Pain Fellowship

[J ROD]

Is this a real option for Psychiatrist? I know it is listed as one of the accredited fellowships but I cant see where a program would take a Psychiatrist.

Psychiatry does not do the procedures like Anes or even PM&R.

I did some research and found little evidence of where Psychiatrists are recently getting into pain fellowships.

It makes sense to me that there is a psychological component in pain but can Psychiatrist really be able to do the interventional procedures like someone from an Anes background.

I have a friend in Anes that plans on doing Pain and he told me I could do it as well if I did Psy since it was listed as one of the residency pathways. I told him I did not think it was a "real" option.

I dont see where a program would take a Psychiatrist over the other specialities.

Would appreciate any thoughts from those that have much more expereince. Thanks.

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[Leo Aquarius]

I'm curious about this too.

 

[oreosandsake]

there are many programs that truly believe in an interdisciplinary approach to pain medicine. I was recently speaking with a PD at a well regarded program and he said that his best fellow was a psychiatrist. that fellow picked up the procedures quite quickly.

look up some actual pain medicine fellowship websites and you will see what type of physicians they are open to training.

btw, you do know that there is a pain medicine forum, right?

 

[splik]

yes there are psychiatrists doing pain fellowships. in terms of numbers compared to anesthesiology/pm&r etc this is hard to read. firstly few psychiatrists want to do this. secondly, you need to stack up against other people applying and often people doing anesthesia are more competitive on paper than psychiatry applicants. a 3rd factor is exposure, people in other specialties may be more likely to do a pain rotation/elective during residency.

so yes psychiatrists can do pain and can do procedures. one of the reasons chronic pain is managed so badly is because we have anesthesiologists etc managing these patients for historical reasons. it is ridiculous! and as a result they often end up on ridiculous amounts of opiates and having pointless interventional procedures that fly in the face of evidence of benefit. these patients then end up worse off! unfortunately we have a pernicious system which rewards us for doing procedures whether they are indicated or not.

 

[vistaril]

Is this a real option for Psychiatrist? I know it is listed as one of the accredited fellowships but I cant see where a program would take a Psychiatrist.

Psychiatry does not do the procedures like Anes or even PM&R.

I did some research and found little evidence of where Psychiatrists are recently getting into pain fellowships.

It makes sense to me that there is a psychological component in pain but can Psychiatrist really be able to do the interventional procedures like someone from an Anes background.

I have a friend in Anes that plans on doing Pain and he told me I could do it as well if I did Psy since it was listed as one of the residency pathways. I told him I did not think it was a "real" option.

I dont see where a program would take a Psychiatrist over the other specialities.

Would appreciate any thoughts from those that have much more expereince. Thanks.

No, it is not a real possibility. There are probably a handful of psychiatrists(out of tens of thousands) in the country who have done an interventional pain fellowship. There are also a handful of people every year who win 8 figures in the lottery.

It is more feasible(even easy and there is a huge demand) for psychiatrists to do postgraduate training in nonint(and non pharm) pain. But you're going to make less doing this in most cases than being a general psychiatrist(usually a lot less), so it's usually something psychologists pursue. I've referred a bunch of patients to a pain psychologist.

Interventional pain procedures are not trivial. It is a one year program iirc, and it's a steep learning curve for even anethesia grads who can put a line under US in anywhere. Psych grads are so far below anesthesia grads in these capabilities that they are in 99.99% of cases not suitable for these fellowships. The very idea is silly.

 

[TexasPhysician]

Yes, it is a very real possibility that few psych residents rarely apply for.

 

[J ROD]

btw, you do know that there is a pain medicine forum, right?

Yeah, I am aware. Just wanted to post it here since it was Psy specific.

I am still waiting for that one person that has done it to post. There has to be someone on here that has done it.

I believe in unicorns.....

 

[vistaril]

Yeah, I am aware. Just wanted to post it here since it was Psy specific.

I am still waiting for that one person that has done it to post. There has to be someone on here that has done it.

