Going back for pain fellowship?

[Gasman23]

I'm in need of advice. I hope this forum helps. I am a board certified anesthesiologist. I'm 5yrs out of residency. I was very much interested in pursuing pain medicine even prior to starting my anesthesia residency. My anesthesia program did not have a pain fellowship or strong pain program so by my last year I had some research experiences but not in pain. I underestimated the level of competitiveness, so when I applied I did not secure a position. I applied again the following year and again did not secure a position. I was discouraged and life happened so I never pursued it again.

Now I'm in private practice anesthesia but honestly I'm not feeling 100% satisfied. I would like to apply again but I don't know if private practice alone makes me a better applicant and if not what can I do to increase my chances at this point? Also should I explore non acgme positions? I've seen some private pain practices offering non acgme fellowship positions but I don't know the +\- or how to determination the ones with a good/bad reputation. I want a good education not a source for cheap labor. I'm not even sure of the process and application deadlines now that there is a pain match. It all looks like a harder road then when I tried in residency. Any advice or information would be greatly appreciated.

---

Members don't see this ad.

 

[SeniorWrangler]

Biggest question in my opinion is the opportunity cost, it is a big difference between the salary of an attending anesthesiologist and a pain fellow for a year and only you know your financial needs and situation.

 

[Gasman23]

Biggest question in my opinion is the opportunity cost, it is a big difference between the salary of an attending anesthesiologist and a pain fellow for a year and only you know your financial needs and situation.

Well I'm not married and no kids. I have enough saved to cover that year in expenses.

 

[Ducttape]

Biggest question in my opinion is the opportunity cost, it is a big difference between the salary of an attending anesthesiologist and a pain fellow for a year and only you know your financial needs and situation.

no offense, but why is it always about money?

i would much rather do something I love and look forward to doing every day than slave away at a job i hate that pays more. thats just me, i guess,...


look into non-ACGME programs...

 

[Gasman23]

no offense, but why is it always about money?

i would much rather do something I love and look forward to doing every day than slave away at a job i hate that pays more. thats just me, i guess,...

Exactly. It's not a money decision for me. More like what would make me happiest till I retire.

Do you know reputable non acgme programs I n the North East or where I could find that information? I'm in the NY/NJ/CT area.

 

[IN2B8R]

Non ACGME = waste of your time and no credentials by any measuring stick. You might as well self educate through weekend courses, as that is fairly equivalent to a non-ACGME fellowship. If you are going to put forth the effort, go for something that actually counts, not for less income for one year, only to walk away with something that counts for nothing!


Sent from my iPhone using SDN mobile app

 

[lobelsteve]

Non ACGME = waste of your time and no credentials by any measuring stick. You might as well self educate through weekend courses, as that is fairly equivalent to a non-ACGME fellowship. If you are going to put forth the effort, go for something that actually counts, not for less income for one year, only to walk away with something that counts for nothing!


Sent from my iPhone using SDN mobile app

Rumor has it that there is going to be a group on non acgme fellowships coming together under multi society support. Big names, great teachers, and not just 2 months of procedures in the whole year like some anes pain programs. Coming together as we speak.

 

[IN2B8R]

I wouldn't drop an attending salary for a year on rumors, but that's just me....


Sent from my iPhone using SDN mobile app

 

[bedrock]

Non ACGME = waste of your time and no credentials by any measuring stick. You might as well self educate through weekend courses, as that is fairly equivalent to a non-ACGME fellowship. If you are going to put forth the effort, go for something that actually counts, not for less income for one year, only to walk away with something that counts for nothing!


Sent from my iPhone using SDN mobile app

Per Steves comments, there are more than a few poor quality ACGME fellowships that provide mediocre procedural training so its ridiculous to compare non ACGME fellowships to weekend courses as there are more than a few, particularly university based spine fellowships, with good training (thats usually limited to the spine).
Only learning procedures through weekend courses is dangerous as this is what noctors try to do.

All things considered, one of the strong ACGME fellowships is preferred over everything, but if someone wants a spine focused pain practice, doing a spine fellowship is a reasonable second choice, and vastly better than only learning procedures via weekend courses.

 

[NJPAIN]

Rumor has it that there is going to be a group on non acgme fellowships coming together under multi society support. Big names, great teachers, and not just 2 months of procedures in the whole year like some anes pain programs. Coming together as we speak.

