Pain versus cardiac fellowship?

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

In our practice cardiac guys work more and take more call (q4) but they’re compensated at an excellent premium for the extra call and hours. I used to do it. It was nice but now I have different priorities in life.
 
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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.


I feel completely trapped. Hate my current practice. There is another practice in town trying to recruit me. Thought this was my ticket out and Im so pissed it didnt hold up.



Did you end up leaving that job? Things get better?
 
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Did you end up leaving that job? Things get better?
Oh yes. Much better now. I still would have stayed at that job over doing cardiac. That situation had nothing to do with pain management and everything to do with a bad contract and work environment. Look, cudos to those who wish to take call and thread swans. I wish to not take call, work 4-5 day weeks, no holidays and make more money than cardiac. 👍🏼

You must have a lot of time on your hands to dig up old posts like that. Good for you. Troll level masterful.
 
Thoughts on pediatric vs cardiac fellowship if equally interested in both in terms of job market, lifestyle (call requirements) and salary?
 
Oh yes. Much better now. I still would have stayed at that job over doing cardiac. That situation had nothing to do with pain management and everything to do with a bad contract and work environment. Look, cudos to those who wish to take call and thread swans. I wish to not take call, work 4-5 day weeks, no holidays and make more money than cardiac.

You must have a lot of time on your hands to dig up old posts like that. Good for you. Troll level masterful.

Sorry if you mentioned this already but where do you live? You’ve got a nice pain gig but I’m wondering if it’s possible for the same trailblazing pain doc to achieve the same success in a more saturated market.
 
Sorry if you mentioned this already but where do you live? You’ve got a nice pain gig but I’m wondering if it’s possible for the same trailblazing pain doc to achieve the same success in a more saturated market.
Its true. Larger city markets are definitely tougher. I live in the suburbs of a mid-sized southeastern city, and while there is some competition in my city, there is most definitely more demand than supply.
 
Just read thru most of this thread, very entertaining 🤣

My anectodal experience....the majority of fellowship trained anesthesiologists who I have met that are no longer practicing within their subspecialty are pain and ICU. I'll let you all interpret this as you see fit.

The most frequent selling point I hear for pain is that there is no call/weekends, a point that has been beat to death in this thread. Honestly, this is really lame compared to the reasons why I enjoy doing cardiac.
 
Thoughts on pediatric vs cardiac fellowship if equally interested in both in terms of job market, lifestyle (call requirements) and salary?
If equally interested in both...

Smelly gross old people every day vs far less gross kids.

Unparalleled collegiality/environment in peds in my experience when compared with the huge variety you'll get in other environments.

I long considered peds, but then I'd do some super sick NICU ex lap where you're transfusing blood products by the syringe and sweating your butt off in a room that's 80°F, and I'd rule it out again.

I chose the awesome surgeries on smelly old gross people every day.
 
If equally interested in both...

Smelly gross old people every day vs far less gross kids.

Unparalleled collegiality/environment in peds in my experience when compared with the huge variety you'll get in other environments.

I long considered peds, but then I'd do some super sick NICU ex lap where you're transfusing blood products by the syringe and sweating your butt off in a room that's 80°F, and I'd rule it out again.

I chose the awesome surgeries on smelly old gross people every day.
On the upside for peds - when you help a sick kid you can make a positive impact for the rest of their life.
 
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 dunno man. There are FPs doing c-sections and I wouldn't call them surgeons. Cardiologists are replacing valves and I wouldn't call them surgeons either.
 
The call, no call argument for caridac vs pain is very variable...
Depends massively on frequency, how busy, number of take backs, presence of residents, speed of surgeons, who covers the csicu.

Personally I love our version of cardiac call. Its very lucrative for us, and we do our most interesting cases on call.

The last place I worked i didn't like our cardiac call, think transplant, vad's, tonnes of slow snotty residents and fellows. I would have hated cardiac i think if I stayed there
 
I dunno man. There are FPs doing c-sections and I wouldn't call them surgeons. Cardiologists are replacing valves and I wouldn't call them surgeons either.
You don't do or think a lot of stuff that makes sense. Don't be jealous now, family medicine. Trust me I wouldnt want to be insulted in that way. Please dont call me a surgeon. Half the surgeons I know are complete toolbags and couldnt diagnose a cold. But I do perform minimally invasive surgeries. As do many interventional cardiologists, dermatologists, etc. Whether you like it or not, I would call pain management a surgical field these days, if you’re actually doing decompressions and fusions. You can call it whatever you want.
 
