Pain versus cardiac fellowship?

[TeslaCoil]

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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.

Perhaps you didnt read the title of the thread. Its a compare and contrast cardiac vs pain. Hence why im here. And whether you like it or not Im still an anesthesiologist. I also practice hyperbaric medicine in my setting. Another great choice of subspecialty. Im sorry that you are taking what im saying personally. Maybe deep down you arent as happy as you claim to be. I hear anesthesiologists who are non-pain trained and have only seen pain patients in residency complaining about pain patients. I dunno who's being dramatic here. Its not as bad as people claim whatsoever, and its a great lifestyle. Am I saying something so terrible?

Like I said, general anesthesia is perfect for some. But for those like me who detest call, pain is an excellent option. This is not an attack on you. Its an effort to help the OP make a decision on where to take his career.

 

[Southpaw]

Perhaps you didnt read the title of the thread. Its a compare and contrast cardiac vs pain. Hence why im here. And whether you like it or not Im still an anesthesiologist. I also practice hyperbaric medicine in my setting. Another great choice of subspecialty. Im sorry that you are taking what im saying personally. Maybe deep down you arent as happy as you claim to be. I hear anesthesiologists who are non-pain trained and have only seen pain patients in residency complaining about pain patients. I dunno who's being dramatic here. Its not as bad as people claim whatsoever, and its a great lifestyle. Am I saying something so terrible?

Like I said, general anesthesia is perfect for some. But for those like me who detest call, pain is an excellent option. This is not an attack on you. Its an effort to help the OP make a decision on where to take his career.

Pain is a great option for those who don’t like the OR, don’t like call, and don’t mind pain patients.

And cardiac is great for those who like anesthesia, like TEE, and want to take care of the sickest of patients.

I responded because of your statement on hours. It wasn’t correct based on the cardiac anesthesiologists I know. If it were correct across the board, I imagine no one would do cardiac. I wouldn’t blame them. I certainly have no desire to work 55-70 hours a week.

On happiness - I appreciate your analysis of me. Believe me, I’m fine. Just ask your husband.

 

[TeslaCoil]

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 make more than my cardiac friends, big city or otherwise. I practice pain and hyperbarics concurrently. Granted im not in a top 10 major city.

 

[TeslaCoil]

Pain is a great option for those who don’t like the OR, don’t like call, and don’t mind pain patients.

And cardiac is great for those who like anesthesia, like TEE, and want to take care of the sickest of patients.

I responded because of your statement on hours. It wasn’t correct based on the cardiac anesthesiologists I know. If it were correct across the board, I imagine no one would do cardiac. I wouldn’t blame them. I certainly have no desire to work 55-70 hours a week.

On happiness - I appreciate your analysis of me. Believe me, I’m fine. Just ask your husband.

In the academic center where I was this was absolutely the case. Transplants and VADs have a special way of destroying your life. I would say its pretty much across the board in any credible academic setting.

I mean you’re right, out there in smaller private hospitals etc its probably better. But most of the cardiac guys I know are still taking Q4 call in my state. I could not be happy doing that.

For the official record: I am happily married to a wife.

 

[Southpaw]

In the academic center where I was this was absolutely the case. Transplants and VADs have a special way of destroying your life. I would say its pretty much across the board in any credible academic setting.

I mean you’re right, out there in smaller private hospitals etc its probably better. But most of the cardiac guys I know are still taking Q4 call in my state. I could not be happy doing that.

For the official record: I am happily married to a wife.

Not everyone does transplants and vads. Most in fact, don’t. I mean, there just aren’t that many people thankfully who need a new heart or a vad.

Q4 across your whole state? That’s a lot of small cardiac practices if you ask me - quite unbelievable when you’re talking transplants and vads. We don’t do either and our cardiac call is Q10ish.

Wife? Sorry, kinda surprised. Your posts have an effeminate quality to them. Hard to put a finger on. Maybe you’re not as happy as you think you are.

 

[TeslaCoil]

Not everyone does transplants and vads. Most in fact, don’t. I mean, there just aren’t that many people thankfully who need a new heart or a vad.