Just curious. What goes on the remainder of the year in an anesthesia pain fellowship that has only two procedural months?


Sent from my iPhone using SDN mobile app

 

[Hoya11]

Just curious. What goes on the remainder of the year in an anesthesia pain fellowship that has only two procedural months?


Sent from my iPhone using SDN mobile app

Refills, trigger point injections, hospital rounding, new patient evals, some psych stuff.

 

[lobelsteve]

Psychiatry, neurology, emg. Squandered months.

The nuts and bolts are as follows: https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/530_pain_medicine_2016_1-YR.pdf

How programs implement this nonsense is upto them.

I think the 2nd coming of PASSOR will take this PIF and retool it so it fits the needs of practicing physicians training. Many of the best and brightest in PMR go into Anes Pain fellowships and do so based on bad advice to get a piece of paper (that is getting more worthless daily). They wind up losing their skills and getting trained poorly or wrongly by pain departments that have abandoned science or never knew it.

 

[Gauss]

Psychiatry, neurology, emg. Squandered months.

The nuts and bolts are as follows: https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/530_pain_medicine_2016_1-YR.pdf

How programs implement this nonsense is upto them.

I think the 2nd coming of PASSOR will take this PIF and retool it so it fits the needs of practicing physicians training. Many of the best and brightest in PMR go into Anes Pain fellowships and do so based on bad advice to get a piece of paper (that is getting more worthless daily). They wind up losing their skills and getting trained poorly or wrongly by pain departments that have abandoned science or never knew it.

If they are going outside ACGME I'm interested in seeing how they obtain funding for their fellows. Academic departments cling to ACGME for CMS funding. It used to be manageable paying fellows based on their productivity, especially since you don't have to follow ACGME rules for proctoring and billing, but those days are likely gone.
And they need to brand the fellowship as interventional spine, not sports med like so many did in order to get ACGME accreditation.

 

[Disciple]

I think the 2nd coming of PASSOR will take this PIF and retool it so it fits the needs of practicing physicians training.

Please elaborate Steve. Did you guys come up with this, this week?

PASSOR lives?

 

[Taus]

Please elaborate Steve. Did you guys come up with this, this week?

PASSOR lives?

Been in discussion for a bit. Via NASS.

The sports boarding for the former passor primarily interventional spine programs is a useless crock of ^*+@ IMO.

Sent from my iPhone using SDN mobile app

 

[lobelsteve]

Please elaborate Steve. Did you guys come up with this, this week?

PASSOR lives?

There are a lot of great folks out there that are running PASSOR like fellowships. I have no fellow incoming this year and have been very peripheral. There was a trial match this year and ten programs participated. I am not a part of the system yet but with the caliber of folks who may run the show, I would be honored to be in their company.

 

[drusso]

There are a lot of great folks out there that are running PASSOR like fellowships. I have no fellow incoming this year and have been very peripheral. There was a trial match this year and ten programs participated. I am not a part of the system yet but with the caliber of folks who may run the show, I would be honored to be in their company.

Steve, it all feels so 1999. I said then and I'll say it now: PM&R programs should just train their residents in the actual skills that the market-place wants. But wait, I know, here's the litany of excuses...

1) what the market place wants is a fad (MSK, Spine, and Pain turned out to be real fads)
2) there is not enough time in a PM&R residency to train residents in that stuff (but plenty of time for useless consult service months)
3) it's all political and PM&R lacks the organizational clout to make that happen at most institutions (okay, time to eliminate dead-wood programs)
4) the future of the specialty is inpatient rehab (well, I guess we know how that one turned out).

 

[Lostin_space]

There are a lot of great folks out there that are running PASSOR like fellowships. I have no fellow incoming this year and have been very peripheral. There was a trial match this year and ten programs participated. I am not a part of the system yet but with the caliber of folks who may run the show, I would be honored to be in their company.

What are PASSOR like fellowships? How come you stopped your fellowship out of curiosity?

 

[hyperalgesia]

I'm in need of advice. I hope this forum helps. I am a board certified anesthesiologist. I'm 5yrs out of residency. I was very much interested in pursuing pain medicine even prior to starting my anesthesia residency. My anesthesia program did not have a pain fellowship or strong pain program so by my last year I had some research experiences but not in pain. I underestimated the level of competitiveness, so when I applied I did not secure a position. I applied again the following year and again did not secure a position. I was discouraged and life happened so I never pursued it again.

