2007-08 Top & Mid Tier Pain Medicine Fellowships

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Calilove

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After review of the very short list of top and mid tier pain medicine fellowships in a previous thread, I wanted to develop an updated version. Feel free to discuss/add/subtract...

2007-08 Top Tier Pain Medicine Fellowships (no particular order)
MD Anderson, Stanford, MGH, Beth Israel (Boston), Brigham, Virginia Mason, Cornell, Dartmouth, Cleveland Clinic, Texas Tech, UCLA

2007-08 Mid Tier Pain Medicine Fellowships (no particular order)
U of Pittsburgh, U of Cincinnati, U Calif Davis, St. Luke's (NYC), Columbia, Case Western, Iowa, Duke, Johns Hopkins, Mayo Clinic (Arizona), Mayo Clinic (Minnesota)

***By the way, top and mid tier are limited to the top "11" programs! I used the 10 + 1 system. This list is based on information from program directors, fellows (current/past), faculty, my own interview experience, and the experiences of different residents I've met on the interview trail.
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Where would you put UCSF on this list?
 
In other words, you're basing your rankings entirely on reputation.

Umm.. How about we come up with a more objective system... one that takes into account quality and amount of time spent on didactics, variety and volume of procedures performed, board pass rate, and percentage of graduates who take 100% pain jobs.

It would be great if you could put this together, but it will never happen. It's like pulling teeth to get folks to cough up info about their programs on this board. Look at the fellowship interview review threads... not nearly as well populated with info as it could be. Most of the info posted is second, third, or fourth hand. People must be frightened of being identified and losing a spot, or upsetting someone in a position of power who could damage their rep. Even at interviews, it was VERY difficult to get fellows to give up the actual number of procedures performed. I would just get blanket assurances that it would be "enough". It's hard to rank programs without any real data.

Calilove said:
After review of the very short list of top and mid tier pain medicine fellowships in a previous thread, I wanted to develop an updated version. Feel free to discuss/add/subtract...

2007-08 Top Tier Pain Medicine Fellowships (no particular order)
MD Anderson, Stanford, MGH, Beth Israel (Boston), Brigham, Virginia Mason, Cornell, Dartmouth, Cleveland Clinic, Texas Tech, UCLA

2007-08 Mid Tier Pain Medicine Fellowships (no particular order)
U of Pittsburgh, U of Cincinnati, U Calif Davis, St. Luke's (NYC), Columbia, Case Western, Iowa, Duke, Johns Hopkins, Mayo Clinic (Arizona), Mayo Clinic (Minnesota)

***By the way, top and mid tier are limited to the top "11" programs! I used the 10 + 1 system. This list is based on information from program directors, fellows (current/past), faculty, my own interview experience, and the experiences of different residents I've met on the interview trail.
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I would disagree that Virginia Mason, UC Davis and Iowa should be listed at all.

I would add Wake Forest as a mid to top tier program.

I don't know about Cornell or Dartmouth.
 
what is the story with Virginia Mason and Univ. Washington, for that matter? I hear that the fellows don't actually get to do much at all. This is all second hand and nothing I can substantiate. However, now that I live in Seattle, I'd like to get the low down on the training programs here...

Thanks.

mid|ine said:
I would disagree that Virginia Mason, UC Davis and Iowa should be listed at all.

I would add Wake Forest as a mid to top tier program.

I don't know about Cornell or Dartmouth.
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I think experience wise Univ. of Cincinnati is among the top programs. Strong didactics, monthly cadaver workshops for the fellows, advanced interventional procedures from SCS to kyphoplasty on a regular basis. It is a busy program, procedure days range from 30-40 procedures and clinic ranges from 30-40 patients with 10+ new patients a day.
 
I am curious why you would think Hopkins is mid tier not top tier.
 
