Thoughts about the UPMC fellowship

[Medman2737]

Does anyone have any information about the UPMC/Pitt fellowship?
How does it compare to other fellowships in terms of interventional procedure training?
Any info appreciated!

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[lobelsteve]

Does anyone have any information about the UPMC/Pitt fellowship?
How does it compare to other fellowships in terms of interventional procedure training?
Any info appreciated!

Interviewed in 2004, decided against when I found out Doris still did blind CESI.
Dr Nash is great and I hear the rest of the attendings are super as well. I really wanted to go as I have family in Pittsburgh. Wound up at Emory.

 

[panetrain]

I interviewed there this last year (Aug 2008), my perception is purely based off of a 1 day interview, therefore current/past pain fellow's from UPMC feel free to correct me. My perception was that this pain program truly practices and promotes a multidisciplinary approach to pain management. I think that they may take this approach to the extreme, which may result in less exposure to the interventional aspects of pain medicine. I got the impression that they felt that interventional pain medicine plays a very limited role in the management of pain. I personally felt that I would not receive the adequate interventional/surgical training that I want to receive from a very short 1 year fellowship. For example, I was told by one of the fellows that they do not implant any of their IPG's or interthecal pumps (they refer them to surgery). On the other hand, they have a very large and diverse group of fellows including PMR, IM, Neuro, Anesth, Psych (9 fellows total) and also have some top notch research opportunities available. If you want a program that is top heavy with IPM, try the world renowned Texas Tech program.

Does anyone have any information about the UPMC/Pitt fellowship?
How does it compare to other fellowships in terms of interventional procedure training?
Any info appreciated!

 

[SJP]

did fellowship there. Very multidisciplinary. When I had completed was concerned that I didn't get enough needle time, but now being out and practicing, I realize that the training was more than sufficient. The reality is that you can't learn everything in one year, and first year out in practice is a high learning curve as you can't look over your shoulder for guidance. Actually learning all the non interventional stuff has been most helpful. That is the biggest difference I have noticed when compared to other pain doctors in the area. Once you're comfortable with fluoroscopy and needle guidance you can do almost any procedure. As far as implants, you can do a one month rotation with a neurosurgeon who does the most implants in the country (and he treats you a lot better than his own residents and fellows). Also, you need to make a decision if all you want to do is implants, as once you get to private practice referring the permanents out leads to a lot more referrals from you neurosurgeon and ortho friends. And in the private world that is who you want referals from. Not from PCP's. So in summary, an excellent program, you will feel comfortable doing almost anything, including the non interventional stuff. But if all you want to learn is doing surgical implants for a year, you will feel frustrated. If that is what you want, look at MD Anderson or Cleavland Clinic

 

[Disciple]

And in the private world that is who you want referals from. Not from PCP's.

Please elaborate.

I think there are some on this forum who would disagree.

 

[Tenesma]

i love my referrals from PCPs... for MANY reasons --- i hate the referrals i get from the spine surgeons...

 

[SJP]

Some PCP's understand what we do and how we can help and they make great referral sources. Unfortunately whether their fault or not, some pcp don't fully understand what a interventional pain specialist does. I will often get random pcp's who will have put a pt on norco's or some other hydrocodone and when the behavior becomes bothersome tell them to come to the pain clinic to get their meds with jsut enough to get to their visit. The flipside, when my ortho, ortho spine and neurosurgeon buddies refer, it's almost always for me to try an injection to see if helpful to prevent unnecessary surgery. The PCP comment was probably a poor choice of words on my part, as you are right some are excellent referral sources, just some aren't. My experience with surgeons is that they understand how we can help. That may just be the market I'm in.

 

[Ligament]

I'd take a referral from a PCP than from a spine surgeon any day!

 

[Disciple]

I think PCPs know what Interventional Pain specialists do, they just figure that since you practice Pain Management it is part of your specialty to handle tough narcotics issues.

It just depends on what your preference is. Some don't like being controlled by surgeons or told what to do. Others don't mind so long as it leads to a procedure, but may hate the narcotic dumps that may come from PCPs.


This would make a good poll. Who is your prefered referral source?


Here's a thought. Do some anesthesiologists shy away from working for surgeons or building a pain practice dependent of referrals from surgeons due to experiences working with surgeons during the CA-1 through 3 years?

Is that possibly part of the reason why many Physiatrists are willing to work for surgical groups?, because they haven't been exposed and soured to similar type experiences?


Opinions?

 

[Tenesma]

i think you touched on something there --- surgeons are used to dictating care and not really that interested in outside opinions, and while they are sometimes right, i just hate the "give this guy some shots and send him back to me".... it is not that they understand what we do, but rather they just want to show the insurance companies that some conservative care was attempted before their fusion.

in fact, the 3 surgeons I work the closest with have all admitted that they rarely if ever read my notes.... hmmm....

re: PCPs dumping.... they will only dump if you let them dump... you can train and educate your PCPs, give CMEs on back pain, narcotics, etc...

 

[PMR 4 MSK]

I think PCPs know what Interventional Pain specialists do, they just figure that since you practice Pain Management it is part of your specialty to handle tough narcotics issues.

It just depends on what your preference is. Some don't like being controlled by surgeons or told what to do. Others don't mind so long as it leads to a procedure, but may hate the narcotic dumps that may come from PCPs.


This would make a good poll. Who is your prefered referral source?


Here's a thought. Do some anesthesiologists shy away from working for surgeons or building a pain practice dependent of referrals from surgeons due to experiences working with surgeons during the CA-1 through 3 years?

Is that possibly part of the reason why many Physiatrists are willing to work for surgical groups?, because they haven't been exposed and soured to similar type experiences?


Opinions?

I was soured when I was a med student. The Orthopods I met especially were the most arrogant people I had ever met. The neurosurgeons were something less than human - just mean, dispicable people. In residency, the myth was perpetuated - "Don't work for orthopods, you'll just be their dumping ground!" Like Tenesma says - people will only dump if you let them.

 

[Disciple]

i think you touched on something there --- surgeons are used to dictating care and not really that interested in outside opinions, and while they are sometimes right, i just hate the "give this guy some shots and send him back to me".... it is not that they understand what we do, but rather they just want to show the insurance companies that some conservative care was attempted before their fusion.

in fact, the 3 surgeons I work the closest with have all admitted that they rarely if ever read my notes.... hmmm....

re: PCPs dumping.... they will only dump if you let them dump... you can train and educate your PCPs, give CMEs on back pain, narcotics, etc...

So, during residency, Anesthesiologists get turned off to working with surgeons and Physiatrists come to accept that no one wants to read PMR consults or progress notes.

I've found some PCPs to be reasonable, some want nothing to do with narcotics, and have made that crystal clear to me.

Depends on how much you need them versus them needing you I suppose.