You don't do or think a lot of stuff that makes sense. Don't be jealous now, family medicine. Trust me I wouldnt want to be insulted in that way. Please dont call me a surgeon. Half the surgeons I know are complete toolbags and couldnt diagnose a cold. But I do perform minimally invasive surgeries. As do many interventional cardiologists, dermatologists, etc. Whether you like it or not, I would call pain management a surgical field these days, if you’re actually doing decompressions and fusions. You can call it whatever you want.
I guess I'm saying that it's possible to perform surgery without being a surgeon. Hence the term proceduralist.
 
I don’t think I’ve ever worked 55 hrs a week in cardiac unless I was picking up extra shifts for my own financial gain. At my busiest I averaged 45, essentially the same as my general colleagues. I don’t sniff 40 anymore unless I’m called in. Which happens 3-4 times per year. And at least at my practice, the pain guy does more weekend work than I do.

Whether it’s general, cardiac or pain, I would never tell someone to pick an anesthesia specialty based on expected hours. That’s unpredictable and somewhat out of your control. Two partners leave? Looks like you’re working more hours. High volume surgical practice leaves? Looks like you’re making less and working less.

Cardiac: like big cases, don’t mind being on call, hate clinic and writing notes

Pain: like clinic, more procedures, don’t like the OR as much, don’t want to get called in at midnight.

Here’s a secret: cardiac docs don’t like getting called in, either. But saving a life is pretty cool.
 
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.

This is very inaccurate. Pain will have less vacation, but most of the pain jobs I looked at paid a range of more than 550 to waaay more than 550. I may not get 12 full weeks off a week at a time, but I do work 4 days a week every week with no nights, call, weekends, or holidays worked, which I find to be much preferable personally than 12 separate weeks but getting called in at 2 a.m. on Christmas to do an emergent case.
 
This is very inaccurate. Pain will have less vacation, but most of the pain jobs I looked at paid a range of more than 550 to waaay more than 550. I may not get 12 full weeks off a week at a time, but I do work 4 days a week every week with no nights, call, weekends, or holidays worked, which I find to be much preferable personally than 12 separate weeks but getting called in at 2 a.m. on Christmas to do an emergent case.
How long ago were you looking and what geographic areas? Just wondering if these jobs are still out there now
 
How long ago were you looking and what geographic areas? Just wondering if these jobs are still out there now
These jobs are definitely still out there. Particularly if you can find a partnership or even partnership-like structure. My buddy in memphis was working 5 day weeks and made 750k doing 70ish procedures per week. 3 clinic days and 2 OR days per week. Paid off all his student debt in year 1. Then went to a 3 day week and still makes 500k per year. Im working 5 days a week and make almost as much, but Im in a better city.

All that being said, there’s also always the other side of the coin. Many practices leave lowball offers hanging out there for any sucker new grad to come along and snatch it up because they dont know what they’re taking on. The number one biggest problem going into pain management is practices who are single owner or few owners exploiting young grads for their own gain. The second biggest problem is cms cuts, but thats pretty much all of medicine.
 
The decision to do fellowship at all is a difficult one (cardiac in my case). Baseline, doing a fellowship is the equivalent to giving up a year of full attending pay (in my case that's $700-800K+). My fellowship earns me ~$30K extra per year at my job, so it will take nearly my entire career to recoup that lost income. Made worse, I didn't match into fellowship the first attempt (when cardiac was competitive), so I worked in academics for a year, making a LOT less money than I would have in my current job. So the cost of my fellowship is likely over $1M in earned income. There are places where cardiac is a bigger income differentiator, but I'm very happy with my current setup.

I have ZERO regret. I didn't do the fellowship for money. I did it because I gain great satisfaction working in the higher acuity environment, with a group of highly skilled surgeons, doing life-saving surgeries. I love the knowledge and skills I acquired in my fellowship and I enjoy using those in my daily work. Our cardiac call burden is minimal as well. I think I did a cardiac case after hours/weekend maybe 3 times all of last year, and 2 of them, I was already in-house for another call.
 
