Did NOT Match for Pain

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jollygoodfellow

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Didn't match for Pain this year, along with 27% or 112 other folks. I am considering non-ACGME programs and/or reapplying for next year . Looking for open programs for 2016...I'm a practicing anesthesiologist so at least I have a job. Any advice?

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i suggest letting the programs you are interested in knowing you are available though the next year. . i bet in at least one of them one of their fellows will drop out, go into rehab, or some other calamity, and then IF you are available
you can walk into a previously unattainable program. sometimes this works out much better than the match, as you are competing against far less applicants. another gambit that i have seen is to offer to be an unpaid fellow.
“Perseverance, secret of all triumphs.” ~ Victor Hugo
 
How many apps/interviews did you do? Personally, I wouldn't go for a non-ACGME position--might as well just practice without fellowship. Many people I know of have had difficulties with insurers and with credentialing....
 
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Can certainly try above suggestion also.... How long have you been in practice?
 
Just looked at match data: looks like Nebraska & UTSW each have an I filled spot. Consider calling these places ASAP and see what they have....
 
thanks for all the info. As of 1105 Central Time today, I had already sent cv and personal statement to the unfilled positions. I've also already now spoken with the POC for both programs..will be a longshot as there are 112 unmatched folks but I'm willing to gamble. I've also already contacted the placed I interviewed.

I've been in Anesthesia practice 6.5 years. You would think my experience as a Flight Surgeon in the USAF, 9 years of hospice and palliative care experience and time in practice would help me...US grad, played football in college (BA, BS), MS in Neuroscience with published research...I submitted 78 applications through ERAS. Got 3 interviews. Was able to attend 2 due to work schedule, last minute notification with the 3rd (my group wouldn't let me have time off). Didn't match. My home program doesn't have a pain fellowship - I went to a good program btw just no pain fellowship! I did 3 months of interventional pain in residency, am an expert in ultrasound blocks and have been doing anesthesia for pain guys and with my clinical experience I could probably start practicing pain without a fellowship but worry about credentialling, getting paid etc. I gave up a bunch of pain interview in 2008 because i was offered a lucrative partnership opportunity that ended up not being a lucrative partnership opportunity...now here we sit. I'm willing to go anywhere and work hard, no red flags, no drug abuse problems...just a family guy trying to make a living. Crazy how competitive it is and how the dynamics are changing...

I'm willing to work for free too...although when I mentioned it to a program when I interviewed they looked at me like I was crazy. I remember talking to an Anesthesia program about this years back and it wasn't well received. If you know of someone successfully doing this please PM me and I'll give it a try.

So now I'm considering non ACGME "private practice" fellowships..I have a friend who just started one and loves it and doesn't anticipate any problems in practice. I've talked with a couple pain guys who did non-accredited and they are having no problems. I would prefer ACGME but looks like they don't prefer me, so I'm going to have to do something to accomplish my career goals. I'd rather be practicing pain and trying to get paid than continue just doing anesthesia.
 
I would not take umbrage to your comments, except for the statement that you feel you could practice pain without the fellowship...

Injections - which are different than anesthesia blocks, btw - are only part of a successful pain practice. Read the threads on this forum. The vast majority of them are not about procedural concerns. the vast majority of the complexity of Pain, are the other aspects.

Even then, your gas blocks are not a complete skill set for Pain.

If you want to be a pure needle jockey, then you might feel comfortable... Until someone needs a stim or a kypho or an RFA.........
 
Agree, just because you can do peripheral nerve blocks for anesthesia purposes and blind lumbar/thoracic interlaminar epidurals, that doesn't mean you can or should practice pain without a fellowship. Those procedures I just listed only constitute 1% of a typical pain practice.

You need a fellowship to properly practice pain, so you treat people appropriately and safely. The best way to do this via an ACGME pain fellowship, but if you're set on pursing spine/pain, there are many good non-accredited fellowships out there, as well as a few sweatshops, so check them out and talk to people who graduated recently from programs that interest you.

In the good non-accredited spine/pain fellowships you may get as good or better procedural experience than the bottom half of ACGME pain fellowships, particularly with high-level procedures such as kyphoplasty or spinal cord stimulator permanent placements. The main clinical issue with non-accredited fellowships is that you'll have a less rich educational experience on pathophysiology, pharmacology, psychological disorders, etc. Most of that can still be learned if you're motivated and do outside learning.

From a practice standpoint, there are many physicians with thriving practices who did non-accredited fellowships. You can practice in most of the country without an issue, and if you stay in Texas, you'll be fine in 95% of practice situations. But you will run into problems if you eventually want to practice in an highly desirable location like LA or Manhattan, as hospitals and insurance companies in these areas may not accredit/pay you.
 
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the relevant question - is it better to do a good non accredited pain fellowship now or wait until an opening in any accredited fellowship. i wonder if there is a #3 option - do the non accredited fellowship now, then transfer into an accredited one?
i have the distinction of doing a pain fellowship (accredited) in 1993. it became accredited mostly because of my efforts - i went around and documented the number of books in the library, time devoted to cancer pain, etc. that was needed for pain accreditation. ACGME did not care about stims, pumps, vplasties or RF when they accredited pain fellowships. i know, because i filled out the forms.
to be honest, at the time, there were better programs than mine that went unaccredited because no one bothered to seek accreditation at those fellowships , or because there was no library or cancer patients in a very good program.
what you are after is really a piece of paper that says you were smart enough or persistent enough to do it "right", which ultimately is what the public wants, because there really is no other way for the public to judge if you are the doctor they want to be seeing. do not kid yourself, this is important. the pencil pusher administrative class rules the USA (at least in California where i work), life is often if not usually unfair, and you will need that piece of paper someday.
 
