Pain still worth it?

[Meyer-Overton]

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Current anesthesia resident interested in pursuing pain after residency. I know the general anesthesia job market is great right now and wondering if its worth doing the extra year from a money/lifestyle standpoint.

 

[mdo1738]

Yes.

 

[SpineandWine]

Current anesthesia resident interested in pursuing pain after residency. I know the general anesthesia job market is great right now and wondering if its worth doing the extra year from a money/lifestyle standpoint.

Usually you know- it’s so different.
Would you rather do clinic or shift work dealing with CV comorbidity
Lifestyle is better in pain, wouldn’t pick for money only

 

[clubdeac]

you should look up that thread on here where they did a salary poll. it is impressive

 

[zaitoun]

Usually you know- it’s so different.
Would you rather do clinic or shift work dealing with CV comorbidity
Lifestyle is better in pain, wouldn’t pick for money only

aren't you still grinding in pain during work hours? That's not so much the case with anesthesia unless you're at a busy trauma center.

 

[jsammi245]

They are two different specialties in terms of lifestyle and work. I do a mix of chronic pain/anesthesia and both have their negatives and positives. My advice is to make sure you like working with chronic pain patients and be in clinic. Hopefully you had a chance to do a rotation in chronic pain. I wouldn't just make my decision based on the anesthesia market. No one can predict the future market of anesthesia. Do the fellowship if this is something you can see yourself doing. The best thing of doing a chronic pain fellowship is you get an entirely different set of skills. I am doing both to maintain my skills as I still have not found my ideal job (yet) if ever but still happy I got a chance to do the extra fellowship despite how great the market is now for anesthesia.

 

[A Deep Breath]

For unconventional lifestyles, anesthesiology is hard to beat. It’s unlikely that’s something you want, but worth a mention.

 

[SpineandWine]

aren't you still grinding in pain during work hours? That's not so much the case with anesthesia unless you're at a busy trauma center.

I don’t believe I’m “grinding”- I like my work. I do not like notes and am too cheap for scribe right now (early on in my practice).

Anesthesia, I can have stressors of call, cardiovascular comorbidities, random add ons, management of CRNAs. Weekend work, staffing issues (CRNAs leave practice easily if they’re recruited elsewhere)

 

[Status Sciaticus]

Did PP anesthesia, now doing PP pain.
Love anesthesia
Love Pain.

I love the bankers hours (8-5PM is my current schedule with an hour for lunch). I can use the bathroom whenever I want, without waiting for a break or in between cases. I especially like that I can make as much as I want or as little as I want based on how productive/efficient I am.
What I dont like about pain is that the patients are difficult to treat overall compared to providing anesthesia for a singular patients. Conversations can drag on if you arent firm and redirect the patients.

What I love about anesthesia is that I am focusing on one patient at a time, and do minimal amounts of notes. Go home at the end of the shift and no work follows you home. Nearly double the amounts of vacation time.

That said, I still do both. Pain on the weekdays, occasional weekend shifts for some extra cash and keeping my skills up.

 

[Painologist]

It is definitely still worth it. You can make much more than a typical anesthesia salary with a busy pain practice with ownership interests. Just depends on which you prefer. To be successful in pain, your days are very busy / efficient, different than the typical laid back anesthesia supervision job. Although, total weekly hours are equal or less in pain with no nights/weekends.

 

[SpineandWine]

Just pick what you want.
You can make 400-600k anesthesia (unlikely to break 800k)
you can make 300-850k pain- typically (sky is roof technically but this is common range for most docs)
Both pay well, pick what you like to do

 

[agolden1]

Anesthesiologist with pain training.

Take a long look at the markets in locations where you/spouse would like to live. Talk to a few pain practices and see if they may be looking to hire and what realistic salary expectations may be compared against anesthesia hours and time.

I live in the Northeast and the pain market is wildly different than the South and Midwest. If the area you can see yourself practicing in has what you consider to be appropriate opportunities for pain, go for it. If it’s a tight market, you’ll be better served by practicing anesthesia.

If you’re uncertain where you want to end up, you can always do the fellowship year and see where it goes. Anecdotally, I do think there are way better jobs in the South/Midwest than in the Northeast/Northwest, but your mileage my vary based on your intended area.

 

[agolden1]

aren't you still grinding in pain during work hours? That's not so much the case with anesthesia unless you're at a busy trauma center.

When you’re a resident, often a fellow, and even a junior attending everything takes longer. 20 followup visits in 20 minute slots seems impossible to work through somehow.

But then you start talking to other people and hearing about seeing 30, 40, 60 patients a day. Your interest gets peaked and you start getting good at dot phrases and the art of being personable and being direct. It turns into a game of efficiency and it becomes kind of fun.

To the right person, it’s not really a grind, but many residents are so slow at clinic and notes they get immediately turned off of it just because they forget that efficiency takes some years to develop.

Same goes for procedures.

 

[Meyer-Overton]

you should look up that thread on here where they did a salary poll. it is impressive

I found one thread but not sure its the one you're talking about. You're saying that the incomes are impressive in a good way?

 

[stsa84]

It's reasonable to end up in a job with Mon - Thur, no call, no nights, no weekends, home by 5 on a bad day, very little stress, >$600k. Still worth it if those things sound nice to you.

 

[Meyer-Overton]

It's reasonable to end up in a job with Mon - Thur, no call, no nights, no weekends, home by 5 on a bad day, very little stress, >$600k. Still worth it if those things sound nice to you.

You know, all those things do sound rather nice

 

[au bon pain]

But then you start talking to other people and hearing about seeing 30, 40, 60 patients a day. Your interest gets peaked and you start getting good at dot phrases and the art of being personable and being direct. It turns into a game of efficiency and it becomes kind of fun.

