Any psych resident here planning to apply for pain fellowship ??
Any psych residents aspiring for pain med fellowship
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I have zero interest in pain fellowship and I think the whole concept of medical treatment of pain is flawed to begin with, but I'm an opinionated a-hole.
That said, I know that psych is eligible for pain fellowships, but I would think you'd be at a significant disadvantage compared to the other three specialties (anesthesiology, PM&R, Neuro). Namely because the other three pathways mean you spend a significant amount of your time sticking needles into specific and discrete areas. Which a lot of pain medicine is as well. *shrug*
From what I understand in terms of ease of getting in its anesthesiology>PM&R>neuro>>>psych.
That said, I know that psych is eligible for pain fellowships, but I would think you'd be at a significant disadvantage compared to the other three specialties (anesthesiology, PM&R, Neuro). Namely because the other three pathways mean you spend a significant amount of your time sticking needles into specific and discrete areas. Which a lot of pain medicine is as well. *shrug*
From what I understand in terms of ease of getting in its anesthesiology>PM&R>neuro>>>psych.
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what in the world would a psychiatrist do in a pain fellowship? Most of the time spent in a pain fellowship(and most of how they actually make $$ in practice) is spent doing interventional procedures.
I have no idea how a psychiatrist would be prepared in the same way an anesthesiologist would for that training.
Not sure, but I think when we've heard stories of psychiatrists matching in "pain fellowships" those are spots where programs have a slot set aside for a non-interventional approach to pain management.....which would of course come with different responsibilities(and different possibilities in terms of practice after training)
I sure as hell wouldn't want to be the patient who gets to have a new fellow(coming from a psych residency) sticking huge needles in my c-spine........
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I am actually a general psychiatry resident who just accepted an offer to an interventional pain fellowship program. It is true that the road to this fellowship is more difficult as a psychiatrist, but it is not impossible. In fact, I have personal knowledge of three other psychiatrists who accepted spots last year (Brigham & Women's, Stanford, USC). None of these spots were designated "non-interventional" and the host institutions have little concern with the lack of procedure time psychiatry is alloted in general training (just as they are not worried about lack of MSK training in anesthesiology & lack of psychosocial treatment training in PM&R and anesthesiology). They believe the year is meant for training us in accordance with our own deficits.
I did negotiate some procedure time into my psych training as a R3 & will be an addiction fellow prior to joining the pain program. Further, I have engaged in a significant amount of research. But my main concentration was on being the best psychiatrist I can be.
The following are programs I interviewed for (either 2010-2011 or 2011-2012 year, in no particular order):
1. Stanford--Simply an amazing program. They don't consider themselves "interventional" but that may be simply because they want to stress that they treat in a multimodal atmosphere. From what I can see, their numbers are more than adequate. Dr. Mackey is simply wonderful. I have the impression that he is personally invested in continually improving the program and in recruiting the absolute best to his program. Stanford harbors a very academic-type environment and I think that there is considerable opportunity to pursue research there as a research fellow if you so desire. I think this program is well-deserving of its fine reputation.
2. MGH/Harvard - Again, a very academic environment with phenomenal leaders/teachers/peers. Their numbers are generally impressive and their track record of getting people the type of job they want after fellowship is remarkable. I enjoyed meeting with the program leadership and it appears fellows are quite happy. The downside for me was Boston, but that is strictly a personal opinion!
3. University of Colorado - This is historically an extremely interventional program where even stim/pump procedures are commonplace. It is divided into a PM&R track and Anesthesiology track, and how much crossover there is is largely up to the fellow. I personally know one of the past fellows and he loved this fellowship. It is a small program (1 in each track) and has limited psych/neuro representation and they have never taken a psych resident before.
4. USC - This program is run by a psychiatrist/pain physician. It is another small program. I think that I would have been happy with this program had I gone, but it is oriented toward those with more non-academic career aspirations. I'm not a huge fan of LA or LA traffic, but I think I'm in the minority! They took a psychiatrist for the 2010-2011 academic year.
5. University of Washington - You will hear all sorts of things about this program and how two fellows left recently. They were cleared by a third party of any wrongdoing & I met with both people that have been accused in these threads of wrongdoing--I actually thought both were pretty amazing individuals. This is where pain was born and though the program is recreating itself, it must be doing a great job. I thought the resources and experiences offered here were extensive and I got the impression that they expected (and got) the best out of people there. I loved Seattle too.
