EM Resident wanting Pain

[hector10]

Hello,
I just started my first year as an EM resident, so far I like it but I'm also intrigued with being a Pain doc. What are things I need to do prior to applying for fellowships?
Thanks

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[TheNolano]

I don’t know how to link a user, but BirdStrike is EM to ACGME pain and posts here quite a bit. I’d reach out to him.

One of his posts

 

[deadhead2]

Hello,
I just started my first year as an EM resident, so far I like it but I'm also intrigued with being a Pain doc. What are things I need to do prior to applying for fellowships?
Thanks

I'm applying to Pain this year from EM. Graduated residency in June so I just started working as an attending. Not sure how the Match will turn out, but things have gone better from the interview side of things than I anticipated. Wish me luck!

Anyway, the most important thing is doing at least one Pain rotation at an academic center with a Pain fellowship. Doing a rotation or two will help you to learn more about the outpatient treatment of chronic pain, medication management, fluoro-guided procedures, etc. It also allows you to know if you actually like it. Pain is extremely different from EM as I'm sure you know. Finally, a rotation will allow you to get LOR from academic Pain faculty. This will help your application immensely. If you decide that you definitely want to do Pain, you can do more rotations to get more experience and additional LOR. Otherwise, just make sure that you understand the application timeline and get stuff ready for ERAS, like asking for LOR early and having a good personal statement ready for when ERAS opens up. If you want to go directly to fellowship from residency, you need to apply as a PGY-2 (or PGY-3 in a 4 year program).

Agree with reaching out to Birdstrike. He's super helpful.

 

[SSdoc33]

I'm applying to Pain this year from EM. Graduated residency in June so I just started working as an attending. Not sure how the Match will turn out, but things have gone better from the interview side of things than I anticipated. Wish me luck!

Anyway, the most important thing is doing at least one Pain rotation at an academic center with a Pain fellowship. Doing a rotation or two will help you to learn more about the outpatient treatment of chronic pain, medication management, fluoro-guided procedures, etc. It also allows you to know if you actually like it. Pain is extremely different from EM as I'm sure you know. Finally, a rotation will allow you to get LOR from academic Pain faculty. This will help your application immensely. If you decide that you definitely want to do Pain, you can do more rotations to get more experience and additional LOR. Otherwise, just make sure that you understand the application timeline and get stuff ready for ERAS, like asking for LOR early and having a good personal statement ready for when ERAS opens up. If you want to go directly to fellowship from residency, you need to apply as a PGY-2 (or PGY-3 in a 4 year program).

Agree with reaching out to Birdstrike. He's super helpful.

LOR on this forum means Loss of Resistance. Better get used to the nomenclature

 

[seattlegas89]

Just started intern year and want to do pain already? Tbh switch into an anesthesia/pmr residency and your odds of ultimately matching into pain probably skyrocket.

 

[painfree23]

What makes you want to do pain?

 

[swamprat]

Just started intern year and want to do pain already? Tbh switch into an anesthesia/pmr residency and your odds of ultimately matching into pain probably skyrocket.

idk anymore I’m EM Pain been out a few years now and it has exploded a bit. I am contacted regularly from EM applicants wanting to go into pain and I know several I have helped guide through and are also now Pain physicians. And no offense to gas or pmr but EM is way more fun . I still do some per diem shifts it’s the perfect balance professionally

 

[seattlegas89]

idk anymore I’m EM Pain been out a few years now and it has exploded a bit. I am contacted regularly from EM applicants wanting to go into pain and I know several I have helped guide through and are also now Pain physicians. And no offense to gas or pmr but EM is way more fun . I still do some per diem shifts it’s the perfect balance professionally

Regardless of your n=3? 4? 5?, it is much easier to get into pain via anesthesia or PMR, which is what I said. If he ultimately wants to just practice pain it is a better option. Sure, if he wants to do some EM still, sticking with it may be better--but he didn't say that. He said he wanted to be a "Pain doc". And as far as "more fun", I guess if your idea of fun is not knowing whether the tube is in the goose or trachea, it would be more thrilling.

