Interventional Pain Med Questions & Future

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BSM_OTO

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Hi interventional pain physicians, I’m currently a medical student in the US and after countless hours of shadowing (in clinic, OR etc.) and doing a ton of research on what the field is like, I’m pretty set on interventional pain. I’m fortunate enough to know a director of pain management at a local hospital through mutual friends so I’ve seen a ton about the field in terms of witnessing procedures, consults etc. and had a few questions that I wanted to get different perspectives on. I originally wanted to do orthopedic surgery due to my interest in the MSK sytem but after shadowing ortho guys I’m not so sure I want to be doing that and pain seems really intriguing instead and may have a great future, and I like how it’s less invasive as well. I always wanted to do surgery or something procedural and this seems like a great alternative, better lifestyle than most surgeons and less intense overall, and I love the MSK system. I’d skip residency and work for a pharmaceutical company or something (as that’s pretty much all a residency-less MD is good for) before doing primary care. Hundreds of hours of shadowing various specialists has allowed me to get a pretty good grasp on what I want to do in the future.

  1. Procedures such as kyphoplasty, MILD, vertiflex, Spinal Cord Stimulators, percutaneous discectomy etc. - do you see pain doctors continuing to do these in decades to come and do they actually work (compared to how much they are used)? Is it true that a lot of the time they don’t really work and they don’t have much science behind them, leading to doctor’s just doing it for $$$ due to nice reimbursements? I know I’m grouping a ton of different procedures into “they”, feel free to pick some out if you feel the need to. I’ve seen and heard that the literature regarding spine surgery is pretty weak (fusions etc), and it makes me wonder if interventional pain procedures will be taking over spine care in the future but again I’m not sure if I’m biased in that though because I want to go into the field.
  2. Reimbursements - it’s hard to tell the future obviously, but to have a private practice that is doing well enough for me to not work for a hospital would be my goal, as I want the autonomy and to own my own business. I’m aware that you can make 7 figures if you get shady but I’m not really interested in that, moreso will income be enough to keep the lights on my practice and be competitive with hospital salaries decades from now so I don’t have to work for a hospital or behemoth group? Keep in mind I’m not asking if this is going to make me rich, rather am I going to still make the median salary and not go out of business.
  3. Regen medicine - seems cool but will it be around decades from now or will it be killed off? Some research seems promising but obviously a lot more needs to be conducted, have you guys experienced that it works well on patients?
  4. I probably would do PM&R - I like the MSK system and have very little interest in spending 4 years learning how to be an anesthesiologist when I have no interest in practicing as one. Would you say that over the years the trend has been pain fellowships accepting more PM&R guys/girls or less PM&R.
  5. Opioids - my fear is that there’s a **** ton of pressure put on you as someone prescribing opioids to a large # of people. You give too much, they get more dependent and can OD. You taper them down, now they suffer and might harm themselves. If your sole goal is to ensure patient safety and health (not just prescribing them pills so they allow you to stick needles in them like some docs do) do you get over the mentally draining part of this job, opioids? I know a guy who retired at 40 (had another source of income) from pain because he said it was too emotionally draining to deal with opioids patients.
  6. How hard is it to get patients and referrals? I’m in a pretty saturated part of the country, would probably open in NYC/Queens/Brooklyn/Staten Island area. Anything a medical student/resident can do to get a head start for when I’m out trying to start my own practice? Any things you successful practice owners wish you new early on in your career?
Honestly my biggest fear with the field is that essentially most of these procedures don’t really work and are a money grab, as I’ve seen people on SDN insinuate, and 20 years from now I’ll just be doing opioids lol.

If I make any statements are idiotic/offensive I apologize in advance, this is all based off assumptions from what I've seen and learned.

Would love any feedback.
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I know this is unrelated to your post, but just a few thoughts. When I was a 1st, 2nd and 3rd year med student I was dead set on emergency medicine. As a 4th year med student I was dead set on PMR and considering inpatient rehab. As an early intern I was dead set on getting a research grant for brain computer interfaces for SCI, TBI, stroke, etc. As a late intern I was dead set on pain medicine. Thinks change, sometimes rapidly. Find a residency that you think you can tolerate.

