I'm starting my EM residency this June and I'm interested in pursuing a pain fellowship. Unfortunately, given the extremely competitive nature of pain fellowships, I think I may be at a disadvantage as I will be training at a medium-sized community program with limited to no research opportunities.
What can I do to make myself a very competitive pain fellowship applicant?
First, ignore the naysayers. They'll never help you get anywhere, but nowhere.
Despite lobel's purple sarcasm font, there's some truth to his post. If you want to do Pain, and only Pain, with no desire to do the primary specialty, then doing an Anesthesia residency is the best odds to get a Pain Fellowship spot. Right or wrong, statistically that's a fact. Even through Anesthesia, a Pain fellowship spot is far from guaranteed, so you should still do a primary specialty you like and would be happy with if you didn't get a spot.
Some Pain fellowships won't even begin to look at you if you're not Anesthesia, even though they're not supposed to be closed like that and certainly won't advertise it if they are (since all programs are supposed to be "multi-disciplinary, now). On the other hand, some Pain programs have a spot or two they like to hold and fill with non-anesthia, non-PM&R people. Since the non-anesth/non-PMR pool is usually very small, paradoxically, you might have much better odds at a program like this, possibly even better than some of the anesth/PMR people. The odd of the EM people applying for ACGME spots that I know of seems to be about 50% (n of <10) which isn't as low as you might think. With EM being "official" now, will this change? I don't know.
To answer your question, here are my thoughts on "how to make yourself more competitive" coming from your situation (EM).
1, 2 and 3 are and always will be to be an excellent, smart, hardworking, team playing, resident that gets good letters of recommendations and scores high on the boards, regardless of "specialty." If you're good, you're good. Quality is quality. Don't forget this.
4. If you can, do a Pain elective if not at home, then an away. If you can't get this, make your own 1 wk, or 2 wk informal elective shadowing an ACGME Pain doctor. Another option, would be an interventional rads elective. Anything where you learn about fluoroscopy and how to use it.
5. In your residency, anything you can do "pain" related, do it. Don't forget about your required presentations. Don't pick "Interesting Rectal Foreign Bodies, 'From the Vault'" as you're topic, as much as you'd like to. Pick "Pain in the ED" or "US guided nerve blocks in the ED" or something to that effect. Show interest early on in this way.
6. Take a Pain cadaver/procedure course, if they'll let you, and if you can get a resident price. Examples:
http://asipp.org/meetings.htm
http://www.spinalinjection.org/?page=activities
7. Research: even if your program is small, that doesn't mean you cant do some form of "research." In fact, I think every residency has some requirement for this. Find something pain related. One example is seen out there was a study that was joint between the ED and Pain dept, where there was a comparison between single shot US guided femoral nerve blocks (do by the ED) vs US guided femoral nerve catheter vs traditional IV meds for hip fractures. That was a good way to get in the door of the "Pain" world.
8. Apply widely, and I cannot emphasize this enough. Apply to every ACGME program in the country; literally, all 80-90 or however many there are. Although it should not be this way, realistically, you may get interviews from 1 in 6 places you apply, and then get an offer from 1 in 6 of those. Do the math.
9. You'll become proficient in wound repair, suturing, do plastics repairs and rotations and hand surgery rotations (super helpful surgical skills that are great skils if doing implantables), as well as ortho rotations, reading xrays and MRIs. You'll do facial nerve blocks, dental blocks, digital blocks, propofol sedations, intubation/rsi, central lines, LPs, and numerous other procedures that bring skills to your fellowship.
10. Sell your uniqueness and be confident in your skills. "I bring something different to the table" will likely go sell better than, "Ooh, ooh, pick me, I'm almost as good as Anesthesia, really!" The perspective in the ED is different, very different. THAT IS A STRENGTH. You will see acute radiculitis, you'll see chronic, you'll see everything in between. You'll see patients that go to a Pain MD, you'll see the patients kicked out of Pain practices that no pain doctor will see. You'll see acute pain from broken necks, you'll see patients 5 wks after their broken neck, you'll se patients 25 yr after their broken neck (albeit not the same patient). You'll see just about every form of acute or chronic pain imaginable in some quantity or form. You'll be proficent in codes/syncope/resucitation which is very valuable in the procedure suite (though fortunately not frequently needed). You'll see patients with epidural hematomas and abscesses, diagnose them and learn how to pick them up early (tell me that's not valuable experience). And probably most importantly, you'll learn "do no harm" better than anyone in any other primary specialty could. You'll tell a family member (many more than one) that their loved one is dead from a prescription opiate OD and despite pushing every ACLS drug, narcan and the kitchen sink, they're still dead. You'll see opiate addiction and patients with this disease at their most terminal rock-bottom state, and you'll never forget these images every time you consider writing a prescription for an opiate. That will be of great benefit not only to you, but to your patients and the field of Pain Medicine, is you should choose to enter it.
PM me if interested.
