Sports and Pain

[klumpke]

Hey everyone, if this has been answered in the past definitely let me know and I can delete. I ultimately want to do Sports Med with my career but understand that it’s hard to swing a fully sports practice so people choose another area to fill the gap ie inpatient rehab, snf, MSK stuff. If I wanted to alternate with sports med and do spine procedures on the other days is this technically what the Sports and Spine fellowship is meant for? Is there a reason I shouldn’t be considering this?

As always, you all are awesome thanks a ton

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[runfastnow]

Lengthy discussions in other posts. If there is a way to search my posts I have done so in the past.

Long story short - I did ACGME PM&R sports fellowship that was about 15-20% spine. Was a D1 team doc and it was fun but ruled my life. Now I do 50% sports/MSK (in the real world they are the same thing) and 50% spine (find I enjoy this more than MSK for now) doing SI, ESI, RF, and MILD.

Unless in a purely academic or non-production based setting very hard to ONLY see athletes - much less higher level athletes - or do long form US evals that take 30+ minutes. It can happen but takes a while and a lot of work to mold your practice make that happen.

 

[klumpke]

Lengthy discussions in other posts. If there is a way to search my posts I have done so in the past.

Long story short - I did ACGME PM&R sports fellowship that was about 15-20% spine. Was a D1 team doc and it was fun but ruled my life. Now I do 50% sports/MSK (in the real world they are the same thing) and 50% spine (find I enjoy this more than MSK for now) doing SI, ESI, RF, and MILD.

Unless in a purely academic or non-production based setting very hard to ONLY see athletes - much less higher level athletes - or do long form US evals that take 30+ minutes. It can happen but takes a while and a lot of work to mold your practice make that happen.

Oh awesome, I actually saw some of your previous posts! So it is still feasible to do interventional spine procedures with solely a sports fellowship (and no pain fellowship or sports/spine fellowship) as long as you just choose a fellowship that offers that kind of exposure?

 

[JBM16BYU]

Hey everyone, if this has been answered in the past definitely let me know and I can delete. I ultimately want to do Sports Med with my career but understand that it’s hard to swing a fully sports practice so people choose another area to fill the gap ie inpatient rehab, snf, MSK stuff. If I wanted to alternate with sports med and do spine procedures on the other days is this technically what the Sports and Spine fellowship is meant for? Is there a reason I shouldn’t be considering this?

As always, you all are awesome thanks a ton

I considered a similar route. One thing to keep in mind though is what jobs will hire you for. I will be speaking in generalities below, note that there will be exceptions (although less often).

Pain Medicine: ACGME Pain Medicine Fellowship. You will learn interventional spine injections, ultrasound-guided procedures (more nerve blocks, less joints), +/- neuromodulation (spinal cord stimulators, DRG, PNS), +/- pumps. You see patients in pain, no matter whether they have anatomical reasons for pain (ex. acute radiculopathy) or non-anatomical reasons (chronic pain syndrome). You take all, you see all. If you are an academic, you will likely have inpatient pain consult responsibilities. Most pain departments are housed under anesthesiology departments. If you are in private practice, you will likely be in pain practice, although some are in surgical groups with orthopedic/neurosurgeons. You will have to manage pain medications, both narcotic and non-narcotic. More often your patients are older and may be difficult to manage. See the Pain Forum for more.

Sports Medicine: ACGME Sports Medicine Fellowship. You will likely learn ultrasound-guided procedures, maybe some diagnostic ultrasound, maybe some regenerative medicine. You will likely have team coverage. For practice, you will likely be (A) in an orthopedic group as their non-operative MSK guy, (B) in an academic sports medicine practice, or (C) working as a PM&R physician who also had a fellowship in Sports Medicine. Like was mentioned, true "sports only" jobs are not super common. You will see athletes, but also weekend warriors who went running and tripped and fell. To stay afloat in private practice, you will likely have to do a good amount of team coverage, which is often not paid and is extra time after work. You are more likely to have more motivated patients who truly want to get better. A lot of your patients will start off with physical therapy as your first prescription. You may or may not get spine training in your fellowship (most places do not teach spine). If you do get spine training, most likely it will be limited to mostly lumbar epidurals, SI joint injections, and facet joints. Some may incorporate MBB/RFA in lumbar spine, but less likely. Spine is not the focus of sports medicine fellowships now. As was mentioned by Dr. DJ Kennedy (Sports-trained, Spine practice) at Vanderbilt in the PM&R Interventional Podcast, if you are a sports physician who does spine, your practice will likely become more and more spine, low back pain, neck pain, etc, and less of true sports.