I believe in unicorns.....

there is a poster who occasionally posts in the pain forum....jettavr or something like that. But again, just because there are a few in the whole country out of tens of thousands doesnt mean it is really realistic.

 

[Leo Aquarius]

You've got nothing to lose, why not apply.

 

[Armadillos]

We need to get jetta to make a FAQ about this

 

[jettavr6]

Psych grads are so far below anesthesia grads in these capabilities that they are in 99.99% of cases not suitable for these fellowships.

Complete nonsense. This wins the prize for the silliest statement posted on these forums lately.

 

[vistaril]

Complete nonsense. This wins the prize for the silliest statement posted on these forums lately.

well let's see....I've done zero epidurals during psych residency, zero lines, zero injections of any kind under ultrasound, zero physician level procedures under US, zero zero zero.....whereas anesthesia(and pm&R with some of these) have done hundreds......

Perhaps we should start a forum poll to see how many of these procedures others have done during their psych residency. I bet the answer(save for a rare case or two where someone did a couple off service during intern year or on neuro during intern year) is also zero zero zero for everyone.

So I'm not totally sure what you base your statement on.

 

[michaelrack]

http://www.vitals.com/doctors/Dr_Joseph_Kwentus.html.

One of my colleagues is certified in Pain. Of course, he is also a dual psychiatrist/neurologist. And he got certified in pain long ago, when training was different than it is today.

In other words, I have nothing relevant to add to this discussion

 

[watto]

One of my co-residents in psychiatry went on to do the pain fellowship at Stanford. Not sure what he ended up doing after that though so all I can say is I've seen the unicorn.

 

[digitlnoize]

.

So I'm not totally sure what you base your statement on.

Psst...I think it's the fact that Jetta is actually a psychiatrist who did pain, and thus, KNOWS WHAT HE IS TALKING ABOUT!!! Unlike someone else who always says nothing in psych is possible.

You're talking about procedures. By the end of a year of pain, I'm sure most us would be quite adept at them. Just because you can't do them doesn't mean no psychiatrist can.

 

[BobA]

I know a psychiatrist who does interventional pain, but they do have a unique background.

But the exception proves the rule.

The fact that we can only come up with rarities shows how few psychiatrists do go on to do pain relatively to fields like Anesthesia or PMR or Neuro.

So if you're a med student wondering if you can do Pain from psych, then "yes it's possible but you'd be better off doing Anesthesia."

However, for psychiatrists who want to do it it's possible if not that common.

 

[vistaril]

Psst...I think it's the fact that Jetta is actually a psychiatrist who did pain, and thus, KNOWS WHAT HE IS TALKING ABOUT!!! Unlike someone else who always says nothing in psych is possible.

You're talking about procedures. By the end of a year of pain, I'm sure most us would be quite adept at them. Just because you can't do them doesn't mean no psychiatrist can.

not nearly as adept as anesthesia(or pm&r) people....a similar thread was posted in the pain medicine forum(well there are actually many dozen frequent pain docs) and the idea(except the 1 in ten thousand candidate) doing interventional pain was scoffed at and made fun of.

 

[vistaril]

I know a psychiatrist who does interventional pain, but they do have a unique background.
.

Im guessing the *very few*(stastically basically zero) people who are BE/BC in psychiatry alone(and not dual boarded people such as the one michael rack mentioned) have an unusual background that makes them different from the average psych resident. Maybe they did a procedure based residency in another country and then matched here in psych. Maybe they completed some of another residency before transferring to psych.

 

[jettavr6]

not nearly as adept as anesthesia(or pm&r) people....a similar thread was posted in the pain medicine forum(well there are actually many dozen frequent pain docs) and the idea(except the 1 in ten thousand candidate) doing interventional pain was scoffed at and made fun of.

At the end of the year, those from psychiatry who have the skill set, are just as adept as performing those same procedures. I'm sure CT Surgery still scoffs at Cardiology for doing stents and other heart procedures.

Rather than make this a debate, I'd be happy to answer questions via PM or phone, from any 2nd or 3rd year psychiatry residents who want to apply to pain.

