Will pain fellowship become competitive again?

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clubdeac said:
Easy to do clinic all day and make 50 rvus per day x 4.5 days per week x 48 weeks x whatever $/rvu you want.

$60/wrvu = $650k

Or $70/wrvu = $750k
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Sounds pretty sweet
 
Meyer-Overton said:
Sounds pretty sweet
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Then again you can just be a VP of any large healthcare system and make 7 figures without ever having to go to 13 yrs of school or grinding day in and day out to see 25+ patients per clinic. That’s way sweeter
 
clubdeac said:
Then again you can just be a VP of any large healthcare system and make 7 figures without ever having to go to 13 yrs of school or grinding day in and day out to see 25+ patients per clinic. That’s way sweeter
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Yeah but then you gotta wear suits everyday, who wants to do that 😆
 
Agast said:
Pain requires much less brain power than anesthesiology. Money aside it’s a cakewalk in comparison.
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If you think that, then you’re really not seeing a very diverse panel of patients or you’re missing a lot of other non-spine pathology like vascular claudication, cancer, polymyalgia rheumatica and other rheumatologic diseases like spondylo arthropathies and the like. That’s the best part of my job. Most anesthesiologist I see are doing crossword puzzles or reading the paper. Plus you can do the same job with a fraction of the training, which is what’s beginning to happen in pain. We should be doing everything we can to stop it as it will only hurt the public. Not sure why anesthesiologists gave up their profession so easily
 
clubdeac said:
If you think that, then you’re really not seeing a very diverse panel of patients or you’re missing a lot of other non-spine pathology like vascular claudication, cancer, polymyalgia rheumatica and other rheumatologic diseases like spondylo arthropathies and the like. That’s the best part of my job. Most anesthesiologist I see are doing crossword puzzles or reading the paper. Plus you can do the same job with a fraction of the training, which is what’s beginning to happen in pain. We should be doing everything we can to stop it as it will only hurt the public. Not sure why anesthesiologists gave up their profession so easily
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So outlook not bright then
 
clubdeac said:
If you think that, then you’re really not seeing a very diverse panel of patients or you’re missing a lot of other non-spine pathology like vascular claudication, cancer, polymyalgia rheumatica and other rheumatologic diseases like spondylo arthropathies and the like. That’s the best part of my job. Most anesthesiologist I see are doing crossword puzzles or reading the paper. Plus you can do the same job with a fraction of the training, which is what’s beginning to happen in pain. We should be doing everything we can to stop it as it will only hurt the public. Not sure why anesthesiologists gave up their profession so easily
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IDK. I agree with Agast on this. My time performing anesthetics required more thought and contingency planning that seeing pain patients. It definitely didnt test my patience as much as pain did though.
 
clubdeac said:
If you think that, then you’re really not seeing a very diverse panel of patients or you’re missing a lot of other non-spine pathology like vascular claudication, cancer, polymyalgia rheumatica and other rheumatologic diseases like spondylo arthropathies and the like. That’s the best part of my job. Most anesthesiologist I see are doing crossword puzzles or reading the paper. Plus you can do the same job with a fraction of the training, which is what’s beginning to happen in pain. We should be doing everything we can to stop it as it will only hurt the public. Not sure why anesthesiologists gave up their profession so easily
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Looking for pathology and ordering diagnostic tests is easy in comparison

Are you an anesthesiologist?
 
clubdeac said:
If you think that, then you’re really not seeing a very diverse panel of patients or you’re missing a lot of other non-spine pathology like vascular claudication, cancer, polymyalgia rheumatica and other rheumatologic diseases like spondylo arthropathies and the like. That’s the best part of my job. Most anesthesiologist I see are doing crossword puzzles or reading the paper. Plus you can do the same job with a fraction of the training, which is what’s beginning to happen in pain. We should be doing everything we can to stop it as it will only hurt the public. Not sure why anesthesiologists gave up their profession so easily
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When I was an anesthesia resident, it was not just about diagnosing and evaluating the patient, but added on top of that were confounding factors such as medications, drug effects, interactions of drugs, interactions with the surgeon, etc.

