how ridiculous the request.
The OR is also just a toxic environment. A large number of OR nurses/staff are unhappy people who are complaining with every word that comes out of their mouths. It is a constant game of "king of the hill" and personally one that I am tired of playing.
Aspect 2. - Political. This is a big concern. As stated above, the field has been partially sold to the AANA and now we are trying to recover as much as possible, which is an uphill battle. With Obamacare around the corner, there is a strong possibility that we are heading toward a two tier system. Anesthesiologists have ZERO leverage in dealing with this. We put to sleep what the surgeons bring into the hospital... period. And if we refuse, the hospital will find someone who WILL put the patient to sleep (CRNA). So when the government decides that maybe anesthesiologists only deserve 40K per year, there is nothing that can be done about it. There is also the matter of hospital politics. Again, we have almost NO leverage. We do not bring money into the hospital. Most often we pull money OUT of the hospital. Therefore we are viewed as a money pit by hospital administration. This fact is obviously being taken advantage of by the various shady AMC businesses out there. I do not want to be a hospital employee. I do not want someone telling me exactly how I have to practice, when I have to work and what I have to cover.
So those are a few of the main reasons why I do not want to go into anesthesia. The reasons that I picked pain can be saved for another post.
I have to disagree here. Anesthesiology seems to be a field where new grads have not only shown up late to the buffet, but also arrived to realize that the earlier customers resold all of the food.
ALL of medicine is under attack from the government, mid levels, etc. The current system is not sustainable, which may be a good thing. I really believe that we are headed for a two tier system. The lower tier hospital systems which most anesthesiologists will have no choice but to work at. Then the upper tier outpatient/ASU which are physician owned. Most likely, these will be where anesthesiologists will make more money in the distant future. In my opinion, a well run pain clinic will be able to do very well in this system. There is actually a good post on SERMO about cash based practice for anyone who is interested.
i think the future is bright for both pain and or anesthesiology. the overwhelming fact is that more of the population is getting older, having surgeries, having complications and failed back, etc..
doing a pain fellowship gets you out of the OR as often as you want, even into a cushy private practice job (250k in an office without call is cushy). you dont do it for the money. It will also make you more marketable since you are able to do consults, advanced blocks, injections in the pain clinic on the side, etc... its the most competitive fellowship for a reason.. if you want to go to an office based practice afterwards you can, or into an OR anesthesiology mix you can open doors... all for one extra year (when you will be getting your license, taking boards and relocating anyway as you transition to attending)
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In your two-tiered system how would one become a part of the upper tier? Obviously it will be the minority but what kind of factors would make it more likely to become part of that
I shouldn't have said upper and lower. Government based and private pay would be more appropriate. Obviously private will pay more than government and allow for a lot more autonomy in taking care of your patients. Keep in mind that I am not talking about private insurance, but more of a fee for service model where the patient pays a REASONABLE fee for service. It is a complicated issue and there are some great posts about it over on SERMO. The ability to accept private over government will be near impossible if you are a hospital based employee in my opinion, which is the direction that the field seems to be going. More and more employees, less and less private practice groups. Obviously, if you dig around the forum, you will find several of the attendings are still living it up with fantastic private practice groups. They are definitely still around, but much more rare than they once were.
Fair enough. Thanks for the reply. I just knew that one could do PM&R and even Psych. However, I couldn't tolerate going through those residencies. I, too, currently enjoy the OR, the acute patients, the life/death situation, pharm/physio.. etc etc. Good to know more about the negatives created by our predecessors. Pain is something I've somewhat considered, but currently I'm more looking at Peds or CT anesthesia; however, I'll have a better idea when I start as a CA-1 in a year.
I am glad to see that most of you med students and residents are thinking. 👍
Keep it up.
Don't sell out the profession. Know what your values are and stay close to them. At the same time, capitalize (not just economically) on your skill set. More and more there will be business types that will try to dictate your practice. Learn their language so you can talk to them.
Gather as much info as you can before dealing with them. I think as anesthesiologists we have a unique skill set. Unfortunately, historically we havent done a good job about 'keeping it within' (guys from other specialities run with it and then throw us back their scraps).
Let's not make the same mistakes our elders did.. 👍
Keep it up.
