Pain Fellowship Reviews

[hoboken]

Texas Tech is definitely the top pain program with Raj and Racz on board. Our program, however, took Leland Lou from Tech (he was #3 behind Raj and Racz) and are set to hire away more of the Tech faculty. Raj and Racz are set to retire soon as well.

do you think this will have much of an impact upon their pain program.....evidently Lou stepped aside as program director earlier this year?!?!

from the UT Southwestern dept. web site;

On June 6, 2006, William E. Johnston, M.D. resigned as Chairman of the Department after more than 4½ years of dedicated service.... John D. McConnell, M.D., Executive Vice President for Health System Affairs and the former chairman of Urology at UT Southwestern, has been appointed as Interim Chair of Anesthesiology and Pain Management.

Resigned or resigned under pressure depending on who you ask. It's a political mess that is hurting the program.

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[ethan.colliver]

Hi to all the folks from Azcom who are reading this forum!

 

[ethan.colliver]

Which of the PMR-run programs are worthwhile? I've heard UMich, Emory, and VCU are not bad.

 

[ethan.colliver]

appreciate all the input. everyone talks about the big name fellowships available. any advice on the smaller, less well-knowns, ie. utah, WA, etc?

Utah has 3 fellowships:

Anesthesia-run (accredited) has a lot of chronic pain mgmt in clinic, run the acute pain service (have NPs to manage pumps), and a soon-to-be fellow wanted to rotate thru PMR fellowship to get more interventions.

PMR-run MSK (non-accredited) fellowship has awesome attendings, 2-3 1/2d of fluoro, MSK clinic, EMGs, etc.

Private doc in Provo has 3 fellows(non-accred) and "good mix" of clinic and OR and even does spinal stim trials. He wants to become affiliated with Anesthesia.

Besides that, SLC is the greatest place to live on earth! Hope that helps.

 

[paz5559]

Utah has 3 fellowships:

Anesthesia-run (accredited) has a lot of chronic pain mgmt in clinic, run the acute pain service (have NPs to manage pumps), and a soon-to-be fellow wanted to rotate thru PMR fellowship to get more interventions.

PMR-run MSK (non-accredited) fellowship has awesome attendings, 2-3 1/2d of fluoro, MSK clinic, EMGs, etc.

Private doc in Provo has 3 fellows(non-accred) and "good mix" of clinic and OR and even does spinal stim trials. He wants to become affiliated with Anesthesia.

Besides that, SLC is the greatest place to live on earth! Hope that helps.

There are two private fellowships in the area

Giovanello's and Rosenthal's

 

[paz5559]

Which of the PMR-run programs are worthwhile? I've heard UMich, Emory, and VCU are not bad.

Just curious, but could you BE any more condescending? Worthwhile? Get over yourself!

Furman, Falco, Slipman, RIC, UW, Wash U, Colorado, Florida Spine Institute, HSS, Beth Israel, Cantu, Wolfe, Giovanello, LAGS, etc, in addition to the ones you already mentioned, are all extraordinary training opportunities.

 

[Disciple]

Cantu?

Is this a new one?

 

[ethan.colliver]

It can be difficult to be understood with the written word. No harm meant.

I have been looking for PMR pain-accredited Pain fellowships that have more EMG and MSK exposure in the fellowship. My attending has pointed to Univ of Colorado, Emory, Harvard, UMich, VCU.

I've enjoyed everyone's input in this thread. It's good to see multiple points of view on such a big subject.

Thx

 

[Truffle Shuffle]

I've read the previous four pages and don't think I skipped over it- What's the word on UPMC?

 

[gecko]

I'm surprised that UCLA's PMR program was not mentioned in the above list. There's lots of EMG exposure. On Dr. Fish's rotation (3 months), you perform on average, 10-12 EMGs per week. I'll rack up over 120 by the end of his rotation.

 

[Stimulate]

Does anyone know how difficult it is to get into a pain fellowship in the California programs or other top programs like cleveland clinic, harvard?

Also is Rush in Chicago and MD anderson good programs?

I have heard that the RUSH Pain Fellows have to take general OR call...heard about a pain fellow (hopefully anesthesia-trained!) who had to do a liver transplant on general OR call. Ouch!!! Wonder if he got an epidural out of it. Suppose it depends on what the pre-op coags were...

 

[Stimulate]

I've read the previous four pages and don't think I skipped over it- What's the word on UPMC?