6. University of California, Davis -- I think this program was pretty amazing. It offers a broad range of clinical learning opportunities while still maintaining its ability to be called a very interventional program. I think the faculty is great & I felt they took a great deal of effort in trying to find if your professional goals could be met with by tailoring their program to you. I also like the fact that, like a few others on this list, this program has 6 fellows. They have revamped their consult structure and the fellows seem to think this has been a very positive thing. Dr. Fishman is boarded in psych, internal medicine, and pain medicine and he definitely brings all this expertise to the table--and he seems to run his program with a great deal of transparency. All faculty were approachable, all fellows were forthcoming with their thoughts about the program. Also, two liked it enough to stay on as faculty next year. This program is being awarded a "Center of Excellence" for pain treatment designation this year.
If I can be of further help, please let me know.
I did negotiate some procedure time into my psych training as a R3 & will be an addiction fellow prior to joining the pain program. Further, I have engaged in a significant amount of research. But my main concentration was on being the best psychiatrist I can be.
The following are programs I interviewed for (either 2010-2011 or 2011-2012 year, in no particular order):
1. Stanford--Simply an amazing program. They don't consider themselves "interventional" but that may be simply because they want to stress that they treat in a multimodal atmosphere. From what I can see, their numbers are more than adequate. Dr. Mackey is simply wonderful. I have the impression that he is personally invested in continually improving the program and in recruiting the absolute best to his program. Stanford harbors a very academic-type environment and I think that there is considerable opportunity to pursue research there as a research fellow if you so desire. I think this program is well-deserving of its fine reputation.
2. MGH/Harvard - Again, a very academic environment with phenomenal leaders/teachers/peers. Their numbers are generally impressive and their track record of getting people the type of job they want after fellowship is remarkable. I enjoyed meeting with the program leadership and it appears fellows are quite happy. The downside for me was Boston, but that is strictly a personal opinion!
3. University of Colorado - This is historically an extremely interventional program where even stim/pump procedures are commonplace. It is divided into a PM&R track and Anesthesiology track, and how much crossover there is is largely up to the fellow. I personally know one of the past fellows and he loved this fellowship. It is a small program (1 in each track) and has limited psych/neuro representation and they have never taken a psych resident before.
4. USC - This program is run by a psychiatrist/pain physician. It is another small program. I think that I would have been happy with this program had I gone, but it is oriented toward those with more non-academic career aspirations. I'm not a huge fan of LA or LA traffic, but I think I'm in the minority! They took a psychiatrist for the 2010-2011 academic year.
5. University of Washington - You will hear all sorts of things about this program and how two fellows left recently. They were cleared by a third party of any wrongdoing & I met with both people that have been accused in these threads of wrongdoing--I actually thought both were pretty amazing individuals. This is where pain was born and though the program is recreating itself, it must be doing a great job. I thought the resources and experiences offered here were extensive and I got the impression that they expected (and got) the best out of people there. I loved Seattle too.
6. University of California, Davis -- I think this program was pretty amazing. It offers a broad range of clinical learning opportunities while still maintaining its ability to be called a very interventional program. I think the faculty is great & I felt they took a great deal of effort in trying to find if your professional goals could be met with by tailoring their program to you. I also like the fact that, like a few others on this list, this program has 6 fellows. They have revamped their consult structure and the fellows seem to think this has been a very positive thing. Dr. Fishman is boarded in psych, internal medicine, and pain medicine and he definitely brings all this expertise to the table--and he seems to run his program with a great deal of transparency. All faculty were approachable, all fellows were forthcoming with their thoughts about the program. Also, two liked it enough to stay on as faculty next year. This program is being awarded a "Center of Excellence" for pain treatment designation this year.
If I can be of further help, please let me know.
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Well, this thread is back from the dead. In the intervening year in change, my decade-long strong desire to work with folks with NMSK issues and the psychodynamics/cognitive-behavioral issues of pain and disability has led me to re-evaluate pain fellowship as a career pathway. I am now pretty sure I am headed down that road. I still balk at the idea of treating pain as a primary problem, but I think that being a 'pain physician' puts you in the driver's seat in managing these patients' manifold issues.
Oh and PainPsychMD was the one who convinced me to give pain a look. And like him, my main focus is on being the best psychiatrist I can be at this juncture.
Oh and PainPsychMD was the one who convinced me to give pain a look. And like him, my main focus is on being the best psychiatrist I can be at this juncture.