Q4 across your whole state? That’s a lot of small cardiac practices if you ask me - quite unbelievable when you’re talking transplants and vads. We don’t do either and our cardiac call is Q10ish.

Wife? Sorry, kinda surprised. Your posts have an effeminate quality to them. Hard to put a finger on. Maybe you’re not as happy as you think you are.

No you are not getting it. At the academic center they do vads and transplants. BUT most of the cardiac guys I know in my state are still taking quite a bit of call. Im definitely happier than many of them.

Well your mom didnt detect any effeminate quality and was satiated. And she was VERY happy. 😉

 

[TheLoneWolf]

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.

I will add a new word to your limited vocabulary:

Hyperbole.

Enjoy. First one is free.

 

[TheLoneWolf]

Shhh, you are not supposed to tell them.

I try to give honest impressions on here. After all, it is for students. I tell you what the pointy shoes pain kids wont

 

[TeslaCoil]

I try to give honest impressions on here. After all, it is for students. I tell you what the pointy shoes pain kids wont

Hey man, thats how I feel about cardiac. Consider me the yin to your yang. Thats what the thread is about. You say cardiac is great and for you it probably is. For me pain and hyperbarics is great and I would never go cardiac. You dont like my vocabulary? Perhaps you prefer french? Se la vie.

 

[sevo00]

Granted im not in a top 10 major city.

Case in point. Thanks for playing

 

[Southpaw]

No you are not getting it. At the academic center they do vads and transplants. BUT most of the cardiac guys I know in my state are still taking quite a bit of call. Im definitely happier than many of them.

Well your mom didnt detect any effeminate quality and was satiated. And she was VERY happy. 😉

She’s dead, so she probably didn’t detect much of anything. That’s a very odd and disturbing place for you to go. Says a lot about you.

My experience with both cardiac and pain is vastly different than yours. If there is a resident honestly considering both of these vastly different fields then they have a lot consider, first and foremost whether they envision their career being in an OR providing anesthesia. Or not.

 

[sevo00]

Maybe you’re not as happy as you think you are.

My thoughts exactly. To come to another forum to try to push your specialty. I mean theres a reason pain has gone basically unmatched the last two years lol. You have em docs and psych residents now matching pain. Yeha no thanks. Seems this Tesla guy not happy with hai choice and now trying to project

 

[TeslaCoil]

She’s dead, so she probably didn’t detect much of anything. That’s a very odd and disturbing place for you to go. Says a lot about you.

My experience with both cardiac and pain is vastly different than yours. If there is a resident honestly considering both of these vastly different fields then they have a lot consider, first and foremost whether they envision their career being in an OR providing anesthesia. Or not.

This was a while back... sorry to hear of her passing. Well, at least she was happy.

Agree with your second statement 100%. Thats why we're here.

 

[ucsfgaspain]

So back to the topic. This is a thousand foot view and won't dive into the weeds. So of course it is grossly generalized and peeps will come up with exceptions.

First divide to think about is whether you fundamentally want to practice anesthesia or not. If not, go PAIN. Why you ask? Because sooner or later this is the decision you will likely face. practices that split time between anesthesia and pain i.e. doing pain in an anesthesia group inevitably prioritize the anesthesia over pain (outside of academia and integrated health systems like kasier). Why? Because the $$$ to the group come through the OR not through the pain clinic. So if u r the pain guy, u r the red headed step child.

Step 2. R u entrepreneurial? If not, go anesthesia. PAIN is predominantly financially lucrative only when you strike out on your own. U ain't killing it when you are an employee of someoneelse. Doctors don't play well together so u r being used and made money off of when u join an established practice or spine group. They want their cut and very rarely divy up the pie years down the road to your satisfaction.

Very few peeps have the balls to be entrepreneurial. Everyone says they are but most are not. They can't stomach the financial risk and uncertainty.

Step 3. Life is a journey. Let's say you decide on pain and then find out you hate it,. u can always revert back to 100% OR. Yeah you lost a year, but oh well that's life. We place way too much emphasis on these sort of decisions. In the grand scheme of things they don't amount to ****. One year of earnings is not going to make or break you. Nothing is irrevocable and we undervalue optionality.