Also, No one can predict what procedures will be around in 5-7 years. And no one can predict reimbursement rates, save for the fact that it will be lower on average across the board. The one thing that will be true is that a large amount of patients will still be on opioids, though fewer above 90 OMEs.
 
BSM_OTO said:
Hi interventional pain physicians, I’m currently a medical student in the US and after countless hours of shadowing (in clinic, OR etc.) and doing a ton of research on what the field is like, I’m pretty set on interventional pain. I’m fortunate enough to know a director of pain management at a local hospital through mutual friends so I’ve seen a ton about the field in terms of witnessing procedures, consults etc. and had a few questions that I wanted to get different perspectives on. I originally wanted to do orthopedic surgery due to my interest in the MSK sytem but after shadowing ortho guys I’m not so sure I want to be doing that and pain seems really intriguing instead and may have a great future, and I like how it’s less invasive as well. I always wanted to do surgery or something procedural and this seems like a great alternative, better lifestyle than most surgeons and less intense overall, and I love the MSK system. I’d skip residency and work for a pharmaceutical company or something (as that’s pretty much all a residency-less MD is good for) before doing primary care. Hundreds of hours of shadowing various specialists has allowed me to get a pretty good grasp on what I want to do in the future.

  1. Procedures such as kyphoplasty, MILD, vertiflex, Spinal Cord Stimulators, percutaneous discectomy etc. - do you see pain doctors continuing to do these in decades to come and do they actually work (compared to how much they are used)? Is it true that a lot of the time they don’t really work and they don’t have much science behind them, leading to doctor’s just doing it for $$$ due to nice reimbursements? I know I’m grouping a ton of different procedures into “they”, feel free to pick some out if you feel the need to. I’ve seen and heard that the literature regarding spine surgery is pretty weak (fusions etc), and it makes me wonder if interventional pain procedures will be taking over spine care in the future but again I’m not sure if I’m biased in that though because I want to go into the field.
  2. Reimbursements - it’s hard to tell the future obviously, but to have a private practice that is doing well enough for me to not work for a hospital would be my goal, as I want the autonomy and to own my own business. I’m aware that you can make 7 figures if you get shady but I’m not really interested in that, moreso will income be enough to keep the lights on my practice and be competitive with hospital salaries decades from now so I don’t have to work for a hospital or behemoth group? Keep in mind I’m not asking if this is going to make me rich, rather am I going to still make the median salary and not go out of business.
  3. Regen medicine - seems cool but will it be around decades from now or will it be killed off? Some research seems promising but obviously a lot more needs to be conducted, have you guys experienced that it works well on patients?
  4. I probably would do PM&R - I like the MSK system and have very little interest in spending 4 years learning how to be an anesthesiologist when I have no interest in practicing as one. Would you say that over the years the trend has been pain fellowships accepting more PM&R guys/girls or less PM&R.
  5. Opioids - my fear is that there’s a **** ton of pressure put on you as someone prescribing opioids to a large # of people. You give too much, they get more dependent and can OD. You taper them down, now they suffer and might harm themselves. If your sole goal is to ensure patient safety and health (not just prescribing them pills so they allow you to stick needles in them like some docs do) do you get over the mentally draining part of this job, opioids? I know a guy who retired at 40 (had another source of income) from pain because he said it was too emotionally draining to deal with opioids patients.
  6. How hard is it to get patients and referrals? I’m in a pretty saturated part of the country, would probably open in NYC/Queens/Brooklyn/Staten Island area. Anything a medical student/resident can do to get a head start for when I’m out trying to start my own practice? Any things you successful practice owners wish you new early on in your career?
Honestly my biggest fear with the field is that essentially most of these procedures don’t really work and are a money grab, as I’ve seen people on SDN insinuate, and 20 years from now I’ll just be doing opioids lol.

