Advice on what to expect in pain management.

[Mssoccer612]

Just wanted to hear different views on the PA in pain management. I'm looking to find a job closer to my boyfriend who is in the air force and a potential is in a pain management clinic. Job description says ~24 pts/day, mostly elderly, Medicare and selfpay, no new patients only regular patients, 8-5 mon thru Thursday and 8-1 Fridays, no nights/weekends/call, all oral pain management, thirty days training...

 

Is this good/bad? Any opinions? Thanks so much.

[wilso2ar]

working in pain can be rewarding. If all they do is medication management then you will be writing a lot of opiates which has its ups and downs. Thankfully I do not run across alot of drug seekers. questions to ask are: what does their pain medication agreement look like and what happens if the patient violates it? Do they do random drug screens on everybody and what happens if they violate that? Do they photocopy scripts or use a computer program to generate them? do they require a photo ID for all patients? What are the providers prescribing habits? Most believe that long acting opiates are the best for chronic pain. be wary of people that prescribe a lot of short acting opiates to everyone. You have to run a tight ship to provide ethical care. I have been doing this for about 3 years and I really enjoy my job. I do a few ultrasound guided or floro guided injections each day which is fun, but the majority of my day is medication management. Get to know your patients and always have a healthy sense of skepticism. You should also be seeing your patients every one to two months.

 

I would be happy to answer any questions that you may have. Again, this can be a rewarding job, but there are a lot of rules that the patients need to follow and not all of them will.

[Joelseff]

I'm only 2 weeks into this field but so far its pretty cool. The ddx's are more narrow than what i saw in IM during rotations (im a noob PA too this is my first gig so "grain of salt" :=-0:) but I am sure there are deeper levels of it. I was a little leery at first about Rxing so much opiates and really getting a lot of use out of that expensive DEA license:sweat: but the practice is very strict on our policies and the Doc is really on top of everything, but it is a little weird... The day is pretty straight forward, Start seeing pt's at 9 knock off at 5 but i give myself an extra 1/2 hour after for charting and printing out the NCV's I did that day. I am on my feet most of the day though. I see 3 pts/hour get a 1/2 hour lunch. The pay is AWESOME compared to the IM and GI offers I got. I also take home call because we are a small new practice, we havent yet gotten an answering service so most of the calls are ppl calling to lv a msg to cx their appts. I would just listen to the msg and hang up on those and leave it for the FO staff but there are a few pt's c/o pain post injection/procedure that I would have to triage. The PA I'm replacing says the home call is not that bad at all. I start taking the call next week when the PA resigns. All in all, I'm taking it day by day and really trying to learn all I can about spine med. Its REALLY interesting and I find it rewarding when a pt comes post ESI or SNRI or post Rhizo who reports 90% improvement of their chronic pain and return close to full function...I do miss my welch allyn Harvey Elite though!:;;D:

[donwinder]

I am considering a pain management job also straight out of school. It was a random offer from a career fair and as I have interviewed with the solo doctor growing practice I am more and more excited about this prospect. I find the field fascinating and this doc will teach me as much as possible for a PA to do which excites me bc I love doing things more than just writing all day. He is flying me out for a in person interview and tour so we are excited about this out-of-left-field option.

[sbb5002]

I am also a new grad and interviewing tomorrow for a family medicine/pain management position. Any advice on interview preparation, specifically for the pain management side, would be great. Still unsure how I feel about this as a first job, but excited to see what it's all about and how I will fit into the practice. Again, any information or advice would be greatly appreciated! Thanks

[Hemegroup]

The red flags are when Oxycodone 30 is flying out the door without any appropriate medical documentation in charts (such as radiology or MRI reports).

[docpowers]

Joelseff, how is the pain management job going. How would a PA with chiropractic and acupuncture experience do in this field. They can get reimbursement for chiro adjustments but very few insurances reimburse for acupuncture. I don't know if I would want to do pain management 5 days a week. Maybe 2 and the rest in something else.

[Joelseff]

I actually left in July to work in Internal Med (more my forte' and much more enjoyable to me). As a DC or L.Ac, you can practice on the patients but I think there are certain guidelines and provisos for that so check with your state board.

[mcneesejd]

Check your state medical board to see if physician ever in trouble. Find out what doc likes to use. I am in Ohio where there are ALOT of pill mills. Our office is one of few legit. We received our Pain License (house bill passed in Ohio requiring such now). I know of 12 offices SHUT down because of inappropriate habits. 1600mg morphine a day, 6 80mg Oxycontin a day for headache, #540 methadone a month, #12 percocet a day- IDIOTIC, UNECESSARY, DEADLY, LIKELY ASSOCIATED WITH ILLICIT DRUGS/DIVERSION. Watch out for doc writing shorts acting as mentioned in post above. Also avoid UDS every visit office- does no good. If patient expect it they will prepare for it. We do all random at appts and random calls and pill counts. Some offices UDS EVERYONE EVERY visit and nothing but make money. Use long actings instead. LOW DOSES. PUSH physical therapy, psych, and do intervention if appropriate. Don't be pill or injection factory. Why all oral meds? Look out for narcotics and elderly. They won't need much. Pain management is often looked at as crap work but consider this...why primary care not want to rx???? Most likely because they are not comfortable. It is an enjoyable field with rewards but psychologically demanding. Patient can suck life out of you if you let them. You must get these patients to realize that pain WON"T kill them but the treatment could. Pills are not the answer- 30 to 50% relief most commonly 30% with lowest risk of addiction, side effects, tolerance. It will only take the edge off. If in pain MUST be active, if not active you are not candidate for opioids. Pills are only a tool on a tool belt and will only do so much. Never 100% pain relief and never for complete 24hrs- be honest and realistic with them and they need to be honest with themselves. Use them short term. You are in a position to treat the pain as a disease just like DM. EDUCATION to patients is huge and most important. They will need to learn how to cope and deal with the pain because it most likely is permanent.