Sports and Spine Fellowship Reviews, Any Opinions

[normalforce]

Hi all, I am looking at the following places for PASSOR S/S Fellowship. Anyone familiar or have any thought on these programs. Thanks.

1. HSS
2. Cleveland Clinic- Spine
3. U of Utah
4. U of Colorado
5. Portner Orthopedic Rehab- HI
6. Florida Spine Institute

Thanks a lot.

NF

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[drvlad2004]

I would contact Portner's program to make sure that they accepting fellows. During the past year, they were not accepting any new fellows. That may have changed for your year. All of the programs you've mentioned are very solid. HSS is a very comprehensive program. On top of it, HSS has great MSK radiology training. If you want more sports training, then Utah is the way to go. Dr. Willick is great.

 

[savealife]

Hi all, I am looking at the following places for PASSOR S/S Fellowship. Anyone familiar or have any thought on these programs. Thanks.

1. HSS
2. Cleveland Clinic- Spine
3. U of Utah
4. U of Colorado
5. Portner Orthopedic Rehab- HI
6. Florida Spine Institute

Thanks a lot.

NF

Are these PM&R "Sports & Spine" fellowships (not just these, but all of them) going to try to become ACGME accredited for Sports Medicine, now that PM&R can do that? I know that Utah is doing so, but I'm interested in the other places... perhaps this could be a good way to circumvent the whole "you have to do an ACGME accredited Pain fellowship to do injections" conundrum?

i.e. if you're accredited as a "Sports Medicine" physician you might be able to do these spinal injections because it was part of your ACGME accredited fellowship training?

Sorry to stray from the original topic, but does anyone have any thoughts on this?

savealife

 

[ampaphb]

I would contact Portner's program to make sure that they accepting fellows. During the past year, they were not accepting any new fellows. That may have changed for your year. All of the programs you've mentioned are very solid. HSS is a very comprehensive program. On top of it, HSS has great MSK radiology training. If you want more sports training, then Utah is the way to go. Dr. Willick is great.

A good friend of mine was Dr. Portner's fellow in '06-'07 - I can put you in touch with her if you PM me.

 

[GQPMR]

Hi all, I am looking at the following places for PASSOR S/S Fellowship. Anyone familiar or have any thought on these programs. Thanks.

1. HSS
2. Cleveland Clinic- Spine
3. U of Utah
4. U of Colorado
5. Portner Orthopedic Rehab- HI
6. Florida Spine Institute

Thanks a lot.

NF

I know of some of these programs from friends that interviewed at these programs.

Regarding HSS, one friend that interviewed there this past year said they have only one interview day per year, so you will be competing that day with some where between 8-12 applicants. Also per a graduate from the program a couple of years ago was noted that there is a heavy research component associated with the program. Not sure if this is still the case, but the friend that interviewed this year mentioned the program is mostly Spine with EMG focus and just some Sports Medicine.

For Dr. Portner's fellowship, I don't know if it is PASSOR recognized this year, but from the 2007 PASSOR fellowship guide online it is not mentioned as having PASSOR recognition. You might want to follow up on that. A friend a couple of years ago did not have many positive things to say about his fellowship. Here are some of the comments he passed down to us :

Pros: Hawaii, easy fellowship, will also train in "Orthopedic Medicine"-Cyriax
Cons: Easy fellowship, depth and quality of interventional training is limited, may be poor academically, little EMG, poor equipment

I am not too sure about what this Cyriax orthopedic medicine is about, but you can find out more on there website: http://www.cyriax.com/default.html

Regarding U of Colorado, I believe they only have 2 spots available now that they share the fellowship spots with the Anesthesia dept. One spot seems to be for the PM&R sports/spine fellowship and the other spot for the Anesthesia Pain fellowship. Per discussions with friends this year, it may be that if there is an internal U of Colorado candidate the sports/spine spot may go to that person. The anesthesia pain spot I am guessing will go to an anesthesia candidate, but I am not sure about that.

Regarding the Cleveland Clinic Spine fellowship, I have heard it is very good academically but may be limited in procedural experience. I know there is someone on the board that may be able to shed more light on this fellowship.

Regarding the Florida Spine Institute supposedly the fellows put out phenomenal procedural numbers from friends that have interviewed there. I believe that Josh Rittenberg from SSRC trained there and he may have more to tell you about that program.

I have heard good things about the U of Utah program. A friend couple years ago gave his take on the program:

It has a Sports, Spine, MSK focus with EMG, Research, Rotations are also in foot/ankle, hand
Pros: Probably strong academically, well balanced
Cons: Depth of interventional training may be limited

Maybe someone in these programs currently can shed light on what is happening now, as it seems that programs continually change their curriculum and may be quite different year after year.

Hope that helps.

 

[Finally M3]

.

Regarding the Cleveland Clinic Spine fellowship, I have heard it is very good academically but may be limited in procedural experience. I know there is someone on the board that may be able to shed more light on this fellowship.

Yes, he PMd me.

And reiterating; the Colorado Sports & Spine generally will take an in-house candidate, but they took an outside candidate this year.

 

[ampaphb]

At FSI, while the numbers were huge, it was my impression that the vast majority of what you were exposed to were bread and butter lumbar procedures. Only Dr. Hanna and Brown did cervical procedures when I rotated there for a week as a resident. I do not believe they do any implantables. Also, the senior-most, interventionist there, Dr. Gruber, just left the practice to joined the Laser Spine Institute. As was stated earlier, Dr. Rittenberg did indeed train there, as did Dr. Thomas, who is now a part of the Cleveland Clinic Spine Fellowship

 

[Dr. Ice]

Im gonna have to disagree with what was said about HSS. Although it may appear to be "comprehensive", the fellows coming out of the program do not feel competent in performing a lot of procedures. I knew one fellow who had to take additional courses after his fellowship to feel more comfortable with performing some otherwise basic interventional procedures. In terms of the sports experience...there is good exposure to that, however I heard that a lot of time scheduling conflicts amongst the fellows creates competition for the more "saught after" games.

I would put this place lower on my list in terms of training, but its base is the upper east side of manhattan, and I guess you cant really beat that!

 

[olafa]

[Pros: Hawaii, easy fellowship, will also train in “Orthopedic Medicine”-Cyriax
Cons: Easy fellowship, depth and quality of interventional training is limited, may be poor academically, little EMG, poor equipment

I am not too sure about what this Cyriax orthopedic medicine is about, but you can find out more on there website: http://www.cyriax.com/default.html


Is this Cyriax method for therapist or physicians? (disclaimer- this is the first time I have heard of this "orthopedic medicine diploma" seems strange to quantify is as such with out a medical liscence- according to the listing most students are PTs) By the looks it appears to me more like manual therapy, taught by therapist. www.om-cyriax.xcom

 

[Shalom77]

Dr. Cyriax was a physician from the UK basically considered the founder of the field of orthopedic medicine. I think his methods are relevant for both PTs and physiatrists. I did learn about him, though, because a PT I know was always quoting him.