Spine Medicine: NASS Interventional Spine and Musculoskeletal Medicine Fellowship / Non-Accredited Pain Fellowship / Non-Accredited Spine Medicine Fellowship. None of these are ACGME so you will not be able to get an ACGME board certification outside of your primary specialty of PM&R. If you want to be in private practice, likely ACGME board will not matter. Some places like you to have "something" so some look at ABPM or ABIPP as other pain boards, but these are not accepted everywhere (check your desired state for coverage). You will learn interventional spine injections and do spine clinic. You will see very similar patients to the Pain Medicine group above, however, you will likely not see cancer pain, pediatric pain, palliative pain, or headache patients. As you would not have completed an ACGME fellowship, many (if not most) pain departments will not hire you. Most work private practice or in orthopedic groups, however, some do work in academic centers either under Orthopedics or PM&R.

Another thing to consider:
-If you want to do 1/2 and 1/2 sports and spine, that may be truly hard to do. Spine procedures come from (A) those referred to you for procedure only within your practice (which means you need to be doing enough to be competent and have others see you are competent so they refer to you) and (B) those who you see and set up for procedure (which means that you need to have a good amount of your clinic time be actual low back pain or neck pain in order to generate patients for spine procedures). Doing 2.5 days sports with ultrasound-guided injections and sports clinic, would only leave you with 2.5 days for spine. If you want to do spine procedures, you then should have probably at least 1.5 days for spine clinic and 1 day for spine procedures. That's only 1 day per week of spine procedures. Most "spine physicians" are doing more than 1 day a week of spine procedures.

My advice:
-Choose either (A) Pain Medicine, (B) Sports Medicine, or (C) Spine Medicine. Get really good at the area you choose and build that reputation for yourself.

 

[klumpke]

I considered a similar route. One thing to keep in mind though is what jobs will hire you for. I will be speaking in generalities below, note that there will be exceptions (although less often).

Pain Medicine: ACGME Pain Medicine Fellowship. You will learn interventional spine injections, ultrasound-guided procedures (more nerve blocks, less joints), +/- neuromodulation (spinal cord stimulators, DRG, PNS), +/- pumps. You see patients in pain, no matter whether they have anatomical reasons for pain (ex. acute radiculopathy) or non-anatomical reasons (chronic pain syndrome). You take all, you see all. If you are an academic, you will likely have inpatient pain consult responsibilities. Most pain departments are housed under anesthesiology departments. If you are in private practice, you will likely be in pain practice, although some are in surgical groups with orthopedic/neurosurgeons. You will have to manage pain medications, both narcotic and non-narcotic. More often your patients are older and may be difficult to manage. See the Pain Forum for more.

Sports Medicine: ACGME Sports Medicine Fellowship. You will likely learn ultrasound-guided procedures, maybe some diagnostic ultrasound, maybe some regenerative medicine. You will likely have team coverage. For practice, you will likely be (A) in an orthopedic group as their non-operative MSK guy, (B) in an academic sports medicine practice, or (C) working as a PM&R physician who also had a fellowship in Sports Medicine. Like was mentioned, true "sports only" jobs are not super common. You will see athletes, but also weekend warriors who went running and tripped and fell. To stay afloat in private practice, you will likely have to do a good amount of team coverage, which is often not paid and is extra time after work. You are more likely to have more motivated patients who truly want to get better. A lot of your patients will start off with physical therapy as your first prescription. You may or may not get spine training in your fellowship (most places do not teach spine). If you do get spine training, most likely it will be limited to mostly lumbar epidurals, SI joint injections, and facet joints. Some may incorporate MBB/RFA in lumbar spine, but less likely. Spine is not the focus of sports medicine fellowships now. As was mentioned by Dr. DJ Kennedy (Sports-trained, Spine practice) at Vanderbilt in the PM&R Interventional Podcast, if you are a sports physician who does spine, your practice will likely become more and more spine, low back pain, neck pain, etc, and less of true sports.

