Pain versus cardiac fellowship?

[Pablo94]

I like both pain and cardiac, but can’t decide between the two. I know they are vastly different, but I would just like some extra training after residency and was wondering what attendings/people with more experience than me would advise? Thank you

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[Onefellswoop87]

Deciding on fellowship

I am in the beginning of my CA-2 year and still undecided on if I want to pursue fellowship or not. I am considering Pain and cardiac fellowship, I know they are both very different from each other, but each has their pros and cons in my opinion. Is it a little too late for me to be in this...

forums.studentdoctor.net

Deja vu . . . must be a glitch in the matrix

 

[nimbus]

Pain is better if you want to run your own business and be an entrepreneur. If not, cardiac is better.

 

[Pablo94]

Deciding on fellowship

I am in the beginning of my CA-2 year and still undecided on if I want to pursue fellowship or not. I am considering Pain and cardiac fellowship, I know they are both very different from each other, but each has their pros and cons in my opinion. Is it a little too late for me to be in this...

forums.studentdoctor.net

Deja vu . . . must be a glitch in the matrix

Lol my bad I don’t know how to delete the post

 

[PpfSuxTube]

One involves dealing with abusive, manipulative people who will do anything to satisfy their cravings for more and more, by getting you to agree to shady practices..

And the other is a pain fellowship

 

[TheLoneWolf]

Cardiac guy chilling on pump doing routine work>90% of the time

Vs

Factory work of 30-40 procedures a day with a prison guard mentality on medication management.

 

[Bertelman]

I love these threads.

“Tell me your anesthesia subspecialty without telling me your anesthesia subspecialty.”

 

[dmk5n]

What don't you want.


you like anesthesia but hate OB, you may be able to leverage cardiac fellowship into getting out of taking OB call. Not everywhere, some places.
You hate call, nights and weekends, do pain. It aint gravy though. Read all the posts in the pain forum, those guys are straight shooters.
There is no free lunch.

 

[Bertelman]

you may be able to leverage cardiac fellowship into getting out of taking OB call.

This.

And it’s totally worth it.

 

[Status Sciaticus]

you may be able to leverage cardiac fellowship into getting out of taking OB call.

This.

And it’s totally worth it.

Or you could do pain and get out of doing both OB and cardiac call. Or any call shift in general. For the rest of your life.

 

[Bertelman]

But then I’ve got to deal with pain patients.

 

[Anesthesia_Guy]

I like both pain and cardiac, but can’t decide between the two. I know they are vastly different, but I would just like some extra training after residency and was wondering what attendings/people with more experience than me would advise? Thank you

Neither. Start working and make $500k. You'll never recoup that by blowing a year in fellowship.

 

[nimbus]

Or you could do pain and get out of doing both OB and cardiac call. Or any call shift in general. For the rest of your life.

But then I’ve got to deal with pain patients.

Cardiac patients are asleep. Pain and OB patients are awake. Many people go into anesthesia because they prefer to take care of patients who are asleep.

 

[PpfSuxTube]

I mostly do cardiac. Today I had to do 7 hernias and gallbladder... get me back to cardiac Pronto... ill do the worst endocarditis or double valve any day over that

 

[ToKingdomCome]

Pain is better if you want to run your own business and be an entrepreneur. If not, cardiac is better.

I do anesthesia and I’m still an entrepreneur

 

[TheLoneWolf]

I did a pain fellowship from probably the most interventional program in a large state.

I often look back and think I should have done a cardiac fellowship. Finances completely aside, it opens more opportunities and makes you a better rounded anesthesiologist.

Low daily case load if doing own cases is a plus.

I have seen current offers for cardiac only PP in big cities, including my own, offering 12 weeks vacation, 550 base plus additional pay for calls/postcalls, full benefits and max retirement contribution, all own cases.

No PP, hospital employed, or academic pain job can match that.

