PM&R and Spine,Sports,Musculoskeletal, and Pain

[MSK]

I am a 4th year going into PM&R and planning to do a Pain or Spine and Sports fellowship. After an anesthesia pain experience, I feel as though a PM&R route would provide a much more comprehensive and relevant knowledge base than an anesthesia residency concerning musculoskeletal or physical exam exposure. How much of this exposure do you typically receive in a pain fellowship? I do recognize that most anesthesia residents get more injection experience? Is this an easier gap to close or vice-versa?

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[briandavis]

Given that my wife is a board-certified pain management Anesthesiologist and the fact that I have participated in the training of over 100 Anesthesiologists in my career, I can say that on the average, there is a lack of straight musculoskeletal training. It is changing at many programs. At UC Davis, they have hired one PM&R faculty member and have brought another (me) to specifically teach musculoskeletal experiences.

The amount of exposure clearly will vary from program to program from one time of year to another based upon patient load, insurance demands of the attending and the exposure of the attending to musculoskeletal examinations.

You REALLY need to decide if you're going to do 'Pain' or 'Sports/ Spine' early on, as the training backgrounds are very different, and could change your choice of residency.

Pain: Anesthesiology teaches you boatloads about the pharmacokinetics of meds, physiology of pain, complication management, procedures, etc. May have less musculoskeletal exposure.
PM&R usually requires additional training to learn the procedures, as there are not enough done in training to meet hospital requirements.

Sports/ Spine: Not usually done by Anesthesiologists - not out of the questions, but given the reduced musculoskeletal exposure, it is not usually done. PM&R is excellently suited in residency to prepare you for a fellowhsip here, as your first three years are spent dealing with the mechanics of injury (minor to catastrophic) and trying to recover to baseline as much as possible.

Hope these help...

Brian

 

[drvlad2004]

It's great to hear a PM&R attending writing on this forum. I am interested in sports/spine injury. What residency program should look at when I start applying?

Thanks

 

[MSK]

Dear Dr. Davis,

Thank you for answering my question about anesthesia vs PM&R and pain management. You seem ideally suited to give advice considering your background. It seems most pain fellowships might be best served by having both types of residents (like yours) so they could learn from each other. Also, ideally, a pain clinic would be multidisciplinary in order to maximize options available to a given Pt (since alot of pain management is trial and error)

Do the PM&R residents in your fellowship continue to do EMG/NCS during your fellowship?


Thanks again

 

[briandavis]

As of right now, the PM&R pain fellows exclusively do Anesthesiology-based Pain Management. It is very difficult to coordinate an experience that combines these aspects of PM&R with the Pain Fellowship. However, given that I do several EMG lectures with them and go over studies with them on an occasional basis, they at least get some continued exposure before the oral boards.

The UCD program appears to be quite unique in it's scope and exposure, and would love to get the fellows into our EMG lab, if possible, as it would really enhance their place as PM&R docs in the community.

Brian

 

[Spine Specialist]

Dear Dr.Davis,

I am a PGY4 looking for a pain fellowship next year. My interest includes sports medicine, spine and interventional pain management. I am not very much interesed in getting anesthesia oriented pain training like spinal cord stimulator insertion and cancer pain care etc.

My main concern at the moment is that the fellowship program ( sports & Intervention) where i want to go is not ACGME accredited. I am worried about the pain certification which is not possible with Non-ACGME accredited program. What do you think abt being a Fellowship trained Physiatrist who does intervention without pain certification? Are there any long term consequences without pain board certification?

I understand FACSM is board certification in Sports Medicine. What are the requirements to pass this exam?

Thanks for your input in this forum.

 

[briandavis]

Dear Pain Specialist:

I cannot tell what the future or current circumstances hold for non-'accredited' Pain folks. There was a big stir several years ago about needing the EMG boards to get better reimbursement or to possibly get credentialing which never panned out. Given the fact that there is now a Pain Board exam (not a pseudoexam like the EMGs or the CAQ for Sports/ Primary Care), it would cedrtainly serve you well to have it. It may mean more to a PM&R doc than an Anesthesiologist, just because of the recognition issues that come from being Board-certified as a PM&R doc. I would recommend talking to some of the PM&R Pain folks out there now that are more heavily into Pain issues than I. I merely have the dual appointment for teaching the Pain folks the Musculoskeletal stuff.

