Anybody happen to read Dr. Cifus latest From the President column in the Physiatrist (AAPMR newsletter)? We discuss this issue all the time on this forum, but it appears that the issue has been made front and center to the rest of our professional membership. In his editorial, Dr. Cifu makes several points which warrant further discussion: 1. Inconsistencies in musculoskeletal/interventional spine/sports fellowships lead to problems when it comes to certification of technical profiency/professional competency. 2. PM&R residents can and should attain adequate skill in the evaluation and management aspect of musculoskeletal/sports/spine medicine during residency, and that additional training in these areas is redundant, if residency training is up to par. 3. PM&R pain and sports subspecialties were created for political reasons, not because Physiatrists need the extra training. 4. Pain fellowships are being used sub-optimally by future Interventional Spine Physiatrists to provide in-depth procedural training and to affirm proficiency in interventional procedures, the evaluation & management portion is redundant, and that it would be more appropriate for Physiatrists to undergo 1 year of training soley focused on procedural training. 5. PM&R residents should expect to be proficient in musculoskeletal/sports medicine after residency, but should expect that it will take several years in practice for their skills to peak, as in any other specialty of medicine or other professions, rather than expect that a fellowship will bypass this timeline. These issues have been identified on this forum in other threads. Weve got the academy president saying there is a problem. In the editorial, clear solutions are not offered (maybe to fuel further discussion). If we acknowledge that not all PM&R residencies provide quality musculoskeletal training, then the use of can and should (in the editorial) provide adequate musculoskeletal training suggests that many PM&R residencies need to improve and be held to a higher standard. By the same token, Dr. Cifu suggests that interventional fellowships need to be standardized in procedural content as well as the technical expertise of the trainers. The question is not so much what to improve as it is how to get the necessary changes implemented. To current residents, or medical students exploring this specialty who will be affected the most by this issue, in what manner would you like to see the training of musculoskeletal Physiatrists evolve? Will make for interesting discussion at next years annual meeting.