Pain Medicine is an Official Subspecialty of Emergency Medicine

[WilcoWorld]

i wonder how much anesthesia hates this. People are very protective of their turf, and pain medicine is a pretty great gig right now. It's sort of like FM guys doing fellowships to be ER certified. The ER guys do not like those dudes at all (from what I can tell persuing some of the threads about FM guys doing EM fellowships). But it is a little different, becasue FM guys doing ER adds more people in the ER workforce, where as pain fellowships there's a certain number so it's not like there's more people joining the workforce.

I think this is very different- @Birdstrike is talking about taking the accredited pathway. EM ‘fellowships’ are not recognized by ABEM.

---

Members don't see this ad.

 

[Birdstrike]

i wonder how much anesthesia hates this. People are very protective of their turf, and pain medicine is a pretty great gig right now. It's sort of like FM guys doing fellowships to be ER certified. The ER guys do not like those dudes at all (from what I can tell persuing some of the threads about FM guys doing EM fellowships). But it is a little different, becasue FM guys doing ER adds more people in the ER workforce, where as pain fellowships there's a certain number so it's not like there's more people joining the workforce.

FM has no official way to be boarded in EM, so any fellowship in EM that they do, is unaccredited and the certificate good only as fish-wrap. On the other hand, EM has as much right to be boarded in Pain as Anesthesia and can do the same ACGME accredited fellowships. So, there's no valid comparison.

Anesthesia can hate it all they want but it's they who approved it. In 2014, EM, FM and Rads were officially recognized as parent specialties along with Anesthesiology (and PMR, Psych/Neuro). Both, the ABA and ABMS approved it. That makes EM as officially a part of the Pain Medicine world as Anesthesiology is, in every way the we in the medical world assess legitimacy and board certification, which is under the American Board of Medical Specialties (ABMS) through programs accredited by the ACGME. EM applicants go to the same accredited Pain fellowships as Anesthesiologists, PMR, Psy/Neuro, FM, Rads and learn right along with them, side by side. Then they take the same ABMS Pain Medicine board exam as the Anesthesiologists and get the same accredited ABMS Pain Medicine board certification as Anesthesiogists.

Don't take my word for it, go right to the source, ABMS. You'll find Pain Medicine as official subspecialties under EM, Anesthesiology, PM&R, Psych/Neuro, FM and Rads. What you will not find anywhere, is Family Medicine under EM or EM under Family Medicine. That war has been waged and lost long ago. But the battle to get EM into Pain with Anesthesia, has been won. I know, because I wrote the application letter for ABEM, which they put the head of ACEP's signature on, and and submitted to the ABA, which they approved and signed off on. So, that battle has been won. Because certain people don't know about it, doesn't make it untrue. Because it hurts certain people's' feelings, also does not make it untrue.

 

[WilcoWorld]

I haven't inflated the prospects. In fact, I've acknowledged that they'll have to work harder to get in. But thinking they're just as qualified (or more so) is not the same as denying the obvious and unjustified bias against them, that you so eloquently have endorsed.

Ohhhh a fight. IT'S A FIGHT!! I LUV INTERNET FIGHTS!!!!

I think the question ought to be

Who is better at reading xrays? EM or Psychiatrist?
Who is better at maintaining an airway? EM or Neurology?
Who is better at treating stroke patients? EM or Anesthesiology?
Who is better at treating mental illness? EM or Radiology?


The answer is clear!!!



ER is second best at everything!!!! LOL. We are in second place in every single aspect of medicine.

This is why if an asteroid hit the earth and selectively wiped out all physicians except for one specialty, the world would be best served if ER doctors survived.

FIGHT!!!! LOL

( I just now recognize I'm a little late with my post LOL)

You two may need to rethink your position about EM being 2nd best.

Our study, though limited, suggests that emergency physicians may not be inferior to neurologist-led stroke teams in the evaluation and treatment of acute ischemic stroke.

In this study comparing stroke alerts seen by Neurologists to those seen by EP's, those seen by neurologists got tPA more often and had the same outcomes. Neurologists give more tPA, ergo they're clearly superior to EP's.

 

[Birdstrike]

Just got messaged from a fellow EM physician that found out they matched in Pain today.

 

[deadhead2]

Just got messaged from a fellow EM physician that found out they matched in Pain today.

