Rad and pain fellowship

[radman123]

Can a radiologist do a pain fellowship?

---

Members don't see this ad.

 

[emd123]

Yes. It's been done before. Any specialty can do an ACGME Pain fellowship. I came from a non-Anesthesia/PMR/neuro/psych specialty and I'm doing just fine. There's many threads on this. Yes also, you can be ABMS Pain certified and take the same boards as Anesthesia and PMR. Now let the flame war begin to rage...

 

[oreosandsake]

the strongest pain applicant i've met this year is a radiologist.

I'm just glad he and I have some variability in our ROLs.

he snoops around on this forum as well.

 

[mid|ine]

I don't know why a rad would do pain over Interventional Radiology. At least w/ IR you have a much broader array of procedures you are trained in, including everything we do in pain (though I think pain guys tend to do pain procedures better then IR guys ;-) )

 

[lord_jeebus]

I don't know why a rad would do pain over Interventional Radiology. At least w/ IR you have a much broader array of procedures you are trained in, including everything we do in pain (though I think pain guys tend to do pain procedures better then IR guys ;-) )

I know two radiologists who did or are doing a pain fellowship, both are already interventional radiologists.

 

[Ducttape]

what is their reasoning for doing pain?

they already do epidurals, LSB, celiac, etc. they have access to CT scans, and are willing to use much more radiation than any interventional pain physician (ive seen CT scans for pudendal nerve blocks). they can do other procedures, like vascular access, TIPS, etc.

they dont have to write scripts, and they have a fall-back - plain radiology - if they cant find procedures.

 

[Disciple]

Maybe they want to have an office based practice, patients in better health, no call, etc.

 

[emd123]

Maybe they want to have an office based practice, patients in better health, no call, etc.

Yeah, I think it's the call. There's a fair amount of 2 am IR emergencies if you're at a tertiary referral type place. Brain aneurysms, embolizing this or that...

 

[Gauss]

I think it's about jobs. Rads jobs aren't easy to find and IR isn't much better

 

[Supinator]

I have a friend doing an IR fellowship at a VERY VERY good institution willing to practice just about anywhere and he can't find a job. Some of them may want an office based practice and actually take care of patients beyond procedures, but I think the job market tells the real story.

 

[freddydpt]

I'm the radiologist applying this year. Thanks for the kind comments oreosandsake!

I decided to do pain management long before I decided on radiology and even wrote about it in my radiology residency personal statement. I felt radiology was the best base specialty for me in order to become the best pain physician I could be, despite the longer path. What many don't realize about IR is that the specialty is primarily vascular, GI, GU and interventional oncology with only a smaller fraction of pain practice. But yes, IR does pain management, including following patients long term. With that said, I'm not a vascular, GU, GI, and interventional oncology kind of guy... I'm a pain guy (and interventional MSK/Neuro radiology guy - hence my fellowship this year). My decision to do a pain fellowship had nothing to do with the radiology job market (although all the doom and gloom every one hears on the forum is way overstated.) I am doing a pain fellowship because I think the training will make me a well-rounded pain physician... and I have a strong interest in academic pain, integrating functional outcomes research with predictive radiologic and physical exam findings.

For those who are curious, look up:
Wade Wong (graduated UCSD pain fellowship - boarded via ABPN)
Rick Obray (graduated Mayo-Rochester pain fellowship - boarded via ABPMR)

Both completed radiology residencies and passed the ABA pain board examination.
Two radiologists are currently in pain fellowship. One at UC Irvine and the other, also interventional radiology fellowship trained, at UC San Diego. I also know of a couple of radiology residents interested in applying for pain fellowship in the upcoming cycle because they've called for advice. You should feel free to contact me at any point, as well.

During my round of 13 interviews there were anesthesia departments who had radiologists on staff in their pain division. In the past, radiologists have also been boarded through the American Board of Pain Medicine through clinical experience and examination rather than ACGME fellowships and the ABA exam.

The path you choose is up to you. I'm choosing the ACGME fellowship route, which I think is the better way to go in this political climate and offers a well-rounded, better defined experience especially coming out of radiology residency.

Either way, bottom line... if you want to be a pain physician, coming out of a radiology residency will give you a great foundation to practice.

 

[Raddoc123]

I know two radiologists who did or are doing a pain fellowship, both are already interventional radiologists.

I am an interventional radiologist who is interested in pain fellowship. May I ask which programs these docs are it or which fellowships may be open to rads?

