Pain Fellowship Reviews

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I too have pondered whether doing EMGs as part of a pain fellowship if you've already done the minimum 200 EMGs as a PM&R resident is useful. There is so much to do and learn in just the pain arena alone I would suspect EMGs would be a diversion to learning what you need to know in pain. Of course I could be wrong.

[QUOTE=C Fiber;4956888]

Originally Posted by gecko

I'm surprised that UCLA's PMR program was not mentioned in the above list. There's lots of EMG exposure. On Dr. Fish's rotation (3 months), you perform on average, 10-12 EMGs per week. I'll rack up over 120 by the end of his rotation.[/QUOTE

Isn't it supposed to be a "pain" fellowship? Who cares about EMG. I thought we were supposed to get enough EMG training in PMR residency already.

I know that both Dr Akbik and Dr Munir are doing great things with the Cincinnati program. They are really making it a much more interventional program and getting far away from script writing

Getting "far away from script writing" is not necessarily a good thing. Fellowship is the only chance you'll have to learn medication mgmt. and although it's not rocket science, it's not as straightforward as you might think. You must be an expert at calculating opioid equivalents, managing opioid rotations, methadone titrations, adjuvant meds, etc. Also, you have to learn how to protect yourself by screening new pts, spotting abuse/diversion, dismissing abusive patients, etc. These are all things I learned in fellowship and use on a daily basis. The vast majority of us practice comprehensive pain management and like it or not, opioid management is part of a comprehensive practice. Even if we didn't want to manage meds, we'd have little choice as most referring physicians fully expect it.

I'm surprised that UCLA's PMR program was not mentioned in the above list. There's lots of EMG exposure. On Dr. Fish's rotation (3 months), you perform on average, 10-12 EMGs per week. I'll rack up over 120 by the end of his rotation.

I really don't get this either. One year isn't enough time as it is. Why would you want to spend so much time doing EMG's when you could be in the OR?

I think "far" was too strong of a term. Before they arrived interventions were not as prevalent, and more B&B. They were doing long term script writing for narcs, without interventions, ect... Fellows now have a much better balance. There is still more then enough medical management to get the required experience, but now after patients are stable script writing is turned over to the referring dr.

I looked through the threads for good programs, but since a lot of that material is old, I was wondering who stood out on top now for being the best programs for training good pain docs coming from the anesthesia end.

I saw Columbia on the list, but I was wondering if that had changed in recent years.

And how about U of Chicago, Rush, and NWH? Do they lack something important compared to the "big" programs?

With regards to the EMGs during pain fellowship, I believe all our previous and current fellows have appreciated being able do some EMGs. We certainly don't feel it has taken time away from our fellowship. We perform EMGs during one of our 3 month rotations, and it's 1 day a week, mixed in with a few follow up patients.

I agree that we all have learned how to perform EMGs in our prior PMR residency training, and we should have all recorded at least 200, but in the practical sense, I think if you don't perform any for a whole year, you forget a ton. I'm certainly glad for it.

I didnt think that it would be worth my time doing EMGs when I was choosing fellowships- definitely was not a priority of mine. Now that Im almost done with fellowship and pretty comfortable with the pain procedures, I wouldnt mind doing a few EMGs here and there just to refresh my skills.

The anesthesia folks here at MDACC are interested in getting some exposure to EMGs and Nerve conductions, so I think that they would benefit the most from EMGs in a pain fellowship- not PM&R and Neuro trained folks.

As a pain physician who has a background in PMR, I find that performing EMGs is an intrigral part of my assessment to help treatment strategies for pain complaints. Yes, a pain fellowship does not need to teach EMGs, but if you are going to be a PMR pain physician, you should keep your skills up and learn how EMG could be used in your daily practice. The idea of a fellowship is to teach you how to manage, build, develop, and deliver an effective and successful practice. This would include injections, surgery, physical examinations, emg, writing a good consultation, managing your office, reimbursement strategies, dictations, marketing, etc...

Hi everyone. This is my first time posting in this forum. I am currently finishing my CA-2 year and am applying for a pain medicine fellowship. I know that the Florida programs were briefly mentioned very early in this thread (a couple of years ago), but I was wondering if anyone could give a more detailed review of them....maybe if you are or were a resident or fellow at any of the programs or if you interviewed at them.
Any info would be great!
Thanks.

