Pain fellowship after Neurology

lobelsteve

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    I am a neurologist interested in applying for pain medicine, anyone on same page

    It's what everyone in Neurology should do. It beats diagnosing things all day and not being able to do more.

    Get a spot.
     
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    PMR 4 MSK

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      Historically, pain fellowships are controlled largely by anesthesia, and so most fellows are anesthesia. PM&R is second largest, and some have trouble getting a fellowship, especially ACGME. A neurologist can expect to have a little harder time, all things considered.
       

      Jcm800

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        Historically, pain fellowships are controlled largely by anesthesia, and so most fellows are anesthesia. PM&R is second largest, and some have trouble getting a fellowship, especially ACGME. A neurologist can expect to have a little harder time, all things considered.

        yeah, if you aren't anesthesia based, then u should not do a pain fellowship!!!! I mean, come on, what if the patient needs a TEE or a Swan? how else will you have the background to do these things...
         
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        lobelsteve

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          yeah, if you aren't anesthesia based, then u should not do a pain fellowship!!!! I mean, come on, what if the patient needs a TEE or a Swan? how else will you have the background to do these things...

          That's what our CRNA's are hired to do. Boo-yeah.
           

          PMR 4 MSK

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            Pain management is easy:

            Anesthesia: "You need an epidural."
            PM&R: "You need PT."
            Neuro: "You need an MRI. And then Gabapentin."

            Fellowship? Who needs a fellowship?
             

            emd123

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              My hat's off to anyone that can land an accredited fellowship spot these days, it's so damn competitive now. 150+ applications for 4 or 5 spots at lots of places. Worse at top tier places. More power to you.
               

              doctorlarry

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                To the original poster...PM me if questions as I am a board-certified pain physician. My pathway was through neurology. I prescribe gabapentin (just to fit the stereotype). I also do implants, kypho, PDD, etc...oh and I prescribe PT from time to time too!
                 

                melancholy

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                  One of the fellows I graduated with and his wife are both neurologists who went through my anesthesia-based pain fellowship. (I'm PM&R) I thought the background of neurology (with some psychiatry exposure) was a nice complement to pain.
                   

                  Jcm800

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                    One of the fellows I graduated with and his wife are both neurologists who went through my anesthesia-based pain fellowship. (I'm PM&R) I thought the background of neurology (with some psychiatry exposure) was a nice complement to pain.

                    in all honesty, i think neurology and pain would be pretty good...
                     

                    painfan

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                      FWIW,
                      on each of my interviews, there were a couple of neurologists interviewing as well.
                      I did an EM residency.
                      I was fortunate enough to get into an ACGME accredited (anesthesiology) Pain fellowship, will be starting in July!
                       

                      happylunchbox

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                        FWIW,
                        on each of my interviews, there were a couple of neurologists interviewing as well.
                        I did an EM residency.
                        I was fortunate enough to get into an ACGME accredited (anesthesiology) Pain fellowship, will be starting in July!

                        I thought you had to do either anes, pmr, neuro, or psych to become boarded in Pain...am I mistaken? How were you able to land your fellowship?
                         

                        Taus

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                          I thought you had to do either anes, pmr, neuro, or psych to become boarded in Pain...am I mistaken? How were you able to land your fellowship?

                          technically you can do pathology or medical genetics and be qualified for a pain fellowship if they will have you.... ie any prior residency will do
                           

                          emd123

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                            This has been covered several times on this forum. Any ACGME accredited residency graduate can be considered for an ACGME accredited Pain fellowship. Some fellowship directors don't know themselves (or claim not to know) that this is true. Actually getting the spot is a different story. Once you're in, and you've completed an accredited Pain fellowship, you're eligible to take the same ABMS board exam as anyone else, even if you're not from Anesth/PMR/neuro/psych. Members from other specialties take the exam through one of the other boards (not ABA) but it is the same exam, written by the American Board of Anesthesia, as everyone else takes. Some programs will not consider anyone not from one of the "big four". Some programs won't even consider you even if you are from PM&R/neuro/psych, if you're not from anesthesia. However, there's a select few, but definite number of actually very good programs that have a tradition of considering applicants from outside the big four specialties for (usually one) of their slots.

