thinking ahead to fellowship...

[Oli]

Advertisement - Members don't see this ad

Im a current MS3 about to be MS4, so it's crunch time to decide 4th year electives-- I know I want to do interventional pain in the long run, and I think I've decided that I'll take the PM&R route rather than Anesthesia (after much deliberation!) My question is: for someone who KNOWS they want to go on for pain fellowship, are there certain places I should try to get interviews/away rotations and land a residency at that would make it easier to get a great interventional pain fellowship after PGY4?? Or is a spot anywhere for PM&R about equal in this regard? Thanks!

 

[Stinky Tofu]

I think you have to consider a few things:

1. Are you interested in Interventional Pain or Interventional Spine?
2. How many electives does a prospective program allow?
3. Does the program or institution have its own Spine or Pain fellowship and would you be interested in that fellowship? Do you get to spend time in the department and do you have to use your elective time to do so?
4. What is the curriculum like at the program you are interested in and is it compatible with your interests?

If you are interested in Interventional Spine, you want to make sure that you go to a program that provides great Electrodiagnostic Medicine training and has a great relationship with Spine Surgery, Sports, and Radiology. When I say great relationship, I mean that they welcome you to rotate through, they frequently lecture, and the management of patients is a collaboration. If you plan to do an Anesthesia Pain fellowship, it is even more important that you have solid training in the above areas because you won't get as much of it during your fellowship.

I'm really only qualified to discuss the program at SRH, but from what I've heard, you might want to consider the following programs (not in order):

1. Mayo Clinic - Graduates of the program have gone on to the Anesthesia Pain fellowships at Mayo. David would obviously be better qualified to answer questions about this program.
2. SRH/Harvard - We have an Interventional Pain fellowship and we rotate through a hospital with a Spine fellowship. Our graduates have also gone on to secure great fellowships in both Neurology and Anesthesia at MGH, BWH, and Children's Hospital.
3. RIC/Northwestern - Widely considered the top PM&R program overall. I'll let the incoming RIC residents discuss the opportunities there.
4. UC Davis - They have a jointly run Interventional Pain fellowship.
5. UTHSCSA (San Antonio) - Dr. Dumitru and Dr. Walsh are big names in the field of PM&R. They also have a jointly run fellowship as well.
6. UVa - I think Dr. Kerrigan was a huge addition to the program and a big loss for us. I believe they also have their own Pain fellowship.
7. University of Michigan - They have both a Spine and a Pain fellowship.
8. Stanford - I'm mentioning this program because of the developement of the Interventional Spine Fellowship that is run by one of our graduates. I really don't know much about the overall residency program itself, but I think the addition of Raj Mitra will improve the Interventional training at Stanford. In the past, I felt this was an area of weakness in the program.
9. UPenn - Dr. Slipman is a big name in Interventional Spine and he runs the Interventional Physiatry Fellowship. As a side note, I just noticed on the UPenn website that one of our graduates last year is now an assistant professor there and director of upper extremity EMGs.

The above list is not meant to be comprehensive and in many instances is not based on first-hand experience. I am just personally more faimiliar with them because I know people in the programs, interviewed there, or worked with graduates from the program.

Also, if you look at the SDN resident roster, we now have a lot of PM&R residents from different programs. You should try and contact them for more specific information about their programs.

 

[Finally M3]

Great post, Stinky.

You mention that a Gas-run Pain fellowship will be light on the Spine, Electrodx, Sports, and Rads components. I would assume that a PM&R Pain fellowship should incorporate these better?

Thanks 🙂

 

[Stinky Tofu]

Great post, Stinky.

You mention that a Gas-run Pain fellowship will be light on the Spine, Electrodx, Sports, and Rads components. I would assume that a PM&R Pain fellowship should incorporate these better?

Thanks 🙂

I think so. Unless they have a Physiatrist or Neurologist on staff, an Anesthesia Pain fellowship will probably have no EDX training.

 

[MSK]

Oli,

I'm starting at RIC in 2005. I am also interesting in pursuing a career in Pain/Spine/Sports/MSK/EDX.

