Less advanced procedures- more interdisiplinary

[lots-o-questions]

Hey y'all coming from a position as a family medicine-psych combo residency. Wanted to get an idea of which programs may be a good fit for me. I'm not super interested in SCS, pumps and so on, but defiantly would love to get plenty of time in the flouro suite as well as tons of experience with US. Im hoping to fill the time that would have been spent on advanced procedures to then do more multidisciplinary stuff such as working with psychologists (obviously), or learning acupuncture. Obviously I'm not anesthesia so any program that requires anesthesia call is out of the picture. Preference would be West coast but I am open to going anywhere. Thanks in advance yall I appreciate whatever insights may come up.

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[dhcofc]

Just do a fellowship with SCS and pumps which will teach you way more than you will need to know for less advanced procedures. Then you’ll live the rest of your life doing less advanced procedures with the confidence acquired by doing operative cases like SCS and pumps. If the most advanced procedure you ever learn is an ESI you will sell yourself short and always be nervous procedurally IMO.

 

[dhcofc]

When your patient comes in nervous for a cervical epidural and you explain to them this is the most advanced procedure you are capable of that isn’t very confidence inspiring. On the other hand when you can explain to them how confident and capable you are with even more advanced operations it’s easier to settle the nervous patient down.

 

[Dr. Ice]

When your patient comes in nervous for a cervical epidural and you explain to them this is the most advanced procedure you are capable of that isn’t very confidence inspiring. On the other hand when you can explain to them how confident and capable you are with even more advanced operations it’s easier to settle the nervous patient down.

Confidence comes from experience not training. Not matter how adept you are at scs pumps, patients can smell newbies. There is an aire that comes from experience that can’t be taught.

 

[lobelsteve]

Confidence comes from experience not training. Not matter how adept you are at scs pumps, patients can smell newbies. There is an aire that comes from experience that can’t be taught.

Bravado. See it in most new grads.

 

[Agast]

I believe closed claims data showed that cervical ESI was the #1 generator of complications. Risk factors were going above C7-T1 and use of sedation.

The best way to allay fears over a procedure is to explain how you will make it safe. I bundle that in with my discussion of the risks during the informed consent.

 

[kstarm]

I have never worked there but historically Washington in Seattle has been a leader in multidisciplinary pain care. Maybe someone else can say more. Probably not where you want to go but the University of Minnesota program has also historically been multidisciplinary focused and perhaps DOctorJay could chime in about Mayo. Hopefully, if you have an interest in certain aspects of pain care your program can figure out a way to get you some experience in that area.

 

[Orin]

Hey y'all coming from a position as a family medicine-psych combo residency.

Almost any fellowship would work for you except for a few of the workhorse programs. Most fellowship director will be very happy to have a fellow that can be placed back into clinic as your co-fellows will love to have your advanced procedure time.

I would strongly counsel you to find psychiatrist that does pain medicine to get some guidance on where to apply and people to talk with.

 

[NJPAIN]

I have never worked there but historically Washington in Seattle has been a leader in multidisciplinary pain care. Maybe someone else can say more. Probably not where you want to go but the University of Minnesota program has also historically been multidisciplinary focused and perhaps DOctorJay could chime in about Mayo. Hopefully, if you have an interest in certain aspects of pain care your program can figure out a way to get you some experience in that area.

I trained at Univ of Washington when it was truly multidisciplinary. Hasn’t been that way in a long time. I don’t know that there are any programs anything like that any longer. All about procedures and $$$$

 

[DOctorJay]

I have never worked there but historically Washington in Seattle has been a leader in multidisciplinary pain care. Maybe someone else can say more. Probably not where you want to go but the University of Minnesota program has also historically been multidisciplinary focused and perhaps DOctorJay could chime in about Mayo. Hopefully, if you have an interest in certain aspects of pain care your program can figure out a way to get you some experience in that area.

Mayo has a world class PRC and I truly miss having the option to send patients to something like that program.

Mayo’s pain fellowship certainly incorporates rotations with the PRC and we had contact and interaction with PT/OT/psych as well as PM&R, Neurology, and Psychiatry. Since I graduated there have been changes in the PRC so Dr. Hooten is no longer in charge.

 

[adiradirim]

Psychiatrist here, currently in a pain fellowship.

Don't narrow your view so early. Apply broadly. I would say that most programs will train you well enough in the bread and butter interventions.
Work-horse (highly interventional) programs won't want you anyways.
Only programs interested in a psychiatrist will interview you. Those programs are much more "multidisciplinary" and see a potential benefit in your presence in the program.

Good luck! PM me if you want to discuss more specifics.

 

[drrosenrosen]

When I was there, University of New Mexico in Albuquerque had a very nice multidisciplinary program with PT, psychiatry AND psychology, IM, neuro, clinical pharmacist, interventional, and even a chiropractor, all under one roof. It was great, but I don't know if they've been able to keep that program up the way it was. Check them out

 

[lots-o-questions]

Thanks y'all, great information!