To apply or not apply

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Dog_luver

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My situation - I'm in a challenging very rigid program. I was going to apply for pain, my app almost finished, have been asking for letters with good success. Recently I asked the doc I worked with during pain rotation in my program for a letter. He said he would write for sports and spine fellowships when I requested pain and spine. I think this person specifically said that I should do spine/sports not pain as they did not know if I had the ability to do things like cervical procedures which I have never done. Given the limited opportunities for me to rotate elsewhere I may not be able to get a different letter from a pain doc. Do I apply w a letter saying that, or do I try to get a different doc, not pain associated to give me a good letter? I feel down that this person would do this although not surprised. He did a similar thing to a previous person in my program.

Is it worthless to apply?

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It is clearly worthless, I think you already convinced yourself
 
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It is clearly worthless, I think you already convinced yourself

Well I was asking. I would think that programs would be like - why does this applicant not have a pain letter? Do you disagree?
 
Ur attending has trump hands

Honestly i do not get not writing a resident a strong letter. I have students rotate from the local med school and i always give them a stellar letter
 
Ur attending has trump hands

What does that mean? I have no clue what that means. I'm really honestly trying to get other people's opinions who are clearly more in the know than me.
I feel frustrated by the situation and can likely get a different letter, but again would like opinions from those of you in the field.
 
Apply and send a different letter in later if possible.
 
Apply and send a different letter in later if possible.

Apply with a letter that says spine/sports? or with a non pain letter? I don't think I can get a different pain letter. I won't be able to rotate with anyoen else
 
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You have presented that you have no options. If u want to be a pain doc apply with what you have.

Get a great letter from your chair. Most fellowships are gas based and they will not be impressed by ur pmr "sports" doc letter anyway.

Think outside the box. Take your vacation and do an observership with a local pain doc and get them to write a letter.
 
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You have presented that you have no-options. If u want to be a pain doc apply with what you have.

Get a great letter from your chair. Most fellowships are gas based and they will not be impressed by ur pmr "sports" doc letter anyway.

Think outside the box. Take your vacation and do an observership with a local pain doc and get them to write a letter.

So we are unable to rotate outside of our institution. And the person who told me they would write a sports/spine letter is the chair, and that person is in pain even though they are pmr. also applications are NOW not in 6 months. We are unable to do an observership. I also have contacted a number of private docs and have not been able to set up an observership. I have 2 other really good letters.

My question is - if I have a letter that does not say pain - because this person will write sports/spine - will that hurt me? Or is that better to apply with general good letters?
 
Apply. Unlikely you will succeed without a chair letter but it is what it is.
 
Yes it is. For the wrong fellowship. I am starting to understand.
 
Yes it is. For the wrong fellowship. I am starting to understand.

Ugh. This person WON'T write me a pain recommendation as they state that I should NOT do pain but I should do sports/spine. so my options are

1-i apply with this letter
2-i apply with all general letters
3-i don't apply
 
Apply with this letter. Gas men think sports/spine is pm&rish for pain.

Maybe it's me and I can't explain things clearly. I'm sorry about that. I'll try one more time - the person who is writing this letter is in PAIN himself. This person told me NOT to do pain, but to do sports/spine. So while he's writing a letter (even though HE is in pain) will not say pain because he does not want me to be in pain. He says I should do sports/spine so this letter will say I recommend Dog_luver for sports/spine fellowship. He is NOT in sports/spine though
 
To reiterate above: don't use your chair's letter and go with what you have.
 
Maybe it's me and I can't explain things clearly. I'm sorry about that. I'll try one more time - the person who is writing this letter is in PAIN himself. This person told me NOT to do pain, but to do sports/spine. So while he's writing a letter (even though HE is in pain) will not say pain because he does not want me to be in pain. He says I should do sports/spine so this letter will say I recommend Dog_luver for sports/spine fellowship. He is NOT in sports/spine though
Is there a reason your pain attending does not think you are a good candidate for pain?
 
Is there a reason your pain attending does not think you are a good candidate for pain?

this person says that i would not be good at cervical procedures (i have never done one), but i do all other procedures - mbbs, epidurals, sijs, etc etc very well so i should not do pain
 
Something doesn't seem right here. Is your attending a gas man? Maybe that's why. Maybe he views pmr as not capable of doing pain. The cervical procedures thing is just an excuse to try to block you from applying for pain for some reason. I can tell you that there are a lot of successful docs out there who don't do any advanced procedures. It's all about what set up you wind up in. Hell, I know a recently stepped down chair of a group largely interventional practice in a huge practice setting who could only do 4 procedures..so there you go.
 
I feel like this is a repeat thread from a couple months ago. OP created an account to post this thread and it pretty much mirrors the one from then with the whole sport and spine thing and issues with cervical procedures. I don't know why this person thinks changing their name and reposting the same thread will yield different results. You got good advice last time and didn't want to listen. Nothing is changing several months later.


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Something doesn't seem right here. Is your attending a gas man? Maybe that's why. Maybe he views pmr as not capable of doing pain. The cervical procedures thing is just an excuse to try to block you from applying for pain for some reason. I can tell you that there are a lot of successful docs out there who don't do any advanced procedures. It's all about what set up you wind up in. Hell, I know a recently stepped down chair of a group largely interventional practice in a huge practice setting who could only do 4 procedures..so there you go.

