Pain Fellowship Rating/Reviews

[hrmm]

I know there is a sticky on the topic but it hasn't been updated in forever. And it seems like a lot changes over the span of a few years in terms of the reputation of a program based on if a well-known attending has retired/moved. If anyone has time, would you mind posting your opinion on the top 10-20ish programs in the country? And please try to disregard things like geography and "the best program is what you are looking for," etc. I'm trying to get a perspective of if the top 100 pain docs (pain fellowship directors, well-known in pain community, top researchers, etc.) were surveyed, which programs would they consider as the top programs in the country today.

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[hrmm]

Here is a list of the major programs that I saw on ACGME to make it easier. Rank away! (and why, if you can explain as well)

Beth Israel Deaconess
Brigham and Women
Case Western
Cedars-Sinai
Cleveland Clinic Foundation
Dartmouth
Duke
Emory
Hopkins
MGH
Mayo
Northwestern
Columbia
Cornell
OHSU
Rush
Stanford
Texas Tech
UCLA
UCSD
UCSF
UChicago
UCincinnati
UColorado
UIllinois Chicago
Michigan
Penn
MDAnderson Houston
UTSW
UT San Antonio
Virginia Mason
UWashington
Wake Forest

 

[painj]

If it is easier for you all-I am fairly certain I have all the accredited fellowships on my web page with the updated contacts, etc--we try to verify the information yearly to make sure it is right--but the listing is there for you: http://www.painrecruiters.com/accreditedfellowshipprograms.html

 

[jj337]

The one I went to is best... But now it sucks cuz I'm not there.

 

[Ducttape]

so you caused its fall from grace?

(Program director: "well, we were doing okay, until jj joined us. now look at us....")

 

[powermd]

Does anyone actually think a community of doctors far removed from the training process will be able to provide meaningful and current rankings of programs? I think the best we can do are case-by-case reviews of programs we are individually familiar with. Applicants on interviews are in the best position to describe the current status of a program, but are unfortunately in the worst position to provide a meaningful review being that they haven't yet practiced pain medicine in the real world.

 

[jj337]

so you caused its fall from grace?

(Program director: "well, we were doing okay, until jj joined us. now look at us....")

That's what I hear... 🙂

In all seriousness, it is so hard to rank a program. It depends on what you are looking for.

 

[emd123]

Does anyone actually think a community of doctors far removed from the training process will be able to provide meaningful and current rankings of programs? I think the best we can do are case-by-case reviews of programs we are individually familiar with. Applicants on interviews are in the best position to describe the current status of a program, but are unfortunately in the worst position to provide a meaningful review being that they haven't yet practiced pain medicine in the real world.

Right. I think it's impossible to come up with a valid/objective ranking list. Talking to fellows that just finished a program would help. Some of the "name" programs may not be as good as advertised and there are some lesser know ones that I'm sure are very solid yet don't have the name. Also, going to a "name" program where tons of time is spent on oddball once a year type of academic procedures, or other stuff you're not going to do, is a waste of time. If you want to stay in academia then it is useful.

My advice is to interview at as many programs as possible. That's the best way to get a feel for a program first hand.

 

[freddydpt]

My best advice is go where the fellows are happy. I've come across so many places (speaking from radiology experience - not pain) where residents/fellows are "happy" in front of the applicants but get them behind closed doors and they literally cry because they are so unhappy-abused and/or poorly trained and/or overworked.

 

[hrmm]

Thanks for the responses but these are all cop-out answers. I am not looking for the most valid/objective ranking of all time (obviously that's impossible). And if you're a dinosaur and 30 years out of fellowship, obviously this would be difficult for you to answer. Not sure why people are so afraid to just list a few programs that they think (completely subjectively) are really good overall. This is just a discussion forum, not a peer-reviewed journal for God's sake.

