All my anesthesiology friends are doing this to avoid nights and horrible hospital hours.
Yes. They deal with it too, just like us.
The patients sound like the worst of the worst, but you're not as constrained by EMTALA, I guess.
Incorrect. The worst of the worst are the ones you see in the ED. I used to see them in the ED, but I don't anymore. That's EM's baby.
My buddy applying to pain right now says that most of the good programs look at anesthesia only.
This is not the way it's supposed to be, but undoubtedly the way it is at some programs. The only way to change it, is for EM people to keep applying, everywhere, until they break through. The best way is to overwhelm the system with sheer volume. Anesthesia can get away with applying to 10 programs. If you're EM, you need to apply to all 80 or 90, to find the programs open to EM. Looking at websites isn't enough. Many that said "Anesthesia and PMR only" gave me interviews. But once you find the programs that don't inappropriately discriminate against EM, not only are you not at a disadvantage, in some ways you're at a greater
advantage. The programs that value multidisciplinary inclusion, are looking to add less common specialties. They consider it an asset. They realize your specialty will learn things from them, and they'll learn things from you, that none of us might expect. They value the cross pollination. It makes everyone more well rounded.
At these programs your stock goes up, and may actually be higher than those of Anesthesia. But don't go by websites and rule places out easily. The only way to decrease your chances of an interview to zero is to not apply. So, apply, apply, apply!
Seems like it's hard to get a decent spot out of EM, from what I hear, which is admittedly just word of mouth.
Correct. It's "hard to get a decent spot" coming from an EM background. But I got one. And I personally know of several others who have, too (less than 10, I'm sure there's many more). Perhaps unexpectedly, the programs EM people are getting into are not the bottom of the barrel, they have tended to be at the stronger programs, at big academic places. I think that is partly because the bigger, stronger, more academic programs are more on the forefront of the fact that Pain is multidisciplinary. Also, the bigger academic places are more used to having multiple trainees of multiple specialties, constantly floating in and out of off service rotations. Plus, some of the smaller, lesser know programs may not actually even know EM has been an official since 2014. Another factor is that many of the worst programs, scut out their fellows to do general anesthesia call, which is a horrible waste of time during a pain fellowship where you only have 12 months to learn and entire specialty. These places necessarily avoid people from non-anesthesia specialties because they're not going to be as useful as scut monkey's placed there to make anesthesia attendings OB call nights, cozier. You wouldn't want to go to these programs. Learning to do OB epidurals would be a horrible waste of time for someone who wants to practice office based Pain Medicine. You'd be much better off getting a good night's rest, so you can scrub a spinal cord stimulator, kyphoplasty or fluoro-guided epidural steroid injections the next day, rather than help an anesthesia attending get REMs.
Then, there's the politics of Pain. Some anesthesia people feel they "own" the subspecialty, that it's their "turf." There's no quick for this, other than to be persistent. If their track record with protecting their specialty from CRNAs is any predictor (it is) then it's only a matter of time before this firewall collapses spectacularly. They don't own it. Not at all.
The biggest barrier to EM physicians going into this fellowship, is the EM physician mindset. Many don't know, or think about it. Many have incorrect information and think it's something other than what it is, and therefore don't see it as highly desirable as their Anesthesia and PM&R counterparts do. Also, there's an inferiority complex that "I'm must not be as good as anesthesia" for this specialty. That's wrong. Emergency Physicians are equally, if not better trained for Interventional Pain than anesthesia, assuming the Pain fellowship is training you to become a Pain physician and not scutting you out to take call for anesthesia doing things irrelevant to the practice of Pain Medicine. If you can thrive in EM, you will absolutely ROCK a Pain fellowship, no problem. You have my personal guarantee.