The bigger mistake I see people make is that they commit to the fallacy of sunken costs and continue on the wrong path. Switch and correct your course. No big deal. The tragedy is when you stick to a "wrong" choice and don't reorient.

Just my honest opinion from a dude who used to practice pain but no longer does. 100 percent OR. Couldn't be happier because I no longer do OB and am part time. I now spend more days cycling than I do in the OR🙂

The more important questions for you is where do you want to live? What type of life do you want to live? Who do you want to live that life with? Etc. All this other stuff is nothing burgers which we overemphasize and lose sight of the aforementioned real issues.

Don't sweat cardiac versus pain. You won't go WRONG in either choice. They are just different. Hell you could forego fellowship and be just fine. Figure out first those bigger answers to the questions I referenced above.

Best of luck!

 

[TeslaCoil]

My thoughts exactly. To come to another forum to try to push your specialty. I mean theres a reason pain has gone basically unmatched the last two years lol. You have em docs and psych residents now matching pain. Yeha no thanks. Seems this Tesla guy not happy with hai choice and now trying to project

Ummm... again... I was invited? How can you have a conversation about cardiac vs pain without a pain doc?

 

[sevo00]

Ummm... again... I was invited? How can you have a conversation about cardiac vs pain without a pain doc?

Btw This is the guy who called himself a “surgeon” a while ago Lmaoo. You don’t do a one year pain fellowship and become a surgeon. Always brings me back to an old saying my attending used to say “pain docs: the ego of a surgeon without the stamina of an actual surgeon”

 

[TeslaCoil]

Btw This is the guy who called himself a “surgeon” a while ago Lmaoo. You don’t do a one year pain fellowship and become a surgeon. Always brings me back to an old saying my attending used to say “pain docs: the ego of a surgeon without the stamina of an actual surgeon”

I believe what I said was, that pain is a surgical specialty. And it is. Nowadays it goes past just implanting stimulators and pumps. Are minimally invasive lumbar decompressions "surgery"? Yes. Is a sacroiliac fusion a "surgery"? Yes. Interspinous spacers? Yes. All surgery. In an operating room. With anesthesia support. It seems you may not have a good grasp on the modern scope of practice of pain management. Don't be grumpy and have a chip on your shoulder because you are limited to one side of the drape. Please explain how functionally any of these procedures are not surgery.

 

[kidthor]

Are minimally invasive lumbar decompressions "surgery"? Yes. Is a sacroiliac fusion a "surgery"? Yes. Interspinous spacers?

I’d personally see a spine/ortho surgeon for all of those procedures myself. I know some pain doctors and IR people do these, but I just don’t think the average pain doctor is going to be consistently skilled in those areas. I’ve seen some disaster minimally invasive kyphoplasty gone wrong cases.

 

[TeslaCoil]

I’d personally see a spine/ortho surgeon for all of those procedures myself. I know some pain doctors and IR people do these, but I just don’t think the average pain doctor is going to be consistently skilled in those areas. I’ve seen some disaster minimally invasive kyphoplasty gone wrong cases.

Thats your call. I dont do kyphos. But I can tell you serious complications from kyphos are very rare, even when done by a pain doc. This still falls within the scope of practice of pain management and pain docs do them all day everyday.

 

[Southpaw]

I believe what I said was, that pain is a surgical specialty. And it is. Nowadays it goes past just implanting stimulators and pumps. Are minimally invasive lumbar decompressions "surgery"? Yes. Is a sacroiliac fusion a "surgery"? Yes. Interspinous spacers? Yes. All surgery. In an operating room. With anesthesia support. It seems you may not have a good grasp on the modern scope of practice of pain management. Don't be grumpy and have a chip on your shoulder because you are limited to one side of the drape. Please explain how functionally any of these procedures are not surgery.