 

[freddydpt]

Technically, all ACGME accredited pain fellowships should be open to radiologists because ABR will be sponsoring the ABA Pain Medicine Examination.
The ones that I interviewed at or was offered an interview:
UC Davis
UCSF
UC Irvine
UCSD
Univ of Washington
Univ of Pennsylvania
Cleveland Clinic
Duke University
SUNY Upstate
Univ of Maryland
Mayo-Jacksonville
Cornell Univ
Dartmouth Hitchcock
Univ of Virginia

There are many I heard back from stating that they would not interview a radiologist because he/she would not be eligible for boards, however, that was incorrect and I sent justifying links. The ABR will be an official sponsor of the pain exam so no program should give that excuse now. Some might say that their program is not structured to handle a non-anesthesiologist, however, most programs (at least the quality ones) are aiming to become more interdisciplinary, so being a radiologist might put you at an advantage at some locations. Best to contact program directors and discuss.

 

[DocMcPain]

" I felt radiology was the best base specialty for me in order to become the best pain physician I could be..."

I'm curious as to why you thought that radiology would be the best speciality to become a pain physician?

 

[lonelobo]

I'm curious as to why you thought that radiology would be the best speciality to become a pain physician?

Ya, me too....can think of at least ten specialties that prepare you much better to be a pain physician

 

[Ducttape]

we all make odd decisions during medical school.

 

[emd123]

Ya, me too....can think of at least ten specialties that prepare you much better to be a pain physician

There's only one: DEA agent.

 

[freddydpt]

I'm curious as to why you thought that radiology would be the best speciality to become a pain physician?

Very broad specialty covering adult, peds, women's health, all surgical fields and pathology. Great generalist education. Focus on technology and image guided procedures. Most importantly, however, is that radiology teaches broad (ridiculously broad) differential diagnosis. Chronic pain in many patients is a diagnostic dilemma. My physical exam skills were already honed from PT school. Radiology seemed like the next natural choice to merge skill sets to become a pain physician. MSK/Neuro radiology fellowship seemed the best preparation for diagnosis of neuromusculoskeletal pain and pain fellowship focuses on procedural diagnostic skills and overall complete patient management. It all just seemed like a logical continuum to me.

 

[bedrock]

It's great prep, just takes a really long time. Are you going to be 40 when you are all done?

I must admit that your skills will be the bomb once you're done, as you will truly be an expert in every aspect of Pain by the time you are finished.
You should eventually be the chair of Pain at a top 5 program.

 

[freddydpt]

I'll be 35 when I'm all done. I wouldn't mind being a chair

It's great prep, just takes a really long time. Are you going to be 40 when you are all done?

I must admit that your skills will be the bomb once you're done, as you will truly be an expert in every aspect of Pain by the time you are finished.
You should eventually be the chair of Pain at a top 5 program.

 

[pmrmd]

To the OP: A radiologist doing a pain fellowship would not be ideal. It works for freddy because of his PT background. History and exam are still the most important part of the job.

 

[freddydpt]

pmrmd, I think you might not fully understand all the rotations in a radiology residency. Many programs require significant time in interventional radiology performing H+P's and clinic time prior to procedures. At my program, this wasn't exclusive to the IR rotation, i.e. body "diagnostic" radiology performed its own interventions requiring H+P's, as well... as did MSK, chest, neuro IR and mammo.

There are also options to rotate through clinical rotations (i.e. I rotated through a primary care sports medicine continuity clinic in my PGY5). Also, prior to any "ordered" procedure from ortho or neuro spine, many radiologists will perform a focused MSK/Neuro exam and report it in the radiology report (but only bill for the procedure). Even more detailed history and physical exam is performed in an MSK ultrasound clinic (where the frequent Rx says "eval and treat").

In addition, for those with programs that continue to have residents learn hands-on ultrasound (GI, GU, Vascular, Small Parts, Mammo), which hopefully is more than half (though # is shrinking), residents will correlate with history and physical exam (their own). Yes, there are many practicing radiologists out there who read films in a dark room and never see patients, but there are many, many, VERY clinically oriented radiologists out there and radiology residency provides the training to do well in any of those settings.

To the OP: A radiologist doing a pain fellowship would not be ideal. It works for freddy because of his PT background. History and exam are still the most important part of the job.

