Would it be irresponsible to choose EM as my base specialty as a route to Chronic Pain?

[bk03]

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Hello everyone,
I have learned more and shadowed a few pain medicine doctors and I’m really falling in love with how they can do hands on procedures and make differences in peoples quality of living. I know the most common routes to pain are via PMR and Anesthesia but PMR to me as a base specialty seems very boring. I think I would much rather enjoy the EM knowledge base that develops in an EM residency even if it is more broad then a PMR or Anesthesia residency would be. Plus EM would be 3 years vs 4 years of PMR/Anesthesia. Would I be dumb to hope I could get into a procedural heavy Pain program straight out of a EM residency? Also, when looking at the job market would it be harder for an EM trained Pain Med doctor as a lot of job postings say they are looking for anesthesia/pmr trained. Any advice would be helpful!

 

[bk03]

Would recommend anesthesia. Am a current fellow coming from ER. Looking at jobs, some still prefer anesthesia background even if you would still be doing full time pain. And even in applying to fellowship, not everywhere takes EM. Hard to know if things will continue to open up but anesthesia would be the safest route. Good luck

What would your advice be to my desire to have that knowledge base where for example if someone breaks their leg, I can do something about it even as a super specialist Pain doc?

 

[bk03]

Would recommend anesthesia. Am a current fellow coming from ER. Looking at jobs, some still prefer anesthesia background even if you would still be doing full time pain. And even in applying to fellowship, not everywhere takes EM. Hard to know if things will continue to open up but anesthesia would be the safest route. Good luck

How difficult was it for you to get into a Pain fellowship?

 

[throway134]

What would your advice be to my desire to have that knowledge base where for example if someone breaks their leg, I can do something about it even as a super specialist Pain doc?

If someone breaks a leg the proper response in a pain office will be to send them to an Ed, whether you’re an em doc or a clown-makeup specialist. You won’t have appropriate tools or resources to fix that in an office in all likelihood, and the liability of trying to do it even if you could is simply not worth it.

What you want to do may change several times over the course of the next 5-10 years. At each step of training the appropriate question to ask yourself is “what would I do if I couldn’t get to the next step.”

I can tell you that only around 25% of the Ed docs I worked with would still say emergency medicine 5 years into the career. Anesthesia and pm&r have a variety of practice options. The Ed basically only has faster and slower eds, (and community vs academic I guess) and there are significant drawbacks to both.

If pain is the goal, i think em is a reasonable but not ideal path to it though I’d defer to people like birdstrike who actually did it. Having said that, I suspect anesthesia is still the more straightforward path and is an interesting speciality. A fair number of em people (myself included) almost did anesthesia as their base specialty because it’s also heavily procedural with a broad patient population and a lot of cool niche knowledge. It’s not as widely known by the public, but they are also excellent people to have around if someone is dying.

Good luck either way

 

[VA Hopeful Dr]

Pick the speciality you would be the happiest in if you don't match since matching isn't guaranteed

 

[BoardingDoc]

How difficult was it for you to get into a Pain fellowship?

It's getting easier to match into pain via EM because of how crazy good the anesthesia market has become. That said, look at the pain graduate data from the past 20 years. The first em boarded doc to become pain boarded was in 2009 I believe. Between 2009 and 2020 there have been between 0 and 3 em boarded docs per year who become pain boarded.

I think that there will be more next year (@TrailRun and I alone bring it to 2) but it's still waaaaaay easier to get in from anesthesia than from EM.

 

[WhatJobDoIPick]

Pick a field that has worse pain fellowship admittance, has worse base job prospects, has worse pay, and has worse lifestyle?

I can't think of anything that makes less sense.

 

[bk03]

Ig my idea to do EM comes from the idea that if my dad calls me with stomach pain, I’d at least like to advise him on what to do next. Ik that’s a silly thing to pick a specialty over but for some reason these kinda, I can help my parents or friends or grandma, thoughts keep pointing me back to EM. Someone tell me I shouldn’t care about that please.

 

[Tiger26]

Ig my idea to do EM comes from the idea that if my dad calls me with stomach pain, I’d at least like to advise him on what to do next. Ik that’s a silly thing to pick a specialty over but for some reason these kinda, I can help my parents or friends or grandma, thoughts keep pointing me back to EM. Someone tell me I shouldn’t care about that please.

I told my mom that she didn't need to go to the emergency department for a tick that had been on for less than 24 hours and that worst case she could just have her primary care doctor call in some doxycycline to be totally reassured.

She ended up going into three different emergency departments (2 before her vacation finished and one upon returning home).

Definitely don’t pick a field just so you can give medical advice for a family member. Residency will end up being a very long experience unless you truly love a specialty.

 

[JAFERD_MD]

This. My family selectively listens to advice. My mom, with her 25 years as a floor nurse, always pulls rank to tell me I’m wrong.