Heard from a CA-3 at UPMC that the pain fellows are happy, get done early each day, and get adequate number of cases including SCS, etc. That is all I know...

 

[Truffle Shuffle]

Happy and good # of procedures-

Thats basically what I wanted to know

 

[wellessness9]

Hi Guys
Your views and experiences are really useful in deciding which program to choose. Thanks for that.
Just wondering if you have any advice on how to go about applying for a pain fellowship. I am an anaesthesiologist with 6 yrs experience in the UK and with a fellowship in pain management. I was wondering if I need to do the USMLE and then an anaesthesia program prior to starting the pain fellowship or can I apply for the pain fellowship rightaway after passing the USMLE. Any advice is welcome.Also any info on pain programs in San Deigo and other institutes in California?
Thanks in advance:

 

[asdfasdfasdf]

Anyone have any info on MCW's pain program?

 

[Lodoc]

Hmmm..lemme think of decent incomplete list of injections

1. Occipital Nerve Block
2. Trigeminal Nerve Block
3. Glenohumeral joint Injection.
4. Acromioclavicular Joint Injection
5. Suprascapular Nerve Block
6. Cervical, Thoracic , Lumbar and Caudal epidural Injections
7. Sacroiliac Joint Injection
8. Coccygeal Injection
9. Z-joint Blocks
10. Knee joint Injection
11. Intercostal Nerve Block
12. Stellate Ganglion Block
13. Lumbar Sympathetic Block
14. Hypogastric Block
15. Ganglion Impar Block
16. Provocative discogram
17. Celiac plexus block
18. Hip Joint injection
19. Bursa injections
20. Carpal tunnel injection
21. Illio-inguinal nerve block
22. Trigger point injection

Just open the Waldman Illustrated Atlas of pain procedures.....

Hi, this is a great list. Waldman seems to have several atlases listed on Amazon.com: atlas of uncommon pain syndromes, atlas of common pain syndromes, and atlas of pain management injection techniques. Obviously the latter is a good one, but do you have any opinion on the other two?

 

[Spine Specialist]

Hi, this is a great list. Waldman seems to have several atlases listed on Amazon.com: atlas of uncommon pain syndromes, atlas of common pain syndromes, and atlas of pain management injection techniques. Obviously the latter is a good one, but do you have any opinion on the other two?

I have only atlas of common pain syndromes which is pretty good and interesting read. I did not care to buy uncommon syndrome atlas.

 

[Stimulate]

I interviewed at Stanford's pain fellowship and thought I would share my experience. Overall I think it is a good pain fellowship. The fellowship director is Dr. Raymond Gaeta. The associate director is Dr. Sean Mackey.

The program accepts approximately 6 fellows each year and is actually looking to expand that to 7 fellows if approved by ACGME. All of the fellows are anesthesia-trained with the exception of 1 PM and R fellow starting last year.

The facilities are OK, however, I heard that they are actually moving the Pain Center from the Stanford Hospital campus over to Redwood City, CA. I was never shown the procedure room, but the patient exam rooms were pretty standard. The fellows each have an assigned cubicle and computer with internet access.

One unique aspect of the fellowship is that the patients are actually scheduled with the fellows and not with attendings. When you see a new consult and recommend a procedure, that patient is assigned on your procedure day if possible. There seems to be good continuity in that regard.

Another unique aspect is that they have an inpatient chronic pain unit. This unit seemed largely like a detox unit but also perhaps kind of a chronic pain/rehab type unit. As as fellow you are responsible for these patients in 2 week blocks that occur every 10 weeks. You will take all of the calls regarding these patients but you rarely have to come in from home. Other than each of those 2 week blocks you have no nights, no call, no weekend duties. Your typical day is done at 1800pm but can run later because you have to dictate all of your notes.

My only weakness that I observed was that I could not get a sense of how many procedures you actually get to perform. The attendings and fellows indicated you get "sufficient number of procedures". I have no reason not to believe them.

I did not receive a list of what procedures they offer/perform. It seemed to me that during the fellowship you get somewhere around 60 procedure days, and during your assigned procedure day you work one-on-one with the attending.

You rotate through the PM&R department, and the VA medical center. There is no moonlighting available within the institution.

Cost of living didn't seem that bad. You qualify for "faculty" housing and can place your name on a list for those apartments. There is a set of older apartments and a set of newer apartments. It seemed to me that a 1 bedroom near stanford was going to be somewhere between $1200-1600 month. I don't know how the move to redwood city will affect that. I would guess that the cost-of-living might get better.