Hey guys,
I'm just starting out the app process. What are pain programs looking for in applicants. Are the numbers important ie board scores, inservices...?

JHU
UMAB
Wake Forest
UT Southwestern Dallas
UC Irvine
Virginia Mason--I know it's a good regional anesthesia program
Univ of Penn
Jefferson

Any input on these programs would be appreciated.

Also, as applicants I know big names help and the more interventional the better. But should we be also geared to doing fellowship in areas we want to practice?

Any comments on Texas Tech and UCSF would be much appreciated.
Thank you.

anyone have any info on NYU?

You need to look for a program that performs alot of procedures...15-20 a day at a minimum. You need to look for Spinal cord stim. numbers, intrathecal pumps, discograms, vertebroplasty etc.
I did 25 SCS in fellowship, and now do around 100 or more per year in private practice. If I did not have the large number in fellowship I would not be as comfortable with all of the "non-standard stims" I run into.
Finally.... I looked for a program that taught the "Business" of pain medicine. You can loose a lot of money by trial and error. Billing companies are not very good at pain billing in general, so you MUST know the ins and outs of the business.
I went to Tufts in Mass. and had a great year. The staff has changed somewhat in the years since, but look it up.
I turned down several "Big name centers" because they did not adhere to the above.
Good Luck

Originally Posted by Painyoungin

JHU
UMAB
Wake Forest
UT Southwestern Dallas
UC Irvine
Virginia Mason--I know it's a good regional anesthesia program
Univ of Penn
Jefferson

Any input on these programs would be appreciated.

Also, as applicants I know big names help and the more interventional the better. But should we be also geared to doing fellowship in areas we want to practice?

youngin,

I am also a younin, but a little a head of you it seems. I will tell you what I know about some of the programs, and then give some info about some others. I start my fellowship in a few months.

Anyway, Virginia Mason has a great pain staff and they do a lot of blocks and seem to have a great clinic. The fellow I talked to loved it and thought it was a great program.

UC Irvine - I was impressed with the program. The 4 or 5 pain staff they have are excited about the field and are recently graduated. They have graduates from UC Davis, UCLA, UC Irvine staff, and someone else that I can't recall. All of them were friendly and they are doing good work. For some reason, when I would ask around, most other programs would poo-poo UCI, but I thought it was great. I would have loved to go there had I not got invited to my first choice.

My other experiences were with UC Davis, and Stanford. Both seemed liked excellent programs with talented staff, but the fellows at UC Davis seemed to work much more hours than all other programs - i'm not sure why - it isn't like they were doing a ton more blocks. The UC Davis fellows did not seem that excited and seemed like they were in a resident roll again. The fellows at Stanford were happy with their program, but not hugely enthusiastic.

I also applied to UCSD, but got no interview. My impression is they fill within most of the time.

Overall, NOBODY seemed to be getting good disc procedures and although all programs claimed they were doing a lot of spinal cord stims, I talked to a rep when I was there who told me the real story and very few were getting done. When I was at one of the programs, the fellow was putting in her first stimulator and I was interviewing in Jan or Feb - can't remember. UCSD is doing a lot of disc stuff (viking caths, IDETs).

There is a pain guy in my town that does kyphoplasty. He went to UCSD. I hope to learn that and all the disc stuff some day - I guess OJT style.

Originally Posted by Educator

You need to look for a program that performs alot of procedures...15-20 a day at a minimum. You need to look for Spinal cord stim. numbers, intrathecal pumps, discograms, vertebroplasty etc.
I did 25 SCS in fellowship, and now do around 100 or more per year in private practice. If I did not have the large number in fellowship I would not be as comfortable with all of the "non-standard stims" I run into.

If you are doing 15 - 25 procedures a day, you are not learning anything, you are a grunt who is making money for the institution or practice. 15-20/day are realistic numbers for an efficient practice once you get OUT of fellowship, but not when you are learning how to DO these procedures. At that speed, with limited experience, you are almost bound to hurt someone periodically.