I would add Jefferson to the mid to top tier level. It is bit under the radar particularly with Penn in town. I trained there so I have some obvious bias.
 
steve cohen et al. at hopkins have done a great job i would consider it top tier - unfortunately none of the new york programs have much to offer as far as top tier goes - so that would mean on the upper east coast you pretty much have Hopkins, Brigham, Beth Israel, Dartmouth and MGH

you can drop cornell - i remember interviewing there and being underwhelmed and then having two buddies go through as fellows (and they were disappointed)
 
Tenesma said:
steve cohen et al. at hopkins have done a great job i would consider it top tier - unfortunately none of the new york programs have much to offer as far as top tier goes - so that would mean on the upper east coast you pretty much have Hopkins, Brigham, Beth Israel, Dartmouth and MGH

you can drop cornell - i remember interviewing there and being underwhelmed and then having two buddies go through as fellows (and they were disappointed)
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Cornell program has changed dramatically in last 2 years-completely revamped; merger with MSK, fellowship class doubled to 8 (2nd largest in country) , 14 pain attendings, etc. Ask any recent graduate or interviewee. Not the same as you or others may recall.
 
Dartmouth clearly does not belong in the top tier. They had to be dragged kicking an screaming into the 21st century and their chair will still argue with you re the need for the use of contrast.

Additionally, I recently heard Dr. Graubert, clearly their most forward-thinking attending, left the program.

That being said, they did recently bring on a really sweet girl (Devi Nampiaparampil) who did her PM&R at Spaulding and then went to the Brigham for fellowship, so perhaps she will shake things up a bit.
 
you know more about the program then i do - my apologies.
 
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I don't think Stanford should be on the list at all. When I interviewed there I had very high expectations and I ended up being completely underwhelmed. They structure the interview process like you are a medical student. I had one attending randomly ask me during my interview session to name a time when I hurt someone in medicine. Give me a break. I thought that was inappropriate for a pain fellowship interview question. One faculty member was quizzing applicants during their interview time with him on topics covered during the mandatory noon patient rounds that they forced the candidates to sit through. I also didn't feel like the fellows did very many procedures at all. And don't even get me started on the inpatient pain service (what a waste of time). Most of the faculty I met seemed very arrogant. I was very dissappointed. The day I interviewed, we hardly even got to talk to the fellows at all. I felt like they were trying to hide something (i.e. the fact they don't do many procedures). Just my two cents but I would not even consider them a mid tier program. There are many other better programs, they just may not have the Stanford name (who cares).
 
I did not interview there, but I know one of the 07-08 fellows that will be going to Stanford. I know he could have had his choice of places and he was impressed with the program.
 
and very different from foxtrot's previous post. foxtrot, when did you interview there? although i am about to respectfully disagree with many of your perspectives, I invite you to add any further insight you may have, as Stanford has become a very popular program. The program director this year there is new, a very personable attending who has been there for a while.


"They structure the interview process like you are a medical student.....One faculty member was quizzing applicants during their interview time with him on topics covered during the mandatory noon patient rounds that they forced the candidates to sit through."

-The interview process was basically the same as all the other places I interviewed. The experience of my friends + my own is that there was no pimping.


"I also didn't feel like the fellows did very many procedures at all."

-I got numbers from the fellows, and felt I would not be limited procedurally (how's that for a vague answer? 😉 there are some programs that clearly do a larger volume of advanced procedures *per fellow* (according to my research CCF, MDA, Brigham, Rush and a few more than I can count on one hand) and my conclusion was that there are truly only a few programs that do more. Especially among the west coast programs.

"And don't even get me started on the inpatient pain service (what a waste of time). "

-Two of the fellows felt the experience gave them a marketing tool to help them land 100% pain jobs in saturated markets

"Most of the faculty I met seemed very arrogant."

-I strongly feel the opposite...more laid back, young, energetic, with great personalities.

"The day I interviewed, we hardly even got to talk to the fellows at all."

-We got more fellow time than we needed, and they were honest about the pros/cons

"I felt like they were trying to hide something (i.e. the fact they don't do many procedures). "

-I feel your pain. Any program that doesn't give you a piece of paper that states the numbers of procedures perormed *per fellow* the previous year gives you this sense. Unfortunately, that is greater than 95% of programs. One of the NYC program directors was upfront with his fellows' numbers, and showed me the procedure logs, which was wonderful...truly inspired my confidence in his program



I think it's an awesome program, especially if you want to stay out west. One of the most imortant barometers may be where the Stanfored anesthesia residents prefer to do their pain fellowships, and I truly don't know the answer to how many wanted to stay on. Incidentally, the research going on in the pain department is incredible, google stanford pain research and you'll be impressed.
 
