Torn PGY3 needing advice

[zenmedic]

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Hello all,

I’m looking for some perspective as I wrap up PGY3. I applied to Interventional Pain at the beginning of this cycle and have a solid number of interviews so far, but I find myself at a crossroads.

To be honest, a primary driver for applying (alongside my interest in MSK and procedures) is the desire to develop a skillset completely distinct from psychiatry. To be clear I love psych, but I have significant concerns about the future of the field, specifically regarding NPs and the potential impact of AI. While I realize pain management has its own set of headaches especially declining reimbursements and the nightmare of increased prior authorizations, it feels like a way to diversify and protect my clinical utility with only one additional year of training. You don't see hospitals allowing mid levels to perform spinal cord stimulations or complex injections in the same way they let NPs have equal practice rights to psychiatrists.

The main drawback is the opportunity cost. I’m tired of training and eager to finally start my life. I even have a great inpatient offer lined up for after graduation if I want it. I’m feeling torn between the long term security of a dual board certification with a procedural skillset vs the immediate appeal of entering the workforce.

Any thoughts or advice would be great.

 

[Cath Up]

Hello all,

I’m looking for some perspective as I wrap up PGY3. I applied to Interventional Pain at the beginning of this cycle and have a solid number of interviews so far, but I find myself at a crossroads.

To be honest, a primary driver for applying (alongside my interest in MSK and procedures) is the desire to develop a skillset completely distinct from psychiatry. To be clear I love psych, but I have significant concerns about the future of the field, specifically regarding NPs and the potential impact of AI. While I realize pain management has its own set of headaches especially declining reimbursements and the nightmare of increased prior authorizations, it feels like a way to diversify and protect my clinical utility with only one additional year of training. You don't see hospitals allowing mid levels to perform spinal cord stimulations or complex injections in the same way they let NPs have equal practice rights to psychiatrists.

The main drawback is the opportunity cost. I’m tired of training and eager to finally start my life. I even have a great inpatient offer lined up for after graduation if I want it. I’m feeling torn between the long term security of a dual board certification with a procedural skillset vs the immediate appeal of entering the workforce.

Any thoughts or advice would be great.

I am a PGY4.

You will have 12 years of post-high school training. My opinion is that doing a 13th year to future-proof your career could be better used both financially and practically towards that same end.

If you took even 1/4 of the time and effort expended in 1 fellowship year (conservatively say 500 hours) and pursued less common psych skills/jobs/arrangements or built relationships in those areas ( e.g. a certain type of therapy, SNF rounding, partial hospitalization attending, medical director stuff, job cobbling, remote call gigs, startup or corporate work, small private practice vacation coverage, licensure in multiple states, clinical expertise in a niche, etc) that would both protect you from encroachment and would contribute to financial goals which would further buffer from your concerns.

 

[comp1]

Pain and psych are only technically possible. I have never actually met anyone who did it. I tend to agree with the above poster. I vote take the inpatient job. If there is something NPs aren't doing now, they will be. There certainly is advanced pain training available for NPs and with just a year, they might end up with more experience than you specific to procedures given what psych residency is like. The good news is that there is plenty of mental health business for everyone.