Orthopaedic medicine is the examination, diagnosis and treatment of non-surgical lesions of the musculoskeletal system. Orthopaedic medicine began in 1929 when Dr James Cyriax observed a number of patients where the diagnosis was vague and the treatment non-specific. There appeared to be no satisfactory method for testing the function of soft tissues to achieve a clinical diagnosis. He developed a system of assessment aiming to accurately diagnose lesions of the musculoskeletal system and a non-surgical method of treatment for soft tissue lesions.
He based his work on the following principles:
All pain has a source
All treatment must reach the source
All treatment must benefit the lesion
Since the approach was formulated by Dr Cyriax, it has undergone constant development and re-appraisal in the light of current research

http://www.somed.org/about.htm

 

[Disciple]

I do not believe they do any implantables. Also, the senior-most, interventionist there, Dr. Gruber, just left the practice to joined the Laser Spine Institute.

Is this the place that's been blasted on the ISIS forum?


http://www.laserspineinstitute.com/

 

[Disciple]

I think the best thing for PM&R residents in this era is to choose a fellowship that will fill in what is missing from your residency training, whether that be sports or interventional/spine training.

Hopefully it's not both.

There are a good number of PM&R spine fellowships that will provide good procedural volume, but only a few that will provide great depth of interventional training, i.e. you will be more geared toward a surgical or MSK group as opposed to a pain practice (not that there is anything wrong with this).

(Aside-There is a new fellowship in Shreveport, Lousiana being advertised in the Archives that looks pretty comprehensive procedure wise. Anybody know anything about this?)

Generally speaking, the greater the sports/MSK component, the less the interventional component and vice-versa.

There are no PM&R fellowships that I know of that provide both in-depth sports and interventional training. So as I stated above, it's kind of mix & match when making your decision.

 

[normalforce]

Thanks for the thoughts everyone....

peter. i'll call u soon. thanks.

NF

 

[Disciple]

Are these PM&R "Sports & Spine" fellowships (not just these, but all of them) going to try to become ACGME accredited for Sports Medicine, now that PM&R can do that? I know that Utah is doing so, but I'm interested in the other places... perhaps this could be a good way to circumvent the whole "you have to do an ACGME accredited Pain fellowship to do injections" conundrum?

i.e. if you're accredited as a "Sports Medicine" physician you might be able to do these spinal injections because it was part of your ACGME accredited fellowship training?

Sorry to stray from the original topic, but does anyone have any thoughts on this?

savealife

I don't think you can do it through that pathway. Injections would have to be part of the standardized sports fellowship requirements for that to happen.

Anyway, I think the ABPMR is trying to develop their own certification to account for the large number of Physiatrists working in MSK or surgical groups who don't really do comprehensive "Pain Medicine".

For the future, I guess ideally, a resident would qualify for the procedural certification through his/her residency training
(would need to go to a forward thinking program) and then go on to a 1 year accredited sports fellowship to cover all the bases without adding more than 1extra year of training.

 

[bedrock]

First, just wanted to thank everyone for their posts on the subject.
I agree with Disciple in that there is more than one way to the end goal of becoming a well-rounded sports/spine/msk physiatrist. By that I mean someone who can evaluate and treat non-surgical acute, subacute & chronic musculoskeletal pain. As a huge proportion of non-surgical MSK pain is back pain, this would include providing the common minimally invasive spinal procedures.

Most PM&R residencies provide reasonable training in common chronic MSK pain conditions, although in a few low-end residencies, the graduates aren't competent for anything but general inpatient rehab(which is fine if that's your goal).

The two distinguishing points in MSK training for most PM&R residencies are one of two things
1-Sports medicine- A minority of programs offer adequate experience in true sports medicine, by this I mean acute and subacute injuries in any joint of the body. We all get exposed to chronic stuff in various PM&R clinics, and in the better programs you see some common athletic injuries, but most graduates even from the better PM&R programs aren't ready to evaluate a college or weekend athlete with anything other than the really common shoulder and knee issues.
2-Interventional spine procedures- A minority of programs give you enough numbers and experience to feel competent to do these on your own without a fellowship. And if you are competent, it's generally only with Lumbar procedures.

I agree with Disciple in that if you want to be a comprehensive PM&R sports/spine/msk person and you go to a PM&R residency that has great sports medicine, then I would recommend you do a Pain or interventional spine fellowship. If you went to a PM&R residency that offers great interventional exposure (including C-spine) they you could do a pure sports medicine fellowship.

Unfortunately, most PM&R programs fall in between on both #1 and #2 and so most PM&R grads could use extra training in both sports medicine and interventional procedures which is why these "Sports & Spine" fellowships are attractive to those of us who want to be comprehensive sports/spine/msk physiatrists, (not a needle jockey and not a sports guy unable to offer an epidural to his many patients with back pain)

 

[bedrock]

Wanted to chime on the these fellowship reviews as I interviewed at most of the Sports & Spine fellowships this last cycle.

I won't comment on the Cleveland clinic and the Florida spine institute programs since they are both simply interventional spine programs so I'm not really sure why they're on a "sports" and spine list. I will add two programs to the list, RIC since they basically originated this fellowship model (of note, the fellowship directors at Utah and Colorado are RIC grads), and the U of Washington which has a young Sports & Spine program but is similar to the rest of the group in its sports and interventional exposure.

In alphabetical order-
Colorado-the most interventional of the group, as of this year it's now officially listed as a PMR "pain fellowship" and you'll be eligible for the pain boards. This is only "sport & spine" fellowship where you are trained in discograms, You'll also get better numbers for RFs than at RIC, HSS, Utah, and UWashington. At those 4 places most fellows are borderline competent in RFs (radiofrequency ablations) due to the low frequency of those procedures as a fellow. Sports is decent but not as well developed as Utah or U Washington. They are somewhat notorious for strongly preferring to take their own as fellows, but outside applicants are sometimes accepted.

HSS-You are blessed and cursed by the HSS name. Greatly helps with jobs afterwards, but a large proportion of your patients at HSS are private and the fellow is relegated to the sideline during many evals and procedures. Have spoken to a couple fellows who mentioned the need for additional procedural training afterwards, mainly with cervical procedures. Some sideline sports exposure to a few high-profile events but inadequate regular experience evaluating acute/sub-acute athletic injuries in clinic which is what you need as a fellow. The HSS name is huge among orthopedists and if you want to work for an ortho group afterwards you can take your pick of locations.