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This is very inaccurate. Pain will have less vacation, but most of the pain jobs I looked at paid a range of more than 550 to waaay more than 550. I may not get 12 full weeks off a week at a time, but I do work 4 days a week every week with no nights, call, weekends, or holidays worked, which I find to be much preferable personally than 12 separate weeks but getting called in at 2 a.m. on Christmas to do an emergent case.

Care to share any publicly available data? Hospitals salaries are largely based off MGMA figures. That's not even 550
This is very inaccurate. Pain will have less vacation, but most of the pain jobs I looked at paid a range of more than 550 to waaay more than 550. I may not get 12 full weeks off a week at a time, but I do work 4 days a week every week with no nights, call, weekends, or holidays worked, which I find to be much preferable personally than 12 separate weeks but getting called in at 2 a.m. on Christmas to do an emergent case.

Not sure if you have actually worked in the field based on prior posts. Let's go through it based on recent ads.

Hi, I have a new pain management opportunity in Southern CA 1.5 hrs from L.A.. Okay for fellows or practicing because they have 2 needs.

Option to do 1099 or W2
350-375K base plus RVU/Bonus
Full benefits and malpractice available if you choose W2
4 weeks’ vacation
Multi-specialty group, pain dept will be new
In house C-Arm
Access to surgery center
2-year partnership

Another one from yesterday:

Happy New Year! Wanted to share some details regarding an interventional pain job in the south:
- $375k - $415k base plus RVU
- Multiple locations in KY, IN and surrounding states
- Interventional pain procedures
- Full time but might have part time or flex scheduling available
- Established patient base
- Malpractice and full benefits available

Not exactly amazing pay. Little vacation is the norm.

Furthermore, no discussion of overhead, a foreign concept for most anesthesiologists, which can be 40-50% of total collections.

Academic jobs tend to be 330ish with full benefits.

Check the pain forums, private practice pain is infamous for revolving door of pre-partners who are let go or rejected by vote from partnership.

4-6 weeks for 300ish and full benefits....that's CRNA pay, who promptly leave at 3pm, never take call, guaranteed 2 breaks and a lunch and chill out in long cases like robot rooms.

Unless you wanna talk about the top 20% of private practice guys who have a strong hold with a huge referral base of insured patients and partial ownership in an ASC. Their money is from facility fees, not from working a pain job.

Most hospital positions are either 2 years of a 400-450 salary then pure RVU afterwards; or a salaried position +/- RVU. Yes, some hospitals get desperate and pay above MGMA but this is less common and tends to be in less geographically desired areas, taking call, med management, inpatient consults.

One of my cofellows took a pure block jock job for large ortho group in a big city. Little to no med mgmt. Essentially one of the ivy anesthesia residencies. No diagnosis or management, they order blocks and he does them. Pay was under 300,000 in 2020ish.

Another cofellow does the typical 3 days clinic PP 40-50ish patients a day plus 2 days of fluoro procedures. Told up front that he must write for or continue all opioids, marijuana,amphetamines, and benzos to keep the referrers happy. Owner of that practice is known for doing 10 stim trials in a day. Happens about once per week. Those are the guys taking 800ish+ post overhead in PP. That or ASC ownership.

For comparison, I have PP cardiac guys in my city, personally know, offered to show me their w-2, who state they make 880 doing their own cardiac cases. Mind you, they take a lot of heart call and frequently work postcall...but they get 10-12 weeks vacation.
 
Care to share any publicly available data? Hospitals salaries are largely based off MGMA figures. That's not even 550

Not sure if you have actually worked in the field based on prior posts. Let's go through it based on recent ads.

Hi, I have a new pain management opportunity in Southern CA 1.5 hrs from L.A.. Okay for fellows or practicing because they have 2 needs.

Option to do 1099 or W2
350-375K base plus RVU/Bonus
Full benefits and malpractice available if you choose W2
4 weeks’ vacation
Multi-specialty group, pain dept will be new
In house C-Arm
Access to surgery center
2-year partnership

Another one from yesterday:

Happy New Year! Wanted to share some details regarding an interventional pain job in the south:
- $375k - $415k base plus RVU
- Multiple locations in KY, IN and surrounding states
- Interventional pain procedures
- Full time but might have part time or flex scheduling available
- Established patient base
- Malpractice and full benefits available

Not exactly amazing pay. Little vacation is the norm.

