Pain vs. Sports&Spine vs. Sports Medicine

[spme]

Please add anything you can to better characterize each fellowship types...

Pain management
-ACGME accredited, will at least receive balanced exposure to variety of procedures
-More competitive to secure a job in urban setting
-Minimal sports exposure if you are looking for sports coverage

Sports & Spine
-Not ACGME accredited, but as far as experiences go, it is basically "best of both world between pain and sports medicine"
-May not be as competitive to apply for urban setting jobs compared to ACGME accredited graduates
-Exposure varies from fellowship to fellowship
-Lack of reliable list of fellowships

Sports Medicine
-ACGME accredited
-If you are looking to work for some college teams or semi/professional teams, this maybe the option
-Solid MSK US exposure
-Minimal to no interventional spine exposure (I hear Spaulding program has a few months of basic lumbar injections)

Question: How competitive is Sports Medicine (PM&R based) compared to pain management? Some say sports medicine is more competitive than pain, due to its scarcity of available spots.

Thanks for your input!

SPME

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[DOctorJay]

ACGME accredited fellowships are very competitive be they sports or pain.

what you need to ask yourself is what are you willing to sacrifice a year of work for in order to get a year of fellowship training and how is that going to benefit you and the patients you would like to help in the future.

and realize that most people who do sports fellowships don't end up doing 100% sports.

 

[Gauss]

things to consider:
the more board certs you have the better; it will open doors for you long term. hospitals and insurances are requiring more certifications in order to allow you to do procedures and pay for them.
pain & spine will have a tumultuous future. Opiates and addiction are a huge societal problem so expect that to be a large part of its future. purely interventional practices are getting cut hard in reimbursement and everyone's trying to get a piece of the pie before it's gone.

 

[AndyDufrane]

as I finish up a non ACGME spine fellowship, looking back, I would have done either an ACGME pain fellowship or sports med, more likely sports med cause the pain patients you need to see in clinic to generate your procedures can be challenging to deal with, if can't get into ACGME fellowship, then save yourself the time and just get a job, I agree, the ACGME label keeps doors open, I have also heard of hospitals and insurance companies shutting the door on docs not trained at ACGME fellowships

 

[Louisville04]

as I finish up a non ACGME spine fellowship, looking back, I would have done either an ACGME pain fellowship or sports med, more likely sports med cause the pain patients you need to see in clinic to generate your procedures can be challenging to deal with, if can't get into ACGME fellowship, then save yourself the time and just get a job, I agree, the ACGME label keeps doors open, I have also heard of hospitals and insurance companies shutting the door on docs not trained at ACGME fellowships

From reading the pain medicine forum, most docs prefer to do procedures in their office instead of the hospital. You can always get PM&R privileges at a hospital. As for insurance companies, you usually have to negotiate rates. Maybe they would reimburse you less if not ACGME trained? Since there are so many non ACGME fellowship trained docs doing procedures, I don't think that door will be shut.

 

[bedrock]

From reading the pain medicine forum, most docs prefer to do procedures in their office instead of the hospital. You can always get PM&R privileges at a hospital. As for insurance companies, you usually have to negotiate rates. Maybe they would reimburse you less if not ACGME trained? Since there are so many non ACGME fellowship trained docs doing procedures, I don't think that door will be shut.

The sky is always falling for the chicken littles of the world. Although there are a couple of small insurances companies in BFE that require ACGME pain boards to reimburse for pain procedures, >99% of U.S. insurance companies will pay physicians of any specialty to do pain procedures, including spine surgeons, radiologists, family doctors, and even mid-levels. If those people are getting paid to do pain procedures, A (non-ACGME) fellowship-trained MD will have no problem getting paid for pain procedures.

The hospital is the only real place that non-ACGME pain docs really do get shut out of, particularly in desirable urban locales.
Fortunately, you can always do just do your pain procedures in your office or local ASC, and send your SCS perms to a surgeon for a paddle lead.

 

[spme]

Thank you all for your 2 cents.

As far as the skills you will learn, here is my understanding for each fellowship.

1. Pain management-you will learn bread and butter procedures such as lumbar injection but also you will learn more risky and invasive procedures such as pump placement, cervical spine injection, rhizotomy etc. You will also learn how to medically manage narcotics better than other 2 fellowship types.

2. Sports & Spine-experience largely differs from program to program but most places will give you combination of basic axial injections, some ultrasound experiences, and some sports coverages (and thus management of on-field injuries like concussion, heat stroke, asthma, acute spine injury etc).
Difference from pain management is you will less likely to perform invasive axial procedures other than bread and butter epidural, caudal, c-spine injections.

3. Sports medicine: few programs may train you with axial injection. But majority of time will be spent learning skills such as diagnostic MSK US. It is also likely that your attending is into things like prolotherapy and PRP and you may get some experience in it. But what's the skill you will be much better by completing sports medicine compared to other 2 fellowship types?


SPME

 

[bedrock]

thank you all for your 2 cents.

As far as the skills you will learn, here is my understanding for each fellowship.

1. Pain management-you will learn bread and butter procedures such as lumbar injection but also you will learn more risky and invasive procedures such as pump placement, cervical spine injection, rhizotomy etc. You will also learn how to medically manage narcotics better than other 2 fellowship types.

basically sums up the educational difference.

Re jobs- there are some jobs in desirable locales where being pain boarded is critical, but plenty of jobs overall for non-pain boarded docs who do spine fellowships


2. Sports & spine-experience largely differs from program to program but most places will give you combination of basic axial injections, some ultrasound experiences, and some sports coverages (and thus management of on-field injuries like concussion, heat stroke, asthma, acute spine injury etc).
Difference from pain management is you will less likely to perform invasive axial procedures other than bread and butter epidural, caudal, c-spine injections.

very few sports and spine programs teach cervical injections and epidurals(5 programs at the most). You need to include that in your decision making because.....

Re jobs- limited in many way for sports and spine grads because many jobs want you do be able to do cervical epidurals/injections. This will keep you from working at many orthopedic practices or pain groups. Lack of cervicals isn't an issue in pmr academic departments, but it often is a problem in the real world.
Jobs can be somewhat limited in that you're hard to define. There are no job postings for sports and spine, but there are plenty for pain or for sports. You can certainly create your own job with your skill set, but hard to do right out of fellowship.

3. Sports medicine: Few programs may train you with axial injection. But majority of time will be spent learning skills such as diagnostic msk us. It is also likely that your attending is into things like prolotherapy and prp and you may get some experience in it. But what's the skill you will be much better by completing sports medicine compared to other 2 fellowship types?

the skill you learn is that you actually know how to care for division i college and professional athletes who have different and often much more challenging problems than weekend warriors. I worked in two clinics with nba and nfl athletes and what you need to know is totally different from the "msk medicine" you get during pmr residency or a sports & spine fellowship. There are so many sports medicine issues you don't see anywhere but a dedicated sports fellowship at a major university

the other skill you should gain is to be much better in msk us and us procedures than many sports & spine docs as they spend much of their fellowship doing spine and lumbar axial injections.

Re jobs- plenty of jobs for sports boarded docs


spme

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