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I would like to start this thread since many of PM&R resident are interested in pain management and or spine care. Obviously there is a huge market for this branch if physiatry these days. Almost 50 percent of the jobs offered in the red or blue journal are combination of interventional pain/spine-EMG and musculoskeletal medicine.
So should I choose a pain fellowship or a spine fellowship? The answer is quite easy it depends on the area of interest, these two sub-specialties have some common procedures but besides that they are quite different.
As pain specialist you not only will manage spine related painful syndromes but also will deal with other pathological issues with pain and their symptoms. You have to have the knowledge of medical and interventional pain control. You have to combine your rehab skills and integrate the interventional and non-interventional skills to manage pain. Your referral sources are spine specialists, which have completed diagnostics and therapeutic interventions without significant help and are looking into more sophisticated pain management like spinal cord stimulator or implantble Intrathecal pumps or pure medical pain control. PCP's , other rehab docs and orthopedic groups are your other major referral source. Your work would be hospital or clinic based and interventions are done in clinic or in the surgical-center or OR. All implantble devices are done in the OR. You could generally train in a pain fellowship which is ACGME accredited which makes you eligible to sit for pain boards. There are many pain fellowship around the country both ACGME and non-ACGME. Some are rehab based which seems to be more interdisciplinary and provide broad base pain training. Physiatrist, psychiatrist and Anesthesiologist compete for the pain fellowships in the country and the competition for the good fellowships are quite tough. Financially you will do quite well and the amount is based on your skills, aggressiveness in interventional aspect, practice style and set up, location, insurances and private vs. academics. Range of income is from 130K academic in metropolitan with incentives to 500k in private practice and up.
A spine specialist to most part will only concentrate on pathological spine issues in more depth. Their knowledge of spine is vast and they are skillful in diagnosing different spine diseases. They complement this part of their practice with performing EMG. Their referral sources are other PMR or Ortho docs to most part. They do market themselves as interventionalist and to most part refer chronic pain situations to pain specialists. There is generally a good working relationship between spine and pain specialist since more sophisticated spine procedures are often done by spine docs like Vertebroplasty and Nucleoplasty. Many pain specialists now perform similar procedures as well to expand the clinical skills. The spine specialists generally work in spine centers and or in private groups with neurosurgeons or orthopedic practices. Interventions are done at spine center or OR. Some procedures like Vertebroplasty is generally done in OR setting. There is no ACGME for spine fellowships yet. Some are PASSOR certified which are the better programs. There are many good and some excellent spine fellowships around the country almost all rehab-based programs. Competition for the best programs are generally tight but since you are only competing within the PM&R specialty, there is a chance that if you are a good resident, you will be able to secure a position. Financially you will also do excellent. Range is similar to pain. If you choose to perform EMG then your income obviously will increase in both specialties.
As an interventional pain fellow interested in many aspects of pain, I love what I do but you should know it is not that easy. Population of patient with chronic / acute pain is a very though population. There are many layers to their problems many of which are psychosocial and difficult to manage. Certainly the burnout rate in pain management is high for this reason and many pain clinicians tend to do it part time. You should be comfortable taking care of difficult patients, have a solid knowledge of anatomy, have a good training in pain and spine procedures and be efficient to become an overall well rounded and successful pain doc. You can't claim to be a pain specialist and only do injections and not manage patients medically. So many physiatrists tend to choose spine fellowships to avoid the chronic pain population, which in theory is good idea but there are may limitations to how far you could be helpful with the injections and eventually many of the patients will end up moths later in pain centers.
There are many good programs around the country and recommending one over the other is sometimes tough. My only advise is to look into the structure and look at how broad base is the program. Programs, which only do injection type interventions, are missing a big chunk of other pain management techniques and the strictly medical management programs are obviously missing procedures skills. Cancer pain exposure, Inpatient pain exposure, Acute pain exposure, chronic pain exposure, headache management, musculoskeletal medicine and interventional pain management including pumps and stims all should be incorporated in a well balanced curriculum which is compatible with ACGME requirement.
Same is valid for a good spine program. Look at all the aspects of the program including EMG skills, interventions, medical management, Disc and Bone interventions and so forth. Look for PASSOR approval as well.