RIC- The granddaddy of them all. In contrast to HSS, this name doesn't mean a great deal to orthopedists, but it's king in PM&R. If you want to be an academic sport/spine/msk physiatrist, there is no better place to go. On the flip side, you may go crazy with the academic requirements if you intend on private practice. Fellow spends about 30hr/week in clinic and >20hrs week on academic projects, you give near weekly MSK resident lectures, journal club, and do research as well. You're ready to run your own fellowship when you're done (if that's what you want) The weakness are less clinic time than other fellowships since you're busy writing papers and powerpoints, just barely adequate bread and butter procedural experience, minimal acute/sub-acute sports injuries (no regular clinics with college athletes) Still very respected and highly competitive. One of the two fellows is often a prior RIC resident, but I believe they take the best overall candidates, (which are often from RIC).

(Normalforce, would appreciate your comments on the RIC fellowship as you're currently doing residency there)

Utah-Has the best acute/sub-acute sports exposure of the group. The fellow does sports with both PM&R and Family Practice sports med attendings which all the prior fellows raved about. (separate FP sports fellowship at Utah). A good model for PM&R sports&spine fellowships as FP runs the college athletic clinics at most universities. Interventional exposure is similar to RIC & UWashington, just adequate exposure to bread and butter procedures. (C & L spine epidurals, facets, RFs,& SIJ injections). Utah is unique in training its fellows in basic non-surgical fracture management. You spend regular time at the ski-clinic in Park City evaluating & casting common closed fractures, i.e. ankles, toes, fingers, wrists. Utah and Mayo are the only two PM&R fellowships in the country that offer decent training in non-surgical fracture management. It's the closest you'll get to orthopedics without the pain of a surgical residency. (FYI the Mayo fellowship is purely sports, no interventional spine). Utah is open to applicants from anywhere but very competitive given its unique opportunities.

U of Washington(Seattle)- The youngest program, now in it's second year. Similar to Utah in most respects. The fellow does sports with both PM&R attendings and the FP sports attendings(separate FP sports fellowship also at UW) which as mentioned for Utah gives you better exposure to acute/sub-acute sports injuries in college athletic clinics than the other Sports & Spine fellowships. Interventional exposure is similar to Utah and RIC, (just adequate exposure to bread and butter procedures. (C & L spine epidurals, facets, RFs, & SIJ injections). The fellow runs his/her own clinic one day/week (with attendings physically located in the same clinic space if you have a question) which is helpful for transitioning to private practice and understanding billing issues. Differs from Utah in that UW offers no significant exposure to non-surgical fracture management. As mentioned in the Utah paragraph, the Mayo and Utah fellowships are unique in this regard.

I hope this is helpful for residents considering where to apply this year.

One thing I wanted to mention is that this was a list and review of the "Sports & Spine" fellowships. To deserve the "& Spine " description I feel that a fellowship should include the entire spine for at least the bread & butter interventions, (i.e. cervicals, and also offer RFs as they are very common spine procedures). There are at least 5-8 other programs I could list that are essentially PM&R sports fellowships that also offer training in the most basic common interventional lumbar procedures, among the most well known are the ones at Washington University(St. Louis), & Atlantic Sports & Spine (with Gerald Malanga formerly of Kessler). There are around 5-6 other programs that fall into this group. Each offer solid sports medicine exposure and also you learn basic lumbar epidurals and lumbar facets injections. No cervicals, no RFs of any sort any of these places. Some of them may offer SIJ injections. I wasn't going to spend another year of my life in fellowship and not learn Cervicals & RFs so I didn't consider these programs and I feel they don't really deserve the "Sports & Spine" name as they skip C-spine procedures, and RFs altogether, but residents should be aware they exist and are another fellowship option besides Interventional spine, Pain, Sports & Spine and pure Sport medicine fellowships.

 

[SSdoc33]

I also interviewed and have heard about many of the programs in the above post, and I think its pretty much dead on. Id say the same thing.

One note for clarification. I really dont think that one can be competent in both sports and spine after one year of fellowship. they are different specialties. if you focus on one side, you lose the other. you can toe the line and try to do both, but you will not be upper eschelon in either. the time spent on the sidelines of a game is time NOT spent performing provacation discography or SCS. the reverse is true as well. and lets not even get into MSK ultrasound or EMGs. i defy anyone to tell me that they have performed enough axial injections and procedures to be competent and handle the complications AND be a comprehensive sports doc. just really REALLY hard to do.

as an aside, lets not forget the practical side of this. concentrating more on the spine side of things will likely make you a more attractive candidate to land jobs, and they will also likely pay more.

 

[drusso]

First, just wanted to thank everyone for their posts on the subject. I agree with Disciple in that there is more than one way to the end goal of becoming a well-rounded sports/spine/msk physiatrist. By that I mean someone who can evaluate and treat non-surgical acute, subacute & chronic musculoskeletal pain. As a huge proportion of non-surgical MSK pain is back pain, this would include providing the common minimally invasive spinal procedures.

Hmmm. So, if you need a *FELLOWSHIP* to be well-rounded, then what's the point of a 4-year residency?

In other specialties, FELLOWSHIP training makes you more specialized, not less specialized. It seems that in physiatry, the term "FELLOWSHIP" is perhaps code-language for "remedial education." If your residency program was weak in MSK Medicine you can do an MSK "fellowship."

If you graduate from an accredited PM&R residency you should be an ipso facto expert in "conservative, nonsurgical MSK & spine care." If you're not, then what exactly is your residency experience making you competent for?? I think that the specialty has a problem if the training it provides over a 3-4 year period of time is not actually preparing graduates for the what physiatrists actually are requested to do outside of large academic teaching centers...manage opioids, diagnose, treat and optimize management of non-operative spine and MSK conditions, disability evaluations, workman's compensation and industrial medicine, perform EMG's, etc. In addition, we are experts in neurological rehabilitation and recovery of function.

According to our specialty academy's website: http://www.aapmr.org/ physiatrists, "focus on restoring function. They care for patients with acute and chronic pain, and musculoskeletal problems like back and neck pain, tendonitis, pinched nerves and fibromyalgia" among other things.

Does the average graduate from the typical PM&R residency program possess the knowledge & SKILLS to function this way? Do we have a credibility problem?

 

[bedrock]

SSdoc33,

You made a couple of good points. Even after a year in one of the best sports & spine fellowships, you'll be good and very competent in sports & spine, but it's not the quite the same as if you devoted yourself to one or the other. I remember talking a doc who did a Med/Peds residency, and practiced both afterwards. He said he was very good at Medicine and at Peds, but still not quite at the level he would be he had chosen one or the other. I think the concept of the broad MSK physiatrist who does sports, interventions, general msk, & EMGs is part of the way our specialty generally looks at patients comprehensively.

The other good point you made was about the demand for interventional training looking for jobs. In the real world, Interventional experience is what determines many jobs, which is one big reason why a Sports & Spine fellowship that doesn't teach you c-spine or RFs may be less desirable as this could impact your marketability for your first job.

