Fellowships Scraping the Bottom of the Barrel: Implications for Pain?

[drusso]

There are unconfirmed rumors that pain fellowships have had problems filling slots and are taking applicants of questionable quality this year.

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[lobelsteve]

They have been taking substandard fellows since Emory 2004.

 

[Baron Samedi]

Our class filled 2/4. We chose to keep some slots unfilled rather than take folks who would struggle.

 

[Doctodd]

anesthesia is too hot right now....it's a cycle. When i was a fellow, nobody wanted to do anesthesia.

 

[Agast]

Our class filled 2/4. We chose to keep some slots unfilled rather than take folks who would struggle.

Devils advocate: How much intelligence is actually required to be a pain management physician

I would argue any MD/DO who is ethical and has hand-eye coordination can be a pain physician

 

[Agast]

And the more obvious conclusion: stop recruiting from anesthesiology so heavily and open more doors to psych/FM/EM/PMR

 

[Pain Applicant1]

Devils advocate: How much intelligence is actually required to be a pain management physician

I would argue any MD/DO who is ethical and has hand-eye coordination can be a pain physician

Interesting viewpoint. So you don't need a lot of intelligence to be a pain physician. Do you even need to be a physician to be good at doing pain? Do you think the vast majority of what you need to know is learned on the job?

 

[Agast]

If you’re a doctor, you’re already met a baseline level of intelligence after successfully passing your various exams

 

[geauxg8rs]

Devils advocate: How much intelligence is actually required to be a pain management physician

I would argue any MD/DO who is ethical and has hand-eye coordination can be a pain physician

Why do you need those two traits? There are plenty of successful, unethical hacks who can’t tell the cervical from the sacral.

 

[Agast]

Why do you need those two traits? There are plenty of successful, unethical hacks who can’t tell the cervical from the sacral.

Let me amend that from “can be” to “should be”

 

[Pain Applicant1]

Now would be the time to go into pain. Fewer pain fellows means fewer pain physicians in the future meaning more patients for future pain docs.

 

[Laryngospasm]

Continually increasing red tape, decreasing reimbursement and ever more difficult to establish your own practice with no end in sight. There are other opportunities attracting people’s attention.

 

[drusso]

Continually increasing red tape, decreasing reimbursement and ever more difficult to establish your own practice with no end in sight. There are other opportunities attracting people’s attention.

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[Espn123]

They have been taking substandard fellows since Emory 2004.

You are correct

 

[lobelsteve]

You are correct

You too?

 

[Espn123]

You too?

I thought you finished in 2003. Not Emory for me, they didn’t let me in…

 

[lobelsteve]

I thought you finished in 2003. Not Emory for me, they didn’t let me in…

2004-05
Taught in 06.

 

[Ronin1]

There has never been a shortage of bad pain doctors

 

[geauxg8rs]

There has never been a shortage of bad pain doctors

Just different iterations of snake oil

 

[nvrsumr]

At least with the oversupply of pain docs and current ease of getting a pain fellowship the NASS fellowships are rapidly expanding! Just heard some mom and pop PP in AZ has 4 for the new year. Of course owned by PE. What could go wrong?!

 

[Agast]

Cut out the middle man and have the fellowships run by the stim companies. Each fellow gets a $100,000 training stipend.

 

[Baron Samedi]

Devils advocate: How much intelligence is actually required to be a pain management physician

I would argue any MD/DO who is ethical and has hand-eye coordination can be a pain physician

The biggest reason we didn't take applicants was professionalism issues.

 

[Laryngospasm]

Stim for everyone! Oh wait that was the 2000s

 

[Status Sciaticus]

Devils advocate: How much intelligence is actually required to be a pain management physician

I would argue any MD/DO who is ethical and has hand-eye coordination can be a pain physician

Its pretty much just some combination of epidurals, facets, joints, stim, surgery. Keep trying things until something works.

Stim for everyone! Oh wait that was the 2000s

Epidural stops working? Straight to stim. (SCS)
Don't want to keep doing RFAs? Straight to stim (Reactiv8)
Knee pain, pelvic pain, groin pain? Straight to stim (DRG)
Neurosurgery didn't work? Straight to stim.

 

[powermd]

Its pretty much just some combination of epidurals, facets, joints, stim, surgery. Keep trying things until something works.



Epidural stops working? Straight to stim. (SCS)
Don't want to keep doing RFAs? Straight to stim (Reactiv8)
Knee pain, pelvic pain, groin pain? Straight to stim (DRG)
Neurosurgery didn't work? Straight to stim.

Sometimes it's that easy, many times not. That's your opportunity to compete.

