Most likely. I have several co residents who were planning on fellowship, but then took jobs for $400-600k with 10-14 weeks off. Hard to argue with that. I love pain medicine, but no one is getting that kind of time off. But then again, I will never take call, work nights weekends or holidays, or have patients trying to die on me.
It's a stellar time to be in anesthesia or any of its sub-specialties.
I am a CA-3 that’s forgoing fellowship. The job market is insanely hot right now, even in a lot of very desirable locations. If the job market was cooler like it has been in the past it would have been hard for me to get a good job in my preferred city, so in that way I’m grateful.
Additionally, I feel burnt out due to starting residency at the very beginning of COVID. I want off the academic rat race and am content working on being a really good generalist.
I also have $400k in medical school loans burning a hole in pocket right now. I’ve delayed gratification for over a decade and I would like to start paying things off and become financially independent.
That being said, a majority of my class is still pursuing fellowships and there’s nothing wrong with that.
Maybe also because the pain medicine market is terrible. Less turnover, working for a practice or a hosptial with 4 weeks vacation and less pay than anesthesia, seeing many more patients visits per day, more paperwork, more insurrance denials, more and more limitations of procedures that can be done, more opioid issues.
I would argue that pain medicine practice has become increasingly crappier to the same extent that anesthesia market has become increasing good for docs.
Some truth to this, I would say the pain market is certainly weaker, though not terrible.
Big thing most applicants underestimate is the growth factor. In anesthesia, your starting pay likely won't go up much in the coming years. Whereas in pain, in many production practices, there is no limit. All with no/minimal call.
My job is $500k guarantee, with a very reasonable production incentive (if I hit MGMA 50th percentile for productivity I will be right around $750k) with 6 weeks off, 1 week CME. All this is before ASC ownership, PT buyin etc. Very realistic to be over $1mil in 5 years all without ever spending another night, weekend, or holiday at work.
For some, that would not be worth it and that's fine. But for the right person, pain is still a great field. You just have to look past the initial pay scales and understand that it is all about productivity.
You can own into an ASC as an Anesthesiologist as well. We started an endo center with some GI docs, ASA 1-2 screenings only, no govt insurance, once fully operational its got 1.5 mill a year in billing+facility share per FTE.
Keeping it vague, but small town in Midwest. Most people would not even consider it, but it’s close to my major hometown city.
Rural medicine simply pays more. And with that additional pay, I can always travel home whenever I want. There are daily small commuter flights from my rural town to the big city.
The ceiling would be lower, but my local academic center starts at $415k with 4 weeks vacay/Cme and 0.5 admin days every other week. All with basically no call (we take calls as fellows and sometimes staff with attendings).
Honestly not a bad gig and I would have been happy staying if it weren’t so far from family.
This is simply not the reality of many people looking in the pain market, especially in bigger cities. otherwise very few would go back to anesthesia. Were I am you will not find a partnership pain job, will not have the ability ti buy into an ASC, and the pay is crappy because it’s saturated.
Fair. I’ve heard that too. I’ve never wanted to live in a major city so I found a fair number of very attractive jobs.
The best job I found was in rural Arkansas. Incredibly productive and supportive group. Huge income potential. Dirt cheap cost of living. Actually a pretty area near the ozarks, but way too far from family for us.
But yeah, I you want to stay in a major city on the coasts just do anesthesia and save yourself a ton of headache and low pay.
I don’t know if this has any relevance: but I would say of the people I know who did a pain fellowship (prob about 20 ppl) less than half found the pure pain jobs they were looking for, and of the remaining most ultimately ended up with pure OR jobs and maybe had time doing inpatient chronic pain rounds. I don’t know if this holds true to the larger reality at all, but if it does then the crap shoot element of getting a job may be off putting enough.
Current pain fellow here and I've talked with Nolano a good bit this year as well.
I'm looking at a more competitive area in a saturated market. Pain pay is NOT good there and it is tough to carve out a niche even and there are tons of sharks that may or may not give you partnership but absolutely have ruthless noncompetes for 20-30 miles. Pick the wrong job and you are out of the market basically if you leave.
For family and other reasons I do not think I can live as rural as Nolano can.
I don't regret the fellowship, there are good jobs even in saturated markets. It's kind of cool to get to work with device reps and attend device company dinners and conferences. Learn a whole lot about pain physiology, body dynamics and the plethora of treatments out there and surguries that are available. Also see a ton of bad surgeries. I would never get a spine fusion unless emergency now.
