Pain Fellowship for Psychiatrists?

[Blitz2006]

So I've been doing some reading online, came across the option of doing pain fellowships (which intrigues me, since I like procedures which is why I like Neuropsych: ECT, rTMS, VNS, etc).

Anyways, I looked on sdn, a few threads, the best one being:

http://forums.studentdoctor.net/threads/psychiatry-and-pain-med.240560/

But I was wondering, what is the realistic chance:

1) For a psych resident to match into a pain fellowship?
2) Psych resident with a pain fellowship under belt that will actually get a decent number of patients?

I'm assuming it will be super competitive for a psych resident. Any idea:

1) How many programs consider psych residents?
2) Which programs in the past 'favor' psych residents?

On the old thread, it looks like cleveland clinic, UPMC and Brigham take (?like) psych residents....

Thanks!

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[Shikima]

Be sure to do an elective or 2 in pain management during your time in residency. Apply broadly and deeply. Consider adding an addictions fellowship.

 

[bonedrone14]

Don't really have any insight or I guess actually anything helpful to add op. But you're not the only one thinking about this. I think addictions+ interventional pain would be a great way to really help people. But I'm just a med student. I'll be interested to see if anyone with experience chimes in.

 

[scudiera]

Also interested in Pain and would love to do some interventions + psych mgmt of pain (think ESI and RFA, not verts, stims, and kyphos)...and I'm also very interested in neurostimulation. Seriously...are we the same person or something? (Are you applying for residency now? If so, PM me, would love to run into you on the interview trail!)

I almost chose another specialty to go into Pain but realized if I don't match Pain I like Psych a lot more than that other field. It is going to be very very challenging. A My guess is Pain fellowships housed in PM&R departments are likely going to be more friendly than ones housed in Anesthesia. I'd talk with your PD about your interest and see who/what can be done to help you. As the problem of chronic pain gets more attention Pain programs will see the benefits of adding Psychiatrists into their fellowships. Some are already starting to, with mixed results. It'll be a slow process and you're going to have to apply broadly, do research and make time to get experience during residency. Psychiatry brings a different and essential angle to pain treatment but I wouldn't go in with the idea that you're going to be a needle jockey. (inb4 vistaril pops up saying we lack the technical skills...yes, we know that...but it's anatomy and we all learned that, if you're motivated you can re-learn the basics - you may not be able to do a difficult ESI on a patient with a craggy, gnarly spine but learn in fellowship and then know your limits when you go out into practice)

As you said it's going to be hard to justify getting to go in on a stim placement or vert/kypho over any another doctor of a different specialty when the annual numbers of some of these procedures is very limited at many programs, but you'll get lots of volume with the other stuff probably.

The short version:
1) For a psych resident to match into a pain fellowship?Low chances
2) Psych resident with a pain fellowship under belt that will actually get a decent number of patients? Not bad once you're there, probably. My home program graduated a Psych resident a few years back who is now Pain boarded and does the full host of interventional pain procedures, but he also went through fellowship 7 years ago, different climate then

I'm assuming it will be super competitive for a psych resident. Any idea:

1) How many programs consider psych residents? All, nominally. Realistically, you're probably not goin to apply unless you think there's a chance they'll even consider you (months of experience during residency, research, etc.)
2) Which programs in the past 'favor' psych residents? Look at PM&R based pain programs. I think one of the UC's has some Psychiatrists in an Anesthesia program right now.

 

[MDROBIN001]

Do not know much about Psych fellowships in pain management, but if you have been trained in any pain management field you will have
NO problem seeing patients as much as you can, you can find a job with a starting payment of
anywhere between $125-$175 per hour

 

[smalltownpsych]

Surprising for me to hear that pain medicine is not eager for psychiatry residents. Chronic pain - depression - somaticizing - addiction - dependent personality traits - hx of abuse or trauma. It all seems pretty interrelated in my experiences. Sure there are the more straightforward cases where the physiological pain is almost the only issue, but those are the cases that can often be managed by a non-specialist.

 

[MacDonaldTriad]

We have had multiple graduates from psychiatry do pain fellowships and they have all been embarrassed with riches of choices on where. These are not difficult fellowships to get into. Most are filled with anesthesiologists, but psychiatrists have their niches that are recognized. I get the suggestion to consider addiction, but I would suggest psychosomatic training as an augmentation. Really, it isn’t that hard to get in.

 

[Shikima]

Don't give up, there is a spot for you.... the key is keeping an open mind while remaining tenacious in creating an avenue for good care.

 

[Blitz2006]

Wow. Encouraging news.

Will definitely strongly consider this fellowship. Figured it would be nice additional variety in a psychiatry career.

 

[scudiera]

". Chronic pain - depression - somaticizing - addiction - dependent personality traits - hx of abuse or trauma" pretty much my personal statement paragraph about how I got interested in psychiatry.

@MacDonaldTriad Based on talking with a lot of Anesthesiology, PM&R, and Neuro residents, current Pain fellows, and recently boarded Pain docs, I would be inclined to disagree with your assessment that it's "not that hard" but of course you know from direct experience with residents at your program and I don't doubt that.. Perhaps you meant to get into treating pain, not necessarily a pain fellowship, and I misunderstood. My question would be how recently have those residents matched into one of these accredited pain fellowships? Take a look at the Anesthesia and Pain boards on SDN to get an idea of the desirability and competitiveness of this fellowship recently. Perhaps it really is quite a bit easier for Psychiatrists than gas folks let on either because they want to keep us out or because it's so competitive for them while the programs have already realized how important psychiatric care is to the management of these patients.

Regardless, I too am encouraged. I was already considering psychosomatics as my way of getting exposure to pain treatment. Maybe after a PM fellowship I'll apply for Pain, or if I feel my matched program has given me sufficient PM experience/electives I'll apply for Pain right out of residency. Things to look forward to on the horizon!

