Pain from a lifestyle (pay, hours, etc.) stand point

[22yis]

Strictly from a lifestlye (hours, pay, call burden, vacation time), would current fellows/attendings (those with more knowledge than a lowly CA-1) recommend pursuing a pain fellowship strictly for the lifestyle benefits. Aside from lifestyle I do enjoy pain interventions, but I also like general a lot.

Thanks for input

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[William Sparrow]

Strictly for lifestyle? No.

 

[gaspasser127]

Lifestyle is a perk of the field but if you don’t really want to do pain for any other reason i bet you’ll be miserable/get burnt out pretty easily.

The market for general anesthesiologists right now is insane. Basically name your price type of situation. You work nights and weekends doing anesthesia and the work can be stressful but you get A LOT of vacation usually and typically a higher starting salary than pain docs (on average)

 

[drusso]

Private practice pain is 5AM-9PM gig for me.

 

[clubdeac]

36 hr weeks for me

 

[Orin]

Strictly from a lifestlye (hours, pay, call burden, vacation time), would current fellows/attendings (those with more knowledge than a lowly CA-1) recommend pursuing a pain fellowship strictly for the lifestyle benefits. Aside from lifestyle I do enjoy pain interventions, but I also like general a lot.

Thanks for input

Pain doesn't stop. Anesthesia does. The patient's and insurers don't stop asking you for things when you leave the clinic. You don't get morning and lunch breaks. There's not generally a CRNA/AA/resident doing billable work with a patient while you're doing something else in the pain clinic.

Pain's controllable. Anesthesia isn't. You can't pick your patient when you're just providing an anesthetic for a surgeon. You can't pick when the emergency rolls in if you're on call. You can decide not to do hard cases or annoying patients with pain.

The money and vacation and hours are far more variable in pain as compared to anesthesia.

 

[hyperalgesia]

Pain at least has predictable, daytime working hours. You can build an office to your specs, set your own schedule, never set foot in another hospital and maintain a low bp. That's lifestyle.

I think generally speaking high $$ is easier to find in anesthesia, where you can walk into a hospital as a 1099 and walk out with 600k. But I personally would not consider a good lifestyle to include overnight call shifts.

 

[Agast]

If you’re interested in lifestyle, go straight to opening an IV ketamine infusion laser Botox med spa instead of waiting around 15 years and getting burned out. The nice thing is anyone can do that regardless of specialty but you get an edge on the ketamine game coming from anesthesia. When I retire I’ll get a retro ice cream truck and refit it as a mobile Botox van and play “Time is on My Side” through the gated communities and all the ladies will come out clutching their AmEx cards, it’ll be $$$

 

[Ducttape]

like everything else, there are good and bad aspects to pain.

it is more of a lifestyle practice inasmuch as you get to set the hours that you want to work and it pays well. if you want to do 5am to 9pm pain (because of the business part of a pain practice), you can. or you can work 36 hours a week. no overnights. no weekends. no holidays.

however, the patient population is much more complicated and demanding and you cant make them happy and quiet relaxed with a bolus of propofol. it requires far more "paperwork" than anesthesia.



get through your CA2 pain rotation, then decide.

 

[SSdoc33]

getting called in to do a labor epidural at 2 am when you are in your 50's doesnt sound like a great lifestyle to me

 

[jsammi245]

Like others said I wouldn't choose pain strictly for lifestyle. But yes, pain has a better lifestyle than most of the anesthesia jobs out there with set hours, no calls, no holidays and no weekends. However, the job itself isn't that easy. Pain patients can be tough and all the interventions you do may not even help them. I know you like the interventional side of things but also look at the medication side. At least in a competitive market you won't be able to get away with just injections (and not everyone will be an injection candidate). Try to get a feel and ask around when you start your pain rotation.

 

[Pain Applicant1]

Not to beat a broken record, I mean not to sound like a dead horse but if you want lifestyle and moolah consider starting a rural pain practice. We'd be happy to have you (just don't come to where I am and take my pts).

Great pay, great patients, no traffic, and beautiful scenery. Can't beat it.