The Stanford program offers an excellent amount of teaching, "adequate" exposure to procedures (don't dwell on this issue during the interview because they won't get specific and they will not like your candidacy), nice quality of life, and excellent location.

 

[intubator]

Hello All,

Thanks for the information. I wanted to ask a quick question to fellow's and other residents paying attention.

I am astonished at the amount of "rounding" the pain fellows seem to do. Where are the residents? Do they not rotate in the pain clinic and carry the pain pager and do consults, etc? I thought that was the whole idea (besides learning) of a fellowship - to finally get to beat down someone lower than you but no get paid as staff. Critical care fellows have residents to "direct", OB fellows have residents to "teach", Cardiothoracic fellows have residents to set up the room, even regional fellows have residents to draw up the meds. How come pain fellows are getting shafted?

Residents do that stuff in my program.

Just curious.

 

[intubator]

I am wondering if there are fellowship programs which additionally offer advanced teaching in peripheral nerve blocks. I've heard that VM offers a 1 month elective during te fellowship, do we know if there are others that might offer more than one month?
Thanks.

I imagine you could get some incredible regional experience with Ultrasound since they have some big names in regional. Dr Swenson's DVD on ultrasound is incredible. Dr. Hare, the fellowship head also does regional. There are some big regional articles that just came out of that institution. I am sure if you went there for pain, you could get some regional experience out of the year.

 

[GIantdork]

hi there, anyone have a list of programs that accept medicine residents in the east? ( I don't mean accept applications, I mean actually accept). Any feeling if you're underqualified as an interventional pain doc w/t anesthesia background? thanks

 

[galenao]

Please advise me . I have been offered a pain fellowship at mcmaster univ, but I plan to return right away to practise in the US. It is not an accredited program and not very interventional. will it be a waste of time to proceed with this fellowship or should I wait and re-apply next year for an accredited US pain program. I am a US trained anesthesiologist in private practice for 4 years now. I applied to about 6 US programs and only got 1 interview at UTSW Dallas. I was not offered a spot. I believe I may not be a competitove candidate as I have no research experience, did not shine during residency and now private practice. I am afraid pain is getting ever so competitive. What do you think. Thanks in advance

Galenao

 

[wellessness9]

truly informative thread - any suggestions on the program at Beth Israel NY - is it the same program as St Luke`s Rosevelt ? Do the two programs differ a lot?

 

[PainDr]

truly informative thread - any suggestions on the program at Beth Israel NY - is it the same program as St Luke`s Rosevelt ? Do the two programs differ a lot?

The Beth Israel NY fellowship is affiliated with Einstein. Fairly interventional and very interdisciplinary. Chair is Russell Portenoy (founding father of long acting opioids)...super nice guy and very well known. I interviewed there and really liked it. Would definately have gone there but was offered a spot at a program higher on my list. Added perk...subsidized housing across the street from the hospital! St. Luke's Hospital is a Columbia affiliate, but I don't think the fellowship itself is affiliated since the official Columbia fellowship is at Presby.

Please advise me . I have been offered a pain fellowship at mcmaster univ, but I plan to return right away to practise in the US. It is not an accredited program and not very interventional. will it be a waste of time to proceed with this fellowship or should I wait and re-apply next year for an accredited US pain program. I am a US trained anesthesiologist in private practice for 4 years now. I applied to about 6 US programs and only got 1 interview at UTSW Dallas. I was not offered a spot. I believe I may not be a competitove candidate as I have no research experience, did not shine during residency and now private practice. I am afraid pain is getting ever so competitive. What do you think. Thanks in advance

Personally, I wouldn't go out of the country for fellowship as you won't be able to sit for the boards. I don't know anything about this fellowship, but you say it's not very interventional...why would you want to go there? Being in private practice is probably your biggest disadvantage and you definately need to cast a wider net. If you're really serious about this and decide to reapply, I'd apply to at least 20-30 programs.

 

[HeyDoc]

Hi PainDr, when you applied for the fellowships did you use each programs application form or one standard form? Thanks, I need to apply to a number of programs but would like to use just one form.

 

[mehul_25]

Typically each program has its own application. Some use institutional applications. They will typically not accept a universal application and I dont think such a thing exists for Pain fellowships. On another note, no offense but filling out the forms is a small price to pay. It makes you sound lazy.

