Fellowship interviews

[Dr. Ice]

Ive been on a few interviews now for Spine/Sports and I have got to say that they have been some of the weirdest experiences I have ever had. The majority of the time (often two days) is spent shadowing the attendings/current fellows. I have been on one interview (not gonna name any names here) where no one asked me anything. I spent the whole time walking around, following the staff, observing procedures, seeing follow ups with the fellows. So, my question is...how the hell do they make their selection? What is this? Is it really just a crap shoot like everyone says? I picture these fellowship directors sitting around one day during happy hour with their current fellows/attendings drinking and pulling random names out of a hat. The whole thing seems pretty shady to me. Anyone else currently in the application process have similar experiences or feedback??

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[SSdoc33]

yeah, id say its a "semi-crapshoot". i went on about 10 interviews last year and most of the experiences are like yours were. the conventional wisdom is that if you have been invited for an interview, then you are pretty far along in the process and you at least have a chance at the fellowship. i think most of the fellowships and directors just want to feel you out, see who you are as a person, try to figure out your style and philosophy, and see if you'd get along well with each other for the year. its CLEARLY not as heavily weighted on an essay, or grades, boards, or even research from what ive seen. the program you come from and who writes your letters probably has more of an effect than anything. for example, i came from an "average-at-best" program, but one of my recs was from someone who knew my current fellowship director well, and that pulled a lot of weight.

the thing is, and this is a bit down the road but not that far, is that it gets even more dicey when people start accepting positions. you may have an offer from one program before even interviewing at another. you may have to be forced to accept a position before even getting the chance to interview at another for fear of losing your spot. in the end, there might be some great fellowships that have budget applicants and some mediocre fellowships with great applicants because of the timing factor.

it does even out a bit, tho, because the "better" applicants do tend to get the "better" fellowships. thus, a "semi-crapshoot".

wow.... now even im confused

 

[Louisville04]

you may have to be forced to accept a position before even getting the chance to interview at another for fear of losing your spot. in the end, there might be some great fellowships that have budget applicants and some mediocre fellowships with great applicants because of the timing factor.

it does even out a bit, tho, because the "better" applicants do tend to get the "better" fellowships. thus, a "semi-crapshoot".

wow.... now even im confused

There are some people who accept positions early on and then drop out if they get a better offer.

 

[dc2md]

There are some people who accept positions early on and then drop out if they get a better offer.

really? fellowships aren't contract-enforced like residencies are? that does suck.

 

[axm397]

really? fellowships aren't contract-enforced like residencies are? that does suck.

There is no "match" day for fellowship. Some people do verbally accept offers then drop out when a better offer comes along. BUT PM&R is a pretty small world and if you do anything too f_cked up, it can come back to bite you. like it the above example - let's say SSdoc33 accepted a spot at the fellowship where his letter writer knew the fellowship director - then dropped it in favor of another fellowship - how do you think that will impact the relationship btwn the letter writer and the fellowship director? On the other hand, a good fellow from a residency program can pave the way for other residents from that program or even the PM&R specialty in the case of Anesthesia pain fellowships. It's amazing what kind of things fellowship directors remember and how people talk. What do you think they do when they see each other at meetings and go out for drinks?

 

[Louisville04]

BUT PM&R is a pretty small world and if you do anything too f_cked up, it can come back to bite you....... It's amazing what kind of things fellowship directors remember and how people talk. What do you think they do when they see each other at meetings and go out for drinks?

Yeah but if you end up working with an orthopedic, neurosurgery, or anesthesia group where there is minimal pm&r contact, how much can it really bite you?

 

[buddy 2004]

Don't they make you sign a contract right away when you accept? If you back out you would then be in breach, which is a universal liability. Of course, no one wants an unhappy employee, so they probably would let you go anyway. But there could be a penalty (at least there should be, somewhere in the contract).

 

[axm397]

Yeah but if you end up working with an orthopedic, neurosurgery, or anesthesia group where there is minimal pm&r contact, how much can it really bite you?

true - but a lot of groups have more than one physiatrist.

Plus I believe in Karma. Maybe I'm too naive and idealistic.