If I make any statements are idiotic/offensive I apologize in advance, this is all based off assumptions from what I've seen and learned.

Would love any feedback.
Click to expand...

I love your enthusiasm, but you're about three decades too late. Pain was the dream of the 90's. When I finished my fellowship, I thought that I was looking forward to 30 years of doing IDET and a thriving intrathecal pump practice.

Most of Pain these days is just cleaning toilets. I don't mean that disparagingly. I mean if you've ever crapped in a dirty truck stop, you know the value of a nice clean toilet. Ditto for Pain. Pain doctors are an indispensable asset to their patients and communities. But one thing is certain: Opioids aren't going anywhere. Humans have had a complicated history with these substances since the earliest years of human civilization.

So, grab a brush and start scrubbing! Welcome aboard. We need people just like you.
 
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drusso said:
I love your enthusiasm, but you're about three decades too late. Pain was the dream of the 90's. When I finished my fellowship, I thought that I was looking forward to 30 years of doing IDET and a thriving intrathecal pump practice.
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Thriving intrathecal pump practice? Who did you think you were going to be implanting pumps in?
 
BSM_OTO said:
Hi interventional pain physicians, I’m currently a medical student in the US and after countless hours of shadowing (in clinic, OR etc.) and doing a ton of research on what the field is like, I’m pretty set on interventional pain. I’m fortunate enough to know a director of pain management at a local hospital through mutual friends so I’ve seen a ton about the field in terms of witnessing procedures, consults etc. and had a few questions that I wanted to get different perspectives on. I originally wanted to do orthopedic surgery due to my interest in the MSK sytem but after shadowing ortho guys I’m not so sure I want to be doing that and pain seems really intriguing instead and may have a great future, and I like how it’s less invasive as well. I always wanted to do surgery or something procedural and this seems like a great alternative, better lifestyle than most surgeons and less intense overall, and I love the MSK system. I’d skip residency and work for a pharmaceutical company or something (as that’s pretty much all a residency-less MD is good for) before doing primary care. Hundreds of hours of shadowing various specialists has allowed me to get a pretty good grasp on what I want to do in the future.

  1. Procedures such as kyphoplasty, MILD, vertiflex, Spinal Cord Stimulators, percutaneous discectomy etc. - do you see pain doctors continuing to do these in decades to come and do they actually work (compared to how much they are used)? Is it true that a lot of the time they don’t really work and they don’t have much science behind them, leading to doctor’s just doing it for $$$ due to nice reimbursements? I know I’m grouping a ton of different procedures into “they”, feel free to pick some out if you feel the need to. I’ve seen and heard that the literature regarding spine surgery is pretty weak (fusions etc), and it makes me wonder if interventional pain procedures will be taking over spine care in the future but again I’m not sure if I’m biased in that though because I want to go into the field.
  2. Reimbursements - it’s hard to tell the future obviously, but to have a private practice that is doing well enough for me to not work for a hospital would be my goal, as I want the autonomy and to own my own business. I’m aware that you can make 7 figures if you get shady but I’m not really interested in that, moreso will income be enough to keep the lights on my practice and be competitive with hospital salaries decades from now so I don’t have to work for a hospital or behemoth group? Keep in mind I’m not asking if this is going to make me rich, rather am I going to still make the median salary and not go out of business.
  3. Regen medicine - seems cool but will it be around decades from now or will it be killed off? Some research seems promising but obviously a lot more needs to be conducted, have you guys experienced that it works well on patients?
  4. I probably would do PM&R - I like the MSK system and have very little interest in spending 4 years learning how to be an anesthesiologist when I have no interest in practicing as one. Would you say that over the years the trend has been pain fellowships accepting more PM&R guys/girls or less PM&R.
  5. Opioids - my fear is that there’s a **** ton of pressure put on you as someone prescribing opioids to a large # of people. You give too much, they get more dependent and can OD. You taper them down, now they suffer and might harm themselves. If your sole goal is to ensure patient safety and health (not just prescribing them pills so they allow you to stick needles in them like some docs do) do you get over the mentally draining part of this job, opioids? I know a guy who retired at 40 (had another source of income) from pain because he said it was too emotionally draining to deal with opioids patients.
  6. How hard is it to get patients and referrals? I’m in a pretty saturated part of the country, would probably open in NYC/Queens/Brooklyn/Staten Island area. Anything a medical student/resident can do to get a head start for when I’m out trying to start my own practice? Any things you successful practice owners wish you new early on in your career?
Honestly my biggest fear with the field is that essentially most of these procedures don’t really work and are a money grab, as I’ve seen people on SDN insinuate, and 20 years from now I’ll just be doing opioids lol.