 

[SeniorWrangler]

The biggest reason we didn't take applicants was professionalism issues.

How do you judge people’s professionalism before they show up? Were they doing beer bongs on Facebook or something? Or just rude during interviews?

 

[Baron Samedi]

How do you judge people’s professionalism before they show up? Were they doing beer bongs on Facebook or something? Or just rude during interviews?

Some of them had rotated with us before, some were bad interviews, and some we had info from their residency training.

 

[sevo00]

There are unconfirmed rumors that pain fellowships have had problems filling slots and are taking applicants of questionable quality this year.

How is this uncomfirmed? It can literally be confirmed with a ten second google search of the latest Nrmp fellowship match data.

 

[Status Sciaticus]

How is this uncomfirmed? It can literally be confirmed with a ten second google search of the latest Nrmp fellowship match data.

Because the NRMP data doesnt tell you the candidate's quality, only their quantitative information.

 

[sevo00]

Because the NRMP data doesnt tell you the candidate's quality, only their quantitative information.

If there are 200 US applicants for close to 400 spots, what do you think the quality of the applicants will be lol. Come on dude use common sense.

 

[Status Sciaticus]

If there are 200 US applicants for close to 400 spots, what do you think the quality of the applicants will be lol. Come on dude use common sense.

Youre right. Only the best quality candidates decided to skip pain medicine and stay in anesthesia, not the financially motivated ones. Looking at the NRMP data, the majority of the programs that didnt fill are lower tiered or new programs, granted some are surprising such as CCF filling 9/10 spots.

 

[bedrock]

Saw this online a few days ago. I didn’t independently verify it.

It seems odd that PMR has much lower residency acceptance rate/appears more competitive than derm, ENT, ortho, plastics, etc.

However, I also know that IMGs historically targeted PMR as it was considered something they could match into besides the primary care specialties. I wonder if this 51% PMR residency match rate is partially due to that?

 

[cowboydoc]

Saw this online a few days ago. I didn’t independently verify it.

It seems odd that PMR has much lower residency acceptance rate/appears more competitive than derm, ENT, ortho, plastics, etc.

However, I also know that IMGs historically targeted PMR as it was considered something they could match into besides the primary care specialties. I wonder if this 51% PMR residency match rate is partially due to that?

The N for PM&R is a lot lower than most specialties, so the data is more easily skewed. PM&R has become much more competitive than in our day. I don’t think it compares to derm/ortho or plastics, though.

 

[drusso]

The N for PM&R is a lot lower than most specialties, so the data is more easily skewed. PM&R has become much more competitive than in our day. I don’t think it compares to derm/ortho or plastics, though.

PM&R skated by for decades as the "Seinfeld" of medical specialties or the secret surf spot only locals knew about...but a lot of secular trends (aging of America, disability advocacy, etc) brought it more into the spotlight. Easier to find information about it now than back in the day.

 

[au bon pain]

The N for PM&R is a lot lower than most specialties, so the data is more easily skewed. PM&R has become much more competitive than in our day. I don’t think it compares to derm/ortho or plastics, though.

And now the opposite has happened with EM. I think the year I matched there were zero unfilled spots. Hard to believe that was over a decade ago. But goes to show you how swiftly private equity can help destroy a specialty.

 

[GlowInTheDark]

Youre right. Only the best quality candidates decided to skip pain medicine and stay in anesthesia, not the financially motivated ones. Looking at the NRMP data, the majority of the programs that didnt fill are lower tiered or new programs, granted some are surprising such as CCF filling 9/10 spots.

Which is amusing because it is like the 3rd best program in the city.

 

[drusso]

Still more bad news for our specialty: How are we going to turn this around?

A 10-Year Analysis of Application and Match Rates for Pain Medicine Training in the United States​

Jason Silvestre, MD, Ameet Nagpal, MD
Pain Medicine, pnae026, A 10-Year Analysis of Application and Match Rates for Pain Medicine Training in the United States
Published:

13 April 2024
Article history

Abstract

Objective
We analyzed application and match rates for pain medicine training in the United States (US) and hypothesized that there would be 1.) greater growth in the number of training positions than applicants, 2.) higher match rates among US allopathic graduates relative to non-US allopathic graduates, and 3.) greater number of unfilled training positions over time.

Design
Retrospective, cross-sectional study of all applicants for pain medicine training in the US

Method
National Resident Matching Program (NRMP) data were obtained over a ten-year period (2014-2023). Match rates and applicant-to-position ratios were calculated and compared over time with linear regression. Comparisons were made with chi square tests.