 

[painballer27]

Not to beat a broken record, I mean not to sound like a dead horse but if you want lifestyle and moolah consider starting a rural pain practice. We'd be happy to have you (just don't come to where I am and take my pts).

Great pay, great patients, no traffic, and beautiful scenery. Can't beat it.

How rural are we talking?

 

[Pain Applicant1]

How rural are we talking?

I would be the wrong person to ask about this as I like to get lost in the wilderness so the more rural and wild the better for me...

...but in reality, it probably doesn't really matter. What's more important is the ratio of the population to the pain doctors. This is what I looked for when I started. I called it a poor man's demographic analysis and used google maps and Wikipedia to obtain the population numbers. I printed out large sections of google maps and taped them together. I then penciled in the population numbers and targeted my catchment area. It was like I was a General planning for war like you see in the movies.

 

[GoBeers]

i'm in private practice pain in west coast. 8-4:30 M-Thur and 7-2 Friday. no weekend, nights, or call. phone system set up to route patients to ED on emergencies. very chill job for me. not sure where I stand regarding annual pay but from a lifestyle perspective, I am very happy.

 

[SSdoc33]

How rural are we talking?

 

[RoloTomassi]

Lifestyle should be considered, but not the highest priority. Cliche, but do what you enjoy the most. If you hate something, 9-5 M-F, no weekend/call will still feel like an eternity and you'll be counting down the days till retirement. Conversely, a more demanding but rewarding job will lead to better long-term career satisfaction.

 

[DrMDAware]

getting called in to do a labor epidural at 2 am when you are in your 50's doesnt sound like a great lifestyle to me

That’s for your 40s as we all know

 

[Baron Samedi]

I work in academic govt practice:
- 7:30am to 4:00pm most days
- 1 week of home call every 3 months, rarely get called
- 1 day admin/OR, 1.5 days clinic, 0.5 days academic, 2 days procedural
- average 9-10 patients a day

Love the lifestyle. I make significantly less money than most, though.

 

[thecentral09]

I’m in an rural area and still work 70 hours/week between actual work/email/home phone calls etc.
Then again, the longer you work for a hospital the more they rely on you for unpaid BS committees, free advertising, training PA’s, educational clinics Etc. Which is also why I’m leaving for private practice

 

[drusso]

I’m in an rural area and still work 70 hours/week between actual work/email/home phone calls etc.
Then again, the longer you work for a hospital the more they rely on you for unpaid BS committees, free advertising, training PA’s, educational clinics Etc. Which is also why I’m leaving for private practice

Can you elaborate on your experiences?

 

[Pain Applicant1]

I’m in an rural area and still work 70 hours/week between actual work/email/home phone calls etc.
Then again, the longer you work for a hospital the more they rely on you for unpaid BS committees, free advertising, training PA’s, educational clinics Etc. Which is also why I’m leaving for private practice

This is the way.

I think going to useless meetings is what really pushed me to start my own practice after fellowship. If you're starting your own PP, feel free to PM me with any questions you have.

 

[clubdeac]

Not to beat a broken record, I mean not to sound like a dead horse but if you want lifestyle and moolah consider starting a rural pain practice. We'd be happy to have you (just don't come to where I am and take my pts).

Great pay, great patients, no traffic, and beautiful scenery. Can't beat it.

take your patients? I thought that's what you'd want. Aren't you retiring?

 

[Asclepius186]

Anesthesia makes more to start with more vacation to start. Pain tends to have higher upside long term, especially in private practice owner scenario and if you can factor in ownership in ASC etc that anesthesiologists don’t have access to.

For me, I enjoyed the practice of pain but I also felt that the long term play in total (financial, life balance, burnout, etc) was better pursuing pain.

 

[painballer27]

How much vacation do most hospital employed pain doctors get? I get that private practice is likely variable

 

[so55b]

How much vacation do most hospital employed pain doctors get? I get that private practice is likely variable

2 years out of training. I get 27 working days off a year excluding holidays. I have 14 sick days but this will lower my RVU production so I never used it. No calls, no weekends so 27 days are more than enough for me.

