Psychiatry and Pain Med

[docpsych]

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Like many I enjoy good lifestyle with a decent salary. Currently I am a 2nd year psychiatry resident at a univeristy program. I miss doing procedures and have explored the possibility of going into pain med which would allow me to do some procedures. Also being in psych i am use to med seekers trying to get extra benzo meds. Overall i have dealt with some degenerate pts and i think i could deal with the pain med seekers. my question is, what are the chances of a psychiatrist getting into a pain program that is procedure based. Are there certain programs that are psych friendly?

 

[bbbmd]

Getting an Interventional Pain Fellowship as a Psychiatry resident would be extremely difficult. I think you have to make a significant effort during residency to acquire skills and training that would show that you wouldn't be a liability. This would require using all of your elective time for this purpose and an audition rotation would pretty much be a necessity. I would also recommend applying to PM&R-based Pain Fellowships because they will likely be more open to accepting Pyschiatry residents.

Im not too sure if applying to PM&R pain would be the way to go either. There are many PM&R residents competing for those FEW spots and I dont think that the programs would choose a psychiatrist over a well qualified PM&R candidate. Dr Windsor's program does have a FP doc as well as a Critical Care doc as fellows this year, not psych. I dont know of any PM&R program that has taken any other specialties, but I could be wrong. I think Cleveland Clinic has a psych-pain fellowship? May want to look into that and see if they do interventional procedures.

Good Luck!

 

[sga430]

cleveland clinic does have a pain fellowship for shrinks. is this the only one? i think there are others that may take u on a case by case basis but not sure how many spots and how competetive it is. this could be possibly the only fellowship that is difficult for shrinks to get? btw how is the pay and how is the patient base different from the usual pain specialist?

 

[RockGoddess]

That is exactly what I am wondering about -- the Cleveland Clinic or other programs for pain management as a subspeciality of Psychiatry. Can anyone tell me more about this fascinating subspecialty?

Also, is there any salary figures for this subspeciality?

Does anyone know what they do on a daily basis?

 

[paindefender]

Progressive programs such as Brighams and Mass Gen have taken psych fellows in the past.

 

[lobelsteve]

If they take a Psychiatrist, I think that greatly attests to the caliber of that particular doc. I know of only one Psychiatrist that I would let wield a needle, but he has no desire to anything related to pain- he's busy with ECT.

 

[Kwijibo]

chaiman, Scott Fishman,MD is a psychiatrist.

 

[drusso]

I don't think that the problem with psych pain med applicants is their "intrinsic worth" as much as it their ability to have had certain experiences and exposure to interventional training in their residencies. Anesthesiology residents are required by their RRC to get at least 3 months of dedicated pain medicine exposure during their residency while most PM&R residents get 2-4 months of exposure to various aspects of pain medicine/interventional spine in their programs primarily through the use of elective time.

Personally, I think that the PM&R RRC should step up to the plate and require demonstrated competency in fundamental skills related to axial injections and pain medicine, but that is a rant for another day. Currently both PM&R and Neruology specialty boards have a bit of a credibility problem by co-sponsoring and promoting subspecialty certification in a field that they do not currently have stringent RRC training requirements for their primary base specialty. The situation would be analgous to internal medicine residencies not offering a required nephrology rotation for their residents.

Thus, some anesthesiologists see this as more evidence that their specialty is still the only one willing to both "talk the talk" and "walk the walk" when it comes supporting the academic base of pain medicine. In their eyes, PM&R and Neuro still remain "Johnny Come Latelies" to the field. For all the huffing and puffing that PM&R does about its role in pain medicine, the board doesn't seem interested in putting its money where its mouth is:

Anesthesia RRC requirements, "at least 3 months in pain medicine that may include one month in an acute perioperative pain management rotation, one month in a rotation for the assessment and treatment of inpatients and outpatients with chronic pain problems, and one month of regional analgesia experience in pain medicine"

PM&R RRC requirements: "The resident must have opportunities for progressive responsibility in diagnosing, assessing, and managing the conditions commonly encountered by the physiatrist in the rehabilitative management of patients of all ages of at least the following: (1) acute and chronic musculoskeletal syndromes, including sports and occupational injuries, (2) acute and chronic pain management, etc"

Neurology RRC requirements: " Residents must receive instruction in appropriate and compassionate methods of end-of- life palliative care, including adequate pain relief and psychosocial support and counseling for patients and family members about these issues."

Psychiatry RRC requirements: "Residents must receive comprehension instruction in the diagnosis and treatment of neurologic disorders commonly
encountered in psychiatric practice, such as neoplasms, dementia, headaches, traumatic brain injury, infectious diseases, movement disorders, multiple sclerosis, Parkinson's disease, seizure disorders, stroke, intractable pain, and other related disorders."