UT Southwestern

Procedure Day
Arrive 7am (earlier if need to do lots of H&Ps & consents)
OR start 7:30am
Lunch 12-12:45pm
Finish Procedures btw 2-3pm
Go down to clinic and finish up/help out - done by 3:30
spend 15-30min responding to phone calls from the day
Home by 4pm

Clinic Day
Arrive 7:30 to round on any inpatients
Clinic starts 8am
Grab lunch as you work
Work till end of clinic ~3:30pm and then see above

do about 10-15 discograms (3 levels each time)
do about 10 IDETS and 10 decompressions
do about 10 SCS's
do about 5-10 pumps
do about 5 vertebroplasties
just finished doing a high dose ketamine infusion over 4days for RSD - marginal results
all call from home - done a week at a time

I come from a "high volume" procedure fellowship so I thought I would comment.

I agree with your thoughts in the sense that a fellow performing this many procedures is making a lot of money for the institution, no doubt.

However, there is a LOT to be learned from a high volume of procedures. That is, assuming you are doing your reading on technique and theory on a daily basis. One sees the huge variation in pathology, anatomy, pain tolerance, and constantly adjusts technique accordingly in a high volume practice. Volume in this sense is invaluable and cannot be replaced by theory/academics alone.

Also, complications are inevitable in pain medicine, no matter how good you are. As long as one takes every effort to prevent them, a complication in fellowship is a better thing than a complication as an attending.

I think high volume procedures (ie 15-30/day) in the first 3-6 months may be too much, depending on the background of the fellow. But later in the fellowship, once the fellow has learned proper technique and complications of that technique, high volume is extremely valuable. I can start practice doing 15-30 procedures a day with no problem as I've learned to be efficient and good in fellowship. Whether I *will* do that many a day is my choice and market demand.

For example, I've heard of fellows that graduate with such a low volume of procedures that they are fearful when it comes to doing them on their own as an attending. Even things as common as intradiscal procedures. Fear (as opposed to caution) while doing these procedures is not safe. I think one should be able start procedures with confidence but respect for murphy's law.

Anyway, with my high volume training I feel I could walk into any practice and perform safely, accurately, and very efficiently, but it was a lot of work. Of course, opinions vary.

Originally Posted by ampaphb

If you are doing 15 - 25 procedures a day, you are not learning anything, you are a grunt who is making money for the institution or practice. 15-20/day are realistic numbers for an efficient practice once you get OUT of fellowship, but not when you are learning how to DO these procedures. At that speed, with limited experience, you are almost bound to hurt someone periodically.

Originally Posted by Ligament

I come from a "high volume" procedure fellowship so I thought I would comment.

I agree with your thoughts in the sense that a fellow performing this many procedures is making a lot of money for the institution, no doubt.

However, there is a LOT to be learned from a high volume of procedures. That is, assuming you are doing your reading on technique and theory on a daily basis. One sees the huge variation in pathology, anatomy, pain tolerance, and constantly adjusts technique accordingly in a high volume practice. Volume in this sense is invaluable and cannot be replaced by theory/academics alone.

Also, complications are inevitable in pain medicine, no matter how good you are. As long as one takes every effort to prevent them, a complication in fellowship is a better thing than a complication as an attending.

I think high volume procedures (ie 15-30/day) in the first 3-6 months may be too much, depending on the background of the fellow. But later in the fellowship, once the fellow has learned proper technique and complications of that technique, high volume is extremely valuable. I can start practice doing 15-30 procedures a day with no problem as I've learned to be efficient and good in fellowship. Whether I *will* do that many a day is my choice and market demand.

For example, I've heard of fellows that graduate with such a low volume of procedures that they are fearful when it comes to doing them on their own as an attending. Even things as common as intradiscal procedures. Fear (as opposed to caution) while doing these procedures is not safe. I think one should be able start procedures with confidence but respect for murphy's law.

Anyway, with my high volume training I feel I could walk into any practice and perform safely, accurately, and very efficiently, but it was a lot of work. Of course, opinions vary.

Even in skiled hands, a 3 level RF, with appropriate images, takes 30-45 minutes; a 3 level lumbar disco takes 30-45 minutes, and a stim trial takes 30 - 45 min.

If all you are doing is interlams and medial branches, and facets all day long, I can see how you can safely do 30 cases in a day, so long as you are flipping between rooms, and don't lose time for turnover, once you get out into private practice. Even so, I bet you get a wet tap more frequently than if you slow down your pace, especially in cervical cases. And if you are seriously doing 30 cases a day, I will bet you are not really doing the 90 second Lidocaine test dose ISIS recommends in the back, and 120 seconds in the neck.