So, my advice to the OP: Assess your own strengths and weaknesses. Become strong in MSK and Neuroradiology. Get involved in an MSK, Sports, Spine, Neuro, or Pain medicine clinic to brush up on the necessary skills (pharmacology, clinical assessment, overall patient management, etc). Go forth and prosper. No base specialty is "ideal". And yes, history and physical exam is still the most important part of the job.

 

[pmrmd]

I'll have a physiatrist examine my hip or shoulder before a radiologist, thank you.

 

[freddydpt]

That's cool. I totally get it. I've worked with both physiatrists and radiologists in clinic. There's a wide clinical competence spectrum among both specialties. I'm not going to give the specifics of some of the stupidity I've observed but I don't want anyone spreading the idea that radiology training is not adequate base training for pain... it's phenomenal if one has gone to a decent residency and dedicated their learning experiences to become a pain physician. What learning experiences? For example: those shoulder, knee, hip, ankle, wrist, elbow (etc) arthrograms everyone orders come with a free history and physical exam before injection.

How does radiology thought process translate to clinical practice? For example, when I read a shoulder (or hip) MRI, I have a specific and thorough checklist to hit all structures, recognize imaging patterns to make specific diagnoses and able to infer mechanisms of injury based on these patterns. That same thought process in the pain fellow/learner translates to a very refined physical examination with the knowledge of all anatomic structures and biomechanics. That level of detail is not taught in many of the base specialties of pain medicine. Definitely not trying to start a "which base specialty is better" war, rather, just claiming non-inferiority.

 

[emd123]

I'll have a physiatrist examine my hip or shoulder before a radiologist, thank you.

Yeah. Because the shoulder exam is what relieves pain. Lol


Flame away.

 

[pmrmd]

Lol. And the MRI does? I presume you practice medicine and understand what was meant by my comment. If not, the exam sort of helps provide the diagnosis, good for those times when the MRI has no findings or is filled with asymptomatic pathology.

 

[Ducttape]

freddy, i think your premise is correct - one can garner sufficient learning in any residency to become a decent pain physician.

There's a wide clinical competence spectrum among both specialties. I'm not going to give the specifics of some of the stupidity I've observed but I don't want anyone spreading the idea that radiology training is not adequate base training for pain... it's phenomenal if one has gone to a decent residency and dedicated their learning experiences to become a pain physician.

therein lies the problem - most residents going through radiology training do not have the clinical competence to be a pain physician, and many programs do not teach it.

fyi, emd, only once in my clinical practice has an MRI actually cured anyone....

 

[lobelsteve]

freddy, i think your premise is correct - one can garner sufficient learning in any residency to become a decent pain physician.


therein lies the problem - most residents going through radiology training do not have the clinical competence to be a pain physician, and many programs do not teach it.

fyi, emd, only once in my clinical practice has an MRI actually cured anyone....

Zapped the pacer?

 

[emd123]

Lol. And the MRI does? I presume you practice medicine and understand what was meant by my comment. If not, the exam sort of helps provide the diagnosis, good for those times when the MRI has no findings or is filled with asymptomatic pathology.

I was just messing with you, man. Trying to lighten it up a little around here. Physiatrists are good at examining shoulders. I'm cool with that.

 

[freddydpt]

freddy, i think your premise is correct - one can garner sufficient learning in any residency to become a decent pain physician.


therein lies the problem - most residents going through radiology training do not have the clinical competence to be a pain physician, and many programs do not teach it.

fyi, emd, only once in my clinical practice has an MRI actually cured anyone....

MRI guided focused Ultrasound may be the wave of the future. But I guess that is an ultrasound cure rather than MRI.

 

[pmrmd]

I was just messing with you, man. Trying to lighten it up a little around here. Physiatrists are good at examining shoulders. I'm cool with that.

Sorry Bro. It's damn near impossible to gauge the tone of someone's comment on these things. Combine it with dealing with PITA people all day and I'm ready to snap sometimes.

 

[emd123]

Sorry Bro. It's damn near impossible to gauge the tone of someone's comment on these things. Combine it with dealing with PITA people all day and I'm ready to snap sometimes.

No problemo

 

[mskraddoc]

I'll have a physiatrist examine my hip or shoulder before a radiologist, thank you.

Considering a mini pain fellowship and was researching and came across this old thread. The comment from pmrmd is inflammatory and uneducated. After performing thousands histories, focused physicals exams for patients having arthrograms and pain injections and immediately seeing the results of the imaging study, I will take my exam skills over most anyone. Such a broad generalization.

