Advice

[Lostin_space]

So currently doing a pain rotation. While I enjoy certain aspects of pain and certain procedures, and while I have another pain rotation lined up for a bit later on in the year, I find it that I am not enjoying certain procedures such as cervical blocks/RFAs, lumbar blocks/RFAs, ESI's, etc. I am also a bit intimidated by the fact that it's mostly a male dominated field, I feel frequently I'm not in the "in" crowd with the dudes and it's difficult to develop more interpersonal relationships with attendings and what not, especially with no female mentors in the field. I also feel that I am graded more harshly than my male residents in part because I'm a girl and not in the in crowd.
I'm re-thinking this whole pain thing. Does anyone have suggestions as to ways to get training in procedures that don't involve spine stuff, but that involve MSK stuff? I would like more exposure if possible before being able to make a final decision on whether I should apply or not.
Any ideas? Thanks!

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[101N]

You should find some women mentors and talk to them.

 

[Lostin_space]

You should find some women mentors and talk to them.

Ha! I have yet to find an interventional pain physician who's a woman. 100% of the department in my program are men, and most of the departments are men. I have repeatedly asked our point of contact/main attending for research opportunities and he tells me that he doesn't have any, even though just about every other person has done some sort of case, etc. with him. I come in on time, I see a ton of patients, offer help to fellow residents/fellows, stay late, try to be proactive asking for opportunities, yet nada. I'm not a bro. I don't drink beer, I don't talk sports, I"m not 6 ft tall, and have tiny hands with manicures. I feel so disappointed.
And again I like certain procedures, but don't know if I would be comfortable doing things like cervical/lumbar RFAs, SCS trials, etc.

 

[nvrsumr]

https://doctordevi.com

Very well regarded female pain doc. I bet if u emailed her she would be happy to mentor u a bit

 

[101N]

Ha! I have yet to find an interventional pain physician who's a woman. 100% of the department in my program are men, and most of the departments are men. I have repeatedly asked our point of contact/main attending for research opportunities and he tells me that he doesn't have any, even though just about every other person has done some sort of case, etc. with him. I come in on time, I see a ton of patients, offer help to fellow residents/fellows, stay late, try to be proactive asking for opportunities, yet nada. I'm not a bro. I don't drink beer, I don't talk sports, I"m not 6 ft tall, and have tiny hands with manicures. I feel so disappointed.
And again I like certain procedures, but don't know if I would be comfortable doing things like cervical/lumbar RFAs, SCS trials, etc.

I trained several - they were my best - and I know several. List your state and I'm sure a bunch of us
will give you folks to speak to.

 

[DOctorJay]

there are excellent female consultants at Mayo


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[hyperalgesia]

Ha! I have yet to find an interventional pain physician who's a woman. 100% of the department in my program are men, and most of the departments are men. I have repeatedly asked our point of contact/main attending for research opportunities and he tells me that he doesn't have any, even though just about every other person has done some sort of case, etc. with him. I come in on time, I see a ton of patients, offer help to fellow residents/fellows, stay late, try to be proactive asking for opportunities, yet nada. I'm not a bro. I don't drink beer, I don't talk sports, I"m not 6 ft tall, and have tiny hands with manicures. I feel so disappointed.
And again I like certain procedures, but don't know if I would be comfortable doing things like cervical/lumbar RFAs, SCS trials, etc.

Female and manicured hands are favorable attributes, they just don't make up for the complete lack of interest in the bread and butter of interventional pain (spine).

 

[lobelsteve]

I think user crybaby on here is a woman.

 

[Lostin_space]

Female and manicured hands are favorable attributes, they just don't make up for the complete lack of interest in the bread and butter of interventional pain (spine).

Doesn't seem to be. For example, I see a bunch of patients, write excellent notes, manage patients moderately well, get along with staff, patients compliment me in front of the program director, I express interest in research, yet I am somehow graded not so high, even on the research component! I have reached out to tons of people so that I can get involved in research as well. There is a male resident who I don't believe has expressed any interest in research, has missed almost 1/3 + of the rotation due to vacation, call/post call days off, etc. yet somehow everything he does is great! I think they already have referred to him as a fellow/future fellow or something like that. Really? It's really frustrating. I have helped run the clinic with only 1 fellow certainly more than once, etc. Yet somehow I'm not nothing special. Not a single woman from my program has matched there - certainly I think in close to 5-10 years from what I can tell. All the people from our institution that have matched have been men. Somehow I feel disappointed, and once again all my drive, hard work, and self confidence takes a huge hit.