 

[bedrock]

If you graduate from an accredited PM&R residency you should be an ipso facto expert in "conservative, nonsurgical MSK & spine care." If you're not, then what exactly is your residency experience making you competent for?? I think that the specialty has a problem if the training it provides over a 3-4 year period of time is not actually preparing graduates for the what physiatrists actually are requested to do outside of large academic teaching centers...manage opioids, diagnose, treat and optimize management of non-operative spine and MSK conditions, disability evaluations, workman's compensation and industrial medicine, perform EMG's, etc. In addition, we are experts in neurological rehabilitation and recovery of function.

Russo,

I hope you don't misunderstand what I meant earlier. I certainly agree that at the end of most PM&R residencies, you will be ready to do conservative care for spine, disability evals, workers/occ med, EMGs and take care of chronic MSk conditions.

However there isn't a single PM&R program (in the US at least) after which you'll be competent in acute/subacute sports med injuries AND all the common interventional spine procedures.

They simply don't exist, which is why there are fellowships.

 

[Ligament]

Hmmm. So, if you need a *FELLOWSHIP* to be well-rounded, then what's the point of a 4-year residency?

In other specialties, FELLOWSHIP training makes you more specialized, not less specialized. It seems that in physiatry, the term "FELLOWSHIP" is perhaps code-language for "remedial education." If your residency program was weak in MSK Medicine you can do an MSK "fellowship."

If you graduate from an accredited PM&R residency you should be an ipso facto expert in "conservative, nonsurgical MSK & spine care." If you're not, then what exactly is your residency experience making you competent for?? I think that the specialty has a problem if the training it provides over a 3-4 year period of time is not actually preparing graduates for the what physiatrists actually are requested to do outside of large academic teaching centers...manage opioids, diagnose, treat and optimize management of non-operative spine and MSK conditions, disability evaluations, workman's compensation and industrial medicine, perform EMG's, etc. In addition, we are experts in neurological rehabilitation and recovery of function.

According to our specialty academy's website: http://www.aapmr.org/ physiatrists, "focus on restoring function. They care for patients with acute and chronic pain, and musculoskeletal problems like back and neck pain, tendonitis, pinched nerves and fibromyalgia" among other things.

Does the average graduate from the typical PM&R residency program possess the knowledge & SKILLS to function this way? Do we have a credibility problem?

agreed dave.

 

[normalforce]

Wanted to chime on the these fellowship reviews as I interviewed at most of the Sports & Spine fellowships this last cycle.

I won't comment on the Cleveland clinic and the Florida spine institute programs since they are both simply interventional spine programs so I'm not really sure why they're on a "sports" and spine list. I will add two programs to the list, RIC since they basically originated this fellowship model (of note, the fellowship directors at Utah and Colorado are RIC grads), and the U of Washington which has a young Sports & Spine program but is similar to the rest of the group in its sports and interventional exposure.

In alphabetical order-
Colorado-the most interventional of the group, as of this year it's now officially listed as a PMR "pain fellowship" and you'll be eligible for the pain boards. This is only "sport & spine" fellowship where you are trained in discograms, You’ll also get better numbers for RFs than at RIC, HSS, Utah, and UWashington. At those 4 places most fellows are borderline competent in RFs (radiofrequency ablations) due to the low frequency of those procedures as a fellow. Sports is decent but not as well developed as Utah or U Washington. They are somewhat notorious for strongly preferring to take their own as fellows, but outside applicants are sometimes accepted.

HSS-You are blessed and cursed by the HSS name. Greatly helps with jobs afterwards, but a large proportion of your patients at HSS are private and the fellow is relegated to the sideline during many evals and procedures. Have spoken to a couple fellows who mentioned the need for additional procedural training afterwards, mainly with cervical procedures. Some sideline sports exposure to a few high-profile events but inadequate regular experience evaluating acute/sub-acute athletic injuries in clinic which is what you need as a fellow. The HSS name is huge among orthopedists and if you want to work for an ortho group afterwards you can take your pick of locations.

RIC- The granddaddy of them all. In contrast to HSS, this name doesn't mean a great deal to orthopedists, but it's king in PM&R. If you want to be an academic sport/spine/msk physiatrist, there is no better place to go. On the flip side, you may go crazy with the academic requirements if you intend on private practice. Fellow spends about 30hr/week in clinic and >20hrs week on academic projects, you give near weekly MSK resident lectures, journal club, and do research as well. You're ready to run your own fellowship when you're done (if that's what you want) The weakness are less clinic time than other fellowships since you're busy writing papers and powerpoints, just barely adequate bread and butter procedural experience, minimal acute/sub-acute sports injuries (no regular clinics with college athletes) Still very respected and highly competitive. One of the two fellows is often a prior RIC resident, but I believe they take the best overall candidates, (which are often from RIC).

(Normalforce, would appreciate your comments on the RIC fellowship as you're currently doing residency there)

Utah-Has the best acute/sub-acute sports exposure of the group. The fellow does sports with both PM&R and Family Practice sports med attendings which all the prior fellows raved about. (separate FP sports fellowship at Utah). A good model for PM&R sports&spine fellowships as FP runs the college athletic clinics at most universities. Interventional exposure is similar to RIC & UWashington, just adequate exposure to bread and butter procedures. (C & L spine epidurals, facets, RFs,& SIJ injections). Utah is unique in training its fellows in basic non-surgical fracture management. You spend regular time at the ski-clinic in Park City evaluating & casting common closed fractures, i.e. ankles, toes, fingers, wrists. Utah and Mayo are the only two PM&R fellowships in the country that offer decent training in non-surgical fracture management. It's the closest you'll get to orthopedics without the pain of a surgical residency. (FYI the Mayo fellowship is purely sports, no interventional spine). Utah is open to applicants from anywhere but very competitive given its unique opportunities.

U of Washington(Seattle)- The youngest program, now in it's second year. Similar to Utah in most respects. The fellow does sports with both PM&R attendings and the FP sports attendings(separate FP sports fellowship also at UW) which as mentioned for Utah gives you better exposure to acute/sub-acute sports injuries in college athletic clinics than the other Sports & Spine fellowships. Interventional exposure is similar to Utah and RIC, (just adequate exposure to bread and butter procedures. (C & L spine epidurals, facets, RFs, & SIJ injections). The fellow runs his/her own clinic one day/week (with attendings physically located in the same clinic space if you have a question) which is helpful for transitioning to private practice and understanding billing issues. Differs from Utah in that UW offers no significant exposure to non-surgical fracture management. As mentioned in the Utah paragraph, the Mayo and Utah fellowships are unique in this regard.

I hope this is helpful for residents considering where to apply this year.

