Psychiatry Residents & Pain Medicine Fellowships

[prominence]

i want to precede this post by stating that i am specifically inquiring about the psychiatry resident who is applying for the NON-TRADITIONAL fellowship (i.e. NOT ANY OF THE FOLLOWING: child psychiatry, geriatric psychiatry, forensic psychiatry, addiction psychiatry, or consultation-liason).

any advice for the psych resident who is applying to an extremely competitive and multidisciplinary fellowship, where there are few, if any, psychiatrists within the subspecialty? (for example, pain management)

in such a case, the psychiatry resident will not only be competing with other psych residents, but will also face strong competition from residents in other specialities (in the example of pain management, there will obviously be anesthesiology, pm&r, and neurology applicants).

assume that a psych resident is fortunate enough to have plenty of 4th year electives to get exposure to the fellowship in question (in this case, pain management). isn't the psych resident at a disadvantage when compared to applicants from other specialities if their 4th year work doesn't get any serious consideration? i mean, if the fellowship application is already submitted by end of 3rd year/ beginning of 4th year, aren't these electives essentially "worthless"?

realistically, the odds are strongly stacked already against the psych resident who is applying for a multi- disciplinary fellowship (like pain management). what, if any, can a psych resident do to make him/herself more marketable before 4th year?

any thoughts on how the psych resident can set him/herself apart from applicants in other specialities before 4th year? is research and strong LORs the ONLY answer?

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[engineer]

good question. you and i can talk maybe privately too. i am interested in pain too and keep hearing psych can forget it. that pisses me off. also can we get a job, assuming we get the fellowship?

 

[gmonavydoc]

good question. you and i can talk maybe privately too. i am interested in pain too and keep hearing psych can forget it. that pisses me off. also can we get a job, assuming we get the fellowship?

If pain is what your goal is then you should have done a residency in a more hands on ,concrete, scientific specialty like pmr or gas. The dexterity and medical knowledge required of pain specialists is best learned in the or, icu or physiatry settings thus PMR and Gas triumph. Neurologists are heavily medicine based and do alot of critical care, lumbar punctures, EMGs, real medicine stuff, thus would be a likely second choice behind rehab and gas..why psych is even eligible blows my mind. Internists or FPs are more qualified than shrinks..face it, alot of psychiatry residents all but frame their stethescopes by pgy-4. My point..if you want to be a needle jockey than go the gas or pmr route if you want to be a specialist in mental illness become a psychiatrist do not use psychiatry as a cush launching pad into painmanagement. Just my opinion.

 

[prominence]

why psych is even eligible blows my mind.

IF psychiatry residents have NO REALISTIC chance at getting pain management fellowships when compared to anesthesiology, pm&r, and neurology residents, then i agree that psych residents should NOT be eligible for pain management fellowships.

an interesting solution would be if psych departments started opening their own pain fellowship programs, exclusively for psych residents.

of course, i dont see that happening in the near future, if at all.

 

[kidshrink]

I would disagree that Psych should be ineligible for Pain Fellowships. The program I have trained at required a great deal of collaborative work with the Pain team. At our institution, pain management takes a very psychological approach and appreciates psychiatry's help in detoxing and exploring psychiatric comorbidities. Knowing some of the faculty in that program, I think that they would be very enthusiastic in having psych applicants. I think it really depends on how you view the field of pain management.

 

[engineer]

dear kidshrink,
where did you train? are you in child psych now? is it good? or is pain good?

 

[sga430]

if it is unfeasible for psychiatrists to be pain specialists then why does the cleveland clinic offer spots to psychiatrists? i agree gas and pm&r residents are more qualified initially but a lot can be learned in a year.

if it is a problem then maybe psych pain fellows should so some kind of prelim year with 3-6 months in pm&r and 3-6 months in gas. don't forget that psychiatrist do 2 months in neuro and 4 months in IM and 4 years of med school. perhaps psych residencies could allow a pain track where we can switch a few postings to do some gas electives.

i am sure there is room and need for psychiatrists in this field.

 

[lobelsteve]

if it is unfeasible for psychiatrists to be pain specialists then why does the cleveland clinic offer spots to psychiatrists? i agree gas and pm&r residents are more qualified initially but a lot can be learned in a year.

if it is a problem then maybe psych pain fellows should so some kind of prelim year with 3-6 months in pm&r and 3-6 months in gas. don't forget that psychiatrist do 2 months in neuro and 4 months in IM and 4 years of med school. perhaps psych residencies could allow a pain track where we can switch a few postings to do some gas electives.

i am sure there is room and need for psychiatrists in this field.

What would be required to make up for the lack of hands on is a kind Psychiatry program that allows for 4-6+ months electives in the senior year to allow rotation through PM&R, Ortho, Neurosurgery, and Anesthesia pain clinic (not OR). Then that 1 year on top would even things out a fair amount.
The background in Psychiatry would be invaluable in getting the patients better, rather than generating massive profits off of them.

Needle jockey = bad, multidisciplinary = good. And yes, I am more needle jockey than hand holding empathizer.

 

[paz5559]

Needle jockey = bad, multidisciplinary = good. And yes, I am more needle jockey than hand holding empathizer.

Needle Jockey = disparaging

Multidiciplinary = bad (implies a mill where patients are run, sequentially, form one specialist to the next until they insurance coverage is exhausted)

INTERdicipliniary = good

(yeah, i know this is semantics, but trust me, the precision of the words you use matter, both to colleagues and payors)

 

[docpsych]

psych docs are pretty good at handling difficult patients and would proove to be quite effective, in my opinion, at pain medicine. i frequently hear that a significant portion of pain deals with pts who are drug seekers. once you deal with >200 schizophrenics, substance abusers, or pts with dementia/delerium, patients in pain clinic are a walk through the park. so if psych doc can handle the pts, the next questions seems to be some doubts on their clinical experience and possibly compentence to understand the practice of pain medicine. i will admit my hands-on clinical experience is limited by choosing psych, but i recall going to med school, passing step 1,2,and 3--so i think being a psych resident i would do just as well as gas or pm&r doc.
being interested in pain, i would not mind doing some training in gas or pm&r prior to starting pain fellowship. remember there is a ton of neurology involved in psych training, which could add to a psych resident's arsenal wanting to pursue pain.
one question i have is, are gas an pm&r worried they are going to loose some of their practice to psych/pain docs?

 

[lobelsteve]

Psychaitry training offers no interventional skills.
There are PM&R residents coming out of programs with over 200 procedures done by themselves. Anes is procedure based.
Don't kid yourself about having surgical skills unless you have had surgical training- as a PM&R/Pain doc- I will be inferior to the surgeon as far as timeliness of my suturing and on handling surgical complications.