 

[gator2886]

I have done pain and cardiac fellowships and practiced both. They each have pros and cons. Pain you are dealing with the public-all day. And they are pain patients. You can tailor you practice to limit fibromyalgia, drug seekers etc but they still are a part of your practice. There are also legit people with real pain that you just can not help. I only did pain for a few years. It sucks your soul out. The upside is no call, nights, evenings or weekends. If done right, you can make a fortune. Cardiac-You are mostly dealing with professionals-surgeons, CRNAs, nurses. If your surgeons are easy to get along with and competent this can be a great and rewarding work environment. Right now the pay is very good for cardiac. The down side is call, nights, evenings, weekends, very tough cases at times. If I had it to do all over again I would have tried to take some extra rotations in cardiac in residency, taught myself TEE and skipped both fellowships, and stayed in the OR.

 

[Onefellswoop87]

I do anesthesia and I’m still an entrepreneur

I’m not a businessman. I’m a business, man.

 

[narcusprince]

One involves dealing with abusive, manipulative people who will do anything to satisfy their cravings for more and more, by getting you to agree to shady practices..

And the other is a pain fellowship

One involves dealing with manipulative abusive people and becoming one yourself.

 

[JiPo]

I did a pain fellowship from probably the most interventional program in a large state.

I often look back and think I should have done a cardiac fellowship. Finances completely aside, it opens more opportunities and makes you a better rounded anesthesiologist.

Low daily case load if doing own cases is a plus.

I have seen current offers for cardiac only PP in big cities, including my own, offering 12 weeks vacation, 550 base plus additional pay for calls/postcalls, full benefits and max retirement contribution, all own cases.

No PP, hospital employed, or academic pain job can match that.

Where are you seeing these offers? I am certainly interested.

 

[Status Sciaticus]

I did a pain fellowship from probably the most interventional program in a large state.

I often look back and think I should have done a cardiac fellowship. Finances completely aside, it opens more opportunities and makes you a better rounded anesthesiologist.

Low daily case load if doing own cases is a plus.

I have seen current offers for cardiac only PP in big cities, including my own, offering 12 weeks vacation, 550 base plus additional pay for calls/postcalls, full benefits and max retirement contribution, all own cases.

No PP, hospital employed, or academic pain job can match that.

Pain at my academic program is offering 500, 6 weeks, and the additional things you mentioned. Granted its not 12 weeks, but its academic. PP private practice works more because they own the business and make significantly more. Its just a question of more money, less vacation vs less money more vacation.

I’m not a businessman. I’m a business, man.

 

[kidthor]

I like both pain and cardiac, but can’t decide between the two. I know they are vastly different, but I would just like some extra training after residency and was wondering what attendings/people with more experience than me would advise? Thank you

Just do whichever one you like more and can picture yourself doing. There’s not much more to it…

 

[Anesthesia_Guy]

I’m not a businessman. I’m a business, man.

Alright Jay Z.

 

[SRYSPAC]

Just do whichever one you like more and can picture yourself doing. There’s not much more to it…

Basically this 👆 I'm pediatric trained and couldn't see myself enjoying less than a 50% peds job. When I get called in on pager for a peds case, it doesn't bother me nearly as much as doing a routine C/S in the middle of the night or a cholecystectomy some surgeon wants to get done at 1 AM. Funny enough, the market has shifted in certain areas, and my new gig pays a lot more for pediatric specialists than general anesthesiologists in the same group, with a similar call burden and the potential for more call pay. I couldn't stomach a cardiac or pain job, but understand that's what some people enjoy, just like some people want to steer far away from kids. At the end of the day, don't think about the numbers, try and find something you're relatively happy doing for 20+ years and stop saying "pain patients this, cardiac surgeons that, etc etc" I wasn't thinking about money when I went into pediatric anesthesia, but now multiple locums gigs are paying north of $350/hour for fellowship trained pediatric anesthesiologists, go figure 🤷‍♂️

 

[caligas]

take some extra rotations in cardiac in residency, taught myself TEE and skipped both fellowships, and stayed in the OR.

Literally did this 20 years ago. Got TEE cert in the old practice pathway. Good times.

 

[GlowInTheDark]

Neither. Go practice. Pocket fat stacks of $$ for 5-10 years and then throw your finger in the air and quit medicine.

😎

 

[zaitoun]

I do anesthesia and I’m still an entrepreneur

what do you do if you don't mind me asking?

 

[Drwine]

One size doesn't fit all. If you do a fellowship you can extend your practice a couple years or so doing what you like so you aren't giving up lost income in the scheme of things. In the 1980s we were getting hosed on reimbursements so having money thrown at me today is better than working an extra year 40 years ago.