 

[nopain1234]

Private practice pain is 5AM-9PM gig for me.

Wow explain

I’m a busy guy and nowhere near

 

[Ronin1]

Contract wise I get 35 days but I also take most fridays off. No one cares honestly about the days since I generate lots of revenue

 

[painballer27]

Contract wise I get 35 days but I also take most fridays off. No one cares honestly about the days since I generate lots of revenue

Nice. How many RVUs?

 

[Ronin1]

Nice. How many RVUs?

Right around 10,000 using the old values.

 

[fathead88]

How much vacation do most hospital employed pain doctors get? I get that private practice is likely variable

5 weeks vacation + 1 week CME

 

[Ferrismonk]

graduated PTO yearly, 4 weeks, then 5, then 6.

 

[PainDoc2025]

Right around 10,000 using the old values.

Whats your salary structure?

 

[painballer27]

Right around 10,000 using the old values.

Sounds like you’re raking it in with a ballin lifestyle as well. Is this in a more rural area?

 

[Ronin1]

Base plus wrvu production bonus plus some other bonuses for metrics/directorship. Not rural

 

[agolden1]

Sounds like you’re raking it in with a ballin lifestyle as well. Is this in a more rural area?

Others may have different takes on this, but having gone through the job search a few months ago, it was surprisingly tricky to find a hospital employee job. Most listed online in the Midwest, south, and Las Vegas.

Cold called a number of hospitals in medium sized cities (population 20,000-200,000) within an hour and a half-2 hrs of skiing across northwest and northeast netted essentially no interviews, nor were there any listings. Will be curious to see if this changes over the next year or so.

 

[painballer27]

Others may have different takes on this, but having gone through the job search a few months ago, it was surprisingly tricky to find a hospital employee job. Most listed online in the Midwest, south, and Las Vegas.

Cold called a number of hospitals in medium sized cities (population 20,000-200,000) within an hour and a half-2 hrs of skiing across northwest and northeast netted essentially no interviews, nor were there any listings. Will be curious to see if this changes over the next year or so.

Well that sucks. Did you eventually find a job? And how did things look in the southeast? I’m most interested in that region

 

[drusso]

Wow explain

I’m a busy guy and nowhere near

I'm up around 5 AM, prep charts for the day, 7 AM breakfast meetings, work 8-5 (lunch at the desk), usually 6 PM-8 PM conference calls, after-work meetings, rainmaking, drug rep dinners, etc, 8 PM-10 PM sign notes. In bed by 11 PM. Later, rinse, repeat.

Private practice is all about discipline and focus.

 

[lobelsteve]

I'm up around 5 AM, prep charts for the day, 7 AM breakfast meetings, work 8-5 (lunch at the desk), usually 6 PM-8 PM conference calls, after-work meetings, rainmaking, drug rep dinners, etc, 8 PM-10 PM sign notes. In bed by 11 PM. Later, rinse, repeat.

Private practice is all about discipline and focus.

Do you know the names of your kids? Their friends? Their teachers?

 

[nopain1234]

I'm up around 5 AM, prep charts for the day, 7 AM breakfast meetings, work 8-5 (lunch at the desk), usually 6 PM-8 PM conference calls, after-work meetings, rainmaking, drug rep dinners, etc, 8 PM-10 PM sign notes. In bed by 11 PM. Later, rinse, repeat.

Private practice is all about discipline and focus.

Full baller schedule

 

[Ronin1]

I'm up around 5 AM, prep charts for the day, 7 AM breakfast meetings, work 8-5 (lunch at the desk), usually 6 PM-8 PM conference calls, after-work meetings, rainmaking, drug rep dinners, etc, 8 PM-10 PM sign notes. In bed by 11 PM. Later, rinse, repeat.

Private practice is all about discipline and focus.

What’s your hourly rate for all this. Is it worth it?

 

[bedrock]

I'm up around 5 AM, prep charts for the day, 7 AM breakfast meetings, work 8-5 (lunch at the desk), usually 6 PM-8 PM conference calls, after-work meetings, rainmaking, drug rep dinners, etc, 8 PM-10 PM sign notes. In bed by 11 PM. Later, rinse, repeat.

