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switch to PMR for this MS3?

Discussion in 'PM&R' started by Hoya11, Apr 28, 2007.

  1. Hoya11

    Hoya11 Senior Member 10+ Year Member

    Sep 4, 2004
    I have made all the arrangements to pursue anesthesia in hopes of going into pain management. I have rotated in anesthesia and I did not like being in the dirty OR, the hours, the nursing situation, the occasional boredom. I felt like, I would do this if I HAD to in order to get into a pain fellowship later. I really like clinic over OR, and talking to patients and making a diagnosis, then offering interventions.

    So time passed and I ran into a few PMR residents/attgs during my nuerosurg/ortho rotations and they have said that they have never really heard of someone wanting pain fellowship and not getting in from PMR. I like the environment they work in, spine centers and nonsurgical management, and the chance to go into pain with what I consider to be more relevant training.

    I think if I were to go into PMR I would want to do a Spine or Pain fellowship because I really like the idea of being able to offer procedures in addition to diagnosis, and I would like to possibly join a spine group or solo pain practice.
    I like dealing with low back pain and spine diseases and being precise with fluoro guided injections.

    So now that I have told you a little bit about me, I just wondered if you folks in the know could corroborate the fact that pain fellowships are attainable from PMR without being a super duper candidate? (step 1 217, Gtown Med) PMR is the residency I want, and pain is the fellowship I want, can I be reasonably certain I will eventually have both and end up in a practice like i described above? Do I have to be a slave monkey in anesthesia for 3 years to be sure I will get pain?

    Thanks for your input...
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  3. Ligament

    Ligament Interventional Pain Management Physician Lifetime Donor SDN Advisor Classifieds Approved 10+ Year Member

    Jan 8, 2002
    If you want to maximize your chances for a pain fellowship I'd go with Anesthesiology residency. I'm very happy I did a PM&R residency and went into an Anesthesiology Pain Fellowship but to be honest, it was a tough road with many uncertainties. I suspect the other Physiatrists on here in Anesthesiology fellowships would concur.
  4. DOctorJay

    DOctorJay 10+ Year Member

    May 8, 2004

    I'm pretty much in the same position as you but have pretty much ruled out anesth for the reasons you listed. I think it's a great field and kind of wish I liked it more since it seems to be a more favorable route to Pain but I just don't think it's for me.

    Certainly a Spine fellowship should be easy to obtain from the PM&R standpoint, Pain will be more of a wait and see type thing I'm guessing. It sounds like you would be happy with the Spine fellowship so if that's the case it looks like PM&R is a good choice. Probably the best thing would be to seriously look at the different practice paths each fellowship prepares you for and decide based on that.

    Good luck and I'm also looking forward to more answers from those in fellowship.
  5. Hoya11

    Hoya11 Senior Member 10+ Year Member

    Sep 4, 2004
    could you elaborate on this please?
    Have you ever met someone dead set on pain who could not get into fellowship? even if they were willing to move anywhere?
  6. Ligament

    Ligament Interventional Pain Management Physician Lifetime Donor SDN Advisor Classifieds Approved 10+ Year Member

    Jan 8, 2002
    Quite a few people unfortunately, from both PM&R and Anesthesiology residencies. It is a competitive fellowship right now, and with the new ACGME fellowship requirements, it is likely that a number of fellowships will be unable to maintain accredidation, thereby making the remaining fellowships even more competitive to obtain.
  7. Hoya11

    Hoya11 Senior Member 10+ Year Member

    Sep 4, 2004
    so how did you manage to do it? Coming from a top school like harvard or columbia or umdnj, would that help? would research help during a year off? And what is your opinon on interventional spine? how does it relate to pain and how is the competition for those spots?

    really.. the only reason i would do anesthesiology is because i was afraid of not getting pain via pmr.. and i feel like that is a bad reason to choose anesthesiology and that I shouldnt be scared to pursue the residency I want and the fellowship I want...
  8. drusso

    drusso Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Nov 21, 1998
    Over the rainbow
    I can empathize with the OP about being interested in pain medicine, but not feeling terribly drawn to anesthesiology training. I was in the same place. The two specialties are very different---the day to day practice of OR anesthesia has very little in common with the day to day practice of pain medicine. I find my physiatry training to be very well-suited for pain medicine and am pleased with my background and skill set. Having said that...

    Ligament points out a political reality (real politik) in the field of pain medicine for PM&R-aspiring pain fellows: Most pain fellowships are based in departments of anesthesiology. Anesthesiology departments exist, first and foremost, to train anesthesiologists. They are happy to consider and interview physiatry applicants, but when push-comes-to-shove there are always "guild" issues. Fellowship directors may face all kinds of internal and external pressures to choose one candidate over another.

    That is not to say that one cannot successfully secure an anesthesia-based fellowship from a physiatry background---I did, Ligament did, and many others on this board. But, I expect all of us will tell you that it requires a little more effort and savviness than you might otherwise expect.

    The other side of the political reality is that PM&R lags behind anesthesiology in its comittment to training sub-specialist pain physicians. There are many reasons for this. One involves the new ACGME requirements for pain fellowships, which sought to create a common interdisciplinary curriculum for pain medicine training and consolidate fellowships at institutions where PM&R and anesthesia directly competed for pain fellowship training opportunities. These requirements have been more difficult for physiatry-based fellowship programs to accomodate than anticipated (despite several years of knowledge and foreshadowing of these requirements). This has resulted in uneasy "marriages" of fellowships at some institutions that may impact your training, PM&R programs voluntarily relinquishing their ACGME accreditation, and/or discontinuation of some PM&R-based pain fellowship programs.

    So, what to do?? Well, first and foremost, you have to *LIKE* your base training. I think it is dumb to do an anesthesiology residency only because you want to do a pain fellowship. What if the financial bottom falls out of pain medicine? What if CRNA's become successful at getting independent practice privileges and establishing "nursing fellowships" in pain medicine? What if you get burned out being a pain doctor? What are you going to do?? To reiterate: I think it is unwise to choose your specialty based upon your sub-specialty aspirations.

    There are other fellowship options in PM&R: Spine fellowships, Sports fellowships, MSK fellowships, etc. All of these incorporate some procedural training not to mention the baseline procedural training you'll receive in your physiatry residency: EMG, joint injections, some basic axial spine injections at some programs, etc.

    That's my $0.02...
  9. Disciple

    Disciple Senior Member 10+ Year Member

    Oct 18, 2004
    I bet if these departments were provided some funding (similar to funding they received to train CRNAs), all these "guild" issues would magically disappear.

    Here's a thought. If a PM&R dept lacks ties to a spine-center or arrangements with Interventional Physiatrists, they loan out their 3rd/4th year residents to the Anesthesia pain clinic to perform EMGs (plus a stipend if necessary) in exchange for allowing each "loaned" resident to perform a certain # number of fluoroscopically guided procedures under supervision.

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