 

[vistaril]

At the end of the year, those from psychiatry who have the skill set, are just as adept as performing those same procedures.

just because someone finishes a 1 year program doesn't mean they acquire a constant skill set that doesn't vary between providers. Let's talk numbers: you're an int pain guy. You must know at least 40-50 others....probably over a hundred. How many others are BE/BC from residency in *only* psych and did no other residency training(either here or elsewhere)?

I did a state by state lookup of this one time and it was pretty obvious that many/most states had NO purely psych pain people. If you can find all these psych int pain guys(besides yourself), feel free to post links to their websites.

 

[billypilgrim37]

I did a state by state lookup of this one time

You really need new hobbies.

 

[jettavr6]

just because someone finishes a 1 year program doesn't mean they acquire a constant skill set that doesn't vary between providers.

Sure - skills vary amongst various providers even within the same specialty.

Let's talk numbers: you're an int pain guy. You must know at least 40-50 others....probably over a hundred. How many others are BE/BC from residency in *only* psych and did no other residency training(either here or elsewhere)?

5 of whom I've spoken to personally. I know of 3 others.

I did a state by state lookup of this one time and it was pretty obvious that many/most states had NO purely psych pain people.

And?

 

[BobA]

Rather than make this a debate, I'd be happy to answer questions via PM or phone, from any 2nd or 3rd year psychiatry residents who want to apply to pain.

Everyone take note- this is an exemplary post: an attending in the know offering to share knowledge with interested individuals to pull them up.

So much better, and more useful, than the banter we usually engage in (myself included).

Thanks Jettavr6!!!



I will also add the useless banter that I think there are many in the pain field who sincerely want psychiatrists involved. I had two hospitals ask if I'd work in their pain clinics when I was on the job hunt and I have nothing on my CV that would indicate I had an interest or skill set that'd be especially useful to them (except perhaps experience with Suboxone). Pain is subjective, many of the meds used are antidepresssnts or something else we'd be familiar with, and there's a lot of co-morbid depression, anxiety, lack of adaptive coping skills and addiction in that population so I can see why they'd be interested in having us involved in some way or another. If ones residency program allows for schedule flexibility (we have 12 elective months) I could see this being used to position oneself for a pain fellowship, even if it'd be a very uphill climb.

 

[OldPsychDoc]

Everyone take note- this is an exemplary post: an attending in the know offering to share knowledge with interested individuals to pull them up.

So much better, and more useful, than the banter we usually engage in (myself included).

Thanks Jettavr6!!!



I will also add the useless banter that I think there are many in the pain field who sincerely want psychiatrists involved. I had two hospitals ask if I'd work in their pain clinics when I was on the job hunt and I have nothing on my CV that would indicate I had an interest or skill set that'd be especially useful to them (except perhaps experience with Suboxone). Pain is subjective, many of the meds used are antidepressants or something else we'd be familiar with, and there's a lot of co-morbid depression, anxiety, lack of adaptive coping skills and addiction in that population so I can see why they'd be interested in having us involved in some way or another. If ones residency program allows for schedule flexibility (we have 12 elective months) I could see this being used to position oneself for a pain fellowship, even if it'd be a very uphill climb.

Hardly useless banter. It's very true. If you go to work for a multi-specialty group, there are many options to exercise your skills in this niche. My boss & I are meeting monthly with a multidisciplinary group to set up mechanisms to identify appropriate vs inappropriate opiate prescribing, help our docs in all departments to figure out how to separate the true addicts from the anxiously habituated and the chronically ill, and to have pathways available to serve each type of patient appropriately. I'll let you know in five years if we've made a dent in it.

 

[vistaril]

Everyone take note- this is an exemplary post: an attending in the know offering to share knowledge with interested individuals to pull them up.

So much better, and more useful, than the banter we usually engage in (myself included).

Thanks Jettavr6!!!