Spine Medicine: NASS Interventional Spine and Musculoskeletal Medicine Fellowship / Non-Accredited Pain Fellowship / Non-Accredited Spine Medicine Fellowship. None of these are ACGME so you will not be able to get an ACGME board certification outside of your primary specialty of PM&R. If you want to be in private practice, likely ACGME board will not matter. Some places like you to have "something" so some look at ABPM or ABIPP as other pain boards, but these are not accepted everywhere (check your desired state for coverage). You will learn interventional spine injections and do spine clinic. You will see very similar patients to the Pain Medicine group above, however, you will likely not see cancer pain, pediatric pain, palliative pain, or headache patients. As you would not have completed an ACGME fellowship, many (if not most) pain departments will not hire you. Most work private practice or in orthopedic groups, however, some do work in academic centers either under Orthopedics or PM&R.

Another thing to consider:
-If you want to do 1/2 and 1/2 sports and spine, that may be truly hard to do. Spine procedures come from (A) those referred to you for procedure only within your practice (which means you need to be doing enough to be competent and have others see you are competent so they refer to you) and (B) those who you see and set up for procedure (which means that you need to have a good amount of your clinic time be actual low back pain or neck pain in order to generate patients for spine procedures). Doing 2.5 days sports with ultrasound-guided injections and sports clinic, would only leave you with 2.5 days for spine. If you want to do spine procedures, you then should have probably at least 1.5 days for spine clinic and 1 day for spine procedures. That's only 1 day per week of spine procedures. Most "spine physicians" are doing more than 1 day a week of spine procedures.

My advice:
-Choose either (A) Pain Medicine, (B) Sports Medicine, or (C) Spine Medicine. Get really good at the area you choose and build that reputation for yourself.

Wow, this was genuinely one of the most helpful posts ive seen in any of these forums. Thank you massively for your thorough reply!! This fully answered my question. Just curious, and no worries if you dont want to share, but you said you were interested in the same career path temporarily- what did you end up choosing? are you glad you chose it?

 

[TheGreatestTrochanter]

If you truly like MSK/sports more than spine, then do not do any of the above fellowships other than a sports fellowship. You simply will not get the amount of acute MSK exposure doing a sports/spine (these are almost all really just spine with some MSK sprinkled in) or pain fellowship.

Spine training is marketable, so if you do sports as a PM&R applicant, the number of jobs interested in you will increased 10 fold if you also can do some interventional spine training as well. Most sports jobs incorporate some of your primary specialty (the most common being FM). There is plenty of need in the rehab community as well, so if you want to add in some botox, EMGs and gen rehab patients, it can actually really increase your MSK practice as well, as I think the MSK pain in this population tends to be overlooked.

I do about 70/30 MSK Sports/Spine/EMG right now, but it will probably be hard to maintain this balance. 50/50 is totally achievable though, and I could also totally stop doing spine I think, but I like being able to do it all. And by MSK sports, I think about half are injuries from sports (fractures, tendinopathy, sprains, strains), and the other half is just MSK aches that have come on as part of life or aging (OA, trigger finger, adhesive capsulitis, etc.)

I think the only inaccuracy in the above post is the assumption that you have to do a ton of event coverage to make your practice work. I know a lot of sports docs who either do very sporadic coverage, or just cover a high school football team (or split one with their practice). It brings in some business, but I think those that do a lot of it, do it because they love it. I don't care much for it, so I cover maybe 8-10 games a year. There are certainly jobs where you are expected to be the head physician for a D1 college, but that is probably the exception, and somewhat coveted by those that love to be with the team, and love the prestige!

 

[JBM16BYU]

Wow, this was genuinely one of the most helpful posts ive seen in any of these forums. Thank you massively for your thorough reply!! This fully answered my question. Just curious, and no worries if you dont want to share, but you said you were interested in the same career path temporarily- what did you end up choosing? are you glad you chose it?

