Doing a NASS fellowship as IM doc?

[Doctor_Strange]

Hello,

I an acquintance of mine I recently learned matched into a NASS fellowship. I had never even learned or heard that this was possible. I have done a deep dive and reading about NASS vs ACGME re: credentialing etc, and I am still unsure what kind of professional/career goals an IM doc who gets NASS training in ISMM would yield? You can't do inpatient with this training for certain. It would appear such an individual would have to seek out a private practice position.

I have the opportunity, if I want to, to pursue such an opening later this summer.

Would appreciate any additional insight.

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[Dr. Ice]

Oh brother, here we go yet again…

 

[PMRorBUST]

I was under the impression that NASS is exclusively for PM&R trained docs.

 

[bear2020]

Hate to be blunt. I would not do this. I don’t know a single group or organization that would allow you to perform any procedures with this background. Would be good to know the program that is willing to do this.

 

[Agast]

There are a ton of unfilled ACGME pain fellowship slots, I wonder if any of them would take an internal medicine grad

 

[Prehealth1011]

There are a ton of unfilled ACGME pain fellowship slots, I wonder if any of them would take an internal medicine grad

Even if they do, you probably can’t be acgme board certified though, since IM graduates are ineligible.

 

[Doctor_Strange]

I find it odd FM can pursue Pain but not IM, but I digress.

Anyways, I just found it strange / unique that certain NASS fellowships were allowing IM docs to train. I just don’t know what practically that meant beyond the fellowship year.

 

[Medman2737]

I mostly lurk, but this is an issue near and dear-plus, my 11:30am isn't on the table yet.

I did IM residency back in 2006 and side-stepped through Occupational Medicine residency and then a Primary Care Sports Medicine fellowship after that.

I tried to go the route of the ACGME pain spots around 2009-2010, but it was Lobel (yes, that one) that agreed to train me from 2011-2012.

Needless to say, he was a great mentor. Totally non-accredited fellowship, but I would put my time with Steve head-to-head against ANY fellowship in the country.

That said, it's been 13 years later and after other training stints (a year doing Addiction Medicine fellowship and a year at Yale doing Hospice and Palliative Medicine), I feel like my pedigree, albeit eclectic, is not "inferior".

That said, ACGME will NOT let you take the pain boards without a residency from a "sponsoring" organization, whether it be Anesthesiology, PMR, Neuro/Psych, or EM. I asked and asked and asked again, but for whatever reason they simply do not align Pain Management with Internal Medicine, though I would argue that our field is 100% an extension of Primary Care (at least that is how I view my role and execute my practice).

To the OP, find the training that prepares you the best for YOUR future. If you don't see yourself going super interventional and would just like to do bread and butter procedures, so be it. If you want the whole she-bang and will try to use your words to treat and could benefit from training in CBT and ACT, go that route. It has to match what you see as your future self.

 

[Prehealth1011]

@Medman2737 how’s the pain job market not being acgme certified?

 

[Medman2737]

My biggest problem is the changing environment of healthcare.

I had been with a multi-specialty group for the last 6 years, but the group is selling out to a larger hospital organization in the South.

I will be able to remain a partner in my ASC (for now), and I will go from base salary with sliding scale bonus based on productivity to an entirely wRVU based model based on productivity.

Using either method, I expect to remain in the 99th percentile of income based on my efficiency and desire to remain busy.

I do all procedures, perform my own surgical implants of my SCS trials and pumps, and have delved into SI fusions/intracepts/PILD/spacers.

I would say at least 80% of my practice is still bread and butter cases done in the office. I have two busy APRN's seeing follow-up's and doing their thing with Botox and easier peripheral joint injections (both have ortho backgrounds).

We will see what it is like to work for a big regional healthcare organization. Touch base with me in six months and I'll let you know how it is going.

 

[Ducttape]

To the OP, find the training that prepares you the best for YOUR future. If you don't see yourself going super interventional and would just like to do bread and butter procedures, so be it. If you want the whole she-bang and will try to use your words to treat and could benefit from training in CBT and ACT, go that route. It has to match what you see as your future self.

i would also suggest to be flexible with your future self.

i initially envisioned being an internist and doing hospital rounds and office practice like my mentor when i was in high school .i never envisioned being an ER doc back then, tho some of my friends did.

3 years of working in a primary care office during residency cured me of that delusion - or so i thought. hence ER, which i still have fond memories. but then the decision to do OR work, which then changed while in residency to do pain - ie go back to the office setting.


so be flexible. nobody expects the Spanish Inquisition...

 

[Doctor_Strange]

Completely coincidental, I may have the opportunity to join a PGY-2 PM&R position actually. I am wondering if it that is a better option? Yes, it would be 3 more years of training + fellowship. I am wondering if being dual-certified in IM + PM&R would confer any benefit to me professionally?

 

[Baron Samedi]

Completely coincidental, I may have the opportunity to join a PGY-2 PM&R position actually. I am wondering if it that is a better option? Yes, it would be 3 more years of training + fellowship. I am wondering if being dual-certified in IM + PM&R would confer any benefit to me professionally?

Do you have any interest in general PM&R? On the inpatient rehab side, that would be huge.

On the pain side of things it would make your path more straight-forward but your IM background, other than making you a generally more well-rounded doctor, would probably not contribute a lot unless you carved out a specific niche for yourself. You probably don't want to do primary care and pain as it would just mean more work for less $$$.

 

[Ducttape]

if you like PMR, this is definitely a better way to go to get in to Pain.

NASS fellowships are nice but it does mean you will be a niche player that requires a specific set of circumstances for a long and fulfilling career, vs being ACGME certified in pain or PMR or IM...

 

[Prehealth1011]

Only you can decide if a 4 year route to pain is worth it after having completed an IM residency. A procedural heavy fellowship (cardio/gi/pccm) seems like a better option.

 

[Ducttape]

those are very competitive to get in to. much more so than pain.

and talking of long routes, he would have to complete IM then do a 3 year cardiology fellowship then a 1 year interventional cardiology fellowship. so 4+ years.

at least with the GI fellowship it is only 3 years after completing IM residency

 

[Doctor_Strange]

I have applied twice to cards and have not matched. 7-10 interviews each time. Hypercompetitive and frankly demoralizing.

I like the idea of general PM&R. The issue with being a hospitalist while the lifestyle is nice and the job is not really that challenging, I feel more or less apathetic about the patients. Who’s to say I would not feel any different working as a PM&R doc in a clinic? I don’t know. But, I think being Cards will be tough to break into.

 

[Gnarvin]

I have applied twice to cards and have not matched. 7-10 interviews each time. Hypercompetitive and frankly demoralizing.

I like the idea of general PM&R. The issue with being a hospitalist while the lifestyle is nice and the job is not really that challenging, I feel more or less apathetic about the patients. Who’s to say I would not feel any different working as a PM&R doc in a clinic? I don’t know. But, I think being Cards will be tough to break into.

It’s very easy to feel that way about pain patients, also…As a matter of fact, I think pain patients are likely the most difficult or among the most difficult to deal with all day every day. Just something to think about.