non anesthesia applicants for ACGME pain fellowship

[AndyDufrane]

so I have been asked by a junior resident from the PMR program I graduated from about whether to apply for ACGME Pain or non-ACGME Interventional spine fellowship, I went the non-ACGME route, so I gave the pros n cons about that, but I did warn him, some ACGME pain programs are more accommodating for non-anesthesia pain fellows, others might not and expect you to take anesthesia call, anyone have a list of truly multidisciplinary ACGME pain fellowships that are better geared for non anesthesia folks.

---

Members don't see this ad.

 

[oreosandsake]

i have heard that northwestern, stanford, and davis more are more "inter-disciplinary"

how does someone w/o anesthesiology training cover call?

 

[emd123]

i have heard that northwestern, stanford, and davis more are more "inter-disciplinary"

how does someone w/o anesthesiology training cover call?

The same way PMR, neuro and psych do. A Pain program should have the fellows taking Pain call, not general anesthesia call, any more than the anesthesia/pain fellows should be taking general PMR call in Pain fellowship.

"Acute pain" call is relevant, but that's easy to learn for someone who's non-anesthesia.

 

[Taus]

See the stickied thread at the top of the PM&R forum:

Its a few years old....but...cut and pasted from that list:

Some traditionally anesthesia run pain fellowships that have taken PM&R in the past:
Oregon
UPenn
Jefferson
Penn State
Beth Israel in NYC
Harvard - both Mass General and Brigham
MD Anderson
UTSW
UC Irvine
Loma Linda
Stanford
Michigan State
Loyola
Univ. of Chicago
I think UCSD??
Cook County
Robert Wood Johnson
Hopkins
Cleveland Clinic
Univ of Pittsburgh
UVA
Univ of Washington
St. Vincents in NYC
Univ of Iowa


PM&R based or strong PM&R presence ACGME accredited pain fellowships:
UCLA
U Colorado
Spaulding
U Mich
Northwestern
MCV/VCU
NRH/Georgetown (accredited??)
LSU
Temple - Falco
UCDavis

 

[oreosandsake]

The same way PMR, neuro and psych do. A Pain program should have the fellows taking Pain call, not general anesthesia call, any more than the anesthesia/pain fellows should be taking general PMR call in Pain fellowship.

"Acute pain" call is relevant, but that's easy to learn for someone who's non-anesthesia.

the poster referenced anesthesia call in reference to being accommodating for non-gas trained fellows.

at cedars sinai, the pain fellows are required to cover the ORs and take anesthesia call.

the same I hear goes with cook county UIC, and some other anesthesiology pain programs. Thus, they will never take a non-gas trained applicant.

every program should have some acute pain service coverage, no? checking on caths and consults on the weekend...?

 

[Taus]

the poster referenced anesthesia call.

at cedars sinai, the pain fellows are required to cover the ORs and take anesthesia call.

the same goes with cook county UIC, and other anesthesiology pain programs. Thus, they will never take a non-gas trained applicant.

a PM&R friend of mine was close to accepting a spot at Cincinnati a few years ago... for a non-anesthesia fellow he would have had to do one non-accredited year of general anesthesia training and then do their agcme pain fellowship.... where he would have to take OR call..... needless to say he did not go for that...

I guess we can't be too upset... as it seems like some of the PM&R accredited ones don't take non-rehab... ie Temple and UCLA-VA

We aren't qualified to take OR call... .they aren't qualified to do EMG's and peripheral MSK/sports.... so be it...

 

[imagoodmanyea]

Would anesthesia resident even choose a program that required them to take OR call? I can't see these programs as desirable unless the fellows get paid for moonlighting

 

[lord_jeebus]

Some traditionally anesthesia run pain fellowships that have taken PM&R in the past:
...
I think UCSD??

We're taking our first PM&R fellow (at least in recent memory) this July at UCSD, and there is always a strong interest in particularly well-qualified non-anesthesiologists. One of my co-fellows is a psychiatrist and we have recently taken from Internal Medicine and Interventional Radiology.

 

[ampaphb]

See the stickied thread at the top of the PM&R forum:

Its a few years old....but...cut and pasted from that list:

Some traditionally anesthesia run pain fellowships that have taken PM&R in the past:
Oregon
UPenn
Jefferson
Penn State
Beth Israel in NYC
Harvard - both Mass General and Brigham
MD Anderson
UTSW
UC Irvine
Loma Linda
Stanford
Michigan State
Loyola
Univ. of Chicago
I think UCSD??
Cook County
Robert Wood Johnson
Hopkins
Cleveland Clinic
Univ of Pittsburgh
UVA
Univ of Washington
St. Vincents in NYC
Univ of Iowa


PM&R based or strong PM&R presence ACGME accredited pain fellowships:
UCLA
U Colorado
Spaulding
U Mich
Northwestern
MCV/VCU
NRH/Georgetown (accredited??)
LSU
Temple - Falco
UCDavis

There should be a third list for programs hostile to PM&R. In the past Rush and BID have fit that description.

