Interventional Spine Fellowship Nightmare
I thought I share this horrible experience with all of you. Maybe it will teach all of you something about doing a fellowship and getting a job. Conversely, maybe someone has a suggestion for me.
I recently finished what ended up being a clinical fellowship in physiatry spine at a prestigious hospital. I am in a rather atypical situation. The fellowship that I was in originally also offered some minimal training in interventional spine procedures, which consisted of one day a week of observation of procedures and another half day a week of performing them under supervision.
The atypical situation is as follows: I was not progressing very fast in performing the procedures, I attribute this to not having this experience during my residency training to any lengthy degree. During this fellowship, the interventional training I received was also not extensive. It was as if they expected me to already be able to perform these procedures at the start of the fellowship. I also had some issues reading x-rays at the beginning of the fellowship and finding the correct targets in arthritic joints. However, I started to progress and feel more confident approximately halfway through the fellowship. Rest assured, I vigorously studied anatomy and procedure books on a full-time basis during that time, as I realized my deficiencies. Despite the progress I was making, they decided to take me off of procedures at the six month mark.
From the very beginning of the fellowship, it was emphasized that interventional procedures were not the main focus, and this was quite obvious by the low volume that I would see during a week. The main preceptor that I had stated that she feels like could become better if I had a higher volume. She tried to get me more time doing procedures with other clinicians but was unsuccessful in getting me a significantly higher volume.
I continued to pursue how to improve performing the procedures. I found some great resources on the Spine Interventional Society website in regards to reading fluoroscopic anatomy. In addition to this, I eventually stumbled upon a simulator that could be used under live floro. The main issues that I was having were needlecraft/precision getting to at target consistently as well as manipulating the florscope to get a perfect picture of the target. Let's be honest, this is a skill that can be improved with practice. The more I used this simulator during a two day workshop, the more comfortable I started to feel. After the conference, I purchased one and just received it.
A new problem that arised was that I was able to get a physiatry job that had involved performing some interventional spine procedures. Since this hospital staff never told me of any specific requirements or any formal piece of paper proving that I was proficient performing the procedures wasn't needed. I felt that this job was a good fit for me. I was always honest with them and told them that my current skill level is not that of a full-time interventionist but would most likely improve overtime with practice and continued education in both conferences and with my new simulator. Verbally, they were in agreement with this. I signed a contract with them back on April 30, 2018 and was slated to start working for them on August 6, 2018. However, they received an accucheck form from my fellowship program that had a checkbox checked off as me not having received full credit for the fellowship due to "only marginal skills at performing spinal injections.” I was told that my clinical skills surpassed that of previous fellows, but my inability to do procedures at the six month mark really caused a big problem to get any gainful employment. Thus, the hospital that hired me told me to withdraw my application for employment, as I most definitely would be denied privileges.
The truth is, I did not get a fair chance to become proficient in performing these procedures. I am trying very hard not to do another fellowship year, as I do not believe I need it. I am not trying to be a needle jockey; Rather, I am only asking for a chance to be able to perform the procedures that I am comfortable in in a hospital or practice setting. Throughout time, I will become better and more proficient. I really do not know how to proceed from here. I'm about to take a full time position in urgent care despite having a physiatry residency training and a fellowship in spine at a prestigious academic institution. I refuse to do inpatient rehab, as I do not enjoy it and do not feel I can utilize my skills in that environment.
Does anyone have any idea how I should proceed in at least having the ability to prove myself again in interventional procedures without taking a 300% pay cut (doing another fellowship) and probably having to move to some other city with my wife and my two young children? For instance, does anybody know of any proctoring programs that can assist people trying to add procedures after the training? I spoke to a surgeon who states that he learned how to do a colonoscopy after his residency training and had to get specific proctoring and ordered you get privileges to perform the colonoscopies at a hospital. I wasn't sure if anyone else was aware of this..
