Any PM&R docs regret going pain?

[klumpke]

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I’m currently between sports and pain right now and wanted to pick your brains. Anyone in a similar dilemma in the past and choose pain? Are you glad you did?

 

[MitchLevi]

No regret from me at all, and FYI you can build a hybrid practice and do both.

 

[klumpke]

No regret from me at all, and FYI you can build a hybrid practice and do both.

To go hybrid would you recommend a pain fellowship and just trying to stay up to practice on US along the way?

 

[cowboydoc]

To go hybrid would you recommend a pain fellowship and just trying to stay up to practice on US along the way?

Yes. I can’t think of anything “sports” related you couldn’t do if you did a pain fellowship, except maybe be a high level team doc. There may be several things you couldn’t do common to pain if you went the other route. (Credentialing/privileges/insurance panels may plane limits on you.)

There are sports and spine fellowships, which may still cause some of the above limitations, and many don’t recommend. (See numerous other threads) I’d stay ACGME track, but NASS fellowship would be the secondary option for what you describe.

Also look at other threads where we complain of how little U/S pays.

To answer title of thread, absolutely not.

 

[drusso]

I’m currently between sports and pain right now and wanted to pick your brains. Anyone in a similar dilemma in the past and choose pain? Are you glad you did?

Do pain. Any pain doc can do sports, but sports docs can't do pain.

Also, everyone thinks that if they do sports they'll be the next major league team doc. Instead, they end up trawling high school wrestling tournaments looking for cases and fluffing coaches.

 

[RoloTomassi]

Instead, they end up trawling high school wrestling tournaments looking for cases and fluffing coaches.

...on their off time. They do visco injections on 80 year olds 8-5.

 

[MitchLevi]

A PMR physician who does a pain fellowship offers great value to ortho groups. You can do all the pain procedures while simultaneously branching out to biologics, peripheral joints and MSK.

Sideline coverage sucks.

I'm sure you don't want to do sports physicals.

Use your baller pain money to get great seats at sporting events and enjoy your night off. Let someone else work that football game.

 

[Czech777]

OR privileges, implantables, neuromodulation, more $$$, more jobs. I looked at both and am very happy I did this vs my sports co-residents. Even if you might not want to do surgery, it’s nice to have the option.

 

[lobelsteve]

I did sideline coverage Friday night. Fun time, hung out with my sone before he heads off to college. Game wasn't exciting. Trainers don't need us and EMT also on sidelines. Did get to assist in mom down on sideline. Chest compressions by trainer for a few seconds and mom popped up embarassed. Likely syncopal episode. Not terribly exciting, thank god for that.

 

[drg123]

Current pain fellow. The others above have captured the key decisive factor for me - With ACGME pain training, the maximum number of doors are open, especially with PM&R primary training. You can do whatever you want procedurally. Whereas the same can't be said of doing Sports. At times, in pain world, which is heavily anesthesiology based, I don't always agree with the approach we take, but that's as a trainee. After fellowship, you're the boss. Do pain unless you're sure you would be satisfied with the more narrow scope of sports.

 

[GlowInTheDark]

Spine/Sports Trained PMR usually sent their patients to us when I was training. What made them uncomfortable was relatively commonplace for us

 

[Bostonspine]

PMR/Pain ortho practice do all pain stuff and MSK injects(fun for me) able to cover my overhead with pain alone can beach out in to MSK PrP as much as I want no sideline coverage. If I wanted to make more money I’d do straight pain

 

[DrSpine]

I did Pain, no regrets. PMR is already sports, you get MSK skills and training, plus Concussion training via TBI. Primarily Care Sports Medicine is really a crash course of MSK for the FM guys. Pain is the more advanced aspect of PMR, allowing you to do all the injections you want essentially.

You can always do a hybrid Spine and Sports Practice. Do Pain over Sports in terms of fellowship.