One thing I wanted to mention is that this was a list and review of the “Sports & Spine” fellowships. To deserve the “& Spine ” description I feel that a fellowship should include the entire spine for at least the bread & butter interventions, (i.e. cervicals, and also offer RFs as they are very common spine procedures). There are at least 5-8 other programs I could list that are essentially PM&R sports fellowships that also offer training in the most basic common interventional lumbar procedures, among the most well known are the ones at Washington University(St. Louis), & Atlantic Sports & Spine (with Gerald Malanga formerly of Kessler). There are around 5-6 other programs that fall into this group. Each offer solid sports medicine exposure and also you learn basic lumbar epidurals and lumbar facets injections. No cervicals, no RFs of any sort any of these places. Some of them may offer SIJ injections. I wasn’t going to spend another year of my life in fellowship and not learn Cervicals & RFs so I didn’t consider these programs and I feel they don’t really deserve the “Sports & Spine” name as they skip C-spine procedures, and RFs altogether, but residents should be aware they exist and are another fellowship option besides Interventional spine, Pain, Sports & Spine and pure Sport medicine fellowships.

Thanks for that awesome response.

As for RIC... We have a S/S lecture that gives balanced exposure to basic inteventional procedures (C/L ESI, RF, SI) and strong MSK/sports, including MSK ultrasound. It is strong didactically and research-wise with many projects to choose from. Not much team sports though. The attendings are the strong point, all phenomenal teachers and people. Since I trained here, I want to go somewhere else for my fellowship, if I choose to do one.

Thanks again.

 

[jackpmr]

Hi guys! Just some thoughts about some of the fellowships described above.

Utah- This is an excellent fellowship. A lot of good exposure to sports injuries and excellent teaching. Your spinal procedures will be very strong.

U of Washington- New program. Pretty weak from what I have heard. Not many procedures and the fellow is essentially like a junior attending. Scut heavy. They expect you to teach the residents.

Florida: Very strong spine procedures. Not any sports but you will get a ton of injections without the intensity of slipman/furman type.

UCLA (pain): Excellent program, a lot of pain but you get great injection experience and Dr. Fish is really ggreat to work with. It is very competitive though.

 

[QuiltedNorthern]

I'm applying next year:

How is the Spaulding/Harvard Pain program in Boston? Is it competitive? With whom do you work with? What are the positives and negatives? Do they have a preference for people from the Spaulding residency program? Do the fellows get well trained? Is it worth doing an away rotation there this Spring/Summer, I'm trying to decide on whether to do one. Any info is appreciated.

 

[ampaphb]

Florida: Very strong spine procedures. Not any sports but you will get a ton of injections without the intensity of slipman/furman type.

Which Florida program are you talking about? Anesthesia? PM&R? UF? FSI?

 

[GQPMR]

I'm applying next year:

How is the Spaulding/Harvard Pain program in Boston? Is it competitive? With whom do you work with? What are the positives and negatives? Do they have a preference for people from the Spaulding residency program? Do the fellows get well trained? Is it worth doing an away rotation there this Spring/Summer, I'm trying to decide on whether to do one. Any info is appreciated.

Regarding Spaulding's pain program, I have heard from a resident there that they typically only interview 4-5 applicants per year for the one fellowship spot they have and many of those candidates tend to be the Spaulding residents. If you do a rotation there and you were pretty strong, it might help your chances.

 

[axm397]

I got an interview offer from Spaulding this year but had already taken another fellowship spot by that time so I didn't go. I did hear from several friends who did the other Harvard pain fellowships(BI, MG, etc.) that Spaulding tends to have the least procedure exposure and more inpatient and chronic pain.

In terms of "in-house" applicants - their website shows only one of four past fellows from Spaulding itself. http://spauldingrehab.org/education/painmanagement

Also, it may seem like a small distinction but there are sports, spine, MSK, and pain fellowships out there. Many fellowship directors and attendings do care about the classification of their fellowships so if you plan on applying to more than one type, be careful with your personal statements and LORs. ACGME accreditation is available for sports medicine and pain fellowships.

 

[axm397]

Hi guys! Just some thoughts about some of the fellowships described above.

Utah- This is an excellent fellowship. A lot of good exposure to sports injuries and excellent teaching. Your spinal procedures will be very strong.

U of Washington- New program. Pretty weak from what I have heard. Not many procedures and the fellow is essentially like a junior attending. Scut heavy. They expect you to teach the residents.

Florida: Very strong spine procedures. Not any sports but you will get a ton of injections without the intensity of slipman/furman type.

UCLA (pain): Excellent program, a lot of pain but you get great injection experience and Dr. Fish is really ggreat to work with. It is very competitive though.

I actually don't think that Furman is that intense. He is definitely not on the same intensity level as Slipman. Very different personalities and teaching styles.

UCLA is a pain fellowship so of course you get a lot of pain. If you want more sports - you should apply to sports fellowships.

Being at RIC and knowing some people at the UW program, I think the fellowships are EXCELLENT academic opportunities but they do tend to be heavy on the academic activities. I think the fellows in the past have actually enjoyed the academic opportunities to teach, lecture, and mentor students and residents. If you have NO interest in research, teaching, and mentoring, then you probably won't be happy at these programs.

 

[bedrock]

I got an interview offer from Spaulding this year but had already taken another fellowship spot by that time so I didn't go. I did hear from several friends who did the other Harvard pain fellowships(BI, MG, etc.) that Spaulding tends to have the least procedure exposure and more inpatient and chronic pain.

In terms of "in-house" applicants - their website shows only one of four past fellows from Spaulding itself. http://spauldingrehab.org/education/painmanagement

Axm- Have to respectfully disagree with the above. I spent a month rotating at the Spaulding pain fellowship, and it has absolutely ZERO inpatient responsibilities. The BWH, MGH, and BI fellows will quote procedure numbers that exceed Spaulding but each program has several fellows. After you divide the # of procedures by the # of fellows at the other Harvard programs, the sole Spaulding fellow actually gets more procedures than most of the other Harvard fellows.
Spaulding also differs from the other Harvard Pain fellowships in that there isn't a regular didactic series for that one fellow. In most ways, it's basically an interventional spine fellowship, but you get Pain boarded.

Spaulding has a very strong tendency to take their own for the Pain fellowship. That website isn't updated yet but the current fellow and next years fellow are both from Spaulding, so that makes 3 out of the last 4 years that they've taken a Spaulding resident.

 

[jackpmr]

Florida Spine in Clearwater: Is a PMR fellowship. You get a ton of spine procedures but hours are great and it has a good reputation among inteventionalists. No sports, just spine. Besides, you can't beat the weather!!

RIC- I heard is excellent, decent procedure exposure and you will get your sports medicine in there.

U of W: It is new to be fair and it is a true sports and spine fellowship but I heard that the teach responsibilities are excessive and that you won't really get great numbers, esp cervicals.

Spaudling: Don't know much about but I guess the harvard name is great. I called them and they told me that they have about 100 people applying for 1 spot- go figure!!

