ACGME PM&R Pain Programs

Discussion in 'PM&R' started by Discount, Oct 24, 2002.

  1. Discount

    Discount Junior Member
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    What is the deal with these new ACGME accredited pain programs? It seems there are only six in the whole nation. Is it worth going to a pain program that is accredited or is it better to go to one of those "PASSOR" approved spine fellowships?

    I am a PGY-4 applying to pain programs and I am like super confused. Does anyone have the scoop on the Spaulding/Harvard pain program... seems like it is more inpatient pain than interventional pain stuff. How about the other ACGME PM&R programs... I think there is one in MCV, York/Sinai, California, Baylor in OK City, Michigan and Spaulding. Anybody apply to these programs or is it worth going to at all?

    I heard Harvard/Spaulding interviews like >40 people for one spot. Are the other programs also this competitive.

    I am really late in the game and just wondering what others think about doing fellowships in pain/spine.
     
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  3. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    There are many more than six ACGME-approved fellowships. I think you're mentioning the six that are PM&R-based. There's a whole bunch that are anesthesia based. In a private conversation with a director of an anesthesia-based pain fellowship at a large southwestern university, he related to me that the demographics of applicants for pain programs are shifting away from anesthesiologists and more towards physiatrsts. He felt that this was secondary to improved job opportunities in OR-anesthesia (as we all know, many anesthesiologist pain management physicians *HATE* chronic pain patients and usually only do it for the money!). I think that ACGME-approved pain fellowships are the way to go, but you should also look into PASSOR fellowships (which might actually be more musculoskeletally-oriented and more closely in tune to how you would practice as a physiatrist) and fellowships through the American Academy of Pain Medicine (AAPM). These AAPM-approved fellowships have very rigorous accreditation standards, are usually more multidisciplinary than purely anesthesia-based pain fellowships and are very open to physiatrists.

    AAPM Website Link
     
  4. Discount

    Discount Junior Member
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    Thanks for the information on the pain programs. But, I am still very confused because there are over 90 anesthesia-based ACGME pain programs and only 6 PM&R based ACGME pain programs. I feel that if I am trained in PM&R, why should I go to another field's (anesthesia) pain program- wouldn't you think that anesthesia people will treat you differently as a PM&R guy.

    I am also wondering if there is some sort of "ranking" for these programs. It seems all the major universities have some kind of pain program- of course, mostly anesthesia based. Does anyone have any kind of idea on which of these programs are PM&R friendly?

    Also... i feel that there is more to pain management than the "point-and-shoot method." I don't think many pain programs incorporate rehab and PT in their treatment for the patient.

    In short, does anyone know the "scoop" on all the pain stuff going around. PM&R pain is in its infancy- and as an infant brought into the new world it just brings confusion.



    :confused:
     
  5. bigfrank

    bigfrank SDN Donor
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    Hi,

    SIX pain PM&R programs? I just did a search on FREIDA and found THREE (Spaulding, UVA, Baylor--OK City). Where are the other 3 supposedly accredited programs?
     
  6. Discount

    Discount Junior Member
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    Big Frank, Check the ACGME website at ACGME.org

    There are six PM&R programs but it seems there is little known about these programs. However, there is a plethora of Anesthesia Pain programs... more than 90 such programs.

    Then PASSOR has their own approved programs in spine. Unfortunately, I don't know what the scoop is on most of these programs as a lot of them are relatively new.

    What does the guys in Michigan and Spaulding think about the new PM&R pain programs there.

    Still confused...
     
  7. Ligament

    Ligament Interventional Pain Management
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    Hey guys,

    I will soon be a PGY-2 at the University of Michigan PM&R program (http://www.med.umich.edu/pmr/), here is what I know so far:

    1. There is an interventional spine/muskuloskeletal fellowship thru PM&R (3 spots per year).

    PM&R/Spine Center: http://www.med.umich.edu/pmr/spine/index.htm
    Spine Fellowship direct link: http://www.med.umich.edu/pmr/spine/fellows.htm

    2. There is a new PM&R run pain management fellowship thru PM&R (?? spots)

    3. The Anesthesiology run pain Fellowship takes PM&R residents as fellows (depends on how many apply).

    http://www.med.umich.edu/anes/education/fellowship/pain_fellowship.htm

    Regards! Ligament
     
  8. drusso

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    I don't know. I'm a big proponent of "cross fertilization" especially in a field like pain medicine. On the whole, I don't think that you'll find anesthesia-based pain programs to be anti-PM&R, although you might find specific programs unwelcoming of physiatrists. Through conversations with anesthesia-based pain fellowship directors, (the dean of my medical school is an anesthesiologist and used to run the pain program at Penn State) the impression I've gotten is that physiatrists do very well in anesthesia-based programs, but may be a little slow to get up to snuff procedurally. It depends upon what sort of injection training and procedures you got during residency. One option is to try to arrange to do a couple of weeks of OB-anesthesia and just practice epidurals (not hard, just requires practice) and try to arrange some procedurally-oriented electives toward the end of your program.
     
