Salary Anesthesia Pain

[BloodySurgeon]

The salaries at my hospital for anesthesia keep increasing and reimbursement in pain keep decreasing. Thinking of jumping ship.

Anesthesia has double the vacation, similar work hours, and same if not more pay with security. Unfortunately they have calls but there are post call days.

Anyone else feel the same about pain and thinking of jumping ship during these opportunistic time. There is a bidding war for anesthesiologists in my area

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[nvrsumr]

If I took 12-16 weeks vacation I wouldn’t make much more than an anesthesia doc. Still no nights, weekends, holidays, calls or answering to Dr Nurse Boss Admin but similar salary

 

[justAstudent]

As someone starting pain fellowship this July, how worried should I be about my future. I keep reading stuff like this everywhere.

 

[BloodySurgeon]

Pain job is 4 weeks PTO plus 5 CME and 5 holidays. Flexible work hours, no weekend, no call.
No narcs, good referrals, but undesirable location.
Hospital base procedures with union staff therefore slow turnover (~15-20mins) and near impossible to produce >75th percentile wRVU
Pain salary >50th percentile, however Anesthesia salary >75th percentile.

Anesthesia job is offering 8 weeks PTO plus 5 holidays and 5 OR union "holidays". You will have to work one major holiday per year.
The position is at the same hospital and the administrators tried renegotiating our terms but they cant compete with the Anesthesia practice
Anesthesia yearly salary is 15% higher with an additional one month more of vacation (10% work salary) with CRNA supervision
In-house call is once a week but its a low volume tertiary hospital and justifies the 25% increase in "salary"
Same benefits (401k, health, life, etc)

What would others do?

 

[BloodySurgeon]

As someone starting pain fellowship this July, how worried should I be about my future. I keep reading stuff like this everywhere.

I am only a couple years into practice, others in this forum have far more experience than I do and I would be happy to hear from them

Just depends on how greedy you are. An anesthesiologists doesn't need to work for patient referrals or reach a specific benchmark to receive a salary bonus. Therefore recent anesthesia graduates typically have a higher salary close to $50k more than pain jobs because they don't need time to grow their practice and therefore overall revenue. There are anesthesia job with and without call. Call usually pays between $1-1.5k in most places in addition to the higher salary. This can add up to an additional $50k salary.

However, the trade off is lifestyle. Pain has a very predictable work hour and very flexible to your needs and desires. For example, my hospital allows me to hold office hours from 9am-7pm on some days so Fridays I can work from 9am-12pm. I have no weekends so its almost like a 3 day weekend every week of the year. In anesthesia, your hours and holidays are at the discretion of the group. If you have a birthday party or wedding you want to attend to you will have to plan months in advance and trade weekends and days with other attendings like in residency. Also, you are respected at a pain job by both the patients and the staff. You are the doctor and you call the shots! I still call patients at home if they miss their appointment and check up on them because I want to. You build a connection and feel amazing when they do well.

I never joined a private practice group because it was hard to find one I really liked but that's where the mythical high salary ($600k+), sponsor-endorsing, tax-evading doctors you read about in the news paper are from. Most of the private groups I liked were affiliated with a local hospitals so I took that as a sign. The more desirable locations were oversaturated by neuro pain, PMR pain, family med pain, psych pain so the starting base salaries for anesthesia pain in these areas were far lower than I expected. In addition, gaining referrals was a huge problem in these mainly RVU base models. If you want to make more than your anesthesia colleagues most likely you will need to sell your soul to either the surgeon, lawyer, or narcotic seeker. I called surrounding spine surgeons who told me if they want their referrals then I should recommend spinal surgery to all their patients if the first procedure I try is not a home run. I also heard many horror stories of poaching staff, patient, and difficulties of starting a practice with lower reimbursements. In addition, difficulties of acquiring ownership at an ASC.

 

[justAstudent]

I am only a couple years into practice, others in this forum have far more experience than I do and I would be happy to hear from them

Just depends on how greedy you are. An anesthesiologists doesn't need to work for patient referrals or reach a specific benchmark to receive a salary bonus. Therefore recent anesthesia graduates typically have a higher salary close to $50k more than pain jobs because they don't need time to grow their practice and therefore overall revenue. There are anesthesia job with and without call. Call usually pays between $1-1.5k in most places in addition to the higher salary. This can add up to an additional $50k salary.