So I’d classify pain as a procedural specialty, not a surgical ‘specialty?’. Maybe you mean ‘sub specialty’ as most surgical fellowships are, but of course pain is not that.

from what I’ve seen and experienced, pumps/implants/everything else you said, etc., when done by a pain doc is an invasive procedure. You can call it whatever you want. By the way, guess what, when pain docs do all that stuff it comes with CALL to cover the complications of those procedures which you continually classify the lack of as one of the major perks of pain.

When I see actual neurosurgeons do a minimally invasive decompression it is vastly different than what I see pain guys do under the anesthesia I provide.

 

[TeslaCoil]

So I’d classify pain as a procedural specialty, not a surgical ‘specialty?’. Maybe you mean ‘sub specialty’ as most surgical fellowships are, but of course pain is not that.

from what I’ve seen and experienced, pumps/implants/everything else you said, etc., when done by a pain doc is an invasive procedure. You can call it whatever you want. By the way, guess what, when pain docs do all that stuff it comes with CALL to cover the complications of those procedures which you continually classify the lack of as one of the major perks of pain.

When I see actual neurosurgeons do a minimally invasive decompression it is vastly different than what I see pain guys do under the anesthesia I provide.

In my decade of doing these I have had to present to the hospital for a complication once. Just once. for a simple infection because a patient went swimming in a lake 3 days after having a stimulator implanted and got a nasty infection. So give me a break.

As far as MILDs go, yes the techniques are different. Ours is even less invasive than theirs and the outcomes are phenomenal.

 

[Southpaw]

In my decade of doing these I have had to present to the hospital for a complication once. Just once. for a simple infection because a patient went swimming in a lake 3 days after having a stimulator implanted and got a nasty infection. So give me a break.

As far as MILDs go, yes the techniques are different. Ours is even less invasive than theirs and the outcomes are phenomenal.

I don’t really care how often you’ve gone in, you’re on call for them. you’ve said one of the major perks is that you’re not on call with pain. The fact is if you’re doing invasive procedures like pumps and stims you’re in fact, on call for them.

 

[TeslaCoil]

I don’t really care how often you’ve gone in, you’re on call for them. you’ve said one of the major perks is that you’re not on call with pain. The fact is if you’re doing invasive procedures like pumps and stims you’re in fact, on call for them.

🤣 Sure. Im on at-home call for exceptionally rare complications.

 

[sevo00]

Don't be grumpy and have a chip on your shoulder because you are limited to one side of the drape.

Lol. And you think if I wanted to do pain I couldn’t get a spot? Why don’t you check the match statistics for the last two years and see how many unmatched spots there are. Literally could walk into a pain fellowship tmrw if that was anyone’s desire. And no, what you do is not surgery and is actually insulting to real surgeons who do 5+ year surgical residency. Get the chip off your shoulder

 

[TeslaCoil]

Lol. And you think if I wanted to do pain I couldn’t get a spot? Why don’t you check the match statistics for the last two years and see how many unmatched spots there are. Literally could walk into a pain fellowship tmrw if that was anyone’s desire. And no, what you do is not surgery and is actually insulting to real surgeons who do 5+ year surgical residency. Get the chip off your shoulder

I never said you couldnt. You're the one being contentious. I couldn't care less.

No chip on my shoulder. But sorry we absolutely do surgery. If you are cutting somebody open and implanting a device and then suturing the patient back up, thats surgery. If you're taking rods and drilling them into somebody's vertebrae and then pumping the vertebrae with cement thats surgery. If you are placing metal fixation across an open joint with screws, then suturing back up, thats surgery. If you are taking a trochar and inserting it into somebody's spine and then using a bone rongeur to perform a laminectomy, thats surgery. Anybody who says otherwise is an idiot.

Lemme guess, dermatology is not a surgical specialty? Ophthalmology? Removing abscesses and cysts not "surgery" enough for you?

 

[sevo00]

.

Lemme guess, dermatology is not a surgical specialty? Ophthalmology? Removing abscesses and cysts not "surgery" enough for you?