Personally I advise you to do an elective in a pain clinic as well as a spine center to get a feeling what it is all about. They are both excellent career choices. Both are major help to patients and are on cutting edge of medical science with more sophisticated procedures they can offer.
Here are some useful links and fellowship info for interested residents. discussion.
AAPM: http://www.painmed.org/about/
ABP : http://www.abpm.org/
North america spine society: http://www.spine.org/spinal_injections.cfm
ISIS: http://www.spinalinjection.com/ISIS/
Pain Management Fellowship under rehab department
[3410531003] VA Greater Los Angeles Healthcare System Program
Greater Los Angeles Veteran Affairs Health Care System
11301 Wilshire Boulevard (w117)
Los Angeles, CA 90073
Pain Management (PM) Quynh Pham, MD (310)268-4935
[email protected]
[3411222008] Emory University Program/Georgia Pain Physicians
2550 Windy Hill Road, Suite 215
Marietta, GA 30067
Pain Management (PM) Robert E. Windsor, MD (770)850-8464
(770)850-9727
[3412312007] Sinai Hospital of Baltimore Program
York Center for Pain Management and Rehabilitation
2901 Pleasant Valley Road
York, PA 17402
Pain Management (PM) Michael B. Furman, MD, MS (717)848-4800
(717)755-9618
[email protected]
[3412412004] Harvard Medical School/Spaulding Rehabilitation Hospital Program
Harvard Medical School/Spaulding Rehabilitation
125 Nashua Street
Boston, MA 02114
Pain Management (PM)
Alec L. Meleger, MD (617)573-2178
(617)573-2769
[3412521006] University of Michigan Program
University of Michigan
1500 E. University Drive
Ann Arbor, MI 48109
Pain Management (PM) J. Steven Schultz, MD (734)937-7210
(734)936-7048
[3414813005] Baylor University Medical Center (Oklahoma City) Program
St. Anthony North Ambulatory Surgery Center
6205 North Santa Fe Avenue, Suite 200
Oklahoma City, OK 73118
Pain Management (PM) Michael J. Carl, MD (405)427-6776
(405)419-5646
For the list of spine fellowships please visit this web page. the list is long and wont fit in my posting . There are some good ones in there including Dr's fortin, windsor, furman, falco and slipman fellwships.
http://www.aapmr.org/member/felsearch.htm
So should I choose a pain fellowship or a spine fellowship? The answer is quite easy it depends on the area of interest, these two sub-specialties have some common procedures but besides that they are quite different.
As pain specialist you not only will manage spine related painful syndromes but also will deal with other pathological issues with pain and their symptoms. You have to have the knowledge of medical and interventional pain control. You have to combine your rehab skills and integrate the interventional and non-interventional skills to manage pain. Your referral sources are spine specialists, which have completed diagnostics and therapeutic interventions without significant help and are looking into more sophisticated pain management like spinal cord stimulator or implantble Intrathecal pumps or pure medical pain control. PCP's , other rehab docs and orthopedic groups are your other major referral source. Your work would be hospital or clinic based and interventions are done in clinic or in the surgical-center or OR. All implantble devices are done in the OR. You could generally train in a pain fellowship which is ACGME accredited which makes you eligible to sit for pain boards. There are many pain fellowship around the country both ACGME and non-ACGME. Some are rehab based which seems to be more interdisciplinary and provide broad base pain training. Physiatrist, psychiatrist and Anesthesiologist compete for the pain fellowships in the country and the competition for the good fellowships are quite tough. Financially you will do quite well and the amount is based on your skills, aggressiveness in interventional aspect, practice style and set up, location, insurances and private vs. academics. Range of income is from 130K academic in metropolitan with incentives to 500k in private practice and up.
A spine specialist to most part will only concentrate on pathological spine issues in more depth. Their knowledge of spine is vast and they are skillful in diagnosing different spine diseases. They complement this part of their practice with performing EMG. Their referral sources are other PMR or Ortho docs to most part. They do market themselves as interventionalist and to most part refer chronic pain situations to pain specialists. There is generally a good working relationship between spine and pain specialist since more sophisticated spine procedures are often done by spine docs like Vertebroplasty and Nucleoplasty. Many pain specialists now perform similar procedures as well to expand the clinical skills. The spine specialists generally work in spine centers and or in private groups with neurosurgeons or orthopedic practices. Interventions are done at spine center or OR. Some procedures like Vertebroplasty is generally done in OR setting. There is no ACGME for spine fellowships yet. Some are PASSOR certified which are the better programs. There are many good and some excellent spine fellowships around the country almost all rehab-based programs. Competition for the best programs are generally tight but since you are only competing within the PM&R specialty, there is a chance that if you are a good resident, you will be able to secure a position. Financially you will also do excellent. Range is similar to pain. If you choose to perform EMG then your income obviously will increase in both specialties.