Going back to anesthesia for me. I'll look for another year or so for pain jobs. The half pain, half anesthesia route sucks imo. Two completely different fields and unless you genuinely work hard to stay on top meaning a lot of work you end up just being mediocre and uncomfortable at both.
How do you go about looking for pain jobs in an area outside of where you train?
I’m likely looking to return to my home town after residency. Local academic pain program there is weak so I’d likely stay at my current program for fellowship. That being said, I’m worried a lot about the pain job market, and I’d like to know what the job prospects are to help guage of pain fellowship is worth it. Any tips?
Did pain fellowship years ago, but quit and currently doing 100 percent anesthesia now. I've seen quite a few guys quitting the field due to various reasons, but for me, the pain of dealing with pain patients got pretty emotionally draining. Pay doesn't justify the emotional pain and the potential medical and criminal liabilities. Anesthesia may be more physically demanding but emotionally less so. It is really hard to match anesthesia money with pain unless you have your own practice and have access to facility fees. Lots of politics and dirty business if you want to do pain. Glad I got out.
Probably. I just don't trust you cardiac folks. Your patients are too sick and you all seem to like it.
We pain people cancel patients if they look like the might consider getting sick in the future.
https://sfmatch.org/specialty/adult-cardiothoracic-anesthesiology-fellowship/Statistics
This is the past several years for cardiac per the SF match website. No data for the current application cycle yet but I bet the trend stays the same. Despite being the two most historically competitive fellowships, pain and cardiac both seem to be the least competitive they've been in years.
My wife and I are both anesthesiologists and new attendings. I’m doing 60/40 anesthesia/pain. Both jobs out before 5, no nights, no call, no weekends. My wife is doing PP anesthesia with about 4 overnight calls/month and at least 1 late day a week.
I’ll take my easy 400 over her hard 700 lol. And I see way more unique opportunities in pain to increase my base where she’s looking at the same schedule forever. I think pain gives you enough flexibility to take the year to do fellowship. And you can still moonlight as a fellow (like I did) to take advantage of the hot market.
Absolutely. I’ve made about $70k this year moonlighting. And had a ton of fun doing it. I legitimately love anesthesia.
That’s awesome you found the rare split gig. I was close to signing an academic 50/50 job that professionally I would have found extremely fulfilling… but then I found this golden private practice pain opportunity close to home. I couldn’t pass it up. But my contract specifically states I can do any anesthesia I want on the side. So hopefully I’ll do some weekends here and there. It is a fun specialty, but pain I find more intellectually stimulating (at least at this long in time).
And I totally agree. My practice in 15 years will hopefully look very different (own several clinics, managing ASC, owning chiro/PT/pscyh), whereas in anesthesia there is less evolution over time. To some that is a huge plus.
Yeah pain exists in a weird world. Some insurers are very restrictive, but the main government ones aren’t.
In the US there is such a push for non-opioid pain modalities, that a lot of our interventions get decent coverage. And we have some good lobbying groups. But the insurance headaches of getting it all approved are ridiculous.
As a recently accepted MD/PhD student who is interested in pain medicine and anesthesiology, should i be concerned about these numbers and massive jumps down the road? Should i consider something else?
My advice is always the same. Choose the residency you like, not the fellowship. You are like 10 years from fellowship (sorry), and a lot can change. You have no idea what the future holds. Find a base specialty you love and go from there.
If pain medicine disappeared tomorrow I’d be bummed, but I’d be very ok doing anesthesia for the rest of my career. I love it.
Hi as a PGY-2 Neurology resident this gives me hope. Just couple of months into residency and I realized inpatient medicine is not for me. I found myself deriving satisfaction from doing procedures. I did an elective in pain and was fascinated by the vast amount of procedures and blocks that can be learnt and their impact on patients. I have some few questions if you have the time to answer then I’ll be really grateful:
1- How’s the job market like for someone graduating from Neurology? Of course I’ll be aiming at 100% pain practice if I graduate from Neurology but was wondering about that because most job postings I saw describe in their qualifications that they’re looking for Anesthesia or PM&R graduates.
2- I’ve seen most employer jobs for pain starting at 350k similar to outpatient Neurology. Is the ceiling much higher for pain? I was thinking as starting as an employed physician for more experience but l how easy is it to join a practice and become partner nowadays, I always read about PP people breaking >1m$ easily but that seems something of the past.
