Do you regret choosing Sports Med?

[klumpke]

PM&R resident deciding between Sports and Pain. I asked this question over in the pain forum and wanted to see what you all thought.

For PM&R grads that were between sports and pain, do you have any regrets choosing sports over pain?

Thanks in advance!

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[Kissmyabjj]

None. In my opinion, we have a much broader skill set in terms of being able to manage acute musculoskeletal problems (especially fractures and dislocations) and develop advanced MSK ultrasound skills that you aren’t really exposed to that much in residency (chime in jpac here to mention not needing a sports fellowship if you do your residency at Mayo). If you really want to be able to learn basic fluoroscopic interventions, you will almost certainly get this exposure in PM&R sports fellowships. I did a family sports fellowship, but I made time every week to work with a pain physician so that I could develop competence in the the basic lumbar interventions (IESI, TFESI, IA facet, MB/DR RFA, SIJ, ganglion impar, etc…). I have really no desire to do SCS, ITB, visceral blocks, or cervical interventions; so a pain fellowship made no sense for me.

 

[runfastnow]

Meant to reply to your post in pain forum. May cross post to get the pain guys riled up (haha).

I am PM&R + ACGME PM&R sports fellowship trained. My fellowship was probably 70/30 sports/spine. I had the same thoughts in residency but did not like the "typical pain patient" when I was a resident (still in the tail end of heavy opiate use). Enjoy sports and spine equally.

Started life as a D1 team doc and was heavy sports vs spine - probably 80/20. No longer do the D1 thing and now that ratio has flipped to probably 85/15 spine/sports.

There is a major difference (or should be) between a spine clinic and pain clinic. I enjoy seeing typical spine pathology and do ILESIs, TFESIs, facet injections, MBBs, and RFs at all levels of the spine. I've also added MILD procedure and Sprint PNS post-fellowship as treatment options. I do not have interest in kyphos, SCS, or chronic med management (unless I decide to initiate).

A good pain fellowship should also expose you to pain pumps, cancer pain, and inpatient pain consults.

If you enjoy this more esoteric pain stuff then do pain it will open doors to that and make it easier to do more advanced procedures at more places.

If you enjoy typical PM&R stuff (MSK, EMG, function, etc.) and are thinking pain just to do spine procedures but want to potential to do the "cool" sports stuff then I'd do an ACGME PM&R sports fellowship (with NASS fellowship back up) and ensure you get spine training (fellowships will be up front about their spine training). If you do ESIs and RFs you will have plenty of business and can punt the "crazy pain patient" for SCS/DRG to your pain colleagues and they can deal with the complications and make the extra $50k per year for the SCS headaches.