I matched into Pain from EM as well! Over the course of my interviews I met 4 other EM applicants, including 1 attending a few years out. Not sure how things turned out for them. Also exchanged PMs with an EM applicant on here, but won’t ID him to respect his privacy. He also matched!

It’s definitely an uphill battle coming from EM but it seems like programs are more and more open to EM candidates. If you’re interested, go for it!

Edit: And thank you @Birdstrike! Your posts were a huge inspiration for me to go for it.

 

[Birdstrike]

I matched into Pain from EM as well! Over the course of my interviews I met 4 other EM applicants, including 1 attending a few years out. Not sure how things turned out for them. Also exchanged PMs with an EM applicant on here, but won’t ID him to respect his privacy. He also matched!

It’s definitely an uphill battle coming from EM but it seems like programs are more and more open to EM candidates. If you’re interested, go for it!

Edit: And thank you @Birdstrike! Your posts were a huge inspiration for me to go for it.

CONGRATS!!

 

[Frazier]

Also see on social media an EM resident matched to Harvard/MGH pain fellowship. I don't know him, but huge congrats!

 

[clibby]

Congrats to those who matched!

I'm not in pain management, but after reading this thread I feel like there is a missed opportunity for this:

 

[avalon10]

CONGRATS!!

After reading this entire discussion, the one logical conclusion is that Birdstrike is completely delusional.

 

[Birdstrike]

After reading this entire discussion, the one logical conclusion is that Birdstrike is completely delusional.

Lol. Obviously.

 

[swamprat]

Im a pain physician - also EM trained but havent worked in months EM due to covid/staff cutting. Interventional pain is exploding. We are becoming the minimally invasive spine guys - similar to interventional cards vs ct surgery. What things I've done since finishing fellowship besides your bread and butter pain stuff (im a few years out of fellowship now)-
- Lumbar discectomy
- SI Joint fusion
- Facet joint fusion
- Indirect lumbar decompression with vertiflex
- Kypho/vertebroplasty
- Not yet indicated a patient for it but just trained on posterolateral lumbar fusion.

Exciting time to be a pain specialist/interventional spine doc. Yes I still write a lot of percocet.

I probably know half the current EM pain fellows or just graduated docs as I've had convos with most of them either at ACEP or on the phone. PM me if you all have any self specific questions

 

[southerndoc]

How in the world can you do a disectomy and joint fusion without a surgical background?!? Amazing.

 

[Birdstrike]

Edit: And thank you @Birdstrike! Your posts were a huge inspiration for me to go for it.

You're welcome x 1,000! I'm glad I could be of help. How's it going? Are you happy?

 

[Birdstrike]

I just did a quick scan through about 5 years of private messages. A lot of EM docs that have messaged me about this subject over the years, have gotten into Pain and are doing great. It's great to hear.

 

[sloh]

EM must be a real dumpster fire when physicians are glad switching from EM to pain haha

 

[Birdstrike]

Do you think at some point a stand alone pathway will develop for pain and interventional, minimally invasive spine? For example, I've seen programs develop combined general surgery/CT surgery residencies and critical care appears to be moving towards its own stand alone multidisciplinary speciality instead of separate pathways from different specialities. I wouldn't be surprised if all of critical care eventually consolidated into a single speciality, although its probably still years away. I could envision a similar future where you do a 3-5 year residency just in pain and interventional, minimally invasive spine. I'm curious though what you all involved in the speciality think though.

For about 10 years, I've heard talk of changing Pain from a fellowship into a residency, or extending the fellowship to two years. As of yet, nothing has changed. Will it? I don't know.

 

[Birdstrike]

I am also EM trained and recently went through the application process, matching at my number #1 choice. On the interview trail I met a couple other EM people as well. We were definitely the minority, but I think that will change. EM also used to be the minority in CC and that is changing too. I think EM is a fairly newer specialty, within the past 40 years, so we are all still finding our niche in medicine.

That being said there were a few programs that did straight up tell me they do not accept EM applicants.

I'm an EM doc who just went through the Pain fellowship application process and landed a position. Here are some random thoughts:

Birdstrike's posts were a huge boost that helped me get past my biggest challenge in getting a Pain spot - my own inertia, inaction, and self-doubt that it even made sense to apply in the first place. I'm certain I'm not the only EM doc who considered Pain that he/she has helped. Bird, if I ever meet you in real life I owe you many beers.

