ED50

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Hey everyone, I have read all the old posts about this and was hoping someone could provide some recent insight/thoughts on this conundrum. I find myself liking peripheral joint issues - knees, elbow, shoulder etc however I have no desire to work with elite athletes nor do I particularly want to be a team doc for college etc ( I would like to work with local teams more as a volunteer activity). I additionally like spinal pathology/rehab and really enjoy time in the fluro suite. I'm not really interested in inpatient pain and am currently ambivalent about palliative pain (I need more exposure). I plan on going into private practice when all is said and done in either a medium - 150k or large 1m city. Sports and spine seems like it will give me the skill set I am looking for but I am worried about the non accredited aspect of it. Any thoughts/suggestions/insults are welcome :)
 

DOctorJay

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Do an accredited pain fellowship and get the paper. Then decide how you want to practice. Ask Taus how he likes his job;)
 
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cbest

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Agreed, do pain. No offense to any sports med docs out there, but I think with a physiatry background, you can always learn more sports/MSK/regenerative medicine. I don't think the same can be said about learning interventional spine/pain procedures in a competent and safe manner.
 
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j4pac

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Agreed, do pain. No offense to any sports med docs out there, but I think with a physiatry background, you can always learn more sports/MSK/regenerative medicine. I don't think the same can be said about learning interventional spine/pain procedures in a competent and safe manner.
This is what it came down to me. Other than elite sports coverage, I should be able to do most things that a Sports fellowship would provide without a fellowship. I think that entering practice without a fellowship is a very valid plan too. The cost of a fellowship is about $150,000 in lost income. I feel like you have to be able to justify that in some way.
 
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ED50

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Thanks for the thoughts, pain fellowship has been my focus for a long time and only recently I discovered liking peripheral joint issues as well. I feel that most of what I want from a sports fellowship I can obtain through other avenues.
 

padresp

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Speaking from someone on the sports side of the fence, I agree with the previous posters. You'd be happiest with pain it sounds like. My 2 cents is that a good sports training will probably give you better knowledge of MSK and sport-specific injury patterns, diagnostic ultrasound, acute injury management, and ability to handle sports teams (that's in addition to sports coverage). This doesn't sound like it's what you are looking for. Some sports programs do have spine procedures, but I don't think it's the same level as you would get in a pain fellowship.
 

NLink0714

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I applied for Pain this year in my program. I'm the only one but 4 of my colleagues went sports and spine.

Biggest issue I saw was credentialing in larger cities/institutions. I'm in a large city and it's nigh impossible for sports and spine people to find jobs here. But pain, even my own institution wants to take people. Smaller areas or rural I don't know but my colleagues are there and said it was definitely easier being boarded.

Echoing what everyone else is saying, credentialing matters. Certification matters. I didn't find pain particularly overtly competitive (it's competitive but do what you can to make yourself a good candidate and it will easily work out). Check out the pain medicine forum, I'll be posting fellowship interview reviews there (that is, unless I don't match...I feel that I will but not going to say anything until it's written and in my hand).
 
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DOctorJay

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with so many private practices being swallowed up by large networks you're doing yourself a big favor to get the ACGME fellowship and paper in hand. It's very possible to be a sports and spine guy at a large ortho group that some time in the future gets swallowed up by a hospital system. they look at your training and say you can still work there but they won't credential you to do any fluoro work.
 
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AndyDufrane

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I am echoing what Dr Jay has already said, do yourself a favor and do either an ACGME pain fellowship if you are slightly inclined to do spine injections, or ACGME sports fellowship if you are not so much into back pain and doing spine injection, real simple, anything outside of that if you are thinking MSK jobs, you are putting yourself at risk of hospitals not credentialing you because of no ACGME pain fellowship, and even insurance companies not giving you credentialing for spine injections...just my 2 cents.

I would disagree with learning to be a sports med physiatrist on the fly, as I worked in a sports med ortho group for a year with a family med sports doc and ortho surg sports med doc, and if a fracture comes through the door, the non op sports med specialist would manage the fracture (casting etc, or refer to surgery) and basically functioned like the ortho surgeon minus obviously the surgery side, so don't think you can hang up a shingle saying sports med physiatrist without actually having done a sports med fellowship
 

myrandom2003

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just fyi every hospital I have been too in four states (indiana, alabama, ohio, new york) accepts american board of pain medicine board certification.
So if you somehow dont end up going the accredited route or going an interventional spine pmr program (such as the university of michigan spine fellowship), then take that test and it should cover you for a lot of places.
 

RM38

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I am a new attending working in private practice pain group. I did a fellowship that is now unaccredited, but has a solid reputation because of who ran it and the fact that it used to be accredited by the ACGME for a long time. I did a wide variety of procedures including pump and stim implants, endoscopic procedures (attendings only for those), inpatient pain consults and the full range of bread and butter stuff. I also live in a state that accepts both ABIPP/ABPM as equivalent board certification in Pain medicine. I am very happy with my job so far in the first 3 months, and I am close to home in area that I like. I do not do inpatient consults in practice or take call. I work mostly 9-5/6 M-F and I am making more than my friends whom did sports fellowships and whom are doing general PM&R. I also am in a Pain only group, so I do not have to deal with surgeons as my boss which is also nice. I agree that I am comfortable managing pretty much any MSK issue that is non-surgical, and if you have decent MSK exposure in residency you should be able to do most of what sports docs do. That being said I recommend doing an accredited fellowship if possible for several reasons as noted above. The big one is that many hospitals and insurances will not credential you without an ACGME fellowship. Knowing this, many places including private practices will not be interested in hiring you, even in states that accept ABIPP/ABPM. Also many sport and spine places don't manage medications, and jobs that will want you to prescribe will want to see that you can safely manage those patients and are comfortable doing so. More than 90% of my patients are within the CDC guidelines, but every now and again I get someone on a very heavy dose of meds that I need to wean and you need to be able to do that without sending everyone into withdrawl. Also some don't know how to read an LCMS, which is usually easy as the companies lay what is in there out for you, but could be an issue if you miss stuff because you don't know what some of the metabolites are. Agree you can get a job in pretty much any setting with a pain fellowship, but could be limited with sports. In the end having the accredited fellowship may make your life much easier, especially if you want to live in a competitive job market. I was not able to find a job in my primary target area partially due to the accreditation issue, but I am not that far away which is ok for me, but may not be for you or your spouse if you have one. I reccommend applying to both accredited and unaccretited places though, as the application process has gotten very competitive and many good applicants don't match. Good luck.
 
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