 

[bedrock]

Considering a mini pain fellowship and was researching and came across this old thread. The comment from pmrmd is inflammatory and uneducated. After performing thousands histories, focused physicals exams for patients having arthrograms and pain injections and immediately seeing the results of the imaging study, I will take my exam skills over most anyone. Such a broad generalization.

Highly inflammatory and arrogant for a radiologist to think their exam skills compared to fellowship trained pain physicians, particularly those who did a PM&R residency first. Doesn't matter that you did a thousand quick exams before you injected someone. That's not the same as learning to do comprehensive physical exam and figuring out the problems to begin with, particularly complex pain issues.

A mini-fellowship won't fix that or your attitude.

 

[SSdoc33]

let me get this straight. you joined SDN, just to point out that you think you can do a good shoulder exam to a post that was written 2 years ago.

o...............k

 

[bedrock]

let me get this straight. you joined SDN, just to point out that you think you can do a good shoulder exam to a post that was written 2 years ago.

o...............k

exactly, seriously arrogant radiologist. Which is also why he thinks he can get by with a mini-fellowship. Guarantee he's going to misdiagnosis lots and lots of patients.

 

[willabeast]

Highly inflammatory and arrogant for a radiologist to think their exam skills compared to fellowship trained pain physicians, particularly those who did a PM&R residency first. Doesn't matter that you did a thousand quick exams before you injected someone. That's not the same as learning to do comprehensive physical exam and figuring out the problems to begin with, particularly complex pain issues.

A mini-fellowship won't fix that or your attitude.

i want to be clear on this - u think PMR docs who did a pain fellowship are the only ones who can do a proper comprehensive physical exam or figure out complex pain issues or figure out problems to begin with?
//I like to think that my arrogance, impetuosity, impatience, selfishness and greed are the qualities that make me the lovable chap I am. //Richard Hammond

 

[bedrock]

i want to be clear on this - u think PMR docs who did a pain fellowship are the only ones who can do a proper comprehensive physical exam or figure out complex pain issues or figure out problems to begin with?
//I like to think that my arrogance, impetuosity, impatience, selfishness and greed are the qualities that make me the lovable chap I am. //Richard Hammond

only physicians who did a pain fellowship. I'm not saying that anesthesia or ER or even radiology physicians don't do a good exam......if they did a full pain fellowship.

I only mentioned PMR, because the radiologist was referring to a post by a PMR doc, as those two residencies(rads and PMR) are polar opposites as to how much time is spent learning and practicing physical exam skills.

 

[mskraddoc]

only physicians who did a pain fellowship. I'm not saying that anesthesia or ER or even radiology physicians don't do a good exam......if they did a full pain fellowship.

I only mentioned PMR, because the radiologist was referring to a post by a PMR doc, as those two residencies(rads and PMR) are polar opposites as to how much time is spent learning and practicing physical exam skills.

I was just pointing out it is possible to learn as a radiologist. Lots of time with ortho rotations, lots procedure time, dedicated msk fellowship and years of practice experience. Sorry if you disagree. Every doc has and should know limitations and I buy no means did I suggest a minifellowship was as comprehensive as a pmr residency.

Hate to argue with a fellow pcar fan!

 

[mskraddoc]

let me get this straight. you joined SDN, just to point out that you think you can do a good shoulder exam to a post that was written 2 years ago.

o...............k

Yeah kind of funny although it took me a whole 45 seconds to register!

 

[Blitz2006]

only physicians who did a pain fellowship. I'm not saying that anesthesia or ER or even radiology physicians don't do a good exam......if they did a full pain fellowship.

I only mentioned PMR, because the radiologist was referring to a post by a PMR doc, as those two residencies(rads and PMR) are polar opposites as to how much time is spent learning and practicing physical exam skills.

Agreed.

I'm a Psych resident, and I obviously can't examine a shoulder as good as a PMR resident. But I'm hoping after a pain fellowship, I will be.

But lets not forget that pain is not just H+P, its also prescribing. In outpatient psych clinic, I have tons of patients who I know the pain docs are PMR guys, and the prescribing of controlled substances is very questionable....so pain docs coming from extremely diverse fields are obviously going to have their own strengths and weaknesses.

