Pain and PM&R

[savealife]

Hi everyone... I'm an MSIII at an allopathic Northeastern medical school, and I'm very interested in PM&R.

I think everyone here has been beating around the same bush for quite some time, so I was hoping that people "in the know" could shed some light on this situation for me. I am 100% sure that I want to do interventional pain medicine, the broad spectrum type of pain medicine offered in anesthesiology departments across the country and in a few PM&R departments, NOT the interventional spine fellowship that is offered at a lot of PM&R departments (just too narrow a spectrum for me). With all of the recent changes in the pain medicine fellowship process, should someone that is confident that they want to do Pain Medicine go into PM&R?

I don't want to get to the end of my residency and realize that I have either no shot or very little shot at getting into pain medicine, but by the same token, I don't really have an interest in anesthesiology either. I would appreciate the response of the people "in the know" as it pertains to this topic.

Thank you,
savealife

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[savealife]

I also should note that I posted this more as a way to guage the response of many different people in the field; it will be nice to have the opinion of many on this particular topic, rather than simply basing a decision on one or two people's thoughts.

-savealife

 

[axm397]

Hi everyone... I'm an MSIII at an allopathic Northeastern medical school, and I'm very interested in PM&R.

I think everyone here has been beating around the same bush for quite some time, so I was hoping that people "in the know" could shed some light on this situation for me. I am 100% sure that I want to do interventional pain medicine, the broad spectrum type of pain medicine offered in anesthesiology departments across the country and in a few PM&R departments, NOT the interventional spine fellowship that is offered at a lot of PM&R departments (just too narrow a spectrum for me). With all of the recent changes in the pain medicine fellowship process, should someone that is confident that they want to do Pain Medicine go into PM&R?

I don't want to get to the end of my residency and realize that I have either no shot or very little shot at getting into pain medicine, but by the same token, I don't really have an interest in anesthesiology either. I would appreciate the response of the people "in the know" as it pertains to this topic.

Thank you,
savealife

So in terms of pure "numbers", you'll probably have a better chance of landing a pain fellowship that fits your description, going into Anesthesiology.

I would also consider other factors such as: what do you hope to learn during residency? What skill sets do you hope to posess ultimately? What kind of options would you want to be able to fall back on should you not get a pain fellowship? Would you want to work as a general anesthesiologist or be a general physiatrist?

In a PM&R residency you will learn good MSK and neuro physical exam skills. You will learn how to do peripheral joint injections. You will be able to perform EMGs. You may even get exposure to musculoskeltal ultrasounds. You will be able to manage inpatient rehab patients with stroke, spinal cord injury, brain injury, etc. You will be able to do consults in different settings for various rehab related issues.

In anesthesia, you will be able to intubate, start a-lines, do epidurals, learn some basic regional techniques, and be able to take care of patients peri-operatively. You will also have exposure to critical care. You will spend a lot of time in the OR working with various types of surgeons. And probably a few more things I'm missing since I'm not an Anesthesia resident (although I did do a rotation in Anesthesia and considered it strongly during medical school and did research in the Anesthesia department.)

Talking to PM&R residents and Anesthesia residents interested in pain may give you a better perspective. You can go to the aapmr website and search for mentors with an interest in pain. You can probably also hop over to the pain and Anesthesia forums on sdn.

 

[Disciple]

Hi everyone... I'm an MSIII at an allopathic Northeastern medical school, and I'm very interested in PM&R.

I think everyone here has been beating around the same bush for quite some time, so I was hoping that people "in the know" could shed some light on this situation for me. I am 100% sure that I want to do interventional pain medicine, the broad spectrum type of pain medicine offered in anesthesiology departments across the country and in a few PM&R departments, NOT the interventional spine fellowship that is offered at a lot of PM&R departments (just too narrow a spectrum for me). With all of the recent changes in the pain medicine fellowship process, should someone that is confident that they want to do Pain Medicine go into PM&R?

I don't want to get to the end of my residency and realize that I have either no shot or very little shot at getting into pain medicine, but by the same token, I don't really have an interest in anesthesiology either. I would appreciate the response of the people "in the know" as it pertains to this topic.

Thank you,
savealife

Statistically speaking you'll have a better chance getting into a comprehensive interventional pain fellowship coming from Anesthesia.

Counterpoint: Should you go into PM&R and get good PM&R training of the new millenium, you'll be better equiped to diversify/"weather the storm" when interventional pain management eventually crashes.

 

[medicineman1]

what do you mean eventually crashes? Ya sure MAYBE MAYBE in the next ten years there will be a residency in pain management vs. a fellowship.

As far the need for pain docs- the needs are increasingly with the age of the population.

eventually crashes?? Not following where you are coming from?

 

[Disciple]

what do you mean eventually crashes? Ya sure MAYBE MAYBE in the next ten years there will be a residency in pain management vs. a fellowship.

As far the need for pain docs- the needs are increasingly with the age of the population.

eventually crashes?? Not following where you are coming from?

Reimbursement for procedures performed in the office was cut for 2007. ASC rates were cut to fall in line with those of the HOPD.

ASIPP, despite all their lobbying and political propaganda, was unable to stop this.

Look at the cuts scheduled for '08. It's even worse.

Healthcare reform is going to take place slowly state-by-state. More money is not going to be given to physicians. More patients in need of pain management doesn't mean higher reimbursement for us. It likely means infiltration of mid-level providers.

 

[savealife]

Anyone else with any thoughts? Or maybe know of some anesthesiology pain fellowships with a good track record for being "PM&R friendly?"

-savealife

 

[axm397]

Anyone else with any thoughts? Or maybe know of some anesthesiology pain fellowships with a good track record for being "PM&R friendly?"

-savealife

I think some of the "PM&R friendly" anesthesiology fellowships depends on which PM&R residency program you graduate from - for example, many PM&R residents go on to anesthesia fellowships in their own programs. Also, one may look into his/her own med school's fellowship opportunities as well. Many anesthesia based fellowships will be PM&R friendly to certain PM&R programs depending on the track record of PM&R fellows who paved the way. So it's hard to identify which anesthesia programs are generally PM&R friendly.

 

[Brooklyndo2.1]

excuse a med student butting in...but...
I just think what should matter is what you want to do baseline...aka do you prefer baseline rehab or baseline anaesthesia...
all the rest is a null point coz we arent THAT great at predicting the future.
who knows maybe next peds will develop some high end procedure and peds will be thehot field who knows

 

[Doctodd]

a pain fellowship will be what you put into it.....if you want to just cruise, then no matter where you go it wont be fruitful.

The next step will be to learn how to run a business....and coding is huge.

T