 

[imagoodmanyea]

You can add UIC, Cook County, and Loyola to the PM&R discrimination list. The only programs that take PM&R in Chicago are NU and U of C.

 

[Spartyon]

Places that used to accept pm&r no longer do due to the massive influx of anesthesia applicants. I know this is true for Loyola and many other acgme pain programs.

 

[specepic]

BID was quite open to PMR when I interviewed there and extended an offer, fwiw

Mayo Roch takes a lot of PMR, though mostly in house PMR

Mayo Jax and Scotts also with recent PMR fellows

For PMR applicants, I think it is important to present your level of procedural experience, as that is a primary concern for anesth faculty, i.e. do you know how to handle a needle? There are some PMR programs that are weak in procedures and if they have taken fellows from those before they will be biased against you.

I told them straight up "I've done __ months of pain, ___ESI's, __RFAs, etc." I also was clear I was there to learn and did not think I already knew it all.

Also, get letters from anesth pain attg's, I noticed how the PD at one program flipped through my file, ignored all letters except the aneth pain one.

 

[ampaphb]

At BID, Dr. Peeters-Asdourian was renowned for being PM&R adverse

 

[specepic]

At BID, Dr. Peeters-Asdourian was renowned for being PM&R adverse

Guess I'm a charmer

In all seriousness, i got that vibe in the interview so I addressed it head on. I did not feel treated unfairly but could tell they were a little hesistant re: PMR and I think I even heard from some fellows that recent PMR had shown up for fellowship with bad needle skills. There was also some ER call coverage for ESI's for rib fractures or something like that and I was informed I would need to acquire skills for bedside ESI prior to entry.

Seemed weird to have fellows do ESI for ER rib fractures but what do I know

 

[bedrock]

Guess I'm a charmer

In all seriousness, i got that vibe in the interview so I addressed it head on. I did not feel treated unfairly but could tell they were a little hesistant re: PMR and I think I even heard from some fellows that recent PMR had shown up for fellowship with bad needle skills. There was also some ER call coverage for ESI's for rib fractures or something like that and I was informed I would need to acquire skills for bedside ESI prior to entry.

Seemed weird to have fellows do ESI for ER rib fractures but what do I know

Same vibe when I interviewed there. I think are trying to demonstrate they will take PMR, they do take one here and there. However, you definitely need to demonstrated preexisiting needle skills from residency or they won't look at you.

 

[Ducttape]

Guess I'm a charmer

In all seriousness, i got that vibe in the interview so I addressed it head on. I did not feel treated unfairly but could tell they were a little hesistant re: PMR and I think I even heard from some fellows that recent PMR had shown up for fellowship with bad needle skills. There was also some ER call coverage for ESI's for rib fractures or something like that and I was informed I would need to acquire skills for bedside ESI prior to entry.

Seemed weird to have fellows do ESI for ER rib fractures but what do I know

Did they mean epidural catheter for rib fracture, flail chest? That makes more sense, running some bupiv for 5-6 days to avoid intubation for respiratory failure...

 

[specepic]

Did they mean epidural catheter for rib fracture, flail chest? That makes more sense, running some bupiv for 5-6 days to avoid intubation for respiratory failure...

I have no idea to be honest. Seemed weird to have pain fellows do this regardless.

 

[Ducttape]

Meta-analyses of various RCTs have shown conflicting results. Epidural anesthesia doesn't seem to change mortality, but may shorten length of time on ventilator (on one meta-analysis ) or not (another one), may decrease post-fx complications....

http://http://journal.opus12.org/o12-ojs/ojs-2.1.1/index.php/o12sci/article/viewFile/267/100

 

[cheetamorf]

Hi All,

I know frequently non-anesthesia applicants are wondering which programs might be accepting of PM&R or not. This is a completely non-scientific based list, but something I came up with based on my own interview schedule and those of others. Since the list hasn't been updated in a while, I figured I'd put something new out there. Please feel free to add/edit this. If it should be put in some other thread please move it there.