Furthermore, no discussion of overhead, a foreign concept for most anesthesiologists, which can be 40-50% of total collections.

Academic jobs tend to be 330ish with full benefits.

Check the pain forums, private practice pain is infamous for revolving door of pre-partners who are let go or rejected by vote from partnership.

4-6 weeks for 300ish and full benefits....that's CRNA pay, who promptly leave at 3pm, never take call, guaranteed 2 breaks and a lunch and chill out in long cases like robot rooms.

Unless you wanna talk about the top 20% of private practice guys who have a strong hold with a huge referral base of insured patients and partial ownership in an ASC. Their money is from facility fees, not from working a pain job.

Most hospital positions are either 2 years of a 400-450 salary then pure RVU afterwards; or a salaried position +/- RVU. Yes, some hospitals get desperate and pay above MGMA but this is less common and tends to be in less geographically desired areas, taking call, med management, inpatient consults.

One of my cofellows took a pure block jock job for large ortho group in a big city. Little to no med mgmt. Essentially one of the ivy anesthesia residencies. No diagnosis or management, they order blocks and he does them. Pay was under 300,000 in 2020ish.

Another cofellow does the typical 3 days clinic PP 40-50ish patients a day plus 2 days of fluoro procedures. Told up front that he must write for or continue all opioids, marijuana,amphetamines, and benzos to keep the referrers happy. Owner of that practice is known for doing 10 stim trials in a day. Happens about once per week. Those are the guys taking 800ish+ post overhead in PP. That or ASC ownership.

For comparison, I have PP cardiac guys in my city, personally know, offered to show me their w-2, who state they make 880 doing their own cardiac cases. Mind you, they take a lot of heart call and frequently work postcall...but they get 10-12 weeks vacation.
I work in the south, I make 650k/yr on 8:00-4:30. 6 weeks vacation. Break that down to hourly pay. Id bet money its more than your cardiac friends on a per hour basis. Im not trying to work myself into an early grave. I consistently work 40-45 hr weeks. Those job offers are just lowball offers. You have to negotiate hard and prove you can hack it in a busy pain practice, or build a busy pain practice yourself.
 
I work in the south, I make 650k/yr on 8:00-4:30. 6 weeks vacation. Break that down to hourly pay. Id bet money its more than your cardiac friends on a per hour basis. Im not trying to work myself into an early grave. I consistently work 40-45 hr weeks. Those job offers are just lowball offers. You have to negotiate hard and prove you can hack it in a busy pain practice, or build a busy pain practice yourself.

Thanks for sharing and transparency. Roughly comes out to 1955 hours a year, so $330 per hour pretax. It's good, no doubt. That being the case, locum anesthesiologists are 350-450 hourly at current rates. I've even seen employment models in the Midwest where supervising pays 350/hour and doing own cases pays a lesser hourly rate.
 
Thanks for sharing and transparency. Roughly comes out to 1955 hours a year, so $330 per hour pretax. It's good, no doubt. That being the case, locum anesthesiologists are 350-450 hourly at current rates. I've even seen employment models in the Midwest where supervising pays 350/hour and doing own cases pays a lesser hourly rate.
Sure. Thats all fair. Locums is really the way to go for young single folks with no kids. Thats definitely what I’d do, at least for some period. Can really do well.
 
I work in the south, I make 650k/yr on 8:00-4:30. 6 weeks vacation. Break that down to hourly pay. Id bet money its more than your cardiac friends on a per hour basis. Im not trying to work myself into an early grave. I consistently work 40-45 hr weeks. Those job offers are just lowball offers. You have to negotiate hard and prove you can hack it in a busy pain practice, or build a busy pain practice yourself.

You do realize you’re liek 90th percentile right
 
I followed along as some pain fellows found their first jobs about 2 years ago.

Salaries from low 300s to low 500s, heavily skewed toward the lower end. Almost all 4 weeks vacation with one offering 2 weeks. Almost none of the jobs seemed intended for a long term symbiotic relationship.