Last year, I was in a similar situation as you are now. I'd recommend applying to and rotating at programs with a significant # of electives which allow you to do the electives in just about anything you want. Two of the best programs in this regard are Spaulding and RIC. When I interviewed, Spaulding had 10 months of electives you could do just about anywhere. I've heard they now have 8 but have added 2 months of required interventional at Spaulding. Regardless, this much flexibility could be ideal for a motivated and independent learner who has a good idea where he wants to end up. The only negative I have heard is that the didactics could be a little better and more comprehensive.

RIC gives you 4 months for electives which can also be done away or in anything you want. In addition, starting midway through PGY-2, you do 1/2 day per week in an outpatient clinic of your choice. (This adds up to about 2-3 months worth of extra electives). According to residents, some have used this 1/2 day as a chance to get more interventional experience. Apparently, one resident did about 250 interventional procedures in six months through this alone. Others have used it to hone your MSK or sports knowledge base. The teaching is supposed to be excellent here as well, maybe even the best in the country. Didactics are strong and comprehensive and you get alot of exposure to MSK, sports, and manual medicine.

These were the 2 programs that offered the most flexibility. (that I saw) Spaulding seemed to have the most electives and could be ideal for someone who wants to subspecialize before finishing residency. Remember, you can always use electives to spend time in areas that are required in other programs. RIC has excellent teaching, a comprehensive curriculum, and enough flexibility to spend alot of time in any area you choose You will need to do a fellowship to have a career in interventional pain. By doing a few electives in this area during residency, you could shine on an away rotation at a program you'd where you'd like to attend.

Also, I'm doing a transitional year with 7 months of medicine/peds/surg/ER (one of these is Rheum. The rest of the year I plan to do rotations in Ortho, Neuro, MSK/Neuro Radiology, Pain, and Research (away). You may want to look for something similar.

Cont'd
From what I saw and heard on interviews, Mayo is one of the very best, if not the best, for electrodiagnostics, sports, and musculoskeletal training. A potential drawback in your case is the limited amount of interventional experience you are rumored to get. However, as Stinky said, Mayo has their own anesthesia pain fellowship. If I remember correctly, you get 3.5 months of electives which can be done in Scottsdale or Jax but not outside Mayo

I really liked UVA also. Thsi program also seemed to have strong outpatient training and is improving. From what I hear, its a great place to do a one month elective rotation in sports medicine. One resident told me to expect no more than 20 interventional procedures during residency and I think the electives (3) are on site so you'd probably have to wait for fellowship to get this experience.

Michigan has 1) interventional exposure during residency
2) 3 different fellowships available in this realm
3) some residents complained that sports is dominated by ortho
4) No away electives but you can do the fellowship there.

An elective rotation at any of these places would be a good experience. It could also help you get a foot in the door for interviews and the match. Spaulding offers an inpatient pain elective. If you are interested in their program, I'd recommend doing an elective there. Apply early, though, I was unable to do this elective during Oct, Nov, Dec.

 

[paz5559]

8? ACGME PM&R RRC Guidlines state, in relevant part I B 1 a:

Duration and Scope of Education
Four years of graduate medical education are necessary to complete
training for a physician seeking specialization in this field, three
years of which must be physical medicine and rehabilitation training.
Of these three years no more than six months can be elective.

I wonder if you might possibly be overestimating the number of months Spaulding allows for electives, or if this is perhaps, a problem for Spaulding, since it seems to violate the ACGME Program Requirements for Resident Education (http://www.acgme.org/downloads/RRC_progReq/340pr703.pdf)?

 

[axm397]

It says on the Spaulding website (http://spauldingrehab.org/body.cfm?id=73#RotationSchedule)
"One of the highlights of our program is a very generous elective schedule (10 months) that allows time to develop areas of interest." 😕

 

[Stinky Tofu]

Technically, a selective is not the same thing as an elective. A Partners selective is pretty much the closest thing you will get to an elective though. We can rotate through any department at one of the Partners institutions.

 

[Oli]

great info fellas. I appreciate the thoughtful responses I've gotten through this site. One more thing...what is all this I keep hearing about early match? I was under the impression that all PM+R programs are done through the regular NRMP with the match results out on match day in March? If not, I may have a lot less time than I thought to get my application together!

 

[drvlad2004]

PM&R does not go through the early match (a.k.a. SF Match). Programs such as neurology, neurosurgery, ENT, urology, and other surgical specialties go through the SF match.