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How competitive are Pain Management fellowships?

Discussion in 'Pain Medicine' started by navs, Jan 19, 2002.

  1. navs

    navs Member

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    Hi guys,

    I was wondering if someone had more info. on the pain fellow thru which, I guess, either field can apply.

    Do u know if the fellow programs have a preference?? I would think since many of the pain departments in hospitals are run by anesth. people they would have a preference for their own kind??

    Also, have u heard of any "turf" war concerning pain practice between the anesth. and PMR guys??

    Just trying to learn a bit more about this. Thanks.
     
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  3. brownman

    brownman Member

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    Well Pain basically works like this,

    In general preferance is given to anesthesia over PM&R if there is an internal anesthesia program. This is primarily because, as you stated previously, most pain programs are run by anesthesia departments. Having said that, the way PM&R can get pain fellowships is:

    a) go to a PM&R sponsored pain fellowhship (honestly I don't know how many of those there are...but I'm assuming not many)

    b) go to a pain fellowship that isn't interventional (which there are a few of, and usually those are PM&R sponsored I believe)

    c) COMPETE WITH ALL THE GRADUATING ANESTHESIA RESIDENTS

    Yeah, that last one is daunting, primarily because so many residents are entering back into the field of anesthesia, and pain is a very popular fellowship. Supposedly the gulf in difference in terms of compensation between private and university is one of the largest of any specialty.

    Well, with all that said, the key point to remember is...DON'T GO INTO A RESIDENCY BECAUSE YOU ENJOY ONE SUB-SPECIALITY OR FELLOWSHIP. Pain is competitive as hell, with most people staying at the place they did residency to pursue pain fellowships. That is the reality...pick whichever one of those two fields you like more, overall. PM&R has some great aspects too it, so does anesthesia. BUT THERE ARE TOO VERY DIFFERENT PERSONALITIES THAT GO INTO THESE FIELDS. Anesthesia can at times be very lonely as a field, whereas PM&R is in general very collegial. My point is don't base the choice on one sub-speciality part of it. Choose on the overall field, because otherwise you'll be miserable the rest of the time you are there.

    OH..just an FYI. They are planning to change the pain fellowship to TWO YEARS. And of course (wouldn't you know it), it'll be during our time in residency. They want to control the numbers going out, and limit interest I think to some degree. Well, c'est la vie.
     
  4. brownman

    brownman Member

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    There is one distinct advantage to being a PM&R and doing pain:

    ORTHOPODS PICK YOU TO DO THE INTERVENTIONAL CASES, because the PM&R guys provide rehab services as well, so they provide higher complimentary value. SO IF YOU ARE A PM&R AND YOU CAN SCORE A PAIN FELLOWSHIP, YOU ARE PRETTY SET.

    The distinct advantages for anesthesia is:

    1) they get first pick usually

    2) they do all the other types of cases plus some orthopedic ones too, and they can book their own OR's to do it if need be.
     
  5. emedpa

    emedpa GlobalDoc

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    just an interesting aside. a lot of PA,s are now getting into pain management groups as well. mostly former P.T.'s or exercise physiologists. a quick search of a national PA magazine site netted the following;
    Physician Assistant #274296 Denver Metro Area, Colorado PREMIERE INTERVENTIONAL PAIN MANAGEMENT PRACTICE IN DENVER AREA SEEKING TOP NOTCH PA TO JOIN PRACTICE Denver Pain Management PA for pain management practice #273960 San Diego, California Pain Management practice in San Diego needs PA to help in practice with office based pain management San Diego Pain Center Physician Assistant #273560 Roanoke, Virginia Busy outpatient physical medicine practice with a specialty in rehabilitation of musculoskeletal pain and injury is seeking a full-time PA-C with excellent clinical skills. Blue Ridge Physical Medicine
     
  6. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved

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    You're right. Many interdisciplinary pain clinics are employing PA's to handle med-refills and return appointments in order to free up the physiatrist or anesthesiologist for procedures.
     
  7. emedpa

    emedpa GlobalDoc

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    believe it or not pa's also do outpatient procedures......
    not trying to start a flame war here just thought people might be interested.
    I know a residency trained md/do has a much better grasp on this but h+p's and common procedures/protocols/algorithms after appropriate supervised training are well within the scope of practice of any p.a.. large groups might add a PA or 2 instead of adding another partner and save hundreds of thousands of dollars per year.
     
  8. docdoc

    docdoc Junior Member

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    how competitive is pain manag fellowship
     
  9. uthscsa07

    uthscsa07 Junior Member

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    :thumbup: Probably highly competitive.:idea:
     
  10. Tollway

    Tollway Member

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    as a CA-1 starting next year, does anybody have any info on this? I am thinking about Pain. I am at Baylor-Houston. Thanks.
     
