Pain Medicine is an Official Subspecialty of Emergency Medicine

[Birdstrike]

I asked Chat GPT to write a 100 word essay explaining why Emergency Physicians should consider completing an Interventional Pain Medicine Fellowship:

"While it is not mandatory for all Emergency Physicians to complete an interventional pain medicine fellowship, it can be a valuable addition to their skill set. Interventional pain medicine is a subspecialty that focuses on managing chronic pain through minimally invasive procedures. With chronic pain being a common complaint among emergency department patients, having the ability to perform such procedures can help to alleviate their discomfort and improve their quality of life. Completing an interventional pain medicine fellowship can also increase the range of treatment options available to emergency physicians, enabling them to provide more comprehensive care to their patients. Therefore, while it may not be necessary, completing an interventional pain medicine fellowship can be a wise decision for those looking to expand their expertise and provide more holistic care to their patients."

Not bad.

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[Primo1]

EM attending a few years out of residency interested in pain med...Did a few days of shadowing that went well, but I am finding it really difficult to set up enough days or a rotation to get a pain medicine LOR. I emailed and called tons of places and it doesn't seem like it is going to happen. Any chance to match w out the pain med LOR? Has this path worked for others that did EM-->pain? Any suggestions? Thanks!

 

[TrailRun]

I’m EM applying pain but the general advice I’ve gotten is, it would be near impossible to match without a pain letter. Like you, I was only able to shadow a few times and felt uncomfortable asking for a letter, but did anyway and the pain doc graciously said yes. So it would be worth a shot! I can’t imagine the letter can really speak to your qualities as a physician but that’s what the other letters are for, I’m hopeful it will say you ask good questions and seem motivated. Good
Luck!

 

[Birdstrike]

EM attending a few years out of residency interested in pain med...Did a few days of shadowing that went well, but I am finding it really difficult to set up enough days or a rotation to get a pain medicine LOR.

I’m EM applying pain but the general advice I’ve gotten is, it would be near impossible to match without a pain letter.

It's possible to get an ACGME Pain fellowships without a Pain letter. I did. All my letters were from EM people. But I can say for sure, @Primo1 , it's good if you can get at least one. If you so much as shadowed even for a "few days," ask that person. The worst they can do is say, "No." Make sure you ask someone who's got a good reputation. Unfortunately, there are some with reputations as pill mills or unethical needle-jockies.

When I applied, I decided that getting letters from people that worked side by side with me for years, or ran the department and group I worked in for years would be far more valuable, than a letter from someone I got from someone who barely knew me. I got one from my ED director, the CEO of my group (an EM doc) and from the Chief of Medicine at the hospital, all who were people that knew me and my competency level, for 8 years. They also knew my personality, work ethic and moral compass.

A couple programs required a letter from my residency director (who had long since retired). For those programs, I asked the current director to write one, and he kindly did based on my residency file. It helped that he was a teaching attending when I was there, so he remember me.

I knew that a letter from some random "Pain guy" I shadowed for one day, who didn't know a damn thing about me, wouldn't be worth the paper it was printed, and that anyone not smart enough to know that, wouldn't be someone I would want to train me.

That being said, if I had shadowed anyone in pain prior to applying, I probably still would have asked them to write me a letter, just to have a token Pain letter. But I hadn't actually shadowed anyone yet. The reason I didn't is because I didn't feel comfortable asking someone to let me shadow them, when my intention was to do fellowship, then come back to the area and be their competition. If there was an academic Pain department near me at the time, I would have tried to get in there. But that wasn't an option to me at the time.

As someone who did EM for a decade, that has now done Interventional Pain Medicine for a decade, I can assure you that if you can learn to do LPs, chest tubes, central lines and intubations, then you can learn interventional pain procedures.

TLDR: If you can get a Pain letter from someone you shadowed, get one. If not, letters that mean something from people that can actually assess your competency, work ethic and moral compass, in a meaningful way, will probably suffice.

 

[HemorrhagicShock]

What is the outlook for pain medicine over the next 10 years? Is it still a specialty where you can open up your own practice?