I've just seen ppl who know ppl who know ppl - and you'd be surprised how small medicine in general can be and how some ppl hold huge grudges. You screw one or two here and there I guess you might be able to fly under the radar but if you're the type that screws everyone I have to believe (for my own sanity) that there would be consequences.

 

[SSdoc33]

in general, the fellowship agreements are verbal until the contract comes thru. there is a good deal of lag time in between when you accept the fellowship and when you sign on the dotted line. even if you do sign, they may let you out of the contract.

i do agree with axm, however. this is a situation that, if at all possible, should be avoided. physiatry is a small field, and somewhere down the line it MIGHT haunt you. also, it is a completely classless move.

HOWEVER, i can't say that there aren't some situations where breaking a verbal contract is the best thing for a particular person in a particular situation. if a fellowship director gets screwed, then they will most likely be able to find a fellow pretty quickly. but if you dont accept a spot because you are waiting for something better and nothing comes, then you are completely screwed. if the fellowship directors dont like it, they can make it a match or agree on a single day (this has been discussed in other forums and hasnt worked for a variety of reasons).

 

[drvlad2004]

So, my question is...how the hell do they make their selection? What is this? Is it really just a crap shoot like everyone says? I picture these fellowship directors sitting around one day during happy hour with their current fellows/attendings drinking and pulling random names out of a hat. The whole thing seems pretty shady to me. Anyone else currently in the application process have similar experiences or feedback??

I have been on a few interviews and will be doing a couple of second interviews. It does feel like a crapshoot. Some friends/residents landed great fellowships but were not particularly stellar residents and some other great applicant took a much longer time to land a spot. It looks like the most prestigious of sports/spine fellowships do carefully select their applicants. One program in the Midwest seemed very selective. I did a phone interview with the program coordinator and then was offered to interview onsite. I get the sense that the program directors want an applicant they can mesh well with. At this point, I would love just to get an offer early after the AAPMR conference so that I can continue my focus on chief resident responsibilities

It is an exhausting process!

 

[Dr. Ice]

My recent experience leads me to believe it is a total crapshoot. One place I recently interviewed at had 75 applicants, and are interviewing 50. However, the interview day is not a real interview. You just follow around the attendings/fellows. Im assuming the 50 they interview are relatively close in "stats" so how much can these directors base their decision on the "feel" of the candidates and how well they think they will "mesh"? How can you really determine these things after a short meeting anyway? It just doesnt make any sense.

I think being able to back out of a verbal agreement gives us (as applicants) some say in where we end up. As it stands right now, we are at the mercy of these directors. I hate to say it, but maybe if this type of thing continues to happen, some changes can be made to the whole selection process.

 

[njdevil]

Let me narrow down the "crap-shoot" for you. In my humble opinion, it depends a lot on who the applicants know and where he/she trained. The sports/MSK world is very small, the academics all know each other and if one attending recommends an applicant to an attending who is a director of a program, well the rest of the application process is just to appear like the program is on the up and up. It is one of the major problems with PM&R fellowship right now...a lot of the application is more political than merit.

 

[lucyz02]

Let me narrow down the "crap-shoot" for you. In my humble opinion, it depends a lot on who the applicants know and where he/she trained. The sports/MSK world is very small, the academics all know each other and if one attending recommends an applicant to an attending who is a director of a program, well the rest of the application process is just to appear like the program is on the up and up. It is one of the major problems with PM&R fellowship right now...a lot of the application is more political than merit.

In general - to those already practicing, Do you see the graduated sports fellows trained in the interventional procedures actually DOING them, have you had any credentialling issues that were unforseen or issues with medical payors?? Thanks in advance, your experienced opinions appreciated as always.

 

[Disciple]

Don't worry about it so much. Alot of large surgical groups use "Sports/Spine" Physiatrists to do their injections.

I practice in a pain group in a region that is by no means BFE and get hand me downs from alot of "Interventional Spine" Physiatrists after they've injected, disco'd and Perc'd the crap out of them.

Of course, then I offer them a Stimulator.



Just kidding.

 

[Disciple]

Come to think of it, I did see a patient the other day who was pissed at her Physiatrist (grad from a prominent PM&R sports fellowship) because he caused fat necrosis to her left gluteal region by attempting a blind SI joint injection.