The biggest piece of advice I'll echo to EM docs considering Pain is to apply as broadly as possible. I was surprised in that I got some interviews at very name brand and bigger programs while not getting as much love from smaller or lesser-known programs.

The bias against EM folks is real. From the perspective of a Pain program director, I can understand the hesitation of taking an EM applicant as they are far more used to/comfortable with training a PM&R or Anesthesia person. But as Pain continues to become more multidisciplinary and more EM folks enter the field this will improve. Faculty at several places I interviewed at commented on how they heard about a great EM fellow at another program or how they see EM as being a great foundation from which to enter Pain. I did have some interviews with faculty that went like "you're an EM doc...why are we interviewing you?" But on a whole this kind of thing occurred far less often than I was expecting. Hopefully the bias is fading, however slowly.

The comment on here about EM being the 2nd best at many things is definitely to our benefit as a Pain trainee. Coming from EM we cannot do a gas induction like our Anesthesia colleagues, don't know much about picking the right prosthesis for patients like our PM&R colleagues, can't give belly CT reads as fast and thoroughly as our radiology colleagues, cannot describe the various MOAs of all the MS drugs on the market like our neurology colleagues, and we cannot manage meds for MDD or do psychoanalysis like our Psychiatry colleagues. But we (and FM) have our own strengths and in many regards we're kind of like the intersection of the circles these other specialties represent on a Venn diagram. Every specialty brings their strengths to the field.

So anyway, you can consider me another data point showing that going from EM to Pain fellowship is doable. Best of luck to everybody considering it.

I matched into Pain from EM as well! Over the course of my interviews I met 4 other EM applicants, including 1 attending a few years out. Not sure how things turned out for them. Also exchanged PMs with an EM applicant on here, but won’t ID him to respect his privacy. He also matched!

It’s definitely an uphill battle coming from EM but it seems like programs are more and more open to EM candidates. If you’re interested, go for it!

Edit: And thank you @Birdstrike! Your posts were a huge inspiration for me to go for it.

Im a pain physician - also EM trained but havent worked in months EM due to covid/staff cutting. Interventional pain is exploding. We are becoming the minimally invasive spine guys - similar to interventional cards vs ct surgery. What things I've done since finishing fellowship besides your bread and butter pain stuff (im a few years out of fellowship now)-
- Lumbar discectomy
- SI Joint fusion
- Facet joint fusion
- Indirect lumbar decompression with vertiflex
- Kypho/vertebroplasty
- Not yet indicated a patient for it but just trained on posterolateral lumbar fusion.

Exciting time to be a pain specialist/interventional spine doc. Yes I still write a lot of percocet.

I probably know half the current EM pain fellows or just graduated docs as I've had convos with most of them either at ACEP or on the phone. PM me if you all have any self specific questions

How are you all enjoying Interventional Pain, compared to General Emergency Medicine, and why? Any other EM/Pain people, feel free to chime in also.

 

[swamprat]

Do you think at some point a stand alone pathway will develop for pain and interventional, minimally invasive spine? For example, I've seen programs develop combined general surgery/CT surgery residencies and critical care appears to be moving towards its own stand alone multidisciplinary speciality instead of separate pathways from different specialities. I wouldn't be surprised if all of critical care eventually consolidated into a single speciality, although its probably still years away. I could envision a similar future where you do a 3-5 year residency just in pain and interventional, minimally invasive spine. I'm curious though what you all involved in the speciality think though.

Hard to say I’m private practice and so far removed from anything related to ACGME/training at this point - I didn’t even realize we just had a new pain match. That being said - I personally think it could be a standalone residency. You would def need an intern year in something to get ur general medicine/physician skills before going into the clinic. Problem I’m sure is all funding and the lack of it. Prob better to take those funds away from these stupid new EM residencies popping up and put it into something else but whatever kinda not my battle anymore

 

[Frazier]

Managing pain, true pain, is a great gift for patients and their QoL...as well as for their families.

I always had an interest in this facet of being a physician -- as a med student even did a lot of shadowing/research in anticipation of being a pain doc -- but I'm personally not enamored with procedures as much as others, so interventional pain medicine wasn't the best fellowship for me.