  11. gasmann

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    Pain is pretty competitive. need to have good ITE scores, good research and great rec letters. having a home prgm that has a fellowship is your highest chance. most prgms have 2 -3 spots and likely will take 1-2 of their own for that spot. so that leaves minimal chance to come from outside prgm.

    for the hoston person - beware MDAnderson pain. lots of changes going on there and current fellows dont seem to like it much. residents are not around as much either so work falls onto fellows!
     
  12. ParaVert

    ParaVert Interventional Pain

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    That is a shame. As an alum (2007), I can honestly say that that program gave me the interventional chops to hang with anyone, anywhere. The didactics were weak, but I can read. My surgeon friends relish the experience-heavy, hands-off approach to education, and so did I. It was a candyshop. I hope it continues to be.
     
  13. TX PAIN DOC

    TX PAIN DOC SDN Lifetime Donor
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    It's amazing that since this was posted in 2002, not much has changed. Also there was talk at the ASRA meeting in San Antonio about changing to a two year pain medicine fellowship. I even heard talk about creating a pain medicine residency with fellowships in interventional pain or palliative care.
     
  14. Jcm800

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    do you know you gave this guy advice 4 years later...he/she is an attending now... i just thought that was funny.
     
  15. Jeff05

    Jeff05 Senior Member

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    pain fellowships just got a whole lot competitive, for a little while. based on current healthcare reform anesthesia salaries will likely plummet - so next application cycle will likely be the most competitive in history.

    as fewer and fewer people enter anesthesia over time other specialties will likely constitute the bulk of pain fellows.
     
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  17. Algiatrist

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    Hmm, no so sure if pain will become MORE competitive. I don't think people will continue on past their gas years since the procedures won't be approved/reimbursed as well, hence less money.

    Further, if anything, this opens the door to more FP's, CRNA's, and weekend warriors looking to "bulk up their RVU's" as PCP's by doing ESI's and facets in the office.

    The pain pooch has been (and will continue to be) screwed by Obamacare

    Just my $.02
     
  18. Zeffer

    Zeffer "My dog ate em. I swear thats the truth!"
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    As a current fellow at MD Anderson let me quickly dispel any myths about perceived weaknesses at MD Anderson. As fellows we work hard in comparison to most other fellowships. This translates into more procedures and the ability to see more patients per day upon completion of the fellowship which means we are able to generate more revenue for ourselves early on in practice. When I compare my procedure list to friends at other prestigious pain programs my kypho, vertebro, and pump trials and implants are off the charts. How many facets, SI's, ESI can you do in one year as a fellow and still feel you are learning? The patient population is incredibly difficult to treat which makes the easy consults that much faster and the difficult consults that much more interesting.

    The faculty here is Amazing! Every single faculty not only works hard along side you but teaches every day. Our ratio of faculty to fellows is 1.5:1. We are working with the people that write the chapters on Pumps, kypho, sympathetic blocks etc. The freedom we receive to determine a course of treatment is wide. I would argue M.D. Anderson is one of the top 3 pain programs in the country.

    As far as stability of the program....We have an excellent mix of established faculty with years of experience and new faculty who are excellent clinicians and are learning to teach. Earlier during this academic year we lost two phenomenal faculty members. Our loss was no longer having them around. With them gone however, our patient population and base has not changed and fresh young faculty, hand picked by some of the finest pain physicians, have joined us. There is not a single faculty member that will berate or belittle a fellow.

    I can not speak for the other fellows, but I would do this year here at M.D. Anderson again without a second thought! The excellence of the program comes from commitment, dedication, focus, and hard work from my fellow brothers who joined me for this journey as well as the faculty that dedicate themselves to our success!

    I would not beware of M.D. Anderson....I would do everything in my power to come to M.D. Anderson!
     
    #16 Zeffer, Mar 23, 2010
    Last edited: Mar 23, 2010
  19. clubdeac

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    For going to such a prestigious program, you're english ain't too good... "working with the people that wright the chapters on Pumps, kypho, sympathetic blocks etc". I think it's spelled w-r-i-t-e. I could be wrong.

    Kidding, I'm just jealous b/c they totally screwed me at my interview and then didn't accept me ;) I've been out a year and honestly don't know a thing about the program now but at the time, I sure wanted to go there. I heard the experience is priceless. Good for you....
     
  20. texan

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    I was a recent fellow at MD Anderson and cannot say enough positives about the program. If you want to have the most "interventional" training out there with one of the largest, most diverse patient populations, this is the place. From meeting other fellows from around the nation during courses and such, our procedures/numbers were greatly above average. We did work harder than most, but I figured that with only a year to learn it was well worth it. Didactics are what you make it, most of us felt that as adults we could study better on our own and did. And not having residents won't be a big loss, it gives the new fellows more cases.
     

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