If an applicant said that they didn't know exactly what path they were going to take in the future but wanted the best, well-rounded, well-respected, and most reputable program to set them up for the most success in the future, what programs would these be? Or if 1000 pain physicans nationwide (PP, academic, research, etc.) were asked about the top 10 programs in the country, which would they list? (Ie. if you were one of the 1000 surveyed, which would you specifically and subjectively list?) If you want to give an explanation as to why you think they are the best (most interventional, fellows are most prepared to take on any job, best reputation, etc.), then that's welcomed too.

 

[Ducttape]

your thinking is flawed, that is the problem.

all the fellowships are required to teach core ACGME information. above and beyond that, yes it is purely subjective, but obviously it is in the eye of the beholder. there is no necessity to saying "i think this is the best program" or "that is better than this" when each is different and unique.

take a car out for a test drive. one guy likes a porsche, another a camaro, another has a beat up 10 year old SUV because he cant afford better. all of them get from A to B.


"wanted the best, well-rounded, well-respected, and most reputable program to set them up for the most success in the future".

its the individual physician that will make him the best, well-rounded, well-respected and reputable physician, not the program. and in fact, if there was an applicant that didnt know what path to take - they should NOT be seeking the "best program to set themselves up". first, they wont get in without the commitment to the field. and the program wont make someone a good pain doc - thats the internal commitment.


if you want a listing of good programs, in my opinion, here is a good list: http://forums.studentdoctor.net/threads/2014-pain-fellowship-interviews.1058844/

 

[lobelsteve]

I have the best fellowship program in the country. Not ACGME, one opinionated attending who doesn't know jack squat. Sex for drugs, procedures for drugs, and self pay line out the door is reviewed weekly as what not to do. Fortunately, we do meds, therapy, counseling, procedures. One fellow per year.

 

[hrmm]

Obviously there is no scarcity of opinion (or trolls) here on SDN. I don't think it is flawed for me to ask a forum of people for their opinion on what they believe to be the best program and an explanation of why they believe that to be. I am specifically looking at people who recently interviewed, current fellows, and recent grads. Here is an awesome example from the fellowship reviews. I am looking for updated/recent info like this but maybe more along the lines of, "I believe these programs are the best for reasons x,y,z." Think of it is this way: an applicant only has a certain amount of time/resources to invest in the application/interviewing process. If location was not a factor, which would be the a few programs that you think are wonderful:

"Cornell: 5 fellows, great name, good program overall, good number of procedures, crazy surgeries going on in the hospitals, you spend time at 3 different places each with a different flavor - some months procedure heavy some months not, some fellows c/o scut, living situation is standard for nyc (horrible compared to everywhere else) you HAVE to live in manhattan per the PD .. the hospital aesthetic is also standard nyc in the same sense but who really cares.. fellows prepared for anything but preferred mt. sinai for nyc.. 7/10

Pittsburgh: 8-9 fellows, good interventions including SCS, happy fellows, organized and structured program with distinguished faculty, good hours, multidisciplinary teaching with a good philosophy, fellows get good jobs, however in pittsburgh but thats cheap and easy to live.. 8/10

BID: 8 fellows, also as advertised by others.. great program, happy fellows, good interventions, overall 8.5/10."

 

[Ligament]

The problem with most (not all) pain fellowships is they are highly dependent on 1 or 2 attendings. Should those attendings leave, (and they do, frequently) then the fellowship may take a fast nose dive. Therefore ratings of these fellowships can change drastically from month to month.

Even large fellowships like the University of Washington program are subject to this. The fellows loved Andrea Trescott when she was director. She did a great job. Suddenly she's gone (though no fault of hers) and poof fellowship takes a dump.

Therefore the only accurate reviews are likely from CURRENT fellows in that program. Even fellows that graduated in the past 1 or 2 years may have now invalid reviews.

As steve Lobel said, he has the best fellowship in the country. 🙂

 

[emd123]

Plus many programs are very small: 1-3 fellows per year. It could be a great program, if the docs are great, or terrible if they're not. But a program so small, will never be "rank-able" on a National scale, because there's so few current or immediate last fellows for there to be any sort of national or commonly agreed upon "reputation." Pain is tiny. A big program is going to have a "big name" simply from name recognition but could be substandard compared to a smaller program, but you'd never know. I wish there was a rank list when I was applying 4 years ago, but there just wasn't, and apparently still is not. It would have saved me a lot of time, trouble and money if there was. It's frustrating, I know.

