Just pain...

[premedk]

I'm a 3rd year and am getting more and more interested in pain. I've shadowed a couple of pain guys and I really like the procedure heavy nature of work, lifestyle...etc. But I don't think I would want to be do general anesthesia or PM&R for a living. Is it worth perusing anesthesia with the sole goal of doing pain? Also, I'm not a strong med student(all Bs and average step 1) and I know pain is a difficult fellowship to match.

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[emd123]

That's a tough question. Doing 4 years of something you don't like, with the hopes you get a competitive fellowship, there's no guarantee you'll get? It's a roll of the dice, and sounds like 4 years (and possibly a whole career) of doing something you know you dislike.

In medical school, I really liked cardiology, particularly interventional, but I didn't want to do three years of general IM first. I did ER instead, the after doing that a few years, ended up getting a Pain fellowship and now I do just Pain, which I do like. I certainly didn't plan it that way. It just sort of happened. Sometimes you have to make your best guess, jump in and see what happens. It reminds me of a great John Lennon lyric,

"Life is what happens to you while you're busy making other plans."

 

[ctts]

Of course this is a very personal decision...

In my own experience, I was interested in PM&R before I was interested in pain. Even if I did not match into pain, I would have been ok practicing some other area of PM&R. I am not much of a risk taker, so if I knew that I would not be happy doing PM&R, I don't think I would have taken my chances with it just to try to get into pain...but that's just me. Along that lines however, and in part depending on which part of the country you live, there are plenty of PM&R people practicing pain without having done a pain fellowship. So maybe you should consider PM&R rather than anesthesia if you are worried about your chances of matching into pain?

 

[knoxdoc]

You don't need a fellowship to do pain. Yes, its the ideal way, but its not the only way. Do either PMR or anesthesia and use all of your elective time to do pain. You will get a firm grasp of basic procedures. Then you can augment your repertoire with ISIS courses, etc. You can also find a mentor to spend a few months with after residency to hone your skills - you wouldn't get paid, but its great free training.

 

[powermd]

You don't need a fellowship to do pain. Yes, its the ideal way, but its not the only way. Do either PMR or anesthesia and use all of your elective time to do pain. You will get a firm grasp of basic procedures. Then you can augment your repertoire with ISIS courses, etc. You can also find a mentor to spend a few months with after residency to hone your skills - you wouldn't get paid, but its great free training.

Not every PMR/anesthesia residency has a great pain program. If this will be your plan, pick somewhere with a great pain program where you won't have trouble arranging elective months. Try to pick one where they let residents do procedures. From my own experience it would have been very difficult to get started in pain without the fellowship because the pain program at my residency was (at the time) weak. There is a lot to be said for doing the procedures with regularity under attending supervision if only to develop good habits that will keep you out of trouble the rest of your career.

 

[lobelsteve]

Not every PMR/anesthesia residency has a great pain program. If this will be your plan, pick somewhere with a great pain program where you won't have trouble arranging elective months. Try to pick one where they let residents do procedures. From my own experience it would have been very difficult to get started in pain without the fellowship because the pain program at my residency was (at the time) weak. There is a lot to be said for doing the procedures with regularity under attending supervision if only to develop good habits that will keep you out of trouble the rest of your career.

Here is the rub: Every pain doc thinks he is the world's greatest. Whether they are fully incompetent or an ISIS ninja, there is no good way of knowing unless you have an insider who has seen a dozen or so docs perform. Word of mouth is not about skills, it is about marketing. Best bet is to get a list of top 5 docs in your area from the following people: Stryker, Neurotherm, KC rep, All 3 SCS reps (they never recommend guys who do not use them). If you are going to follow soeone, make sure they trained ACGME and have legit board certs. Would look for ISIS instructor but that is no guarantee of skills either. FIPP/WIPP in theory is better, knowing a few I put no faith in that system.

 

[ampaphb]

ACGME doesn't matter. Board certification doesn't matter. Some ISIS instructors are good, others I wouldn't let do a procedure on my dog. WIP/FIPP is associated with ASIPP, and thus has minimal credibility. Reps sometimes know who is technically good, but don't have a clue who is smart/knows what procedure to do.

You can train a monkey to do these procedures on young healthy patients. You need to train with someone who can teach you what to do, when to do it, and how to get out of trouble when things don't go well.

Makes no difference it the program lets you do procedures during training. Go to a program that has a good fellowship. Learn the basicis. Get to know the director. Whether you do his/her fellowship, or one he thinks highly of, if you have his/her blessing, that's all that matters. Pain is a very small world. Everyone knows everyone else. Whether it's Mike Furman, Jim Rathmell, Rick Derby, or Mike Depalma, a rec from the fellowship director will get you what you want.

 

[emd123]

ASIPP...has minimal credibility.

Why do you say this?

 

[ampaphb]

ASIPP ... has minimal credibility.

Why do you say this?

Because the "science" the organization produces is designed to justify reimbursement

 

[sdnuser001]

I am in the same boat as OP in that I am a medical student primarily interested in interventional pain but since pain is not its own residency yet I am stuck btwn choosing anesthesia and pm&r as a base residency with the hopes that I will be able to land an accredited fellowship after residency. I am leaning to pm&r since you have the option of practicing pain even without a fellowship and also have the ability to do unaccredited spine fellowships if you can't match an acgme fellowship.