 

[Disciple]

SSdoc33,

You made a couple of good points. Even after a year in one of the best sports & spine fellowships, you'll be good and very competent in sports & spine, but it's not the quite the same as if you devoted yourself to one or the other. I remember talking a doc who did a Med/Peds residency, and practiced both afterwards. He said he was very good at Medicine and at Peds, but still not quite at the level he would be he had chosen one or the other. I think the concept of the broad MSK physiatrist who does sports, interventions, general msk, & EMGs is part of the way our specialty generally looks at patients comprehensively.

The other good point you made was about the demand for interventional training looking for jobs. In the real world, Interventional experience is what determines many jobs, which is one big reason why a Sports & Spine fellowship that doesn't teach you c-spine or RFs may be less desirable as this could impact your marketability for your first job.

The problem is that musculoskeletal Physiatry is in an adolescent stage in its development.

If you look back to the 1990's and earlier, we've made considerable progress. We went from having few musculoskeletal experts and few if any with interventional skills, to having many practitioners who are polarized one direction of the other and a few with intermediate skills in both.

What's the next step? Obviously, a physiatrist who has a high level of skill in both. It took 15+ years to get to where we are now. Drusso accurately describes the problems remaining. How do we reach the endpoint in a shorter amount of time?

What has for the past 10-15 years been considered "fellowship" training needs to be incorportated into standard PM&R residency training. "Fellowship" training can then be used to equip Physiatrists with the newest skills sought after in today's markets.

For example,

Resident Physiatrist X gets solid base training in Sports, Occ Rehab and basic interventional procedures during a 4 year residency, thereby qualifying for a CAQ in procedures-Check.

He/she then goes on to a 1 year sports/spine fellowship (accredited in sports) where he/she sharpens up EMG skills, learns or sharpens up ultrasound skills, and learns advanced spinal procedures such as vertebral augmentation and maybe stim trials.

All bases covered in 5 years and what is produced is a true musculoskeletal expert.

Why is this advantageous? It resolves the conflict between interest in sports and obtaining marketable skills (procedural). A Physiatrist with such skills would be very attractive to large surgical groups, especially large ortho groups who may employ both spine surgeons and sports surgeons, who would no longer have to hire multiple physicians, when they could hire one highly skilled Physiatrist. 1.5 Days of procedures, a day of EMGs, 2 days of consults/ f/u, ultrasound and joint injections. The fact that you would likely not being doing medication refills would free up the time to make this type of schedule possible.

Advance 15 years beyond that and perhaps by that time Physiatrists no longer have to work for surgeons.

Regarding what's described above as Sports and Pain Medicine being different fields. It's all a matter of perception. The primary care to Ortho/Neurosurg then to a. Pain management or b. Primary care sports med was established at a time where musculoskeletal Physiatry did not exist, and there were no providers who could provide comprehensive musculoskeletal care. Musculoskeletal Physiatry is not yet strong enough to supplant the current paradigm, so until then, instead of being marketable with your PM&R certification, we're required to get piece-meal certification.

It's kind of like USMLEs

PM&R Boards (Step I)

Steps II-V (Pain Boards, Sports Boards, EMG Boards, certification for IMEs, etc.)

 

[agdoc04]

The problem is that musculoskeletal Physiatry is in an adolescent stage in its development.

If you look back to the 1990’s and earlier, we’ve made considerable progress. We went from having few musculoskeletal experts and few if any with interventional skills, to having many practitioners who are polarized one direction of the other and a few with intermediate skills in both.

What’s the next step? Obviously, a physiatrist who has a high level of skill in both. It took 15+ years to get to where we are now. Drusso accurately describes the problems remaining. How do we reach the endpoint in a shorter amount of time?

What has for the past 10-15 years been considered “fellowship” training needs to be incorportated into standard PM&R residency training. “Fellowship” training can then be used to equip Physiatrists with the newest skills sought after in today’s markets.

For example,

Resident Physiatrist X gets solid base training in Sports, Occ Rehab and basic interventional procedures during a 4 year residency, thereby qualifying for a CAQ in procedures-Check.

He/she then goes on to a 1 year sports/spine fellowship (accredited in sports) where he/she sharpens up EMG skills, learns or sharpens up ultrasound skills, and learns advanced spinal procedures such as vertebral augmentation and maybe stim trials.

All bases covered in 5 years and what is produced is a true musculoskeletal expert.

Why is this advantageous? It resolves the conflict between interest in sports and obtaining marketable skills (procedural). A Physiatrist with such skills would be very attractive to large surgical groups, especially large ortho groups who may employ both spine surgeons and sports surgeons, who would no longer have to hire multiple physicians, when they could hire one highly skilled Physiatrist. 1.5 Days of procedures, a day of EMGs, 2 days of consults/ f/u, ultrasound and joint injections. The fact that you would likely not being doing medication refills would free up the time to make this type of schedule possible.

Advance 15 years beyond that and perhaps by that time Physiatrists no longer have to work for surgeons.

Regarding what’s described above as Sports and Pain Medicine being different fields. It’s all a matter of perception. The primary care to Ortho/Neurosurg then to a. Pain management or b. Primary care sports med was established at a time where musculoskeletal Physiatry did not exist, and there were no providers who could provide comprehensive musculoskeletal care. Musculoskeletal Physiatry is not yet strong enough to supplant the current paradigm, so until then, instead of being marketable with your PM&R certification, we're required to get piece-meal certification.

It's kind of like USMLEs

PM&R Boards (Step I)

Steps II-V (Pain Boards, Sports Boards, EMG Boards, certification for IMEs, etc.)

I agree 100% on where you stand on the issue. My question as a current residency applicant, is which current residency programs are providing the training to best achieve this right now? I know that there is no program currently providing enough exposure, but which ones are closest?

 

[rehab_sports_dr]

Quick comments about the RIC fellowship:

I think the overall assessment of the RIC fellowship are, for the most part, pretty fair and adequate.

Now that I am out about 6+ months from the fellowship, a few additional benefits that I hadn't anticipated:

1. Serving as medical director. Both the other fellow and I went right from fellowship into being hte medical directors for spine clinics. I don't know that would have been possible from many other fellowships. I think the broad exposure to surgeons, radiologists, PTs, and the large supervisory component over residents helped set my frame of mind in place that I let feeling very comfortable running the show. I felt very comfortable engaging surgeons and PTs as peers, and knew how to speak their language intelligently, and could them to engage me as a peer.

I think other fellowships would have better employed me to be an employee. I think RIC did a good job getting ready to be boss.

Some more specific examples: I had to develop protocols for nursing, staffing. I saw in clinic architercture sessions with management. I thik the breadth of conversations, beyond just technical skills, was very helpfull. The monday lunches with Press, Rittenberg, Lento, Plastaras, Ihm, and Fonda- just picking their brains on how to run a practice- all very helpful stuff I appreciate even more in retrospect.