I actually ended up choosing to pursue a Neuromuscular Medicine Fellowship. I really love general PM&R and EMG and just wasn't going to be satisfied with any of the above routes because doing pain, sports, or spine would ultimately take away from my total EMG time. Plus, I felt that my residency training was more than sufficient for managing musculoskeletal and spine complaints (acute/chronic), performing botox injections, performing ultrasound-guided injections, and basically fulfilling all aspects of what I personally wanted. If my time has both spine injections and EMG competing for it, I personally would choose EMG because I frankly enjoy it more. There are a lot of individuals who perform spine injections because it is high in demand (ACGME Pain, ACGME Sports, NASS Spine, Non-NASS Spine, Non-Accredited Pain, PM&R, Anesthesiology, some Family Medicine, some surgeons, and even some non-physicians like CRNA, NP, ND, etc.) A well-performed EMG can be, unfortunately, harder to find. In addition, doing a Neuromuscular Medicine Fellowship allows me to further learn how to diagnose and manage difficult/complex NMD, improve upon my ultrasound skills by concentrating on Neuromuscular Ultrasound and perform even more difficult EMG studies (ex. post-operative brachial plexus repair surgeries to assess for reinnervation, single-fiber EMG, facial EMG, assessment of how well electrophysiologically someone with CIDP is responding to treatment, lumbosacral polyradiculoneuropathies, etc.) I am happy with my decision.

 

[runfastnow]

n = 1 but my practice is definitely shifting away from pure sports most of the year (still very heavy sports during the late summer and fall with football) but if you do spine those patients will seek you out - you just have to decide how much you like treating back/neck pain and fight the flow towards spine.

When I was doing team doc stuff I kept spine very simple and just did lumbar ESIs and SI joints. When that ended I found spine care being more stimulating and rewarding (both personally and financially - lot of crappy spine care in rural mountains around me) than rotator cuff tendinitis, meniscus, etc. So I expanded services to RF, cervical ILESI, did some SIS courses to refresh from residency/fellowship and gain skills (highly recommend SIS courses), and got trained in MILD once I had ~1000 spine injections under my belt since I see a ton of obese, medically complex central stenosis.

Current setup:
Have my RN with me 100% of time that acts as nurse/scribe/assistant - does most of note in the room, handles phone calls, sets up injections/EMGs.
Clinic: 20-30 patients per day in clinic Monday, Wednesday, and Thursday and 8-10 on half day Tuesday. Random mix of injections, EMGs, new, and follow ups. Have a small handful of PM&R patients doing SCI/CVA/spasticity management.
Procedures: 1-2 MILD cases and/or overflow spine procedures on Tuesday half day, 15-20 ESI/RF/SIJ/MBB on Friday

Like DJ (and others) said - if you do spine your practice will creep towards that if you aren't careful but I think it is a valuable skill to have in your pocket. A lot of sports docs at my training institution (big academic place) who did spine would try to not advertise it but if someone had an SI joint or radiculopathy that was sent to them as a referral for some other problem would be able to do the appropriate procedure which I think is super valuable.

 

[timisdaman]

Going along with what was already said:

In general -

1. Sports = MSK and ultrasound
2. Pain = Mostly spine, heavy Fluoro
3. Sports and Spine = Mostly spine, mostly fluoro

There will be sports fellowships that train in fluoro, and pain fellowships that train in ultrasound.

However, the key is - what patient population do you want to manage, and then, what procedures do you want to offer?

The patients and money will come no matter what you decide.

As an aside, I am Sports Medicine. I had fluoro training, but for my jobs, I dropped that procedure set. I was not interested in managing those conditions, and they dominated my schedule such that I had no slots to see the conditions I wanted to. There are few pure Sports Medicine jobs, and they mostly go to Family Medicine. Most jobs are going to be "MSK", or a combination of Sports/MSK and general physiatry / EMG / spine.

