Retraining in Pain

[Fpg1245]

Currently board certified in another specialty and seriously considering retraining but still have questions

1. It’s a 1 year fellowship but do people really feel comfortable doing procedures like celiac plexus blocks and SCS after just 1 year?

2. Is there a lot of discrimination among employers of pain docs whether they come from anesthesia or PMR vs radiology and rad onc?

3. Do most pain docs also do any medical therapy like opioid prescribing etc or can you successfully avoid that in a lot of cases?

4. What’s the ideal practice scenario say in a larger area but not nessarily a city?

5. How are you getting patients? Referrals? Direct advertising?

I still have a bit of investigating and I’m sure I’ll have more questions in the future. Appreciate any input though

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[GoBeers]

1. yes
2. no
3. probably most do mix but very very possible to have no opioid practice (it'll just take much longer time to build)
4. that's up to you but i would guess most would love to do private practice community interventional only
5. direct door to door marketing for medicare/PPO, and talking to local ipa/hmo groups to be in network

 

[agolden1]

1. It’s a 1 year fellowship but do people really feel comfortable doing procedures like celiac plexus blocks and SCS after just 1 year?
Yes

2. Is there a lot of discrimination among employers of pain docs whether they come from anesthesia or PMR vs radiology and rad onc?
Depends on the nature of the practice. In my (albeit limited) experience, practices hire what they know. If a group is primarily PMR, they may hire primarily PMR. If mostly anesthesia, they'll stick with anesthesia. Many orthopedic groups in my general area (Northeast) have a strong preference for PMR trained docs over any other specialty. Take a look at the market you want to practice in and see if there are folks practicing who have your specialty background. Perhaps even talk to some practices of interest.

3. Do most pain docs also do any medical therapy like opioid prescribing etc or can you successfully avoid that in a lot of cases?
Mixed bag. It actually can be very rewarding to find solutions PCPs/orthos just don't care about. Not every answer is at the tip of a needle. HOWEVER, make sure you will have the latitude to prescribe how YOU want to prescribe. Not whatever the practice standard is.

You don't want to write medical marijuana and opioids? You should not receive pushback
No benzos and opioids? You should not receive push back. etc.

4. What’s the ideal practice scenario say in a larger area but not nessarily a city?

Whatever makes you happy. Highest hospital employ salaries in the middle of no where (town population 10,000-15,000). Coasts are a bit saturated. Midwest seems good

5. How are you getting patients? Referrals? Direct advertising?

Lunch with referring docs.

I still have a bit of investigating and I’m sure I’ll have more questions in the future. Appreciate any input though

Li

 

[SeniorWrangler]

1. Yes, IF it's a procedurally focused fellowship where you get lots of cases. You can also do extra training through SIS/ASIPP which are pretty cheap when you're a trainee. You should decide on scope of practice when you're picking a fellowship to apply to.
2. Yes.
3. It's up to you, and where you want to practice.
4. See number #3. Fashionable locations, coastal locations, and places with active pain fellowships will probably be saturated.
5. Referrals are the way to go, there are lots of posts on the subject in this forum. Direct advertising may bring in a lot of patients looking for med management.

 

[Pain Applicant1]

1. It’s a 1 year fellowship but do people really feel comfortable doing procedures like celiac plexus blocks and SCS after just 1 year?

Depends how much exposure you have. SCS companies will further train you, don't worry. Refer to a university setting for CPBs if you're not comfortable doing them, etc. Typically in private practice, you want quick, straightforward procedures to maximize your office.


2. Is there a lot of discrimination among employers of pain docs whether they come from anesthesia or PMR vs radiology and rad onc?

There shouldn't be. If you're on your own just make your pts happy and you'll get referrals. If you're employed, keep the pts happy and generate profits for the company. That's all employers really care about.


3. Do most pain docs also do any medical therapy like opioid prescribing etc or can you successfully avoid that in a lot of cases?

Yes, they do, despite them saying they don't. Difficult to avoid.

4. What’s the ideal practice scenario say in a larger area but not necessarily a city?

I like PP and can't imagine being employed.

5. How are you getting patients? Referrals? Direct advertising?

Once established they'll come via word of mouth and through referrals. To break referral patterns when you first start set up lunches through the SCS reps with all providers in your area. Try to impress them by sounding confident but not arrogant.

 

[Fpg1245]

Thank you for the insight.
What are the offers like for new fellows say in city, suburb, or needy areas?
I’m assuming there’s a base salary and production.

 

[TrailRun]

Side question, but is celiac plexus block in the wheelhouse of pain docs? I would assume IR CT guided but am just an EM doc applying to pain so don’t know. Or maybe at fancy places like the Brigham?

 

[Ronin1]

Side question, but is celiac plexus block in the wheelhouse of pain docs? I would assume IR CT guided but am just an EM doc applying to pain so don’t know. Or maybe at fancy places like the Brigham?

It’s in the wheelhouse but I just send them to either the endoscopic ultrasound guys or IR. It’s not really a financially viable procedure for me to do

 

[Agast]

Side question, but is celiac plexus block in the wheelhouse of pain docs? I would assume IR CT guided but am just an EM doc applying to pain so don’t know. Or maybe at fancy places like the Brigham?

If you can do a lumbar sympathetic block, you can do a celiac plexus block, superior hypogastric plexus block. Same skills.

 

[Pain Applicant1]

Side question, but is celiac plexus block in the wheelhouse of pain docs? I would assume IR CT guided but am just an EM doc applying to pain so don’t know. Or maybe at fancy places like the Brigham?

Yes, definitely. I even published an article on it during residency.

I don't do them anymore and i refer them out. If the patient really needed my help I would but I try to avoid procedures that I don't do all time. This way, I can be as efficient as possible and keep the conveyor belt moving along. A procedure not done all the time can slow things down since it would take longer to do.

 

[Ducttape]

I do them not infrequently. Maybe 2 a month.

Should not take any longer than an LSB.

 

[Centurion38]

Celiac blocks are not a big deal. Trans-aortic approach is fun. I put in an IV and pre-load with some crystalloid.

The patients who require celiac plexus blocks on the other hand, are not my cup of tea.