If I make any statements are idiotic/offensive I apologize in advance, this is all based off assumptions from what I've seen and learned.

Would love any feedback.
Click to expand...
I agree with the others in this forum that you are waaayyy to early in the game to worry about these things. Choose a primary specialty that you like, then half way through that if you still are interested in pain, then apply for that.

Every specialty has their own doom and gloom situations. Don't worry about them. Do what you think you're supposed to do, what you'd enjoy, and don't worry about the rest. This is the best advice I can give. If you worry about things you can't control, you'll never be happy.

That being said, here's my short answers to your questions.
1. Procedures come and go. Everything we do as pain specialists are temporizing measures. None of us "cure" pain. Some procedures work better than others. New evidence for and against various procedures is always being created. Sometimes things that work great stop getting paid for, other times things that don't work well get paid well. This is also in flux. When you graduate you'll do what you can to help your patients with the tools that are available to the best of your ability. Only worry about that, not what individual procedures are currently in vogue.

2. Reimbursements in general will continue to go down, not up. Interventional pain pays better and will likely continue to pay better than your primary specialty. 7-figure paychecks are likely a thing of the past. You should be able to keep your lights on just fine if you run your practice smartly though.

3. RegenMed is the new kid on the block, high-quality evidence is being gathered. There is some good evidence for and some evidence against.
4. I disagree with the others above. Opioids are on their way out. All evidence points towards they help with acute pain, but not with chronic pain. Or rather more accurately, patients become tolerant to the pain relieving properties of them over time and side effects (including risk of overdose/death) increase as the dose escalates. These are not an appropriate treatment option for chronic pain, with few exceptions.

Also keep in mind you are not required in any way to practice in a way that you think is dangerous. If you don't think opioids are appropriate, don't write them. Simple.

5. If you are dead set on opening a private practice in New York City area and trying to compete with the large hospital systems and established groups, you will almost assuredly fail. I would recommend either changing your plans to an employment model or moving away from the city. The cards are heavily stacked against you in this arena.
 
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Your expectations seem realistic for the most part, but no one knows yet if even next year we will take a 10% pay cut from Medicare so 10 years in the future, no one has any idea.

No matter how certain you are you want to do a specialty, try really hard treat every specialty and rotation as something you could do for the rest of your life. You never know when it might be if you keep your mind open. I was 100% sure I was going to do neurology from undergrad up until 3rd year med school, when I did my neurology rotation. Before that I’d done a bunch of neurology shadowing, fMRI research in undergrad, etc. Fascinating subject matter, loved the neuroscience of it, but the clinical practice was not something I found I actually enjoyed once I tried doing it. My first year of med school, there was a second year student who told us, while volunteering in the anatomy lab to teach us neuroscience “I want to do neurosurgery more than a I want to breathe.” I think she had the test scores, research, and motivation to do it, but now she’s a pediatrician.
 
You are on the right track. PMR---> Pain. That will give you flexibility. There is a ton of pain in the world. you will be needed. How you do opioids will be up to you, set the tone early and stay ethical and you will be fine
 
Why would you do PMR to pain. Anesthesia gives you a valuable skill in high demand at the moment and well paying, and gives you the opportunity to split your time at an academic job if you choose.