However, the trade off is lifestyle. Pain has a very predictable work hour and very flexible to your needs and desires. For example, my hospital allows me to hold office hours from 9am-7pm on some days so Fridays I can work from 9am-12pm. I have no weekends so its almost like a 3 day weekend every week of the year. In anesthesia, your hours and holidays are at the discretion of the group. If you have a birthday party or wedding you want to attend to you will have to plan months in advance and trade weekends and days with other attendings like in residency. Also, you are respected at a pain job by both the patients and the staff. You are the doctor and you call the shots! I still call patients at home if they miss their appointment and check up on them because I want to. You build a connection and feel amazing when they do well.

I never joined a private practice group because it was hard to find one I really liked. Most of the private groups I liked were affiliated with a local hospital so I took that as a sign. The more desirable locations were oversaturated by neuro pain, PMR pain, family med pain, psych pain so the starting base salaries for anesthesia pain in these areas were far lower than I expected. In addition, gaining referrals was a huge problem in the metro cities. If you want to make more than your anesthesia colleagues most likely you will need to sell your soul to either the surgeon, lawyer, or narcotic seeker. I called surrounding spine surgeons who told me if they want their referrals then I should recommend spinal surgery if the first epidural is not a home run. I also heard many horror stories of poaching staff, patient, and difficulties of starting a practice with lower reimbursements. In addition, difficulties of acquiring ownership at an ASC.

Thank you for your insight.

 

[deleted875186]

The salaries at my hospital for anesthesia keep increasing and reimbursement in pain keep decreasing. Thinking of jumping ship.

Anesthesia has double the vacation, similar work hours, and same if not more pay with security. Unfortunately they have calls but there are post call days.

Anyone else feel the same about pain and thinking of jumping ship during these opportunistic time. There is a bidding war for anesthesiologists in my area

I am one year into practice, thinking the same thing about possibly taking an anesthesia job.

Pros would be higher pay, don’t have to deal with opioids, don’t need to try to work hard to get incentive bonus. While I like the continuity of patient care in pain, I hate the unhelpable opioid legacy patients that are so frequent in my area.

Cons would be less predictable schedule, have to take overnight call, take s**t from surgeons, and pain is very saturated in my area so I am concerned about transitioning back to find a job if I leave.

I hear what yojr saying about the salary, it is very enticing, I think it’s a potentially good move, realizing that if pay comes down in the future or schedule becomes less tolerable you just look for another pain gig.

 

[gazzer]

I think pain to anesthesia is a difficult transition even after being just a couple years out. But, anesthesia to pain much easier in my opinion.

 

[Status Sciaticus]

Debating the same thing, but with a different perspective. Will start my first job in August, but looking at applying into pain this year. General anesthesia salary is pretty good (~500k) with 8-10 weeks off. But on the other hand, pain has no real ceiling for the entrepreneur-ly minded.

 

[fathead88]

I think it’s natural to wonder about going back to OR anesthesia. I mean, after all, it is probably your 2nd favorite field in medicine.

For me, since I started Pain, I have spent every night in my own bed. I have seen my kids every day before work, have been home every evening for family time. Never missed a weekend etc. That to me is priceless. 50th percentile salaries are about equivalent, but anything above starts to skew Pain>Anesthesia.

Just remember the grass is always greener...

 

[PainDoc2025]

Pain > Anesthesia for sure; higher ceiling for pay with Pain vs. Anesthesia, fairly equal 50th percentile pay for both, no weekends, no call, no nights, likely 40-50 hour weeks, partnership/ownership in practices

 

[GoBeers]

private practice community pain and I love it. the monday-thursday 8-5 , friday 8-2 cannot be stressed enough. no nights, weekends or holidays is key for my sanity and growing family.

i'll never go back to anesthesiology, not even for that extra 100k in salary. not having full control of schedule and the idea of being on call again for any semblance of an emergency is too much stress for my liking at this point. opioid management can potentially be a burden only if you let it.

 

[deleted875186]

private practice community pain and I love it. the monday-thursday 8-5 , friday 8-2 cannot be stressed enough. no nights, weekends or holidays is key for my sanity and growing family.

i'll never go back to anesthesiology, not even for that extra 100k in salary. not having full control of schedule and the idea of being on call again for any semblance of an emergency is too much stress for my liking at this point. opioid management can potentially be a burden only if you let it.