I don't necessarily care about decreasing reimbursement for pain, but how does that look as well? (what good is an EM income if you can do it only for 10 years, and so if pain has decreasing reimbursements, but it's something you could do for 20+ years, then philosophically that seems like a great exit strategy)

Also for the pain guys... do ever miss EM? Many of us have the soul and heart of an ER doctor, and it seems tough to leave that spirit, even though the entire context around EM is completely F'd up.

 

[deadhead2]

What is the outlook for pain medicine over the next 10 years? Is it still a specialty where you can open up your own practice?

I don't necessarily care about decreasing reimbursement for pain, but how does that look as well? (what good is an EM income if you can do it only for 10 years, and so if pain has decreasing reimbursements, but it's something you could do for 20+ years, then philosophically that seems like a great exit strategy)

Also for the pain guys... do ever miss EM? Many of us have the soul and heart of an ER doctor, and it seems tough to leave that spirit, even though the entire context around EM is completely F'd up.

I’m not an expert by any means (just out of fellowship) but it is definitely still possible to start a Pain practice depending on the area you are in. However, PP is becoming more difficult in essentially every specialty due to regulatory burden, site of service differential, hospital/PE acquisition of practices including referral sources, etc. In my area, it would be very tough to open a successful PP.

Like most specialties, Pain also has to deal with decreasing reimbursement for procedures, onerous prior authorization requirements, and stupid insurance/CMS guidelines. Income still seems to be solidly higher than EM though. In my area, I will be making significantly more while working regular hours and no weekends/holidays.

Overall, I find Pain to be very sustainable for now. I can definitely see myself lasting 20-30 years easily. That certainly wasn’t the case for EM.

I certainly don’t miss most of EM, but I realized that EM wasn’t right for me midway through intern year. Then, I started looking for an out. Sure, I miss a good resuscitation or interesting undifferentiated patient, but overall, I have no desire to return to the pit.

 

[GatorCHOMPions]

What is the outlook for pain medicine over the next 10 years? Is it still a specialty where you can open up your own practice?

I don't necessarily care about decreasing reimbursement for pain, but how does that look as well? (what good is an EM income if you can do it only for 10 years, and so if pain has decreasing reimbursements, but it's something you could do for 20+ years, then philosophically that seems like a great exit strategy)

Also for the pain guys... do ever miss EM? Many of us have the soul and heart of an ER doctor, and it seems tough to leave that spirit, even though the entire context around EM is completely F'd up.

I think the outlook is similar to EM in terms of job market, but with more upside. In coastal markets it is very tight, and the barriers to starting your own practice are exceedingly high. You either need to take on huge risk or have backing with family money or other outside investments. Being employed in these markets isn't the worst, though. Starting salaries are around 300-350k and potential to make like 400-600k depending on how much you want to work, and how much you're being taken advantage of, after being established 2-3 years out. In the Midwest, South, and Southwest you can make bigger money with lots of opportunities both employed and with starting up your own thing.

In terms of reimbursement, on the Pain Forum people are always complaining about insurance dropping coverage or reducing payment for this or that procedure but isn't that all of medicine? On the flip side, for those of us who are hospital employed there was a huge bump up of RVU values from 2020 to 2021 for office visits:

In terms of missing EM, I think I miss the idea of it more than the practice of it. I love talking about all the sexy topics in EM, and the coworkers are much cooler, but the day-to-day grind bugs the hell out of me. I am still doing per diem because I am fearful of losing skills, want to make an extra buck while just starting out in Pain, and I think some part of me has Stockholm syndrome.

 

[TrailRun]

Anyone applying Pain this cycle having luck with interviews? I had thought the great Anesthesia job market and overall lower applicant numbers to pain this year would make it easier to match, but I’m wondering if coming from EM is a red flag due to the recent match results and it seeming people want to “escape” EM

 

[Birdstrike]

Also for the pain guys... do ever miss EM? Many of us have the soul and heart of an ER doctor, and it seems tough to leave that spirit, even though the entire context around EM is completely F'd up.

No, I don’t miss EM. If you have the “heart and soul” of an ER doctor, then stay an ER doctor.

 

[Birdstrike]

…I’m wondering if coming from EM is a red flag due to the recent match results and it seeming people want to “escape” EM

Pain is a fellowship. Everyone applying could be said to be “escaping” something, whether EM, PM&R, OR Anesthesia or another specialty. That includes the person interviewing you. This fact doesn’t change year to year.

