1. I noticed that for a lot of the PM&R pain guys, they seem to market themselves as being able to provide many PM&R services (EMG etc) in addition to typical pain stuff. Did you feel underprepared to enter pain practice right after fellowship?
I did not feel underprepared. EMGs are considered like a procedure and I think the PM&R people put that out there as if to say, "Here's one more procedure I can do." But it's only a drop in the bucket. EMGs aren't that usual, that often, for pain. Maybe when history and MRI disagree to such an extent I need a tie-breaker to make a diagnosis, I'll order an EMG. But they're also operator dependent. So I don't order many. And when I do, I just refer them to a non-Pain PM&R or neuro person. Plus, some of those PMR guys leading with "I do EMGs" may not be fellowship Pain-trained. And there may be multiple procedures they don't do, so they throw out the EMG thing. I wouldn't worry about it.
If you do a fellowship, you'll be way
way more prepared than a huge amount of non-fellowship people out there that claim to be "pain doctors." And there's not really a big market for "general PM&R services" in most Pain practices, that I can see. Outpatient Pain and general PM&R are as different as outpatient Pain and sitting in an OR running halothane on a surgical patient, that is, completely different.
2. How marketable would you say an EM pain guy is compared to the PM&R or Anesthesia pain guy? This is another concern I have.
If you went to an ACGME Pain program that does lots of procedures, and you pass the boards, you'd be equally marketable as a PR&R or Anesthesia Pain person. You might be more marketable, if they were not fellowship trained or went to a fake fellowship, which is not an insignificant number of people claiming to be 'pain specialists.'
3. Do you do any SCS/implants or kyphoplasties? Can you touch (just briefly) on what procedures you primarily do in your practice?
Thanks again!
I did many SCS trials and implants in fellowship. But currently, I do spinal cord stimulators trials, but not implants. The trials are temporary stimulators you can place under fluoro, in office. Implants require an OR either at a hospital or ACS. If you want to be a surgeon, you'll do trials and implants. If you don't want to be a surgeon, you'll do only the trials.
I also do kyphoplasties. Those can be done in hospital, ACS or in office. I do the easy ones, medically stable, in-office in my fluoro suite. Anything more difficult, bad lungs or higher in the spine than I'm comfortable with, I send to on of the ortho spine or neurosurg guys I know. Again, I have no desire to ever set foot in a hospital again, be a cowboy, or get 'surgeon calls' at 2 am. I'm happy to let someone else be the hero. Been there, done that.
My fellowship did tons of procedures, literally everything and then some. But kyphos were the one thing I wished we had more of. For some reason, IR took most of them. So, after fellowship, I had one of the kypho reps fly me to Tampa to do a cadaver course to hone my skills. After a year of learning all the other procedures, kypho was easy to learn. It's a really cool procedure. I wish I got more of them. But they're fun and work really well.
I also do lots of cervical and lumbar epidural steroid injections, facet nerve blocks, joint injections (shoulder, hip, knee, wrist, hand, sacroiliac, ankle), tendon/tendon sheath injections, occipital nerve blocks, radiofrequency nerve ablations (lumbar, cervical, knee), sympathetic nerve blocks, trigger point injections, joint bursa injections, and others.
I feel like if I do make the leap, I'll probably just have to take whatever fellowship I get (obviously always the case with the match, but I doubt I'll get my pick of fellowship).
Maybe or maybe not. This was how I approached it: My plan was to a apply to every program in the country. But since this was before Pain being in the Match, it was a rolling process. I had sent out 30 something applications when I started getting interviews. I paused applying temporarily and flew around the country to a hand full of interviews. I took the first offer I got, at a solid procedure-heavy program in a big city.
When I got the call I was on an ED shift, and I jumped up and down in the back hallway of my ED fist pumping and thanking the heavens like a crazy person, because I knew the day had come I could have a normal life again. I then stopped my search. I then worked more shifts than I ever did in my life the next 6-7 months to save money, so that the last day I left my ED, would be the last shift I ever had to work in an ED, ever again.
I did get credentialed with a locums company near my program and the ED director there said I could have shifts, but I never took any. Life was too good, at that point, to do that.
P.S.
The day-to-day practice of Pain has so little to do with the day to day practice of the base specialties the whole "who's better suited for Pain" conversation is actually kind of dumb. Pain training is best viewed more like a 1-year, crash-course residency, than a fellowship continuation of anything. And that goes for all the specialties.
To the extent you base specialty does matter, there are two things that do help: General procedural skills and clinical diagnostics. EM lines up very well on both fronts. EM physicians' only disadvantages are, being late to the Pain game, and a general refusal to ever imagine themselves as useful outside of the walls of an ED.