 

[drg123]

I actually ended up choosing to pursue a Neuromuscular Medicine Fellowship. I really love general PM&R and EMG and just wasn't going to be satisfied with any of the above routes because doing pain, sports, or spine would ultimately take away from my total EMG time. Plus, I felt that my residency training was more than sufficient for managing musculoskeletal and spine complaints (acute/chronic), performing botox injections, performing ultrasound-guided injections, and basically fulfilling all aspects of what I personally wanted. If my time has both spine injections and EMG competing for it, I personally would choose EMG because I frankly enjoy it more. There are a lot of individuals who perform spine injections because it is high in demand (ACGME Pain, ACGME Sports, NASS Spine, Non-NASS Spine, Non-Accredited Pain, PM&R, Anesthesiology, some Family Medicine, some surgeons, and even some non-physicians like CRNA, NP, ND, etc.) A well-performed EMG can be, unfortunately, harder to find. In addition, doing a Neuromuscular Medicine Fellowship allows me to further learn how to diagnose and manage difficult/complex NMD, improve upon my ultrasound skills by concentrating on Neuromuscular Ultrasound and perform even more difficult EMG studies (ex. post-operative brachial plexus repair surgeries to assess for reinnervation, single-fiber EMG, facial EMG, assessment of how well electrophysiologically someone with CIDP is responding to treatment, lumbosacral polyradiculoneuropathies, etc.) I am happy with my decision.

That's great. Good for you! You clearly have done your homework on all paths and have made an informed decision that aligns your interests and outlook with the job you want to have. I agree, NM has a lot to offer intellectually and it fills a gap. I considered it too. But one thing that I just could not get past was the financials. Have you talked to anyone about what compensation is for typical NM jobs in academia or private practice? I suspect yes, but I'm curious what you found. Money is not my main priority, but I found the salaries for NM (at least in academia) to be hard to stomach.

The averages look OK but if you find yourself on the low end of that curve, it's a bit depressing (at least for my and my family's financial goals/needs). But financials aside, I think PM&R is well-suited for NM and can offer a unique perspective and practice. Enjoy!

 

[DMBandFan86]

If you’re seeing 6 patients a day and doing research then I could see that salary. But still low for any physician. They likely get compensated extra for teaching and a pension.

If you see a normal clinic schedule, perform procedures +/- hospital consults then i would think you would make a normal salary.

 

[Dansk2011]

That's great. Good for you! You clearly have done your homework on all paths and have made an informed decision that aligns your interests and outlook with the job you want to have. I agree, NM has a lot to offer intellectually and it fills a gap. I considered it too. But one thing that I just could not get past was the financials. Have you talked to anyone about what compensation is for typical NM jobs in academia or private practice? I suspect yes, but I'm curious what you found. Money is not my main priority, but I found the salaries for NM (at least in academia) to be hard to stomach.

View attachment 357301
The averages look OK but if you find yourself on the low end of that curve, it's a bit depressing (at least for my and my family's financial goals/needs). But financials aside, I think PM&R is well-suited for NM and can offer a unique perspective and practice. Enjoy!

You can definitely find good non-interventional jobs with heavy emg focus that pays well. Have a friend who lives in an amazing location working for a hospital based ortho group doing a lot of emgs, joint injections, spasticity management, and initial work up for back/neck pain making base 290k with great wrvu bonus. Will easily clear 400k this year. Takes no call and no weekends. Gets 30+ days off per year plus holidays with unbelievable support. Not a bad gig. Usually done his work around 4-5 pm. You just have to look and consider some places that aren't saturated which is typically large coastal cities.

 

[drg123]

You can definitely find good non-interventional jobs with heavy emg focus that pays well. Have a friend who lives in an amazing location working for a hospital based ortho group doing a lot of emgs, joint injections, spasticity management, and initial work up for back/neck pain making base 290k with great wrvu bonus. Will easily clear 400k this year. Takes no call and no weekends. Gets 30+ days off per year plus holidays with unbelievable support. Not a bad gig. Usually done his work around 4-5 pm. You just have to look and consider some places that aren't saturated which is typically large coastal cities.

That's great to hear. Thanks for sharing. To clarify, you're describing an "EMG Plus" job that includes other procedural things that PM&R docs will do but not Neuromuscular (Neurology) focused ones typically don't. I think the numbers I shared are for straight NM docs. I can definitely see if one is willing to do EMG and other RVU-generating services like joint injections and botox, you could make good money. But EMG + NM clinic alone.. I think that's harder.