Now I'm in private practice anesthesia but honestly I'm not feeling 100% satisfied. I would like to apply again but I don't know if private practice alone makes me a better applicant and if not what can I do to increase my chances at this point? Also should I explore non acgme positions? I've seen some private pain practices offering non acgme fellowship positions but I don't know the +\- or how to determination the ones with a good/bad reputation. I want a good education not a source for cheap labor. I'm not even sure of the process and application deadlines now that there is a pain match. It all looks like a harder road then when I tried in residency. Any advice or information would be greatly appreciated.

I totally agree there is potentially some excellent training available in non-acgme accredited fellowships. Some are marketed as "Spine" fellowships which is what many of us market ourselves anyway. In my area, the only people who look down on the "Mickey Mouse Boards" are other pain specialists. Patients, hospitals, and other referral sources don't have a clue and don't care. Few people are "100% satisfied" though. If I were in your shoes, I would probably be saving, investing, and preparing to exit the practice of medicine.

 

[Stim4me]

You want better outcomes in our field, stop supporting nonsense non acgme programs. They either become certified via collaborating or just disappear. We have enough of crappy so called "county hospital trained" pain guys everywhere.... train well or keep people out of the field, that's the pyramid of medicine. You see any non acgme neurosurgery programs out there???

 

[bedrock]

You want better outcomes in our field, stop supporting nonsense non acgme programs. They either become certified via collaborating or just disappear. We have enough of crappy so called "county hospital trained" pain guys everywhere.... train well or keep people out of the field, that's the pyramid of medicine. You see any non acgme neurosurgery programs out there???

There are some high quality university medical school based, (not private or county hospital based), spine fellowships that provide good training, and better spine procedural training than the worst ACGME pain fellowships.

ACGME is still the best first choice, but a university Spine fellowship is a reasonable second choice if someone doesn't land an ACGME position.

Regarding non ACGME neurosurgery training----

All neurosurgery spine fellowships are non ACGME.
All ortho spine fellowships are non ACGME.
All other ortho fellowships except hand are non ACGME.

 

[Stim4me]

There are some high quality university medical school based, (not private or county hospital based), spine fellowships that provide good training, and better spine procedural training than the worst ACGME pain fellowships.

ACGME is still the best first choice, but a university Spine fellowship is a reasonable second choice if someone doesn't land an ACGME position.

Regarding non ACGME neurosurgery training----

All neurosurgery spine fellowships are non ACGME.
All ortho spine fellowships are non ACGME.
All other ortho fellowships except hand are non ACGME.

There is something to be said about these specialties.....Sounds like they don't even need the validity of acgme since they are gold standard programs... we on the other hand have way too many hybrids.

 

[drusso]

We have enough of crappy so called "county hospital trained" pain guys everywhere.... train well or keep people out of the field, that's the pyramid of medicine. You see any non acgme neurosurgery programs out there???

I can think of three bonafide "county hospital" pain/sports fellowships. Are there others?

http://www.jpshealthnet.org/academics_research/fellowship_programs/sports_medicine
http://www.cookcountyhhs.org/medical-clinicalservices/anesthesiology/fellowship/
http://www.utsouthwestern.edu/education/medical-school/departments/anesthesiology/index.html

 

[Stim4me]

I can think of three bonafide "county hospital" pain/sports fellowships. Are there others?

http://www.jpshealthnet.org/academics_research/fellowship_programs/sports_medicine
http://www.cookcountyhhs.org/medical-clinicalservices/anesthesiology/fellowship/
http://www.utsouthwestern.edu/education/medical-school/departments/anesthesiology/index.html

Good find. maybe we should continue to dilute our field further. Or maybe we should control the quality of fellows that are allowed to practice.

 

[bedrock]

Good find. maybe we should continue to dilute our field further. Or maybe we should control the quality of fellows that are allowed to practice.

I certainly don't advocate for just anyone practicing pain medicine. People who did one of the poorer quality private procedure mill type fellowships generally aren't very good in practice. I also hate primary care or semi-retired physicians from other specialties that just decide to open a "pain medicine" practice without any fellowship training at all.

Still, I think our top priority needs to be keeping noctors out of pain medicine. No one is more dangerous than a PA or NP who doesn't understand what they don't know, as that's how they maim or kill people.