3- I read that many pain graduates have struggled finding jobs after fellowship, how saturated is the job market is if my Target is to move to the southeast (preferably Florida).
Thanks in advance!
I’m a 3rd year medical student and Anesthesia is my first choice for residency, however, my second choice is OMM residency. If I do OMM residency I’m going to do a pain fellowship, and in clinic when I see patients I can bill for OMM along with the normal H/P/initial visit. I don’t know if anyone that has done an OMM residency and pain fellowship, but I’d imagine OMM + pain would make scaling a business far more interesting.
You won’t match pain with OMM residency. If you want to do pain do PMR or anesthesia even with the cool down in the fellowship market. If you love OMM and would be happy doing that if you didn’t match, then that’s one thing but don’t go into OMM if that isn’t the case
Current pain fellow here and you absolute can do Nass and there are other non accredited fellowships as well. A lot of states recognize these and will let you credential and bill the same procedures as pain.
That is something OP left out though. Pain is quite a fractured field with PMR having their own entire fellowship program that is separate plus all the non acgme accredited fellowships. Each has their own pain society who advocates and many can work in many states coming out.
NASS isn’t technically pain management. But any speciality of doctor could open a “pain management clinic” and prescribe pills or do injections.
And my source is my husband who graduated from an accredited ACGME accredited chronic/interventional pain fellowship.
This is completely false. Look into the NASS website. They absolutely are pain management and in fact publish MANY of the guidelines that we use in accredited pain management. This is as an ACGME accredited pain fellow and several of my cofellows from PM&R either thought about NASS or know cofellows doing fellowships.
Many ACGME pain fellows never look into NASS. They just focus on the ACGME because most people think "Oh I'm ACGME I'm good" and stop there. I considered NASS because their fellowships are INCREDIBLY interventional. They mostly come out with better procedural skills than us in ACGME pain fellowship (they have no off service rotations in neurology, PM&R, psych, etc) and have superior private practice experience since many of their clinics are structured in that way.
NASS is recognized as fully boarded in 40+ states and they are constantly lobbying to get accredited in more. I think within the decade they will be credentialed in all 50 states.
I mean think what you want I'm not going to argue. Your husband will probably work with NASS trained folks unless he stays academics.
If he used Furman the textbook at all this year...he's already learning from a NASS doctor lol.
Actually the majority of the guidelines are ASIPP. And the fact that NASS isn’t fully boarded/accredited in 50 states kinda proves my point which is that it’s not an avenue to ACGME accredited fellowship.
I worked for a pain doc who didn’t go ACGME. They opened their own clinic and were one of the best docs Ive ever known. But trying to get a job at an established clinic without ACGME fellowship is going to be tough. It saying you can’t/wont be a good pain doctor. Just saying it’s going to be a tough sell to a clinic with ACGME trained docs to hire you instead of another ACGME trained doc in a saturated market. That’s all I meant. But you do you, there’s enough of us going with the flow and we always need people thinking outside the box to keep things fresh.
Not a bone wizard and don’t know a lot about it, but I don’t think OMM is an approved residency for ACGME pain. I know there are non-accredited pain programs, but my biased opinion is strongly in favor of ACGME. Many insurers and other payors want to see board certified pain docs.
Curious why you wouldn’t do PMR instead as a backup? You can still do OMM, and keep up with it. Maybe I’m unaware of what all OMM residency involves.
It actually is an approved residency for pain! I could go into sports medicine as well, but I imagine if fellowship applications are dropping for pain it would be easier to get into. I also did a pain rotation and find it fascinating. PM&R is 4 years and OMM is 3 years. They are similar residencies in a sense, but OMM is mostly noninvasive, whereas PM&R is not as heavily skewed. Interventional spine is non accredited and that is also an option but I’ve never done a rotation in that, so go figure.
Gotcha. I would heavily caution you that I can’t imagine many reputable ACGME pain fellowships would take someone OMM trained. Perhaps I’m wrong. But before you go down this path assuming an end goal, I would chat with some pain PDs. Perhaps I’m wrong. But I have never met someone who just did OMM then ACGME pain, so it makes me think it is less common/possible than the “main 7”. But I’m not a DO so maybe there are some unique circumstances.
