Pain Fellowship Question for a PGY-3: Is a 6-Month Longitudinal Pain Experience Acceptable Instead of Normal 4 week pain rotation(s)?

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I’m a PGY-3 Psychiatry resident and curious what your thoughts are on this approach to preparing my application for pain. Before you read what’s below, the question I have for you is: would this experience be comparable to or acceptable in substitution of a standard home pain rotation or away pain rotation? Will this be enough exposure to apply to pain fellowship?


My residency program has oddly constrained elective time during PGY-4 (and virtually none during PGY-3). You are required, in PGY-4, to always be in clinic a minimum of 2 days per week meaning I cannot do any away rotations for pain, and I cannot do a standard rotation (like a 4 week block) uninterrupted even within my hospital system. Luckily we have a pain fellowship program and I have spoken with the fellowship director, and he has encouraged me to come in as much as I can. My plan is to use the “elective time” I have during PGY-4, particularly between July-December, to work with our pain faculty and fellows. From what I understand, I will be treated as if I am doing a standard rotation by our pain department, and therefore be given normal exposure to procedures on the days that I am there (max 3 days per week, but for up to 6 months).


Otherwise, I have solid step scores. In terms of research, I have 2 pain-related case reports and one meta analysis (and 10 publications prior to residency).

 

[spine1105]

Seems perfectly fine to me, here's my advice in order of priority (assuming you pass your boards/STEP 3):
1) Get a letter from that fellowship director or another APD that is STRONG. You need it to talk about 1) work ethic, 2) professionalism, 3) empathy and tenacity to help patients, and 4) your technical skills. You go to fellowship to learn the last part, but no attending wants to work with anyone who isn't top tier in the other three. Please do not ignore this; show you care about Pain Patients. Bust your ass on that rotation and show you own your patients, even as a PGY-3.
2) Study your flouro anatomy. If you can quickly interpret an AP, lateral, CLO, ILO, how to count cervical spine and basic peripheral joint plain films, you'll be starting (surprisingly) weeks ahead of your co-fellows next year. Read the first few chapters of Furman during your PGY4 year again and again and practice your spinal/touhy dexterity on gel models or pork. You do this **** and get a feel for Bread and butter and you'll instill so much confidence in your PD at the start of Fellowship you'll be flying in no time.
2) Get involved in a society/conference at least once before apps. Get on a resident/fellow committee, journal club, or attend a conference where you can show involvement at a national level. IPSIS, NANS, AAPM, ASRA, ASPN, NASS etc. all very solid and you are likely to meet directors at each (ASRA has a PD meet and greet). For better or worse, the Pain world if very interconnected on social media, so showing up at these things and showing your face helps always (especially with programs that care about this stuff - some programs are looking for you to talk about how you'll represent them at conferences or with research as a fellow). But don't destroy your wallet to attend a conference, that LOR outlined above is still far more important.
3) Research; you're good on this, be prepared to talk about it.


Aways are overrated imho; as a Fellow I felt I saw it hurt residents more than helped them. I ended up at a "top tier" program without a single away, just very strong LORs from my home program.

Also, no serious Pain program looks at Apps until after the holidays. PDs/APDs want to spend December-Jan with their families and then NANS always comes up at the end of January. Feel comfortable submitting your App around January, don't sweat it.

 

[sdkjfbsdfsvcsdfvc]

Really appreciate the insights. I know recent pain match years have had lots of unfilled programs, but still not sure how many programs to apply to. My instinct is to just apply to all of them to cast a wide net. The other lingering thought I have is: will a psych pedigree shut doors for hospital based or private practice jobs. Private practice pain seems to primarily be pmr and anesthesia, but this seems to reflect historical match representation by specialty, as opposed to the increasingly multidisciplinary shift we’ve seen in the last 4 years in response to fewer anesthesia applicants. I mean I’ve even seen occ med and IM pain fellows / recent alumni in the last 2 years, which I guess I find surprising given that they have to do ABPM instead of ABMS, unless they are DO. Part of me wonders what kind of practice options they’ll have.

 

[Orin]

Really appreciate the insights. I know recent pain match years have had lots of unfilled programs, but still not sure how many programs to apply to. My instinct is to just apply to all of them to cast a wide net. The other lingering thought I have is: will a psych pedigree shut doors for hospital based or private practice jobs. Private practice pain seems to primarily be pmr and anesthesia, but this seems to reflect historical match representation by specialty, as opposed to the increasingly multidisciplinary shift we’ve seen in the last 4 years in response to fewer anesthesia applicants. I mean I’ve even seen occ med and IM pain fellows / recent alumni in the last 2 years, which I guess I find surprising given that they have to do ABPM instead of ABMS, unless they are DO. Part of me wonders what kind of practice options they’ll have.

Okay, so every program is different, but most programs appreciate applications being complete as soon as possible, even if they don't look at them until later. A psychiatry fellow isn't unheard of, but it's less common. Try to connect to folks like Ajay Wasan at UPMC or other pain psychiatry on LinkedIn or at professional meetings.

The research stuff isn't that important for most fellowships. The hands-on exposure is critical though for you. Psychiatrists aren't known for having good hands or knowing anatomy, so that's a great experience for you to bolster the stereotypical weaknesses that people assume you would have.

Apply to programs with a large number of fellows as they're more likely to kick the tires on an atypical applicant.
Ask your letter writers to reach out on your behalf to the top programs you want to go to and/or reach out on your own to the program directors to establish that you actually are interested in their program.
Use your signals wisely.

The job market will be a different beast and in PP, it'll more be a discussion of whether you're able to get on insurance panels, so keep track of your case records and maintain good relationships with the physicians that'll vouch for your clinical skillset.

 

[BobBarker]

Get you a spine model and Furman’s atlas. Review all of the procedures planned for the next day at home. Work on tinkering, handyman projects as much as possible. Take a suturing basics course on your own.