People on the pain forum share incomes about double that range.

My experience starting a practice has been that 3 local hospitals have offered me arrangements that would put me in that SDN range. These were hospitals looking to start or expand their pain program rather than advertised jobs. So something about the new grad job search doesn’t work in pain.

While things aren’t looking good for private practice, I’m less inclined to recommend pain if starting your own practice is out of the question. In some situations, it’s the only way to have a good job.
 
I’ve made 750 the last 3 years pain only. 3 1/2 days a week. Less than 30 hours a week. All production. Take about 7 weeks off additionally. Hospital employed. We just hired another doc at 550 guarantee plus production bonus. The good jobs exist but you will never see one advertised.
 
I only do pain episodically. I’m fellowship trained in pain.

I love the interventional procedures and little bit of patient relationship …but honestly it can be overwhelming and it has its own set of problems from a business standpoint - greedy hospitals, asc partnerships, difficult patients and expectations of referring surgeon etc

Insurance companies not wanting to play fairly

But with all that, you are your own boss and develop your own brand. Pain is closer to psychiatry than anesthesia in my opinion. Yes procedures are great but there is a lot of medication mgt and workup and diagnosis and care coordination as well.

If you’re going to do pain - do it solo and be your own practice owner. No other arrangement is worth it imo because the real value of a pain practice should you exit, is in patient census and “monetizing units” ie how many patient encounters you have through insurance. Second best arrangement is a fair $ per unit rvu where you’re busy and get paid for production

All other arrangements are bogus. Like 40-45 pts a day jobs with 500-600k salary as advertised. I had one practice reach out to me with that offer last week and I threw it back at their face not because I was being disrespectful but because I know what it’s like to run and manage a busy pain practice. It’s a lot of liability, headache, managing staff, patients etc etc. a lot of time spent at nights and on weekends doing notes and doing prep if you want quality work.

You need to look at pain mgt as owning your own shop. Set up ethical, decent and common sense treatment protocols and go from there.

Anesthesia is simpler, better, and less headache overall when you compared to pain. These days with the locums income it’s a no brainer.

But you don’t have autonomy or real decision making power. It can be good or bad. Depending on what you value.

I suggest do both for a little while and see what you like.

Being a resident and fellow is very different than actually doing it yourself.

It will be hard to do cardiac plus pain due to call requirements. I do a split pain/ gen anesthesia because personally I only have a daytime schedule with prn call which I take voluntarily.

I do well and I’m satisfied as I retain autonomy.
 
I never really considered a pain fellowship, but in the 2000s when I was a resident we talked about it amongst ourselves. Seems at that time there were two paths toward making a good income in pain

1) be a "pill mill" skirting the edges of ethics by refilling opioid prescriptions

2) be a "block jock" and run a conveyor belt of needle procedures

The consensus was that (2) was preferable - more fun and potentially more lucrative. But there was also a lot of talk about how a large fraction of pain procedures were futile, that we knew they were futile. How a lot of the money came from doing the requisite ESIs to try something before spine surgery, or placing expensive implants of dubious efficacy. The less ethical places had an undercurrent of unspoken understandings with patients along the lines of "hey if you let me stick needles in you for a few months and bill your insurance along the way, I'll refill your oxy for a while" ...

It was a rare, rare practice that didn't refill opioids for everyone and did few blocks, instead focusing on coping mechanisms, non-opioid medical management, etc. And of course those places weren't making any money.

Is the pain landscape better now? Is interventional pain mostly good care for these patients or is it still a bunch of handwaving and placebo.

I'm not really casting any stones here - god knows there's a lot that goes on in the OR that maybe isn't in the objective best interest of the patient's well being. But the above cynical realities of pain practice were one (of several) things that turned me off to pain. (These days I do my part to keep the device industry moving by helping put TAVRs in 90+ year olds!)
 
I never really considered a pain fellowship, but in the 2000s when I was a resident we talked about it amongst ourselves. Seems at that time there were two paths toward making a good income in pain

1) be a "pill mill" skirting the edges of ethics by refilling opioid prescriptions

2) be a "block jock" and run a conveyor belt of needle procedures

The consensus was that (2) was preferable - more fun and potentially more lucrative. But there was also a lot of talk about how a large fraction of pain procedures were futile, that we knew they were futile. How a lot of the money came from doing the requisite ESIs to try something before spine surgery, or placing expensive implants of dubious efficacy. The less ethical places had an undercurrent of unspoken understandings with patients along the lines of "hey if you let me stick needles in you for a few months and bill your insurance along the way, I'll refill your oxy for a while" ...

