Your point is well taken but I would have serious pause comparing pain to cardiac, GI, EP, ortho, gen surg etc. Even something like rheumatology.
Perhaps they have falling reimbursement but that's the only contention of yours that holds. These fields don't have their technologies and established procedures rapidly called experimental and insurance puts a stop to it.CMS is not pushing annual proposed 9% cuts to them like to pain (across the board btw).
We dont have Cochrane, JAMA, NEJM putting out annual papers showing that other fields meds and procedures don't work with any frequency like that of pain. They go out of their way annually to roll on pain procedures, their questionable scientific underpinning, and their long term efficacy.
Furthermore, I don't believe fields like ortho cardio GI etc struggle to make payroll and are cornered into doing unnecessary procedures routinely to "make a good living". They don't have to undergo skeevy business practices and act against their best medical and moral judgments.
No, I argue that the problems of pain are unique to that field and not reflection of medicine in general.
I've been doing pain for almost 8 years, full time. It can be the best job in medicine, or the worst job in medicine.
PP Pain, in my opinion, is mostly a cesspool. Either you are managing difficult, drug seeking, drug abusing patients or you farm this out to mid-levels and do procedures on them. Hint: you will be inherit these patients when your NP or PA quits, and you will stand tall before the Board or the DEA when they screw up as their "collaborating physician." Drug rep dinners, sleazy marketing, office managers dictating your practice templates and even practice style, payday loans for injections (!!??) in house UDS, insurance fraud, questionable procedures, in house DME, the list goes on. Hope you like 5 pm conversations in the parking lot "hey Doc, let me talk to you for a minute." Concealed carry permit or jiu-jitsu skills highly recommended.
Solo PP Pain in an opioid free practice can be idyllic. Takes a while to build. Better marry rich or inherit wealth or go into debt. But if you are willing to sacrifice and have a good business sense, this can be done.
Academic pain can be either very good, or very bad. Usually low-no opioid in each case.
Hospital pain can also be good or bad depending on your setup, compensation model, referral sources, admin expectations.
Many pain docs, especially PM&R, are working for large Ortho Spine groups. In this setup, you will generally be fed referrals, and there will be low expectations for opioid management. EMG skills are rarely valued. This can be a nice setup, especially if you have ASC buy in. In many practices though, the pain docs are bastard step children, have no true autonomy and are merely procedure monkeys for unscrupulous ortho spine surgeons. Hint: since all your referrals for procedures etc. are fed to you by a spine doc you are easily and inherently replaceable, no matter how good you think you are at 3 level TFESI's.
Do pain because you like dealing longitudinally with patients. If you are good, capable, and patient your practice will eventually flourish and you will see fewer and fewer drug seekers and more and more LOL's with non surgical stenosis who benefit from MILD, young people with hot radics who do well with ESI's, and PLPS patients who really do well with SCS.
Finally- the problems pain faces are not unique to the specialty. There is also no shortage of unethical Physicians in other specialties. If I had a dime for every Ortho Spine, or GI doc or cardiologist doing completely unnecessary ALIF/TLIF/endoscopy/Watchman and procedures du jour I wouldn't be wasting my time posting on this forum.
I'd open my own practice with the capital and drive all my young employees into the ground while I profited off their labors and slept with their spouses.