No offense, but a non interventional PMR job sounds terrible. Maybe you do some EMGs, but other than that ….
 
dipriMAN said:
Why would you do PMR to pain. Anesthesia gives you a valuable skill in high demand at the moment and well paying, and gives you the opportunity to split your time at an academic job if you choose.

No offense, but a non interventional PMR job sounds terrible. Maybe you do some EMGs, but other than that ….
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Many people with chronic pain have disability issues, but very few of them need to be intubated.
 
I'm a PGY-3 applying to pain. I think the future for pain is mixed.

On the upside, new therapies and innovations are coming out rapidly & opiates are falling out of favor.

On the downside, job market is already saturated. Many of our pain fellows have signed for jobs that are 50-50 pain with general anesthesia. The only ones that found 100% pure pain jobs are going to midsized towns or small cities.

Choose your primary specialty carefully as it may become a huge part of your future career and practice. In anesthesia we also offer regional as a nice procedural alternative to pain 🙂
 
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WhatLamina said:
I'm a PGY-3 applying to pain. I think the future for pain is mixed.

On the upside, new therapies and innovations are coming out rapidly & opiates are falling out of favor.

On the downside, job market is already saturated. Many of our pain fellows have signed for jobs that are 50-50 pain with general anesthesia. The only ones that found 100% pure pain jobs are going to midsized towns or small cities.

Choose your primary specialty carefully as it may become a huge part of your future career and practice. In anesthesia we also offer regional as a nice procedural alternative to pain 🙂
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Yes. If you ever tired of pain you have an excellent specialty tj fall back on with anesthesiology, that will always have a high demand.

I will admit, I don’t know how in demand a non interventional PMR doc is at the moment, but I bet it is not as in demand as a general anesthesiologist.
 
dipriMAN said:
Yes. If you ever tired of pain you have an excellent specialty tj fall back on with anesthesiology, that will always have a high demand.

I will admit, I don’t know how in demand a non interventional PMR doc is at the moment, but I bet it is not as in demand as a general anesthesiologist.
Click to expand...
Or CRNA/PAA.
 
dipriMAN said:
Yes. If you ever tired of pain you have an excellent specialty tj fall back on with anesthesiology, that will always have a high demand.

I will admit, I don’t know how in demand a non interventional PMR doc is at the moment, but I bet it is not as in demand as a general anesthesiologist.
Click to expand...
Well, they are the ones we usually talk about hiring to see office visits instead of NPs...
 
Another med student here interested in pain medicine. I’ve messaged a few active members of this forum individually, but I’d love to hear from more current docs regarding the field and whether or not you guys would recommend it to current students. Thanks!
 
seems like the field is moving towards min invasive surgeries... and interestingly enough even without that, for better or worse, I meet more and more surgeons or ex-surgeons practicing IPM.
 
oreosandsake said:
seems like the field is moving towards min invasive surgeries... and interestingly enough even without that, for better or worse, I meet more and more surgeons or ex-surgeons practicing IPM.
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The marketing is moving that way. The patients do not need it. 98% ESI/MBB/Joint inj.
 
Barleycorn said:
How many procedures do you a do a week in an ethical practice? Asking as current fellow.
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I do all of them.
I do not have a PA or NP or RN do any of my injections.

9 on monday
11 on tues
10 on wed
5 tomorrow (1 SCS trial)
3 Friday (2 implants)

This is a light week.
Average 8-10 per day overall.
I feel like I am middle of the road as far as aggressiveness.
Being on salary with a cap makes it easier to tell patients to try PT, meds, etc first.
 
oreosandsake said:
seems like the field is moving towards min invasive surgeries... and interestingly enough even without that, for better or worse, I meet more and more surgeons or ex-surgeons practicing IPM.
Click to expand...
Do you mean moving toward IPM trained docs doing min invasive surgeries or surgeons doing min invasive surgeries as “pain doctors”?
 
The pessimist in me says we will be doing fewer procedures in the future, or be paid less for them, or both.

Medicare generally runs a hefty deficit. I'd like to think cost savings comes from fixing inefficiencies but if the past is any indication I highly doubt it.
 