And ANY of the aforementioned procedures, not to mention IDET or Nucleoplasty, will clearly slow you down still more.


My point is that, even at the end of fellowship, I think if you are doing more than 15 cases a day, you aren't doing much learning. Half-way through your fellowship? There is no chance you are learning the nuances of these procedures at that speed. But hey, that's just me.

We'll have to agree to disagree. You have some valid points. Everybody learns differently based on volume and teaching. Somebody else may say 8 procedures a day is too much for a pain fellow. Its all our opinion at this point. Also, it depends of the length of your workday!

30 procedures a day happens about once every two weeks for me on a regular basis. That is often 12 hour work day at a very well run office. 10-15 a day is usual, so I get a good mix. And of course on days with perc discs, stims, pumps, face injections, pump and generator explant/replants, the turnover is slower. Certainly nobody could do 30 of these a day safely, so I agree with you in that sense.

ISIS also recommends a placebo block for medial branches, and no sedation for most procedures. A number of ISIS instructors and board members routinely use sedation, so it is important to follow the guidelines as just that; an advisory tool, not a rule. They have some guidelines in search of hard evidence at this time, and some of the guidelines are certainly arguable in real life practice.

Originally Posted by ampaphb

Even in skiled hands, a 3 level RF, with appropriate images, takes 30-45 minutes; a 3 level lumbar disco takes 30-45 minutes, and a stim trial takes 30 - 45 min.

If all you are doing is interlams and medial branches, and facets all day long, I can see how you can safely do 30 cases in a day, so long as you are flipping between rooms, and don't lose time for turnover, once you get out into private practice. Even so, I bet you get a wet tap more frequently than if you slow down your pace, especially in cervical cases. And if you are seriously doing 30 cases a day, I will bet you are not really doing the 90 second Lidocaine test dose ISIS recommends in the back, and 120 seconds in the neck.

And ANY of the aforementioned procedures, not to mention IDET or Nucleoplasty, will clearly slow you down still more.


My point is that, even at the end of fellowship, I think if you are doing more than 15 cases a day, you aren't doing much learning. Half-way through your fellowship? There is no chance you are learning the nuances of these procedures at that speed. But hey, that's just me.

Originally Posted by Ligament

ISIS also recommends a placebo block for medial branches, and no sedation for most procedures. A number of ISIS instructors and board members routinely use sedation, so it is important to follow the guidelines as just that; an advisory tool, not a rule. They have some guidelines in search of hard evidence at this time, and some of the guidelines are certainly arguable in real life practice.

ISIS recommends a double block paradigm, based on Dr. Dreyfuss' seminal article (Spine. 2000 May 15;25(10):1270-7), prior to performing RF.

ISIS's "Guidelines" were named that so that attornies could not use them in court as a minimum standard. That being said, if you don't test dose, and inadvertently inject a low lying Artery of Ademkewicz, or a cervical medulary or radicular artery, you up the creek, IMHO.

Sedation is an interesting word - propofol is anesthesia, not sedation, IMHO, and has no place in either RF or discography.

What if you do a test dose which is negative and still get a cord infarct? Are you at fault because you did not use DSA as well? Is there literature showing that a test dose of local reduces the incidence of cord or brain injury? (I'm not sure but don't think there is). Also, many people do not inject local in the neck or lumbar spine for epidurals, so no need for a test dose. We should probably move this discussion to another thread as it is interesting.

Originally Posted by ampaphb

ISIS recommends a double block paradigm, based on Dr. Dreyfuss' seminal article (Spine. 2000 May 15;25(10):1270-7), prior to performing RF.

ISIS's "Guidelines" were named that so that attornies could not use them in court as a minimum standard. That being said, if you don't test dose, and inadvertently inject a low lying Artery of Ademkewicz, or a cervical medulary or radicular artery, you up the creek, IMHO.

Sedation is an interesting word - propofol is anesthesia, not sedation, IMHO, and has no place in either RF or discography.

Originally Posted by Ligament

What if you do a test dose which is negative and still get a cord infarct? Are you at fault because you did not use DSA as well? Is there literature showing that a test dose of local reduces the incidence of cord or brain injury? (I'm not sure but don't think there is). We should probably move this discussion to another thread as it is interesting.