Hmm yeah dermatology is not surgery…literally never heard anyone call it surgery before. And no you’re not a surgeon no matter how wish you were and what you think. Sorry to break the news to you buddy. If I needed any of those procedures or my family did, I would not go to someone who trained in a one year fellowship for them. I would go to an actual orthopedic or neurosurgeon

 

[TeslaCoil]

Hmm yeah dermatology is not surgery…literally never heard anyone call it surgery before. And no you’re not a surgeon no matter how wish you were and what you think. Sorry to break the news to you buddy. If I needed any of those procedures or my family did, I would not go to someone who trained in a one year fellowship for them. I would go to an actual orthopedic or neurosurgeon

Well theres a news flash for you buddy. Derm is definitely a surgical specialty. You're a doctor and you've never heard of MOHS surgery? Thats pretty sad.

Another news flash, most orthos are too busy doing knee replacements to bother with these smaller and less invasive procedures.

 

[TeslaCoil]

Hmm yeah dermatology is not surgery…literally never heard anyone call it surgery before. And no you’re not a surgeon no matter how wish you were and what you think. Sorry to break the news to you buddy. If I needed any of those procedures or my family did, I would not go to someone who trained in a one year fellowship for them. I would go to an actual orthopedic or neurosurgeon

Who do you think removes skin cancer? lol

 

[sevo00]

Derm is definitely a surgical specialty. You're a doctor and you've never heard of MOHS surgery?

Yes Mohs is. Not general derm. I don’t get are you actually ******ed or just playing one for fun?

 

[TeslaCoil]

Yes Mohs is. Not general derm. I don’t get are you actually ******ed or just playing one for fun?

No. Not just MOHs thats just one example. General dermatologists regularly perform surgery. Never watched doctor pimple popper? Surgery. All day long. Thats okay. Just stick to sevo bro.

 

[PpfSuxTube]

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.

That's a very accurate depiction of cardiac anesthesia. I wouldn't want an anesthesiologist doing my cabg if they weren't chilling on pump...

When you do something a tonne of times it's all easy and chill...

 

[TeslaCoil]

That's a very accurate depiction of cardiac anesthesia. I wouldn't want an anesthesiologist doing my cabg if they weren't chilling on pump...

When you do something a tonne of times it's all easy and chill...

Yea okay I get that it was hyperbole. Yes once they're on pump its "just chillin", what about when your deathly ill cardiac patient crashes on induction? not so chill then. Heart hard to restart? not so chillin. Have to crash back on pump? Patient crashes in transport? yea. real chill.

 

[TeslaCoil]

I once did a heart that crashed back on pump twice because anastomoses didnt hold. Case took 23 hrs. I did an aorta where we infused something like 80 units of blood. Patient still had an ischemic bowel from too long of cross clamp time. Had to then have an en bloc resection to postpone sepsis until the family could say goodbye. Then we had to pull her off life support. Yea. Real chill.

 

[pgg]

Yea okay I get it. It was hyperbole. Yes once they're on pump its "just chillin", what about when your deathly ill cardiac patient crashes on induction? not so chill then. Heart hard to restart? not so chillin. Have to crash back on pump? Patient crashes in transport? yea. real chill.

It takes the right kind of person to not get anxious during those events. With time everything becomes routine, but it's not for everyone.

I'd be miserable in any specialty that involves clinic. To each their own.

 

[TeslaCoil]

It takes the right kind of person to not get anxious during those events. With time everything becomes routine, but it's not for everyone.

I'd be miserable in any specialty that involves clinic. To each their own.

Thank you.

 

[sevo00]

I once did a heart that crashed back on pump twice because anastomoses didnt hold. Case took 23 hrs. I did an aorta where we infused something like 80 units of blood. Patient still had an ischemic bowel from too long of cross clamp time. Had to then have an end-block resection to postpone sepsis until the family could say goodbye. Then we had to pull her off life support. Yea. Real chill.

Sounds like a skill issue. You suck at anesthesia

 

[sevo00]

No. Not just MOHs thats just one example. General dermatologists regularly perform surgery. Never watched doctor pimple popper? Surgery. All day long. Thats okay. Just stick to sevo bro.