 

[neurodoc]

Thus, some anesthesiologists see this as more evidence that their specialty is still the only one willing to both "talk the talk" and "walk the walk" when it comes supporting the academic base of pain medicine. In their eyes, PM&R and Neuro still remain "Johnny Come Latelies" to the field. For all the huffing and puffing that PM&R does about its role in pain medicine, the board doesn't seem interested in putting its money where its mouth is...[etc]

This sounds a bit too confrontational and "turf" protective. I agree that when it comes to interventions, like epidurals and nerve blocks the anesthesiologist has had the most training and experience, but that does not mean that other physicians, such as physiatrists, neurologists, neurosurgeons, and even psychiatrists can't do further training and become competent in pain management. I know many who are quite competent.

Nick

 

[Disciple]

Personally, I think that the PM&R RRC should step up to the plate and require demonstrated competency in fundamental skills related to axial injections and pain medicine, but that is a rant for another day. Currently both PM&R and Neruology specialty boards have a bit of a credibility problem by co-sponsoring and promoting subspecialty certification in a field that they do not currently have stringent RRC training requirements for their primary base specialty. The situation would be analgous to internal medicine residencies not offering a required nephrology rotation for their residents.

Thus, some anesthesiologists see this as more evidence that their specialty is still the only one willing to both "talk the talk" and "walk the walk" when it comes supporting the academic base of pain medicine. In their eyes, PM&R and Neuro still remain "Johnny Come Latelies" to the field. For all the huffing and puffing that PM&R does about its role in pain medicine, the board doesn't seem interested in putting its money where its mouth is:

Anesthesia RRC requirements, "at least 3 months in pain medicine that may include one month in an acute perioperative pain management rotation, one month in a rotation for the assessment and treatment of inpatients and outpatients with chronic pain problems, and one month of regional analgesia experience in pain medicine"

PM&R RRC requirements: "The resident must have opportunities for progressive responsibility in diagnosing, assessing, and managing the conditions commonly encountered by the physiatrist in the rehabilitative management of patients of all ages of at least the following: (1) acute and chronic musculoskeletal syndromes, including sports and occupational injuries, (2) acute and chronic pain management, etc"

I think it has to do with the core of what PM&R is really about. We don't have the "Physiatric Association of Pain Medicine", we have PASSOR, and we try to spin things so they fit under the heading of pain medicine. Are there good PM&R pain docs? Yes. Is every Physiatrist who wields a needle a pain doc? No.

Most of us PM&R interventionalists seem to love ISIS and NASS, while my Anesthesia instructors lean towards ASIPP, AAPM, ASRA, APS.

In the several lectures I've been to on complications of interventional procedures, the favorite case example used is "Dr. X, Physiatrist, who took a weekend course and subsequently made his patient a quad".

Physiatrists are going to continue to do injections whether they have the proper training or not. I think the responsible thing for the ABPMR to do, as you've stated above, is to provide the proper training during residency with continual updates, which could only help our credibility.

If not during residency, then make MSK an official subspecialty of PM&R (whatever we need to call it, and encompassing spine, sports and general MSK) so that we can both serve and provide quality control for a large and continually growing proportion of ABPMR diplomates.

In my opinion, Pain Medicine is about relieving pain, whatever the etiology. Spine, Sports and general MSK is about non-surgical Orthopaedic care. There is some overlap, but I believe clearly delineating the difference between the two would help to eliminate the typical argument "My background contributes more to pain medicine than yours".

Okay, now back to the original topic.

 

[Spine Specialist]

In the several lectures I've been to on complications of interventional procedures, the favorite case example used is "Dr. X, Physiatrist, who took a weekend course and subsequently made his patient a quad".

^^^This statement is absoultely true. During last year ASIPP cadaver course/CME sessions one noted speaker ( anesthesiologist) made a similar statement like " A physiatrist who performed cervical trigger point injection or needle myography of cervical paraspinals caused spinal cord trauma"..which was very offensive. I felt like his tone was slightly degarding physiatrists. Next day, i called CEO of ASIPP, complained to him about the speaker and explained to him that it was not fair . He simply replied that even anesthesiologist can cause spinal cord trauma during interventional procedures. no big deal. I think he is right.

 

[sga430]

now that the pain fellowships opened up to psych, is there anything to add to this thread? still trying to find out what a pain psych does and how much he or she makes?? i like pain and psych and am more interested in the non- procedural aspects?

 

[ParaVert]

My friend, a psych resident from Baylor, is starting an anesthesia based pain fellowship in Pittsburg in July. He interviewed at a lot of programs and had a tough time, but he got one.