I understand it appears anesthesiologists seem to be slackers and maybe after years of doing the same thing, some are. But the core work of anesthesia is more complex than pain management with significant greater potential for disaster.


Tho neither are as stressful as ER...
 
Agree that pain is not as stressful as OR anesthesia. Better hours, patients’ life support system is generally not at risk, and no freakin’ pager. And in my opinion, the rewards of doing a good job are more perceptible in pain. 8 years removed from the OR, I would still choose pain, hands down.
 
What is the reason for the nationwide anesthesia “shortage”?
 
Agast said:
Looking for pathology and ordering diagnostic tests is easy in comparison

Are you an anesthesiologist?
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Are we talking about brain power or ease of profession? I’m not an anesthesiologist so getting my info from anesthesia friends and seeing anesthesiologists do crossword puzzles during surgery

I think one can make pain really simple without much thinking or can make it as complex as primary care

I trained at a combined anesthesia/PMR pain fellowship. I saw all sorts of zebras. The anesthesia guys weren’t as concerned about the cause of pain as much as they were with treating it. Stim for the leg pain and pump for the back pain. They were skilled and aggressive but didn’t think once about working anyone up for anything. And one could argue that’s not their job.

That’s not remotely close to how I practice
 
clubdeac said:
Are we talking about brain power or ease of profession? I’m not an anesthesiologist so getting my info from anesthesia friends and seeing anesthesiologists do crossword puzzles during surgery

I think one can make pain really simple without much thinking or can make it as complex as primary care

I trained at a combined anesthesia/PMR pain fellowship. I saw all sorts of zebras. The anesthesia guys weren’t as concerned about the cause of pain as much as they were with treating it. Stim for the leg pain and pump for the back pain. They were skilled and aggressive but didn’t think once about working anyone up for anything. And one could argue that’s not their job.

That’s not remotely close to how I practice
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Just curious, why would you be able to argue that it's not their job? Why do you choose to practice differently?
 
clubdeac said:
If you think that, then you’re really not seeing a very diverse panel of patients or you’re missing a lot of other non-spine pathology like vascular claudication, cancer, polymyalgia rheumatica and other rheumatologic diseases like spondylo arthropathies and the like. That’s the best part of my job. Most anesthesiologist I see are doing crossword puzzles or reading the paper. Plus you can do the same job with a fraction of the training, which is what’s beginning to happen in pain. We should be doing everything we can to stop it as it will only hurt the public. Not sure why anesthesiologists gave up their profession so easily
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Are you anesthesia or PMR?
 
slowthai said:
Just curious, why would you be able to argue that it's not their job? Why do you choose to practice differently?
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Bc many don’t. Their job is to control the pain presumably AFTER it has been determined that the pain is not curable or correctable such as functional abdominal or pelvic pain or CRPS.
 
there are certain ways that anesthesiology and ER are very similar.

to wit, hours of boredom intermingled with minutes of shear terror.



and there are certain ways that PMR and internal medicine strike me as being similar.

hours of boredom twiddling thumbs... 😊
 
SSdoc33 said:
the field is fine.

been hearing the doom and gloom for 20 years.

i still make more every year.....
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This is like those boomers who are so disconnected with new hires bc they’ve always established their practice for 20+ years 🙄🙄🙄 your experience Is not reflective of the new job market man
 
kirbydoc said:
This is like those boomers who are so disconnected with new hires bc they’ve always established their practice for 20+ years 🙄🙄🙄 your experience Is not reflective of the new job market man
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Well, then, if you’re an anesthesiologist just do gas work and kill it although apparently you will “need to use more than 10% of your brain” according to some on here as opposed to pain. And if you’re pmr, you can easily see pretzels in a nursing home somewhere, do med management (conservatively) which is still more than most are willing to even touch now, for way less risk than doing spine intervention.