Private practice is all about discipline and focus.

I think you need to hand off some of that. I work quite hard doing 10hr worksdays each weekday, and generate 14K annual wRVU, but I think you’re working too much. (And I used to own my own practice)

Can’t a nurse do some/all of chart prep?
Do you need a breakfast meeting every day?
You’ve been in PP for for a while now, do you still need to spend that much time marketing?

 

[nvrsumr]

Real baller. Sometimes being successful in PP means drinking from a fire hydrant. Not always easy to titrate.

 

[Orin]

I'm up around 5 AM, prep charts for the day, 7 AM breakfast meetings, work 8-5 (lunch at the desk), usually 6 PM-8 PM conference calls, after-work meetings, rainmaking, drug rep dinners, etc, 8 PM-10 PM sign notes. In bed by 11 PM. Later, rinse, repeat.

Private practice is all about discipline and focus.

Mindfulness Hurts. That’s Why It Works.

Facing the painful parts of life head-on is the only way to feel at home with yourself.

www.theatlantic.com

"Avoiding yourself won’t work in the long run"

 

[drusso]

Do you the names of your kids? Their friends? Their teachers?

Since I did two terms on the school board and lead 3 contract negotiations with the teachers union, they know me.

 

[drusso]

What’s your hourly rate for all this. Is it worth it?

If you want to stay close to the money,

I think you need to hand off some of that. I work quite hard doing 10hr worksdays each weekday, and generate 14K annual wRVU, but I think you’re working too much. (And I used to own my own practice)

Can’t a nurse do some/all of chart prep?
Do you need a breakfast meeting every day?
You’ve been in PP for for a while now, do you still need to spend that much time marketing?

If you want to stay close to the money, you've got to stay engaged in the day-to-day. I also believe in the power of role-modeling. I expect no one to work harder than me and I make that clear every day. I make sure I'm the first in the office and the last to leave. When people complain about their jobs or workload I say with the authenticity of mind and spirit, "Don't sell me problems, sell me solutions. Do as I as do."

Success comes from discipline and it takes a lot of discipline to be in PP.

Which Is Better: Discipline or Motivation?

It takes a consistent effort to truly manage our valuable time.

www.inc.com

 

[RoloTomassi]

I'm up around 5 AM, prep charts for the day, 7 AM breakfast meetings, work 8-5 (lunch at the desk), usually 6 PM-8 PM conference calls, after-work meetings, rainmaking, drug rep dinners, etc, 8 PM-10 PM sign notes. In bed by 11 PM. Later, rinse, repeat.

Private practice is all about discipline and focus.

Seems like you can shave a lot of time off. I'm in a busy PP but I'm more 8-5 M-R.

7-8 AM. Do you have to have a daily AM meeting? We have weekly MD meetings, otherwise the department heads have their own that I don't micromanage.

6-8 PM. I may have a dinner 2x/week but it's important, not drug rep stuff.

8-10 PM. Notes? Why can't you have finished this before leaving, using scribes, templates, less time on sdn?

 

[nimbus]

Pain at least has predictable, daytime working hours. You can build an office to your specs, set your own schedule, never set foot in another hospital and maintain a low bp. That's lifestyle.

I think generally speaking high $$ is easier to find in anesthesia, where you can walk into a hospital as a 1099 and walk out with 600k. But I personally would not consider a good lifestyle to include overnight call shifts.

Occasional overnights and calls are intermixed with precall and postcall days off (our overnight calls are 5pm-7am) and many short days (7-10 or 7 to noon). Anesthesia is a mixed bag.

 

[Ducttape]

now a real baller would have raked in all that money, but have a Jonathan to do all the charting, another Jonathan do procedures, and a 3rd Jonathan attend the sundry meetings...

 

[Pain Applicant1]

take your patients? I thought that's what you'd want. Aren't you retiring?

I'm teetering. Not an easy decision to make but slowly cutting down towards that. Taking it day by day.