 

[TheGreatestTrochanter]

EMGs can be an OK money-generator in the right setting. I am in a sports practice, but do an average of 5 EMGs a week. Since 90% of these are for hand weakness and clearly CTS vs UNE I can do it in 20 minutes, which fits into my normal clinic schedule. Only hard part is the one time every couple months it looks like it could be a bigger deal (peripheral polyneuropathy or ALS), where it ends up taking a ton longer. In the end, I've only had one that was motor neuron disease, and I end up sending them to NM anyways, as I'm not equipped for managing this at all in my clinic.

Hard part financially about NM medicine is most of the EMGs are going to be more complicated, and the billing is not substantially more even for the increased time you spend. Ever since EMGs took a reimbursement cut they are much less popular and wait times most places is pretty long. I'm sure you will always have a job doing EMGs!

 

[Coop2]

Hi all! I'm wondering if anyone knows of any programs that are ACGME accredited sports medicine along with NAAS accredited interventional spine for PM&R? (I only know of Michigan State University) Thanks!

 

[JBM16BYU]

As far as I know, Michigan State's 2-year fellowship is the only one that resembles that. If it hasn't changed, Michigan State's first year is non-ACGME interventional spine and EMG and the second year is ACGME sports medicine. I had heard through the grapevine that they were going to try and have that first year be NASS-recognized, but I am not sure if that has happened yet. Per the ISMM fellowship portal on NASS website, it hasn't happened yet in their fellowship directory (chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.spine.org/Portals/0/Assets/Downloads/Education/Match-Opportunities.pdf).

Other things that resemble this are Wash U's and HSS fellowships. However, both of these fellowships have both ACGME sports medicine spots and NASS-recognized interventional spine spots. Unless things have changed, while the spots interact and may have similarities, you do not match into both spots simultaneously, you have to choose.

 

[Coop2]

Thank you JBM16BYU!

 

[Coop2]

As far as I know, Michigan State's 2-year fellowship is the only one that resembles that. If it hasn't changed, Michigan State's first year is non-ACGME interventional spine and EMG and the second year is ACGME sports medicine. I had heard through the grapevine that they were going to try and have that first year be NASS-recognized, but I am not sure if that has happened yet. Per the ISMM fellowship portal on NASS website, it hasn't happened yet in their fellowship directory (chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.spine.org/Portals/0/Assets/Downloads/Education/Match-Opportunities.pdf).

Other things that resemble this are Wash U's and HSS fellowships. However, both of these fellowships have both ACGME sports medicine spots and NASS-recognized interventional spine spots. Unless things have changed, while the spots interact and may have similarities, you do not match into both spots simultaneously, you have to choose.

How much does it tend to matter if a interventional spine fellowship is NASS recognized or not?

 

[JBM16BYU]

How much does it tend to matter if a interventional spine fellowship is NASS recognized or not?

A benefit of a NASS-recognized ISMM fellowship is that it has to go through a point system to actually get "recognized" by NASS (chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.spine.org/Portals/0/assets/downloads/Education/For-Program-Directors.pdf). Programs that have met those requirements are posted on their fellowship directory. Programs that have applied and not yet met those requirements have a "provisional" time period to meet those requirements and are listed at the bottom of the fellowship directory. I would personally say that that would be of benefit for an applicant because you know that certain requirements had to be met to be called a "NASS-recognized" fellowship and there is some standardization. Just like fellowships in other arenas, each fellowship will vary place by place, but they have to at least meet the bare minimum set by NASS.

The gamble you take with non-NASS spine, non-ACGME pain, or non-ACGME sports fellowships is that you don't have that same level of standardization. These fellowships can be well-run, provide great education, and give you good skills, or the fellow may end up being more of an assistant or a way for a practice to see more patients and make more money off of cheap labor. It is variable without standardization.

Depending on your personal career goals, area of the country you want to practice, type of clinical practice (private practice vs. hospital employed vs. academic vs. VA... etc.), and types of procedures you would like to learn, individuals may find benefit from either types. Just make sure to talk to prior fellows, current fellows, the staff at the programs, etc. to make sure you get a really good feel for what the fellowship offers and what to expect. I would recommend doing that no matter the type of fellowship you choose to pursue.