 

[Ducttape]

"Cornell: 5 fellows, great name, good program overall, good number of procedures, crazy surgeries going on in the hospitals, you spend time at 3 different places each with a different flavor - some months procedure heavy some months not, some fellows c/o scut, living situation is standard for nyc (horrible compared to everywhere else) you HAVE to live in manhattan per the PD .. the hospital aesthetic is also standard nyc in the same sense but who really cares.. fellows prepared for anything but preferred mt. sinai for nyc.. 7/10

Pittsburgh: 8-9 fellows, good interventions including SCS, happy fellows, organized and structured program with distinguished faculty, good hours, multidisciplinary teaching with a good philosophy, fellows get good jobs, however in pittsburgh but thats cheap and easy to live.. 8/10

BID: 8 fellows, also as advertised by others.. great program, happy fellows, good interventions, overall 8.5/10."

And please try to disregard things like geography and "the best program is what you are looking for," etc.

the information you are posting is of inherent value, and i agree more should be posted, but does not constitute a ranking of "which programs would they (sic) consider as the top programs in the country today". you have posted a rating system - more vague, but not damnable by assigning #1, 2, 3,...

what are your metrics for making a ranking?

on top of that, what emd and Ligament state are also pertinent.
i would also note that most ACGME programs (sorry Steve, i dont know non-ACGME curriculums) can provide high quality education in pain.


imho, the best pain program is the one I finished 4 years ago. i chose it 100% based on location. as a final side note, i know that patients arent interested where you got your fellowship training. maybe med school. rarely residency. never fellowship.

 

[hrmm]

The problem with most (not all) pain fellowships is they are highly dependent on 1 or 2 attendings. Should those attendings leave, (and they do, frequently) then the fellowship may take a fast nose dive. Therefore ratings of these fellowships can change drastically from month to month.

Even large fellowships like the University of Washington program are subject to this. The fellows loved Andrea Trescott when she was director. She did a great job. Suddenly she's gone (though no fault of hers) and poof fellowship takes a dump.

Therefore the only accurate reviews are likely from CURRENT fellows in that program. Even fellows that graduated in the past 1 or 2 years may have now invalid reviews.

As steve Lobel said, he has the best fellowship in the country. 🙂

This is actually pretty helpful. As anecdotal as it may seem, info like this about UW would never have reached a random applicant like me if it weren't for threads like this with people who are a little bit more in the know. Thanks.

 

[Ligament]

This is actually pretty helpful. As anecdotal as it may seem, info like this about UW would never have reached a random applicant like me if it weren't for threads like this with people who are a little bit more in the know. Thanks.

To further clarify, even though the fellowship took a dump when Dr. Trescott left, it may have picked up again with addition of the new fellowship director. But I have no idea. They seem to change frequently at UW. Just goes to illustrate my point that quality can vacillate.

 

[oreosandsake]

I have heard that Brett Stacey from OHSU is moving up to Seattle soon as the new Director of the program

 

[jj337]

done

 

[hrmm]

I graduated the UT Southwestern pain fellowship in 2010 which had 3-4 fellows and 3 locations (private, public, and VA and a little at Childrens) with tons of bread and butter cases, a hand-full of crazy once-in-a-career diseases, kypho, vertebro, SCS trials and perms, and pump implants. We worked with 8-9 attendings who were well qualified and a few who rocked but one star left half way through my year to go to MD Anderson. It hurt the program at that time but we picked up a few other attendings and the program picked up once again. There were a bunch of attendings - some good, some bad, and some who didn't pay attention to anything and I wondered why they were there (which wasn't all that bad sometimes).

What I am trying to say is that depending on the month during my fellowship and which location I was at, I would have strongly endorsed the program or told you to go to another place.

Pain programs are extremely fluid with so few attendings.

Thanks jj337. It's crazy how fellowships can change so much in a short period of time.

