Anesthesiology - Pain Management

All, I was hoping for some advice, though it may be a little early. I will (hopefully) be matriculating to medical school in the Fall of 2010. I was originally thinking I would go through radiology, but after my volunteering experience have been drawn to anesthesiology by way of pain management. I volunteered in a rehabilitation hospital and saw numerous patients that received this treatment in addition to their exercises. Many of them stated that this not only allowed them to get through the rigorous therapy but also through their daily lives - which especially touched me. I have always considered anesthesiology, but never as greatly as radiology until this experience. I was hoping for some insight into this field, such as demand (which I can only assume is great), competitiveness for residency, typical work day post residency and fellowship. Any other insight would be greatly appreciated. Thanks in advance for all of the comments.

First of all, Pain Management is a fellowship. Fellowships are additional training programs undertake after completion of a residency to sub-specialize.

At this time, Pain Management is a 1 year fellowship for an anesthesia graduate, although there has been talk of expanding it to either 18mos or even 2 years - no official word on that to my knowledge. I am uncertain, but for non-anesthesiologists, the fellowship may already be 2 years. You can enter Pain Management after a couple of different residencies - not just anesthesia. To the best of knowledge, the list is as follows: anesthesia, PM&R (physicial medicine and rehab), psych and neurology. Be sure and check on that list. When I was finishing up my residency (and spent the mandatory month on pain as an anesthesia resident) - only anesthesia & PM&R were allowed, BUT, both psych and neuro had been conditionally approved to be added to the list.

How competitive are these fellowship? Well, I do not think they are too competitive. they are not chip shots, but it is nothing like landing a slot in GI or cardiology.

Pain can be extremely lucrative! I know of more than one Pain Specialist making in the UPPER 6 figure and low 7 figure range. The lifestyle of a pain doc is pretty damned spiffy too. Very few on-call emergencies; so mostly can be dealt with from the bed on the phone. And, some pain docs get sufficient OR time in their fellowships that they can surgical privileges to place spinal cord stimulators and interthecal pumps, which can add substantial $$ to your bottom line.

However, in my humble opinion - and a very commonly held opinion among anesthesia residents - pain is not extremely competitive due to the patient population. While a significant subset of pain patients are essentially healthy folks with pain issues that you can really make better and phenomenally improve their lives, many practices’ pt vase is primarily comprised of long-term chronic pain patients who tend to be a very different cohort than the ones described above.

Of course, please filter my opinion in context of what makes most anesthesiologists tick. Virtually all of us have ADD, abhore the thought of even walking thru a clinic let alone having one, have ZERO interest in any “chronic” care and tend to enjoy the fact that virtually all of our patients are instubated and asleep. We, anesthesiologists are a departure from the ‘norm’ and, as such, the chronic and needy (our perception) nature of chronic pain patients does not truly fit our mold. If I correctly recall, the reason for allowing other specialists to do the fellowship is that there is far more need in the patient population that was being met by anesthesia folks going into pain. The entire specialty is an offshoot of anesthesia, but the personality of the profession and providers is a diverges from what most folks would “see” as an anesthesiologist. So, we opened it up to other types of providers.

One consideration regarding Pain practices is that you would be a physician that brings money into a facility, and as such might be treated differently than purely an anesthesiologist that often has their income supplemented by a hospital, and can be treated more like an employee.

As a practicing anesthesiologist, I have considered returning to do a pain fellowship for this reason.

Overheard from a pain patient this week: “Yeah, I don’t think the Lo’-tabs are enough; I need them higher-up tabs.” Not really germane I just had to share the hilarity.

  • MattFugazi Said:
Overheard from a pain patient this week: "Yeah, I don't think the Lo'-tabs are enough; I need them higher-up tabs." Not really germane I just had to share the hilarity.

LOL! I love it...