 

[TeslaCoil]

I like both pain and cardiac, but can’t decide between the two. I know they are vastly different, but I would just like some extra training after residency and was wondering what attendings/people with more experience than me would advise? Thank you

What type of lifestyle do you want? DO NOT underestimate the importance of lifestyle. If you are ready to take call and be doing high stress cases for the rest of your foreseeable future then do cardiac. If you love yourself a little more than that, don't want to take call and want to make essentially the same money, do pain.

 

[TeslaCoil]

Just do whichever one you like more and can picture yourself doing. There’s not much more to it…

disagree. There is much more to it. I cant stand when I see hollow, cliché answers like this. Im sorry, but the life cardiac... SUCKS. Absolutely sucks.

 

[PpfSuxTube]

disagree. There is much more to it. I cant stand when I see hollow, cliché answers like this. Im sorry, but the life cardiac... SUCKS. Absolutely sucks.

Are you saying cardiac anesthesia sucks?

Maybe where you work buddy or worked, Not everywhere... sorry to hear

 

[TeslaCoil]

Are you saying cardiac anesthesia sucks?

Maybe where you work buddy or worked, Not everywhere... sorry to hear

Im saying the lifestyle sucks. Yes. Everywhere I've worked. You're comparing a subspecialty that takes call to one that does not. That alone is a profound difference in lifestyle. ~45-50 hr weeks in pain compared to 55-70 in cardiac everywhere I've been. Pretty sure that applies to most places, unless you're an outlier.

 

[TeslaCoil]

Cardiac guy chilling on pump doing routine work>90% of the time

Vs

Factory work of 30-40 procedures a day with a prison guard mentality on medication management.

this is such a misrepresentation.

 

[TeslaCoil]

Neither. Go practice. Pocket fat stacks of $$ for 5-10 years and then throw your finger in the air and quit medicine.

😎

this is not a bad answer. Excellent time to go into locums general anesthesia. The job outlook is outstanding.

 

[zaitoun]

Im saying the lifestyle sucks. Yes. Everywhere I've worked. You're comparing a subspecialty that takes call to one that does not. That alone is a profound difference in lifestyle. ~45-50 hr weeks in pain compared to 55-70 in cardiac everywhere I've been. Pretty sure that applies to most places, unless you're an outlier.

those 45-50hrs a week can also be very painful even if you don't take call or work weekends.

 

[TeslaCoil]

those 45-50hrs a week can also be very painful even if you don't take call or work weekends.

A job is a job. Yes, sometimes it can be, but at least you’re home by 5 pm consistently and off every weekend. And you wont be awoken to go in for an emergent cardiac case. Ever.

I really dont think the level of painful is comparable. Thats just me. Pain is pretty much the life o’reilley for the most part. You train yourself up a good scribe and you’re good to go.

What specifically is painful about pain mgmt? Difficult patients? You dont have to put up with it. You make your assessment, and if they dont like or want what you offer theres the door. Have a nice day.

 

[sevo00]

A job is a job. Yes, sometimes it can be, but at least you’re home by 5 pm consistently and off every weekend. And you wont be awoken to go in for an emergent cardiac case. Ever.

I really dont think the level of painful is comparable. Thats just me. Pain is pretty much the life o’reilley for the most part. You train yourself up a good scribe and you’re good to go.

What specifically is painful about pain mgmt? Difficult patients? You dont have to put up with it. You make your assessment, and if they dont like or want what you offer theres the door. Have a nice day.

id rather shoot myself in the head then do pain mangement for a living. this guy swears pain tis the holy grail of medicine. Id rather have days where i get to home at noon and random days off in the middle of the week post call.

and as far as pay. i live in a big city and literally every pain doc here makes less than a general anethesiologist. youre next response might be well they need to move to a less saturated area. well guess what some people prefer actual big cities

 

[nimbus]

id rather shoot myself in the head then do pain mangement for a living. this guy swears pain tis the holy grail of medicine. Id rather have days where i get to home at noon and random days off in the middle of the week post call.

and as far as pay. i live in a big city and literally every pain doc here makes less than a general anethesiologist. youre next response might be well they need to move to a less saturated area. well guess what some people prefer actual big cities

I went into anesthesia because I hated every kind of clinic in medical school.

