pain medicine fellowship after EM residency?

EMhopeful987

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    I'm about to start my intern year in an academic 4 year EM residency program in July. Given the grim future job outlook for EM (an estimated 9000 EM physicians are predicted to be unemployed by 2030) I've been looking into fellowship options so that I have a backup plan in case I can't land an EM attending job after residency. I've done rotations as a student in typical EM fellowship fields (ultrasound, critical care, etc) but to be honest I just didn't find them that interesting. Pain medicine catches my eye however because there's plenty of procedures (love working with my hands) and there's an outpatient component that would allow me more freedom from hospital based control.

    I've been doing some reading though and noticed that its mostly anesthesia and PMNR trained physicians that go on to pain medicine fellowships. I want to ask, any advice or tips for an incoming EM resident to help me standout and secure a pain medicine fellowship at the end of residency? I'm willing to move to undesirable middle of nowhere areas in the country if need be. Ideally I would like to work part time as an EM attending (as I do find ER work interesting) and part time as a pain medicine physician. At the same time though if EM attending jobs are really obsolete by the time I finish residency then I would fall back on pain medicine as full time work. Thanks in advance.
     

    Orin

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      I'm about to start my intern year in an academic 4 year EM residency program in July. Given the grim future job outlook for EM (an estimated 9000 EM physicians are predicted to be unemployed by 2030) I've been looking into fellowship options so that I have a backup plan in case I can't land an EM attending job after residency. I've done rotations as a student in typical EM fellowship fields (ultrasound, critical care, etc) but to be honest I just didn't find them that interesting. Pain medicine catches my eye however because there's plenty of procedures (love working with my hands) and there's an outpatient component that would allow me more freedom from hospital based control.

      I've been doing some reading though and noticed that its mostly anesthesia and PMNR trained physicians that go on to pain medicine fellowships. I want to ask, any advice or tips for an incoming EM resident to help me standout and secure a pain medicine fellowship at the end of residency? I'm willing to move to undesirable middle of nowhere areas in the country if need be. Ideally I would like to work part time as an EM attending (as I do find ER work interesting) and part time as a pain medicine physician. At the same time though if EM attending jobs are really obsolete by the time I finish residency then I would fall back on pain medicine as full time work. Thanks in advance.
      I've got no clue about there being too many EM docs in a few years. I can tell you it's hard to get into pain without exposure to it. You need letters and support from your local pain program.

      Try to interact with your academic program's pain program to find a mentor/champion to guide you. Maybe you can develop projects and programs that help EM and pain build fruitful/valuable connections like pathways to minimize opioid prescribing, utilization of bedside blocks to reduce acute pain, or faster referral pathways for acute problems with their interventionalists. You need someone though to be willing to write letters and connect you to a fellowship program that might take you.

      Many pain physicians are shackled to hospitals too though, so you're picking your poison here.
       

      cowboydoc

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        I'm about to start my intern year in an academic 4 year EM residency program in July. Given the grim future job outlook for EM (an estimated 9000 EM physicians are predicted to be unemployed by 2030) I've been looking into fellowship options so that I have a backup plan in case I can't land an EM attending job after residency. I've done rotations as a student in typical EM fellowship fields (ultrasound, critical care, etc) but to be honest I just didn't find them that interesting. Pain medicine catches my eye however because there's plenty of procedures (love working with my hands) and there's an outpatient component that would allow me more freedom from hospital based control.

        I've been doing some reading though and noticed that its mostly anesthesia and PMNR trained physicians that go on to pain medicine fellowships. I want to ask, any advice or tips for an incoming EM resident to help me standout and secure a pain medicine fellowship at the end of residency? I'm willing to move to undesirable middle of nowhere areas in the country if need be. Ideally I would like to work part time as an EM attending (as I do find ER work interesting) and part time as a pain medicine physician. At the same time though if EM attending jobs are really obsolete by the time I finish residency then I would fall back on pain medicine as full time work. Thanks in advance.
        You’re too deep in training to worry about the doom and gloom in medicine. Focus on your training, get some exposure to pain at your institution, then get in on some research that is related to pain if you really like it, agree with above. Best!
         
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        painfree23

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          I'm about to start my intern year in an academic 4 year EM residency program in July. Given the grim future job outlook for EM (an estimated 9000 EM physicians are predicted to be unemployed by 2030) I've been looking into fellowship options so that I have a backup plan in case I can't land an EM attending job after residency. I've done rotations as a student in typical EM fellowship fields (ultrasound, critical care, etc) but to be honest I just didn't find them that interesting. Pain medicine catches my eye however because there's plenty of procedures (love working with my hands) and there's an outpatient component that would allow me more freedom from hospital based control.

          I've been doing some reading though and noticed that its mostly anesthesia and PMNR trained physicians that go on to pain medicine fellowships. I want to ask, any advice or tips for an incoming EM resident to help me standout and secure a pain medicine fellowship at the end of residency? I'm willing to move to undesirable middle of nowhere areas in the country if need be. Ideally I would like to work part time as an EM attending (as I do find ER work interesting) and part time as a pain medicine physician. At the same time though if EM attending jobs are really obsolete by the time I finish residency then I would fall back on pain medicine as full time work. Thanks in advance.
          why are you doing EM to begin with with this negative outlook?
           

          avalon10

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            To the OP-
            I wouldn’t listen to a word of Orin’s comment. You don’t need “letters and support from your local pain program” to apply to a pain fellowship. Like with anything else, it’s good to get to know people and get letters and recommendations etc, but no more than in any other field.
            As far as pain doctors being “shackled to hospitals,” sure, there are “many,” but pain is one of the fields that you can work completely outside of a hospital.
            I don’t think that there are many fields in medicine in which you can completely escape being in a healthcare system, but you can do it in pain as much as you can in any field.
            My point is that if you want to be your own boss and work outside of the hospital world and all of the BS that goes with it, you can do that in pain.
             