I will also add the useless banter that I think there are many in the pain field who sincerely want psychiatrists involved. I had two hospitals ask if I'd work in their pain clinics when I was on the job hunt and I have nothing on my CV that would indicate I had an interest or skill set that'd be especially useful to them (except perhaps experience with Suboxone). Pain is subjective, many of the meds used are antidepresssnts or something else we'd be familiar with, and there's a lot of co-morbid depression, anxiety, lack of adaptive coping skills and addiction in that population so I can see why they'd be interested in having us involved in some way or another. If ones residency program allows for schedule flexibility (we have 12 elective months) I could see this being used to position oneself for a pain fellowship, even if it'd be a very uphill climb.

of course people in the pain field want psychology and psychiatrists involved- but NOT for interventional pain. There is a tremendous shortage of decent pain psychologists/psychiatrists. Nobody disputes that. I can't find any in my area to refer patients, and I'm not in a tiny area.

As for pain fellowships, there are plenty of ways for psychiatrists to readily get post-graduate training in pain therapy now.....but there just arent a lot of people who want to do this.

 

[vistaril]

Sure - skills vary amongst various providers even within the same specialty.



5 of whom I've spoken to personally. I know of 3 others.

can you provide links to a few of their websites?

 

[michaelrack]

of course people in the pain field want psychology and psychiatrists involved- but NOT for interventional pain.

Agree with this. Hospitals would love for psychiatrists to staff the clinics, while the block jocks make the big bucks.

 

[jettavr6]

can you provide links to a few of their websites?

No.

 

[michaelrack]

Is this a real option for Psychiatrist? I know it is listed as one of the accredited fellowships but I cant see where a program would take a Psychiatrist.

http://forums.studentdoctor.net/showthread.php?t=1007604

"By ease of obtaining a fellowship:

Anesthesia>PMR>Neuro>>>>>anything else. In that order."

 

[TexasPhysician]

Im guessing the *very few*(stastically basically zero) people who are BE/BC in psychiatry alone(and not dual boarded people such as the one michael rack mentioned) have an unusual background that makes them different from the average psych resident. Maybe they did a procedure based residency in another country and then matched here in psych. Maybe they completed some of another residency before transferring to psych.

I vote for an experiment. Apply to every pain fellowship out there. Let us know how many interviews you get. Someone else will write your personal statement so that you can't purposefully botch it.

Without actually trying, you have no idea how difficult it actually is to match.

 

[vistaril]

I vote for an experiment. Apply to every pain fellowship out there. Let us know how many interviews you get. Someone else will write your personal statement so that you can't purposefully botch it.

Without actually trying, you have no idea how difficult it actually is to match.

well you could say the same for a lot of stuff....I'm *technically eligible* to apply for ent match this year as well.....I have a medical degree. I've passed step 1, 2, etc. There isn't anything that definitively disqualifies me from getting an ent spot. But I don't know need to try to go through the ent match to know i'm not a strong candidate...

 

[SeniorWrangler]

It's plenty hard, I think. Pain medicine is largely dominated by anesthesia with lesser contingents of neurologists and rehab docs. Some pain fellowships are very, very anesthesia-oriented, to the point where the fellows take non-pain anesthesia call, and they likely won't be interested in psychiatry.

That said, there are some psychiatrists in pain programs around the country and there seems to be some openness to them in some programs, particularly the pain programs that are less focused on procedures and more focused on interdisciplinary chronic pain management, where behavioral health is a huge part of the treatment.

If you are really interested in pain, then get busy right now in residency: get to know your local pain providers at your academic center. Go to their grand rounds, talk to people, see if you can do an elective in their clinic. Try to get involved in some pain-related research, see if there are any shrinks or psychologists around who are doing research on pain and try to work with them if you can. Look at docs like Scott Fishman and Steve Passik and do likewise. You can also go to educational programs put on by the various pain societies, there are a ton of them, and even interventional pain courses if you can get them to let you attend. All this will help you decide whether this is right for you, and also show pain fellowship directors that you've got an abiding interest in pain and know a lot about it already and thus will be an asset to their program, rather than just being a funny psychiatrist who thinks injections are fun.

Also, develop a thick skin right now; if you take this route, you will be a zebra among the horses.