I'm always happy to refer my patients on service or in clinic to our interventional colleagues when they might have an ace up their sleeve that I can't provide when it comes to complex pain management.

Recently had a pt who benefitted from celiac plexis block for recalcitrant pain despite optimized medical approach. Patient, family, my team -- we were all grateful.

It's a great subspecialty.

 

[GatorCHOMPions]

I’ll throw another nod toward @Birdstrike for inspiring me to apply and match this cycle. It almost feels like there’s a cult following now.

For anyone thinking of applying, feel free to PM me. I have a few years of attending experience too, so I’m the non-traditional of non-traditional applicants. I can’t say it was easy but feel it will definitely be worth it.

 

[Birdstrike]

Update: To those who are interested. I just got a private message from an another EM physician who was recently accepted to a Pain Fellowship (ACGME). The steady trickle of EM applicants getting accepted, continues. It's totally doable, and has been for a long time.

 

[hector10]

@Birdstrike can you comment on which programs these docs matched to?

i need some hope right now, I’m a pgy1 and not liking EM as much as I thought I would.

 

[Birdstrike]

@Birdstrike can you comment on which programs these docs matched to?

i need some hope right now, I’m a pgy1 and not liking EM as much as I thought I would.

Some of the programs names I know, some I don't. What would be best if they would chime in here, themselves, or DM you. But what I advised people to do, is to apply to all the programs. All 80 or 90. That's the only way to be sure you capture all the programs that might be open minded to someone with a background like ours. Cherry picking is too likely to miss potentially favorable programs that may not announce their viewpoint publicly. You have to overwhelm the long odds as a non-traditional applicant, with volume. It works.

A phone call, email or tip on an internet forum isn't enough to see if they might bite. You've go to put an application in front of them.

Get (or make) a Pain rotation. Then apply everywhere and you'll have a shot.

 

[Birdstrike]

Unsuccessful people look to those that say, "You can't do it," for advice.

Successful people make a habit of proving people that say, "You can't do it," wrong.

It's up to choose which of those people you're going to be.

 

[Franzd'Epinay]

Im a pain physician - also EM trained but havent worked in months EM due to covid/staff cutting. Interventional pain is exploding. We are becoming the minimally invasive spine guys - similar to interventional cards vs ct surgery. What things I've done since finishing fellowship besides your bread and butter pain stuff (im a few years out of fellowship now)-
- Lumbar discectomy
- SI Joint fusion
- Facet joint fusion
- Indirect lumbar decompression with vertiflex
- Kypho/vertebroplasty
- Not yet indicated a patient for it but just trained on posterolateral lumbar fusion.

Exciting time to be a pain specialist/interventional spine doc. Yes I still write a lot of percocet.

I probably know half the current EM pain fellows or just graduated docs as I've had convos with most of them either at ACEP or on the phone. PM me if you all have any self specific questions

From the outside looking in, it seems like the fellowship should be a lot longer than one year given the procedures you listed.

I'm just thinking that if someone told me that in one year I could be an expert in all the spinal procedures you listed, I would have a really hard time believing them.

 

[swamprat]

From the outside looking in, it seems like the fellowship should be a lot longer than one year given the procedures you listed.

I'm just thinking that if someone told me that in one year I could be an expert in all the spinal procedures you listed, I would have a really hard time believing them.

You are 100% correct - it should be longer but its not and your not an expert in those procedures - you learn the basics - how to guide a needle under fluoroscopy, anatomy, med management etc.

However if your motivated you get out and continue your education - more self directed. I'm 3 years out now - the stuff I do now I wouldn't even contemplate or attempt when I was fresh out. I've read, attended courses, had other physicians work with me to get me to where I am today. Sure I could have just stuck to bread and butter stuff but advancing the field and helping patients in other various ways is very satisfying to me career wise - all depends on your motivation when you get out

 

[Birdstrike]

From the outside looking in, it seems like the fellowship should be a lot longer than one year given the procedures you listed.

I'm just thinking that if someone told me that in one year I could be an expert in all the spinal procedures you listed, I would have a really hard time believing them.