 

[BobBarker]

If you don't want to do bread and butter spine procedures it will never work out well and would be a waste of a pain fellowship. You can do joint injections, write prescriptions, and do emg's with your residency training.

Of course, you would probably have to go to work for a general ortho group...

 

[Lostin_space]

If you don't want to do bread and butter spine procedures it will never work out well and would be a waste of a pain fellowship. You can do joint injections, write prescriptions, and do emg's with your residency training.

Of course, you would probably have to go to work for a general ortho group...

I feel torn honestly. I would definitely want to do more than joint injections, I would definitely like to do blocks, or some blocks, but not sure if I want to do cervical RFAs, stim trials, etc. I also have not had the actual possibility to do them yet. I'm not sure if I am feeling more on the dumps because I feel kind of isolated with the sausage fest, or because I don't feel appreciated, etc. I've also had difficulty finding people to help me get involved, do research, etc which I find frustrating. I don't think most residents have to search soo hard for opportunities, and it might be related to the fact that I'm a gal and maybe more on the quiet side. Can't change that.

 

[bedrock]

https://doctordevi.com

Very well regarded female pain doc. I bet if u emailed her she would be happy to mentor u a bit

She was one of my co-residents at Harvard. Very outgoing, which is likely why she has gravitated toward being the medical expert for various news stations and magazines.

To the OP- As others have mentioned, pain won't be a good fit for you if you have no interest in common spine procedures. I don't know a pain doctor who doesn't offer epidurals and RFA both cervical and lumbar. However, you can decided not to do SCS and kyphoplasty and still hold down a regular pain job.

If you are mainly interested in MSK problems other than the spine, you may also want to consider a sports medicine fellowship, as "Sports medicine" is basically code for peripheral joint problems, both acute and chronic. You will learn to examine, diagnose, and inject every joint, tendon, bursa, etc other than the spine, but there are no big intimidating procedures like kypho or SCS in sports medicine.

Also, there are a lot more females in non-operative sports medicine, than in pain.

 

[Ligament]

Lots of opportunities if you are a female pain doc. I know lots of them. The sausage fest sounds unique to your program. You sound like you are doing an ortho rotation!

Also, if you don't want to do the more invasive procedures, don't waste time on a pain fellowship.

 

[hyperalgesia]

Doesn't seem to be. For example, I see a bunch of patients, write excellent notes, manage patients moderately well, get along with staff, patients compliment me in front of the program director, I express interest in research, yet I am somehow graded not so high, even on the research component! I have reached out to tons of people so that I can get involved in research as well. There is a male resident who I don't believe has expressed any interest in research, has missed almost 1/3 + of the rotation due to vacation, call/post call days off, etc. yet somehow everything he does is great! I think they already have referred to him as a fellow/future fellow or something like that. Really? It's really frustrating. I have helped run the clinic with only 1 fellow certainly more than once, etc. Yet somehow I'm not nothing special. Not a single woman from my program has matched there - certainly I think in close to 5-10 years from what I can tell. All the people from our institution that have matched have been men. Somehow I feel disappointed, and once again all my drive, hard work, and self confidence takes a huge hit.

You seem overly preoccupied with gender roles and expectations. Why do you have a Mars symbol as your avatar?

 

[Agast]

I don't know the specifics of your program but I want you to reframe your thinking a bit: they're not overlooking you because you are a woman, they are overlooking you because your male counterparts are louder and more pro-active. How can you say you don't want or like to do cervical RFA when you've never done one before? Epidurals and facet joint injections are like any other procedure in pain, you determine the target and deploy the medication.

What you can do is speak up and say "Hey I haven't seen a spinal cord stim yet, do you mind if I watch this next one?" Attending probably won't say no. Don't wait to be invited (this is true for all things in life if you really want something) you show up and say "thanks for letting me watch this, I spend most of my time in clinic and I wanted to check out more procedures. I saw Mr X after he got his spinal cord stimulator and he had <blah blah blah insert anecdote here> <insert follow up question that shows you synthesize data> You get the drift. Some attendings love to teach and hear themselves talk. Find this guy and ask good questions.

