Hi, I'm done with anesthesiology CA1 but thinking of moving to PMR. Just curious, is it harder to get into pain with PMR vs through anesthesiology. And if it is harder what are my chances for pain fellowship through PMR. Please advise thanks.
PMR to Pain Vs Anesthesiology to Pain
- Thread starter Magusdoc
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Probably harder as PM&R. Traditionally, most programs are anesthesia-based and there is apparently still a lot of turf battles going on, as well as some outright discrimination towards PM&R. But many PM&Rs still find fellowships.
this is only due to the inferiority of PMR physicians
(edit, orchid or whatever the text is for sarcasm)actually, if you finish another year of anesthesia, and then go to PMR and then do a fellowship, you will be one of the best trained docs out there...but its kind of a long road...
why are you thinking about leaving anesthesia for PMR, out of curiousity. THey are very different, as im sure you know? i have just never met anyone that LEFT anesthesia for something in medicine. I have met a few people that have left anesthesia for rehab, haha.
despite probably more rounded training from PMR, it is still easier to get into fellowships from the narrowly trained anesthesia residencies. But as long as you are motivitated, you can do well from either...
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the stress improves as you get more comfortable... the first year (CA-1) is the scariest, the CA-2 year you think you know everything, same with the CA-3 until the last 6 months when you again realize you dont know anything (at least hopefully, you realize you dont know anything)
after you do it for a while the stress isnt as big of a deal, but it never goes away, and it shouldnt, its part of what keeps you on your toes.
Couple of days ago my partner and I were talking about how many people we may have either killed, or at least contributed to their deaths, haha.
its not really like that, im just kidding. But you are trying to keep people alive while someone is trying to do unnatural things to them...
Pain is not without stress either. There are many days where I am waiting to get the call from the ER after a procedure... but much less than anesthesia.
its only a few months into the CA-1 year, it will probably improve...
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Doesn't PM&R have their own pain fellowships in addition to being actively sought after in anesthesia based programs (as programs move toward multidisciplinary)? To me PM&R applicants would be in the perfect position to secure a pain fellowship. Much easier than Neurology at least...
There are many more Anesthesia based pain fellowships than Rehab or Neuro. And definitely some turf issues exist so I am sure it's easier to get a pain spot coming from Anesthesia. But if you're miserable doing what you do, you won't be a very good resident and that will make things harder (in addition to you're being miserable). I think PM&R is excellent training for pain. But I have to confess I sometimes envy the extra skill set that anesthesiologists have, outside of pain. I would love to have the option to diversify, maybe do OR anesthesia once/week. People complain, they go to sleep, etc... But if you know for sure, you never want to practice OR anesthesia, PM&R will train you to do EMGs which is also a very valuable skill. As far as landing a pain fellowship spot, if you really want to do it and stay focused, you can certainly do it from either specialty.
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Hey man...read the posts here. Then see what the common trend here is. Look at which specialty has more of the Pain Fellowship Domain...pursue that one
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At this time, still easier through Anesthesiology.
You'll probably be getting into your practice around the time the changes from the health care bill start to take effect. It would be a good idea to think about what you which field you would rather be involved with if Interventional Pain Management becomes undesirable to practice.
If you're an Anesthesiologist, you'll go back to the OR. If you're a Physiatrist, you'll probably continue practicing musculoskeletal medicine minus the interventional procedures. You'll probably need to do a higher percentage of Occ Med/Work Comp (IMEs, EMGs, etc) +/- some Sports Med, +/- inpt rehab.
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Having just gone through the fellowship application, I didn't have any problem whatsoever getting a spot as a PM&R resident. I only applied to ACGME based programs and was even offered a position while I was still a PGY 3. I turned down several big name programs that many on these forums consider amongst the upper echelon of pain fellowships and ended up landing my first choice (which did happen to be an anesthesia based program). I would recommend doing a lot of research though and getting solid letters of recommendations. I had 6 publications, mostly in pain, which definitely helped me.
With that said, while some programs made it clear that they promote the multidisciplinary approach and that they actively seek non-anesthesia residents, others directly told me that they prefer anesthesia residents because of their better procedure skills. Of course, I would counter that I can complement their skills with my physical exam exam experience and knowledge of neuromuscular anatomy, for which the interviewers tended to agree with. Feel free to use this if you want.
Nonetheless, for me, I'm glad I chose the PM&R path because I want to have a sports med, interventional pain, and EMG practice when all is said and done. However, the average PM&R resident vs the average anesthesia resident... I would have to say that the anesthesia resident definitely has the upper hand. Remember, most ACGME pain fellowships are anesthesia based and tend to consider their own first.