 

[Iamnew2]

Oh awesome, I actually saw some of your previous posts! So it is still feasible to do interventional spine procedures with solely a sports fellowship (and no pain fellowship or sports/spine fellowship) as long as you just choose a fellowship that offers that kind of exposure?

You can do what you would like, however in real life most practices and particularly more saturated/selective states would want you to have an ACGMe accredited pain fellowship for spine procedures. Whether you know what you are doing or not is kind of irrelevant it's mostly the whole issue about liability. If something were to happen, and it was taken to court, the malpractice attorney would be like, "Dr Kulmpke, so you didn't complete an ACGME accredited pain fellowship is that right?" or something of the sort. Most academic and/or Anesthesia/Pain practices likely won't hire you without an accredited fellowship. Many practices where I'm at won't hire non-ACMGE pain fellowship docs for spine related stuff - even Ortho ones, although that varies. They have plenty of docs who have the fellowship - but other states may differ. I do have some classmates however who practice in different states that have been able to be hired without doing ACGME pain fellowships and one that I think didn't even do a fellowship and somehow does spine procedures - I would never recommend that no matter how much training you've gotten. If you do the NASS/non-accredited fellowship, you likely would end up in the Ortho bro (sorry guys!) type practice, which I stay as far away from - while I'm sure some people might have good experience in this set up, I would say that typically it ends up as a bad deal for the PM&R doc.

I suppose if you had your own private practice and could garner enough patients you could do spine. As others have mentioned, doing an exclusively sports gig is rare/difficult/unlikely.

Based on my experiences with residency, I think doing a sports fellowship regardless of how good you are if you end up in an Ortho practice as someone has mentioned in the past will leave you covering a bunch of games unpaid, during the week/weekends which I'm sure is exhausting, and doing a bunch of knee injections for OA with the sprinkle of athletes. The high end athletes typically go to Ortho.

I guess anything is possible, but I think it's a challenging path.

 

[TheGreatestTrochanter]

Not sure why you would want both - hard to see a practice where you do a spectrum interventional spine plus sports. Most PM&R sports fellowships will give you extra spine training. I did a sports fellowship and also do epidurals, RFA of the c and l spine, and joint RFA. This in combo with sports training keeps me busy and its hard to keep up with all that! I send people out for SCS or intracept, thoracic injections, etc. If you are doing all the heavy pain/spine stuff you are going to move away from a sports population anyways so I think a waste of a second year of training.

 

[sdnuser001]

You can do what you would like, however in real life most practices and particularly more saturated/selective states would want you to have an ACGMe accredited pain fellowship for spine procedures. Whether you know what you are doing or not is kind of irrelevant it's mostly the whole issue about liability. If something were to happen, and it was taken to court, the malpractice attorney would be like, "Dr Kulmpke, so you didn't complete an ACGME accredited pain fellowship is that right?" or something of the sort. Most academic and/or Anesthesia/Pain practices likely won't hire you without an accredited fellowship. Many practices where I'm at won't hire non-ACMGE pain fellowship docs for spine related stuff - even Ortho ones, although that varies. They have plenty of docs who have the fellowship - but other states may differ. I do have some classmates however who practice in different states that have been able to be hired without doing ACGME pain fellowships and one that I think didn't even do a fellowship and somehow does spine procedures - I would never recommend that no matter how much training you've gotten. If you do the NASS/non-accredited fellowship, you likely would end up in the Ortho bro (sorry guys!) type practice, which I stay as far away from - while I'm sure some people might have good experience in this set up, I would say that typically it ends up as a bad deal for the PM&R doc.

I suppose if you had your own private practice and could garner enough patients you could do spine. As others have mentioned, doing an exclusively sports gig is rare/difficult/unlikely.

Based on my experiences with residency, I think doing a sports fellowship regardless of how good you are if you end up in an Ortho practice as someone has mentioned in the past will leave you covering a bunch of games unpaid, during the week/weekends which I'm sure is exhausting, and doing a bunch of knee injections for OA with the sprinkle of athletes. The high end athletes typically go to Ortho.

I guess anything is possible, but I think it's a challenging path.

Can you explain why you stay away from the ortho bro practices and why it is typically a bad deal for the PM&R doc?