 

[Florida Gator]

So where are the good fellowship programs and what are your grounds for this decision?

 

[Finally M3]

I have been on a few interviews and will be doing a couple of second interviews. It does feel like a crapshoot. Some friends/residents landed great fellowships but were not particularly stellar residents and some other great applicant took a much longer time to land a spot. It looks like the most prestigious of sports/spine fellowships do carefully select their applicants. One program in the Midwest seemed very selective. I did a phone interview with the program coordinator and then was offered to interview onsite. I get the sense that the program directors want an applicant they can mesh well with. At this point, I would love just to get an offer early after the AAPMR conference so that I can continue my focus on chief resident responsibilities

It is an exhausting process!

Who you know seems very important. VERY important.

 

[Disciple]

So where are the good fellowship programs and what are your grounds for this decision?

Just check out the PASSOR guide. None of them are what I would call bad. They all either have a greater component of interventional techniques or a greater emphasis on musculoskeletal/orthopedic evaluation.

If you want to become skilled at both, I would pick one that is more focused on volume and variety of interventional procedures, because there are some programs that will train you in superior musculoskeletal evaluation during residency. Conversely, there are no PM&R residency programs that will provide you with an adequate volume of advanced interventional techniques.

 

[normalforce]

Hi Disciple...

When you say advanced, are you referring to IDET, RFA, Stims, Pumps?

When I reviewed the fellowship list (PASSOR), the .pdf file that you get as a member, not the AAPMR listing... there are several fellowships that list extensive exposure and management of the above. I think out of 41 total felowships, 4 or 5 had the extensive exposure.

I can PM these programs if u would like.

Thanks,

NF

 

[Finally M3]

Hi Disciple...

When you say advanced, are you referring to IDET, RFA, Stims, Pumps?

When I reviewed the fellowship list (PASSOR), the .pdf file that you get as a member, not the AAPMR listing... there are several fellowships that list extensive exposure and management of the above. I think out of 41 total felowships, 4 or 5 had the extensive exposure.

I can PM these programs if u would like.

Thanks,

NF

Yo; can you forward me the pdf via PM? It's a bit too late for me, but I think some of the younglings here (at my program) may enjoy taking a peek.

There are still places that teach IDET? I thought the interest has dropped sharply in that insurance reimbursement has been very poor...

 

[ihaveaquestion]

Hi Disciple...

When you say advanced, are you referring to IDET, RFA, Stims, Pumps?

When I reviewed the fellowship list (PASSOR), the .pdf file that you get as a member, not the AAPMR listing... there are several fellowships that list extensive exposure and management of the above. I think out of 41 total felowships, 4 or 5 had the extensive exposure.

I can PM these programs if u would like.

Thanks,

NF

I'm interested as well. Would you mind sharing these programs with me via PM? TIA.

 

[Disciple]

Hi Disciple...

When you say advanced, are you referring to IDET, RFA, Stims, Pumps?

When I reviewed the fellowship list (PASSOR), the .pdf file that you get as a member, not the AAPMR listing... there are several fellowships that list extensive exposure and management of the above. I think out of 41 total felowships, 4 or 5 had the extensive exposure.

I can PM these programs if u would like.

Thanks,

NF

Yes, minus RF, for facets anyway

and the generalized statement was my excuse so I didn't have to go through all the specific programs.

One thing residents may want to be aware of is that the volume/variety of procedures listed are sometimes overstated, specifically when it comes to things like implants, PDD, etc. Those procedures may be done but usually not by the fellows.

PASSOR fellowships are really in existance to teach MSK/Sports and Spine/Interventional Spine. The only PASSOR fellowships that will teach you things like implants in significant volume would be Windsor's and maybe a few others. For those who don't want a pain practice, that won't matter. Same for IDET, which is pretty much a dead procedure now anyway.

For a resident who wants to do the whole Sports/Spine thing in it's purest form a best case scenario would be residency obviously with good sports/MSK/Spine/basic injections followed by 1 year for polishing on advanced procedures. Worst case scenario, residency with little or poor MSK/procedural training followed by pain fellowship, then spine fellowship, then sports fellowship (esp with ACGME sports thing).