Once, at 2am, she called saying my stoic grandfather had crushing chest pain. I said call 911 ("No, they'll take us to Crap Hospital"). I then found a STEMI hospital ("No, that one’s bad"). So I told her to do whatever she wanted. She drove him to another hospital, where he was diagnosed with a high-risk NSTEMI/borderline STEMI. This was during COVID lockdown with hospitals all full, so his transfer was delayed, and he nearly coded in the ED he transferred to. He got tubed by a BAFERD and walked out neuro-intact a week later, after I also nearly forced my family to consent to a cath.

You'd think that would have changed things. Nope. I'm still viewed as the kid 3 years later.

 

[Birdstrike]

I went to Pain from EM in 2011, and while it’s easier now to get into Pain via EM, it’s still a lot easier the do so from anesthesia.

Like others have suggested, you have to balance the fact that a fellowship is not guaranteed. Because of that, the ease of getting a fellowship shouldn’t be your only concern. It’s important, but so is the fact that you’ll have to do your primary specialty at least 3-4, years or perhaps much longer.

These are difficult decisions.

 

[oldtown]

Ig my idea to do EM comes from the idea that if my dad calls me with stomach pain, I’d at least like to advise him on what to do next. Ik that’s a silly thing to pick a specialty over but for some reason these kinda, I can help my parents or friends or grandma, thoughts keep pointing me back to EM. Someone tell me I shouldn’t care about that please.

After 15+ years of family members always calling for medical advice, I would suggest picking a field that is least applicable to the average person, to discourage said calls. PM&R and anesthesia both fit the bill well.

 

[gutonc]

Choosing a specialty so you can answer family member's medical questions is perhaps the most ridiculous idea I've heard of. But if you really want that, choose FM. That said, choosing something as irrelevant to most people as possible is the real MVP move here. Trust me, you will quickly tire of family and friends asking you dumb s*** that they should be asking their own doctor.

In my experience, the further I got along in my own training and career, the less people asked me medical questions. I'm an oncologist so I pretty much just say "It does/doesn't sound like cancer" and leave it at that. Nobody asks a follow up question. It's glorious.

 

[AlmostAnMD]

Pick a field that has worse pain fellowship admittance, has worse base job prospects, has worse pay, and has worse lifestyle?

I can't think of anything that makes less sense.

lol

exactly my thought

Why not just match OB and try to get it from there? Make something hard even harder, if that's OP's goal.

 

[throway134]

Ig my idea to do EM comes from the idea that if my dad calls me with stomach pain, I’d at least like to advise him on what to do next. Ik that’s a silly thing to pick a specialty over but for some reason these kinda, I can help my parents or friends or grandma, thoughts keep pointing me back to EM. Someone tell me I shouldn’t care about that please.

i can’t emphasize enough how much you don’t want this.

Your judgement with family members is completely compromised. I draw the line at aom and conjunctivitis for what I’m willing to deal with for my direct family.

You really want to be the guy that blew off his dads aaa, or conversely be dealing with your parents thinking you’re blowing things out of proportion when you tell them what to do for chest pain as above?

People call you with an agenda. It’s not malicious, it’s just the way people are. You don’t know their medical hx. You usually get a garbage history from them, don’t get an opportunity to do an exam, and then get asked heavily leading questions to get them to do what they wanted anyway. Despite all the (sort of) jokes we make about these things not mattering, they do.

For what it’s worth, I as a premed used to ask myself “what would be useful if the apocalypse happened.” I was an idiot. I still am, but I’m also older now.

 

[cyanide12345678]

I told my mom that she didn't need to go to the emergency department for a tick that had been on for less than 24 hours and that worst case she could just have her primary care doctor call in some doxycycline to be totally reassured.

She ended up going into three different emergency departments (2 before her vacation finished and one upon returning home).

Definitely don’t pick a field just so you can give medical advice for a family member. Residency will end up being a very long experience unless you truly love a specialty.

My parents don’t even think I’m a real doctor 😂😂😂 only in the Asian/subcontinental culture can you be a ER doctor and still be a disappointment 😂

All we do is triage to the real doctors apparently😂

 

[RustedFox]

My parents don’t even think I’m a real doctor 😂😂😂 only in the Asian/subcontinental culture can you be a ER doctor and still be a disappointment 😂

All we do is triage to the real doctors apparently😂

Stepmom is a career nurse that is Dunning-Kruger'ed to the max.
Every time I state something simple medical-wise, I get asked: "How do you know that?"
Bish, I know it because I'm a physician with 15 years of experience now STFU.

 

[Birdstrike]

I just heard Pain was a weak match this year with significant unfilled spots at good programs. May not be so hard to get into, as it used to be.

Looks like a hot anesthesia market is keeping anesthesia Pain applicant numbers down.

 

[HemorrhagicShock]

I just heard Pain was a weak match this year with significant unfilled spots at good programs. May not be so hard to get into, as it used to be.

Looks like a hot anesthesia market is keeping anesthesia Pain applicant numbers down.

I hear and read over and over again that it's also the pain market itself isn't doing so well either, so it seems like its a dual effect

 

[HemorrhagicShock]

How’s Emergency Medicine doing?

Ha! Come on birdstrike, even you're not that dense. That's not the topic/question I was asking.

Yes EM sucks. I'm well aware.

