difference between int medicine and pain is night and day.
1. the variety - injection day vs clinic day for example.
2. the time you get to spend with the patient is much greater.
3. the fact that, as a specialist, you can say "these medications aren't good for you" and be extremely confident that you are correct.
4. some patients get better from their chronic pain. not many, but some. rarely does anyone ever get better from a chronic IM condition, be it cardiac, pulmonary, diabetic, HTN, etc.
5. its much easier as a pain doc to "discharge" a patient from a practice. just say "I have nothing more to offer, go to Ducttape's clinic." at least that's what happens around me...