Results
Growth in the number of annual training positions (261 to 377, 44% increase) exceeded growth in the number of interested applicants (398 to 415, 4% increase) (P < 0.001). Annual applicant-to-training position ratios decreased (1.5 to 1.1, P < 0.001). The representation of US allopathic graduates among incoming pain medicine fellows decreased over the study period (73% to 58%, P < 0.001) while US osteopathic graduates increased (9% to 28%, P < 0.001).

Match rates increased for both US allopathic graduates (71% to 91%, P < 0.001) and non-US allopathic graduates (51% to 81%, P < 0.001). From 2018 to 2023, US allopathic graduates (79%) had higher match rates than US osteopathic graduates (60%, P < 0.001) and international medical graduates (57%, P < 0.001). More available annual training positions went unfilled over the study period (2% to 5%, P = 0.006).

Conclusions
Stagnant annual applicant volume and increasing number of available training positions have led to increasing match rates for pain medicine fellowship training. Fewer US allopathic graduates are pursuing pain medicine training. The increasing percentage of unfilled training positions warrants ongoing surveillance.

 

[bedrock]

Still more bad news for our specialty: How are we going to turn this around?

A 10-Year Analysis of Application and Match Rates for Pain Medicine Training in the United States​

Jason Silvestre, MD, Ameet Nagpal, MD
Pain Medicine, pnae026, A 10-Year Analysis of Application and Match Rates for Pain Medicine Training in the United States
Published:

13 April 2024
Article history

Abstract

Objective
We analyzed application and match rates for pain medicine training in the United States (US) and hypothesized that there would be 1.) greater growth in the number of training positions than applicants, 2.) higher match rates among US allopathic graduates relative to non-US allopathic graduates, and 3.) greater number of unfilled training positions over time.

Design
Retrospective, cross-sectional study of all applicants for pain medicine training in the US

Method
National Resident Matching Program (NRMP) data were obtained over a ten-year period (2014-2023). Match rates and applicant-to-position ratios were calculated and compared over time with linear regression. Comparisons were made with chi square tests.

Results
Growth in the number of annual training positions (261 to 377, 44% increase) exceeded growth in the number of interested applicants (398 to 415, 4% increase) (P < 0.001). Annual applicant-to-training position ratios decreased (1.5 to 1.1, P < 0.001). The representation of US allopathic graduates among incoming pain medicine fellows decreased over the study period (73% to 58%, P < 0.001) while US osteopathic graduates increased (9% to 28%, P < 0.001).

Match rates increased for both US allopathic graduates (71% to 91%, P < 0.001) and non-US allopathic graduates (51% to 81%, P < 0.001). From 2018 to 2023, US allopathic graduates (79%) had higher match rates than US osteopathic graduates (60%, P < 0.001) and international medical graduates (57%, P < 0.001). More available annual training positions went unfilled over the study period (2% to 5%, P = 0.006).

Conclusions
Stagnant annual applicant volume and increasing number of available training positions have led to increasing match rates for pain medicine fellowship training. Fewer US allopathic graduates are pursuing pain medicine training. The increasing percentage of unfilled training positions warrants ongoing surveillance.

We need to what derm does and limit spots.

Maybe increasing fellowship numbers by an over a hundred is just too many spots.

 

[AlvinKamara]

We need to what derm does and limit spots.

Maybe increasing fellowship numbers by an over a hundred is just too many spots.

We’re gonna do what EM has done and over saturate our own field.

 

[oreosandsake]

We need to what derm does and limit spots.

Maybe increasing fellowship numbers by an over a hundred is just too many spots.

👍🏼
Lot of people call themselves pain specialists already
Local acupuncturist, Chiro, FM/IM/EM/ any M doc and pill mill

NP programs “training” on spine procedures
APP movement

Unaccredited fellowships filled the void when acgme was more selective then nass fellowships came online

Still hard to find docs trained to do all the complex pain not just the low hanging fruit of bread and butter spine and big $ devices looking for a diagnosis

We sound like dinosaurs “back in my day I had to walk up hill both ways to the hospital to get a pain fellowship”

I hope they cut back on the spots. I’d prefer not to have slacker residents pollute the future of my specialty

 

[Laryngospasm]

The problem with pain is obvious.. if you want to do a really good workup and exam consultation discuss lifestyle choices and on and on and do u/s guided injections etc you will not make much money at all.. if you had say a guarantee and were able to see patients at your own pace you could actually take good care of them. It’s almost impossible now. So the money motivated folks that do go into it churn and burn and push nebulous procedures and treatments and the people who want to make a difference in people’s lives either go into something else or give up and do more bread and butter stuff to make money.
It gets worse with every change like the recent Medicare tpi rule etc.. then we just become like many of the spine surgeons who see 60pts a day and somehow they all need surgery.