I'm not naturally a go-getter and I tend to be more quiet. There were plenty of times I resented the guys in my program for being more "likeable" and squeaky wheels who got the cool procedures. That didn't stop me from applying to fellowship and during the interview trail I realized no one cares how many times you stuck a needle in someone's back because they are going to train you the way they want. So the cavalier guy who sails in and says "well this is the way I always did it" and refuses to change bad habits is no one's friend. You know what the job of the fellow is in any medical specialty? To make the attending's life easier. So if you know how to see tons of consults, finish your work and keep patients happy with their care you will be a program rockstar. If you are trainable and receptive to input you will be a good fellow.

I put on a persona that I jokingly call "what would an entitled white male do." The principle is that no one just gives you stuff unless you act like they're supposed to and then it confuses them. You can think of it as "how do all those high maintenance girlfriends convince guys to buy them Gucci bags (while I'm still eating at Denny's). I'm a resident, I'm being paid to learn as much as possible from you, so here I am learning as much as possible from you and that includes the goodies.

I've been practicing for a little over a year now. I love having my own patients. When your patient comes back to you with shining eyes telling you how they walked 5 miles at the Renaissance Festival after your procedure it feels kind of awesome. My patients tell me stuff about their personal lives they don't tell their PCPs. And since a lot of them have to see you once a month you are really, truly their doctor. I have also had patients tell me they wanted to specifically see a woman.

Anyways, residency is stressful and it's hard to avoid comparing yourself to your peers. PM me if you have any other thoughts.

 

[SeniorWrangler]

It can be hard as a female physician to find ways to be assertive without getting pegged as pushy or worse (See: Clinton, H.) but it's really important.
Also, there may be a lot of macho jerks in your particular program, but that's probably not every single attending, try to find the reasonable ones.

 

[Ducttape]

1. consider sports med, or even just PMR if you don't like spine.
2. I have worked with multiple women pain docs, and under a few as a resident/fellow. one is my mentor and the primary reason I went in to pain. and not because of a needle, but because how she interacted with patients and helped them find a better way than opioids or injections.
3. pain fellowship is not just interventional pain medicine. and you might find that you enjoy the spine procedures once you get the opportunity.
id guess you are in a heavy interventional program, but otherwise pain attendings do take note of those who have great clinical acumen and knowledge base and seem excited to be there...

 

[Ligament]

I put on a persona that I jokingly call "what would an entitled white male do."

Don't pull out your sexism and white racism here. How about "what would a confident woman or man do?"

 

[Lostin_space]

1. consider sports med, or even just PMR if you don't like spine.
2. I have worked with multiple women pain docs, and under a few as a resident/fellow. one is my mentor and the primary reason I went in to pain. and not because of a needle, but because how she interacted with patients and helped them find a better way than opioids or injections.
3. pain fellowship is not just interventional pain medicine. and you might find that you enjoy the spine procedures once you get the opportunity.
id guess you are in a heavy interventional program, but otherwise pain attendings do take note of those who have great clinical acumen and knowledge base and seem excited to be there...

I don't think I like sport med per se. I would like to work with the general population and I do like procedures but I am on the fence re: spine ones. I guess it is true that I have not unfortunately had much experience with them but still. I am finding it hard to make a connection with any of the attendings. I have asked for opportunities numerous times but still have nothing. I really dont' know where else to look. I think most of the attendings are good and decent people I just don't seem to be able to have any type of mentoring relationship with them or any opportunity. I also have noticed that fellow male residents in my own program have received a good deal of mentoring and assistance when they've asked. I mean I guess I know where I should stop pushing, it's not like I can continue pressing for opportunities if I;m told there aren't any. Yet I find it difficult to believe that there aren't and wonder how others get them. It's frustrating for me. I work hard and try my best, but I am not going to be an expert overnight, and feel that I need some assistance, direction, guidance, opportunities in this case.

 

[clubdeac]

So you say you're doing a pain rotation. I didn't see whether you said you were a resident or med student? And if you're a resident, PMR or Anes? And is the program an anesthesia run program. All these things will influence how much time you get doing procedures. Also why do you not like cervical blocks/RFAs, lumbar blocks/RFAs, ESI's? Is it more b/c of unfamiliarity with them. Do you feel scared or intimidated by the procedure. It's ok if so...I think everyone is at first to a certain extent. However if that's the case, you shouldn't shy away from the field b/c of that. You will quickly become very comfortable doing them. I went from feeling completely inept with a needle as a fellow to a year later believing I had the best hands in the world

 

[hyperalgesia]

The time for hand holding and assistance ends abruptly at about M3. It hits like a hammer for the unprepared. The transition from M3-R1 is the difficult period when boys and girls turn into doctors. By R2, only outliers still talk about the unfairness of it all. That puts the OP in approximately the M3/4 zone.