 

[Stim4me]

I certainly don't advocate for just anyone practicing pain medicine. People who did one of the poorer quality private procedure mill type fellowships generally aren't very good in practice. I also hate primary care or semi-retired physicians from other specialties that just decide to open a "pain medicine" practice without any fellowship training at all.

Still, I think our top priority needs to be keeping noctors out of pain medicine. No one is more dangerous than a PA or NP who doesn't understand what they don't know, as that's how they maim or kill people.

Good points, too much dilution. Do nurses practice pain medicine in other countries?? Other countries weren't lucky enough to have bill clintons departing executive actions...

 

[RM38]

University/Academic based pain or sports and spine fellowships that are non ACGME accredited include places like Hopkins, Wisconsin, Michigan, UPenn, Cleveland Clinic, UCLA, Kansas, Mt. Sinai, Hospital for Special Surgery, Stanford, Rutgers and maybe a few others that I can't think of. Also, some of those fellows are working side by side with the accredited fellows from those institutions when they rotate through the spine center, so at least some of their training is pretty much the same depending on the program. Both Furman's (pain and then as sports) and Falco's (under Temple) programs were also recently ACGME accredited, but have continued in the unaccredited form currently. DePalma also has his own program and he used to be the PD at VCU. There are many people out there needing pain/spine services and not enough accredited pain programs to train the demand for physicians coming out of fellowship. If there were enough programs all of the unaccredited places would probably be gone as their grads would never be able to find jobs. That is not the case currently, so they will likely continue. At least creating a unified training standard is a way to ensure that the programs are giving a higher quality education to their fellows.

 

[drusso]

https://www.acgme.org/Portals/0/PFAssets/PublicationsPapers/Strategic Plan Summary.pdf

Key Insight Findings

As Strategy workshop participants analyzed the future operating environments of their scenarios, their first important job was to clarify what the demand for medical services would look like in each future scenario. Before they could design the future medical system of each scenario, they first had to understand the “future market pull.” Listed below is a subset of those insights into the future. It would be reductionist to claim that only a few insights generated the new ACGME strategic agenda. Nevertheless, across the scenario teams’ analyses, these key issues appeared frequently as touchstones for the future medical system, education, and accreditation.

 There will be increased complexity in society generally, and patient care specifically, as previous professional boundaries blur or merge and new professional silos emerge, calling for an ever more seamless and disciplined interprofessional team-based approach to health care delivery and medical education.
 There will be increased information transparency, with accompanying challenges to the verification and veracity of competing offerings of data and analyses with consequent implications for the variable meaning of “value” in the delivery of medical care.
 There was no consensus on the future shape of health care delivery, nor on the number of physicians that will be needed; therefore the maximization of provider career flexibility will be crucial.
 The “commoditization” of health care services accelerated across the scenarios. This turned out to be a very complex and profound phenomenon. It included highly standardized (price-driven) services at entry level, and shifting responsibilities and risks among health professionals in interprofessional team-based care. Surprisingly, it was also seen in former “high-end” procedures that could be rigorously standardized or automated.
 Patients will be shouldering more risk in the future in terms of cost sharing, but also in terms of increasing personal responsibility for following therapy guidelines, and in some cases for lifestyle choices. Risk will also be shared within many interprofessional team-based care settings among practitioners and between practitioners and various management and insurance approaches.
 There will be little tolerance for approaches to accreditation, credentialing, and licensing with burdensome process inefficiencies and multiple actors with either conflicting or incompatible standards.
 There was such diversity in medical delivery approaches that the current dichotomous conceptualization of the physicians workforce (e.g., “primary care-subspecialist,” “generalist-specialist”) turned out not to be a very useful approach for planning the future of the medical profession and medical education.
 There was no clear optimal specialty distribution across the scenarios (due to the uncertainties and the pace of change exhibited across the scenarios in technological, economic, and societal issues), therefore the medical education system must be capable of supplying a wide variety of distributions of physicians by specialty.
 Combined, almost all of the key insights across the scenarios indicated that there will be profound pressures to de-professionalize all of the health care professions, not just physicians.