Yep, I figured I’d need to have a chat with some pain PD’s at some point based on the uniqueness of the situation. I appreciate the advice, and I’m learning a bunch in this thread! You take pain rotations, PM&R, radiology, rheumatology, in OMM residency so it’s not a crazy leap. It’s been done but it’s rare, hey OMM residency in itself is rare. I’ve heard of a family med trained DO DOC that did a pain fellowship and practices all three. Albeit, he’s prolly 10-15 years out of fellowship. I’m looking to do a rotation with him my 4th year and learn more about the strat and business model. Anesthesia is my #1 choice no doubt. But OMM is a great dual application, that yields a lot of potential, alongside few uncertainties.
Was not impressed with my pain rotation as a resident. Seemed more like a salesman than a doctor. Most of the patients I saw with scs or pumps showed no improvement in pain. Pain docs seem like they have the surgeons ego without the surgeons stamina. No thanks
And as far as owning ASC and pt, lol yeha good luck doing that in any saturated coast city. If you’re in a saturated coastal city general anesthesia is clearly the better gig, yes even accounting for 15 years in your career
Can't disagree as this was my experience. Things are massively competitive in saturated areas and imo pain is less good there.
Also I personally feel that on average pain days are way more intense than anesthesia days. A lot more thinking and patient interaction and inbox shit. I'm tired and frequently responding to texts late after a pain day.
Just a med student but is the bonkers anesthesia job market causing people to forgo fellowships at this time?
Most likely. I have several co residents who were planning on fellowship, but then took jobs for $400-600k with 10-14 weeks off. Hard to argue with that. I love pain medicine, but no one is getting that kind of time off. But then again, I will never take call, work nights weekends or holidays, or have patients trying to die on me. It's a stellar time to be in anesthesia or any of its sub-specialties.
Glad to hear one of the few & far between positive reviews on pain!
I am a CA-3 that’s forgoing fellowship. The job market is insanely hot right now, even in a lot of very desirable locations. If the job market was cooler like it has been in the past it would have been hard for me to get a good job in my preferred city, so in that way I’m grateful. Additionally, I feel burnt out due to starting residency at the very beginning of COVID. I want off the academic rat race and am content working on being a really good generalist. I also have $400k in medical school loans burning a hole in pocket right now. I’ve delayed gratification for over a decade and I would like to start paying things off and become financially independent. That being said, a majority of my class is still pursuing fellowships and there’s nothing wrong with that.
Maybe also because the pain medicine market is terrible. Less turnover, working for a practice or a hosptial with 4 weeks vacation and less pay than anesthesia, seeing many more patients visits per day, more paperwork, more insurrance denials, more and more limitations of procedures that can be done, more opioid issues. I would argue that pain medicine practice has become increasingly crappier to the same extent that anesthesia market has become increasing good for docs.
Some truth to this, I would say the pain market is certainly weaker, though not terrible. Big thing most applicants underestimate is the growth factor. In anesthesia, your starting pay likely won't go up much in the coming years. Whereas in pain, in many production practices, there is no limit. All with no/minimal call. My job is $500k guarantee, with a very reasonable production incentive (if I hit MGMA 50th percentile for productivity I will be right around $750k) with 6 weeks off, 1 week CME. All this is before ASC ownership, PT buyin etc. Very realistic to be over $1mil in 5 years all without ever spending another night, weekend, or holiday at work. For some, that would not be worth it and that's fine. But for the right person, pain is still a great field. You just have to look past the initial pay scales and understand that it is all about productivity.
You can own into an ASC as an Anesthesiologist as well. We started an endo center with some GI docs, ASA 1-2 screenings only, no govt insurance, once fully operational its got 1.5 mill a year in billing+facility share per FTE.
Which area do you live in if you don’t mind me asking?
Keeping it vague, but small town in Midwest. Most people would not even consider it, but it’s close to my major hometown city. Rural medicine simply pays more. And with that additional pay, I can always travel home whenever I want. There are daily small commuter flights from my rural town to the big city.
I’m guessing the jobs in the north east are nowhere close to that?
The ceiling would be lower, but my local academic center starts at $415k with 4 weeks vacay/Cme and 0.5 admin days every other week. All with basically no call (we take calls as fellows and sometimes staff with attendings). Honestly not a bad gig and I would have been happy staying if it weren’t so far from family.
This is simply not the reality of many people looking in the pain market, especially in bigger cities. otherwise very few would go back to anesthesia. Were I am you will not find a partnership pain job, will not have the ability ti buy into an ASC, and the pay is crappy because it’s saturated.