EDIT: I didn't want to start a new thread, but are there any professional societies for pain psychiatrists? I googled around recently and didn't find any. There are some special interest groups in pain societies, but I didn't find a specific org for psychiatrists who primarily do pain management.

 

[Fabio001]

http://www.hopkinsmedicine.org/psychiatry/specialty_areas/pain/

Is anyone familiar with this program or any others like it? It certainly seems that there are institutions out there who see the value in a multidisciplinary approach to the field. As a third year medical student who is very interested in pain management and psychiatry I really want to believe that the field is opening up for psychiatry as I've been counseled by advisers that I should pick the primary specialty I'm interested in first, then approach the field of pain management from there.

Does anyone know any psychiatry programs flexible enough to allow one to spend a significant amount of time (6+ months) rotating with the pain service? Would this even make a difference by way of competitiveness for a fellowship spot?

 

[OldPsychDoc]

I would look for programs that have substantial elective time in PGY4 (or earlier) and are at institutions that support a pain fellowship. Best chance to make the connections that will give you a reasonable chance to get into a fellowship.

 

[Fabio001]

Thanks for the Reply! Does anyone have any insight on specific residencies/locales that would provide elective time during PGY3 to allow someone to experience a month or two in a comprehensive pain center? Additionally, it would be expedient that the pain service be open-minded enough that a psych resident wanting to rotate wouldn't just be scoffed at...

I know there were some posts a couple years ago by one PsychPain that indicated the he/she was able to get some procedure time during PGY3. Do any of you have direct experience seeing this sort of thing happen?

 

[painballer27]

Bump. Anyone have any updates on this topic as of 2022?

 

[J ROD]

Glad I did not do it....lol

 

[painballer27]

Glad I did not do it....lol

Why?

 

[J ROD]

Why?

Have you met pain patients? tough crowd to please and deal with daily.....

 

[painballer27]

Have you met pain patients? tough crowd to please and deal with daily.....

Yeah I have. Spent a couple of weeks in a pain clinic and out of the ~200 clinic encounters maybe 3 of them I’d describe as difficult. And really no more difficult than patients in other fields. I’ve heard that too about pain patients but in my limited experience I haven’t really found it to be true

 

[allantois]

Yeah I have. Spent a couple of weeks in a pain clinic and out of the ~200 clinic encounters maybe 3 of them I’d describe as difficult. And really no more difficult than patients in other fields. I’ve heard that too about pain patients but in my limited experience I haven’t really found it to be true

I don't know why anyone would want to be involved in pain.. the field is a complete mess defined by a symptom which everyone thinks no one should tolerate any amount of

 

[painballer27]

Pain is interesting in my experience. Good mix of clinic and quick procedures. Get to have long term relationships with patients. No nights, weekends, or call in most cases. 2021 MGMA for psychiatry median is 278k. For anesthesia pain it is 494k and non- anesthesia pain 438k. 90th % for psych is 425k whereas pain is breaking 800k. This is a significant difference and I would imagine has something to do with why some people want to do pain.

 

[medhead1990]

I have seriously considered pain vs an addiction fellowship verse doing both, (Or stop putting my family through the hell of training and just go start working — Internal Medicine/Psychiatry resident)

It is possible but it’s an uphill battle as a psychiatrist. I was at the 2022 AAPM meeting in April and I actually got to talk with the psychiatrist who is currently a pain fellow at Stanford and he told me “You have to prove that you are comfortable/very interested in putting needles in peoples back‘s because in fellowship that is a huge part of what you do”. He said interest for pain psychology or reasonably minor procedures is probably not gonna be enough to get you into a Fellowship. that being said when you’re done with your fellowship you can do whatever you want. However bear in mind if you’re in an employed position you will have a lot of pressure to do as many procedures is reasonably possible in the c arm suite because that’s what generates revenue.

I definitely think there’s a place for psychiatrists in pain and the general feel I got from this last year‘s AAPM meeting was that the vast majority of the field agrees. That being said there is some inherent risk that program directors have to consider when taking on a psychiatrist that they will have a tremendous learning curve when it comes to the procedures which may pose a challenge for both the fellow and the program despite their strengths in clinical acumen.