I agree with what @swamprat just said. Pain fellowships should either be two years, or Pain should be a residency. But currently, it is neither. 1 year is enough to learn the bread and butter procedures and some advanced procedures. But you do have to do some self study on your own. For example, I took a company paid kyphoplasty class after fellowship to beef up my skills in my first year out of fellowship, because I wanted to and the Kypho company made it very easy. It helps to do that with some of the more advanced stuff, especially if you didn't do many in your fellowship. It's also needed, if new techniques come along, which happens all the time as technology advances.

 

[hector10]

What do you think of non-acgme pain fellowships?
I was told that I could sit for ab of pain medicine and get credentialed that way?

 

[Birdstrike]

What do you think of non-acgme pain fellowships?

None will allow you any official board certification or credentialing. They're equivalent to "EM fellowships" for Family Physicians.

I was told that I could sit for ab of pain medicine and get credentialed that way?

You likely can. But that's not an officially recognized board. Very few people or places are going to consider it official.

If you wouldn't go to a non-accredited EM program and settle for a non-accredited EM certification, you shouldn't do it for your subspecialty. If you want to be a subspecialists in something, you should be an recognized expert in it. You can only get that recognized training and credentials. That's my two cents.

 

[partypantss]

Is there anything we should be looking for in residency programs if we want to keep pursuing a pain fellowship an option? Does it really matter a lot where you go?

 

[swamprat]

Is there anything we should be looking for in residency programs if we want to keep pursuing a pain fellowship an option? Does it really matter a lot where you go?

If you wanna do pain do anesthesia still not a standard or common pathway. Prob 15 of us at this point

 

[Birdstrike]

Is there anything we should be looking for in residency programs if we want to keep pursuing a pain fellowship an option? Does it really matter a lot where you go?

I agree with the above that if Pain is your primary goal, residency in Anesthesia > PM&R > EM + every other specialty, is your best chance. If you do go the EM path, however, try to find a program that will let you do an elective rotation in Pain. For some reason, arranging a Pain elective as an EM resident appears to be more difficult than simply applying cold turkey and getting into a fellowship. Although I was never able to do it, it would definitely help though, if you could do a Pain rotation first.

 

[partypantss]

I agree with the above that if Pain is your primary goal, residency in Anesthesia > PM&R > EM + every other specialty, is your best chance. If you do go the EM path, however, try to find a program that will let you do an elective rotation in Pain. For some reason, arranging a Pain elective as an EM resident appears to be more difficult than simply applying cold turkey and getting into a fellowship. Although I was never able to do it, it would definitely help though, if you could do a Pain rotation first.

Gotcha, well I'm for sure doing EM, just curious about the prospect of pursuing pain if I decided to in a year or two and how my residency program selection may affect things. I think it's such a niche "forge your own path" route though that there isn't much solid advice someone can give. I imagine academic places that generally are supportive of elective time/ finding your niche would be the places that would most likely enable that sort of thing. Thanks!

 

[GatorCHOMPions]

Gotcha, well I'm for sure doing EM, just curious about the prospect of pursuing pain if I decided to in a year or two and how my residency program selection may affect things. I think it's such a niche "forge your own path" route though that there isn't much solid advice someone can give. I imagine academic places that generally are supportive of elective time/ finding your niche would be the places that would most likely enable that sort of thing. Thanks!

Any EM program with a Pain Fellowship at the same institution would give you a leg up since you’d be much more able to do an elective rotation there, get an LOR, and be involved in other ways. Look at ERAS for a complete list of fellowships.

 

[Birdstrike]

I think it's such a niche "forge your own path" route though that there isn't much solid advice someone can give.

There's plenty of advice I, and the others that have gone the EM/Pain route, can give on this subject. But I think it's very smart to view it as a "forge your own path" route, like you do. There's a lot of truth to that and nothing will be handed to you easily. There is no safe, or surefire, path.

Probably the biggest advice I can give you, is to overwhelm the longer odds (as an EM applicant) with sheer volume, and apply to all the programs. That means all 80 or 90, whether they're in the Match or not. It can be brutally labor intensive, particularly the ones that are outside the match, but worth it. I don't think you can predict very well, which programs are going to be "EM friendly," as everyone understandably wants to do. I got interviews at places that advertised being "Anesthesia only." I also got rejected at places that claimed to be more open and "multidisciplinary." You can always turn down interviews and fellowship offers at places that are undesirable, if you have too many, but you can never create one out of thin air, from where you did not apply.

I imagine academic places that generally are supportive of elective time/ finding your niche would be the places that would most likely enable that sort of thing.