During the Q&A at the ISIS meeting in Utah, the point was raised that, no death or cord infarct has occured (not just documented, 'cause that wouldn't take into account those cases still in litigation) when ISIS guidelines, including 2 views, test dosing, and the use of fluoroscopy and contrast prior to the injection of steroid) were used in ESI's or TFE's, both of the neck and low back.

DSA is a useful tool, and may be more important when a weekend course-trained practitioner doesn't know what to look for on a routine fluoroscopic image.

To your question of literature, at present, to my knowledge, there are still less than 30 catastrophic complications documented in the literature. With that small an N. Clearly tens of thousands of these procedures are done daily.

The objection to test-dosing is a false one - the real reason people don't do it is that it adds 90 seconds to each lumbar ESI, and 120 to each cervical procedure you do. Presuming you do nothing but lumbar cases on your 30 procedure days, that means at minimum, an additional 45 minutes, or potentially 3-4 fewer cases that day. So let's not make this a purely scientific discussion - feral interventionists don't want to wait the extra 90 seconds because it will cost them money to do so.

Just got back from my pain fellowship interview at UCLA. Have to say I am very impressed! A lot of programs have things "on paper" and have very loose definition of the word "exposure" but this program truly is what it says it is. It is comprehensive and fellows learn everything there is to know about pain management while actually getting the opportunity to perform a myriad of procedures. Someone already posted about the schedule/work load there: http://forums.studentdoctor.net/show...76#post4364476 so I won't.

The faculty members were young, energetic, and obviously knew their stuff. The opportunity to work with so many different faculty members (anesthesia, PM&R, psychiatry) is great as opposed to working with one faculty member - because you get to learn different ways of handling patients/situations. All the attendings were very approachable and all had a great sense of humor. (some more than others) the atmosphere is laid back yet stimulating and the facility was one of the most beautiful I have seen.

I really liked the structure of 3 month rotations because it gives you time to get to know the attendings 1:1 and earn their trust - which translates to more autonomy with procedures. On my interview days, I probably saw 20-30 procedures in 2 half day procedure clinics including sympathetic blocks, cervical discogram, RF, tons of TF ESIs, caudal, pump revision.

Interview days: they interview about 4 per week. 2 interview days. You get a schedule ahead of time. Definitely need to rent a car to get to the various locations. (if you can, get a gps unit) You will spend time at different locations. I spent time at the VA pain clinic, pain rounds, Fish - Ortho procedures, Prager procedures and clinic. No pimping - just "what would you do" type questions during clinic. I could tell they had read my CV and personal statement as they asked me about things on my CV. They will take you out to lunch and you will have the chance to talk to them about why pain, why UCLA, etc. Also will take you out at night to mingle with residents/fellows/attendings. Fun social atmosphere.

Overall probably the best PM&R pain fellowship program in the country. (I know that distinction will go away soon) Young energetic faculty, world famous pain attendings (opportunity to work with Prager can definitely help when it comes time to look for a job according to fellows). Fellows have gone on to private practice and academic jobs all over the country. No problem getting jobs. You will get multiple job offers at very nice places. AND you get to spend a year in beautiful sunny LA!! (which would be a great change from Chicago winters!) It is definitely my top choice for fellowship. Getting competitive though - they said they have already received 80+ applications for the 4 spots. I'm guessing they interview about half? (4 per week x 2-3 months) I think in the past they have taken 1-2 from UCLA so that leaves 2-3 spots for us outsiders.

Good luck to all!

Originally Posted by axm397

Just got back from my pain fellowship interview at UCLA. Have to say I am very impressed! A lot of programs have things "on paper" and have very loose definition of the word "exposure" but this program truly is what it says it is. It is comprehensive and fellows learn everything there is to know about pain management while actually getting the opportunity to perform a myriad of procedures. Someone already posted about the schedule/work load there: http://forums.studentdoctor.net/show...76#post4364476 so I won't.

The faculty members were young, energetic, and obviously knew their stuff. The opportunity to work with so many different faculty members (anesthesia, PM&R, psychiatry) is great as opposed to working with one faculty member - because you get to learn different ways of handling patients/situations. All the attendings were very approachable and all had a great sense of humor. (some more than others) the atmosphere is laid back yet stimulating and the facility was one of the most beautiful I have seen.

I really liked the structure of 3 month rotations because it gives you time to get to know the attendings 1:1 and earn their trust - which translates to more autonomy with procedures. On my interview days, I probably saw 20-30 procedures in 2 half day procedure clinics including sympathetic blocks, cervical discogram, RF, tons of TF ESIs, caudal, pump revision.