I am glad to hear that you had a good experience, Joshmir. But I did not and neither did several of the applicants who interviewed with me that day because we ended up talking about it at the end of the day. Like I stated in my post, I wish that it would have been a different experience because I really was excited to interview there but after the day was over, I felt dissapointed. As to when I interviewed, it was towards the latter half of the interview cycle this year.
Maybe the two fellows I spoke with were not the same ones you spoke with because both of them told me that the program was not high in interventional procedures. They get the bread and butter blocks but no pumps and very little stims.
The interview process was very different from any of the programs where I interviewed because no other programs asked candidates odd psychological questions or questions from a lunch lecture to see if you were paying attention. Maybe the day you interviewed, they decided not to do it. I don't know.
The fellows I spoke with did not feel like the inpatient pain service was particularly beneficial but it was something they had to do in order to get through. I do not feel like someone needs to give me a piece of paper telling me what blocks they do but when you ask about procedure such as cryo, pulsed RF, pumps and stims, I think they should be able to give you a good answer. I did not get that unfortunately.
I do not dispute that Stanford is a research power house. And I also do not dispute that many of the residents want to stay on at Stanford or stay nearby but I got the feeling that was mainly because it was California and California is a great state to live in.
Maybe when I interviewed they had already made their selections and were just interviewing to go through the motions. I don't know. But there were several other little irritating things that also occurred. For example, we were given directions to goto the pain clinic in the hospital after we interviewed in another building but the directions were not that great. And we spent quite a bit of time wondering around the hospital trying to find out where the pain clinic was located rather than someone taking us there. Also, they did not pay for a hotel room the night before the interview. Now I am not saying that these kinds of things should be the reasons why you choose a program but these added little perks are just nice courtesies to offer candidates. I felt like everywhere I turned the "you are lucky to be interviewing at Stanford" attitude prevailed. And I do feel very lucky to have interviewed there but I just felt like the people I met with seemed very arrogant. I am sure they will have no problems filling because it is Stanford and it is Palo Alto. But the interview experience I had certainly did not warrant the ranking of a top tier pain program.
 
insightful posts, foxtrot-


"They get the bread and butter blocks but no pumps and very little stims. "

-it's unfortunate that a program's procedure average per fellow is something that depends on whom you ask...i wonder if the answer is somewhere in the middle or if one of us spoke with fellows that were primarily outliers...and i guess it also depends on whether you want to trial or implant. the people I spoke with planned to do stims and pumps as part of their practice and were not concerned about their ability (nor their ability to get hospital priveleges for these procedures, which can be challenging in competitive markets on the east coast, i have no idea about cali)....however, they may be joining groups where they plan to "apprentice" on the first couple...which is a common scenario, especially with vertebroplasty

re the inpatient rotation, you're right, the fellows freely admitted they didn't like it when they were on the rotation, but for a minority of fellows it was a marketing tool that helped them get competitive 100% pain jobs in san diego, SF, etc

"Maybe when I interviewed they had already made their selections and were just interviewing to go through the motions."

-so many things about the interview process left me feeling desperate and angry. I hope it worked out well for you. Maybe these problems will be fixed when there's a fellowship match.

where else did you interview? for the record, I feel I the best programs you never hear anyone talk about on this board are Pitt and Mayo-Phoenix...I would have loved to go to their programs.
 
Thanks man. I wish you the best of luck too. I hope you were able to get into a good program. I did get into the program that I wanted so I am happy. After going through the whole interview process, I really feel that there needs to be a match for pain. What really sucks is that if you get multiple offers from different programs at different times, say a month apart. I agree with what you said about Pitt, I have heard it is a good program. I wish that I could have interviewed at Mass General with Rathmell. I think MGH is an excellent program but I am not a super genious ivy leaguer. I also think MD Anderson is a great program. You work hard but I really got the feeling that when you leave there you can do almost any pain procedure, which in my opinion is why you spend a year in fellowship.
 
