I was wondering if I could get some advice. I am currently a PGY4 anesthesiology resident however I am being asked to resign due to issues with substance abuse. I plan(ned) on a career in pain and was considering applying for non accredited pain fellowships. Do you believe this would be an issue in regards to practice, credentialing, and reimbursements? I have always planned on pain and will most likely apply for a residency in PMR to achieve this goal, something I should have done before I started anesthesia, but am considering all options at this point. Any advice would be greatly appreciated.
Resign?
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First you need to address the substance abuse issue. Other residencies are going to want to know why you left. State licensing boards will want to know why you did not finish. If you have a substance abuse issues you need to get into a rehab for health care professionals ASAP and deal with that issues first.
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Not that I'm an expert in this or anything, but I seem to remember hearing that an anesthesiologist with a substance abuse problem is basically a death sentence. If that's true, then wouldn't you need to get far, far away from any specialty that heavily involves narcotics?
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Not really, something like 10% of anesthesiologists have a substance abuse problem at some point during their career. Just have to go to a tx course sponsored by the state board and stay clean.
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You should really try and bargain your way into coming back after treatment. Being dismissed is very likely a death sentence for a person that's already damn near 4 years into their Medicare funding.
what do you mean?
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Without knowing the specifics, if you have substance abuse problems that are concerning enough for you to "resign" an anesthesia position in your last year of training, a career in pain management in which you would be prescribing narcs frequently, doing injections, etc. sounds like a bad idea simply due to access/opportunity. From an intellectual standpoint, it makes sense to minimize dealing with or prescribing medications with high abuse potential on a regular basis. I am not a PD, but I would question someone coming into my program wanting to specifically do pain mgmt who has had a very recent problem. Do you have an interest in PMR outside of pain management? You will need to be forthcoming about this issue with future PDs/employers/hospitals since every license, credentialing, insurance, etc. application specifically asks about substance abuse problems. Getting a license in a new state may be contigent upon enrolling in the new state's monitoring program, depending on the licensing board. If the problems are in the remote past, it shouldn't be an issue and won't hold things up so long as you provide all the requested information and followed rules as set by the monitoring group and licensing board. But until it is truly "in the past" and you have proven to be a safe and sober provider, you may find yourself under more scrutiny and have a tougher time finding a (pain) position.
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I agree with the above. It probably depends upon whether your substance problem was alcohol, or narcs/injectables. If alcohol, then you probably have some chance of getting back into anesthesia and ultimately into pain. If this was a narc problem, then a career in pain is extremely high risk for you. Honestly, I think it will either be impossible to get a spot, or that you shouldn't even try. Pain docs (especially those that do procedures) are routinely exposed to syringes of high potency narcotics. This would be a very unsafe situation for you, the chance of relapse would be tremendous.
Its narcs...but I disagree about the exposure to narcs as a pain doc. Most pain docs inject steroids, local, RFAs, nerve stims...the only situation where I believe I would be exposed to high potency narcs would be in placing an intrathecal pump which is fading away as a treatment modality. Pain docs are more surgeons than anesthesiologists...imo.
Ill post this is in the pain forum and see what they say.
Ill post this is in the pain forum and see what they say.
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You may be right about that, and it will be interesting to see what happens in the pain clinic forum. But I think the bigger hurdle will be getting back into Anesthesia. I'm not trying to be mean or judgmental. The concern is that being exposed to substances may make you relapse, despite your best intentions.
Good luck what ever path you choose to follow.
Good luck what ever path you choose to follow.