How can you maximize your chances of getting an accredited fellowship? Go to a pm&r residency with a pain fellowship in the pm&r department and get involved with research as early as possible? And how important is your med school record (i.e. grades and board scores) in terms of landing a fellowship?

Also if you can't get an accredited fellowship your first year out of residency is it possible to do an unaccredited fellowship and then apply for an accredited one the year after? Is this something that is commonly done/would it increase your chances of getting an accredited fellowship your second time around?

 

[clubdeac]

To answer the original post, quit med school. Get an online nursing degree from DeVry and boom you're set to do pain. If that doesn't suit you and you don't like PMR or Anesthesia, you could always do psych or neurology or shoot, ER. Bunch of ER docs on this forum. Or do IM/FP and open a strictly non-interventional practice.

 

[hyperalgesia]

I am in the same boat as OP in that I am a medical student primarily interested in interventional pain but since pain is not its own residency yet I am stuck btwn choosing anesthesia and pm&r as a base residency with the hopes that I will be able to land an accredited fellowship after residency. I am leaning to pm&r since you have the option of practicing pain even without a fellowship and also have the ability to do unaccredited spine fellowships if you can't match an acgme fellowship.

How can you maximize your chances of getting an accredited fellowship? Go to a pm&r residency with a pain fellowship in the pm&r department and get involved with research as early as possible? And how important is your med school record (i.e. grades and board scores) in terms of landing a fellowship?

Also if you can't get an accredited fellowship your first year out of residency is it possible to do an unaccredited fellowship and then apply for an accredited one the year after? Is this something that is commonly done/would it increase your chances of getting an accredited fellowship your second time around?

Don't put all your eggs in that basket. You can end up doing some pain with either PM&R or Anesthesia. I would try to decide which primary specialty suits your personality better and go with that. The best chance of getting into a fellowship (or anything else), is enjoying and succeeding in what you are currently doing. Do the thing that you like the most and go from there. Med school grades and boards don't make any difference. You are a great resident. You are completely engaged. People enjoy working with you. You have done several pain electives and can talk about your experience that clearly demonstrates your interest. You are skilled with your hands (by gift or practice). You are flexible and patient. You will either get a fellowship spot or will find some other more satisfying option.

 

[UMichGas]

If pain medicine didn't exist, what specialty would you choose? You have to assume you won't get a fellowship and you need to be happy with your primary specialty.

I originally matched into Neurology. Then I rotated through PMR and anesthesia pain clinics at the end of my 4th year of med school and I realized that pain medicine is a field that really excited me. I started my intern year and reached out to about thirty fellowship programs to understand the likelihood of getting a pain fellowship position from a neurology residency program. The response was underwhelming. I made a decision to leave Neurology and switch into Anesthesia to improve my odds of getting into a pain fellowship. I don't entirely regret my decision because I have already received an offer for a fellowship position that I really wanted. But, I will say that it has been a tough transition to do something well that you never really saw yourself doing. I hustle hard everyday and by the end of this I do like Anesthesia, I am good at it, and I can see myself doing it if pain doesn't work out. Point being though that if I stuck with neurology and I didn't get the pain fellowship at least I would have been doing something along the lines of what I wanted to do to begin with. It's kind of a gamble either way.

No matter which of the fields you choose you have to do them wholeheartedly for people to support you and for you to succeed. What would you do if pain didn't exist? Which field can you see yourself doing more wholeheartedly? Which field can you practice in that will satisfy you without pain? These are some questions you need to answer.

 

[ampaphb]

Not sure anyone else is quite as crazy as me, but when I was in residency, I took a several weeks of vacation, and spent them at fellowships. Florida Spine Institute, Emory, a week with Rick Derby, a week with Paul Dreyfuss, a week at Penn (when Dr. Slipman was still there) and a week at HSS. I got letters of recommendation, and became a known quantity at each of those fellowships. This, in addition to working with the fellows and Dr. Aprill at LSU, doing in house pain electives, and attending ISIS, NASS, and AAPM each of my years as a resident.

"80% of success is showing up" Woody Allen​

 

[emd123]

Because the "science" the organization produces is designed to justify reimbursement

If a study is done with less than perfect methodology, then I think it's fair to question that and we should, ie, let's repeat with improved study design, less bias, etc. Also, I don't agree with everything many societies/organizations claiming to represent me, do or support (see the AMA).

However, I do think ASIPP deserves serious points for standing up to support and defend the specialty of Pain in times of trouble. That's my opinion, anyways.

 

[ampaphb]

ASIPP does a wonderful job at defending our reimbursement. However, I would never base my clinical decisions on studies they produce.

 

[imfrankie]

Not sure anyone else is quite as crazy as me, but when I was in residency, I took a several weeks of vacation, and spent them at fellowships. Florida Spine Institute, Emory, a week with Rick Derby, a week with Paul Dreyfuss, a week at Penn (when Dr. Slipman was still there) and a week at HSS. I got letters of recommendation, and became a known quantity at each of those fellowships. This, in addition to working with the fellows and Dr. Aprill at LSU, doing in house pain electives, and attending ISIS, NASS, and AAPM each of my years as a resident.

"80% of success is showing up" Woody Allen​

Yep, that's the way to excel at most things: spend the off-season hungrily training.