 

[smalltownpsych]

From a non-physician standpoint, I find the concept of an anesthesiologist managing chronic pain to be a bit odd. How much experience with awake patients do they actually get during their training? My experience with them has been limited to "count to ten" while they inject a medication in your IV and you get to about 3. It is definitely an area of medicine where I have only a layman's understanding so correct me if I'm wrong. I am on the hospitals pain management team and we might be losing our pain management NP so not just idle curiosity on my part.

 

[MacDonaldTriad]

Well, I may have a relatively small "n" given the number of pain fellowships, but it is a match and students seem to be getting interest from multiple places. There are not the top residents necessarily, although some are. The few psychiatrists in my area that advertise pain expertise seem to be educated over seas and trained here.

 

[splik]

pain is a competitive fellowship unlikely psychiatry fellowships. for psychiatry fellowships there are far more spots than applicants. for pain, 28% of applicants went unmatched this year...

 

[bonedrone14]

As a 4th year med student, this is all confusing with info saying its easy/its hard to land a fellowship as a psych guy/gal. What would he some things to keep in mind in picking a residency? Obviously networking is the real key here...so I'm guessing places that have some time for research early on or maybe an elective month in third year might be good bets? Would it be out of line to mention my thoughtsof doing this in interviews if asked about possible career goals? I ddon't want to leave psychiatry but really just feel this would be a great way to diversifymy practice. I don't want to come off as looking for a backdoor to a different career.

 

[splik]

i think people will find it refreshing if you say you are interested in pain! certainly better than the usual "I'm interested in child psychiatry". Some programs have psychiatrists who also are pain trained, whereas others have psychiatrists who consult to the pain clinic (my program has both). Some residencies have pain as a required rotation. I think it would be great to express an interest in this in the interview trail. It is an historical accident that pain falls under anesthesiology, psychiatrists are theoretically more adept to handle patients with chronic pain. Programs that will get you au fait with addictions (including using methadone and suboxone), personality disorder, and training in mindfulness stress reduction, CBT, DBT, and hypnosis, that have psychiatrists doing pain work (clinically or research), and that allow you do this sort of work would be good. If you can do an elective no later than the middle of your PGY-3 year that would be good. Doing research related to pain, attending the pain conferences at the hospital, getting to know the people who work in pain at the hospital would all be good ideas.

I don't think it is hard for psychiatrists to do pain, except that psychiatry residents may in general be less competitive than say an anesthesiology resident. they may also be disadvantaged in getting less exposure to the field than residents in PM&R or anesthesiology though you should be able to make up for these deficiencies. But pain is a multidisciplinary field and most pain departments recognize the importance of interdisciplinarity in the field.

 

[scudiera]

This is interesting. I've actually been warned to not paint myself as "the pain guy" on my upcoming residency interviews because it's so niche and uncommon, and it may make it seem like I'm not interested in most of the rest of Psychiatry.

For those who don't know: the Pain fellowship originated in Psychiatry departments.

 

[bonedrone14]

Splik's comment made me feel really good about going in to interviews and talking about this...now the most recent one makes me leery about it again lol. I guess ultimately I'd rather be upfront and honest and get weeded out of a place that they'll be put off by my interests since I'll need the people at my program in my corner come fellowship match time. Plus I'm always super awkward when I try to act like what I think someone wants me to be anyway...

Thanks for all the advice everyone. And splik, I'll definitely keep those things in mind on the interview trail.

One last question that may be super dumb...I see that the application is for matching in December...would that be December of 4th year of residency? Would that theoretically allow some of my 4th year electives to be useful in my application?

 

[A Deep Breath]

Figured it would be nice additional variety in a psychiatry career.

Realistically, I think that a lot of us see pain as a way to do some procedural work as a psychiatrist. Without much basis other than years of reading SDN, I'm skeptical that any desirably located pain practice is going to have an interest in giving someone a part-time procedural gig so that they can bounce around to general psychiatry gigs the rest of the week. Does that ever happen?

 

[splik]

This is interesting. I've actually been warned to not paint myself as "the pain guy" on my upcoming residency interviews because it's so niche and uncommon, and it may make it seem like I'm not interested in most of the rest of Psychiatry.

This sounds like terrible advice. You are a competitive applicant and should be looking for a program that would be supportive at nurturing your interests in whatever it is that most captivates you. You need to be able to ask the relevant questions about how well the program would prepare you for applying for a fellowship in pain. For example, at my program we would try and have you interview with faculty who work clinically/research wise in pain and/or are pain fellowship trained. Most larger programs will try and have you interview with faculty who match up with your interests. You do yourself a disservice if you aren't honest about your interests.

Every year we meet people who are interested in areas such as pain, sleep, palliative medicine. There are people with far more "niche" interests than that. It makes your somewhat different, more memorable, and if a particular hospital looks aghast at your interest in it, then it's not somewhere you want to be anyway.

 

[Blitz2006]

This essentially my question as well.

Is it possible to do pain 1 or 2 days a week? I still want my bread and butter to be mood disorders and anxiety, neuropsychiatry stuff.

This is more for variety and diversifying my knowledgea base and interests.

Realistically, I think that a lot of us see pain as a way to do some procedural work as a psychiatrist. Without much basis other than years of reading SDN, I'm skeptical that any desirably located pain practice is going to have an interest in giving someone a part-time procedural gig so that they can bounce around to general psychiatry gigs the rest of the week. Does that ever happen?

 

[Shikima]

You can make what ever kind of clinic you'd like and can envision. Be sure you find a health system where you'll be able to collaborate rather than everyone worrying about their piece of the pie.

 

[scudiera]

Thank you so much for the advice.