My point is, what makes pain a great field is that it literally is a mish-mash of 5-6 specialties. If a psych resident can scrub in and learn how to do SCS/Kyphos (which I have already quite a bit on my elective and I obviously hope to furthermore in pain fellowships), I don't see why a radiologist can't learn how to examine shoulders.

 

[Timeoutofmind]

Agreed.

I'm a Psych resident, and I obviously can't examine a shoulder as good as a PMR resident. But I'm hoping after a pain fellowship, I will be.

But lets not forget that pain is not just H+P, its also prescribing. In outpatient psych clinic, I have tons of patients who I know the pain docs are PMR guys, and the prescribing of controlled substances is very questionable....so pain docs coming from extremely diverse fields are obviously going to have their own strengths and weaknesses.

My point is, what makes pain a great field is that it literally is a mish-mash of 5-6 specialties. If a psych resident can scrub in and learn how to do SCS/Kyphos (which I have already quite a bit on my elective and I obviously hope to furthermore in pain fellowships), I don't see why a radiologist can't learn how to examine shoulders.

Talking about poor prescribing habits of certain specialities...I am not PMR but anyway, Side bar:
Why do psychiatrists hand out benzodiazepines like candy when there is no good evidence for efficacy with ATC use, they are addictive to the max, and they should really only be used PRN for panic attacks, and long term use is associated with morbidity and mortality, and people abuse and sell them like crazy? I truly don't get it...

 

[Blitz2006]

Talking about poor prescribing habits of certain specialities...I am not PMR but anyway, Side bar:
Why do psychiatrists hand out benzodiazepines like candy when there is no good evidence for efficacy with ATC use, they are addictive to the max, and they should really only be used PRN for panic attacks, and long term use is associated with morbidity and mortality, and people abuse and sell them like crazy? I truly don't get it...

Good psychiatrists don't.

I have never prescribed Xanax or Ativan in my life. I only do klonopin for GAD, 1 MG Bid is my max dose.

For panic attacks I bridge with klonopin and Ssri. I start tapering off klonopin after 6 weeks, and get them off it within 3 months.

Benzo PRN does not help panic attacks. It takes roughly 30 min for a Benzo to kick in, panic attack by definition should not last longer than 15 to 20 min.


It's better than some pain docs who dump Xanax and methadone together.... Sigh.


Sent from my SM-N910V using Tapatalk

 

[needachange2017]

R1 here hoping to match in pain.

I have a kind of interesting take on the above verbal war.

I was an anesthesia resident for 2yrs before switching to radiology. In anesthesia, everyone, and I mean EVERYONE in my chronic pain department (comprised of all anesthesiology trained pain docs, which I believe is the majority of fellowship programs out there) spoke badly about PMR trained pain docs. I don't want to go into specifics, but it was very derogatory.

It's kinda funny to me that now PMR docs are saying radiologists can't become competent pain docs.

I've realized in medicine, everybody has an ego and wants to put other specialties down.

 

[nvrsumr]

Interest and determination is all that matters. Most the the great docs in any field engage in alot of self directed learning. Books and ivory towers can only teach the basics.

 

[arbiflow]

Speaking of radiology, for private practice pain docs without a system wide EMR, who do you refer your patients to for imaging and how do you get the images back from them? Can you view the MRIs online or is it always a CD? How do you store your fluoro and US images for your practice? Does anyone partner with local radiology groups for PACS/image viewing/dictation/other IT solutions?

 

[Ligament]

Speaking of radiology, for private practice pain docs without a system wide EMR, who do you refer your patients to for imaging and how do you get the images back from them? Can you view the MRIs online or is it always a CD? How do you store your fluoro and US images for your practice? Does anyone partner with local radiology groups for PACS/image viewing/dictation/other IT solutions?

I refer to any local imaging faciliy. I can view CDs or get online access to the imaging facilities viewer. I store images on a USB drive which then go into a HIPAA compliant (god I hate HIPAA) cloud solution. How do you mean partner with radiology groups for dictation and IT solutions?

 

[arbiflow]

I refer to any local imaging faciliy. I can view CDs or get online access to the imaging facilities viewer. I store images on a USB drive which then go into a HIPAA compliant (god I hate HIPAA) cloud solution. How do you mean partner with radiology groups for dictation and IT solutions?

I just meant if anybody bought a license for a dictation software to use for notes from local radiology groups or partnered to store their fluoro/xray/ultrasound images on the radiology groups' PACS

 

[ZJz4]

Are there still radiologists completing interventional pain fellowships ?