2. Reading MRIs. I feel like the experience I gained reading peripheral MRIs was good. I feel like the experience I gained reading spine MRIs was great. Ruth Ramsey has written textbooks on Spine MRI, and is an awesome teacher. While I am certainly not on the level of the radiologists I work with now, I probably pick up 1 to 2 findings weekly that were not initially observed by the radiologists (which is mostly a function of me knowing the patient history better, so I know better what I am looking for). This has proven extremely helpful.

3. Learning personal skills. All the docs, but Joel Press and Paul Lento in particular, have some of the most-mind blowing people skills. Learning how to see how the deal with difficult personalities or unexpected findings- incredibly helpful.

4. Becoming more familiar with PT and chiropractic care. The therapists and chiro at RIC are incredibly good, and I feel much better in my ability to write a good script, and how to critique the outcomes of the therapy results. I feel like I have a pretty good understanding of some of the more complicated PT algorithms, and has definitely led to more intergrated care.

5. Improved biomechanical assessment exam. I definitely am picking on more subtle biomechanics glitches than I did pre-residency. My ability to breakdown the movements of even obscure sports I've never played has been helpful.

6. The academic stuff (teaching, lecturing, journal club) makes me feel much more comfortable on a clinical level. I've had some discussions with high level adminstrators on systems-issues that need to be put in place to improve patient care. It could be intimidating meeting 1-on-1 with chairs and higher level adminstrators, but I feel that academically I don't have to apologize for sitting at the table, and it's easier to gain their respect to get stuff done.

7. Networking- lots of impressive people come through in a year- leaders of PASSOR (Herring, Smith, Prather, Geraci, etc) pass through frequently, expanding more the minds you pick and learn from. Other great teachers within the RIC family (Sliwa, Marciniak, Fitzgerald) stick out to me. Great teachers from with Northwestern (I learned a bunch from the MSK radiologists). RIC Acaedemy courses bring in great people.

For all of the reasons- these are clinical benefits that suit any type of leadership positions, even in private practice settings.

I am guessing that RIC probably does this better than elsewhere. The other "cousin" programs have some similar and additional strengths, and a different mix of weaknesses. Doing it all over again, RIC would be a clear #1 no brainer for me, and I would also look at Utah, Colorado, Washington, Wash U, Larry Chou, and Geraci pretty seriously

 

[daphilster78]

Axm- Have to respectfully disagree with the above. I spent a month rotating at the Spaulding pain fellowship, and it has absolutely ZERO inpatient responsibilities. The BWH, MGH, and BI fellows will quote procedure numbers that exceed Spaulding but each program has several fellows. After you divide the # of procedures by the # of fellows at the other Harvard programs, the sole Spaulding fellow actually gets more procedures than most of the other Harvard fellows.
Spaulding also differs from the other Harvard Pain fellowships in that there isn't a regular didactic series for that one fellow. In most ways, it's basically an interventional spine fellowship, but you get Pain boarded.

Spaulding has a very strong tendency to take their own for the Pain fellowship. That website isn't updated yet but the current fellow and next years fellow are both from Spaulding, so that makes 3 out of the last 4 years that they've taken a Spaulding resident.

That's exactly right, there is no inpatient pain at Spaulding anymore. The one fellow will get a ton of spine injection experience both with PM&R and 1anesthesiology attending. There are much fewer opportunities to do SCS, pumps, or peripheral nerve stimulators as the other harvard institutions. The approach to managing pain is very multidisciplinary, and emphasis is also placed on non-interventional methods (psychology, PT, meds). Having spoken with a fellow from this program, the training is excellent. This fellowship is highly competitive with probably around 60 applicants for 1 spot.

 

[axm397]

sorry - I probably had old information.

I spoke to the BI and MGH fellows from 2006-7 year.

I think all the PM&R pain fellowships quoted getting about 60+ applicants. The anesthesia pain fellowships got more because they get both PM&R and anesthesia applicants.

 

[normalforce]

Hey all, again, thanks for all the responses.

Can anyone give me recs, or names of programs, that are high in VOLUME of lumbar and cervical procedures (including RF and discography). I am less concerned about research and ACGME accreditation and most concerned about volume and breadth and depth of procedures (everything except pumps and stims).

Thanks.

 

[Disciple]

If you're not looking for an Anesthesia fellowship, Slipman's or Windsor's would probably be your best bet. The new MCV and Michigan spine fellowships that have been mentioned on other threads would be good I'm sure.

Rick Derby has a fellowship where you'll probably do everything.

There are Physiatry groups with well known "spine guys" who may not have formal fellowships at the present time, but have trained many Physiatrists in the past and who have been advertising to hire on new docs (e.g. Saul brothers, Falco).

Maybe you could come up some type of informal fellowship/stay with the practice type of arrangement.

 

[Diamox]

There are Physiatry groups with well known "spine guys" who may not have formal fellowships at the present time, but have trained many Physiatrists in the past and who have been advertising to hire on new docs (e.g. Saul brothers, Falco).

Maybe you could come up some type of informal fellowship/stay with the practice type of arrangement.

I'm wondering if the chitchat on SDN is mostly biased towards "Fellowships" leaving out other training opportunities? ie loose partnerships where you see your own patients (and make money) but get procedural experience through a mentor.

I would be interested to hear peoples take on what Disciple referred to in the above quote.

 

[dc2md]

I'm wondering if the chitchat on SDN is mostly biased towards "Fellowships" leaving out other training opportunities? ie loose partnerships where you see your own patients (and make money) but get procedural experience through a mentor.

I would be interested to hear peoples take on what Disciple referred to in the above quote.

Diamox, here's an example of what you're talking about...i think. We got this job opportunity forwarded to us from our program coordinator today.

MASSACHUSETTS (Springfield area) – Well-established Single Specialty Ortho Group seeks to add a PM&R Physician with Pain interest. The position is a combination of pain management and general rehab. The new Doctor will work with a Spine Fellowship trained Ortho that will train the PM&R Doctor in invasive pain management, flouro-guided procedures, facets and blocks. The new Physician will perform EMG’s, epidurals, neuromuscular and trigger point. The guarantee is $140k to $150k, plus productivity. Partnership is available in 24 months with fixed assets buy-in. The location is in the Springfield area and is 90 minutes to Boston. This is a great university location with lots of beautiful outdoor areas. The area has a strong educational system and the location offers great quality of life.

SOUTH CAROLINA (Smaller town) – Single Specialty Group of Orthopaedic Surgeons seek to add a PM&R Doctor with a Pain interest. This position will be split between general PM&R (EMG’s, NCS etc.) and interventional procedures. The group’s current Pain Fellowship trained PM&R Doctor will train a new PM&R Doctor on interventional procedures. Successful candidates will provide non-operative management of spinal disorders, as well as general muscular skeletal cases. The new Doctor will perform EMG’s, general rehab and therapeutic spinal procedures (epidurals, neuromuscular and invasive pain management). The group also generates strong ancillary income. The group has their own ASC which contains two fluro-suites. This high volume practice should allow the new Doctor to be very busy from the start and produce a high income. There is a strong compensation package, plus a production based bonus program. Also, partnership is available! Compensation program is productivity based with partners at a very high income for the area! The group is well-managed with reasonable overhead. This SC location offers a great quality of life, low cost of living, colleges and is 90 minutes to the coast.