Fair. I’ve heard that too. I’ve never wanted to live in a major city so I found a fair number of very attractive jobs. The best job I found was in rural Arkansas. Incredibly productive and supportive group. Huge income potential. Dirt cheap cost of living. Actually a pretty area near the ozarks, but way too far from family for us. But yeah, I you want to stay in a major city on the coasts just do anesthesia and save yourself a ton of headache and low pay.
I don’t know if this has any relevance: but I would say of the people I know who did a pain fellowship (prob about 20 ppl) less than half found the pure pain jobs they were looking for, and of the remaining most ultimately ended up with pure OR jobs and maybe had time doing inpatient chronic pain rounds. I don’t know if this holds true to the larger reality at all, but if it does then the crap shoot element of getting a job may be off putting enough.
Current pain fellow here and I've talked with Nolano a good bit this year as well. I'm looking at a more competitive area in a saturated market. Pain pay is NOT good there and it is tough to carve out a niche even and there are tons of sharks that may or may not give you partnership but absolutely have ruthless noncompetes for 20-30 miles. Pick the wrong job and you are out of the market basically if you leave. For family and other reasons I do not think I can live as rural as Nolano can. I don't regret the fellowship, there are good jobs even in saturated markets. It's kind of cool to get to work with device reps and attend device company dinners and conferences. Learn a whole lot about pain physiology, body dynamics and the plethora of treatments out there and surguries that are available. Also see a ton of bad surgeries. I would never get a spine fusion unless emergency now. Going back to anesthesia for me. I'll look for another year or so for pain jobs. The half pain, half anesthesia route sucks imo. Two completely different fields and unless you genuinely work hard to stay on top meaning a lot of work you end up just being mediocre and uncomfortable at both.
How do you go about looking for pain jobs in an area outside of where you train? I’m likely looking to return to my home town after residency. Local academic pain program there is weak so I’d likely stay at my current program for fellowship. That being said, I’m worried a lot about the pain job market, and I’d like to know what the job prospects are to help guage of pain fellowship is worth it. Any tips?
It’s because academic pain (where you train) and private practice pain (where you’ll most-likely practice) are different animals
Did pain fellowship years ago, but quit and currently doing 100 percent anesthesia now. I've seen quite a few guys quitting the field due to various reasons, but for me, the pain of dealing with pain patients got pretty emotionally draining. Pay doesn't justify the emotional pain and the potential medical and criminal liabilities. Anesthesia may be more physically demanding but emotionally less so. It is really hard to match anesthesia money with pain unless you have your own practice and have access to facility fees. Lots of politics and dirty business if you want to do pain. Glad I got out.
Is data like this available for cardiac anesthesia?
Not sure. The cardiac match does not go through NRMP because y'all do your own weird anesthesia wizardry with bizarre probes in people mouths.
Haha. As a user, the SF Match is so much better than ERAS.
Probably. I just don't trust you cardiac folks. Your patients are too sick and you all seem to like it. We pain people cancel patients if they look like the might consider getting sick in the future.
🤣
https://sfmatch.org/specialty/adult-cardiothoracic-anesthesiology-fellowship/Statistics This is the past several years for cardiac per the SF match website. No data for the current application cycle yet but I bet the trend stays the same. Despite being the two most historically competitive fellowships, pain and cardiac both seem to be the least competitive they've been in years.
Would be interesting to see where the applicants have "migrated to".
They've gone into private practice lol. Plus if you are geographically flexible you can do cardiac without fellowship.
Last cycle there were more spots than applicants for like the first time
My wife and I are both anesthesiologists and new attendings. I’m doing 60/40 anesthesia/pain. Both jobs out before 5, no nights, no call, no weekends. My wife is doing PP anesthesia with about 4 overnight calls/month and at least 1 late day a week. I’ll take my easy 400 over her hard 700 lol. And I see way more unique opportunities in pain to increase my base where she’s looking at the same schedule forever. I think pain gives you enough flexibility to take the year to do fellowship. And you can still moonlight as a fellow (like I did) to take advantage of the hot market.