5 years vs 7.

Unfortunately there aren't PM&R fellowships that can provide everything. Maybe in 10 or 15 years.

 

[ampaphb]

Same for IDET, which is pretty much a dead procedure now anyway.

Since you have said it in two separate posts, IDET is not at all a dead procedure, and can often be approved for comp and medico-legal payers.

 

[lucyz02]

Yo; can you forward me the pdf via PM? It's a bit too late for me, but I think some of the younglings here (at my program) may enjoy taking a peek.

There are still places that teach IDET? I thought the interest has dropped sharply in that insurance reimbursement has been very poor...

or you could just post it here? I am sure there are plenty interested.... thanks

 

[ampaphb]

or you could just post it here? I am sure there are plenty interested.... thanks

Posting materials for which access requires a membership fee would likely be a copyright violation.

 

[Xardas]

or you could just post it here? I am sure there are plenty interested.... thanks

Don't be cheap!!!

pay the $25 (resident cost) to join PASSOR and get access to it legitimiately.

Professional societies do need some giving back from the community to survive.

 

[ampaphb]

Don't be cheap!!!

pay the $25 (resident cost) to join PASSOR and get access to it legitimiately.

Professional societies do need some giving back from the community to survive.

PASSOR serves little if any function, and should be rolled back up into the Academy.

 

[Xardas]

PASSOR serves little if any function, and should be rolled back up into the Academy.

I agree with you on that point.

 

[lucyz02]

Don't be cheap!!!

pay the $25 (resident cost) to join PASSOR and get access to it legitimiately.

Professional societies do need some giving back from the community to survive.

pretty accusatory for someone I don't even know... I am a member but I rarely use their site. Last visit I found the site convoluted and not very user friendly - along with aapmr. I was only trying to ease up the process and not be cheap. Anyhow thanks for the input.

 

[lobelsteve]

I am a member but I rarely use their site. Last visit I found the site convoluted and not very user friendly - along with aapmr. I was only trying to ease up the process and not be cheap. Anyhow thanks for the input.

That was Phil Tasca's job. We were RPC members 2002-2003 and he was taking suggestions on how to improve the website. They never let him go forward with any of the suggested changes.

The RPC was completely ineffective at doing anything at that time, despite our best efforts.

 

[axm397]

We're working on improving the website AND updating the fellowship database stuff. If you have specific examples of where the website is difficult to maneuver, information that's hard to find, etc. and/or suggestions on how to improve the website - specifically - please pm me.

We've told them that the website is difficult to navigate but they need SPECIFIC examples and concrete suggestions - not just vague generalizations.

Thanks!

 

[Disciple]

Since you have said it in two separate posts, IDET is not at all a dead procedure, and can often be approved for comp and medico-legal payers.

Useful in some patients, but from a practicality standpoint....

Few of the private payers will pay for it.

Few Medicare patients have the right discs for it.

I have about 8 pending auth through Work-Comp (been waiting for over 6 months). Maybe some of the patients will get fed up and get on their attorneys about it.

Besides, I think Bi-Accuplasty will blow up soon, if for no other reason than ease of use.

So, in the context of the thread, as long as a fellow has sufficient repetition at some sort of disc access they'll be fine. If they want to do cervical discos/decompressions but don't do it their fellowship, the skills involved in stellate ganglion blocks will probably translate.

 

[Disciple]

PASSOR serves little if any function, and should be rolled back up into the Academy.

I think they realize that and want to use the vehicle of the AAPMR for their purposes.

I keep hearing over and over that their membership has had no growth over the past 7 years or so. Either they are losing members at the same rate as they are gaining new ones, or the membership remains those who joined 10-15 years ago while today's residents and new grads just don't find the organization useful.

Maybe someone who is going to Boston can give an update in a couple of weeks.

 

[ampaphb]

Besides, I think Bi-Accuplasty will blow up soon, if for no other reason than ease of use.

Makes perfect sense, and I wish it were so. Sadly, until they get a CPT code, you are unlikely to get paid for your work, if you use their equipment.