I've met a few MDs and DOs in New York who hire CRNA's to do epidural and other spinal injections. If trained well, is it legal and ethical? I can't seem to find whether it's legal online, and I'm pretty good at digging stuff up on the internet usually. but from what I've seen people say on here, it's dangerous. I'm confused how these doctor's are doing it at such a high volume with no problem. And no, not joint injections, I'm talking about spine injections that are fluoroscopy guided. Thoracic, Lumbar and Cervical Epidural Injections. Is this a thing?
 
BSM_OTO said:
I've met a few MDs and DOs in New York who hire CRNA's to do epidural and other spinal injections. If trained well, is it legal and ethical? I can't seem to find whether it's legal online, and I'm pretty good at digging stuff up on the internet usually. but from what I've seen people say on here, it's dangerous. I'm confused how these doctor's are doing it at such a high volume with no problem. And no, not joint injections, I'm talking about spine injections that are fluoroscopy guided. Thoracic, Lumbar and Cervical Epidural Injections. Is this a thing?
Click to expand...
I don’t think you realize the Pandora’s box you just opened with this thread. In short, for a non doctor to do any spinal injection is not ok...the rest you will read on here..well..have a glass of wine or 5 and enjoy...
 
It’s cliche but figure out what specialty you like and go from there. Interventional pain can be reasonably reached from PMR, anesthesia, or neurology. Think about back up plans. I picked anesthesia initially because it has a pretty nice variety of sub specialties from ICU to pain to peds to general.

There’s no perfect job.
 
BSM_OTO said:
I've met a few MDs and DOs in New York who hire CRNA's to do epidural and other spinal injections. If trained well, is it legal and ethical? I can't seem to find whether it's legal online, and I'm pretty good at digging stuff up on the internet usually. but from what I've seen people say on here, it's dangerous. I'm confused how these doctor's are doing it at such a high volume with no problem. And no, not joint injections, I'm talking about spine injections that are fluoroscopy guided. Thoracic, Lumbar and Cervical Epidural Injections. Is this a thing?
Click to expand...
"Legal" depends on state, however most likely it is "legal". It depends on the state I believe. That being said, CRNA's have some training in regional anesthesia techniques but almost none in chronic pain management. Can they learn? Absolutely, anyone can "learn" how to do anything procedural. Thing is they will follow the algorithm and get screwed if something goes wonky.

To answer your other question, for me, a cervical epidural is 100 million times scarier than a lumbar epidural, and I spent 4 years (double CRNA training time) learning anesthesia AFTER medical school, then did another year (about half of CRNA total anesthesia training time) doing just chronic pain management during fellowship.

In other words, there is no way in hell I'd let a CRNA do any pain procedure on me or my wife. I'd probably let them sit my random general anesthesia or OB case (not head/heart/vascular/neuro) as long as they had an Anesthesiologist backup.
 
lobelsteve said:
The marketing is moving that way. The patients do not need it. 98% ESI/MBB/Joint inj.
Click to expand...

I also agree with this statement. This comment will be viewed as not being on board with “moving the field forward”.

YOU need a discectomy (endoscopic or otherwise) Who are YOU going to consult? A fellowship trained spine surgeon or one of the ASIPP endoscopic discectomy instructors (arguably the “best” in our field)? I know where I am going. Same for most if not all of the MISS procedures.

Our field needs a power washing before we can advance.
 
nvrsumr said:
Sounds like someone wants to hire NPs to do injections in an auto injury chiro clinic.
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I'm asking a question.

Would I do it? No.

Am I curious? Yes, because I can name countless MD's I know personally that do it, and I'm shocked that they do, the more I read on here.
 
How Possible to still be busy doing PP in big costal cities like NYC, Boston etc. how common are 4 day work weeks in PP?
 
Chelsea FC said:
How Possible to still be busy doing PP in big costal cities like NYC, Boston etc. how common are 4 day work weeks in PP?
Click to expand...