 

[Stim4me]

University/Academic based pain or sports and spine fellowships that are non ACGME accredited include places like Hopkins, Wisconsin, Michigan, UPenn, Cleveland Clinic, UCLA, Kansas, Mt. Sinai, Hospital for Special Surgery, Stanford, Rutgers and maybe a few others that I can't think of. Also, some of those fellows are working side by side with the accredited fellows from those institutions when they rotate through the spine center, so at least some of their training is pretty much the same depending on the program. Both Furman's (pain and then as sports) and Falco's (under Temple) programs were also recently ACGME accredited, but have continued in the unaccredited form currently. DePalma also has his own program and he used to be the PD at VCU. There are many people out there needing pain/spine services and not enough accredited pain programs to train the demand for physicians coming out of fellowship. If there were enough programs all of the unaccredited places would probably be gone as their grads would never be able to find jobs. That is not the case currently, so they will likely continue. At least creating a unified training standard is a way to ensure that the programs are giving a higher quality education to their fellows.

I trained at UPENN pain Med/anes. And Slipmans fellows were FOBs who barely spoke English and were forced to publish his nonsense studies. They were of the lowest quality candidates. They had limited access to the true spine center and had no OR or implant time. Slipman was kicked out of upenn due to his shady PI work and "fellowship" sweat shop.... I imagine a lot of non acgme programs are the same. Sure you can throw names around, but if you haven't actually trained or seen these nonsense programs , I wouldn't defend them.... we have too many chiefs in pain Med who think their name is enough to run a program . You need the right resources to run an ethical program, or you have a bunch of shady "pain fellows" tainting the field...

 

[SSdoc33]

I trained at UPENN pain Med/anes. And Slipmans fellows were FOBs who barely spoke English and were forced to publish his nonsense studies. They were of the lowest quality candidates. They had limited access to the true spine center and had no OR or implant time. Slipman was kicked out of upenn due to his shady PI work and "fellowship" sweat shop.... I imagine a lot of non acgme programs are the same. Sure you can throw names around, but if you haven't actually trained or seen these nonsense programs , I wouldn't defend them.... we have too many chiefs in pain Med who think their name is enough to run a program . You need the right resources to run an ethical program, or you have a bunch of shady "pain fellows" tainting the field...

as usual, just a whole lot of bluster.

the previous poster noted 11 such fellowships, but you focus on one of them. sure, slipman's an a-hole. ok. his fellows were not all "FOB", and some of them were VERY highly qualified. you think you have the expertise to comment on this because you happened to be in trained in the same city as a non accredited fellowship?

the quality of the individual programs vary greatly -- just like the ACGME accredited programs. please realize than anything posted by stim4me is done so under the taint of his own glasses, rather than of objectivity.

 

[drusso]

Sure, slipman's an a-hole. ok. .

Ahh, but, do you think he *KNOWS* he's an a-hole?

http://forums.studentdoctor.net/threads/difficult-egotistical-colleagues.1225059/

 

[Stim4me]

Ahh, but, do you think he *KNOWS* he's an a-hole?

http://forums.studentdoctor.net/threads/difficult-egotistical-colleagues.1225059/

NASS pointed out his a hole ness in their journal when he was paid 100k by ambulance chasing lawyers to smear a professional colleague. If he can read he should be aware of his dislike

 

[SSdoc33]

Ahh, but, do you think he *KNOWS* he's an a-hole?

http://forums.studentdoctor.net/threads/difficult-egotistical-colleagues.1225059/

nice deflection. and yes, i do

 

[lobelsteve]

NASS pointed out his a hole ness in their journal when he was paid 100k by ambulance chasing lawyers to smear a professional colleague. If he can read he should be aware of his dislike

ANd if you talk to the lawyer, it was worth every penny. Slipman is an A level witness.
But a total shmo of a doc.

 

[SeniorWrangler]

 The “commoditization” of health care services accelerated across the scenarios. This turned out to be a very complex and profound phenomenon. It included highly standardized (price-driven) services at entry level, and shifting responsibilities and risks among health professionals in interprofessional team-based care. Surprisingly, it was also seen in former “high-end” procedures that could be rigorously standardized or automated.
 Combined, almost all of the key insights across the scenarios indicated that there will be profound pressures to de-professionalize all of the health care professions, not just physicians.

Highlighted the most important words there. These are the forces reshaping medicine, we can see it already in anesthesia where AMCs are turning anesthesia care into a de-professionalized commodity to be delivered by interchangeable groups of providers for a negotiated low price...

 

[RooAgg10]

There are a lot of great folks out there that are running PASSOR like fellowships. I have no fellow incoming this year and have been very peripheral. There was a trial match this year and ten programs participated. I am not a part of the system yet but with the caliber of folks who may run the show, I would be honored to be in their company.