A) What are some ways you’ve found to be personable and (politely) direct while seeing +30/d?
B) More importantly, how do you end visits quickly without making the patient feel miffed/slighted and wanting to come back (especially if not doing COT)?

I'm pretty good at A, but always interested in hearing soft-skill pro tips. For B, definitely curious as I'm probably too nice in this regard.

 

[GlowInTheDark]

A) What are some ways you’ve found to be personable and (politely) direct while seeing +30/d?
B) More importantly, how do you end visits quickly without making the patient feel miffed/slighted and wanting to come back (especially if not doing COT)?

I'm pretty good at A, but always interested in hearing soft-skill pro tips. For B, definitely curious as I'm probably too nice in this regard.

A) not managing medications and making it very clear on multiple phases of intake.
B) I leave room, nurse or MA comes in to set up next steps and walk them out the door

 

[zaitoun]

Anesthesiologist with pain training.

Take a long look at the markets in locations where you/spouse would like to live. Talk to a few pain practices and see if they may be looking to hire and what realistic salary expectations may be compared against anesthesia hours and time.

I live in the Northeast and the pain market is wildly different than the South and Midwest. If the area you can see yourself practicing in has what you consider to be appropriate opportunities for pain, go for it. If it’s a tight market, you’ll be better served by practicing anesthesia.

If you’re uncertain where you want to end up, you can always do the fellowship year and see where it goes. Anecdotally, I do think there are way better jobs in the South/Midwest than in the Northeast/Northwest, but your mileage my vary based on your intended area.

How do you suggest looking at salaries/job offers in the south/midwest?

 

[agolden1]

A) What are some ways you’ve found to be personable and (politely) direct while seeing +30/d?
B) More importantly, how do you end visits quickly without making the patient feel miffed/slighted and wanting to come back (especially if not doing COT)?

I'm pretty good at A, but always interested in hearing soft-skill pro tips. For B, definitely curious as I'm probably too nice in this regard.

I'm capped at 20 patients a day-ish so I'm not even the best person to ask about all of this.

However, I am at a point where I'm getting through my visits and finishing my notes and having additional time in between patient visits where I could probably see twice as many patients all in all and would be happy to do so.

I don't have a secret for ending the visit. Just a natural flow to the conversation that seems to end I guess? Or that I feel is natural ending for the conversation. I haven't had complaints about too short patient visits or lack of information, and my practice manager is very upfront about that kind of stuff.

 

[agolden1]

How do you suggest looking at salaries/job offers in the south/midwest?

Google maps the areas you want to live. Look at practices within them. Are there recent graduates who have joined or is it all people who have been in practice for 8-10 years.

Look for pain management clinics, ortho, and spine offices. Look at hospitals with hospital employ physicians. Make a spreadsheet.

Make some cold calls and find out if they might be expanding at some point in the next 2-3 years and what they'd be looking for in an applicant, and where they'd be expanding. Ask to leave a message for practice manager. You won't get salary info until, but the numbers listed above are a good indicator.

In my area (where wife feels very attached) within about a 75-100 mi radius, there just aren't that many pain jobs, let alone GOOD ones with a partnership track. After first graduating, I didn't think I had the money, knowledge, or resilience to open my own practice and that has turned out to be true. If I had known pain jobs were this scarce in my area, I may not have done the fellowship even though I love what I do.

While your milage may vary, three good friends who all trained in the last three years have dropped it to go back to 100% anesthesia jobs given the current market and vacation packages.

 

[Ferrismonk]

Honestly, they'll both pay well. Anesthesia will pay more up front and give you more vacation forever. Pain will require lots of soft skills and time to develop a practice. You'll never take vacation like anesthesia does, but you *can* make more money. There is rarely call on nights/weekends.

I like both, but I like not having to manage ASA 4+ patients with terrible airways and prima donna surgeons every single effing day.

As I tell my students/residents when I stop clinic for a bit to teach while I take another sip from my coffee, or when I get caught in traffic and am a few minutes late, I like being the rate limiting step.

 

[Laryngospasm]

As someone who actively practices both.. the difference in the level of respect you get in being the one who runs the clinic vs providing a service to the ones who call the shots is quite noticeable. When I was younger I was much more able to subjugate my ego and tell myself I’m just providing a service. Now I’m much more likely to tell someone to go …. Themselves when they are crappy for no reason. This and the lack of call/nights/shorter days/ less death/ doing epidurals all night so the OB doesn’t have to be up at night/and finally scheduling my own vacation when I want vs fighting to trade with others are big differences that should be considered. Also if you are hospital employed anesthesiologist you are much more likely to get dictates from the dbs in admin with no discussion on your side. I also notice the lifestyle of anesthesia slowly being squeezed wile the admin tries to maximize what they get from each anesthesiologist. There are a lot of negatives to pain as well insurance issues, patient and family issues, opioid issues. However you have more powers to minimize these by setting up the practice how you like.

 

[Agast]

I think I would have liked the flexibility of doing prn anesthesia as I near retirement…some of our CRNAs are doing this and enjoying dipping their toes in more free time. Being a part-time clinician is hard because the liability is full-time and you have the overhead of maintaining full-time staff who can respond to your patients.

 

[rexed]

Current anesthesia resident interested in pursuing pain after residency. I know the general anesthesia job market is great right now and wondering if its worth doing the extra year from a money/lifestyle standpoint.

Haven't done an anesthesia case since last day of residency and don't miss it one bit. The anesthesia market is cyclical, past or current performance/pay does not guarantee future performance - although same could be said about pain. Pain has been great for myself and it seems for many of my colleagues and there is nothing better than having your own practice and being your own boss plus less chance of having CRNAs replace you.

 

[Meyer-Overton]

Thanks for all the responses guys, good stuff