  9. Discount

    Discount Junior Member
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    Does anyone know anything about the PM&R pain programs in California? I think it is the West LA V.A. and UCLA multicampus program... also wondering about MCV and Spaulding/Harvard. Does anyone know people applying to these programs and relative competitiveness?
     
  10. The only program I know about is the one at UC Davis. The program is jointly run by PM&R and Anesthesiology. They take three PM&R and three Anesthesia residents per year. With regards to the program at Spaulding, I should know more about it, but I don't. I'll try to ask around these next couple of weeks. I met our current Pain fellow at one of meetings. At the time (July or August) he stated that he was quite fortunate to have gotten a spots. Applications have increased significantly since we obtaines ACGME accreditation. I think he was told that applications were up four to fives over the previous year and it was still early in the process. The fellowship here focuses on chronic pain managment as well as Interventional procedures. I know that several of our former graduates who went on to do Anesthesia-based Pain Fellowships are returning to help with the further developement of our own program and fellowship. I heard that our Fluroscopy suite would be completed in October, so perhaps it is done already. Previously, the residents and fellows would go to MGH, BWH, and BIDMC to learn these procedures and rotate on their service. I am sure many will still choose to do this, but there will be more in-house opportunities now.

    Most of the time, obtaining fellowships at an outside institution is tougher because they favor their own residents. However, over the last couple of years, the residents in our program interested in Interventional Pain (including this year's crop of PGY-4s) have gone on to do Anesthesia run fellowships at Harvard affiliated hospitals.
     
  11. Discount

    Discount Junior Member
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    Stinky,

    How come people in the Spaulding rehab program apply to the anesthesia-based harvard programs rather than their own PM&R based pain program. In other words, do people in your PM&R programs apply to their own PM&R pain program.

    Just wondering, because if Harvard has such a good PM&R pain program it should attract their own residents first... or does harvard not believe in incest?
     
  12. I've never really had the opportunity to ask the previous residents about this. However, my guess is that these are some of the reasons:

    1) Our program only got ACGME accreditation this year and I'm sure this was a significant factor.

    2) We have ample opportunities to rotate with the PM&R Pain docs as residents so I'm sure many just want a new setting and a different perspective.

    3) One of the Harvard Anesthesia programs provides exposure to both the Pediatric and Adult populations (this was the reason cited by one of our current PGY-4s).

    Good luck and let us know where you match.
     
  13. rehabdoc

    rehabdoc Member
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    re: Discount

    I am in the process of interview for pain fellowship myself.

    As PGY-4 , interested in interventional pain, I believe you need to learn the procedures from people who have been doing this for over 20 years, the anesthesiologists. You in 10-15 year, could be leader in pain management as physiatrist but in this stage of the game, physiatry as profesion has little experience in interventional spine and pain management and learning from people with limited experience will lead to unfulfilling education for you. Most great interventional physiatrists are in private practidce with anesthesiologists and are not in teaching positions....

    Spaulding rehab offers great inpatient pain experience but is low on procedures, So if inpt is you goal, go for it otherwise stay away.


    I highly recomend you to look into anesthesia based programs, you will thank me for it later

    Most spaulding residents interested in pain management move on to other harvard programs or other u niversities to do fellowship in pain if they can. I partialy agree with stinky tofu reasoning ....when there is BI and MGH and Brigham why spaulding?
     
  14. Discount

    Discount Junior Member
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    Rehabdoc,

    Are you getting a lot of interviews? Since u r from a top program you shouldn't have problems getting a spot. So in terms of rankings, which hospital is considered a "lesser Harvard?"

    Beth Israel and Spaulding are like the lesser Harvards?
    MGH and Brigham are the greater Harvards...

    Please explain...

    i thought Spaulding pain program was the best. Now it seems MGH and Brigham is the best.
     
  15. Considering that you are a "PGY-4", aren't you a little late in the game?
     
  16. Discount

    Discount Junior Member
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    As you well know chronic pain lasts for a long time.

    It is never too late to help alleviate pain.

    Join me in the campaign against pain.

    As rehabdocs, our mission is to improve function.

    I am indeed late in the game. Just wondering what other guys are doing. Its either a fellowship and/or working for workers comp. So is the Spaulding program past its deadline.. i wanna apply? Am I too late? did they already get a pain fellow?
     
  17. rehabdoc

    rehabdoc Member
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    There are no better on worse harvard it is all dependent on what is your preference.

    Inpt :Only Spaulding offers
    Procedures: Brigham has the most exposure

    It is quite late to apply now...try non-ACGME programs too for insurance
     
  18. Discount

    Discount Junior Member
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    How come Spaulding only offers inpatients? Where did all the inpatients go?
     

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