I posted this in the PM&R fellowship sticky, but here are the programs that participated this year and are the "founding members" of the NASS Interventional Spine Fellowship Consortium.

From what I've been told on my fellowship trail, the eventual goal is to have a shared curriculum (interventional spine, MSK US) that sets a minimal standard for the fellows. An example given to me of collaboration among the programs would be some sort of online live lecture series.

The programs participated in their own match-like process called the "common offer date" on 9/17/16. I've copied and pasted the details of the letter that was offered to interviewees.

------------------------------------------------------------------------------------------

You are receiving this letter because you have applied to one or more of the Interventional Spine and Musculoskeletal Medicine fellowship programs listed on the accompanying page.

These programs have agreed to a Common Offer Date for the 2016 interview cycle of Saturday September 17, 2016. This letter is intended to provide you with information on the Common Offer Date (COD). You will receive this letter from each program you have applied to and this serves as confirmation of the program’s participation in the process. Note that this is not an automated match; however, the goal is to improve the offer process for the applicant and the programs to ensure the best possible fit for both.

The Common Offer Date process is as follows:
1. The programs have agreed that no formal offers will be given prior to the COD.
2. The applicant may inquire about their status with the programs prior to the COD only. The individual programs may decide the degree to which they will offer feedback to an applicant.
3. On the COD, applicants should refrain from making status inquiries to keep phone lines open during the offer process.
4. The applicant should have a “rank list” of these programs ready prior to the COD. Carefully consider each program with friends and family prior to the COD. There will be a very limited window for this on the COD.
5. The applicant should confirm accurate personal email address(es) and phone number(s) with each program prior to the COD to ensure prompt communication.
6. At 10AM Eastern (7AM Pacific) each program will make their first round of offers to applicants via telephone and/or email. The number of offer calls will be equal to the number of available positions. An applicant that receives an offer will have up to 1 hour to respond either accepting or declining the offer.
7. If an applicant declines an offer, or fails to respond in a timely manner, the program will extend an offer to the next applicant on their list.
8. After accepting an offer verbally, the program will notify the applicant in writing
9. Acceptance of an offer from a program implies that the applicant will withdrawal applications from other programs or any future matches including the Pain and Sports Medicine matches.

Participating programs for 2016:
Alabama Orthopedic, Spine, & Sports Medicine Associates Interventional Fellowship (4-5 positions) Birmingham, AL
Program Director: Brad Goodman, M.D.; Program Director and Coordinator: Sri Mallempati, M.D. Assistant Director: Charles Totoro Carnel, M.D.

Cleveland Clinic Spine Medicine Fellowship (4 Positions) Cleveland, Ohio
Program Director: Russell DeMicco, DO; Asst. Directors: Adrian Zachary, DO, MPH and Santhosh Thomas, DO, MBA

Desert Spine & Sports Physicians (1-2 positions) Phoenix, Arizona
Program Director: Susan Sorosky, M.D. Assistant Director: Brad Sorosky, M.D.

Hospital for Special Surgery (3 Positions) New York, NY
Program Director: Peter J. Moley, MD Asst. Director: James Wyss, MD

NERA Spine, Sports & Pain Medicine (1 position) Bethlehem, PA
Program Director: Scott Naftulin, DO

OSS Health Interventional Spine & Sports Medicine Fellowship (6 positions; 3 July, 3 January) York, PA
Program Director: Michael Furman, M.D.

University of Pennsylvania Spine, Sports, & Musculoskeletal Medicine Fellowship (3 positions) Philadelphia, PA
Program Director: Christopher T. Plastaras, MD

Rothman Institute (1 position) Philadelphia, PA
Program Director/Coordinator: Jeffrey Gehret, DO

The Spine and Sports Center (1 position) Interventional Spine and Sports Fellowship Houston, TX
Program Director: Benoy Benny, M.D.

EvergreenHealth Sport & Spine Care (1 position) Kirkland, WA
Fellowship Director: Alison Stout D.O.

 

[hypnosMD]

I'm in need of advice. I hope this forum helps. I am a board certified anesthesiologist. I'm 5yrs out of residency. I was very much interested in pursuing pain medicine even prior to starting my anesthesia residency. My anesthesia program did not have a pain fellowship or strong pain program so by my last year I had some research experiences but not in pain. I underestimated the level of competitiveness, so when I applied I did not secure a position. I applied again the following year and again did not secure a position. I was discouraged and life happened so I never pursued it again.

