Forgive my ignorance, and maybe someone can explain this to me. But other than nerve blocks, what are you offering by doing this fellowship?
It's about what the fellowship would offer
you. It gives one access to an entirely different specialty, that in the past had been primarily a very competitive (primarily) Anesthesia subspecialty. Pain Physicians do much more than nerve blocks and write prescriptions. Many do kyphoplasty, place spinal cord stimulators, facet joint blocks, epidural steroid injections, radiofrequency nerve ablations, fluoro and/or ultrasound guided hip/knee/shoulder injections and other procedures. Unlike some of the EM fellowships, this fellowship allows an EP to truly be a subspecialist, and practice in any practice setting they want, including outpatient/office-only, hospital-based, or surgery-center based (+/- ownership). There's very little (if any) night, weekend or holiday work including call, in most practices. There's zero issues with circadian rhythm disruption, for the most part, unless actively working ED shifts.
As said by Siggy above, opiate prescribing by a Pain Physician in his own office or surgery center, is on his own (and DEAs) terms, without any influence of EMTALA, or Press Ganey (unless a hospital employee). Many Pain Physicians have office policies where: new patients are by referral only, no prescriptions are given on the first visit, and where old records, imaging, a resulted drug test, Rx database report and public drug arrest records are checked prior to any opiate prescription is written. Patients can be discharged from the practice if in violation of prescribing agreements, as opposed to EMTALA-based care in the ED. The pendulum is swinging much more against opiates nationwide, but reliance on opiates in ones practice can be on either end of the spectrum with some practices more reliant on prescribing, some completely non-opiate (about 15% of Pain Physicians) and some offering low dose opiates in select cases.
Downsides include recent reimbursement cuts for office based practices (but not hospital based physicians) and being at the center of the current opiate abuse epidemic (though Emergency Medicine, Primary Care, Ortho/spine, psych and other specialties are by no means immune). I think a background in Emergency Medicine, uniquely prepares one to deal with this issue, better than any other. If, as an Emergency Physician who has treated lots of addiction and prescription opiate overdoses you think opiates are over prescribed, take an active role in the Subspecialty and make that known. We have a seat at the table now.
It's worth doing a month elective if you are a medical student, or EM PGY 1 or 2. It's great for EPs to have another option to broaden their horizons, training and practice options. This is a positive step for the specialty. I think more EPs should take an active role and exert their influence in the field of Pain Medicine, from their own background and perspective.