Either have accepted Non-PM&R/Non-anesthesia applicants or saw one interviewing there
UPMC (Pitt)
Mayo Jacksonville
Brigham & Women’s
Cleveland Clinic
Dartmouth
NYP – Cornell Tri institutional
OHSU
UWashington Seattle
MGH

Consider PM&R at least
BIDMC
Emory
Cook County
Johns Hopkins
Loma Linda
Mayo Arizona (sounds like they preferred 1 Anes+ 1PM&R)
Northwestern (has PM&r track and other track, unclear if other track considers non-anesthesia)
Montefiore (PM&R based)
Stanford
UC Davis
UC Irvine
UC San Diego
UC San Francisco
Maryland (requires 1 month of general anesthesia)
Michigan (has PM&R and anesthesia tracks)
USC (Likely considers all, PD is psych)
UT San Antonio (seems split between PM&R and anesthesia)
UT Southwestern Dallas
VCU (probably just PM&R)
Toledo (although their PD left and they didn’t match anyone)
Kansas
Oklahoma
UAlabama @ Birmigham
LSU (PM&R only I believe)
Colorado (has PM&R track, anesthesia track, and ped’s track). Maybe could get a chance if you wanted to do peds and made that clear in your statement.
West LA VA (only accepts PM&R)

 

[FollowTheMoney]

I’m not sure why, but Anesthesiology consists of people with the least common sense of any specialty. They have allowed CRNAs to run rampant and now these mid level providers have scooped up all the easy gigs that pay well out in private practice, which has screwed over younger anesthesiologists. Now with pain medicine fellowships, they are accepting everyone and their mother from all these other specialties, thereby also screwing over anesthesiology residents. I mean this in the most non-offensive way possible and I’m not saying PMR, Neurology, Psych, or whoever else wouldn’t be a good pain physician, but you don’t see other specialties opening up their own competitive exclusive fellowships to all these other specialties. For example, Ortho Spine, IR, Derm based fellowships, etc all keep their fellowships within their own specialty. It just amazes me how the older anesthesiologists continue to screw over the younger generation, even if it’s unintended.

 

[oreosandsake]

Hi All,

I know frequently non-anesthesia applicants are wondering which programs might be accepting of PM&R or not. This is a completely non-scientific based list, but something I came up with based on my own interview schedule and those of others. Since the list hasn't been updated in a while, I figured I'd put something new out there. Please feel free to add/edit this. If it should be put in some other thread please move it there.

Either have accepted Non-PM&R/Non-anesthesia applicants or saw one interviewing there
UPMC (Pitt)
Mayo Jacksonville
Brigham & Women’s
Cleveland Clinic
Dartmouth
NYP – Cornell Tri institutional
OHSU
UWashington Seattle
MGH

Consider PM&R at least
BIDMC
Emory
Cook County
Johns Hopkins
Loma Linda
Mayo Arizona (sounds like they preferred 1 Anes+ 1PM&R)
Northwestern (has PM&r track and other track, unclear if other track considers non-anesthesia)
Montefiore (PM&R based)
Stanford
UC Davis
UC Irvine
UC San Diego
UC San Francisco
Maryland (requires 1 month of general anesthesia)
Michigan (has PM&R and anesthesia tracks)
USC (Likely considers all, PD is psych)
UT San Antonio (seems split between PM&R and anesthesia)
UT Southwestern Dallas
VCU (probably just PM&R)
Toledo (although their PD left and they didn’t match anyone)
Kansas
Oklahoma
UAlabama @ Birmigham
LSU (PM&R only I believe)
Colorado (has PM&R track, anesthesia track, and ped’s track). Maybe could get a chance if you wanted to do peds and made that clear in your statement.
West LA VA (only accepts PM&R)

essentially every one of those programs takes PM&R.

maybe a stretch at cook, Oklahoma and USC

 

[emd123]

I’m not sure why, but Anesthesiology consists of people with the least common sense of any specialty. They have allowed CRNAs to run rampant and now these mid level providers have scooped up all the easy gigs that pay well out in private practice, which has screwed over younger anesthesiologists. Now with pain medicine fellowships, they are accepting everyone and their mother from all these other specialties, thereby also screwing over anesthesiology residents. I mean this in the most non-offensive way possible and I’m not saying PMR, Neurology, Psych, or whoever else wouldn’t be a good pain physician, but you don’t see other specialties opening up their own competitive exclusive fellowships to all these other specialties. For example, Ortho Spine, IR, Derm based fellowships, etc all keep their fellowships within their own specialty. It just amazes me how the older anesthesiologists continue to screw over the younger generation, even if it’s unintended.

The truth of the matter is, that Pain never was a single-specialty subspecialty. All while Snesthesiologists had their own Pain fellowships, PM&R and neuro had their own. Also, while they may not have had their own formal pain "fellowships," other specialties such as IM, FM, Rad, Emergency Medicine (78% of ED patients have a complaint of some type of pain, with 40% having an underlying chronic pain disorder) and others have done plenty of heavy lifting regarding treating patients in acute and chronic pain, all along, also. So, to say that Pain was ever "owned" and then "lost" by any one specialty, leaves out a large part of the story.