However, when asked, “Why do you want to do a Pain fellowship?” you should explain why you chose to apply to Pain as opposed to a hundred other paths you could have taken. There’s no need to dwell on the obvious, that everyone in Pain is there, because they wanted something other than their first chosen specialty.

I didn’t try to hide the fact that I wanted out of EM. I explained that while I enjoyed EM for the 10 years I did it (okay, I exaggerated a bit and moved the decimal over from 1.0 to 10.0 years, but I digress) and that I wanted something different for the next 20 years of my career. Then I explained why I thought Pain was a better fit for me, for that part of my career. It was heartfelt at the time and, fast-forward 10 years, turned out to be true. At least 1 program took it to heart. One is all you need.

 

[Birdstrike]

What is the outlook for pain medicine over the next 10 years?

The future of the most important thing about Pain Medicine remains bright. There are no signs that Interventional Pain Physicians will be required to work nights, weekends, holidays or suffer from chronic circadian-rhythm dysphoria, in the future.

 

[Birdstrike]

In terms of missing EM, I think I miss the idea of it more than the practice of it.

Same. I miss the idea of what I thought EM could be and should be, but never what EM turned out to be in reality, for me.

 

[wmcpain]

We are pleased to announce that Westchester Medical Center (WMC) is accepting applications for a fellow for its newly ACGME accredited Chronic Pain Fellowship for the academic year of 2023-2024 (start day July 1 2023).

WMC is a level 1 trauma center and the pain program is a part of the Anesthesiology Department. The WMC Pain Program has grown substantially during the last ten years. Currently the practice does most advanced procedures including Vertiflex, Kyphoplasties, Osteocool, Vertebral Bone Biopsies, Peripheral Nerve Stimulators and Spinal Cord Stimulators (both trials and implants). In addition, we perform several simpler office based procedures including cryoablation, epidurals, sympathetic blocks (including stellates, ganglion impar and celiac plexus blocks) RFAs and nerve blocks. The position does not require any calls.

The multidisciplinary fellowship includes rotations with neurology, mental health, PMR and anesthesiology.

For further inquiries, please forward your CV to [email protected]

 

[Birdstrike]

We are pleased to announce that Westchester Medical Center (WMC) is accepting applications for a fellow for its newly ACGME accredited Chronic Pain Fellowship for the academic year of 2023-2024 (start day July 1 2023).

WMC is a level 1 trauma center and the pain program is a part of the Anesthesiology Department. The WMC Pain Program has grown substantially during the last ten years. Currently the practice does most advanced procedures including Vertiflex, Kyphoplasties, Osteocool, Vertebral Bone Biopsies, Peripheral Nerve Stimulators and Spinal Cord Stimulators (both trials and implants). In addition, we perform several simpler office based procedures including cryoablation, epidurals, sympathetic blocks (including stellates, ganglion impar and celiac plexus blocks) RFAs and nerve blocks. The position does not require any calls.

The multidisciplinary fellowship includes rotations with neurology, mental health, PMR and anesthesiology.

For further inquiries, please forward your CV to [email protected]

Attention EM applicants interested in Pain

 

[Fox800]

I'm interested in applying to pain, and would love to chat with anyone that's gone through the application in the past 2-3 years. Thanks!

 

[ER BlueBlood]

I plan to link up with a personal injury attorney and take his pain/amputee referrals for loads of money. Kyphoplasty all day erryday…That’s what medicine is all about now from what I’m seeing in Austin lol

 

[Birdstrike]

Another one!

Private message, today:

"Hi Birdstrike. Hope you're having a good holiday weekend. Just wanted to say that I ended up matching and couldn't be happier with Pain fellowship. I echo everything you've stated about Pain vs. EM. I'm not stressed out when I'm at work. No one is sick. No one is dying. Pain procedures are fun and satisfying when you're done and injecting medication. The patients are nice and are nowhere near worse than ED patients. I am very happy with my desicion to pursue Pain and have you to thank.

I did want to run one thing by you. I am absolutely rocking it in clinic compared to my anesthesiology and PMR co-fellows. I am quick to see patients. I am concise. I have a sense of urgency to keep our clinic moving. I come up with a differential diagnosis and plan for all of my patient's which I present unprompted to my attendings. They have taken notice and appreciate it. I have my EM training to thank.