            EMhopeful987

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              To the OP-
              I wouldn’t listen to a word of Orin’s comment. You don’t need “letters and support from your local pain program” to apply to a pain fellowship. Like with anything else, it’s good to get to know people and get letters and recommendations etc, but no more than in any other field.
              As far as pain doctors being “shackled to hospitals,” sure, there are “many,” but pain is one of the fields that you can work completely outside of a hospital.
              I don’t think that there are many fields in medicine in which you can completely escape being in a healthcare system, but you can do it in pain as much as you can in any field.
              My point is that if you want to be your own boss and work outside of the hospital world and all of the BS that goes with it, you can do that in pain.
              Thank you for your response. Do you know if it's feasible to split your time between working pain part time and working in the ER part time? Or is pain medicine something that you have to be all in for and working full time in?
               

              Jigsaw

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                Why do all these residents in these random residencies want to do pain just because they don’t like their residency.

                Isn’t it better to just change to a residency you like?
                 
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                avalon10

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                  Thank you for your response. Do you know if it's feasible to split your time between working pain part time and working in the ER part time? Or is pain medicine something that you have to be all in for and working full time in?
                  Rethinking the way I worded this- maybe Orin was right about the “local pain program." You probably WILL need to access an academic pain program you can, trying to rotate thru it somehow and spending time around the people there to get an idea what the field is about and to get letters of recommendation from anyone in academics. He had a good idea about doing some project that would link your ER experience with pain. If you can manage to do this in an academic department, that place will probably be your best bet to get a fellowship. Like anything else, when you apply they will want to see that you have some experience in the field, and know the terminology etc as well as the other stuff that academic people are looking for.
                  Getting into an academic pain fellowship will be a lot easier if you meet people in academic pain.
                  As fast as splitting time between pain and ER, I have no idea.
                   
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                  Ducttape

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                    Thank you for your response. Do you know if it's feasible to split your time between working pain part time and working in the ER part time? Or is pain medicine something that you have to be all in for and working full time in?
                    it is very difficult. the problem will probably be the schedule. you can do pain part time.

                    you really have to have some modicum of stability in your schedule for your pain job. if you are working in EM (unless you are doing purely urgent care), you will be doing shift work.

                    most of the EM docs I know that did a sports med fellowship struggled with this, and you really need to find a situation that allows you to block off time so you wont be working a night shift then have a day clinic.

                    Why do all these residents in these random residencies want to do pain just because they don’t like their residency.

                    Isn’t it better to just change to a residency you like?
                    maybe because pain is a fellowship?

                    to switch over, you have to be really stupid to drop EM medicine then do an anesthesiology residency when you are in your 40s and another year doing Pain. or masochistic



                    (I like to think I am not stupid. i guess masochistic)
                     

                    GatorCHOMPions

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                      I am about to enter a pain fellowship from EM (with attending experience too). There are a few EM to Pain docs active on the EM forum so try there if you don’t get all your questions answered here.

                      Without dedicated elective time I had to hustle and volunteer my time on “off” days at the local pain program, got a letter, and had some additional EM-Pain related projects on my CV. You most certainly need dedicated pain experience to have a shot at matching. You should also just want the exposure to see if you’ll like it.

                      As far as the job market, I can’t comment personally, but from what I hear it’s a lot better than EM these days. Doing a hybrid split seems difficult and the stars have to perfectly align. I plan to do 100% pain when I’m done unless I could find one of those ideal setups (in academia?) splitting time, but I’m not counting on that and neither should you.
                       
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                      Orin

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                        The biggest thing is the switch from being bound to a clinic/patients and shift work. The insurance authorizations and patient messages can be never ending, where as your shift ends.

                        A lot of providers do split with different things though but I'm not sure how that would be in PP vs academics as priorities and fund flows are different. In academics, I know there are some anesthesia programs that have EM faculty in their department, like at UNC-CH where their anesthesiology department's vice chair of research works attends in the ER.

                        I would listen though to the folks that have done this like GatorCHOMPions.

                        I would agree that the sky is falling everywhere though, so figure out what you like first rather than being afraid of failing at it. If you like it, you'll have betters odds of being good enough to get a job in it.
                         
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                        Birdstrike

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                          Thank you for your response. Do you know if it's feasible to split your time between working pain part time and working in the ER part time? Or is pain medicine something that you have to be all in for and working full time in?
                          It's much better to do on field full time, than try to split. However, I do know a guy who did 50/50 EM and Pain with a very large group out West (Kaiser). I suppose you could do this with a tertiary academic center also. But 90% of jobs (either EM or Pain) are going to be looking for full time people. The reason is simple: It costs time and money to recruit and employ someone. One full-timer is cheaper than two part-timers (twice the recruiting dinners, twice the overhead, twice the malpractice insurance, twice the work to get credentialed, etc)
                           

                          Jigsaw

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                            it is very difficult. the problem will probably be the schedule. you can do pain part time.

                            you really have to have some modicum of stability in your schedule for your pain job. if you are working in EM (unless you are doing purely urgent care), you will be doing shift work.

                            most of the EM docs I know that did a sports med fellowship struggled with this, and you really need to find a situation that allows you to block off time so you wont be working a night shift then have a day clinic.


                            maybe because pain is a fellowship?

                            to switch over, you have to be really stupid to drop EM medicine then do an anesthesiology residency when you are in your 40s and another year doing Pain. or masochistic



                            (I like to think I am not stupid. i guess masochistic)
                            All these recent posts are from people in their residency not practicing
                             
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