Just like a young buck to constantly blame “boomers” gen x, their parents, the government, McDonalds, Putin, for being “out of touch”

You can survive regardless..you just need the cahones to do so
 
I think anesthesia should just relinquish control of pain once and for all. Y’all have a better job market, and let’s face it, you didn’t choose anesthesia as a primary speciality out of love or empathy for patients. Most of you could most likely not stomach a Tbi, stroke, or sci rotation without being either thoroughly bored/disinterested or just not caring.

I’m mostly kidding…except not really 😆
 
yes most of anesthesiologists do not care about a tbi or stroke or sci rotation.

thats why they didnt do pmr.

similarly, i highly doubt a pmr doc would care about doing an Ob rotation, or an inpatient pain rotation, or spend hours upon hours working in the neuro/spine OR room.
 
Agast said:
Looking for pathology and ordering diagnostic tests is easy in comparison

Are you an anesthesiologist?
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It's the time course of the decision making too. In the OR you have to run through a differential and treat within minutes or even seconds. In pain you can say "alright let's try this injection/med and I'll see you back next month"
 
Dr. Ice said:
I think anesthesia should just relinquish control of pain once and for all. Y’all have a better job market, and let’s face it, you didn’t choose anesthesia as a primary speciality out of love or empathy for patients. Most of you could most likely not stomach a Tbi, stroke, or sci rotation without being either thoroughly bored/disinterested or just not caring.

I’m mostly kidding…except not really 😆
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I don't get it.

Is this supposed to be a dig against anesthesiologists?

What does TBI, Stroke, or SCI have to do with most of interventional pain medicine?
 
Darkside_ said:
I don't get it.

Is this supposed to be a dig against anesthesiologists?

What does TBI, Stroke, or SCI have to do with most of interventional pain medicine?
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Spoken like someone who has never seen a case of cervicogenic headache after whiplash, post-concussion syndrome cephalgia, hemiplegia CROS, SCI osteoporosis resulting in VCF…
 
clubdeac said:
If you think that, then you’re really not seeing a very diverse panel of patients or you’re missing a lot of other non-spine pathology like vascular claudication, cancer, polymyalgia rheumatica and other rheumatologic diseases like spondylo arthropathies and the like. That’s the best part of my job. Most anesthesiologist I see are doing crossword puzzles or reading the paper. Plus you can do the same job with a fraction of the training, which is what’s beginning to happen in pain. We should be doing everything we can to stop it as it will only hurt the public. Not sure why anesthesiologists gave up their profession so easily
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That's easy. Follow the money.
 
As an anesthesiologist, I can guarantee you that anesthesia is WAY more stressful and intellectually rigorous than pain is. Yes, there are lazy stupid people in each profession, but anesthesia is way harder.

People see the anesthesiologist reading or playing a simple game and think they're just zoning out, when in reality they're listening to everything going on in the room and preparing plan A, B, C, and D for every little eventuality that might kill their patient. We work hard to make sure they never happen and everybody just assumes that anesthesia is easy when nothing happens. And trust me, there are LOTS of things that damage patients.

Anesthesia is currently so hot right now because a confluence of factors. One, we got hosed hard during covid and many people simply retired early or quit. Also, it seems that there is an ever-expanding number of locations that need anesthesia staffing and new surgeries that need anesthesia as well.

Meanwhile pain is getting relatively hosed, but it's still much better than standard PMR/Neurology/etc. Now that anesthesiologists aren't applying, there's some wiggle room for the non-anesthesia folks.
 
drusso said:
Spoken like someone who has never seen a case of cervicogenic headache after whiplash, post-concussion syndrome cephalgia, hemiplegia CROS, SCI osteoporosis resulting in VCF…
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Sure. I see this stuff and send it to my friendly non-interventional physiatry colleagues down the hall.
 
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