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Why the hate? Everyone, psychiatry resident, anesthesiology resident, medical student -- has to do a procedure on a patient for the first time, and I don't want to be the one who's first, no matter who is doing it.
Psychiatry is eligible for a reason. Pain is as mental as it is physical.
Psychiatry is eligible for a reason. Pain is as mental as it is physical.
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fj25 : Because there is still significant political inertia against psychiatry in many programs/areas of the country, the number of places you apply to may vary. I cast my net pretty wide, applying to 20 programs this year....
If you are a 3rd year resident and you want to get a 2011-2012 spot, you should be submitting applications now. Some places have already started interviewing and offering spots to people.
Hope this helps
If you are a 3rd year resident and you want to get a 2011-2012 spot, you should be submitting applications now. Some places have already started interviewing and offering spots to people.
Hope this helps
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I don't think there's any hate in his/her words, just a lot of surprise.
Come on, be honest.
A psychiatrist versus an anesthesiologist: do you really believe they both equally prepare you for sticking needles in pts' spines? I understand what you said, that there's a first time for everyone, but fact is the anesthesiologist has been learning procedures 4 years prior to the fellowship. The psychiatrist can (maybe) do ECT
I'm not saying that all psychiatrists aren't fit for pain medicine. One of the things I love about psychiatry is that there really is room for everyone. I'm sure there are people who took electives, worked as flight surgeons/GMOs, did research like masterofmonkeys, etc, who are well prepared for such a fellowship.
That said, the average psychiatrist/psych resident is not. So, it's understandable for people to be surprised
I completely agree with you that most pain is mental. And I think that's why the majority of psychiatrists stop there.
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How much training does a general anesthesiologist get in pain management? Yeah, they do epidurals, but what else? How much of their training is truly translational into "sticking needles in pts' spines?"
From my limited experience anesthesiologists are mostly gas passers rather than needle jockies. There are programs like Swedish in washington state that pride themselves on regional anesthesia but do the rest really get well versed in injections? I also understand the interventional component to pain to be mostly under fluroscopy, which, well, you can learn just fine during your fellowship.
Correct me if I'm wrong, but at this point I would have no qualms seeing a psych based pain doc for interventional injections.
From my limited experience anesthesiologists are mostly gas passers rather than needle jockies. There are programs like Swedish in washington state that pride themselves on regional anesthesia but do the rest really get well versed in injections? I also understand the interventional component to pain to be mostly under fluroscopy, which, well, you can learn just fine during your fellowship.
Correct me if I'm wrong, but at this point I would have no qualms seeing a psych based pain doc for interventional injections.
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My well-crafted reply was deleted, so here's the summary:
Many anesthesiology programs have pain management in their pgy3 years. They have some experience already in this field
Never said psychiatrists shouldn't be able to get the fellowship. I was just saying it's a select few
Even if anesthesiologist do mostly gas, they still do things like intubation on a daily basis. I've found (in my limited experience) that those clinicians (paramedics to docs) who spend more time 'poking' are more comfortable and skilled in learning new ways to poke patients. In other words, practicing procedures is a great way to prepare for learning other unrelated procedures. It's a feel that one gets
Many anesthesiology programs have pain management in their pgy3 years. They have some experience already in this field
Never said psychiatrists shouldn't be able to get the fellowship. I was just saying it's a select few
Even if anesthesiologist do mostly gas, they still do things like intubation on a daily basis. I've found (in my limited experience) that those clinicians (paramedics to docs) who spend more time 'poking' are more comfortable and skilled in learning new ways to poke patients. In other words, practicing procedures is a great way to prepare for learning other unrelated procedures. It's a feel that one gets
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Agree with this. If you are starting from the beginning, might be best to get a feel for how well a program will work with you to get you needle time before you match there. Or you might get lucky like myself, and find that your program will be very accommodating. 3rd and 4th year have enough elective time that it should be possible to get some procedure time if both the pain dept and the psych dept are amenable to that.
Personally I feel it's extremely important to have psychIATRY well-represented in pain as well as rehabilitation. While psychology is already well involved in these fields, there is a certain benefit to having physicians trained to understand the body as well as the mind active in the field.
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I was looking through the archives and came across this post. I think it would be good to shed some light on the pain fellowship opportunities available now in 2013. Has anyone here gone through a pain fellowship lately, any advise for people that might be interested. What programs are psych friendly?
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Do we really need 2 threads going about pain fellowships?
http://forums.studentdoctor.net/showthread.php?t=1005455