 

[sga430]

what do u recommend a pgy-1 psych rez to do in order to get pain?

 

[spinal]

what do u recommend a pgy-1 psych rez to do in order to get pain?

It is simple dude. Quit and start an anesthesiology residency.

 

[lucyz02]

now that the pain fellowships opened up to psych, is there anything to add to this thread? still trying to find out what a pain psych does and how much he or she makes?? i like pain and psych and am more interested in the non- procedural aspects?

It's my impression that the pain fellowships within psych ARE non-interventional, more along the lines of medical management and addiction medicine etc... this may be what you are looking for. The PMR and anesthesia based programs are definately INTERVENTIONAL. I would check out the psych programs if non-interventional is what you want. Go to Frieda...

 

[sga430]

It's my impression that the pain fellowships within psych ARE non-interventional, more along the lines of medical management and addiction medicine etc... this may be what you are looking for. The PMR and anesthesia based programs are definately INTERVENTIONAL. I would check out the psych programs if non-interventional is what you want. Go to Frieda...

how does the practice and the salary of a non-interventional pain doc differ from the interventional one??

 

[PainDr]

how does the practice and the salary of a non-interventional pain doc differ from the interventional one??

I doubt you'll find that kind of info in this forum as everyone here is an interventionalist. You'd have to find an noninterventionalist and talk to them.

 

[ParaVert]

they can't afford internet access.

sorry, couldn't help myself

 

[Dillan]

Good day if anyone is still viewing this thread, i'm not sure about whether i should open a new topic, but does anybody know how to apply for Chronic Pain Management Program in the Department spy phone of Psychiatry ?

 

[jsaul]

there is a pscyh doctor who did a pain fellowship. he has his practice near me. I have seen him book cases in the hospital including vertebroplasties

 

[researchlover]

Hopkins has one of the best inpatient pain treatment programs and it is run entirely by the psychiatry department. Chronic pain is quite complex and psychiatrist are well positioned to deal with this issue.

Chronic pain is generally followed with mental illness that requires behavioral therapy, ECT, and medication. By treating the mental illness, the pain is easier to manage. There is also whole gamut of medication (from anticonvulsants to sNRIs) to treat pain, and psychiatrist are well attuned to the interplay between medication.

 

[PinchandBurn]

Hopkins has one of the best inpatient pain treatment programs and it is run entirely by the psychiatry department. Chronic pain is quite complex and psychiatrist are well positioned to deal with this issue.

Chronic pain is generally followed with mental illness that requires behavioral therapy, ECT, and medication. By treating the mental illness, the pain is easier to manage. There is also whole gamut of medication (from anticonvulsants to sNRIs) to treat pain, and psychiatrist are well attuned to the interplay between medication.

you must be a psychiatrist or going into it..

 

[vistaril]

you must be a psychiatrist or going into it..

Im a psychiatrist, and what the premed guy wrote above is crazy talk.....there are actually a handful of psychiatrists across the country(like literally a handful) who did a pain fellowship with all the interventional stuff you guys do, but Im not sure how in the hell they got in there.....even more, I'm not sure why those people didnt just do pm&r instead of psych as both are noncompetitive......

I don't think psychiatry has much to offer for chronic pain pts. Or at least much to offer that the chronic pain pts want.

 

[Pain Applicant1]

Hopkins has one of the best inpatient pain treatment programs and it is run entirely by the psychiatry department. Chronic pain is quite complex and psychiatrist are well positioned to deal with this issue.

Not exactly, I'm a Hopkins grad.

If you want an interventional fellowship, it will be difficult, albeit not impossible, as a psych resident. Be sure to get good letters, publish articles, and do your homework. Most importantly, pay no attention to the naysayers 🙂

 

[vistaril]

Not exactly, I'm a Hopkins grad.

If you want an interventional fellowship, it will be difficult, albeit not impossible, as a psych resident. Be sure to get good letters, publish articles, and do your homework. Most importantly, pay no attention to the naysayers 🙂

seeing as how the OP is a premed, it should be pointed out again(and Im sure it's obvious anyways) that psychiatry is not a suitable residency to go into if one wants to do interventional pain.

 

[Pain Applicant1]

seeing as how the OP is a premed, it should be pointed out again(and Im sure it's obvious anyways) that psychiatry is not a suitable residency to go into if one wants to do interventional pain.

Respectfully disagree. The Brigham and Women's at Harvard Medical School last year had a psych fellow and an attending there is a psych.

I'm sticking to my guns: If you want an interventional fellowship, it will be difficult, albeit not impossible, as a psych resident. Be sure to get good letters, publish articles, and do your homework. Most importantly, pay no attention to the naysayers.