Interview days: they interview about 4 per week. 2 interview days. You get a schedule ahead of time. Definitely need to rent a car to get to the various locations. (if you can, get a gps unit) You will spend time at different locations. I spent time at the VA pain clinic, pain rounds, Fish - Ortho procedures, Prager procedures and clinic. No pimping - just "what would you do" type questions during clinic. I could tell they had read my CV and personal statement as they asked me about things on my CV. They will take you out to lunch and you will have the chance to talk to them about why pain, why UCLA, etc. Also will take you out at night to mingle with residents/fellows/attendings. Fun social atmosphere.

Overall probably the best PM&R pain fellowship program in the country. (I know that distinction will go away soon) Young energetic faculty, world famous pain attendings (opportunity to work with Prager can definitely help when it comes time to look for a job according to fellows). Fellows have gone on to private practice and academic jobs all over the country. No problem getting jobs. You will get multiple job offers at very nice places. AND you get to spend a year in beautiful sunny LA!! (which would be a great change from Chicago winters!) It is definitely my top choice for fellowship. Getting competitive though - they said they have already received 80+ applications for the 4 spots. I'm guessing they interview about half? (4 per week x 2-3 months) I think in the past they have taken 1-2 from UCLA so that leaves 2-3 spots for us outsiders.

Good luck to all!

Other than Dr. Fish, who are the other PM&R staff affiliated with the program?

Originally Posted by ampaphb

Other than Dr. Fish, who are the other PM&R staff affiliated with the program?

Here's the list of clinical staff:
http://www.spinecenter.ucla.edu/Prog...ical_Staff.asp

I met: Dr. Pangarkar, Dr. Zirovich, Dr. Pham (program director and fellowship director), Dr. Aragaki, and Dr. Kim. they are all PM&R.

what's the drive like between all the different locations?

I went from my friend's UCLA housing to the VA on 405 - (I think it was less than 10 miles on mapquest) took about 20min, then from VA to UCLA surg which took about 5-10min. next day UCLA housing to CAST took about 20min, from CAST to VA about 5-10min, VA to UCLA clinic 10min, then from UCLA to airport - about an hour (rush hour)

Obviously, I don't live there and most of my commute was not during rush hour. Any of the current or past fellows care to comment?

How are the following programs? Is the experience good enough?

JHU
UCSF
U of Mich

Does anyone have any info on the baystate / tufts program?

I just graduated from this fellowship. In response to the drive times between locations, the above quotes are pretty accurate, but you could probably save another 5 mins on some of the routes if you learn which roads are less traffic heavy. But no one has really complained about the driving distances.

With regards to the attendings, there are also a couple of other anesthesia pain attendings that were not on the list, which include Dr. Mahrou and Dr. Rafizad (both were fellowship trained at UCLA's Anesthesia pain program with Dr. Ferrante), and Dr. Sadoughi. Also, Dr. Kim (PMR based) is not yet on the list as he is a relatively new addition to the program.

Feedback requested on the following programs (from residents, fellows, interviewees...)

Baystate (Tufts)
Wash U
Dartmouth
U of Virginia
Oregon Health Sciences
U of Wash
U Penn
U of Pitt


Thank you

Hi All
Just wondering if there`s any feedback on the pain fellowship at Beth Israel in NY. Is this program tied up with the St Luke`s Roosevelt program?
What is the ranking if you have one for the Beth Israel NY program?
Thanks

Originally Posted by NEPain

I've followed this discussion with interest. I finished my fellowship in pain medicine recently and am now faculty at Dartmouth. I would be interested in knowing what people have heard about the fellowship at Dartmouth.
I have no interest other than to gain insight into our reputation so as to improve any perceived deficiencies and make sure the good things continue.

Would also like to know what potential applicants are looking for when choosing a fellowship.

I am interested in relocating to the Northeast and would like to know more about this program; as well as how it compares to other pain programs.

Originally Posted by mid|ine

Feedback requested on the following programs (from residents, fellows, interviewees...)

