applying for pain medicine as nontraditional applicant

[AndyDufrane]

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so I am thinking about applying for a pain medicine fellowship, but I have been working, not currently in residency, I have been working for 4 years part time in an ortho sports medicine practice and they want me to expand and rev up the nonoperative spine portion, because they would eventually like to recruit a spine surgeon, so going back to apply for pain fellowship at this stage, any input on this process, since I graduated, I was an author on lumbar stenosis paper, and have been doing basic lumbar spine procedures. I imagine getting a letter of rec from a pain doc might be a good start, but I don't think any institutions that have pain fellowships will allow nonresidents to do an elective, so is shadowing or observership worth pursuing, I have reached out to the places I did my previous training also to see if I could at least engage in some clinical experience that may generate a LOR, any other input? thanks

 

[nvrsumr]

If you are already comfortable doing lumbar procedures I would just go to several courses for cervical procedures. An ortho group is not going to require you to do alot exotic pain procedures. The opportunity cost to take a year off for fellowship is huge

 

[Ligament]

Spine surgeon and ortho group is only going to request very basic procedures in the spine. I agree with nvrsumr, don't waste a year of your life in fellowship if you already are employed as an attending. They won't want you to do RFA cause they don't want the patient to get long term relief (will reduce their surgical load), they will just request joint and ESI injections.

 

[AndyDufrane]

Spine surgeon and ortho group is only going to request very basic procedures in the spine. I agree with nvrsumr, don't waste a year of your life in fellowship if you already are employed as an attending. They won't want you to do RFA cause they don't want the patient to get long term relief (will reduce their surgical load), they will just request joint and ESI injections.

my bigger concern is the trend that I am seeing in the big picture, I have a colleague who did an unaccredited fellowship, insurances won't pay for his LESIs because he is not board certified in pain medicine, also seeing this trend in some hospitals in my local area where they won't credential you to do spine injections if your not pain boarded, and with the private practice arena ever shrinking, I don't want future opportunities to be lost because of no pain med boards, heck I am even seeing VA jobs that advertise for physiatrist doing spine injections requiring pain boards, so the writing I think is on the wall.

 

[DOctorJay]

Yet we have CRNAs lining up to take courses in IPM. Craziness!


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[AndyDufrane]

Yet we have CRNAs lining up to take courses in IPM. Craziness!


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yeah I think the easier route would be to go back and become a NP or CRNA, since its seems the sky is the limit for mid level providers in this healthcare environment🙂

 

[j4pac]

my bigger concern is the trend that I am seeing in the big picture, I have a colleague who did an unaccredited fellowship, insurances won't pay for his LESIs because he is not board certified in pain medicine, also seeing this trend in some hospitals in my local area where they won't credential you to do spine injections if your not pain boarded, and with the private practice arena ever shrinking, I don't want future opportunities to be lost because of no pain med boards, heck I am even seeing VA jobs that advertise for physiatrist doing spine injections requiring pain boards, so the writing I think is on the wall.

That's scary as ****...and very helpful to know.

 

[RM38]

At least the VA will accept ABPM as board certification, which you can take if you did an unaccredited fellowship. If they are affiliated with an University and have a accredited pain fellowship working within that VA, they may still require ABMS though. I have also heard rumblings that people are trying to create accreditation for spine fellowships as well. Not sure how far off that would be or if it would actually happen, but there has been talk of it at least.

 

[AndyDufrane]

At least the VA will accept ABPM as board certification, which you can take if you did an unaccredited fellowship. If they are affiliated with an University and have a accredited pain fellowship working within that VA, they may still require ABMS though. I have also heard rumblings that people are trying to create accreditation for spine fellowships as well. Not sure how far off that would be or if it would actually happen, but there has been talk of it at least.

yeah I still think its up to a particular organization of what they will allow, but I am just noticing a trend of ABMS pain boards becoming the standard in more organizations,

 

[RM38]

If insurances won't pay for LESI due to no ABMS pain boards, then the AAPMR needs to jump on this. Especially since that means that technically they may not allow the accredited sports guys at the PM&R based places to do them either if they learned that in fellowship. I don't know the statistics, but one could argue in PM&R there are probably as many if not more grads going into unaccredited sport and spine or pain fellowships than accredited ones considering there are only 286 spots in the match (some don't participate) and probably at least 60% or more of those go to anesthesiologists. It is tough to know for sure due to the fact that I don't think anyone knows exactly how many PM&R folks do unaccredited fellowships, but it could have a major negative impact on the field if it becomes common.