The opioids do get to me. I don’t mind prescribing, I think an opioid can help some people, especially the older arthritis in ever joint people. But seeing a lot of younger patients on opioids, fibro on opioids, legacy patients, etc, does get to me.

 

[GoBeers]

The opioids do get to me. I don’t mind prescribing, I think an opioid can help some people, especially the older arthritis in ever joint people. But seeing a lot of younger patients on opioids, fibro on opioids, legacy patients, etc, does get to me.

I hear you. but first visits are always consultations. I know you know that nothing is owed to them. As I'm also sure you do, I speak my thoughts and explain my beliefs and principles firmly. I continue to be happily surprised when I win patients over. We are but humble, simple physicians just trying to help our community with safety as our first priority.

 

[nopain1234]

I have a unique perspective, I split time between pain and anesthesia 50/50 for 4 years. Pain is undoubtedly the better life. Do not minimize dealing with douchebag surgeons, CRNAs, malignant OR staff, morbidly obese pts, and ASA 4s. I always told myself “just get through the am then you can bail to your office”. It was my safe haven. There are no perfect jobs, my recommendation is to scale your pain practice to make it comparable to anesthesia. Everyone can do it.

Realize we are sitting in the car bird seat. Should anything ever happen to pain medicine we have one hellova back up plan.

 

[Yo GabbaPentin]

The opioids do get to me. I don’t mind prescribing, I think an opioid can help some people, especially the older arthritis in ever joint people. But seeing a lot of younger patients on opioids, fibro on opioids, legacy patients, etc, does get to me.

The weekend or late evening scheduled trach/peg cases that I had no ability to turn down also got to me. Every specialty will definitely have things that get to you. In my opinion, 15% pay leading to much less freedom would not equal an improvement in happiness.

 

[RoloTomassi]

The worst thing about pain is opioids. Solutions: build a non-opioid practice, as several others here have done (takes effort, like all good things), or work with ortho/nsg (they're not all bad).

 

[drusso]

Pain was the dream of the 1990s. It's now been mostly cannibalized by Noctors and Mid-levels.

Pain surgeons have no one to blame but themselves for letting it happen.

As someone starting pain fellowship this July, how worried should I be about my future. I keep reading stuff like this everywhere.

 

[nopain1234]

Pain was the dream of the 1990s. It's now been mostly cannibalized by Noctors and Mid-levels.

Pain surgeons have no one to blame but themselves for letting it happen.

Really anesthesia as a whole has nobody to blame but themselves outside of CCM.

Can you expand on “Noctors and mid-levels” cannibalizing pain? I wasn’t aware this has already happened but know a ton of CRNAs are working to encroach on the specialty

 

[Timeoutofmind]

Interesting reading this thread as the two main things I like about pain over anesthesia (I do both) have not been mentioned:

1. Anesthesia is largely cookie cutter and obvious. Not always, but often. Whereas, in pain, I see people every day with previously missed diagnoses. I always have my thinking cap on. Saw a polymyalgia rheumatica, hip OA, and new compression fracture Friday. All missed by other providers. And many, many more every day with poorly managed diagnoses. You can make a massive difference in people's lives in pain. Is there pain coming from their hip or their back? Walking them around after a flouro guided hip inj and explaining that 100% relief with the local = hip is the pain generator, and then explaining all the incidental lumbar MRI findings that their PCP ordered are not relevant to their primary pain complaint. Or the conversations we have every day regarding if a patient should see a spine surgeon or not based on their pathology and comorbidities etc. For instance, I don't send anyone to surgery for axial pain. Think about if these unfortunate patients saw a pain doc/NP/PA on the gravy train of an ortho wack-a-back practices all around me. Game over.

I went into medicine to help people and make a difference in the world.

2. In pain, I can control what procedures I am doing, how I am doing them, when I am doing them. Same with meds. In Anesthesia, you take on the surgeon's risk, CRNA you are suprivising's risk, OR nurse risk, PCP who medically "cleared them", etc as if an injury occurs, they are going to name everyone.

