when are they extending the fellowship length??

[myrandom2003]

One of the senior residents at my program who is going into pain fellowship starting in July, said one of the attendings mentioned that the fellowships were going to be 2 years starting in 2009. Any truth to this? Not trying to start anything, but just wondering if this is something i need to plan for...

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[Doctodd]

i think USF(South Florida) in tampa already did it.

T

 

[PMR 4 MSK]

An extra year of indentured servitude? Better come outta that fellowship with some mad skills and serious credentials...

 

[GQPMR]

Implementing the new ACGME requirements for pain fellowships (they were just put into practice this past July, which probably won't change for many programs until their next ACGME site visit in 2009 or 2010) vs. starting a Pain Residency is what it will boil down to. The likelihood of a Pain Residency starting within the next year or two is pretty low. The more likely events will be that Pain Medicine (the subspecialty it is now) will start to increase training periods to properly accommodate the new ACGME requirements to either 18 months (as Cleveland Clinic has already) or potentially 24 months. Once this takes place, the catalyst to convert it to a residency will be great enough to start moving it that direction and probably in about 5-7 years we will see what people have been foreshadowing, the Pain Residency... Of course this is all speculation and I am only basing this on mostly secondhand (some firsthand) conversation with various members in the pain world. Obviously, we (the pain world) all have to agree on this and there in lies the problem...

 

[PMR 4 MSK]

I'm all for having a pain specialty, but here's a question I have:

Pain Management seems to have a signficant burn-out rate. I was there once, and closed my practice, moved across the states and joined a group doing more general physiatry with some pain management, really more acute than chronic.

So if you do a 4 year or so Pain Management residency, and after 5-10 years you burn out on it, then what can you do?

As it is now, you can fall back on your primary field - PM&R, Anesth, etc.

 

[minstral]

Id be willing to do two years if it means significant experience in spinal cord stim implants, vertobroplasty and kyphos. Am I right in assuming a typical 1 year program doesnt give you very much experience in these more "surgical" procedures?

 

[lord_jeebus]

Am I right in assuming a typical 1 year program doesnt give you very much experience in these more "surgical" procedures?

I'm just an MS4 but I've done rotations at two places. One place had fellows do very little implants - maybe one pump and one stim in the year! Another had fellows doing several of each every month.

So it probably depends more on where you train than 1 year vs. 2.

 

[Disciple]

I'm all for having a pain specialty, but here's a question I have:

Pain Management seems to have a signficant burn-out rate. I was there once, and closed my practice, moved across the states and joined a group doing more general physiatry with some pain management, really more acute than chronic.

So if you do a 4 year or so Pain Management residency, and after 5-10 years you burn out on it, then what can you do?

As it is now, you can fall back on your primary field - PM&R, Anesth, etc.

I think you'd see alot of docs stop prescribing meds. You may see more boutique practices with burn out docs opting out for spine and musculoskeletal practices. It's like work comp where anybody can do it (Chiros, Physiatrists, Anesthesia pain docs, Neurologists, Surgeons). I know a couple orthopods who do alot of work comp while operating very little and spend most of their time doing IMEs and dispensing meds out of the clinic.

What about a pain "hospitalist" or inpt pain specialist? This could be an attractive option if the pay were high enough. You would be under no pressure to prescribe anything you didn't feel was appropriate (first line of defense would be the ER). It would end the mental fatigue of arguing over meds. Patient gets argumentative, you simply walk out of the room and write your orders in the chart. You wouldn't care if they get upset since you have no clinic that you hope they come back to. Patient tries to get out of bed to get in your face, you simply walk out of the room and have the nurse call security.

 

[lobelsteve]

I think you'd see alot of docs stop prescribing meds. You may see more boutique practices with burn out docs opting out for spine and musculoskeletal practices. It's like work comp where anybody can do it (Chiros, Physiatrists, Anesthesia pain docs, Neurologists, Surgeons). I know a couple orthopods who do alot of work comp while operating very little and spend most of their time doing IMEs and dispensing meds out of the clinic.

What about a pain "hospitalist" or inpt pain specialist? This could be an attractive option if the pay were high enough. You would be under no pressure to prescribe anything you didn't feel was appropriate (first line of defense would be the ER). It would end the mental fatigue of arguing over meds. Patient gets argumentative, you simply walk out of the room and write your orders in the chart. You wouldn't care if they get upset since you have no clinic that you hope they come back to. Patient tries to get out of bed to get in your face, you simply walk out of the room and have the nurse call security.

This is much more palatable then going to the hospital for lunch and after work to round on patients you will probably never see again. I used to work in a clinic that covered the hospital and was consulted for addiction, detox, and even one time to write meds for discharge for a NS. I wrote what meds she should prescribe in my consult note but left the Rx's blank. What a
B1TCH!

 

[drusso]

What about a pain "hospitalist" or inpt pain specialist? This could be an attractive option if the pay were high enough. You would be under no pressure to prescribe anything you didn't feel was appropriate (first line of defense would be the ER). It would end the mental fatigue of arguing over meds. Patient gets argumentative, you simply walk out of the room and write your orders in the chart. You wouldn't care if they get upset since you have no clinic that you hope they come back to. Patient tries to get out of bed to get in your face, you simply walk out of the room and have the nurse call security.

Anyone who has ever done inpatient pain consults can tell you that it can get pretty miserable at times. The best "upside' is that your patients are pretty much a captive audience. But, getting those PACU post-op pain consults from surgeons who don't want or don't know how to manage pain...painful.

I once got a pain service consult on a patient who still intubated in the OR...

 

[Ligament]

Anyone who has ever done inpatient pain consults can tell you that it can get pretty miserable at times. The best "upside' is that your patients are pretty much a captive audience. But, getting those PACU post-op pain consults from surgeons who don't want or don't know how to manage pain...painful.

I once got a pain service consult on a patient who still intubated in the OR...

I hear that. I got a consult on a comatose patient once...