 

[emd123]

(I realize the original post is from 2005, but I'd like to weigh in on this one, anyways.)

There is no doubt that getting into an Pain Fellowship from a psych background will be very difficult for even high quality applicants. However, given the fact that the psychological aspect of chronic pain is extremely prevalent, and largely ignored, I think we need more psychiatrists going into Pain, interventional included. If you think you have good aptitude for procedures, take a Pain elective in residency, get some basic procedures under your belt, maybe even take an ASIPP cadaver course, and you might have a shot if you apply widely enough. That being said, if you are sure you want to do pain, anesthesia is far and away your best bet statistically if you are at the medical student stage. In my opinion, the belief that you have to spend 4 years in general anesthesia to learn interventional Pain procedures is a myth. If you go to a quality fellowship like the one I graduated from (2 days ago), you'll do hundreds of epidurals, medial branch blocks, and other bread and butter procedures. If you're lucky, you may even do a few dozen implants.

How many 2 minute epidural steroid injections do you have to do to be competent? 300? No, but you'll do that many in a good (and highly interventional) fellowship. If an anesthesia intern can learn loss of resistance technique, so can you. For better or for worse, pain is multidisciplinary, and will become more so in the future.

{ Disclosure: I graduated an ACGME accredited fellowship, will take the ABA board exam this year and I come from the specialty category of "other", that is: non-anesthesia, non-PMR, non-neuro, non-psych, which some fellowship directors claim they don't know is possible. Oh, I almost forgot, I had treated an estimated 21,000 patients with pain, prior to fellowship, but I know that doesn't mean anything 🙂 }

 

[vistaril]

Respectfully disagree. The Brigham and Women's at Harvard Medical School last year had a psych fellow and an attending there is a psych.

I'm sticking to my guns: If you want an interventional fellowship, it will be difficult, albeit not impossible, as a psych resident. Be sure to get good letters, publish articles, and do your homework. Most importantly, pay no attention to the naysayers.

but this is relevant for someone who in the middle of a psych residency realizes "oh my gosh, I want to do pain".......then whether it's possible to go from psych to pain or not is realistic to address.

for someone who has not even begun residency yet and wants to do pain, clearly psych would be a very stupid would to go as it would be much harder to do. Since pm&r and psych are both noncompetitive, it would make much more sense for a wannabe pain person to do pm&r instead of psych.

Also, why someone would *want* to do interventional pain and a psych residency is completely illogical. If you are of the mindset of liking interventional stuff, do pm&r instead. (or anesthesia if you're an average applicant)

 

[Pain Applicant1]

but this is relevant for someone who in the middle of a psych residency realizes "oh my gosh, I want to do pain".......then whether it's possible to go from psych to pain or not is realistic to address.

for someone who has not even begun residency yet and wants to do pain, clearly psych would be a very stupid would to go as it would be much harder to do. Since pm&r and psych are both noncompetitive, it would make much more sense for a wannabe pain person to do pm&r instead of psych.

Also, why someone would *want* to do interventional pain and a psych residency is completely illogical. If you are of the mindset of liking interventional stuff, do pm&r instead. (or anesthesia if you're an average applicant)

...unless of course you like psych and think that will prepare you best for the type of pain practice you'd like in the future. I personally don't feel a psych or an anesthesia based residency would have prepared me as well as my PMR residency/anesthesia fellowship did for the practice that I currently have. Nonetheless, this is getting boring and I'll agree to disagree with you

 

[jettavr6]

If you are of the mindset of liking interventional stuff, do pm&r instead. (or anesthesia if you're an average applicant)

Or better yet, encourage that particular medical student/resident to decide for themselves which path they want to take and how to take it. What may seem illogical to you, may be reasonable and achievable to someone else.

 

[PMR 4 MSK]

Always keep in mind you may one day need your primary specialty to fall back on, should your subspecialty not pan out. Pain medicine is facing some potentially serious payment cuts in the coming years, and will not likely be financially viable for all currently in it. You may need to go back and work the OR, rehab unit or psych ward some day.

 

[Jcm800]

Always keep in mind you may one day need your primary specialty to fall back on, should your subspecialty not pan out. Pain medicine is facing some potentially serious payment cuts in the coming years, and will not likely be financially viable for all currently in it. You may need to go back and work the OR, rehab unit or psych ward some day.

Amen!

best piece of advice yet. although i shudder when i think of how I will/would respond to "table up, anesthesia" if i ever have to do it again...

 

[facets]

You and I will both be guests of the state-because if I EVER hear "table up anesthesia again"-I'M KILLING SOMEONE! Hey, can I get disability?