 

[Diamox]

Yea, that's pretty much what I'm talking about.

 

[PainMaster]

I have an interest in interventional spine procedures- epidurals, facets etc...I don't see myself writing narcotic scripts for chronic pain patients or placing pumps, so to again ask the same tired old age question, what is the best type of fellowship? Spine or Pain? Does the ACGME/PASSOR accreditation become an issue or is that something that will be resolved in the near future?

 

[Louisville04]

I have an interest in interventional spine procedures- epidurals, facets etc...I don't see myself writing narcotic scripts for chronic pain patients or placing pumps, so to again ask the same tired old age question, what is the best type of fellowship? Spine or Pain? Does the ACGME/PASSOR accreditation become an issue or is that something that will be resolved in the near future?

From reading other posts on here, it seems anesthesia doesn't want pm&r in interventional pain ...so I don't think it will be resolved in the near future.

IMHO, you should do an ACGME accredited pain fellowship. However, this is much more competitive since most of them are anesthesia based.

 

[axm397]

I have an interest in interventional spine procedures- epidurals, facets etc...I don't see myself writing narcotic scripts for chronic pain patients or placing pumps, so to again ask the same tired old age question, what is the best type of fellowship? Spine or Pain? Does the ACGME/PASSOR accreditation become an issue or is that something that will be resolved in the near future?

decision about fellowship is based on your career goals. Do you only want to do interventional spine with MSK? sports? Do you want to work in a hospital? ASC? academic? private practice? what location/region of US? competitive market? multispecialty group? higher risk interventional procedures or "bread and butter" stuff?

And clarification - the ACGME accredits fellowships. PASSOR does NOT accredit fellowships. PASSOR is a group within AAPMR that has a standard for what it thinks a good PM&R MSK fellowship should offer - and those who do get "PASSOR" approved. With PASSOR's reintegration into the AAPMR, not sure where that leaves fellowships.

 

[jackpmr]

The acgme accredits pain fellowships. If you want to be a pain doctor then go for an acgme pain fellowship. If you want to do sports and spine, do a sports and spine fellowship.
The field of pain management does not own the rights to do procedures. In fact, these procedures are done by many specialties ie radiology, fp, pmr, neurologists, neurosurgery etc who are certainly nor acgme pain boarded.
Secondly, there are many the are pain-boarded who don't know anything about procedures.
Bottom line, do what you like and where you can get the best training. If your not interested in pain, there is no point in wasting a year when you are better off training in something that you like. Just my 2 cents!

 

[ampaphb]

I have an interest in interventional spine procedures- epidurals, facets etc...I don't see myself writing narcotic scripts for chronic pain patients or placing pumps, so to again ask the same tired old age question, what is the best type of fellowship? Spine or Pain? Does the ACGME/PASSOR accreditation become an issue or is that something that will be resolved in the near future?

Does your listing mis-state your current level of training? If you are truly a med-student, it seems premature to be worrying about the minutia of ACGME vs non-ACGME 4 years in advance of the decision. The rules will undoubtedly change significantly in the interim

 

[Disciple]

I have an interest in interventional spine procedures- epidurals, facets etc...I don't see myself writing narcotic scripts for chronic pain patients or placing pumps

Why is your screename "PainMaster" then?

Anyway, I wouldn't worry about it so much. You have 3 options if you're not interested in comprehensive pain management.

1. I may have mentioned this before, but the ABPMR is considering some kind of certification for Musculoskeletal or "Interventional Spine" Physiatrists. This was discussed at the AAPMR meeting last fall. Also, read Dr. Cifu's front page column in the latest issue of the AAPMR's newsletter "The Physiatrist".

2. The ABPM is submitting an application to the ACGME for creation of a pain residency. Their prior applications to the ABMS to create Pain Medicine as a distinct specialty were rejected, in part due to the fact that they had no residency programs. So, now it appears they're going to the root of the problem.

3. The American Board of Interventional Pain Physicians (ABIPP) backed by ASIPP is lobbying to get their examination accepted by the ABMS to certify physicians in "Interventional Pain Medicine". If any pain organization makes things happen politically, it's ASIPP.

If any of the above three things happen, the you have nothing to worry about.

 

[dc2md]

excellent information disciple. i didn't know this was going on. could this then be a way around the anesthesiology-controlled fellowships and therefore allow two different pain/intervention fellowships under the same institution??

 

[Disciple]

There is no rule that states that you cannot have 2 fellowships that teach spinal injections at the same institution. The guidelines state that there cannot be 2 accredited "pain" fellowships at the same institution.

Option 1 above would allow you to do procedures as an "Interventional" or "Musculoskeletal" Physiatrist.

Option 2 would probably lead to pain fellowships eventually being transformed into residency programs. There would be no more "subspecialty" certification. You would have Pain Physicians and Interventional Physiatrists.

Option 3 would split Pain Management into Pain Management vs. Interventional Pain Management, ala Cardiology vs. Interventional Cardiology, which as far as I know (I could be wrong) are different certifications, not one obtained after the other.

I don't see all three happening. Maybe 1 and 2 or 1 and 3.

On the other hand, Option 3 could complicate the process by making residency programs have 2 different tracts, one which would lead to certification via option 2, and an interventional tract which would lead to certification via option 3. Or certification via option 2 could be a pre-req to certification via option 3. I don't really know. Specifics on option 3 have not really been clarified at this point.

 

[DOctorJay]

what then is the definition of "institution"? could a VA associated with an "institution" be considered a separate "institution" and therefore 2 accredited pain fellowships would be affiliated with a university system but co-exist as separate "institutions" for this purpose? how about a stand alone rehab hospital as a separate "institution"? is this how Spaulding's PM&R pain spot works?

 

[ampaphb]

Why is your screename "PainMaster" then?

Anyway, I wouldn't worry about it so much. You have 3 options if you're not interested in comprehensive pain management.

3. The American Board of Interventional Pain Physicians (ABIPP) backed by ASIPP is lobbying to get their examination accepted by the ABMS to certify physicians in "Interventional Pain Medicine". If any pain organization makes things happen politically, it's ASIPP.

If by politics, you mean Capitol Hill, then yes, ASIPP's finincal contributions to strategically placed members of Congress may give them some clout.

If, however, you mean the politics of medicine, ISIS, NASS, and AAPM seem to have the lion's share of the power (i.e. seats in the AMA's House of Delegates, etc)