 

[sevo00]

I went into anesthesia because I hated every kind of clinic in medical school.

same. most people that went into anesthesia did so because they hate clinic and talking to patients lol. idk why this guy is comign onto the anesthesia forum to try to convince us pain is a better field lol. i always see pain docs leaving their field to come back to anesthesia. never seen the opposite happen

 

[TheLoneWolf]

this is such a misrepresentation.

What is misrepresented? I worked PP and academic in both fields

 

[pgg]

disagree. There is much more to it. I cant stand when I see hollow, cliché answers like this. Im sorry, but the life cardiac... SUCKS. Absolutely sucks.

The cardiac anesthesia lifestyle can be great ... if you're at a hospital that doesn't do VADs or transplants. Those are the soulsucking nighttime cases.

Doing CABGs and valves and the occasional arch during daylight hours is pleasant.

Every once in a while I'll be on home pager call and have to come in for a dissection, but that's not more than a couple times per year.


Also, hearts are always solo, so being on the cardiac anesthesia team skews my practice toward solo work and away from medical direction. Which is a reason all by itself to do cardiac.

 

[TeslaCoil]

What is misrepresented? I worked PP and academic in both fields

Cardiac guy chillin on pump. You think thats an accurate depiction of cardiac anesthesia? I certainly wouldnt want you doing my CABG with that overview. Thats actually pretty terrifying.

Pain medicine is factory work? Not sure what kind of toxic practice you worked in to develop that depiction. Not accurate. Sorry. I do 70-90 procedures per week and its really not all that bad. Am I careful about who I prescribe narcotics to yes. And do I use them sparingly and as a last resort yes. All of that is normal. And yes you have to monitor patients on narcotics closely.

 

[DrN2O]

What is misrepresented? I worked PP and academic in both fields

Shhh, you are not supposed to tell them.

 

[sevo00]

Cardiac guy chillin on pump. You think thats an accurate depiction of cardiac anesthesia? I certainly wouldnt want you doing my CABG with that overview. Thats actually pretty terrifying.

oh god give me a break dude. youre more dramatic than my wife

 

[TeslaCoil]

oh god give me a break dude. youre more dramatic than my wife

Hmm. I thought you had a husband.

 

[sevo00]

Hmm. I thought you had a husband.

Are you going to acknowledge any of my other responses to you above?

 

[TeslaCoil]

Are you going to acknowledge any of my other responses to you above?

There are your type and then there are my type. Im not denying OR anesthesia is a better fit for some. The OP was about pain vs cardiac anesthesia. In my opinion its like comparing apples to oranges. And once again, in my opinion, the lifestyle is better in pain, as objectively as I can state it.

General anesthesia is a decent gig. I said so above.

 

[Southpaw]

Im saying the lifestyle sucks. Yes. Everywhere I've worked. You're comparing a subspecialty that takes call to one that does not. That alone is a profound difference in lifestyle. ~45-50 hr weeks in pain compared to 55-70 in cardiac everywhere I've been. Pretty sure that applies to most places, unless you're an outlier.

Where have you been? Not my experience where I’ve been. Cardiac guys work the same hours as generalists in my group.

 

[TeslaCoil]

Where have you been? Not my experience where I’ve been. Cardiac guys work the same hours as generalists in my group.

And are you putting in 45 hour weeks with no call, weekends or holidays?

 

[Southpaw]

And are you putting in 45 hour weeks with no call, weekends or holidays?

You do realize this post is on the anesthesiology forum, correct? Just making sure you didn’t get lost on the way to the pain forum. Yes, my group covers nights, weekends, and holidays. Yes, I cover my share. So do the cardiac guys.

Do I deal with pain patients? No, I put them to sleep.

Are you happy with pain? It seems so. I’m happy for you. Plenty here are happy w anesthesia including those who do cardiac. We work about 40 hours a week in my group. We get post call days and post-night call weeks. We get 8 weeks vacation. Many take more. We generally have a good time working together. I hope it’s the same for you and your colleagues in the pain world.

Oh, also we are business owners.