As an interventional pain fellow interested in many aspects of pain, I love what I do but you should know it is not that easy. Population of patient with chronic / acute pain is a very though population. There are many layers to their problems many of which are psychosocial and difficult to manage. Certainly the burnout rate in pain management is high for this reason and many pain clinicians tend to do it part time. You should be comfortable taking care of difficult patients, have a solid knowledge of anatomy, have a good training in pain and spine procedures and be efficient to become an overall well rounded and successful pain doc. You can't claim to be a pain specialist and only do injections and not manage patients medically. So many physiatrists tend to choose spine fellowships to avoid the chronic pain population, which in theory is good idea but there are may limitations to how far you could be helpful with the injections and eventually many of the patients will end up moths later in pain centers.
There are many good programs around the country and recommending one over the other is sometimes tough. My only advise is to look into the structure and look at how broad base is the program. Programs, which only do injection type interventions, are missing a big chunk of other pain management techniques and the strictly medical management programs are obviously missing procedures skills. Cancer pain exposure, Inpatient pain exposure, Acute pain exposure, chronic pain exposure, headache management, musculoskeletal medicine and interventional pain management including pumps and stims all should be incorporated in a well balanced curriculum which is compatible with ACGME requirement.
Same is valid for a good spine program. Look at all the aspects of the program including EMG skills, interventions, medical management, Disc and Bone interventions and so forth. Look for PASSOR approval as well.
Personally I advise you to do an elective in a pain clinic as well as a spine center to get a feeling what it is all about. They are both excellent career choices. Both are major help to patients and are on cutting edge of medical science with more sophisticated procedures they can offer.
Here are some useful links and fellowship info for interested residents. discussion.
AAPM: http://www.painmed.org/about/
ABP : http://www.abpm.org/
North america spine society: http://www.spine.org/spinal_injections.cfm
ISIS: http://www.spinalinjection.com/ISIS/
Pain Management Fellowship under rehab department
[3410531003] VA Greater Los Angeles Healthcare System Program
Greater Los Angeles Veteran Affairs Health Care System
11301 Wilshire Boulevard (w117)
Los Angeles, CA 90073
Pain Management (PM) Quynh Pham, MD (310)268-4935
[email protected]
[3411222008] Emory University Program/Georgia Pain Physicians
2550 Windy Hill Road, Suite 215
Marietta, GA 30067
Pain Management (PM) Robert E. Windsor, MD (770)850-8464
(770)850-9727
[3412312007] Sinai Hospital of Baltimore Program
York Center for Pain Management and Rehabilitation
2901 Pleasant Valley Road
York, PA 17402
Pain Management (PM) Michael B. Furman, MD, MS (717)848-4800
(717)755-9618
[email protected]
[3412412004] Harvard Medical School/Spaulding Rehabilitation Hospital Program
Harvard Medical School/Spaulding Rehabilitation
125 Nashua Street
Boston, MA 02114
Pain Management (PM)
Alec L. Meleger, MD (617)573-2178
(617)573-2769
[3412521006] University of Michigan Program
University of Michigan
1500 E. University Drive
Ann Arbor, MI 48109
Pain Management (PM) J. Steven Schultz, MD (734)937-7210
(734)936-7048
[3414813005] Baylor University Medical Center (Oklahoma City) Program
St. Anthony North Ambulatory Surgery Center
6205 North Santa Fe Avenue, Suite 200
Oklahoma City, OK 73118
Pain Management (PM) Michael J. Carl, MD (405)427-6776
(405)419-5646
For the list of spine fellowships please visit this web page. the list is long and wont fit in my posting . There are some good ones in there including Dr's fortin, windsor, furman, falco and slipman fellwships.
http://www.aapmr.org/member/felsearch.htm