 

[PainDr]

Typically each program has its own application. Some use institutional applications. They will typically not accept a universal application and I dont think such a thing exists for Pain fellowships. On another note, no offense but filling out the forms is a small price to pay. It makes you sound lazy.

Have to agree. Applying for fellowship is a major pain. As a neurologist, I had to apply widely...25 programs! I can't tell you how many hours I spent completing fellowship applications. Also, I typed all my applications. During interviews, several people commented that they really appreciated my effort. Many just completed the applications in ink...very bad form!

 

[drusso]

Many just completed the applications in ink...very bad form!

No doubt. Typing helps.

 

[paz5559]

Just curious - in this day and age, where the only typing I do is on a computer, how do you fill out an application other than by hand, unless you happen to have an old typewriter sitting somewhere up in your attic?

 

[gecko]

I also typed all my applications (over 30!)....and yes, it was a pain. Some applications allow you to download and type in (some pdf files, or word applications)....but those that didn't, I just went to my medical library, and they had a couple typewriters that they let me use.

 

[PainDr]

Just curious - in this day and age, where the only typing I do is on a computer, how do you fill out an application other than by hand, unless you happen to have an old typewriter sitting somewhere up in your attic?

My residency program let me use their typewriter. Kinko's also has typwriters that you can use. It's definately a major pain.

 

[Alpamayo]

I went through the Cleveland Clinic program. It was great in terms of procedures - there is no shortage of tfesi, mnbb, rfa's, inb, sij. Within a month or two, those all became routine. There was also plenty of tec's sgb, lsb, celiac, trigeminals and splanchnics too. Every 3 weeks, each fellow would get a day in the OR...you'd get a full day of doing pumps and stims, so by the end of training I had implanted about 25 of each. There are some outstanding instructors [Stanton-Hicks, Kapural, Basali, Narouze to name but a few], and once you get to know them, they prove to be great mentors and very personable. While they do expect you to work hard [slackers will be eaten ALIVE], they do take pride in teaching, and afford you as much independence as you can handle. They also are not afraid to show up after the day is done, and buy the fellows a round of drinks. Another bonus - there is a lot to be said for Cleveland Clinic name recognition, especially when you are trying to land that first job. However, there were some down sides. There was no formal didactic teaching, you're expected to read on your own...sink or swim when it comes to passing the boards, you need the discipline to organize and stick to a study schedule. Also, the call schedule is tough...you are the scut monkey. The fellow takes overnight call in house, holds the pager for both the acute and chronic service, and spends the whole day and night sevicing upto 60 epidurals and nerve catheters, answering after hour phone calls from patients, and dealing with the frequent flier chronic pain patients in the ER. This was a couple of years ago, so this situation may have changed, where the fellow may serve an "advisory" role to the resident, but check this out to be sure. You have 3 weeks of electives, which is not nearly enough to round out your knowledge.

Since I left, there has been some turnover. One of the Cleveland Clinic faculty, Salim Hayek, is now the chairman of the Pain Department at University Hospital at Case Western University...just down the street from the Clinic. Also, two of the fellows I trained with at the Clinic [both of whom have solid skills and who enjoy teaching motivated residents / fellows] have also joined University. Dr. Hayek is a great mentor, he'll bring treamendous energy to Case Western. This program is going to be a shining star very quickly....

If you're looking for strong pain programs....Cleveland is a great place to consider.

 

[Ligament]

I put the applications in adobe photoshop and overlaid text boxes to fill in the blanks. Looked perfect but took a hell of a long time. I was even able to perfectly match the font type and size to the application itself. I sent out a lot of applications...

Just curious - in this day and age, where the only typing I do is on a computer, how do you fill out an application other than by hand, unless you happen to have an old typewriter sitting somewhere up in your attic?

 

[Stimulate]

I put the applications in adobe photoshop and overlaid text boxes to fill in the blanks. Looked perfect but took a hell of a long time. I was even able to perfectly match the font type and size to the application itself. I sent out a lot of applications...

I wish I was good enough at computers to be able to do that! One idea is to make a copy of each application, fill it out in ink, and then find a secretary at the hospital and pay him/her to type the applications for you. They may be able to make it look more professional and neat, and also save you some valuable time that you can use for studying for boards, watching the super bowl, etc.