Baystate (Tufts)
Wash U
Dartmouth
U of Virginia
Oregon Health Sciences
U of Wash
U Penn
U of Pitt

Thank you

Just came back from interview at UPenn. I had no idea what to expect and was pleasantly suprised.(although it was HOT and HUMID - the hottest day of the year - walking around in a black suit with heels - ugh!) The interview arrangement was a bit disorganized. I think the coordinator was filling in and overextended - they switched interview days and weren't the best at communicating.

Interview day - started around 9:30 ended by 3:30. Meet with chair Dr. Fleisher, Dr. Dell Burkey, Dr. Wu, and new fellowship director Dr. Ashburn. Dr. Ashburn started about 2 months ago and has already made significant improvements to the program. He was at Utah then formed his own pharma company and worked in industry for years - then missed academics and was recruited to Penn. I believe he was also a past president of APS. The chair is very committed to pain and they have great working relationships with other departments at Penn. Dr. Ashburn said this year was an unusually competitive year for some reason - they got over 60 applications for their 3 positions. They only invited 4 of the PM&R applicants for interviews. They are wrapping up their interview season and will be making rolling offers by the end of August.

I interviewed with 3 other applicants. 2 internal applicants and 1 from Columbia. The internal applicants said there were 4 people applying for the fellowship this year from Penn. They do typically take at least 1 from Penn. After morning interviews - had nice lunch with the 3 current fellows. They seemed very happy. One from Penn, one from Harvard, and another who was an attending for 10 years. All Anesthesia. But they have taken PM&R in the past. (from the Penn PM&R program) I was pleasantly suprised that all the faculty members and fellows were very open to having other disciplines and seemed receptive to having PM&R applicants.

The fellowship used to be structured where each fellow does a rolling cycle of 1 wk each of acute pain, chronic pain, and OR. They are hoping to get up to about 1 implantable/week. They take home call 1 week at a time - and that call is as back up - residents get first call (also home call) and they consult the fellow if they don't know what to do. They do 1 weekend day (typically Sundays) every 3-4 weeks. They have a temporary arrangement at this time to have the Slipman fellows (nonaccredited PM&R pain/spine fellowship) rotate on 1 week at a time for the non interventional rotations. Those fellows take call as well - which ends up nice bc means less call for the pain fellows. They are also building in a palliative care/consult rotation, neurology and PM&R rotation (they will be learning EMGs), and some kind of ortho rotation. They are already quite interdisciplinary - they have two neurologists on staff, Dr. Wu used to be in a neurosurgery program before switching so he is very interested in spinal procedures, and a psychologist on staff. They are in the process of moving the pain clinic at Presby to another site - probably at graduate hospital where the patient population will be better insured and therefore more reimbursable procedures.

The fellows get a nice variety of procedures - TF and IL ESIs, RFs, pumps, stims, blocks, etc. There's not much they don't do. Dr. Burkey said they don't do many IDETs - that's about it. Many of the faculty members are certified in acupuncture and at least 1-2 of the fellows get certified during fellowship. Dr. Burkey has been certified for 10+ years and strongly endorses the UCLA acupuncture program. The fellows also get funded trips to conferences teaching pump/stim insertion.

I was very impressed by Dr. Ashburn. He is hoping to take an already excellent fellowship program and make it the best program in the country. He has served as a reviewer for the ACGME so he knows how to stay accredited and is hoping to get as many as 6 accredited spots in the next couple years. He is also hoping to get at least 1-2 academically oriented fellows and is willing to find funding to have them stay on as faculty members at Penn. they already have 2 such faculty members with nice grants. They do NOT have a quota for other disciplines (like some other fellowships) and they just interview the "best candidates". They are not committed to take all anesthesiology or all Penn candidates.

Bottomline: An excellent well rounded pain fellowship with relative little scut, very nice lifestyle as fellows, and very fun and energetic faculty members who actually care. This fellowship will continue to get better in the coming years under the leadership of Dr. Ashburn.

Noticed there was some mention of the Anes Emory program on here awhile back and was wondering if anyone knew if their program was still 1/3 acute pain management. Any insight would be awesome as I am debating on whether to interview there.

Originally Posted by clubdeac

Noticed there was some mention of the Anes Emory program on here awhile back and was wondering if anyone knew if their program was still 1/3 acute pain management. Any insight would be awesome as I am debating on whether to interview there.

also interested in learning more about Emory's program...