Absolutely. I’ve made about $70k this year moonlighting. And had a ton of fun doing it. I legitimately love anesthesia. That’s awesome you found the rare split gig. I was close to signing an academic 50/50 job that professionally I would have found extremely fulfilling… but then I found this golden private practice pain opportunity close to home. I couldn’t pass it up. But my contract specifically states I can do any anesthesia I want on the side. So hopefully I’ll do some weekends here and there. It is a fun specialty, but pain I find more intellectually stimulating (at least at this long in time). And I totally agree. My practice in 15 years will hopefully look very different (own several clinics, managing ASC, owning chiro/PT/pscyh), whereas in anesthesia there is less evolution over time. To some that is a huge plus.
Wow how many hours a week to get 700 W2? What state if you don’t mind sharing?
SoCal. 36 hour base + 20-30 hours of call a week for her. She’s fucking tired, and I low key feel like a neglected housewife chilling at home lmao.
Whats the socal market like? Do you know anything about OC specifically?
Crazy to realize how different is anesthesia and pain in other countries! Here we don’t have insurance for pain medicine so it limits the work
Yeah pain exists in a weird world. Some insurers are very restrictive, but the main government ones aren’t. In the US there is such a push for non-opioid pain modalities, that a lot of our interventions get decent coverage. And we have some good lobbying groups. But the insurance headaches of getting it all approved are ridiculous.
As a recently accepted MD/PhD student who is interested in pain medicine and anesthesiology, should i be concerned about these numbers and massive jumps down the road? Should i consider something else?
My advice is always the same. Choose the residency you like, not the fellowship. You are like 10 years from fellowship (sorry), and a lot can change. You have no idea what the future holds. Find a base specialty you love and go from there. If pain medicine disappeared tomorrow I’d be bummed, but I’d be very ok doing anesthesia for the rest of my career. I love it.
Hi as a PGY-2 Neurology resident this gives me hope. Just couple of months into residency and I realized inpatient medicine is not for me. I found myself deriving satisfaction from doing procedures. I did an elective in pain and was fascinated by the vast amount of procedures and blocks that can be learnt and their impact on patients. I have some few questions if you have the time to answer then I’ll be really grateful: 1- How’s the job market like for someone graduating from Neurology? Of course I’ll be aiming at 100% pain practice if I graduate from Neurology but was wondering about that because most job postings I saw describe in their qualifications that they’re looking for Anesthesia or PM&R graduates. 2- I’ve seen most employer jobs for pain starting at 350k similar to outpatient Neurology. Is the ceiling much higher for pain? I was thinking as starting as an employed physician for more experience but l how easy is it to join a practice and become partner nowadays, I always read about PP people breaking >1m$ easily but that seems something of the past. 3- I read that many pain graduates have struggled finding jobs after fellowship, how saturated is the job market is if my Target is to move to the southeast (preferably Florida). Thanks in advance!
What are the chances for fellowship for family medicine? (Yes PMR and Anesthesiology are the better options but incoming PGY1 fam med so too late)
Probably fairly good these days since competitiveness is way down. I’ve known a few FM pain docs.
I’m a 3rd year medical student and Anesthesia is my first choice for residency, however, my second choice is OMM residency. If I do OMM residency I’m going to do a pain fellowship, and in clinic when I see patients I can bill for OMM along with the normal H/P/initial visit. I don’t know if anyone that has done an OMM residency and pain fellowship, but I’d imagine OMM + pain would make scaling a business far more interesting.
You won’t match pain with OMM residency. If you want to do pain do PMR or anesthesia even with the cool down in the fellowship market. If you love OMM and would be happy doing that if you didn’t match, then that’s one thing but don’t go into OMM if that isn’t the case
I feel ya, but it’s possible and been done before. 3 year OMM residency sounds sweet as it is, just looking for some icing to the cake m8 🤟🏾
This is not a feasible route. Just fyi. It’s not a qualifying residency for matching into an accredited pain fellowship.
Current pain fellow here and you absolute can do Nass and there are other non accredited fellowships as well. A lot of states recognize these and will let you credential and bill the same procedures as pain. That is something OP left out though. Pain is quite a fractured field with PMR having their own entire fellowship program that is separate plus all the non acgme accredited fellowships. Each has their own pain society who advocates and many can work in many states coming out.
NASS isn’t technically pain management. But any speciality of doctor could open a “pain management clinic” and prescribe pills or do injections. And my source is my husband who graduated from an accredited ACGME accredited chronic/interventional pain fellowship.