Busy in a single specialty pain group, solo pain practice or pain practice within an ortho/spine/multi specialty practice? All different.
 
Asclepius186 said:
It’s cliche but figure out what specialty you like and go from there. Interventional pain can be reasonably reached from PMR, anesthesia, or neurology. Think about back up plans. I picked anesthesia initially because it has a pretty nice variety of sub specialties from ICU to pain to peds to general.

There’s no perfect job.
Click to expand...

Is it significantly harder to get a pain fellowship from PM&R or neurology as opposed to anesthesia? I know a lot of pain fellowships are run by anesthesia departments
 
bdoc13 said:
Is it significantly harder to get a pain fellowship from PM&R or neurology as opposed to anesthesia? I know a lot of pain fellowships are run by anesthesia departments
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I've researched this extensively. Anesthesia is the easiest to get a pain fellowship, with PM&R being a very close second. I think over time that gap between anes and pmr is closing. It's very rare to see neuro fellows at pain programs, I wouldn't recommend going that route unless you love neuro and don't mind being a neurologist without a pain fellowship.
 
BSM_OTO said:
I've researched this extensively. Anesthesia is the easiest to get a pain fellowship, with PM&R being a very close second. I think over time that gap between anes and pmr is closing. It's very rare to see neuro fellows at pain programs, I wouldn't recommend going that route unless you love neuro and don't mind being a neurologist without a pain fellowship.
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Every year there's about 5 to 10 people who get board certified through the American Board of Psychiatry and Neurology. I'm a psychiatrist currently in a pain fellowship. I know about 10 or so psychiatrists who did pain fellowships and I know zero psychiatrists who applied and didn't get a spot. I think the interest for specialties outside of anesthesia is growing but it's definitely and uphill battle.

Is there any specific data on the percent of applicants that applied and matched pain for each specialty? I know there are small numbers that apply, but if they always match, that's a different story.

I've been looking for this for years and found nothing. Thanks!
 
adiradirim said:
Every year there's about 5 to 10 people who get board certified through the American Board of Psychiatry and Neurology. I'm a psychiatrist currently in a pain fellowship. I know about 10 or so psychiatrists who did pain fellowships and I know zero psychiatrists who applied and didn't get a spot. I think the interest for specialties outside of anesthesia is growing but it's definitely and uphill battle.

Is there any specific data on the percent of applicants that applied and matched pain for each specialty? I know there are small numbers that apply, but if they always match, that's a different story.

I've been looking for this for years and found nothing. Thanks!
Click to expand...
i just barely see any psych or neuro residents in pain fellowships, literally can count on one hand how many i've seen combined after looking at countless pain fellowships websites. I know anesthesia is the most preferred one, with PM&R being a close second.
 
drusso said:
I love your enthusiasm, but you're about three decades too late. Pain was the dream of the 90's. When I finished my fellowship, I thought that I was looking forward to 30 years of doing IDET and a thriving intrathecal pump practice.

Most of Pain these days is just cleaning toilets. I don't mean that disparagingly. I mean if you've ever crapped in a dirty truck stop, you know the value of a nice clean toilet. Ditto for Pain. Pain doctors are an indispensable asset to their patients and communities. But one thing is certain: Opioids aren't going anywhere. Humans have had a complicated history with these substances since the earliest years of human civilization.

So, grab a brush and start scrubbing! Welcome aboard. We need people just like you.
Click to expand...
I don’t know how to like a post more than once, so I’m quoting this amazing post and going to like my own post - but just know it is your post for the double-like.
 
nvrsumr said:
Do NASS fellows get to round on their boss surgeons post op patients too?
Click to expand...
Just saw the schedule of didactic lectures for NASS fellowships. Several PDs and prominent attendings are giving lectures across all programs. Smart. And higher quality than single site.
 
I know and respect a number of nass folks. Multi site lectures sound good. I like to poke a bit. I don’t think unaccredited fellowships move my specially -pain medicine forward long term. Have told previous Nass presidents the same.
 
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