 

[callmeanesthesia]

idk anymore I’m EM Pain been out a few years now and it has exploded a bit. I am contacted regularly from EM applicants wanting to go into pain and I know several I have helped guide through and are also now Pain physicians. And no offense to gas or pmr but EM is way more fun . I still do some per diem shifts it’s the perfect balance professionally

Ugh, EM was the longest month of my residency, and I only worked 17 days of it.

 

[Ducttape]

there are at least 2 of us on this forum that worked in ER before doing pain.

I for one am not boarded in ER, because I worked a long time ago in a galaxy far far away doing EM when most docs were not from ER programs.

 

[drusso]

there are at least 2 of us on this forum that worked in ER before doing pain.

I for one am not boarded in ER, because I worked a long time ago in a galaxy far far away doing EM when most docs were not from ER programs.

Ponder this:

Pain and EM emerged has specialties around the same time. EM has been very successful at establishing itself and advocating for its interests. Pain not so much.

 

[lobelsteve]

Ponder this:

Pain and EM emerged has specialties around the same time. EM has been very successful at establishing itself and advocating for its interests. Pain not so much.

EM has a residency program. Pain is all bastards.

 

[Ducttape]

EM Board was willing to screw over all the non-boarded ER docs in favor of board certification. Pain has not been.

 

[lobelsteve]

EM Board was willing to screw over all the non-boarded ER docs in favor of board certification. Pain has not been.

If you knew any of those non boarded guys, you would know how lousy they were. Many had to become pain docs and take part in the SOS scam.

 

[drusso]

If you knew any of those non boarded guys, you would know how lousy they were. Many had to become pain docs and take part in the SOS scam.

EM literally wrote the book on SOS scamming...and they have advocated HARD to preserve their member's ability to bill in and out of network at their own discretion.

Surprise Billing: ACEP Working to Protect Emergency Physicians' Income and Reputation - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

www.acepnow.com

Pain physicians should be envious of EM's well-coordinated policy efforts.

 

[DODOCSS]

EM literally wrote the book on SOS scamming...and they have advocated HARD to preserve their member's ability to bill in and out of network at their own discretion.

Surprise Billing: ACEP Working to Protect Emergency Physicians' Income and Reputation - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

www.acepnow.com

Pain physicians should be envious of EM's well-coordinated policy efforts.

Peds ED

 

[Ducttape]

have to tout advantages of NY. the disadvantages seem to be trumped enough...


https://nyshealthfoundation.org/wp-content/uploads/2019/02/new-yorks-efforts-to-reform-surprise-medical-billing.pdf#:~:text=Under New York State’s surprise bill law, patients,patient’s standard in-network copayment, deductible, or coinsurance rate.

"New York was the first state to enact a surprise bill law, which put it at the forefront of early efforts to address a growing area of frustration and concern for consumers."

"Prior to the law being passed, the New York State Department of Financial Services (DFS), the agency responsible for overseeing insurance companies in New York, conducted a review of more than 2,000 complaints received regarding surprise bills. It found that 90% of surprise bills were not for emergency services but for other in-hospital services."

"Under New York State’s surprise bill law, patients no longer have to pay out-of-network provider charges for surprise out-of-network services that are higher than the patient’s standard in-network copayment, deductible, or coinsurance rate."

 

[BloodySurgeon]

have to tout advantages of NY. the disadvantages seem to be trumped enough...


https://nyshealthfoundation.org/wp-content/uploads/2019/02/new-yorks-efforts-to-reform-surprise-medical-billing.pdf#:~:text=Under New York State’s surprise bill law, patients,patient’s standard in-network copayment, deductible, or coinsurance rate.

"New York was the first state to enact a surprise bill law, which put it at the forefront of early efforts to address a growing area of frustration and concern for consumers."

"Prior to the law being passed, the New York State Department of Financial Services (DFS), the agency responsible for overseeing insurance companies in New York, conducted a review of more than 2,000 complaints received regarding surprise bills. It found that 90% of surprise bills were not for emergency services but for other in-hospital services."

"Under New York State’s surprise bill law, patients no longer have to pay out-of-network provider charges for surprise out-of-network services that are higher than the patient’s standard in-network copayment, deductible, or coinsurance rate."

I still see hospitals bill half in network and half out of network for services unfortunately. Had to help my parents maybe 2 years ago after getting an outrageous out of network bill. Forwarded the hospital a similar link and got it all removed the next day.