 

[clubdeac]

do pain and then make sure you get into a good ortho or spine group that doesn't focus on opioids or med management

 

[dmk21]

This is slightly off subject but does anyone have regret down the pain route in comparison to general inpatient PM&R (whether it be acute, subacute, SNF, ect) from a time flexibility standpoint? (Not the fellowship perspective but from career perspective cause I know I can always just forgo my fellowship training)

Resident in rehab now who enjoys the work in inpatient/pain but feel a split in what practice to go into. I feel like going into pain, while on average I’ll have a higher income it’ll come at a cost of (on average) of higher working hours in comparison to inpatient. Also the flexibility in general PM&R seems so amazing and seems like you can make a decent living for very easy hours (kicking my self now as I should have considered anesthesia residency and just done locums)

 

[DrSpine]

This is slightly off subject but does anyone have regret down the pain route in comparison to general inpatient PM&R (whether it be acute, subacute, SNF, ect) from a time flexibility standpoint? (Not the fellowship perspective but from career perspective cause I know I can always just forgo my fellowship training)

Resident in rehab now who enjoys the work in inpatient/pain but feel a split in what practice to go into. I feel like going into pain, while on average I’ll have a higher income it’ll come at a cost of (on average) of higher working hours in comparison to inpatient. Also the flexibility in general PM&R seems so amazing and seems like you can make a decent living for very easy hours (kicking my self now as I should have considered anesthesia residency and just done locums)

Inpatient Rehab means weekend calls and dealing with hospital Admin. No thanks.

 

[Baron S]

Sports was the worst part of residency for me. Spending inordinate amounts of time trying to figure out why some 30 year old's shoulder clicks sometimes or why some 45 year old's ankle hurts around mile 12 of his marathon was the closest thing to hell in medicine I've experienced.

Zero regrets doing fellowship whatsoever. I had decided on Pain before I decided on PM&R.

 

[SSdoc33]

none

 

[MitchLevi]

Sports was the worst part of residency for me. Spending inordinate amounts of time trying to figure out why some 30 year old's shoulder clicks sometimes or why some 45 year old's ankle hurts around mile 12 of his marathon was the closest thing to hell in medicine I've experienced.

"I know my body."

- Every low level Crossfit person ever.

 

[GoBeers]

usually I see PMR pain associated with multispecialty ortho groups, as opposed to anesthesia pain folk.
is there a particular reason for this?

 

[DOctorJay]

usually I see PMR pain associated with multispecialty ortho groups, as opposed to anesthesia pain folk.
is there a particular reason for this?

ortho docs like to have PM&R docs around to do EMGs

that said there is a local private ortho group that has 2 pain docs who are anesthesia trained and I don't believe they've ever had PM&R trained pain docs so it does happen

also, glad I did pain and instead of sports

 

[Dr. Ice]

I know some very successful sports docs doing a ton of regen. That’s the only way. Otherwise it’s all about spines

Also ultrasound can be self taught. I did it. It takes work, but it can be done

 

[Bostonspine]

usually I see PMR pain associated with multispecialty ortho groups, as opposed to anesthesia pain folk.
is there a particular reason for this?

All the single specialty pain groups in my area anesthesia only starting a bit higher for them cause they do Mac for their partners if they are not busy(pays better than EMG Monkey for Hand & foot and ankle). My group has 2 anesthesia and 1 PM&R(me) also an internist(pain fellowship trained)

 

[Doctodd]

the sports guy i remember in residency was Dr Cianca. He was also doing accupuncture. His biggest procedure was a suprapatellar knee injection. I have nothing bad to say about him except that his rotation was boring.

Dr. John Cianca, MD - Human Performance Center Houston

Dr. John Cianca founded the Human Performance Center in 1994. He uses his expertise to diagnose and treat muskuloskeletal conditions at HPC Houston.

hpchouston.com

 

[Dr. Ice]

All the single specialty pain groups in my area anesthesia only starting a bit higher for them cause they do Mac for their partners if they are not busy(pays better than EMG Monkey for Hand & foot and ankle). My group has 2 anesthesia and 1 PM&R(me) also an internist(pain fellowship trained)

I’ll never (never say never) but I hope to never do another EMG again. Have always hated it, and especially now what it pays..forget it.

 

[MitchLevi]

Haven't done an EMG since 2016.

 

[sdnuser001]

EMG still pays better than clinic so it can work if the spine surgeon is feeding you direct injections and you don't mind doing it. It can often be used to generate procedures as well. You have to ask all those CTS rule outs if their neck hurts anyway since it could be a radic. If they say yes then that's a potential procedure right there.

 

[waityouresmart]

Yes. I can’t think of anything “sports” related you couldn’t do if you did a pain fellowship, except maybe be a high level team doc. There may be several things you couldn’t do common to pain if you went the other route. (Credentialing/privileges/insurance panels may plane limits on you.)