With that said, while some programs made it clear that they promote the multidisciplinary approach and that they actively seek non-anesthesia residents, others directly told me that they prefer anesthesia residents because of their better procedure skills. Of course, I would counter that I can complement their skills with my physical exam exam experience and knowledge of neuromuscular anatomy, for which the interviewers tended to agree with. Feel free to use this if you want
.Nonetheless, for me, I'm glad I chose the PM&R path because I want to have a sports med, interventional pain, and EMG practice when all is said and done. However, the average PM&R resident vs the average anesthesia resident... I would have to say that the anesthesia resident definitely has the upper hand. Remember, most ACGME pain fellowships are anesthesia based and tend to consider their own first.
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this is the best post of the bunch. Reading tea leaves on how reimbursements will change in 5 years is an exercise in futility, but one thing is for certain; they will drop.
I am VERY glad i have a robust EMG referral source.
I have been talking with some friends in PMR and it seems like a very good option, something I'm really wanting to do, but now the problem is how to find a spot not sure I want to wait till 2011 spot, since I have a year internship in surgery, and CA 1 with anes, hoping to find some PGY 2 PMR Spots.
What are your recommendations on how to go about doing this? Thanks.
What are your recommendations on how to go about doing this? Thanks.
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do you know what CA-1 means? Clinical Anesthesia - (year) 1. so i'm pretty sure you're looking for a PGY-2 spot for PMR. (post-graduate year). good luck or something...
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Hey man...read the posts here. Then see what the common trend here is. Look at which specialty has more of the Pain Fellowship Domain...pursue that one
This is really no longer the case...at least for many, if not most programs. The new rules for ACGME pain fellowships (beginning with the classes starting in 2006 or 2007) require that fellows spend a certain amount of time, perform a certain number of procedures and see a certain number of patients from anesth, PM&R, neuro and psych. For this reason, many programs are hiring multidisciplinary staff and accepting multidisciplinary fellows. Additionally, alot of anesth staff are starting to recognize and appreciate the unique skill sets of neuro and PM&R. So, it's becoming somewhat easier to get an ACGME anesth pain fellowship, regardless of your residency.
I'm a neurologist who interviewed at several top programs and ended up with my first choice. And that was over 5 years ago! Of course, my application was extremely strong...pain clinic rotations starting in med school, pain research, letters from mentors in the field, etc.
Is it still easier to get a fellowship if you're from anesth? Yes, but not at all like it used to to be. You should pursue the specialty you're most interested in.
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My two cents:
PM&R is a great base residency for pain medicine. You'll appreciate all the MSK training, EMG, disability, neurorehab, etc and it will serve you well *DAILY* in your practice of interventional pain management. For me, physiatry was best match to my temperment and interests. Had I not done pain, I probably would have done a brain injury fellowship--I like rehab.
However, it will be a little harder to get an anesthesia-based fellowship due to institutional and departmental politics involved in selecting fellows. Anesthesia departments have a mandate to train to anesthesia residents/graduates and will naturally look at those applicants closer. You'll have to stand out coming from a non-anesthsia background. Nearly every fellowship in the country has trained non-anesthesia fellows so you're not doing something that's never been done before, but you're competing against other applicants with an "affiliation advantage."
Here's my real concern with pain/physiatry. I believe that organized physiatry is walking away from the sub-specialty of pain medicine in terms of its professional society/specialty support in favor of an "interventional spine" model or "interventional physiatry" concept which appears to be something less than a full-fledged ACGME pain medicine fellowship, but something more than the usual complement of skills and knowledge you acquire in a standard 4 year PM&R residency. I base this perception upon recent editorials in PM&R journals, discussions with specialty leaders, and personal observations over the last 3-5 years. Paradoxically, as pain medicine fellowships became "more multidisciplinary," in their training requirements, the development of PM&R-based pain fellowships suffered. Most anesthesia departments have more clout than PM&R departments at most academic institutions and as training opportunities consolidated, PM&R-based programs evaporated.
I consider myself a pain physiatrist. I diagnose, treat, and rehabilitate patients with painful conditions, regardless of etiology, using all available modalities (pharmacologic, nonpharmacologic, interventional, exercise, etc). I have a very broad practice ranging from inpt consults to implantables. I know that there are others like me as they post here frequently, yet I find less and less available for me at formal physiatry venues and Academy CME's/symposia, etc. Even though my sub-specialty certificate is issued from the ABPM&R, I must supplement my CME with attendance at a variety of other venues in order to feel like I'm maintaining my skills and knowledge at the "state of the art."