 

[ampaphb]

Heidi Prather

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[Lostin_space]

The time for hand holding and assistance ends abruptly at about M3. It hits like a hammer for the unprepared. The transition from M3-R1 is the difficult period when boys and girls turn into doctors. By R2, only outliers still talk about the unfairness of it all. That puts the OP in approximately the M3/4 zone.

Completely disagree. That's why people have mentors, and others who make calls on their behalf, etc.

 

[Stim4me]

There's a blogger called heathermed, a female pain attending. PM her, I'm sure she'd be helpful...

 

[bedrock]

Completely disagree. That's why people have mentors, and others who make calls on their behalf, etc.

Still sounds like you're more interested in just complaining about your situation and blaming everything bad that happens to you, as happening solely because of your gender, instead of looking inward to consider an unbiased perspective on your strengths and your weaknesses.

 

[101N]

Completely disagree. That's why people have mentors, and others who make calls on their behalf, etc.

Your observations about the personality types of those of us who came before are
pretty accurate. But this specialty is changing and becoming less procedurally focused
even now. A more holistic, behaviorally focused, and multi/interdisciplinary model will
succeed the pills and procedures of old. As that model emerges the aggressive cowboy
personalities won't be attracted to it any more.

Don't be turned away by the hubris of either your fellow students or instructors.
You just haven't yet met folks like you in the specialty. They exist.

 

[BobBarker]

I checked out your old posts to see if you were PMR or gas. You posted about what I think is the real reason they aren't taking you seriously as a potential pain fellow.

 

[hyperalgesia]

Completely disagree. That's why people have mentors, and others who make calls on their behalf, etc.

Remember this moment when you are an attending and you are approached by someone in training looking for an opportunity!

 

[Lostin_space]

Remember this moment when you are an attending and you are approached by someone in training looking for an opportunity!

I certainly will, and to the best of my ability, I try to help students/lower level residents now as much as I can actually.

 

[neutro]

I'm sorry to say and I will try not to sound harsh, but you are giving a ton of excuses to not be able to practice bread and butter procedural pain medicine.
Your notes as a resident (I'm not sure if you're anesthesia or PMR or neurology) may be long and good in your opinion, but I doubt they communicate the many complexities of evaluating and managing the pain patient and then selecting the appropriate intervention and documenting your decision making as an experienced pain attending. I do not believe that it is possible to accomplish that as a resident or even as a fellow. You need independent practice experience and likely a pain fellowship, to really learn, describe and acknowledge the many subtleties inherent to a pain patient.

and this....

I feel torn honestly. I would definitely want to do more than joint injections, I would definitely like to do blocks, or some blocks, but not sure if I want to do cervical RFAs, stim trials, etc. I also have not had the actual possibility to do them yet. I'm not sure if I am feeling more on the dumps because I feel kind of isolated with the sausage fest, or because I don't feel appreciated, etc. I've also had difficulty finding people to help me get involved, do research, etc which I find frustrating. I don't think most residents have to search soo hard for opportunities, and it might be related to the fact that I'm a gal and maybe more on the quiet side. Can't change that.

?feel appreciated?
If you feel this way, then you should not practice pain medicine! You are going to be faced with a lot of difficult patients everyday. If you are finding it difficult to fight with your co-residents to do some procedures, then you may have a hard time managing clinic. Your gender is not going to make a difference (although it helps being 6'1" and 200 lbs), Rather its your ability to handle stress and difficult patients and weeding out the BS'ers that will be important. I would say, probably the worst, unhappiest and complaining patients that no one wants to deal with, are pain patients. Some of them will never be helped. For them it will be risk stratification, councelling and rehab for which the community and your referring physicians will look to you for. Yet, you will have to navigate your way through and negotiate a reasonable plan with them on a daily basis.
Being able to hold your ground is probably one of the most important attributes of a pain physician. You should start developing this now - by aggressively seeking more procedures! If I were you and if I were serious about this, I would reach out to the attending. Its their job to teach. Its your job to ask. Forget the formalities please.
It will also depend on what kind of a practice you are in. I am hospital based, and I have a 50/50 mix with meds and interventions. Most of my patients on opiates are cancer patients. If you're interested in being a block jock, rather than being a true consultant in pain medicine, then that is different - I do not recommend you practice that way by the way.

Good luck.