 

[Birdstrike]

Ha! Come on birdstrike, even you're not that dense. That's not the topic/question I was asking.

Yes EM sucks. I'm well aware.

They all have their advantages and disadvantages.

 

[GassYous]

I just heard Pain was a weak match this year with significant unfilled spots at good programs. May not be so hard to get into, as it used to be.

Looks like a hot anesthesia market is keeping anesthesia Pain applicant numbers down.

A lot of pain trained people are going back into anesthesia

 

[sloh]

A lot of Pmr residents I talk to also don’t think pain is worth it

 

[bronx43]

A lot of Pmr residents I talk to also don’t think pain is worth it

Seems like the market is very saturated. Even in my semi-rural area, there are 5 pain docs competing for business.

 

[DeadCactus]

Ig my idea to do EM comes from the idea that if my dad calls me with stomach pain, I’d at least like to advise him on what to do next. Ik that’s a silly thing to pick a specialty over but for some reason these kinda, I can help my parents or friends or grandma, thoughts keep pointing me back to EM. Someone tell me I shouldn’t care about that please.

If you literally just want to give medical advice to family and friends, other's have already addressed the many flaws in that thinking. Many people end up in FM or EM because they want to be a "real doctor" and find value/fulfillment in the broad knowledge base and patient presentations. If that's what you're trying to get at, it's a valid consideration. The bottom line is, as has been said, pick the specialty that fits what you want if fellowship doesn't happen.

I will say that many people who pursue a niche or subspecialty start to find area of expertise more rewarding and important than their general medical knowledge.

 

[Birdstrike]

Seems like the market is very saturated. Even in my semi-rural area, there are 5 pain docs competing for business.

It definitely is very, very saturated. Increasingly so, where I’m at.

 

[Birdstrike]

A lot of pain trained people are going back into anesthesia

For increasing salaries in anesthesia?

 

[HemorrhagicShock]

It definitely is very, very saturated. Increasingly so, where I’m at.

If somebody were to make the decision to go to pain fellowship today, I would assume that would mean matching for a start date of June 2025?

Assuming a 1-year fellowship, a graduation date of June 2026, what kind of market do you think will exist at that time?

Are the trends pretty solidly in one direction?

 

[sloh]

Seems like the market is very saturated. Even in my semi-rural area, there are 5 pain docs competing for business.

Know some anesthesiologists here in SoCal who went to prestigious pain programs. All have pretty bad job offers even compared to some of the bad anesthesia gigs lol

 

[BoardingDoc]

If somebody were to make the decision to go to pain fellowship today, I would assume that would mean matching for a start date of June 2025?

Assuming a 1-year fellowship, a graduation date of June 2026, what kind of market do you think will exist at that time?

Are the trends pretty solidly in one direction?

Job market is pretty grim. Pure pain jobs are very hard to find in any geographically desirable area. Most places that have openings will tell you to do 2 days pain, 3 days anesthesia/em/whatever.

 

[GatorCHOMPions]

Re: pain jobs in desirable areas, it takes patience, timing and luck. I found a decent job at literally the 11th hour June of my fellowship. A few months later a job I had applied for previously contacted me, I interviewed for kicks, and they offered me the job. The second job in many ways was even better than the first but I didn't want to make a change so quickly.

I've scanned the market the 1-2 years since and there's been a couple bad jobs out there, one seemingly decent one that had a handful of applicants.

I consider myself lucky. To answer OP directly, choose anesthesia or PMR and then contemplate Pain afterward. There are a number of jobs where it's clear the preference is anesthesia/PMR.

 

[dchristismi]

When friends or family ask me medical questions, I say "It's rabies" and run away quickly while they try to grasp what I just said.

Alternatively, now that I do hospice, I ask if they really want my answer, because clearly, they don't.

 

[Birdstrike]

If somebody were to make the decision to go to pain fellowship today, I would assume that would mean matching for a start date of June 2025?

Assuming a 1-year fellowship, a graduation date of June 2026, what kind of market do you think will exist at that time?

Are the trends pretty solidly in one direction?

I don’t know the whole market. I only know my are which is saturated and it’s made my current job tough. But, I just got hired by the big ortho/Spine/Pain group in town and will be making a job change.

I’m still very glad I get to have a normal life. It makes it all worth it.

 

[WhatJobDoIPick]

Yeah, it seems like pain has more push factors than pull. As in, people apply to pain fellowship because they're fleeing bad EM experiences or (in the past) bad anesthesia markets rather than actually being drawn to pain medicine. This, in itself, is a recipe for burnout.

It makes sense, because really, who actually wants to manage these patients day in and out?

I'm glad that some people have seemingly unicorn jobs where they just do procedures all day on the most compliant and genteel of patients, but this seems like the minority.

 

[VA Hopeful Dr]

I don’t know the whole market. I only know my are which is saturated and it’s made my current job tough. But, I just got hired by the big ortho/Spine/Pain group in town and will be making a job change.

I’m still very glad I get to have a normal life. It makes it all worth it.

Dang it man, I just sent 2 patients to your old group who are moving from my area to yours.