So I haven't heard anyone talk about MCV's PMR pain program and am wondering why. Interviewed there and it appears as though they have several experienced and well published faculty, get tons of exposure to almost everything (pumps, stims, vertebro, kypho, disco, IDET etc) and you get to sit for the pain boards when it's all done. Is there something I don't know?😎
 
from the 2 friends who went to Stanford within the last couple of years, they didn't have many positives to mention. A lot of mention about a heavy dose of psych and light on procedures.

Most anestheia residents in NY were pretty underwhelmed with the program in manhattan (despite the names). We had 5 from our program who all went to greener pastures (BID, BWH, Clev, UCLA, Hopkins), and in keeping in touch with them, seemed to have made the right decisions.
 
blupofol said:
from the 2 friends who went to Stanford within the last couple of years, they didn't have many positives to mention. A lot of mention about a heavy dose of psych and light on procedures.
Most anestheia residents in NY were pretty underwhelmed with the program in manhattan (despite the names). We had 5 from our program who all went to greener pastures (BID, BWH, Clev, UCLA, Hopkins), and in keeping in touch with them, seemed to have made the right decisions.
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you are right about that
 
Hey what does everyone think about the MCV/VCU program!?!?!?!? 😕
 
mid|ine said:
that its not a top or mid tier program.
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The PM&R fellowship at MCV most certainly IS at the very least, a mid tier program, despite what midline says - Mike DePalma is one of the smartest young guys in the field (co-author of Dr. Slipman's book) and MCV is one of the few PM&R based programs that managed to maintain its ACGME accreditation
 
mid|ine said:
that its not a top or mid tier program.
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So I'm really curious as to why not. It sounds like you get tons of procedures and a wide variety of exposure to disco's, RFA, IDET, vertebro, kypho, pumps, stims and all the bread and butter you could want. Not sure how they are on medication management or acute pain. But from the previous posts sounds like you'd be WAY better off going there than Stanford. Plus look at DePalma's CV, you won't get through it.
 
I would determine a programs ranking based on a number of factors:
-Quality of education/procedure experience
-Quality/reputation of staff
-Reputation of the program
-How competitive is the program/what is the quality of the average fellow
-What is the hospital association
-What is the department association
-What job opportunities does the fellowship open that others may not
 
ampaphb said:
The PM&R fellowship at MCV most certainly IS at the very least, a mid tier program, despite what midline says - Mike DePalma is one of the smartest young guys in the field (co-author of Dr. Slipman's book) and MCV is one of the few PM&R based programs that managed to maintain its ACGME accreditation
Click to expand...


Thanks Peter 😉 Appreciate the back up.
 
Ligament said:
what is the story with Virginia Mason and Univ. Washington, for that matter? I hear that the fellows don't actually get to do much at all. This is all second hand and nothing I can substantiate. However, now that I live in Seattle, I'd like to get the low down on the training programs here...

Thanks.
Click to expand...


Here is my story about Virginia Mason. I am currently a pain fellow there. The pain clinic typical starts at 10:30 and finishes up at 3:30, so that is the amount of time we have each day to do blocks. It is true that if the clinic opened at 8 and stayed open till 6, I might get more blocks.

I have been in the pain clinic for only 2 1/2 months. Here are my numbers. I have no idea if this is a lot or a little, but I have been VERY please with my experience. The attendings are wonderful and very knowledgable. The patient population is grateful and respectful. I get free breakfast and dinner (which is a very nice perk :laugh: )

LESI: 63
CESI: 24
MBB: 22 (both lumbar and cervical - no thoracic yet)
RFA: 13
SNRB: 15
Celiac Plexus block:13
SCS implant: 6
IT pump: 3

I have also done a variety of other blocks (stellate, lumbar sympathetic, pyriformis with xray and ultrasound, botox in anterior scalene for TOS, and a myriad of other random stuff)

The telling thing for me is this - of the 200 or so people I have recorded in my book of patients I have seen in the clinic, 80% were blocks. Of the 20% that weren't a procedure I did, many of those were follow ups from implants or tunneled epidurals or whatever.

I don't know what makes a "top tier" program, but I love it here. One might feel that a downside from this program is that by the end I might not be the perfect guy to take care of a chronic pelvic pain patient with severe fribromyalgia - I would say, that is true - I have seen very LITTLE of these types of patients. Oh well, you can't win them all.🙂 I should also add that I think I have written a refill perscription for opioids maybe twice.
 
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