I did want to run one thing by you..."

 

[TrailRun]

Good luck to anyone matching tomorrow! I ended up with 2 interviews (only applied to 8 - family reasons).

 

[namethatsmell]

Good luck to anyone matching tomorrow! I ended up with 2 interviews (only applied to 8 - family reasons).

Good luck to you.

EM-->Pain is becoming less and less of a "secret." In recent months more and more of the pain recruiter emails add on EM to Gas and PM&R as base training wanted in their postings. Not to say that the absence of seeing EM specifically listed in a posting should stop anybody from applying; what they all really want is a BE/BC pain doc who has done an ACGME accredited followship.

 

[Birdstrike]

Good luck to anyone matching tomorrow! I ended up with 2 interviews (only applied to 8 - family reasons).

Good luck @TrailRun !

 

[Fox800]

Can someone explain the fellowship application cycle timing? It seems very drawn out and off-cycle from other ACGME accredited fellowships.

 

[doctoroxygen]

Can someone explain the fellowship application cycle timing? It seems very drawn out and off-cycle from other ACGME accredited fellowships.

It’s very long. Applications open December the year before the match and the match happens in the September/October of the year before the July 1 start date.

Good luck to all applicants! Pain fellowship was the best professional decision I ever made.

 

[GatorCHOMPions]

The recent Match results were not the greatest for Pain, but could present an opportunity for more EM docs to join the ranks. There were something like 61 open spots if I am not mistaken. The job market for general anesthesia and PMR, particularly the former, is on fire which is a big factor. The pain job market isn’t all roses either but if you look hard and are somewhat flexible there are good ones out there, and imo the future outlook is still brighter than EM.

 

[TrailRun]

The recent Match results were not the greatest for Pain, but could present an opportunity for more EM docs to join the ranks. There were something like 61 open spots if I am not mistaken. The job market for general anesthesia and PMR, particularly the former, is on fire which is a big factor. The pain job market isn’t all roses either but if you look hard and are somewhat flexible there are good ones out there, and imo the future outlook is still brighter than EM.

any of the EM people on here match? I unfortunately didn't, but really limited myself geographically. It seems there were more unfilled spots than applicants, so if you're flexible on location could have definitely landed a spot this year. I've gotten several scramble interview offers but none work my family. For me, at this point it's hard to know definitely that I would love a career in Pain enough to uproot my family for a year for fellowship (and the hours and paycut it entails). I shadowed a few days and the fluoro procedures seems cool, but as an EM attending can't do a rotation or anything like that. Debating about reapplying next year. Any idea how to best know if this field is a good fit?

 

[GatorCHOMPions]

any of the EM people on here match? I unfortunately didn't, but really limited myself geographically. It seems there were more unfilled spots than applicants, so if you're flexible on location could have definitely landed a spot this year. I've gotten several scramble interview offers but none work my family. For me, at this point it's hard to know definitely that I would love a career in Pain enough to uproot my family for a year for fellowship (and the hours and paycut it entails). I shadowed a few days and the fluoro procedures seems cool, but as an EM attending can't do a rotation or anything like that. Debating about reapplying next year. Any idea how to best know if this field is a good fit?

You won’t know for sure if you’ll love it until you make the leap. I can’t speak to your personal situation but as for me the negatives kept piling on top of the EM side of the scale that ultimately I had enough and said I would take a spot anywhere in the country when I applied. In addition, the positives about Pain were tipping the scale in the same direction. As luck would have it I had to fly my pregnant wife and young child across the country for the fellowship year. Best year of our lives up to this point, and legitimately considered staying, but ultimately we came back to where we were from for my pain job.

In terms of the hours and pay cut, the former is much easier on a family as a pain fellow than EM attending unless you have a unicorn gig but then why are you leaving. As for the income, what I did when I matched was work a couple shifts extra per month to bank some money. Hunker down on spending, too. Finally, most fellowships allow moonlighting during the year.

If you’re hell bent on location and need to beef up the application, keep banging on the doors of pain doctors in your area. Call and email PDs or private practices. Offer to scribe or think of something else useful. Join the local pain societies, network and attend meetings to get your name out there and on research projects. You’ve made it this far as an EM attending, you can do all of the above and more if you want.

