1st NP Job: Pain Management, bad move?

guest416560 · Sep 30, 2018

Mobile Pain Doctors Found Guilty of Running Pill Mill

I would never, ever work for a pain medicine practice. The above story scared me and should scare you to find alternate employment. YES there are legitimate pain control clinics but unfortunately you never know if they are until you are working there. I believe two NPs were caught up in this mess at the time of publication.

guest416560 · Sep 30, 2018

Second Nurse Practitioner Sentenced in the Dr. Ruan & Dr. Couch Pill Mill Case | USAO-SDAL | Department of Justice

Dodongo, APRN, NP · Oct 1, 2018

I wouldn't work for a pain management practice. First of all, it's a sketchy gray area in medicine. Second, your actual medical knowledge will atrophy over time. Trying to find another job after this, especially if your first job after graduation, will be very difficult.

djmatte, ADN, MSN, RN, NP · Oct 1, 2018

I've said this in other places. You can do well in pain management and it's a good area under the right circumstances. Those being that they are offering multiple modality therapies that focus on minimizing the use of opiates and are focused on treating more than just symptoms. Injection training can be invaluable career wise. But imo 100k is too low with the risks of that field regardless of experience. I would counter with 125 plus incentives at a minimum. But be wary of what you're walking into and be cognizant of what you're prescribing and why.

allnurses Guide · Oct 2, 2018

It's not a great career move, in my opinion, for a new grad.

bryanleo9 · Oct 15, 2018

Pain management is a tough practice, especially in this day and age with the "opoid epidemic" we hear so much about. Even though a good portion of the overdose deaths are from injecting these opiates into veins....the stigma with the pills sticks around. The government seems to be cranking up the crackdowns on narcotic prescriptions.

The patients you will see will be a mix of legit and flat out drug addicts. The latter is a population we see a lot in prison. Guess where these drug addicts tell me they will be going when they parole? Yes, a pain clinic near you.

You need to get experience so I understand looking into the job. The population can wear out staff. So many times you will hear how they are "allergic to everything but narcotics.". You will be told how they will sue you if you don't give them want they need. I am done with this population after dealing with them for years.

If it's all you can find I would take it for a while . The pain clinic here is hiring all the time and that's a red flag.

OBigdog26, MSN, RN, NP · Feb 21, 2019

Hi! Any updates on your career in pain management? I'm in a similar position that you were in. I interviewed at a few spine and pain places. The first one wants me to see 20-25 pt's per day, the second practice appears to be better suited for me as a new grad where I can spend more time with patient's and average seeing about 16-20.

Goldenfox · Feb 21, 2019

David,

27 patients is not high for pain management clinics. I worked in one as a locum and I was seeing an average of 40 a day. If you're having trouble finding a job and this is all there is for now, take it so you can gain some experience, but go into it with both eyes wide open. Most people who own/run pain clinics are greedy and unethical. Always be on the lookout for anything that could jeopardize the license that you worked so hard for. The state government and the DEA will have you under a microscope.

There are legitimate pain clinics...a few. Most are still pill mills. Get some experience but don't plan on staying in this venue too long. It is not respected by the medical community because of all the fraud and fake clinical practice associated with 'pain management', be looking for your next job as soon as you hit three months. Its kinda like the home health risk assessment type jobs that are everywhere now. You really don't want that stuff occupying too much real estate on your CV because it doesn't impress anyone.

The clinic I worked in was owned by people who had no clue. They had no health care training or background. They told me they are businesspeople who went to a seminar about the best way to make good and quick ROI. And pain management was it. They were greedy, but not entirely bad people. I had to teach them things. Many things....things that would make their clinic financially successful---BUT, that they had to make it real, and actually do the workups, and provide service that can be rationalized and not just be giving out candy to drug seekers.

They wanted me to stay on there. I was making them a LOT of money, and they offered me a really good salary to stay. But if you are a serious clinician you need to move on after a while. It becomes rote, and there is no real challenge to it. If you are prescribing narcotics, take the time to do your assessments, order the appropriate diagnostics, and make sure to review the drug screens. Anything or any patient that you have a bad feeling about always trust your instincts. Don't be afraid to set limits with your patients. Some of them will try to bully and manipulate you. And document everything objectively. If the DEA shows up for an audit you must have no reason at all to worrying about anything.

$100k is low. I would ask for more. Also, in pain management its not so much the contract that you have to watch out for its the ethics of the place itself. Do they follow the law? Are they serving patients who have real pain management needs or are they just doing easy assessments and writing prescriptions. You will quickly figure this out.

Home Health Columnist / Guide · Feb 21, 2019

6 hours ago, OBigdog26 said:
Hi! Any updates on your career in pain management?

Followup: David last posted in November 2018,

Thanks to all AN members who responded.

Trauma Columnist · Feb 21, 2019

We have several pain management clinics in my area:

1. One affiliated with our large hospital system which encompasses a multi-disciplinary approach including social workers, psychologists, RNs, APRNs, MDs, CRNAs, PT/OT. It is very well respected and few pts are on narcotics.

2. Another pain management clinic does nerve blocks, joint injections, etc. and its run by an ortho group.

Both of these places have months long wait times. Not really feasible when you have a pt with pain to wait for months and months.

FullGlass, BSN, MSN, NP · Feb 23, 2019

Pain management is a fine choice if it is a reputable clinic. If their website shows they offer multiple types of treatment, and does not emphasize narcotics, then that is a good sign. There are many interventional pain management clinics that do not prescribe any opioids, or only do so as a last resort. Ask around and do internet research on the clinic and its providers to get a sense of their reputation and practices.

Depending on where you are located, $100K for first year is not bad, especially since you are going to get a lot of valuable training. You could negotiate a healthy increase for the 2nd year, once you have solid skills under your belt.

Not everyone can find a good general primary care job right out of school. Pain is still the #1 reason people go to see their provider and pain management will give you valuable skills should you decide to move into general primary care later on. I see a lot of pain patients in our general primary care clinic. Should you stick with pain management, specialty NPs make more money than general NPs.