 

[brewdoc]

I am a practicing anesthesiologist looking to do a pain fellowship next year. Has anyone heard anything about the programs at UVM or Baystate (Springfield)? I heard rumors that UVM got away from endless inpatient pain rounds when Rathmell was there but now are back doing that. I am looking for a program that is heavy on chronic pain procedures - not so much on acute pain stuff since I already have a good deal of experience in that area.

Thanks!

 

[Finally M3]

I wish I was good enough at computers to be able to do that! One idea is to make a copy of each application, fill it out in ink, and then find a secretary at the hospital and pay him/her to type the applications for you. They may be able to make it look more professional and neat, and also save you some valuable time that you can use for studying for boards, watching the super bowl, etc.

Ligament isn't that good either; he had major help!

At the same time, he was VERY organized; much more than I would ever be

 

[Ligament]

I sure did have a lot of help from my wonderful woman. She put in some major hours helping me in the application process. Thanks for calling me out on this one Finally M3!

Ligament isn't that good either; he had major help!

At the same time, he was VERY organized; much more than I would ever be

 

[saibaji]

Hi all, first of all this is an excellent forum for pain fellows/to-be-fellows. I was wondering if anyone has any news about the Pain program at UTMB in Galveston Texas?

 

[medicineman1]

Anyone have any info on west coast anesthesia based pain fellowships that may be inviting to PM&R residency graduates? I am aware of UC Davis. I know that drusso went to OHSU (not sure what the environment is like there now, as faculty have changed)? any info on other california or washington programs? I have heard Virginia Mason and Univerity of washington are not "friendly" toward non anesthesia applicants? anyone care to share knowledge or insight?

 

[mid|ine]

I would agree with most of the above. The following list is based on my interviews and info from others on the interview trail.

Best Programs (in no particular order):
B&W, BID, MGH, UCLA (both Anesth and PM&R), UCSF, Texas Tech, Mayo Jacksonville, Cleveland Clinic, MD Anderson, Wake Forrest, Columbia, Cornell.

Very Good Programs (in no particular order):
Emory (Anesth), UT Southwestern, UT Houston, Einstein, UC Davis, West Virginia.

These are just my opinions. I'm sure I've left out some excellant programs so feel free to add to the list.

Things change quickly as program directors move, important procedures change, ect...

Posts rating the "top" programs are now all about 2 years old. Does anyone wish to weigh in with lists of top programs AND what makes them top programs?

 

[FLK 1]

Having gone through the application and interview process during the fall of 2006, I can tell you that most of these programs are still the ones generating the most interest from candidates. People I met on the interview trail seemed most impressed with BID, BWH, MD Anderson, Cleveland Clinic, etc.

As for what makes them the top programs, I think it’s the large number of ADVANCED interventional techniques they all perform. Most programs out there will give you adequate experience with bread and butter blocks and a few pumps and stims throughout the fellowship year. The programs above will give you a ton of implantables, as well as vertebroplasty, kyphoplasty, and disc procedures in addition. These programs also recognize that most of their fellows had plenty of exposure to acute pain in residency, so they maximize the chronic pain experience for fellows. Outstanding faculty and facilities are common to these programs as well.

With the exception of Columbia and Cornell, I would say that this list of “best programs” at least correlates well with “most interventional programs”. Only you can decide if that makes a program one of the best. I would add Wash U and Cincinnati as programs which are becoming highly interventional. As for the list of “very good programs” listed above, UT Houston is no longer around.

Would love to hear other people's thoughts...

 

[brewdoc]

Having gone through the application and interview process during the fall of 2006, I can tell you that most of these programs are still the ones generating the most interest from candidates. People I met on the interview trail seemed most impressed with BID, BWH, MD Anderson, Cleveland Clinic, etc.

As for what makes them the top programs, I think it’s the large number of ADVANCED interventional techniques they all perform. Most programs out there will give you adequate experience with bread and butter blocks and a few pumps and stims throughout the fellowship year. The programs above will give you a ton of implantables, as well as vertebroplasty, kyphoplasty, and disc procedures in addition. These programs also recognize that most of their fellows had plenty of exposure to acute pain in residency, so they maximize the chronic pain experience for fellows. Outstanding faculty and facilities are common to these programs as well.

With the exception of Columbia and Cornell, I would say that this list of “best programs” at least correlates well with “most interventional programs”. Only you can decide if that makes a program one of the best. I would add Wash U and Cincinnati as programs which are becoming highly interventional. As for the list of “very good programs” listed above, UT Houston is no longer around.