I just graduated from the Medical College of Wisconsin Pain Fellowship this year. Dr. Stephen Abram is the director of the program. He has really turned it around! It is a great program now. You get lots of interventions, tons of med mgt experience, a peds pain month, and 5 months at the VA hospital which is just great. I highly recommend this program to anyone interested in pain. Milwaukee is also a great town to live in. It was a lot of fun living by the lake. So at least check it out. You will be happy you did!

Originally Posted by paingal

also interested in learning more about Emory's program...

I spoke to a fellow that just graduated and she indicated that there is still some acute pain coverage but they've really changed it around and vastly increased their numbers of procedures and implants

any input on Stanford and Southwestern's pain programs?

Current Pain Fellow at UTSW-Dallas, enjoy the program and training
Case load at VA
-a lot of bread and butter cases (MBNBs, ESIs,cervical, Caudals, RFA)
-Disc procedures (Discos, IDET, Decompression)
-Some exposure to vertebro/kyphoplasty
-SCS/Pumps and revisions
Overall at VA the hours are quite favorable 7-4, light call
Can't comment yet on the other locations McDermott or Parkland, but Parkland has switched over to an ASC and has great staff. The fellows there are happy and don't seem overworked at all.
Would come to this program again-very satisfied.
-please dont hesitate to contact with questions

Originally Posted by TX.DR

Current Pain Fellow at UTSW-Dallas, enjoy the program and training
Case load at VA
-a lot of bread and butter cases (MBNBs, ESIs,cervical, Caudals, RFA)
-Disc procedures (Discos, IDET, Decompression)
-Some exposure to vertebro/kyphoplasty
-SCS/Pumps and revisions
Overall at VA the hours are quite favorable 7-4, light call
Can't comment yet on the other locations McDermott or Parkland, but Parkland has switched over to an ASC and has great staff. The fellows there are happy and don't seem overworked at all.
Would come to this program again-very satisfied.
-please dont hesitate to contact with questions

I have heard that 2 big names at UTSW/Dallas. Dr. Day and Dr. Lou already left and the chairman resigned. Who is doing the above procedures?

Originally Posted by spinal

I have heard that 2 big names at UTSW/Dallas. Dr. Day and Dr. Lou already left and the chairman resigned. Who is doing the above procedures?

They've hired at least two interventional attendings - one former fellowship director(I think) at LSU, and a recent grad from MD Anderson.

We have plenty of attendings (five fellowship trained here at the VA alone)
We have four procedure days a week (and working on getting a fifth). These days each have a different attending (with different training and style) each day.
By no means are we dropping off in procedures and have plenty of attendings to staff and share their experience with us.
Parkland has two attendings full time and McDermott has two as well
Grand total of 9 attendings.

Hello all,
I'm interested in ANY ACGME accredited interventional-pain fellowship. I'm board certified in PM&R and EMG.
Can anyone help guide me?
There are a very few PM&R fellowships, but I'm also interested in anesthesia-pain.
Awaiting sincerely for some guidance as to where to begin,
Regards and thanks in advance !!

Anyone have info on the following?

Univ. of Colorado PM&R Pain

Look here:

http://analgesia.home.att.net/timbo.html

FOR Cornell/MSK:
Under the menu itmes "Schedules/Hosp FAQs"

Originally Posted by texan

Anyone have info on the following?

Virginia Mason in Seattle
Oregon Health Sciences Univ.
Univ. of Colorado PM&R Pain
Spaulding Pain
Northwestern PM&R Pain
Univ of Michigan PM&R/Anesthesiology Pain
Cornell/MSK Pain
Beth Israel NYC

Any info is appreciated.

I was wondering if anyone had any insight on the University of Vermont's pain fellowship. I interviewed there and really liked it but they currently do not have any fellows secondary to faculty changes in the pain clinic. Any advice would be appreciated.

Anyone have any info on this program. I heard it was a pretty good program a few years back but things may have since changed. I know it's at least in a highly desirable locatin

Originally Posted by clubdeac

Anyone have any info on this program. I heard it was a pretty good program a few years back but things may have since changed. I know it's at least in a highly desirable locatin

I have never know University of Iowa to have a reputation as a good pain program, in fact the opposite. They do have (or had) good regional training.

Originally Posted by mid|ine

I have never know University of Iowa to have a reputation as a good pain program, in fact the opposite. They do have (or had) good regional training.

Really? I thought I had heard they had a decent program a few years back albeit it's in the midwest. Thanks for the input . . . oh well