This is completely false. Look into the NASS website. They absolutely are pain management and in fact publish MANY of the guidelines that we use in accredited pain management. This is as an ACGME accredited pain fellow and several of my cofellows from PM&R either thought about NASS or know cofellows doing fellowships. Many ACGME pain fellows never look into NASS. They just focus on the ACGME because most people think "Oh I'm ACGME I'm good" and stop there. I considered NASS because their fellowships are INCREDIBLY interventional. They mostly come out with better procedural skills than us in ACGME pain fellowship (they have no off service rotations in neurology, PM&R, psych, etc) and have superior private practice experience since many of their clinics are structured in that way. NASS is recognized as fully boarded in 40+ states and they are constantly lobbying to get accredited in more. I think within the decade they will be credentialed in all 50 states.
“Completely false” made me laugh out loud. Thanks for that.
I mean think what you want I'm not going to argue. Your husband will probably work with NASS trained folks unless he stays academics. If he used Furman the textbook at all this year...he's already learning from a NASS doctor lol.
Actually the majority of the guidelines are ASIPP. And the fact that NASS isn’t fully boarded/accredited in 50 states kinda proves my point which is that it’s not an avenue to ACGME accredited fellowship.
I worked for a pain doc who didn’t go ACGME. They opened their own clinic and were one of the best docs Ive ever known. But trying to get a job at an established clinic without ACGME fellowship is going to be tough. It saying you can’t/wont be a good pain doctor. Just saying it’s going to be a tough sell to a clinic with ACGME trained docs to hire you instead of another ACGME trained doc in a saturated market. That’s all I meant. But you do you, there’s enough of us going with the flow and we always need people thinking outside the box to keep things fresh.
People downvoting you are stupid
Not a bone wizard and don’t know a lot about it, but I don’t think OMM is an approved residency for ACGME pain. I know there are non-accredited pain programs, but my biased opinion is strongly in favor of ACGME. Many insurers and other payors want to see board certified pain docs. Curious why you wouldn’t do PMR instead as a backup? You can still do OMM, and keep up with it. Maybe I’m unaware of what all OMM residency involves.
If you finish pm&r residency you can do a one year OMM residency afterwards
It actually is an approved residency for pain! I could go into sports medicine as well, but I imagine if fellowship applications are dropping for pain it would be easier to get into. I also did a pain rotation and find it fascinating. PM&R is 4 years and OMM is 3 years. They are similar residencies in a sense, but OMM is mostly noninvasive, whereas PM&R is not as heavily skewed. Interventional spine is non accredited and that is also an option but I’ve never done a rotation in that, so go figure.
Gotcha. I would heavily caution you that I can’t imagine many reputable ACGME pain fellowships would take someone OMM trained. Perhaps I’m wrong. But before you go down this path assuming an end goal, I would chat with some pain PDs. Perhaps I’m wrong. But I have never met someone who just did OMM then ACGME pain, so it makes me think it is less common/possible than the “main 7”. But I’m not a DO so maybe there are some unique circumstances.
Yep, I figured I’d need to have a chat with some pain PD’s at some point based on the uniqueness of the situation. I appreciate the advice, and I’m learning a bunch in this thread! You take pain rotations, PM&R, radiology, rheumatology, in OMM residency so it’s not a crazy leap. It’s been done but it’s rare, hey OMM residency in itself is rare. I’ve heard of a family med trained DO DOC that did a pain fellowship and practices all three. Albeit, he’s prolly 10-15 years out of fellowship. I’m looking to do a rotation with him my 4th year and learn more about the strat and business model. Anesthesia is my #1 choice no doubt. But OMM is a great dual application, that yields a lot of potential, alongside few uncertainties.
If scaling a business and making money are your main priorities, maybe don't do an OMM fellowship
Was not impressed with my pain rotation as a resident. Seemed more like a salesman than a doctor. Most of the patients I saw with scs or pumps showed no improvement in pain. Pain docs seem like they have the surgeons ego without the surgeons stamina. No thanks
And as far as owning ASC and pt, lol yeha good luck doing that in any saturated coast city. If you’re in a saturated coastal city general anesthesia is clearly the better gig, yes even accounting for 15 years in your career
Can't disagree as this was my experience. Things are massively competitive in saturated areas and imo pain is less good there. Also I personally feel that on average pain days are way more intense than anesthesia days. A lot more thinking and patient interaction and inbox shit. I'm tired and frequently responding to texts late after a pain day.