Another monkey wrench that I’ve been able to appreciate is that most of the more “multidisciplinary“ programs which have historically taken a psychiatrist or two tend to also be the very big name programs (think Stanford, mayo, Hopkins). I think this is part because these are the institutions with big enough money that they can have fellows do less money making procedures and not really worry about the financial consequences. This is cool in the sense that if your psychiatrist is other places that would be “interested in you“ it’s intimidating as these are the top overall institutions in the country and getting into their program as a psychiatrist or not a psychiatrist is a very impressive feat.

Of note another person you can look up who is the psychiatrist who did an interventional pain fellowship is the program Director for Beth Israel who did psychiatry residency and addiction fellowship and then interventional pain.

While I am by no means an expert on the subject as I am actively going through the decision making process myself I’m happy to talk with other people because maybe I can help them and they can help me.

 

[TexasPhysician]

Cool. Do you personally know of any psychiatrists who have gone into pain? I'm a med student and my goal is pain. Trying to decide whether I should do anesthesia which is a more direct route, or psychiatry, which I'd probably enjoy more but I still want to do pain.

If you are sure on pain, definitely do anesthesia first or even PM&R. You’ll significantly hinder yourself with psych.

 

[adiradirim]

I'm a current psychiatry trained pain fellow. I was lucky to get a ton of elective time and pain rotations and ended up doing 100+ epidurals/injections before graduating psychiatry and multiple research papers and book chapters in pain.

If pain is your goal from med school, do anesthesia or PMR. I only found out I liked pain in PGY2.

On the interview trail, I got a lot of interviews and a lot of places were very interested in me because I was a psychiatrist. The same amount of places had absolutely zero interest in me for the same reason.

It's doable for a highly motivated individual who has a plethora of opportunities for rotations, research, connections, mentorship, and hands on experience.

Personally I think psychiatry is a great route into pain management from a clinical perspective as long as you have a knack for procedures. The logistics make it a nightmare though.

 

[Alemo]

I'm a current psychiatry trained pain fellow. I was lucky to get a ton of elective time and pain rotations and ended up doing 100+ epidurals/injections before graduating psychiatry and multiple research papers and book chapters in pain.

If pain is your goal from med school, do anesthesia or PMR. I only found out I liked pain in PGY2.

On the interview trail, I got a lot of interviews and a lot of places were very interested in me because I was a psychiatrist. The same amount of places had absolutely zero interest in me for the same reason.

It's doable for a highly motivated individual who has a plethora of opportunities for rotations, research, connections, mentorship, and hands on experience.

Personally I think psychiatry is a great route into pain management from a clinical perspective as long as you have a knack for procedures. The logistics make it a nightmare though.

So I get the research part, but how did you convince someone to teach you to do epidurals etc? I imagine they are used to training anesthesia residents who have placed hundreds of IVs etc. And how did you get all that elective time???

 

[adiradirim]

So I get the research part, but how did you convince someone to teach you to do epidurals etc? I imagine they are used to training anesthesia residents who have placed hundreds of IVs etc. And how did you get all that elective time???

LOL I don't remember exactly how I did my first one. I just asked to do it? I told them I had done LPs on neurology (which happened to be true). You can do rotations in chronic pain, acute/perioperative pain, interventional spine, and even interventional radiology which will all get you experience in imaging guided procedures.

I went to a large academic center for residency and had a lot of elective time (12ish months total but I fast tracked into child psych so I only got like 5 which were all pain related). I set up a psychiatry consult clinic for one of the outpatient pain rehab programs. Then I did a child psych fellowship with a goal of doing pediatric pain and during my interview I told the PD that I would come if they let me do all my elective time with the pain service. They emailed the pain service attendings that day and they responded that they'd be happy to take me so I accepted the offer. I was the only fellow to ever to work with them for more than a week so they taught me everything lol.

Before my pain fellowship, I'd say 80% of the procedures I did were on children.

This is very unusual and I recognize this 😂

 

[Alemo]

Wow!