It was a rare, rare practice that didn't refill opioids for everyone and did few blocks, instead focusing on coping mechanisms, non-opioid medical management, etc. And of course those places weren't making any money.

Is the pain landscape better now? Is interventional pain mostly good care for these patients or is it still a bunch of handwaving and placebo.

I'm not really casting any stones here - god knows there's a lot that goes on in the OR that maybe isn't in the objective best interest of the patient's well being. But the above cynical realities of pain practice were one (of several) things that turned me off to pain. (These days I do my part to keep the device industry moving by helping put TAVRs in 90+ year olds!)

Private insurance didn't take long to notice the merry go round of endless procedures per patient. Option 2 that you mentioned is becoming less and less tenable. CMS wants 9% annual cuts to pain management....across the board, not just certain procedures. Our professional societies proudly announce with its just a 4.5% across the board decrease in billing codes as a success with heavy negotiation.

Now, several established procedures are classified as "experimental" and thus not covered.

Now need a neurologist clearance who has go state the necessity of a kypho to get it covered.

They now bury you in paperwork and prior auths to get procedures cleared.

Limitation on number of lumbar and cervical procedures per annum regardless of Pathology.

Can even deny claims post procedure.

Even though Medicare pays less than commerical rates...at least payment for your procedure is not something to worry about.
 
I recently came to know that many patients have filed complaints with fda about scs and poor outcome

Also came to learn that Australia will be banning scs
 
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“In the United States, spinal cord stimulators account for the third-highest number of medical device injury reports lodged with the Food and Drug Administration, which collected more than 80,000 incidents since 2008.”

80k reported is a lot

I bet the number is much higher as many people probably don’t bother reporting it.
 
If they’re banning surgeries with bad outcomes, back surgery for back pain would be first up.
They all go for psych eval prior to implant, and a good percentage are obviously crazy to everyone around, yet they all pass the eval! Its a great system..

🤣 imagine a private practice psychiatrist, not clearing for an implant....likely won't be getting referrals from that pain guy again. Easier to say severe psychiatric disease that is either stable or worsened by chronic pain.
 
“In the United States, spinal cord stimulators account for the third-highest number of medical device injury reports lodged with the Food and Drug Administration, which collected more than 80,000 incidents since 2008.”

80k reported is a lot

I bet the number is much higher as many people probably don’t bother reporting it.
So what are the first and second highest?
 
So what are the first and second highest?
“Patients report they have been shocked or burned or have suffered spinal-cord nerve damage ranging from muscle weakness to paraplegia, FDA data shows. Among the 4,000 types of devices tracked by the FDA, only metal hip replacements and insulin pumps have logged more injury reports.“


Perplexity:
 
I recently came to know that many patients have filed complaints with fda about scs and poor outcome

Also came to learn that Australia will be banning scs
Thats sad because for every one patient who loses efficacy there are probably 5 that see benefit. Its not foolproof, like any therapy we offer. How many therapies do you know of that are 100% successful?
 
“Patients report they have been shocked or burned or have suffered spinal-cord nerve damage ranging from muscle weakness to paraplegia, FDA data shows. Among the 4,000 types of devices tracked by the FDA, only metal hip replacements and insulin pumps have logged more injury reports.“


Perplexity:
Funny Ive only rarely ever seen patients who were significantly shocked in my career thus far. And Ive never once seen a patient burned.
 
Funny Ive only rarely ever seen patients who were significantly shocked in my career thus far. And Ive never once seen a patient burned.
I understand.

But then again you’re n =1 and not representative of population as a whole.

Clearly scs is under scrutiny.
 
Thats sad because for every one patient who loses efficacy there are probably 5 that see benefit. Its not foolproof, like any therapy we offer. How many therapies do you know of that are 100% successful?
I am yet to see a C-section that didn't result in a baby being delivered! (Not talking about collateral damage here)
 
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