What's your gut-level reaction to this?
Started by drusso
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This was one of the two reasons why i picked pain over gas. Even though i could maybe make more in gas i still pick pain. You are never your own boss. You are just there to help them do their surgeries.
There are ways to make yourself “less fireable.” I worked for a gas group who wanted to start a pain practice at the hospital. The leader of the group solely wanted to do it so his group would have more lines of service. They also did more for icu particularly after hours. All to make their group less replaceable. That’s smart. But you will always be wondering when you are getting underbid
The other reason i chose pain over gas was as a senior resident you run the board when you are on call and function like the junior attending (at our program it actually meant you were the attending).
We had an ortho attending wanting to add a case at 1 am. I told him it would follow the bowel perf or the finger reattachment. I said the bowel case just went back and the attachment won’t be done till the next am start anyway. So he said fine I’ll just do the case when i come back from vacation. It struck me. Again we have no control, we are just there to make the cases happen. If someone can do it for a nickel less they will do it. I don’t regret my choice.
There are ways to make yourself “less fireable.” I worked for a gas group who wanted to start a pain practice at the hospital. The leader of the group solely wanted to do it so his group would have more lines of service. They also did more for icu particularly after hours. All to make their group less replaceable. That’s smart. But you will always be wondering when you are getting underbid
The other reason i chose pain over gas was as a senior resident you run the board when you are on call and function like the junior attending (at our program it actually meant you were the attending).
We had an ortho attending wanting to add a case at 1 am. I told him it would follow the bowel perf or the finger reattachment. I said the bowel case just went back and the attachment won’t be done till the next am start anyway. So he said fine I’ll just do the case when i come back from vacation. It struck me. Again we have no control, we are just there to make the cases happen. If someone can do it for a nickel less they will do it. I don’t regret my choice.
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capitalism at its finest.
what is there to complain about?
what is there to complain about?
My gut reaction is that’s a crappy salary. He’s better off now.
there appear to be multiple locums jobs for anesthesia around. i get 3-4 phone calls a day from different recruiters.
Which means pain fellowship will become competitive again.
But what about the group of applicants who matched when it was easy? Theymay be systematically discriminated against.
As they maybe should? I think the current pool of applicants is the reason there is a push to increase fellowship to 2 years. If all fellows had the same level of procedural training as an anesthesia resident, there would be zero thought of increasing fellowship length. A neurologist or ER doctor cannot learn all the nuances of neuraxial procedures in 1 year.
Ooo yeah you should say that to BoardingDoc’s face
Hand eye coordination and mental 3D modeling is an innate skill and a few rotations in residency isn’t going to make you superior.
And given the practice model is now mid levels see all the patients and order the (probably wrong) procedure it doesn’t matter how you trained
Hand eye coordination and mental 3D modeling is an innate skill and a few rotations in residency isn’t going to make you superior.
And given the practice model is now mid levels see all the patients and order the (probably wrong) procedure it doesn’t matter how you trained
I’ve learned more out of fellowship than in fellowship and continue to improve. Plenty of bad anesthesia pain docs out there, although hard to tell if it’s bad skills or just greed and laziness.
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I would love to hear you explain how I, a lowly ER doc, was apparently unable to "learn all the nuances" of neuraxial pain procedures in a year, and am currently practicing as an inept dilettante.
The procedural training of anesthesia residents is steadily becoming less useful. The push for fascial plane blocks, loss of thoracic epidurals, lack of fluoro guided procedures, and overall discomfort in clinic makes them harder to work with than physiatry based trainees these days. They're more comfortable in the OR area but they struggle with being the proceduralists.
I agree that the fellowship is too short, so all the nuance isn't going to transfer regardless of your base training, especially with the growth in the variety of procedures we have access to now and the lack of volume in most academic centers.
I agree that the fellowship is too short, so all the nuance isn't going to transfer regardless of your base training, especially with the growth in the variety of procedures we have access to now and the lack of volume in most academic centers.
I graduated residency with over 1,000 labor epidurals, hundreds of pain fluoro procedures, over 700 regional ultrasound guided blocks/catheters, assisted dozens of SCS implants, and the list goes on. Residency training does matter. I understand not all anesthesia residencies are equal and experiences may vary. I’ve learned a lot out of training as well, but those 1000s of needle reps in residency were extremely valuable to my ability as a pain doc. Not saying it’s impossible, but much harder to become a truly capable pain doc from an ER residency or the like…
It depends a lot on the program and on the fellow. During my time as a resident and fellow, the fellow that struggled the most was the former ER resident.
Doesn't mean that someone can't learn, but the volume of exposure is important - either during training or after. Hence, 2 years of fellowship training may be beneficial for those who did not spend 3 months of residency in the pain clinic. But most can become proficient if they choose to do so.
Doesn't mean that someone can't learn, but the volume of exposure is important - either during training or after. Hence, 2 years of fellowship training may be beneficial for those who did not spend 3 months of residency in the pain clinic. But most can become proficient if they choose to do so.
Yeah, that's not the reality for 99% of programs now as volumes are very different.
Either way, each base specialty brings a different value to the table and the key part of capability/quality as an attending is more the individual than the training IMO.
1000 labor epdiurals teaches you bad habits and is counterproductive for image guided for procedures.
There's obviously a benefit to getting reps under your belt. That said, this stuff ain't that hard.
Also, I think you underestimate the general procedural skills one develops in the ER from things like complex wound repair, US guided procedures, chest tubes, LPs, etc etc. Is it needlework? Not exclusively. Does it make you good with your hands? Yes.
I would quite happily pit my procedural skills against my cofellows who were anesthesia. That isn't a dig against them. They're excellent. I'm just saying that the edge they had over me in terms of doing epidurals vanished within the first 6 months of fellowship, just like their surgical skills took a fair bit of time to catch up to mine.
