I am thinking about possibly doing a Psychiatry fellowship in the future and I heard some guy on Reddit mentioning "Interventional Pain Psychiatry", but I haven't been able to find any information about this fellowship online. All I found was something called "Interventional Psychiatry" where they do ECT and Ketamine infusions. What's the difference and how can I find out more information about these two? Does anyone know about these subspecialties?
Interventional Psychiatry vs Interventional Pain Psychiatry
- Thread starter pnp072000
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There's no fellowship for "interventional psychiatry", since nobody wants to do ECT as it reimburses poorly. The efficacy of ketamine is TBD, and the availability now of Spravato will likely render this modality obsolete in a few years. TMS is used frequently but the procedure is trivial enough that you can learn it in one CME session--at most one week-long trip to Bermuda....
There may be more interventions on the horizon--stellate ganglion block, non-invasive vagus nerve stimulator, ketamine/hallucinogen facilitated psychotherapy, etc. whether they'll be lucrative enough to be billable through insurance or frequently enough in cash private practice to make profit is yet unclear.
You can become a straight pain specialist from psychiatry and do things like pressure point and fluo-guided steroid injections. However, pain groups tend to also do other more lucrative, invasive procedures like spinal stimulator placements--which you can learn, but if you are not used to do catheter-based procedures it's a very steep learning curve--these are risky procedures. The employability of psychiatrists in a pain group is low-moderate, and I suspect given how non-procedure based psychiatrists can now earn a very nice salary doing straight or subspecialty psychopharm (i.e. child/addiction), this is route quite uncommonly pursued. Psychiatry is becoming more known as a well-paid lifestyle field, but it's a rare case where it has little to do with procedures.
There may be more interventions on the horizon--stellate ganglion block, non-invasive vagus nerve stimulator, ketamine/hallucinogen facilitated psychotherapy, etc. whether they'll be lucrative enough to be billable through insurance or frequently enough in cash private practice to make profit is yet unclear.
You can become a straight pain specialist from psychiatry and do things like pressure point and fluo-guided steroid injections. However, pain groups tend to also do other more lucrative, invasive procedures like spinal stimulator placements--which you can learn, but if you are not used to do catheter-based procedures it's a very steep learning curve--these are risky procedures. The employability of psychiatrists in a pain group is low-moderate, and I suspect given how non-procedure based psychiatrists can now earn a very nice salary doing straight or subspecialty psychopharm (i.e. child/addiction), this is route quite uncommonly pursued. Psychiatry is becoming more known as a well-paid lifestyle field, but it's a rare case where it has little to do with procedures.
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"Interventional psychiatry" fellowships aren't accredited fellowships. I suppose there might be some value in doing the work if you're specifically looking to do that kind of work, but it's not as if you're going to be board certified in "interventional psychiatry."
I finished residency this past summer and my current job is nearly exclusively "interventional psychiatry" (primarily ECT though I also do esketamine treatments and will start doing TMS in the fairly near future once our new TMS device arrives). I didn't get any explicit training in these modalities in the form of a "fellowship" or other formal didactic curriculum beyond my general psychiatry training. Having now done it for a few months, I think such a fellowship would be largely a waste of time and an excuse to get paid less to provide cheap labor for whatever institution is sponsoring the "fellowship."
I finished residency this past summer and my current job is nearly exclusively "interventional psychiatry" (primarily ECT though I also do esketamine treatments and will start doing TMS in the fairly near future once our new TMS device arrives). I didn't get any explicit training in these modalities in the form of a "fellowship" or other formal didactic curriculum beyond my general psychiatry training. Having now done it for a few months, I think such a fellowship would be largely a waste of time and an excuse to get paid less to provide cheap labor for whatever institution is sponsoring the "fellowship."
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What is our specialty coming to that the thing that really works reliably best with a good effect size for MDD, with few truly solid alternatives (sorry SSRIs, CBT, you're just ok) is being replace by an abusable drug with lots of clinical trials deaths and ~equal number of positive and negative trials and probably and effect size across them all about as big as a pat on the back.
Don't write off ECT just yet. If/when your local Medicaid ever moves to capitation based payments, you can bet the lackies at your hospital will be closing down that esketamine clinic real fast and pushing ECT like oxycontin in 1999. Maybe your interventional training with ECT focus will have you in position to profit.
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What really needs to happen with ECT is CMS needs to stop dragging their heels and actually put 90870 on the approved list of procedures for ambulatory surgery centers. That is where access to ECT will improve. The politics and hospital road blocks, and just general apathy towards psychiatry is frustrating as I've experienced with starting a service in the past and even now trying to do so again.