No one has ever referred to a general dermatology procedure as surgery. It’s just a procedure. I don’t understand how this is a point of contention

 

[TeslaCoil]

Sounds like a skill issue. You suck at anesthesia

🤣 mmk. Im pretty sure you've done my work for me making yourself look like a dumb@zz talkin about "these arent surgeries". Idiot.

 

[TeslaCoil]

No one has ever referred to a general dermatology procedure as surgery. It’s just a procedure. I don’t understand how this is a point of contention

Here is a simple article for lay people explaining what dermatology is. May be a tough read for you though. Thats alright Im already convinced you are a verified CRNA.

What is a Dermatologist? What They Do, Conditions Treated, Procedures

A dermatologist is a highly trained doctor who can help diagnose and treat a wide variety of skin, hair, and nail-related conditions.

www.healthline.com

 

[deleted87051]

No. Not just MOHs thats just one example. General dermatologists regularly perform surgery. Never watched doctor pimple popper? Surgery. All day long. Thats okay. Just stick to sevo bro.

I’ve watched a few episodes and was pretty surprised to see what she does in her office with local anesthesia. Many of those procedures would get GA no question where I work.

 

[TeslaCoil]

I’ve watched a few episodes and was pretty surprised to see what she does in her office with local anesthesia. Many of those procedures would get GA no question where I work.

I have done anesthesia for some plastic surgery level removals of basal cell carcinomas done by derm. Talkin like removing 30% of the scalp.

 

[sevo00]

Here is a simple article for lay people explaining what dermatology is. May be a tough read for you though. Thats alright Im already convinced you are a verified CRNA.

What is a Dermatologist? What They Do, Conditions Treated, Procedures

A dermatologist is a highly trained doctor who can help diagnose and treat a wide variety of skin, hair, and nail-related conditions.

www.healthline.com

Did you serious just sent me an article from health link

 

[PpfSuxTube]

I once did a heart that crashed back on pump twice because anastomoses didnt hold. Case took 23 hrs. I did an aorta where we infused something like 80 units of blood. Patient still had an ischemic bowel from too long of cross clamp time. Had to then have an end-block resection to postpone sepsis until the family could say goodbye. Then we had to pull her off life support. Yea. Real chill.

Cardiac mortality is well published and understood. 1 to 3% for electives, about 10 to 20% for emergencies...

Just cause your patients die doesn't mean you have to be stressed about things. Everyone dies man.

If you do the right things at the right time, why stress?

We do essential surgery, big surgery, life saving surgery daily. Every day there's a severe MR or critical AS or whatever that will die inside a year without us... there's solace and comfort in that...

I dont feel any less stress when I cross the corridor one week every 8 to do main OR anesthesia... possibly more stress honestly as I dont have the back stop of icu, perfusion, expected range of bad outcomes...

All work comes with stress @ the start, once you do a tonne of cases you just get used to it... aortic dissection, tonnes of blood, big lines etc etc. Its just another set of procedures. No more no less than your blocks or rhizotomy etc

 

[TeslaCoil]

Cardiac mortality is well published and understood. 1 to 3% for electives, about 10 to 20% for emergencies...

Just cause your patients die doesn't mean you have to be stressed about things. Everyone dies man.

If you do the right things at the right time, why stress?

We do essential surgery, big surgery, life saving surgery daily. Every day there's a severe MR or critical AS or whatever that will die inside a year without us... there's solace and comfort in that...

I dont feel any less stress when I cross the corridor one week every 8 to do main OR anesthesia... possibly more stress honestly as I dont have the back stop of icu, perfusion, expected range of bad outcomes...

All work comes with stress @ the start, once you do a tonne of cases you just get used to it... aortic dissection, tonnes of blood, big lines etc etc. Its just another set of procedures. No more no less than your blocks or rhizotomy etc

Im aware of all of the above. Nonetheless, I could not do what you do. I respect the hell out of you guys. You are absolutely higher level intensivists than I. Its just not for me. I was not bashing cardiac. Its probably a lot more important than what I do. My entire point was the same as many have pointed out in this thread- its just not for everybody and requires careful consideration.

