Enough Fellowships to go around?

[bigfrank]

Hi,

I was curious about something. Let's say that I don't match at a "top 5" program in PM&R, matching at another institution.

I really want to do a pain management (interventional) fellowship or an interventional spine fellowship.

Are there going to be enough spots out there? I know that PM&R is a small field but it seems like (literally) 95% of PM&R residents now want to do outpatient PM&R.

So my question basically deals with the number of pain/spine fellowships vs. the number of applicants.

Thanks, Frank

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[Ligament]

I've been wondering the same.

I think the PM&R representatives on this board (Stinky, Drusso, others) may not accurately represent the interests/career intents of all new/aspiring PM&R residents. It is true that all the SDN Physiatrists are interested in pain/spine (myself included), but many of the other new PM&R residents I have met have no idea what they want to do, and many others want to do inpatient rehab/SCI stuff.

I am sure the fellowships will be competetive for us, but I do not think it is accurate to assume everybody wants to do PM&R for pain/spine.

I do not know the total # of spine/pain fellowships, as many of the pain fellowships are actually run by anesthesia, and those programs that take PM&R docs are somewhat difficult to keep track of.

regards! Ligament

 

[Ichi]

Can someone clarify the question of practicing interventional spine. My understanding is that beginning of 2003, if one wants to be boarded in pain management, one needs to do a fellowship in ACGME accredited fellowship. My question is, will I be able to practice interventional spine if I complete a program which is not ACGME accredited? Do I have to be board certified in pain to get reimbursed by insurances and to get hospital previledges if my main practive is interventional spine ( epidurals, discographys,...etc.) without doing the other procedures an anethsiologist performs? Currently I know that PASSOR has set of recommendations that one can follow to get the previledges to practice interventional spine. If I don't have to be boarded to receive previledges or get paid, I would forego the ACGME pain fellowship and just do a tradtional PM&R spine fellowship.

 

[drusso]

Ichi,

You do not have to do a traditional ACGME-approved fellowship to practice interventional spine physiatry. In fact, in many ways a physiatry-based spine fellowship might better prepare you for real world practice and help you keep up your electrodiagnostic skills. The question becomes for most of us, "What will the standard be for interventional pain medicine in the future?" Will part of that standard involve fellowship-level accredited training? Right now, ACGME-approved pain fellowships are quickly becoming the standard for pain medicine. Pain medicine is not the same as spine medicine, but if you were applying for privileges at a community hospital or outpatient surgery center to do discograms, IDETs, etc it might put you in a better position politically and credential-wise if you have a ACGME-approved fellowship under your belt.

There are no firm answers to these questions. Right now the majority of pain practitioners are not fellowship-trained. This is an evolving issue.

--Dave

 

[bigfrank]

I think that someone who does an Interventional Spine or Musculoskeletal Fellowship wouldn't even necessarily claim to be a "pain management specialist." Rather, would s/he claim to be a "non-operative spine care proceduralist"?

And, if you were working for a Orthopaedic group and "happened" to do lots of pain management, would it really matter if you were ACGME-certified?

I don't know the answer to these questions, but my rationale seems to make sense intuitively.

My original question had to do with:

NUMBER of PM&R applicants wanting to do Spine OR Pain vs. NUMBER of slots available for Spine OR Pain (and maybe even MSK).

Frank

 

[drusso]

Frank,

I think that the number of fellowships is kind of in flux from year to year based upon local funding issues. However, traditionally only a minority of residents go on to complete fellowships directly after residency. Most want to work a while and earn some real money and pay back loans. I don't have a good answer for your question.