Subspecializing pays off?

To make money in pain management, you really need to run a cash business for procedures. A lot of pain managment is medical, and the insurance companies don't pay squat for this.... they're paying less and less for procedures, too. You can make some serious $$$ in pain, but it can be tough to get a cash practice going.

 

unfortunately fellowship training doesn't afford a lot of extra cash in anesthesia except pain.

I've often heard that one never makes up the cash lost during the extra year of training even if he/she works for 30 years.

Anesthesia is different than a lot of specialties in that you are paid for time in the OR not for what you are doing in the OR. (correct me if I'm wrong) I've heard a set price paid per 15 mins of anesthesia time.

I don't think that set price changes any if you are doing pedi hearts vs. gall bladders.

One might get extra compensation in private practice if he/she is fellowship trained and there is a need for that training within their practice. If so, I doubt the extra cash is that significant.

As for ICU, I think the billing is really screwed up where these guys work their arse off and don't get any $$ benefit for it. It is kind of like medicine; they can only bill for what they put in their notes and procedures that they do. All the other thinking is free.

In the end, I would only do a fellowship if I was really interested in doing, something like pedi full time or if I wanted to stay in academics. (Not for the money)

 

MDAs are paid for their time, usually in units of 15 minutes. Yet, there is a baseline value/amount for each case and this varies with complexity and urgency. Thus an emergent pedi heart has a much higher value than an elective lap chole even if both took exactly 1 hour.

I had always been under the impression that other than pain, fellowships don't add monetary value. The dept. chair at Emory said that he has a discounted cash flow model which demonstrates that the net present value of fellowship training is worth about 2 million dollars on average assuming 30 years working as an attending. I never asked him for his model although I should have. I wonder if anyone else remebers hearing this.

 

I agree that unfortunately in anesthesia, your income does not increase with specialization.

Cardiac: Make more per case, but tend to work longer hours so income per hour is about the same.

Peds: May actually make less because you're mostly doing ASA 1 cases, plus you're likely to be practicing in an urban area with a larger population of indigent non-insured patients

OB: Make about the same as a general anesthesiologist, less if you're doing high risk and have higher malpractice

Critical Care: Almost always make less than a general anesthesiologist, hence fellowship programs are desperate for applicants