Now I'm in private practice anesthesia but honestly I'm not feeling 100% satisfied. I would like to apply again but I don't know if private practice alone makes me a better applicant and if not what can I do to increase my chances at this point? Also should I explore non acgme positions? I've seen some private pain practices offering non acgme fellowship positions but I don't know the +\- or how to determination the ones with a good/bad reputation. I want a good education not a source for cheap labor. I'm not even sure of the process and application deadlines now that there is a pain match. It all looks like a harder road then when I tried in residency. Any advice or information would be greatly appreciated.

 

[willabeast]

I'm in need of advice. I hope this forum helps. I am a board certified anesthesiologist. I'm 5yrs out of residency. I was very much interested in pursuing pain medicine even prior to starting my anesthesia residency. My anesthesia program did not have a pain fellowship or strong pain program so by my last year I had some research experiences but not in pain. I underestimated the level of competitiveness, so when I applied I did not secure a position. I applied again the following year and again did not secure a position. I was discouraged and life happened so I never pursued it again.

Now I'm in private practice anesthesia but honestly I'm not feeling 100% satisfied. I would like to apply again but I don't know if private practice alone makes me a better applicant and if not what can I do to increase my chances at this point? Also should I explore non acgme positions? I've seen some private pain practices offering non acgme fellowship positions but I don't know the +\- or how to determination the ones with a good/bad reputation. I want a good education not a source for cheap labor. I'm not even sure of the process and application deadlines now that there is a pain match. It all looks like a harder road then when I tried in residency. Any advice or information would be greatly appreciated.

"Now I'm in private practice anesthesia but honestly I'm not feeling 100% satisfied."
i suspect that you will not find pain much different in your satisfaction rating. if you are 60% satisfied with anesthesia you will be 60% satisfied with pain if the practice is similar. (work hours etc.)
the only exception to this would be if you had some sort of personal life changing event that was very much connected to pain. the specialties are somewhat different, but i think you will find there can be much variation between anesthesia practices, such that you could find one that suits you better than changing specialties.
look at the following study - the satisfaction experienced by docs is very much tied to measurable things like hours worked per week, income, affiliation with a medical school. these sorts of things are specialty independent.
//We also found satisfaction was significantly and positively related to income and employment in a medical school but negatively associated with more than 50 work-hours per-week, being a full-owner of the practice, greater reliance on managed care revenue, and uncontrollable lifestyle. We observed no statistically significant gender differences and no differences between African-Americans and whites.//
http://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-9-166
for example - you hate 0300 emergency C sections. you are not making good money because of low collection rate. . no respect from the surgeons cause the CRNA's are competing with you. dislike trauma. on call too much. switch to a surgery center - 8 AM to 5 PM days, no weekends, no nights, 100% collection rate possible, if you are a partner lots of respect and if surgeon disrespects you ask said surgeon to find another surgery center.

 

[epidural man]

The ACGME requirements now for fellowship is ridiculously low. It is so surprising.

I think our fellow fulfills the procedural requirements in about a month.

 

[bedrock]

The ACGME requirements now for fellowship is ridiculously low. It is so surprising.

I think our fellow fulfills the procedural requirements in about a month.

And that's a problem in other places as fellows in the worst ACGME programs struggle to reach their numbers. The procedural requirement numbers should be increased so all ACGME programs provide decent procedural training or are forced to lose their accreditation.

 

[Got Em]

University/Academic based pain or sports and spine fellowships that are non ACGME accredited include places like Hopkins, Wisconsin, Michigan, UPenn, Cleveland Clinic, UCLA, Kansas, Mt. Sinai, Hospital for Special Surgery, Stanford, Rutgers and maybe a few others that I can't think of.

Where are you getting this information? These programs bolded above are all have ACGME accredited programs on the NRMP list.

Are you thinking about a few university programs that also have a non-accredited spine/sports/MSK fellowship? I can't find non-ACGME fellowships for some of the bolded programs above. For the hospitals that have both, if you compare the NASS list, the program directors for these programs are different than in the ACGME list.

 

[RM38]

The AAPM&R jobs website is the best place to look for the unaccredited programs list. They used to have a section just for fellowships, but then they merged it into the jobs website for some reason. Not all of them are on there, but most are. You may have to google them individually to find them all. They will usually be listed as sport and spine, spine medicine or interventional spine fellowships.