I agree.

Give it a shot. It's definitely worth considering doing the fellowship if you're lucky enough to be offered a spot. Good luck!

 

[Airborne Flt Doc]

Emergency Medicine docs want to do Internal Medicine Pain Management jobs now and they are also working as Hospitalist now too in the dual rual hybrid (ER/IM) and observation programs. Mayby $150/hr and experienced ABEM colleagues and residents or telling me this is the going rate for their services nowadays, if your really lucky mayby $185/hr

Students, FP/IM is the way to go and keep all your options open.

 

[dadaddadaBATMAN]

Emergency Medicine docs want to do Internal Medicine Pain Management jobs now and they are also working as Hospitalist now too in the dual rual hybrid (ER/IM) and observation programs. Mayby $150/hr and experienced ABEM colleagues and residents or telling me this is the going rate for their services nowadays, if your really lucky mayby $185/hr

Students, FP/IM is the way to go and keep all your options open.

What a fascinating combination of ignorance, both of em and of pain medicine.

Let’s start with the fact that im is not eligible for pain fellowship (em, anesthesia, pm&r, psych, neuro are).

I am making significantly more per hour than your “going rate” as a fresh attending, and I am probably on the low end of my class as I took an employee position with some nice benefits.

I have never met an “ed hospitalist.” If they exist they are probably old school im fm docs.

Family practice is great and pretty flexible, but it hardly offers a huge array of fellowships. Im certainly does, but I don’t think that’s particularly helpful advice.

Solid trolling though, and a nice necrobump from a few months ago. The eyes had just started to go fixed and dilated

 

[Birdstrike]

Emergency Medicine docs want to do Internal Medicine Pain Management jobs now

A small percentage of EM physicians have gone into interventional Pain Medicine, which is the same fellowship anesthesia/PMR/neuro/psych/rads&FM do. I'm not sure what "internal medicine pain management is," but I sure don't want to do it.

 

[Birdstrike]

If you're coming from an EM or other non-anesthesiology background, you should apply to all 110+ programs (however many there currently are) including those in the match and those not in the match. Because some will have outdated websites that say, "Anesthesia only" but they interview multiple specialties. Plus, these preferences change year to year. Overwhelm the longer odds with volume and apply everywhere. However:

Stanford had an EM physician in their 2019-2020 class.

Harvard has a notable EM/Pain person on faculty and has for years (go straight to "Bio")

MD Anderson has taken EM applicants and has a notable Pain fellowship trained EM doc on staff.

Dartmouth even has an Family Medicine physician in their 2020-2021 class.

I also happen to personally know EM people who either did fellowships at, or got interviews at, the following places:

UC Davis, University of Pittsburgh (UPMC), University of Iowa, Mt. Sinai/Beth Israel (NYC), Mass General, Beth Israel (Boston), UT San Antonio. I'm sure there are others. If anyone knows of any others, please post.

But as laborious as it is, apply to every program (100+), in the Match and outside the match. You may even have higher odds at non-match programs, since these programs tend to have fewer applicants.

Regardless, people are doing it. There's not reason not to, if you're interested, since Pain is an official subspecialty of EM (see ABEM). The biggest deterrent I see among EM people is a confidence gap, not a knowledge or skills gap.

List of all ACGME Pain fellowships, below:

 

[deadhead2]

If you're coming from an EM or other non-anesthesiology background, you should apply to all 80 or 90 programs (however many there currently are) including those in the match and those not in the match. Because some will have outdated websites that say, "Anesthesia only" but they interview multiple specialties. Plus, these preferences change year to year. Overwhelm the longer odds with volume and apply everywhere. However:

Stanford had an EM physician in their 2019-2020 class.

Harvard has a notable EM/Pain person on faculty and has for years (go straight to "Bio")

MD Anderson has taken EM applicants and has a notable Pain fellowship trained EM doc on staff.

Dartmouth even has an Family Medicine physician in their 2020-2021 class.

I also happen to personally know EM people who either did fellowships at, or got interviews at, the following places:

UC Davis, University of Pittsburgh (UPMC), University of Iowa, Mt. Sinai/Beth Israel (NYC), Mass General, Beth Israel (Boston), UT San Antonio. I'm sure there are others. If anyone knows of any others, please post.