So, bottom line: Physiatry, yes. But, like most things in life---Buyer Beware.
PM&R is a great base residency for pain medicine. You'll appreciate all the MSK training, EMG, disability, neurorehab, etc and it will serve you well *DAILY* in your practice of interventional pain management. For me, physiatry was best match to my temperment and interests. Had I not done pain, I probably would have done a brain injury fellowship--I like rehab.
However, it will be a little harder to get an anesthesia-based fellowship due to institutional and departmental politics involved in selecting fellows. Anesthesia departments have a mandate to train to anesthesia residents/graduates and will naturally look at those applicants closer. You'll have to stand out coming from a non-anesthsia background. Nearly every fellowship in the country has trained non-anesthesia fellows so you're not doing something that's never been done before, but you're competing against other applicants with an "affiliation advantage."
Here's my real concern with pain/physiatry. I believe that organized physiatry is walking away from the sub-specialty of pain medicine in terms of its professional society/specialty support in favor of an "interventional spine" model or "interventional physiatry" concept which appears to be something less than a full-fledged ACGME pain medicine fellowship, but something more than the usual complement of skills and knowledge you acquire in a standard 4 year PM&R residency. I base this perception upon recent editorials in PM&R journals, discussions with specialty leaders, and personal observations over the last 3-5 years. Paradoxically, as pain medicine fellowships became "more multidisciplinary," in their training requirements, the development of PM&R-based pain fellowships suffered. Most anesthesia departments have more clout than PM&R departments at most academic institutions and as training opportunities consolidated, PM&R-based programs evaporated.
I consider myself a pain physiatrist. I diagnose, treat, and rehabilitate patients with painful conditions, regardless of etiology, using all available modalities (pharmacologic, nonpharmacologic, interventional, exercise, etc). I have a very broad practice ranging from inpt consults to implantables. I know that there are others like me as they post here frequently, yet I find less and less available for me at formal physiatry venues and Academy CME's/symposia, etc. Even though my sub-specialty certificate is issued from the ABPM&R, I must supplement my CME with attendance at a variety of other venues in order to feel like I'm maintaining my skills and knowledge at the "state of the art."
So, bottom line: Physiatry, yes. But, like most things in life---Buyer Beware.
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Some of you guys are talking like interventional pain management is going to die completely away...I don't see that at all! I do agree reimbursement is going to go down, at least for a while, but I sincerely doubt it will get so bad that Steve Lobel has to go back to inpatient rehab and Algos and Gorback have to go back to OR anesthesia...
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I don't think it will completely die away. There will always be patients who need epidurals, facet injections, etc.
There is the possibility, however, that interventional procedures will one day be devalued to the point that it's not worth it, to most, to put up with the opioid issues.
When that happens, there will be a shortage of interventional pain physicians, and the most sought after pain jobs will be in Ortho or Neurosurgical groups.
There is the possibility, however, that interventional procedures will one day be devalued to the point that it's not worth it, to most, to put up with the opioid issues.
When that happens, there will be a shortage of interventional pain physicians, and the most sought after pain jobs will be in Ortho or Neurosurgical groups.
this is why i dont put up with opiods now. which is somehting i have mentioned before that really bothers me. It seems that people will write narcs for people in hopes of getting procedures out it...
nothing will change for me, except that i will make less money on the interventions. the ones i write narcs for now, are the ones that i would write them for wheter an intervention is needed or economically worth it. For me, it probably means going back to part time anesthesia, maybe 2 days a week or heading into academic anesthesia...
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That's the way it is in saturated markets, unless you were lucky enough to open your practice in the 1990's.
And not just for pain physicians.
Alot of newer spine surgeons do a substantial volume of revision surgery if they don't have the support of a large group.
And sometimes, even if they are part of a large group, as the partners are likely to take most of the good cases.
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i opened my practice in 2006. there is a pain doc and a spine surgeon on every corner. i showed up and said send me your patients and i will take care of them in the way i think is best, but i will not take over narcs, or take over your dumps... I dont manage fibro, chronic abdominal pain, and "chronic pain disorder" it was slow at the beginning, and i lost many patients to the guys that will dole out the narcs to get "good" patients, but its worked out. I could make more money, but i would hate what i do. I also had anesthesia to pay the bills at the beginning, and i phased it out when i could.
it can be done. not to say my practice is perfect, it still has its problems, as i have some great referrals, who slip a dump in here or there, that i try to help out with, and the hospital drives me crazy with its inappropriate and ridiculous consults..