The Fellow of the ACSM is not an exam. It requires service to the ACSM and certain other aspects of service to the Sports community at large. If interested - you would need to join the ACSM (www.acsm.org) and look at the criteria for 'Fellow'. It usually takes about 5-7 years after finishing residency to get the required stuff. It requires working with Sports programs, lecturing, etc.

Good luck....

 

[rehabdoc]

I would like to agree with Dr. Davis regarding accreditation in pain management. I am currently in an ACGME accredited pain management program with wonderful mix of interventional spine as well as non-interventional pain management/Head ache/ cancer and Musculoskeletal-Chronic pain. I believe when it comes to applying to top jobs being academic or private practice, in order to be competitive you must be board eligibility or board certified. Few years down the road when number of board certified PM&R pain practitioners increases, it will be a must to have it in order to remain competitive. Also is in court of law your training in ACGME accredited program will be a stronger support for you in case of complications.

In my experience, board certification in EMG is also quite helpful since it order to get referral from primary cares that might not know you, being board certified means you are as qualified as the neurologist next door. Interestingly neurology graduates almost by default are considered qualified to do EMG's in the eyes of a PCP. My personal believe is while you are fresh with the material and you have the energy to study and pass it, why not; it can only open more doors for you.

Good luck in securing a pain fellowship program. Please consider U-Penn, Spaulding, UC-Davis, Michigan spine, and Emory for your training. In Anesthesia based programs I was quite impressed with Brigham, Cleveland clinic, Mayo and MGH . Apply early and have strong rec letters. Good luck.

 

[Spine Specialist]

Thanks for the replies Dr.Davis & rehabdoc.

I understand it is good to have EMG board certification and Pain certification. I am going to work on getting both of them. Definitely, i want to be a qualified and skillfull physiatrist.

I am sure many visitors of this forum would be attending AAPMR assembly at Chicago in October. Has anyone registered for PASSOR course? I have registered for phase one course. Some people say it is good to attend the course when you are in fellowship. I felt it would give me some experience and may(?) give an edge in my fellowship application. It is expensive to attend with your resident salary....but, i thought it is an investment.

rehabdoc,
I hope you are having fun in your fellowship.

 

[airforce1981]

I'm a medical student interested in PM&R, I'm particularly interested in the spinal/sports medicine side of this field. Unfortunately, the Air Force does not have a PM&R residency.
One Air Force doctor suggested that I do Anesthesiology and try to seek all the musculoskeletal cases out in my training. Then perhaps after my Air Force commitment I could do another PM&R residency or perhaps do some certification courses to hone in on spinal/sports medicine. Does anyone have any insight into this idea? Do you think I'll be barking up the wrong tree in a 4 year anesthesiology residency if my true interest is spinal/sports medicine? Thanks for your time!

 

[briandavis]

Dear Airforce1981,

I was not aware that the Air Force did not offer PM&R Residencies.

I think what you need to decide is whether or not you want to be an interventionalist more than not. Anesthesiology will give you great training to do spine and other more advanced injections, but will not give you the scope of the musculoskeletal you may be searching for that is more desirable for sports medicine, i.e. less interventional.

To save yourself a lot of years of training, you could consider doing a Primary Care residency with a fellowship in Sports to have your focus mostly in the areas of musculoskeletal. Your training in Spine or spine injections will be limited, but that's whay I say you need to decide whether you're interested in injections or not.

You could always do two residencies, but ugh!

Hope this helps.

Brian A. Davis, MD
Assoc. PRofessor, PM&R, UC Davis MEd Ctr.
Dir. of Sports & Spine Care, UC Davis PM&R

 

[DistantMets]

Could you apply for the Walter Reed Army program? There has to be a way to do a civilian residency if there are no availiable programs.

 

[vikingsfan]

NOPE. The PM&R Residency Program at Walter Reed ONLY takes Army applicants. Our Air Force and Navy bretheran either have to change uniforms (to Army) or serve their commitment and get out. For more specifics see the fun we are having on the Military Medicine forum.