There are sports and spine fellowships, which may still cause some of the above limitations, and many don’t recommend. (See numerous other threads) I’d stay ACGME track, but NASS fellowship would be the secondary option for what you describe.

Also look at other threads where we complain of how little U/S pays.

To answer title of thread, absolutely not.

PMR/Pain ortho practice do all pain stuff and MSK injects(fun for me) able to cover my overhead with pain alone can beach out in to MSK PrP as much as I want no sideline coverage. If I wanted to make more money I’d do straight pain

I did Pain, no regrets. PMR is already sports, you get MSK skills and training, plus Concussion training via TBI. Primarily Care Sports Medicine is really a crash course of MSK for the FM guys. Pain is the more advanced aspect of PMR, allowing you to do all the injections you want essentially.

You can always do a hybrid Spine and Sports Practice. Do Pain over Sports in terms of fellowship.

do pain and then make sure you get into a good ortho or spine group that doesn't focus on opioids or med management

ortho docs like to have PM&R docs around to do EMGs

that said there is a local private ortho group that has 2 pain docs who are anesthesia trained and I don't believe they've ever had PM&R trained pain docs so it does happen

also, glad I did pain and instead of sports

I know some very successful sports docs doing a ton of regen. That’s the only way. Otherwise it’s all about spines

Also ultrasound can be self taught. I did it. It takes work, but it can be done

Thanks everyone above for commenting - I'm currently also deciding between pain & sports, but definitely want to practice at least some spine/fluoro. I'll be applying to fellowship from a PM&R residency that is heavy in sports and ultrasound exposure. Can any of the private PM&R pain folks who work in an ortho setting perhaps comment on your patient population? For example, do you get a fair amount of new patients with issues that you can actually fix/make a difference in, or are you doing straight pain management for referred patients who have tried everything under the sun? Or some combination?

For reference, I'm currently rotating with an anesthesia pain department with a heavy focus on advanced stim, pumps, opioid management, for patients who have exhausted so many other treatments, and all of this stuff is making me anxious about wanting to basically practice bread and butter pain/spine with a side of MSK/regenerative that I'm actually interested in.

 

[MitchLevi]

PMR doctors fit into Ortho groups nicely.

I do chronic MSK pain, a combination of spine and joints.

I don't see fibro, pelvic pain, facial pain, etc.

If you join an ortho group you will NOT do pumps, and they would prefer you not do chronic opiates (I do some opiates by choice).

EMG is negotiable (I don't do it).

My partners send me PRP, and one of our guys wants me to consider VIA disc (he's one of their primary authors).

 

[lobelsteve]

PMR doctors fit into Ortho groups nicely.

I do chronic MSK pain, a combination of spine and joints.

I don't see fibro, pelvic pain, facial pain, etc.

If you join an ortho group you will NOT do pumps, and they would prefer you not do chronic opiates (I do some opiates by choice).

EMG is negotiable (I don't do it).

My partners send me PRP, and one of our guys wants me to consider VIA disc (he's one of their primary authors).

Following Doug Bealle 's posts on LinkedIn. Great success, greater complication rates currently.

 

[GoBeers]

PMR doctors fit into Ortho groups nicely.

I do chronic MSK pain, a combination of spine and joints.

I don't see fibro, pelvic pain, facial pain, etc.

If you join an ortho group you will NOT do pumps, and they would prefer you not do chronic opiates (I do some opiates by choice).

EMG is negotiable (I don't do it).

My partners send me PRP, and one of our guys wants me to consider VIA disc (he's one of their primary authors).

Are you asked to manage opioids for their post op patients?

 

[RoloTomassi]

If you are PM&R in ortho group you will primarily be doing fluoro spine so best to do pain fellowship.

 

[MitchLevi]

Are you asked to manage opioids for their post op patients?

No

 

[MitchLevi]

Following Doug Bealle 's posts on LinkedIn. Great success, greater complication rates currently.

I'm hesitant.

 

[DoYouEvenLiftBro]

some ascs / hospitals won’t credential you for spine procedures if your not fellowship trained

You can learn any sports thing and dont need the accreditation to practice

If and when you have kids, sports coverage is evenings and weekends and kind of annoying in that sense. You’re just watching ppl who aren’t your kids. You can still have a practice treating “sports” pts but they’ll probably be more your weekend warriors and cross fitters who will be down for PRP/BMaC anyways

Do pain, then make your practice what you want