Pain vs Anesthesia for those with non-medical entrpreneurial interests


5+ Year Member
Mar 2, 2015
Hi all,

Tried a search for this, a lot of talk about schedule, but more about overall hours as opposed to flexibility. Sorry in advance if this is a redundant topic. I'm a CA-3 in Anesthesia at a competitive program that was very interested in pain medicine as a CA-2 but ultimately decided not to pursue it at that time. Now as a CA-3 with the recent pain match I'm starting to wonder if that was the wrong decision. I'll start by saying I do enjoy Anesthesia, but I also enjoyed my pain management rotation quite a bit (I feel I'd be happy in either one - maybe with a slight preference to pain), ultimately I decided to pursue Anesthesia due to what I perceived was more flexibility in scheduling. Now that I'm in the job search, I think that's true to some extent, but realized that I had always assumed PP pain required you building a practice and thus required more of the 9-5 MtoF lifestyle. I'm still considering pain quite seriously for a couple reasons: persistent job fears/CRNA/AMCs (warranted or not) in Anesthesia, longer lifespan in pain/higher income potential (less physically taxing), and increasing importance of interventional pain in the face of the opioid crisis (aka job security) . On the other hand schedule flexibility is extremely important to me as I have other, non-medical entrepreneurial interests requiring meetings, phone calls, dinners and occasionally trips out of town. So, I wanted to ask the experts - would pain medicine be a viable field for me knowing that I require some baseline schedule flexibility? Is it realistic to have some weekdays off to pursue my other interests? Based on research that I have done so far, doesn't seem like there is a ton of availability for what I'm looking for, but I feel like it's impossible to truly understand the job market unless you're in the job market. Ultimately, I know it's only a year, but I also don't want to have to deal with that opportunity cost if it will not ultimately benefit me. I also don't want to mischaracterize my intentions to the private practice groups that are currently recruiting me.

Appreciate the help!


TL;DR - is there any schedule flexibility in PP pain for those with outside entrepreneurial interests or am I expected to work 9-5 MtoF with 4-8 weeks of vacation.
Apr 13, 2016
  1. Attending Physician
I think you are better off with anesthesia for what you describe. Build your outside entrepreneurial interests during the free weekday hours and longer vacation you will have, and use that to phase out of clinical duties when the call gets too long.
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Trench Dog
15+ Year Member
May 8, 2005
  1. Attending Physician
They are both so different. Call will kick your ass in the or depending on the job. Even tons of time off won’t make up for this. Your opinion as a general rule doesn’t matter in the or. You are part of the machine in the basement and it had better keep running.
At least in pain there is minimal to no call and you can make yourself valuable to other providers and the hospital and/or start your own practice which unfortunately seems to get harder every year. You can also control your schedule more in pain. You can take days off, have holidays off etc. I have found that even with tons of time off in the OR it often doesn’t fall at the right time and if you think your partners will cancel their trips for your kids birthday you are probably mistaken. Everyone having fun at the beach on the summer weekend? Youre on call... but don’t worry you’ll have Monday off when everyone with a normal job is at work. Your friends taking a trip to Europe and want you to go? You’re working that week. You can try and trade but it is not possible all the time. You may get less vacation but YOU schedule it in pain.
CRNAs seem to grow more malignant by the year but who knows what that really means. It is a very complex decision and is somewhat akin to being asked to decide which of two food dishes you prefer before you have tried them. And there can be way more flexibility with pain as your in control of your schedule.
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10+ Year Member
Jul 27, 2009
You may have more control in a pain practice than in the OR anesthesia, but you'll have more free paid time in the OR anesthesia practice. Neither job is as flexible as you might want, but in the pain clinic if I'm not working that day, I'm losing money. In the OR if I'm not working, I am likely still getting paid for being available. In that off time, there's a lot more hanging over the head of an average pain provider in terms of documentation, insurance work, practice building, etc, as compared with the anesthesia side. It's not that either is harder or easier, but the day to day and stressors are just totally different. If you're looking just for a place for safe financial capital, then go with anesthesia as you can just be a cog. If you're looking for something more, then go with the one you enjoy more.
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Pain was the dream of 1990's.


We couldn't convince ANYONE to do a pain fellowship and join our practice. We even offered to train them; no one wanted to do pain management. Things changed in about '99 with higher reimbursement. Then EVERYONE wanted to do pain.

For the original poster, there is no such thing as a "day off" during the week for pain. You have a fixed overhead and you need to be there seeing patients. That is sacrificing 1/5th of your revenues, which would probably equate to a 25-33% "haircut" on your income.

Do what you like. Don't go into pain as a perceived better lifestyle or better income. It is a long career and you have to like what you do.
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