 

[Birdstrike]

any of the EM people on here match? I unfortunately didn't, but really limited myself geographically. It seems there were more unfilled spots than applicants, so if you're flexible on location could have definitely landed a spot this year. I've gotten several scramble interview offers but none work my family. For me, at this point it's hard to know definitely that I would love a career in Pain enough to uproot my family for a year for fellowship (and the hours and paycut it entails). I shadowed a few days and the fluoro procedures seems cool, but as an EM attending can't do a rotation or anything like that. Debating about reapplying next year. Any idea how to best know if this field is a good fit?

I got a private message from one EM doc that matched.

 

[swamprat]

any of the EM people on here match? I unfortunately didn't, but really limited myself geographically. It seems there were more unfilled spots than applicants, so if you're flexible on location could have definitely landed a spot this year. I've gotten several scramble interview offers but none work my family. For me, at this point it's hard to know definitely that I would love a career in Pain enough to uproot my family for a year for fellowship (and the hours and paycut it entails). I shadowed a few days and the fluoro procedures seems cool, but as an EM attending can't do a rotation or anything like that. Debating about reapplying next year. Any idea how to best know if this field is a good fit?

Uhh dude the paycut for 1 year is nothing. I pulled in like 715K last year working 9-4 in my W2 pain job. This does not include my other side gigs - some of which (consultant work) I only have because I am a pain MD. Now if you don't like it it is what it is but the paycut/investment of a year of fellowship is well worth it financially with the increased earning potential of a pain MD.

 

[psychemdoc]

Uhh dude the paycut for 1 year is nothing. I pulled in like 715K last year working 9-4 in my W2 pain job. This does not include my other side gigs - some of which (consultant work) I only have because I am a pain MD. Now if you don't like it it is what it is but the paycut/investment of a year of fellowship is well worth it financially with the increased earning potential of a pain MD.

Yes but you’re also easily top 5% of pain and probably in an area not saturated. Nothing wrong with it. Kudos to you. We’re all jealous. It just may not be replicable by many if not most of EM > Pain docs. Birdstrike for example I believe at one point mentioned that he makes around the same. So it is a year of lost income but it’s obviously still worth to it to him if it keeps him practicing as opposed to burning out and leaving altogether which is the worst case scenario for everyone.

 

[swamprat]

Yes but you’re also easily top 5% of pain and probably in an area not saturated. Nothing wrong with it. Kudos to you. We’re all jealous. It just may not be replicable by many if not most of EM > Pain docs. Birdstrike for example I believe at one point mentioned that he makes around the same. So it is a year of lost income but it’s obviously still worth to it to him if it keeps him practicing as opposed to burning out and leaving altogether which is the worst case scenario for everyone.

I live in south florida its saturated trust me - I have a good job I will say that compensates me fairly although they still make a good amount of $ off me. Just need to understand how compensation in pp pain works and what is a fair number ur employer makes off you. I am in the top earning for a non-owner employed pain MD however average for sure is 500K if not a little more.

 

[namethatsmell]

Yes but you’re also easily top 5% of pain and probably in an area not saturated. Nothing wrong with it. Kudos to you. We’re all jealous. It just may not be replicable by many if not most of EM > Pain docs. Birdstrike for example I believe at one point mentioned that he makes around the same. So it is a year of lost income but it’s obviously still worth to it to him if it keeps him practicing as opposed to burning out and leaving altogether which is the worst case scenario for everyone.

The top 5% for pain is well above this number.

Pain pay varies massively and is heavily dependent on what city/region you're in and if you're employed pp vs hospital vs have ownership.
Years into practice (to build up a panel/referrals), opioid vs non-opioid management, local insurance environments, etc all play a big role as well.

I tell every pain-interested EM doc who asks that they'll likely make EM-similar $ or a bit better.

 

[sevo00]

Uhh dude the paycut for 1 year is nothing. I pulled in like 715K last year working 9-4 in my W2 pain job. This does not include my other side gigs - some of which (consultant work) I only have because I am a pain MD. Now if you don't like it it is what it is but the paycut/investment of a year of fellowship is well worth it financially with the increased earning potential of a pain MD.

