Questions on a Pain Management Fellowship. Anesthesiology vs PMR?

[bajastapler]

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Hi Guys!

First off please excuse my ignorance, as I am only a first year. Also, I would like to preface by saying that I tried to do some research on the boards, but most of the threads are 5+ yo and ran off onto tangents.

After doing some soul searching and creeping on SDN, I've come to the belief that I would enjoy a career in anesthesiology or PMR. Moreover, I can imagine myself wanting to pursue a fellowship in pain management. Below are a couple of questions I had. Any comments, critiques, advice would be greatly appreciated.

1) I am a bit confused as to whether there are 2 separate categories of "pain management fellowships" or if there is just 1 category of "pain management fellowships" that both anesthesiologist and physiatrists apply for. My understanding is that there is just 1 set of fellowships that both candidates apply for?

2) My understanding is that "pain management" is a fairly competitive field. Could someone relate the level of competition into terms of an internal medicine fellowship (as I am more familiar with those). Ie. "getting into pain management is like an internal med trying to get GI"

3) Would I be a better candidate for pain management if I were to go the anesthesiology route or the PMR route?

4) Would my approach towards a patient - in a pain management setting - be different if I was anesthesiology trained vs PMR trained? I imagine it would? Which background would allow me to handle more complex cases? Which background would make me more marketable to an academic institute? Also, in your opinion, which background would lead to a more satisfied patient outcome?

5) I know that there is alot of heat on these boards about the future of anesthesiology. Taking out the factor of $$$; however, would you pursue anesthesiology again? If so, what would you do differently to maximize your job satisfaction.

6) Any other comments would be greatly appreciated as I am a budding first year - who, at the end of the day, has no idea wtf I am doing :X.

Thank you for your time an consideration.

-staples

 

[lord_jeebus]

The majority of pain fellowships exist within departments of anesthesiology. Most of the remainder are in departments of PM&R. Most fellowships these days accept applicantions from any specialty, but there is generally a political advantage to coming from the specialty of the department. Overall, this puts anesthesia applicants at a significant advantage, and anyone who isn't from anesthesia or PM&R at a major disadvantage. To be board-certified in Pain Medicine by the ABMS, you must come from Anesthesiology, PM&R, Neurology, or Psychiatry. There is an alternative board, the American Board of Pain Medicine, which will certify people from every specialty but I don't know if such certification can be used to describe one's self as "board certified" in all states.

Pain has historically been the most competitive fellowship for anesthesia residents, and likely is the most competitive for PM&R. Not sure if this is still the case, especially given major cuts in procedure reimbursement due to hit next month. It is competitive enough that many applicants will not match anywhere; before the match era, it was competitive enough that one would usually commit to the first program that made an offer (my fellowship made 4 offers out of 200 applicants and all 4 of us accepted immediately).

I imagine that my clinical skills might be somewhat stronger in clinic if I came from PM&R. I have a lot of confidence in my procedural skills, which I could credit to coming from anesthesia, but my non-anesthesia co-fellows were also strong procedurally by the end of fellowship. What makes you marketable to a particular academic program depends on what they are looking for. My co-fellow was a psychiatrist which made him a rarity and he was offered an academic pain job that I was not considered for. I don't think background plays strongly into patient satisfaction.

 

[bajastapler]

thank you for the response. it's given me alot to think about.

If I could ask a followup question to you guys out there:
1) What are your impression of california (so-cal/norcal) and texas (houston/austin/san antonio/dallas) markets?
2) Are these markets (both academic and private practice) that ultimately require a fellowship to even be considered or would I be able to find work as a plain-old anesthesiologist with no fellowship training.

*from what I've read on SDN, I get the implication that for cali cities: I need a fellowship to even be considered for a highly desirable city (such as san fran or LA). And from what I've read: Texas-cities are easier to find jobs in, but the salaries are on the lower-end of the pay scale.

 

[ssmallz]

thank you for the response. it's given me alot to think about.

If I could ask a followup question to you guys out there:
1) What are your impression of california (so-cal/norcal) and texas (houston/austin/san antonio/dallas) markets?
2) Are these markets (both academic and private practice) that ultimately require a fellowship to even be considered or would I be able to find work as a plain-old anesthesiologist with no fellowship training.

*from what I've read on SDN, I get the implication that for cali cities: I need a fellowship to even be considered for a highly desirable city (such as san fran or LA). And from what I've read: Texas-cities are easier to find jobs in, but the salaries are on the lower-end of the pay scale.

You're a first year.....since you stated you'd be happy in a few different residencies I assume you mean you're a 1st year med student. The questions your asking about are pretty irrelevant to your situation b/c you are so far out from looking for a job any advice we could give you will almost certanly be outdated and useless by the time you're ready to look. Find a specialty you like and go from there. You can get a job anywhere if you're willing to work for it

 

[Maverikk]

Yeah, you'll definitely change your mind by the end of 3rd year. And read the thread in the pain medicine forums about the cuts they just released for pain procedures, basically close to 40-50% cut for the most common procedures (ESIs), which essentially means cutting salary in half or switching up procedures, most of which can't be done as fast as ESI. I think pain medicine is going to get a lot less competitive next year

 

[Consigliere]

With the radical cuts in pain management reimbursement, I'd consider another fellowship.