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

[bk03]

---

Members don't see this ad.

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!

 

[Snowmen96]

With the caveat that I am PM&R trained, I don't understand why someone set on pain medicine would choose a specialty other than PM&R.

You can have the best interventional skills, but your injections will be useless if your diagnostic skills are sub-par and you do the wrong injection. To me, it is beyond clear that PM&R gives you the most MSK knowledge, physical examination abilities and diagnostic skills.

 

[willabeast]

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!

I was trained (and boarded) in PM, IM, and Anesthesiology. I worked in a PMR dominated department. The problem you MIGHT have as a EM trained pain doc is in diagnosis both MS and IM. But this could be overcome if your referral sources were competent. I noticed PMR and Anesthesia docs get into trouble when they missed IM diagnosis (cardiac ischemia, cancer) and Anesthesiology docs fail to diagnose neurological issues (for example I was referred a CRPS hand issue from a hand surgeon that turned out (after a trip to Cleveland Clinic) to be a ligated nerve. I solved future neurological inadequacy by insisting all CRPS patients see a neurologist first. A few litigation problems can sink you. Somehow in a 40 year career i was never successfully sued (by the grace of God probably). A boring practice should be the goal. My two cents.

 

[mdo1738]

It’s impossible to tell that far in advance. Right now, EM probably can fairly easily get into a good pain fellowship since most anesthesia folks are just doing general anesthesia. But in the very possible event that the anesthesia market cools off over the next couple years, then you’re screwed when the anesthesia applicants start applying to fellowships again.

 

[doctoroxygen]

With the caveat that I am PM&R trained, I don't understand why someone set on pain medicine would choose a specialty other than PM&R.

You can have the best interventional skills, but your injections will be useless if your diagnostic skills are sub-par and you do the wrong injection. To me, it is beyond clear that PM&R gives you the most MSK knowledge, physical examination abilities and diagnostic skills.

I am EM practicing pain exclusively and agree with this. PM&R will give you the most relevant knowledge and skillset for this field. Anesthesia will help with finding a job as many jobs are only open to anesthesia. EM still faces job market difficulty in finding pain jobs though this may improve over the next several years.

From an entirely impractical standpoint, I do enjoy having a very broad medical knowledge from EM that is irrelevant to what I do day to day.

 

[specepic]

I think it is great you are asking the question. It is always tough to know what you do not know

Although emergency medicine into a pain fellowship would be a less typical track, I do not really see anything wrong with it as long as you go into it knowing that you need to do is much as you can to improve your knowledge base within neurology, orthopedics, and PM&R, and perhaps psychiatry

I think the most key thing for you would be to find a pain fellowship that promises to help make sure you are well-rounded by the time you are done, and ALSO perhaps look into appropriate electives during your emergency medicine residency

 

[Baron Samedi]

If you think PM&R is boring, wait until you try Pain Management.

 

[painER]

I'm an EM grad and current pain fellow. From a procedural/knowledge base there is nothing wrong with an EM background. Sure, there are areas you are weaker than a PMR/anes grad, but a lot of other areas you are stronger. Like everything it's a trade off and you just need to be aware of your weaknesses and work on them.

With that said, if your goal is pain, I wouldn't do EM. And that is purely practical advice. The fellowship programs are run by anesthesia/pmr. They are going to want to take their own grads all things being equal. When the anesthesia pain interest rises again, it's going to be way harder to land a fellowship spot as a EM grad.

Also, who says when you get into residency you are still want to do pain. Things change. Consider what else you may be interested in when you are choosing a residency.

 

[drrosenrosen]

I wouldn't recommend doing any residency that you wouldn't want to do as a career. If pain turns out not to be what you want, you want to be able to fall back on your primary specialty as something you'd be happy to do.

 

[drusso]

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!

Do EM and then a medical toxicology fellowship. You'll thank me 15 years from now when you're on your boat in Maldives raking in the bucks doing virtual depositions in between scuba sessions.

 

[Ducttape]

unless something has changed, i dont remember med tox attendings making glorious money. they were miserable while they were working shifts in the ER too.

 

[Fox800]

unless something has changed, i dont remember med tox attendings making glorious money. they were miserable while they were working shifts in the ER too.

Plus you're forced to work at academic medical centers.

 

[BoardingDoc]

Do EM and then a medical toxicology fellowship. You'll thank me 15 years from now when you're on your boat in Maldives raking in the bucks doing virtual depositions in between scuba sessions.

I only have a handful of friends who did a tox fellowship after EM. None of them make more doing it than they do in pure EM. One of them did the fellowship, did tox for 2 years at a big academic center and then quit to go back to EM full time because the work/money ratio just wasn't there in tox.

I suppose it's possible to make bank doing legal work as a toxicologist, but that's like saying you should just go be Michael Jordan. Probably not gonna happen.