 

[Radetzky]

This was a while back... sorry to hear of her passing. Well, at least she was happy.

Agree with your second statement 100%. Thats why we're here.

I’ve had explosive diarrhea that was less vile than you are.

 

[Status Sciaticus]

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 guess Ill chime in here as well. I dont mind pain patients. Theyre much more tolerable than dealing with CT sturgeons, coming in at 6AM to do lines and set up the room because the cardiac surgeons want to start earlier than everybody else.

The whole, no call, no nights, no weekends thing also helps.

I still do anesthesia and take call at level 1 and level 2 trauma centers FWIW, but I imagine that will phase out as I get older.

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.

Does your business generate a profit? Or is it a business in name to cover the cost of services? Does your business have a cash-on-cash?
Anesthesia groups arent real businesses in the strictest sense. Theyre incorporated yes, but its not comparative to a pain practice or another procedural/surgical practice that generates revenue on a set schedule.

 

[TeslaCoil]

I’ve had explosive diarrhea that was less vile than you are.

Play with fire and get burned.

 

[pgg]

Cardiac mortality is well published and understood. 1 to 3% for electives, about 10 to 20% for emergencies...

Just cause your patients die doesn't mean you have to be stressed about things. Everyone dies man.

If you do the right things at the right time, why stress?

We do essential surgery, big surgery, life saving surgery daily. Every day there's a severe MR or critical AS or whatever that will die inside a year without us... there's solace and comfort in that...

Agreed.

I find cardiac anesthesia to be much lower stress than pediatric anesthesia.

Part of that is simply because I've done a lot of cardiac for a long time, and I rarely do peds.

But a big part of it is that everyone knows and understands that old people getting heart surgery are sick and that the risk is not trivial. And, they understand if nothing is attempted, usually it means a relatively short, uncomfortable, dyspneic, grim prognosis. If the outcome is poor, the family is still sad and disappointed, but rarely shocked. Stark contrast to anything involving a kid - any bad outcome is catastrophic and unexpected. The family's response often includes anger and a need to find someone to blame.

If things are going poorly in the cardiac OR, there's always the fallback plan of heading to the ICU on mechanical support. Very, very rare for someone to die in the OR. An ICU death is interpreted much differently than an OR death by family members. It doesn't make complete logical sense, but it's true.

 

[TeslaCoil]

Agreed.

I find cardiac anesthesia to be much lower stress than pediatric anesthesia.

Part of that is simply because I've done a lot of cardiac for a long time, and I rarely do peds.

But a big part of it is that everyone knows and understands that old people getting heart surgery are sick and that the risk is not trivial. And, they understand if nothing is attempted, usually it means a relatively short, uncomfortable, dyspneic, grim prognosis. If the outcome is poor, the family is still sad and disappointed, but rarely shocked. Stark contrast to anything involving a kid - any bad outcome is catastrophic and unexpected. The family's response often includes anger and a need to find someone to blame.

If things are going poorly in the cardiac OR, there's always the fallback plan of heading to the ICU on mechanical support. Very, very rare for someone to die in the OR. An ICU death is interpreted much differently than an OR death by family members. It doesn't make complete logical sense, but it's true.

Yea but even with an understanding of all of that, there are those of us who cant stomach it for a careers length. Hats off to you there.

 

[JStarMD]

Retired Anesthesiologist. My 'pain' pals enjoyed practices with which they had control, but closed their practices before their planned retirements because it was too expensive and exhausting to run a private pain practice---even with fee-for-service and cash options. And that's certainly a marked contrast to the 'cardiac' guys who made good money, didn't have employee and practice management headaches--but had long hours including nights, weekends and holidays. Tho' is a pain v cardiac thread, but I'll vote for neither! You will lose a year's income and its future interest if you do either fellowship at a time when there are many options to keep you fully employed at a great income level in whatever setting you'd prefer. It seems that an anesthesiology subspecialty today is not what it was----a lot of training that buys you more headaches without big upside. And you don't need increased responsibility (that usually doesn't include adequate payment for same). I say skip the fellowship and (---finally!---) get to work.