No this person is in PMR. And I agree with you -this person does not do any cervical procedures himself, and they only do a handful of procedures themselves. I even spoke to one of the residents who matched into pain and this person told me they were not planning on doing any cervical procedures, and that lots of pain docs out there do not do them. i agree it's merely that he wants to block me from applying to pain. I even requested if I could do an away rotation, since I felt this might be an issue, and I was told no - they told me well we can't pay you if you do an away - I said fine don't pay me. Then they were like oh well you still can't do it.
 
This is one of the most confusing discussions ever.

Your attending is a D!ck. Tell him you are applying for Pain fellowships and you have no need for a sports & spine fellowship. His argument about cervical procedures is absolutely ******ed, unless he feels you have horrible hands and cannot safely do more delicate procedures.
 
This is one of the most confusing discussions ever.

Your attending is a D!ck. Tell him you are applying for Pain fellowships and you have no need for a sports & spine fellowship. His argument about cervical procedures is absolutely ******ed, unless he feels you have horrible hands and cannot safely do more delicate procedures.

While I think you should apply, I have a bit of a different perspective and please tell me if I am wrong. Personally, I believe anyone who graduates from an interventional pain fellowship and his board certified in pain should be capable and ready to provide cervical procedures if indicated. I think it is demeaning to our specialty to have people graduating from fellowship who "don't feel comfortable" with cervical procedures when approximately 30% of outpatient pain visits are related to cervical pain.
I would compare this to an orthopedic surgeon who doesn't feel comfortable with wrist or ankle fractures or neurosurgeon who didn't get adequate training in doing brain surgery. It doesn't just look bad on you, but it also looks bad for our profession and board accreditation. If your fellowship trained in pain medicine you should feel comfortable in all "generally accepted" procedures that can help patients with pain.
 
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This is one of the most confusing discussions ever.

Your attending is a D!ck. Tell him you are applying for Pain fellowships and you have no need for a sports & spine fellowship. His argument about cervical procedures is absolutely ******ed, unless he feels you have horrible hands and cannot safely do more delicate procedures.

Well he wont write for pain. I can't force this person to do something he doesn't want to do, and given the program's refusal to let me rotate elsewhere, even when I have agreed to no salary for that month since they "can't pay me to be elsewhere" leaves me with the options that I presented. I think that if this person recognizes that I am really good at OTHER procedures, the chances are that I would be good at cervical ones too. Another of the attendings in the program who does basic procedures and is in no way an interventionalist has told me I am one of the residents that's best at procedures. I also come from a different procedurally heavy specially, where again I was told that I was excellent at procedures. I have small hands, but again he has stated to me both verbally and in written form that he feels I'm really good at other procedures. Again I have never ever performed a cervical procedure. This person says he does not know if I have the adequate spatial orientation to do cervical stuff. I guess that's the rationale he's using, and I guess he would not support me for a pain fellowship. So I don't have the option to have his letter say pain.
 
While I think you should apply, I have a bit of a different perspective and please tell me if I am wrong. Personally, I believe anyone who graduates from an interventional pain fellowship and his board certified in pain should be capable and ready to provide cervical procedures if indicated. I think it is demeaning to our specialty to have people graduating from fellowship who "don't feel comfortable" with cervical procedures when approximately 30% of outpatient pain visits are related to cervical pain.
I would compare this to an orthopedic surgeon who doesn't feel comfortable with wrist or ankle fractures or neurosurgeon who didn't get adequate training in doing brain surgery. It doesn't just look bad on you, but it also looks bad for our profession and board accreditation. If your fellowship trained in pain medicine you should feel comfortable in all "generally accepted" procedures that can help patients with pain.

Well this attending does not do cervical stuff and refers all the cervical stuff to someone else.
 
Dog_luver
do you happen to have another name on SDN and have you posted similar questions before?
 
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I feel like this is a repeat thread from a couple months ago. OP created an account to post this thread and it pretty much mirrors the one from then with the whole sport and spine thing and issues with cervical procedures.


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Seems like what lost_inspace posted... maybe you could talk to her to compare situations....


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Yeah, if this is not the same person than they must be from the same program. I agree with the people above. You have to apply with what you have from a letter standpoint. I don't get why he would tell you to do sport and spine, but not pain due to potential issues with doing cervical procedures. I interviewed at several of those types of fellowships and cervicals were taught at all of them, so that really shouldn't be the reason to do one over the other. Also, if you do have some issues learning the injections, then that is something they should be teaching you, which is the point of doing a fellowship. If you still can't get it then that is another issue and then in that case maybe you shouldn't be doing any of these procedures anyways. But if you are doing well and getting good feedback, I would think that is likely not the case and you could probably learn to do everything with time. Maybe that guy is trying to tell you in a passive aggressive way he doesn't feel you will likely match into pain and would rather see you focus on sport and spine fellowships. Or he is just biased against pain and thinks that we in PM&R just belong more in the sport and spine realm of things. Not sure if either is the case, but like I told lost in space, you just have to apply and see what happens. Apply to some sport and spine places as back ups though also.
 
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