Multiple Fellowships-How to do/use them?

[Sohalia]

---

Members don't see this ad.

Hi, I'm an MSIII, soon to be doing an MSIII.5 research year in PM&R. After much consideration I've decided on neuro. I like procedures and have decided that I definitely want to do an interventional type pain fellowship after residency, and most likely would want my primary research focus to be pain. My mom (a PM&R physician) suggested that I could also do a fellowship to get a greater background in EMG, EEG--i.e. a 1 year clinical neurophysiology fellowship.

I know pretty much anything is technically feasible, but I was wondering if anyone could give me practical insight into how I could use these 2 fellowships--is it likely that I could be an academic neurologist who works primarily in pain clinic/on pain research, and still spend a half day in EMG clinic or doing EEGs? (In other words, is it likely that I could do mainly pain stuff but also get out and do some other procedures if I have training for them?) If not, then how could these 2 fellowships be used in conjunction with one another?

Also, what would be the best order to do these 2 fellowships in? I would think clinical neurophys then pain, since pain is what I want to end up in 🙂 and I would mainly be interested in learning the technical skills associated with the clinical neurophys fellowship. Ideally I would want to get all my training done then look for an attending position. Can anyone see a reason why this would not work/would be a bad idea?

Thanks!

 

[Stinky Tofu]

If your primary interest is in doing both Neurophysiology studies and Interventional Pain, I think a shorter route would be through a PM&R program compatible with your interests. I haven't met any Neurologists that do both because in most cases it would require two fellowships.

Currently, at MGH's Neurophysiology lab, there is a Physiastrist finishing up the fellowship. His practice starting in August will consist of doing EDX studies and Interventional Pain procedures all day. This was really only possible because he did 6+ months of Interventional Pain rotations during residency and became quite proficient. Frankly, he could've been good at most EDX studies even without a fellowship because he spent 6+ months in the Neurophysiology lab at MGH and BWH as a resident. I think he did a fellowship because he was interested in doing more advanced studies (single fiber, rep stim, EEGs, evoked potentials, etc.), wanted to participate in clinics, and was interested in research.

While it might be nice to do both EEGs and NCSs/EMGs, the advice I've heard given to the outgoing fellows is that it really doesn't pay well to do EEGs in private practice. You also need to consider what your volume will be because you'll need to buy a machine. Also, consider what the incentive would be for a referrring physician to refer to you over an epilepologist (who will both read and treat) given that your practice is primarily interventional pain management. In an academic setting, they won't have one person floating through three departments. Realistically, I think you could do primarily Interventional Pain and a few NCSs/EMGs throughout the week. This isn't an uncommon setup for a Physiatrist who joins an Ortho group. If you are set on doing Neurology, I would try and find a program that offers a lot of electives or plenty of time in the Neurophysiology lab so you could forego the Neurophysiology fellowship. Without a fellowship, you won't be doing the more advanced studies. Most Neurologists and Physiatrists don't want to do these studies. I just don't think it's worth doing the fellowship if you want to primarily do interventional pain.

 

[neurologist]

Another thing to keep in mind is that almost all neurophys fellowships are heavily weighted toward either EMG or EEG, and don't give a balanced amount of both (i.e, you do about 10 months of one and 2 of the other). There are a few programs that spilt 50/50, but they are unusual.

Overall, I agree with the Tofu guy: if you're dead set on pain, but still want to dabble in EMG, you may be better going the PMR route and then doing a pain fellowship. The other option would also just be to get as much EMG training as possible during residency, do the pain fellowship, and then just learn/do EMG on your own -- you don't absolutely NEED to be fellowship trained to do EMG. As for EEG, forget it. You won't be doing any if you're working out of a pain clinic.

For info and links to all kinds of neuro fellowships, go to:

http://www.aan.com/students/awards/fellowship.cfm

 

[Sohalia]

Thanks for the replies guys. It is very hard to decide between PM&R and neuro if you like procedures. (Clinic type procedures I mean, not critical care!)

Since I'm interested mainly in pain, I'd want to use my electives during residency to focus on that, as opposed to boning up on EMGs at that time. I know 2 fellowships might sound crappy to some, but given these are generally 1 year fellowships, I think I'd be up for doing it.

So if I were to do an EMG weighted neurophys fellowship and a (interventional) pain fellowship back to back, would that look wierd at all? (As in, would I have trouble getting into a good interventional pain program coming out of a neurophys fellowship, perhaps because I might not seem committed?)