question about job options

[chocolate]

I am strongly considering doing a chronic pain fellowship when I finish my anesthesiology residency, however would really like to practice both anesthesiology and pain when I'm finished.

I realize that most people practice exclusively pain here, however I'm really interested if a mixed option would be available outside of academia?

I like the idea of chronic pain because I miss some of the long-term relationships and enjoy the interventional plus counseling aspects of pain, however still very much enjoy my time in the ORs....any suggestions/insights are welcome.

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[stim111]

I have seen multiple posting on job boards for anesthesiologists who can have both pain and anesthesia. Not uncommon at all.

 

[PainDevil]

That's what I'm doing for now, a mix of OR anesthesia and Pain. I'm convinced that eventually, I'll need to gravitate in either direction, but I don't think it's a bad option to start with-- especially out of fellowship.

OR anesthesia is VERY different from Pain medicine, but some skills do come in handy. For example, if you're used to placing lumbar plexus catheters for hip surgery, you can apply this to the cancer patient with intractable hip pain as well.

Some issues to consider:

* There are all types of anesthesia groups out there, some progressive, some not. You don't want to go somewhere where they think that OR anesthesia call is "harder" than pain call, or even worse, make you take OR call.

* Depending on where you go, the Pain clinic might be a drain on the anesthesia group (i.e, more reimbursement in OR anesth. than in Pain), or vice versa. If your Pain division is successful and has a good reputation in the medical community, the anesthesia group will find you invaluable, as this would mean more leverage (politically) for the group when dealing with hospital administration.

* Anesthesia groups usually exist in hospitals, and hence, the Pain clinic may be hospital-based. Although this can mean lower overhead (your staff/equipment/space covered by hospital), it also means that you're often required to see everyone-- i.e, tons of Medicaid, etc. Also, a hospital-based pain clinic may be required to provide inpatient consult coverage for the hospital-- definitely not fun. And if you do lots of inpatient consults, believe me, you'll feel like an eternal resident/fellow.

* How much OR anesthesia versus Pain? As you build your Pain practice, there will be an expectation that you are available for your referral sources. "Sorry, I can't see your patient because I'm in the OR the next two days" just doesn't cut it.

I'm sure there are more issues on hand, but that's what I can think of at this moment. It can be quite frustrating at times, but once again, I don't think it's a bad way to get your feet wet.

Good luck!
Paindevil

 

[PMR 4 MSK]

I'm PM&R, so can't give you my experience, but I do interact with many Anesthesia guys and have talked about this subject to many of them.

It's hard to do both for the simple reason pain is hard to do part-time. On your OR days, someone will always be needing to cover you in the office. If you have a group arrangemnt where you are all doing this, it can work out ok, but then the patients never know which doc will return calls, or will see them when they need same-day work-ins. In the grand scheme, not a big deal, but does affect continuity of care. And lets face it, 2 pain guys never approach the same problem the same way, even in gourps.

A lot of guys do split like this when they are early in their careers, but one aspect or the other seems to take over more, or they gravitate to one more due to liking it more or the other less. Around me, the pain guys do almost exclusively pain, except I know at least 1 does just one day of OR/wk. They do however, often do anesthesia call.

As an analogy, when I started out, I ran an inpt rehab ward 1/2 time and did a pain clinic 1/2 time. The pain clinic grew to the point I could no longer do the inpt rehab, plus pain paid better, with no call.