Would love to hear other people's thoughts...

Has anyone had any recent experience with SUNY Buffalo, Mass General, UVM, Pitt, or Case Western with regards to the above?

Thanks!

 

[mid|ine]

I would add Wash U and Cincinnati as programs which are becoming highly interventional.

I know that both Dr Akbik and Dr Munir are doing great things with the Cincinnati program. They are really making it a much more interventional program and reducing the script writing. Cincinnati also continues to have great exposure to big name regional docs - Dr Bridenbaugh is a legend and Dr Pai is an amazing resource as well. Dr Bridenbaugh and Dr Raj had put Cincinnati on the map in the past and it is really becoming a very strong program again.

I have not worked with Dr Akbik as much, but he has been a very good teacher and is clearly very knowledgeable and skilled. I have worked quite a bit more with Dr Munir and he has been fantastic. He has a very enjoyable laid back personality, is very patient when teaching, and has a great skill set. They are both aggressively moving the program to be more and more interventional.

Having done med school and residency and Cincinnati I'm looking for a change and a chance to broaden my teaching exposure, but other programs are really going to have to show that they are offering something better then Cincinnati.

 

[C Fiber]

I'm surprised that UCLA's PMR program was not mentioned in the above list. There's lots of EMG exposure. On Dr. Fish's rotation (3 months), you perform on average, 10-12 EMGs per week. I'll rack up over 120 by the end of his rotation.[/QUOTE

Isn't it supposed to be a "pain" fellowship? Who cares about EMG. I thought we were supposed to get enough EMG training in PMR residency already.

 

[mid|ine]

Any feedback on the current state of MGH? I have heard that is a very good teaching program but that its weaker in terms of interventional training.

 

[mehul_25]

Any feedback on the current state of MGH? I have heard that is a very good teaching program but that its weaker in terms of interventional training.

I suspect it will improve quickly with regards to the interventional aspect now that Rathmell has been hired there.

 

[Ligament]

I too have pondered whether doing EMGs as part of a pain fellowship if you've already done the minimum 200 EMGs as a PM&R resident is useful. There is so much to do and learn in just the pain arena alone I would suspect EMGs would be a diversion to learning what you need to know in pain. Of course I could be wrong.

I'm surprised that UCLA's PMR program was not mentioned in the above list. There's lots of EMG exposure. On Dr. Fish's rotation (3 months), you perform on average, 10-12 EMGs per week. I'll rack up over 120 by the end of his rotation.[/QUOTE

Isn't it supposed to be a "pain" fellowship? Who cares about EMG. I thought we were supposed to get enough EMG training in PMR residency already.

 

[PainDr]

I know that both Dr Akbik and Dr Munir are doing great things with the Cincinnati program. They are really making it a much more interventional program and getting far away from script writing

Getting "far away from script writing" is not necessarily a good thing. Fellowship is the only chance you'll have to learn medication mgmt. and although it's not rocket science, it's not as straightforward as you might think. You must be an expert at calculating opioid equivalents, managing opioid rotations, methadone titrations, adjuvant meds, etc. Also, you have to learn how to protect yourself by screening new pts, spotting abuse/diversion, dismissing abusive patients, etc. These are all things I learned in fellowship and use on a daily basis. The vast majority of us practice comprehensive pain management and like it or not, opioid management is part of a comprehensive practice. Even if we didn't want to manage meds, we'd have little choice as most referring physicians fully expect it.

I'm surprised that UCLA's PMR program was not mentioned in the above list. There's lots of EMG exposure. On Dr. Fish's rotation (3 months), you perform on average, 10-12 EMGs per week. I'll rack up over 120 by the end of his rotation.

I really don't get this either. One year isn't enough time as it is. Why would you want to spend so much time doing EMG's when you could be in the OR?

 

[mid|ine]

I think "far" was too strong of a term. Before they arrived interventions were not as prevalent, and more B&B. They were doing long term script writing for narcs, without interventions, ect... Fellows now have a much better balance. There is still more then enough medical management to get the required experience, but now after patients are stable script writing is turned over to the referring dr.

 

[GassiusClay]

I looked through the threads for good programs, but since a lot of that material is old, I was wondering who stood out on top now for being the best programs for training good pain docs coming from the anesthesia end.

I saw Columbia on the list, but I was wondering if that had changed in recent years.

And how about U of Chicago, Rush, and NWH? Do they lack something important compared to the "big" programs?