 

[Dr. Ice]

I’ve always found anesthesia to be an interesting profession. I also find it extremely interesting that anesthesiologists would want to treat pain in an outpatient setting. From my observation, from working with anesthesiologists in the asc, they really have minimal interest even doing the most minimal interaction with, let’s call them “people.” One of our gas dudes obviously has so much disdain for “people” that he forces their head into pillow as he pushes his cocktail, chanting..”ok enough talking, time to relax.” This guy also practices pain on the side.

I’m a physiatrist. The entire speciality is based on listening and dealing with complaints. Pain complaints, in every way. Their physical complaints, psychological complaints, family complaints, “functional” complaints. And by training, I’m supposed to sit there and listen to all of this with a empathetic face.

I wonder if my anesthesia colleagues can do this, fake it as well as me for even half the time that I am trained to do it regularly, or whether or not it even matters. Because pain patients are very difficult to dealt with.

My skill set, after 12 years of experience, I can assure anyone is on par with any subspecialty trained individual..regardless of my training. And I would emplore anyone on this site to take me up on it.

For those of you doing anesthesia and pain..how do you split your personality so well? This is a genuine question, as I imagine most of you went into anesthesia would like to minimize actual human interaction, or at least limit it to 3-5 minutes max

 

[Ducttape]

as a boarded pain doc, boarded nonpracticing anesthesiologist, a former boarded internist and former ER doc, i can guarantee you i spend a lot more time talking to patients than you do. in contradistinction, the "biggest" pain doc in this area who wants to be a KOL is PMR and is notorious for spending almost no time with patients and making his midlevels do all of his face to face.


where we came from doesnt necessarily determine how much actual time we spend talking to patients, or how hard we work. my procedure days are my fun days and a lot less stressful.

 

[hiyaman]

The area where you practice also matters. My general neck of the woods every pain patient has been put on opioids unless they're brand new patient. And usually "new patients" are either been seen by 1-2 pain docs previously or are on opioids from PCP that is now retired.

 

[cowboydoc]

as a boarded pain doc, boarded nonpracticing anesthesiologist, a former boarded internist and former ER doc, i can guarantee you i spend a lot more time talking to patients than you do. in contradistinction, the "biggest" pain doc in this area who wants to be a KOL is PMR and is notorious for spending almost no time with patients and making his midlevels do all of his face to face.


where we came from doesnt necessarily determine how much actual time we spend talking to patients, or how hard we work. my procedure days are my fun days and a lot less stressful.

Certainly, you can appreciate that you are FAR from the the average, and your anecdotal experience doesn't negate the generalization. There is a fair degree of self-selection in medical specialties. Most don't go into anesthesia to socialize at work. Many are drawn to PM&R for reasons that include more patient face time. Similarly, the average radiologist doesn't seem like the type that would gravitate toward a pain clinic.

There are plenty of questionable actors from both primary fields in the specialty. I don't think this was supposed to devolve into yet another "which is a better primary specialty discussion." Individuals change differently based on their experiences. (The same heat that melts the butter, hardens the egg, or something.) I think the commentary on personality and how one approaches this field is interesting.

I think many go into PM&R really liking patient interaction. The training and then work expose one to a ton of everyone else's baggage and, the burnout rate is high in the field, despite the good hours and lifestyle for most. Not sure what that looks like for anesthesia. If a person went into anesthesia because they prefer to deal with sedated patients, doing pain does not make a whole lot of sense.

In my experience, I strongly prefer to play poker and socialize with my local anesthesia colleagues over my PM&R colleagues. I gravitate toward PM&R colleagues at national conferences, as there doesn't seem to be as many of us.

 

[GoBeers]

Certainly, you can appreciate that you are FAR from the the average, and your anecdotal experience doesn't negate the generalization. There is a fair degree of self-selection in medical specialties. Most don't go into anesthesia to socialize at work. Many are drawn to PM&R for reasons that include more patient face time. Similarly, the average radiologist doesn't seem like the type that would gravitate toward a pain clinic.

There are plenty of questionable actors from both primary fields in the specialty. I don't think this was supposed to devolve into yet another "which is a better primary specialty discussion." Individuals change differently based on their experiences. (The same heat that melts the butter, hardens the egg, or something.) I think the commentary on personality and how one approaches this field is interesting.