 

[powermd]

I graduated the UT Southwestern pain fellowship in 2010 which had 3-4 fellows and 3 locations (private, public, and VA and a little at Childrens) with tons of bread and butter cases, a hand-full of crazy once-in-a-career diseases, kypho, vertebro, SCS trials and perms, and pump implants. We worked with 8-9 attendings who were well qualified and a few who rocked but one star left half way through my year to go to MD Anderson. It hurt the program at that time but we picked up a few other attendings and the program picked up once again. There were a bunch of attendings - some good, some bad, and some who didn't pay attention to anything and I wondered why they were there (which wasn't all that bad sometimes).

What I am trying to say is that depending on the month during my fellowship and which location I was at, I would have strongly endorsed the program or told you to go to another place.

Pain programs are extremely fluid with so few attendings.

I interviewed there in 2008 and thought they had a fantastic program. I remember being pretty disappointed when I didn't get an offer from them.

 

[jj337]

edit

 

[nvrsumr]

What you want to learn procedurally and otherwise can change with changing reimbursement or your interests. Per example I chose BWH for fellowship because I wanted alot of exposure to implants and opioid medication management which I lacked in my PMR training. I really wanted to keep up with EMGs and they were cool enough to buy me a machine and gave me half a day clinic to perform EMGs.

I have stopped doing implants because of decreasing reimbursement and difficulties with scheduling. I don't write for nacotics because I have lost faith they get my patients "better". EMG reimbursement was cut 50% a year ago and I feel stupid for having wasted the time getting "board certified" and spending the extra time and efforts to keep up with them as a fellow. Finally, I'm a solo doc with my own office based practice. No one cares if I did an ACGME fellowship or learned on the back of a cereal box. It's my personality that drives business in my door not letters after my name.

I thought I was getting the best training at the best fellowship but really there wasn't a huge addition to my skill set beyond what I had learned as a PMR resident that has carried over plus I lost a year of income. Go where you feel you fit the best and it will all work out.

 

[gdub25]

I'll go ahead and give you a quick review on the program that I thought was the best on my interview trail this year.

Scott and White in Temple, TX. This place is a good example of a small program that hasn't gotten much attention or recognition despite being exceptional. They have had a fellowship for just 3 years now and take 2 fellows per year. They have taken internal candidates so far and probably why they are such a well kept secret. The fellows were extremely happy and truly felt their training was second to none. They got a ton of procedure experience, i.e. 100+ spinal cord stims per fellow, and something like 20+ kyphos per fellow, discograms, celiac plexus blocks, catheter lysis of adhesions, as well as hundreds of the bread and butter injections. They also did some ultrasound guided stuff, and did some peripheral nerve and joint stuff. The clinic was run like a private practice setting, patients seen and procedure done on the same visit most of the time. They had two fluoro rooms going all day long, every day. Fellows worked one Saturday a month doing pain clinic (which they got paid extra for) and there was no inpatient call at all that I can remember. Fellows also had the option to pick up OR shifts working as an attending at the surgery center to make extra money. The program director trained at Texas Tech when it was in it's prime and there are a good mix of other attendings, one from OHSU and one from UT Southwestern that I can remember. Everyone there seemed to get along great and everyone, literally from the fellows and attendings to the ancillary staff, they all talked about how great it was to work there.

The only weaknesses I saw were one, they don't do much research. Not that big of a deal to me because I plan to work in private practice, as do the majority of people when they finish fellowship. And two, the hospital is in Temple, TX. The town isn't very big, maybe 50-60,000 people, which is a negative for some people. For me personally it is fine. It's a slower lifestyle type place and I have a family, plus cost of living is cheap.

Overall, this is a procedure heavy program in a small town with a clinic that is operated like a private practice. For me, I believe this program better prepares their fellows to graduate and hit the ground running in private practice several steps ahead of fellows from any other program. They learn the entire spectrum of pain management and become proficient in all procedures commonly done in the pain community.

For some perspective, I also interviewed at Vanderbilt, Mayo - AZ, OHSU, Colorado, UVA, UT Southwestern

Hope this helps.