715k is above 90th percentile for pain. Using this as a convincing factor is a little misleading in my opinion. All the pain docs I know make between 400-500k. That’s awesome that you make that much but the average is actually In the mid 400s. Someone going into pain with the belief that they will be making 715k will be very disappointed…

 

[Birdstrike]

The salary bell curve spreads wider to each side, in Pain, compared to EM. It varies by region, hours worked, type/volume of procedures done, lifestyle, ownership and ethics. You're also paid in reduced stress, better sleep, healthy circadian rhythms and the ability to have a normal life. I've had years where I made more than I did in EM and some where I made less. I don't currently make nearly as much as @swamprat but I have too good of situation in every other way, to rock the boat.

 

[swamprat]

715k is above 90th percentile for pain. Using this as a convincing factor is a little misleading in my opinion. All the pain docs I know make between 400-500k. That’s awesome that you make that much but the average is actually In the mid 400s. Someone going into pain with the belief that they will be making 715k will be very disappointed…

Still 4-500K is prob better than most EM docs outside of locums last i checked the market. I think u can easily find a 500K pain job not so much EM.

 

[Msq995]

EM resident here in a three years program and I matched into pain. With the anesthesia market we have a very good opportunity in matching.

I messaged Bridstrike two years ago and his words were so encouraging and from there I did all of my electives in pain and had three LoRs at the end from pain docs + a PD letter.

 

[miacomet]

I really wish sleep were a subspecialty. I emailed ABEM and they were dinguses.

 

[Apollyon]

I really wish sleep were a subspecialty. I emailed ABEM and they were dinguses.

You expected something else?

 

[miacomet]

You expected something else?

No. But it's stupid. I won't recert and I won't pay them anything.

 

[Goodlife1119]

Could anyone currently practicing Pain speak to the current job market? I have previously heard that the market is not that great and fellows sometimes happen to find jobs where starting pay is not very good. On the other hand, I have also heard the market is okay. Some say that starting offers are low but with meeting RVU goals the overall salary is fine within year one or two. Thank you ahead of time for taking the time to respond.

EDIT: I realize my original post is confusing. My first question is 1. How is the job market? 2. How difficult is it to find a job where you are able to replicate a EM salary within 1-2 years ( without working at a pill mill/bad ethics)?

 

[BoardingDoc]

Could anyone currently practicing Pain speak to the current job market? I have previously heard that the market is not that great and fellows sometimes happen to find jobs where starting pay is not very good. On the other hand, I have also heard the market is okay. Some say that starting offers are low but with meeting RVU goals the overall salary is fine within year one or two. Thank you ahead of time for taking the time to respond.

For whatever reason, people are frequently guarded about answering this sort of question directly. The recent thread on EM salaries where we all flat out posted our hourly rates and comp was something of a welcome change from that mentality. I hope you get the answers you're looking for, but most of these threads are met with either "genetic answer that doesn't actually discuss salary" or "I'm in the top 10 percent and here's the bucket of doubloons I get paid each month"

 

[GatorCHOMPions]

Could anyone currently practicing Pain speak to the current job market? I have previously heard that the market is not that great and fellows sometimes happen to find jobs where starting pay is not very good. On the other hand, I have also heard the market is okay. Some say that starting offers are low but with meeting RVU goals the overall salary is fine within year one or two. Thank you ahead of time for taking the time to respond.

EDIT: I realize my original post is confusing. My first question is 1. How is the job market? 2. How difficult is it to find a job where you are able to replicate a EM salary within 1-2 years ( without working at a pill mill/bad ethics)?

The job market is quite tight in competitive areas like major metros, near the mountains or beaches. I have experience looking in some of those places and can shed some light. First, you may not find a job in a specific location so plan to be within an hour of your target. Second, if you want to avoid a high opioid and/or questionable ethics practice you may sacrifice some earning potential. Expect to make a starting salary of around 275-325k. After 1-2 years I’d expect at least 350k upwards of 500k+ all depending on the exact setup even in a low opioid, ethical practice. There are too many variables to account for to give you anything more specific. A couple jobs I interviewed with offered as low as 200k starting salary and those were clearly auto-no’s.