I think many go into PM&R really liking patient interaction. The training and then work expose one to a ton of everyone else's baggage and, the burnout rate is high in the field, despite the good hours and lifestyle for most. Not sure what that looks like for anesthesia. If a person went into anesthesia because they prefer to deal with sedated patients, doing pain does not make a whole lot of sense.

In my experience, I strongly prefer to play poker and socialize with my local anesthesia colleagues over my PM&R colleagues. I gravitate toward PM&R colleagues at national conferences, as there doesn't seem to be as many of us.

Since we are speaking generalities... I wonder how many anesthesiologists were former surgical residents (including myself) who switched over from the dark side. For me, I pursued pain management as a way to reconnect with the longitudinal and procedural aspect of care.

 

[drusso]

Certainly, you can appreciate that you are FAR from the the average, and your anecdotal experience doesn't negate the generalization. There is a fair degree of self-selection in medical specialties. Most don't go into anesthesia to socialize at work. Many are drawn to PM&R for reasons that include more patient face time. Similarly, the average radiologist doesn't seem like the type that would gravitate toward a pain clinic.

There are plenty of questionable actors from both primary fields in the specialty. I don't think this was supposed to devolve into yet another "which is a better primary specialty discussion." Individuals change differently based on their experiences. (The same heat that melts the butter, hardens the egg, or something.) I think the commentary on personality and how one approaches this field is interesting.

I think many go into PM&R really liking patient interaction. The training and then work expose one to a ton of everyone else's baggage and, the burnout rate is high in the field, despite the good hours and lifestyle for most. Not sure what that looks like for anesthesia. If a person went into anesthesia because they prefer to deal with sedated patients, doing pain does not make a whole lot of sense.

In my experience, I strongly prefer to play poker and socialize with my local anesthesia colleagues over my PM&R colleagues. I gravitate toward PM&R colleagues at national conferences, as there doesn't seem to be as many of us.

Physiatrists aren't much fun at cocktail parties but fun at the gym...

 

[drrosenrosen]

Since we are speaking generalities... I wonder how many anesthesiologists were former surgical residents (including myself) who switched over from the dark side. For me, I pursued pain management as a way to reconnect with the longitudinal and procedural aspect of care.

That's my story too

 

[Ferrismonk]

I did anesthesia because I wanted to go into pain... I'm a nice guy.

Anesthesiologists who don't like awake patients stay in the OR, and if they do a proper fellowship, it's usually Cardiac in my experience.

The nasty anesthesiologists who "do pain on the side" are usually the older ones who didn't do a proper fellowship and just want the money,

 

[Dr. Ice]

as a boarded pain doc, boarded nonpracticing anesthesiologist, a former boarded internist and former ER doc, i can guarantee you i spend a lot more time talking to patients than you do. in contradistinction, the "biggest" pain doc in this area who wants to be a KOL is PMR and is notorious for spending almost no time with patients and making his midlevels do all of his face to face.


where we came from doesnt necessarily determine how much actual time we spend talking to patients, or how hard we work. my procedure days are my fun days and a lot less stressful.

Well then we live in different spheres. All the KOL folk are anesthesia people around me who love to pontificate, go to country clubs with reps, love wires and batteries, and have PAs and NPs do follow ups, narc up so they keep coming back for more of the newest fanciest whatever…etc. Maybe because you are multi speciality trained you have a different life/practice philosophy, but in my geography, I’m not experiencing what you speak of

 

[Ducttape]

Tim Deer is PMR.

Daywood Sayeed is Anesth.

Paul Lynch is Anesth.

Patrick Buchanan is PMR.

David W Lee is PMR. (see ASPN thread)

so both fields have KOLs.

 

[drusso]

Tim Deer is PMR.

Daywood Sayeed is Anesth.

Paul Lynch is Anesth.

Patrick Buchanan is PMR.

David W Lee is PMR. (see ASPN thread)

so both fields have KOLs.

Tim Deer is Anesthesia.

 

[Ducttape]

rechecked, you are correct.

mistook DABPM as DPMR.

 

[nvrsumr]

Ive heard of two of the guys on that list but Im not a fanboy

 

[PainDoc2025]

Tim Deer is PMR.

Daywood Sayeed is Anesth.

Paul Lynch is Anesth.

Patrick Buchanan is PMR.