But as laborious as it is, apply to every program (100+), in the Match and outside the match. You may even have higher odds at non-match programs, since these programs tend to have fewer applicants.

Regardless, people are doing it. There's not reason not to, if you're interested, since Pain is an official subspecialty of EM (see ABEM). The biggest deterrent I see among EM people is a confidence gap, not a knowledge or skills gap.

List of all ACGME Pain fellowships, below:

Great advice by @Birdstrike as usual!

I will be starting fellowship this year. I applied to 80 programs and received 11 invites: OHSU, Medical College of Georgia, University of Florida, Penn State, UVA, VCU, EVMS, University of Michigan, University of Rochester, LSU, and University of Mississippi. Not sure exactly how open each of these programs are to EM, but they all at least considered an EM candidate so that's something!

Ultimately matched where I did my Pain away rotation as a PGY-3 and I am extremely happy. I won't say where I matched for anonymity although I'm sure my identity is easy enough to determine with the information in my postings as is.

Like Birdstrike said, EM people can absolutely do this and should go for it if they have the desire. Hopefully more and more programs will open up to EM as more and more EM-trained docs apply. Just since I applied and matched, I have received 3 PMs from EM attendings interested in Pain and 9(!) PMs from EM residents who are considering Pain fellowship or have submitted applications! Obviously the interest is there.

 

[Birdstrike]

Great advice by @Birdstrike as usual!

I will be starting fellowship this year. I applied to 80 programs and received 11 invites: OHSU, Medical College of Georgia, University of Florida, Penn State, UVA, VCU, EVMS, University of Michigan, University of Rochester, LSU, and University of Mississippi. Not sure exactly how open each of these programs are to EM, but they all at least considered an EM candidate so that's something!

Ultimately matched where I did my Pain away rotation as a PGY-3 and I am extremely happy. I won't say where I matched for anonymity although I'm sure my identity is easy enough to determine with the information in my postings as is.

Like Birdstrike said, EM people can absolutely do this and should go for it if they have the desire. Hopefully more and more programs will open up to EM as more and more EM-trained docs apply. Just since I applied and matched, I have received 3 PMs from EM attendings interested in Pain and 9(!) PMs from EM residents who are considering Pain fellowship or have submitted applications! Obviously the interest is there.

Great post, and congrats!

 

[GatorCHOMPions]

Below is the list I have compiled from various EM/Pain people on SDN of programs who have offered EM applicants an interview. A huge caveat, though, is that this is a changing and advancing target each year. I can't stress enough the importance of applying to virtually everywhere. The program I matched at was not on this list and in fact advertised on their website something like "applicants from anesthesiology, PMR, neurology, and psychiatry are encouraged to apply". No mention of EM and yet that's where I matched. In general the larger programs (like 4 or more fellows) are more open to non-traditional applicants, but note some smaller programs on this list as well.

UCSD
Loma Linda
UC Irvine
Stanford
UC Davis
University of Florida
Medical College of Georgia
University of Iowa
Northwestern
Loyola
LSU
BID
BWH
MGH
Hopkins
Detroit Medical Center
University of Minnesota
Mayo Clinic
OHSU
Michigan
WashU
University of Mississippi
Cooper
RWJ
University of New Mexico
Montefiore/Albert Einstein
Mount Sinai
NYP Columbia
NYP Cornell
University of Rochester
Cleveland Clinic
UPMC
Penn State
MD Anderson/UT Houston
UT San Antonio
EVMS
UVA
VCU
Virginia Mason

 

[Birdstrike]

Below is the list I have compiled from various EM/Pain people on SDN of programs who have offered EM applicants an interview. A huge caveat, though, is that this is a changing and advancing target each year. I can't stress enough the importance of applying to virtually everywhere. The program I matched at was not on this list and in fact advertised on their website something like "applicants from anesthesiology, PMR, neurology, and psychiatry are encouraged to apply". No mention of EM and yet that's where I matched. In general the larger programs (like 4 or more fellows) are more open to non-traditional applicants, but note some smaller programs on this list as well.