If you are geographically flexible, I see postings online and know from colleagues that salaries can fairly easily start at 400k+ and go up from there after you’re established.

 

[TrailRun]

The job market is quite tight in competitive areas like major metros, near the mountains or beaches. I have experience looking in some of those places and can shed some light. First, you may not find a job in a specific location so plan to be within an hour of your target. Second, if you want to avoid a high opioid and/or questionable ethics practice you may sacrifice some earning potential. Expect to make a starting salary of around 275-325k. After 1-2 years I’d expect at least 350k upwards of 500k+ all depending on the exact setup even in a low opioid, ethical practice. There are too many variables to account for to give you anything more specific. A couple jobs I interviewed with offered as low as 200k starting salary and those were clearly auto-no’s.

If you are geographically flexible, I see postings online and know from colleagues that salaries can fairly easily start at 400k+ and go up from there after you’re established.

Does that apply to hospital-employed and academic? Or is the 2 year ramp up just a feature of private practice? I'm sure the salary is lower but seems like academic is a way to avoid over reliance on opiates, etc

 

[hopefulgasman]

Does that apply to hospital-employed and academic? Or is the 2 year ramp up just a feature of private practice? I'm sure the salary is lower but seems like academic is a way to avoid over reliance on opiates, etc

This notion that academics = avoid overrelying on opiates is just wrong. In PP or out in the community, you can say no or have that be your policy (for what it’s worth) period. At a tertiary care center, you are the end goal for those that have seen countless others to no avail, not to mention inheriting/receiving countless internal referrals for that very reason since opioids fall under the “pain umbrella.” This is all from firsthand experience.

 

[GatorCHOMPions]

The recent Match results were not the greatest for Pain, but could present an opportunity for more EM docs to join the ranks. There were something like 61 open spots if I am not mistaken. The job market for general anesthesia and PMR, particularly the former, is on fire which is a big factor. The pain job market isn’t all roses either but if you look hard and are somewhat flexible there are good ones out there, and imo the future outlook is still brighter than EM.

Someone that has been in contact with me just scrambled into an open spot. They were an attending out for a few years and only had some basic pain shadowing experience from what I understand.

 

[namethatsmell]

Someone that has been in contact with me just scrambled into an open spot. They were an attending out for a few years and only had some basic pain shadowing experience from what I understand.

That’s awesome! I’ve advised several folks to go after these spots.

 

[NNPV21]

Hey, EM PGY-1 here looking for insight about applying to Pain/ISMM. Can someone talk about how to create a path during your first year? Getting an elective, research, LoR?

 

[doctoroxygen]

Hey, EM PGY-1 here looking for insight about applying to Pain/ISMM. Can someone talk about how to create a path during your first year? Getting an elective, research, LoR?

If your program has elective time in PGY1, I would not use it for a pain elective. Part of the elective is going to be an audition of sorts and you’ll make a better impression as a more senior resident, particularly coming from a non-anesthesia background. If you like or can tolerate research, try to get involved in something related to EM analgesia.

 

[Birdstrike]

1. Elective Pain Rotation (hugely important)

2. Shadowing as much as possible

3. Research if able.

4. Letters of Rec

5. Attend Pain Conferences. Make connections. Pain is very small. A single connection could be life and career changing.

6. Bolster Procedure log during residency. If you can learn to be good at EM procedures, you can learn to be good at Pain procedures.

 

[Birdstrike]

Apply to all 100+ ACGME program to use sheer volume to overwhelm the more challenging odds as a non-traditional applicant. (You can do anything, anywhere, for 1 year). That include programs in the match and those outside the match.

 

[Birdstrike]

I just received a message from another EM physician who got an offer for an open spot in a strong pain fellowship.

 

[HemorrhagicShock]

Without putting too much detail out there how much did they have to hustle to get that spot? Did they have tons of extracurricular stuff and/or research experience with pain?

It seems like the competition for pain out of EM is skyrocketing and I'm trying to get an idea of what a competitive candidate looks like these days out of EM (not necessarily a gasser who is applying out of a strong gas program, who I would assume would have a much easier time matching in pain)

At my current job we now get rotating EM residents and it's interesting to hear how many of them are interested in pain, but can't imagine any of them are competitive for it without an inordinate amount of effort given the new EM-based interest.