I too did not matched, was warned by everybody that it is almost impossible to match in Pain from Neuro if you do not have a Pain fellowship at your institution and neither have any LORs from anesthesiologists...
 
I've had some fellows when I was a resident who were coming back after being out. It is difficult because they felt they already knew a lot and were used to a great deal of independence. Some faculty found them difficult to teach. Not sure if that would apply for you, but I'm sure even though your application is stellar, you likely have some negative biases due to your extensive experience.

Regarding neurology, or any of the other nontraditional backgrounds, it helps to have connections to get in the door.

Maybe try getting to the ASRA meetings or some of the local pain meetings to network with faculty?

Do re-apply though. Know folks who have re-applied after a research/instructor/other fellowship year and matched on the next go around to great places.
Do also touch base with your top programs or places you interviewed and didn't get in, because people do back out, and rarely new positions are made off-cycle.
 
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Thanks for all the comments and help.
I agree with Orin that experience is probably a negative for me.

to Ducttape et al's points - I have a diverse set of skills and experience - not your average gas passer. don't want to be a cowboy or block jock. just want to have some independence and diversity in my practice. Looks to be possible to do this with my current situation and skills in TX.

willabeast - I thought of your idea of doing non accredited then ACGME but not sure if it's a good thing or bad thing...could be seen by many as bad I dunno. If my current experience is a negative probably even more of a negative if I'm already trained in pain? I have primary care, hospice and palliative, anesthesia, real world and military experience and it's not enough to get a spot...who really knows what goes through the program directors and committee's minds in selecting candidates? I could be as simple as top scores get interviews, or who you know...

I'm going to wait on the non-accredited path for now...I have a friend currently doing one here in Texas I'm in contact with and want to see how it goes. I also have an offer to do one at a different private practice group here in Texas. Or - I do have some support to create a non-accredited fellowship at my current group as we have several pain docs who are also anesthesiogists (why make someone else a bunch of money when I can stay at my group...?? might be a no-brainer). Or - I can just continue to do anesthesia...lots of options. Maybe I'll just open a bar and cure this entrepreneurial affliction.

I'm not going to go do a research year or other fellowship..Yesterday I actually briefly thought of doing a CV fellowship to get back into academia, sent out an email for application for 2017...and almost threw up thinking about it, so I don't think that was one of my better ideas.

I just found that MD Anderson has a "cancer anesthesia" fellowship that has some cool rotations, and you can pursue TEE certification I think so maybe some value there, but it's an institutional certificate and nonACGME so what's the point other than getting my foot in the door for a "maybe" at MDA Pain. Looks like a cool fellowship, but for me probably not a good financial decision IMO.

I have a good job and salary now and a family to think of. It's bad enough I'm trying to give up my salary for a year as it is to pursue my Pain pipe dream, and my wife will lose her mind if I go back to fellow salary for 2 years for minimal financial gain in the long run. I'm not doing this necessarily for any salary bump - I just want some bit of independence and diversity in my practice.
I'm looking into the few remaining open program spots, will continue to sniff out any that open up, and will probably reapply for next year.
If I have the same results a year from now, I will re-evaluate my situation.

sorry to hear about PAINEURO...best of luck!
 
I accepted a spot at a program before the match that is currently unaccredited, but used to be within the last couple of years. I interviewed at both accredited and unaccredited places and for the most part I agree with most of the statements above on unaccredited positions. I accepted the position because I felt that the procedural experience was equal or better than the accredited places I interviewed at and I felt that the program had a pretty good overall exposure to pain including some inpatient, but now minus some of other multidisciplinary aspects that I agree are important to know. I have the availability in some of my electives to the help bridge that gap though so hopefully I will be able to learn a lot of those aspects before I start and can carry that knowledge through to my fellowship and expand upon it. I guess since the OP is already in practice that might be difficult, but for others on here who are thinking about unaccredited spots for next year that is something to think about. Also when it comes to the unaccredited places it is important to know that while some are great, others are not and you are essentially their scut monkey generating billing in exchange for learning how to do procedures with not a ton of teaching. I saw some people do stuff that made little sense to me other than to just try and generate more billing and I admit I would have not opted out of the match to go to any of those places, but I did feel the instructional level at some were great as I typically spent 1 or even 2 days shadowing there to see what it was like. All but one of the fellows that I met at these places were able to find a job where they wanted to live and he was being very specific in where he was looking. It was also in a very competitive job market and that city has several accredited programs in it, so that may have made it tough for him. I am also PM&R and it seems to be more common place for us to do unaccredited fellowships since there are very few PM&R based pain fellowships now, although most of the unaccredited ones don't really advertise themselves as pain fellowships and are more along the lines of sport and spine fellowships. There are definitely places that may not be willing to offer me a job, but for the most part the various job recruiters (including the one from my home program and several other PM&R academic spots) have said that they care more about you having actually done a fellowship and can prove that you have experience in the area and that at a minimum you can be boarded in your primary specialty rather than specifically pain. I also looked up the general area where I want to live and found several people practicing after doing unaccredited fellowships so I figured I would likely be ok. It was a tough decision as I had a interviews at some accredited places that I liked, but like the OP I didn't have a ton of interviews at was offered a spot at a place I thought was good so I went with it, but agree that people should know your options could be limited in the future.
 
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