David W Lee is PMR. (see ASPN thread)

so both fields have KOLs.

Side note, since his name came up - Dr. Deer made 400k from consulting fee payments from various companies in 2020 (breakdown of which companies in the link below). Just from consulting fees and not including clinical salary, pretty insane honestly but good for him.

Open Payments Data - CMS

openpaymentsdata.cms.gov

 

[mid|ine]

Side note, since his name came up - Dr. Deer made 400k from consulting fee payments from various companies in 2020 (breakdown of which companies in the link below). Just from consulting fees and not including clinical salary, pretty insane honestly but good for him.

Open Payments Data - CMS

openpaymentsdata.cms.gov

$2m in 2019. Covid was bad for Tim.

 

[mid|ine]

Looks like I average about $600 per year. That's a rounding error for the big guys. Thats OK, not willing to sell myself or travel that much, even for $2m. I wonder how much he brings in from his clinical practice?

 

[PainDoc2025]

$2m in 2019. Covid was bad for Tim.

Oh my, I didn't even see those 2019 numbers. Insane.

 

[PainDoc2025]

Looks like I average about $600 per year. That's a rounding error for the big guys. Thats OK, not willing to sell myself or travel that much, even for $2m. I wonder how much he brings in from his clinical practice?

It looks like it was founded in 1994 by him with ~4 locations and another Physical Therapy location they seem to own. With 3 physicians, 3 NPs, 2 PAs, and 3 PTs working under him. I'd imagine he makes $1+mil just from the ownership of all those locations.

 

[Iamnew2]

Physiatrists aren't much fun at cocktail parties but fun at the gym...

 

[BobLoblaw78]

It is exactly this sad sack, debbie-downer response that makes them no fun! Otoh, I read the second half of the statement, look at my belly and

 

[Iamnew2]

It is exactly this sad sack, debbie-downer response that makes them no fun! Otoh, I read the second half of the statement, look at my belly and

I don't go to the gym

So sad that we are no fun at cocktail parties.

 

[chudat]

thinking of jumping ship back to my primary specialty too

pain is horrible in saturated coastal cities, low pay, high opioid, workers comp/no fault, low vacations, nonstop patient calls

none of which I have to deal with in my primary specialty

edit#1. not to mention the number of pts you have to see in order to meet collections; working in hospitals is terrible too, having to deal with administrative nuisance, inpatient rounds

 

[GoBeers]

thinking of jumping ship back to my primary specialty too

pain is horrible in saturated coastal cities, low pay, high opioid, workers comp/no fault, low vacations, nonstop patient calls

none of which I have to deal with in my primary specialty

edit#1. not to mention the number of pts you have to see in order to meet collections; working in hospitals is terrible too, having to deal with administrative nuisance, inpatient rounds

what's the typical salary for coastal cities in your experience?

 

[Iamnew2]

what's the typical salary for coastal cities in your experience?

250k starting?

 

[GoBeers]

250k starting?

yikes that's bad.
my colleagues all found PP jobs 280-350k in west coast areas

 

[PainDoc2025]

yikes that's bad.
my colleagues all found PP jobs 280-350k in west coast areas

For Pain or PM&R?

 

[Iamnew2]

For Pain or PM&R?

PM&R right now is in the 300's-400k plus. The pain offers I have been emailed are in the 200's - anywhere from 250-280 to low 300's like 325.

 

[chudat]

yikes that's bad.
my colleagues all found PP jobs 280-350k in west coast areas

Lol hows that good

Much more in anesthesia. Plus if you do anesthesia at community hospitals youre not working throughout most nights. No trauma or crazy cases, just bread and butter all day. No crazy patients not dealing with after hr calls etc

 

[Iamnew2]

Lol hows that good

Much more in anesthesia. Plus if you do anesthesia at community hospitals youre not working throughout most nights. No trauma or crazy cases, just bread and butter all day. No crazy patients not dealing with after hr calls etc

What does anesthesia pay these days?

 

[GoBeers]

Lol hows that good

Much more in anesthesia. Plus if you do anesthesia at community hospitals youre not working throughout most nights. No trauma or crazy cases, just bread and butter all day. No crazy patients not dealing with after hr calls etc

it's better than the 250k listed by other poster. that's why i'm asking you what you consider bad salary in competitive cities like LA, SF, SD ?