Don't sell out the profession. Know what your values are and stay close to them. At the same time, capitalize (not just economically) on your skill set. More and more there will be business types that will try to dictate your practice. Learn their language so you can talk to them.
Gather as much info as you can before dealing with them. I think as anesthesiologists we have a unique skill set. Unfortunately, historically we havent done a good job about 'keeping it within' (guys from other specialities run with it and then throw us back their scraps).
Let's not make the same mistakes our elders did.. 👍
There's a lot of truth in PinchandBurn's posts; People would do well to take them into account.
I don't know Steve Lobel, so I have no comment.
An additional hardship re: establishing pain practices I've encountered:
1) Large orthopedic, neurosurgical or PMR groups may hold the keys to patient referrals.
2) They have their own outpatient surgical centers/clinics.
3) They hire their own pain interventionalists at a fraction of the billings these individuals bring in and only self-refer for procedures.
4) I'm told it's legal as long as the referral is made for a different day from their own evaluation.
So, if you attempted to start your own practice in said town/city, you'd lose a large chunk of referrals off the bat. Might make it near impossible to start a practice in such a place if catchment area is small.
I don't know Steve Lobel, so I have no comment.
An additional hardship re: establishing pain practices I've encountered:
1) Large orthopedic, neurosurgical or PMR groups may hold the keys to patient referrals.
2) They have their own outpatient surgical centers/clinics.
3) They hire their own pain interventionalists at a fraction of the billings these individuals bring in and only self-refer for procedures.
4) I'm told it's legal as long as the referral is made for a different day from their own evaluation.
So, if you attempted to start your own practice in said town/city, you'd lose a large chunk of referrals off the bat. Might make it near impossible to start a practice in such a place if catchment area is small.
Lately I have talked to a lot of older physicians, who after they cannot convince me to go into dermatology instead of anesthesia, decide to tell me that I am crazy for wanting to go into CT anesthesia. They always tell me that I should go into pain management instead.
Why do I hear this so soft often? What's so great about pain management?
I would love to hear your reasons, if they haven't already been posted (I can't say I did the most exhaustive search of the forum).
Thanks!
Why do I hear this so soft often? What's so great about pain management?
I would love to hear your reasons, if they haven't already been posted (I can't say I did the most exhaustive search of the forum).
Thanks!
In general, I think most physicians realize at some point in their careers that overnight call is painful and that dealing with emergencies in the middle of the night sucks balls. When you start your professional education, the thought of saving lives is exhilarating. When you save your first life as an intern, it's a great feeling. As you progress through residency, the "high" of dealing with life threatening emergencies wears off, more often than not it's replaced with a sense of frustration and cynicism.
It's one thing to save an otherwise healthy twenty something who has decades of life and productivity ahead of him or her. Saving the 95 year old demented guy with critical AS, chronic renal failure, diabetes, and heart failure...that's a different story entirely. Unfortunately, the majority of emergencies tend to occur in the latter patient population, not the former.
With this in mind, it's pretty clear why many people gravitate toward pain management. Outpatient practice setting with very few (if any) true emergencies, predictable and controllable work schedule, light call responsibilities, decent pay, lots of cool procedures. You can be your own boss, so to speak, if you own a practice. You can make a significant difference in your patients' quality of life, which is satisfying. It's a rarity to see a pain management physician in the ER or hospital in the middle of the night dealing with an emergency.
Granted, it isn't the gravy train that it used to be, and there are certainly plenty of headaches (figuratively and literally) associated with the field--difficult patients sometimes, insurance hassles, etc. HOWEVER, interventional pain is still a pretty sweet life when you compare it to other specialties in medicine that deal with high acuity patients on a daily basis.
It really is the dermatology of anesthesia subspecialties. Not perfect. The field has some issues, but you can definitely be a happy physician in the field if you focus on the positive aspects of it.
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Thanks...I really appreciate the insight.
I hear this sh.t from MOST of our OLDER Cardiac guys. The younger ones say they'd do it again.
I think the older dudes saw a major decline in cardiac surgery and a huge growth in Pain.
The younger ones are seeing steady (not growing) demand for their services (and maybe even growing depending on where they are). Also, the younger CT people were probably the ones who couldn't ever have seen themselves doing pain in the first place.
But, yeah, I've totally noticed this too.