                            Now, that being said, if you come from let's say, Pathology, and you have no experience with actual live pain patients who have pain (LOL), the chances of you getting a spot, with how competitive Pain is right now, is slim to none. If you are ER, Internal Medicine, Ortho, Neurosurg, Interventional Radiology, it's incumbent upon you to prove to the fellowship selection committees that you have the background, desire, knowledge and skill to be considered. Likely, you're going to have to work much harder, have better board scores, do more research, show more dedication, or generally prove why they should take you over someone who's skill set they're much more comfortable with. I know partly from personal knowledge, and partly from reading this forum, that people from each of these above specialties have gotten into accredited fellowship spots.

                            Historically, politically and by sheer numbers Anesthesia dominates. The debate will rage on over "who's the best" fit for Pain. This whole debate used to irritate me, but now I think the whole argument is kind of fun, like a good old fashioned sports rivalry. As far as I'm concerned, "if you're good, you're good". I've seen good and not so good from different specialties. It has a lot more to do with whether or not a particular person in particular is committed to excellence, than what primary specialty you started out in and no longer practice.

                            As far as I'm concerned, Pain is its own specialty. You're either a Pain specialist, or you're not. What specialty you practiced in your "previous life" becomes less and less important as time goes by. This is where "Pain" as a distinct specialty needs to grow up a little bit and have its own 4 year residency (now 1 yr fellowship) and distinct physician-only specialty board (but that's a whole different political drama that needs its own thread). It's very similar to the days before ER residencies (1970s) where "everybody did ER", literally. One night the internist covered the ER, the next night the surgeon covered, the next night the dermatologist, and so on. If you showed up with your heart attack the day the dermatologist was covering, you were screwed, and so on. The care was not acceptably consistent as you can imagine. Out of this need came EM residencies. And so, Pain needs to come together with its own distinct residency, Board, evidence-based standards of care, reference text, and so on. As much as chronic pain is becoming and will continue to become epidemic with the growing elderly population, the need for this will become more obvious and hopefully, much of it will come to fruition.
                             
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                            emd123

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                              FWIW,
                              on each of my interviews, there were a couple of neurologists interviewing as well.
                              I did an EM residency.
                              I was fortunate enough to get into an ACGME accredited (anesthesiology) Pain fellowship, will be starting in July!

                              There is a growing but still small number of EM physicians who've taken this path. The ACGME lists specifically what skills they expect from non-anesthesiologist, non-physiatrists, and so on. See page 10 and 11 here:

                              http://www.acgme.org/acWebsite/downloads/RRC_progReq/sh_multiPainPR707.pdf

                              The specialty of Pain Medicine, is so much different than "chronic pain in the ER". It's a totally different animal.
                               

                              Ducttape

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                                It's very similar to the days before ER residencies (1970s) where "everybody did ER", literally. One night the internist covered the ER, the next night the surgeon covered, the next night the dermatologist, and so on. If you showed up with your heart attack the day the dermatologist was covering, you were screwed, and so on. The care was not acceptably consistent as you can imagine. Out of this need came EM residencies.

                                Technically, that is true.

                                However, by the 1980s, most emergency departments had taken to the practice of hiriing only internal medicine, family practice, or general surgery physicians. In fact, some emergency departments advertised that they had int med/fam practice docs for medical side and surgeons for the trauma side of their emergency department.

                                The fad of EM residency was popularized as much or more by the percieved income that could be generated by the program, and growth was rapid as it was thought to be a "lifestyle" job.

                                Unfortunately (or not, depending on your perspective), board certification which was initially promoted as a "recommendation" became a "necessity" for practice in emergency medicine.
                                 
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