Psychiatry to Pain Medicine?

[whosnisarg]

Hey all!

I was just curious - any psychiatry trained pain medicine physicians out there? If not, why? I'd think (very ignorantly I'll presume) that because pain can be an emotional response, psychiatry-pain physicians could be helpful, no?

In terms of fellowship, are there any that would consider psychiatry residents since many are located in anesthesia departments and PM&R and neuro have a tough time filling spots?

Lastly, what would be some pros/cons of going into a pain fellowship from psych residency as opposed to anesthesia trained fellows?

Thanks, guys. 🙂

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[michaelrack]

Pain fellowship is to learn procedures.... you don't need a pain fellowship to treat the psych aspects of pain

Only do a pAin Fellowship if you want to do procedures

 

[Monocles]

Lastly, what would be some pros/cons of going into a pain fellowship from psych residency as opposed to anesthesia trained fellows?

Pros: $$$

Cons: harder to get into pain fellowship compared to anaesthesia applicants. I know people from TOP psych programs who struggled to get into mid-tier pain fellowships.

 

[BiscoDisco]

Pros: $$$

Cons: harder to get into pain fellowship compared to anaesthesia applicants. I know people from TOP psych programs who struggled to get into mid-tier pain fellowships.

Any recommendations of things to do in residency if one wanted to try for a pain fellowship?

 

[TexasPhysician]

Any recommendations of things to do in residency if one wanted to try for a pain fellowship?

Pain electives and research. They can pump out a lot of publications. Friend of mine had his name on 20+.

 

[Monocles]

Any recommendations of things to do in residency if one wanted to try for a pain fellowship?

In addition to what TexasPhysician wrote above^, network! If you can get yourself known to pain fellowships (through some sort of elective) and they like you, it becomes a much easier process.

You would be surprised how much of fellowship acceptance is based on who knows who.

 

[Merovinge]

There are some pain folks (although relatively few) that do non-interventional pain. If you were to go this route you basically combine addictionology with pain medicine which is absolutely in psychiatry's wheelhouse. I will say I have two friends who went gas>pain and both of them got worn down by their pain practice enough to do general anesthesia for a significant portion of their practice, so there is clearly space in the field for someone who doesn't find America's opioid crazed populous grating.

 

[adiradirim]

Psychiatry resident currently applying to pain fellowship, so we'll see how it goes...

If you have an option and pain is your goal, do anesthesia.

Going in from psychiatry definitely has benefits for pain practice, especially due to outpatient practice, similar medications (antidepressants/anticonvulsants), difficult patients, controlled drugs, experience interviewing patients. Difficulties are mostly hands on experience, procedures, physical exam. The anesthesiology trained docs and nurses LOVE having you around and your input on tough cases. This is true whenever you are off service though.

The best you can do as a psychiatrist is getting as much experience doing pain as you can. Rotations, procedures (logging them), research, presenting at conferences, interfacing with pain doctors, getting good letters of recommendation, and showing interest. You can even figure out ways to work with more pain patients by being the psychiatric consultant in residency (depends heavily on your program if this is possible).

Also, when applying, you will see several programs that are "multidisciplinary" versus programs that are more procedure heavy. SDN seems to be skewed in favor of procedure heavy programs, which prefer anesthesiologists. Some programs will even have fellows covering anesthesia call, which you obviously can't do as a psychiatrist.

It is definitely an uphill battle, but not impossible. I've met/heard of several psychiatrists who went into pain. I've never heard of someone who applied and didn't match. however, there's only a handful of psych residents that apply each year, so it is hard to find data.

Hope that's helpful.

 

[Gavanshir]

My understanding is it is an uphill battle to get paneled with insurance companies without a procedurally oriented residency program. Also litigation and malpractice will be an issue given the grave difference in procedural experience between a psych grad and anyone from anesthesia/pmr or even neuro.

If you go the non-procedure route in pain management, then why even bother with the fellowship? You can do that as a general psych or with addictions training. I'm sure $$ wouldn't be different either since it's the procedures that bring in the big bucks.

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[SourceOfDenial]

What kind of pain medicine do you want to do? Treat nonmalignant chronic pain? Treat pain in serious illness? Inpatient? Outpatient? Procedures? Therapy?

A pain fellowship is not the only pathway to treating and understanding pain. If you want to do pain procedures then that’s likely your only pathway. But if other aspects interest you a pain psychology fellowship may be an option in some places(or specialized training in certain therapies) or a palliative medicine fellowship. I treat pain every day using opioids, oral and IV adjuvants, ketamine, precedex, and all manners of PCAs and CADDs. I’d argue that pain fellowship isn’t the best way to prepare you to treat pain outside of interventions.

You will run into issues with credentialling down the road if you do inpatient work. Might not be a big deal but some places may require a surgical or anesthesia BC for OR time. I run into this occasionally in palliative medicine being in an internal medicine department. Or hospital regulations saying ‘only anesthesia can start XYZ med’. Also, half the time pain doesn’t do something but IR does.

 

[adiradirim]

You will run into issues with credentialling down the road if you do inpatient work. Might not be a big deal but some places may require a surgical or anesthesia BC for OR time. I run into this occasionally in palliative medicine being in an internal medicine department. Or hospital regulations saying ‘only anesthesia can start XYZ med’. Also, half the time pain doesn’t do something but IR does.

This is the most annoying part of doing anything "atypical" in a hospital...