UCSD
Loma Linda
UC Irvine
Stanford
UC Davis
University of Florida
Medical College of Georgia
University of Iowa
Northwestern
Loyola
LSU
BID
BWH
MGH
Hopkins
Detroit Medical Center
University of Minnesota
Mayo Clinic
OHSU
Michigan
WashU
University of Mississippi
Cooper
RWJ
University of New Mexico
Montefiore/Albert Einstein
Mount Sinai
NYP Columbia
NYP Cornell
University of Rochester
Cleveland Clinic
UPMC
Penn State
MD Anderson/UT Houston
UT San Antonio
EVMS
UVA
VCU
Virginia Mason

Wow, that's great. The list has expanded a lot over the past few years. Great sign. I agree with applying to all (>100) programs to overwhelm our tougher odds, with sheer volume. You can always cancel interviews, or turn down extra offers. But you can't create one out of thin air, where you didn't apply, but had a chance and never gave it a shot.

Why do EM applicants think this is so impossible, when it's clearly not?

Because of the anesthesia and PM&R residents telling them it is. It's the same mind-games we all dealt with from the, "You'll never get into Medical school" crowd. They don't want any extra competition for those spots!

 

[AlvinKamara]

Wow, that's great. The list has expanded a lot over the past few years. Great sign. I agree with applying to all (>100) programs to overwhelm our tougher odds, with sheer volume. You can always cancel interviews, or turn down extra offers. But you can't create one out of thin air, where you didn't apply, but had a chance and never gave it a shot.

Why do EM applicants think this is so impossible, when it's clearly not?

Because of the anesthesia and PM&R residents telling them it is. It's the same mind-games we all dealt with from the, "You'll never get into Medical school" crowd. They don't want any extra competition for those spots!

Getting close to graduating and thinking harder about this. What can I do in my last year to bolster my application for pain?

 

[Birdstrike]

Getting close to graduating and thinking harder about this. What can I do in my last year to bolster my application for pain?

Have you done an Interventional Pain Rotation? That's probably the biggest thing you could do to bolster your application. If you can't get a rotation, consider doing a pain procedure cadaver course (not as a substitute for a fellowship, but pre-applying to fellowship), where you do injections on cadavers under fluoroscopy. You have to pay to take these and they may be harder to find during COVID. Doing lots of shadowing, wouldn't hurt, either. Getting to know local Pain MD's, going to local, state or national Pain meetings can't hurt. It helps to network; Pain is a very small subspecialty. Doing research during residency that is Pain related, never hurts. There are lots of EM topics that also are relevant to pain (either acute or chronic) which are equally relevant to EM and could count as both. Getting exposure to anything related to regional anesthesia (nerve blocks) could also help.

 

[AlmostAnMD]

Doing research during residency that is Pain related, never hurts.

I dunno, it kind of sounds like...a pain


>_>

I'm sorry

I'm very sorry

I've contributed nothing

 

[Birdstrike]

I dunno, it kind of sounds like...a pain

It is a pain. Isn't that the point? (haha)


But on a more serious note, I got into fellowship with zero research background, and no interest in it. So I agree with what (I think) you're getting at. But for people with an interest in research or for those who it comes easily, it may be a helpful application-bolstering option. Or not. I don't know. Whatever works. Or if it's just too much of a pain, they can stay in the ED. That's okay, too.

 

[hector10]

How do you get away rotations ? Do you email the program coordinator??

 

[Frazier]

@Birdstrike Do you maintain ABEM certification to this day practicing only pain?

It isnt clear to me if it is something that we HAVE to do, but given our subspecialty certifications are sponsored by ABEM I imagine we must?

I saw a group of IM subspecialists discussing how it isnt required to stay ABIM certified for their IM subspecialties -- made me wonder about EM.

 

[Birdstrike]

@Birdstrike Do you maintain ABEM certification to this day practicing only pain?

It isnt clear to me if it is something that we HAVE to do, but given our subspecialty certifications are sponsored by ABEM I imagine we must?

I saw a group of IM subspecialists discussing how it isnt required to stay ABIM certified for their IM subspecialties -- made me wonder about EM.

I still am board certified in EM, as well as my subspecialty. I've maintained both going on 9 years, now. But I have very good news for you, my friend!

"Physicians certified by the American Board of Emergency Medicine (ABEM) who also hold an ABEM-issued subspecialty certificate are no longer required to maintain their core Emergency Medicine (EM) certification as long as they are participating in an ABEM-accepted Maintenance of Certification Program." - ABEM, 10/02/2018