PM&R...very interesting....

[Goose...Fraba]

hey folks,
was wondering if you can give me some advice. Im a ms3 and I was talking to a classmate of mine, and of course the inevitable "So figured out what you wanna do yet" question came up.

I told him that I actually enjoy many aspects of psych (even though some people despise it because they are a tough patient population to deal with) but cant see myself doing it full time.

I liked surgery because of the technical aspect of the field, but after my 50th lap choley I was bored outta my mind, not to mention the pleasant personalities found in surgery and OR staff

I kind of liked IM, and Neurology, but didnt really grab me you know....

Then I did a short rotation with a pain management doc in town..... loved it, I think I found my calling. IMO it has a little of all the nice things I liked about the above fields.

So now Im stuck, I was able to talk to more than a few pain docs, and they all came out of anesth. programs. but honestly I think that PM&R docs probably come out of residency and fellowship with a little more meat on there bones, as opposed to anesth. plus fellowship, just my oppinion though.

So knowing that this is what I would like to do (work/ or set up a pain clinic, doing mostly blocks/chronic pain), which route would make it easier to get a pain fellowship gas or pm&r?

And before somebody yells out, BUMP or read the FAQ's, I just want honest opinions, I know that practically speaking pm&r would maybe give me better training, but pain seems to be dominated by gas folks, and reading the whole thread about accredited vs non accredited pmr pain/spine fellowships makes me nervous.

Also it seems like a good chunk (50% or more) of pm&r residents are looking to do pain/spine fellowships (stiff competition) whereas in gas not as many look for pain fellowships (translate:easier to get into pain slot)

well what do you guys think? I know that some of these aspects have been discussed in one way or another in multiple other threads, but a fresh perspective would help me a ton! basically I am worried if I do pm&r and want to do a pain/spine fellowship competition would be so tight that I would have a prayer, as opposed to gas where chances may be better......
Goose

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[drusso]

hey folks,
was wondering if you can give me some advice. Im a ms3 and I was talking to a classmate of mine, and of course the inevitable "So figured out what you wanna do yet" question came up.

I told him that I actually enjoy many aspects of psych (even though some people despise it because they are a tough patient population to deal with) but cant see myself doing it full time.

I liked surgery because of the technical aspect of the field, but after my 50th lap choley I was bored outta my mind, not to mention the pleasant personalities found in surgery and OR staff

I kind of liked IM, and Neurology, but didnt really grab me you know....

Then I did a short rotation with a pain management doc in town..... loved it, I think I found my calling. IMO it has a little of all the nice things I liked about the above fields.

So now Im stuck, I was able to talk to more than a few pain docs, and they all came out of anesth. programs. but honestly I think that PM&R docs probably come out of residency and fellowship with a little more meat on there bones, as opposed to anesth. plus fellowship, just my oppinion though.

So knowing that this is what I would like to do (work/ or set up a pain clinic, doing mostly blocks/chronic pain), which route would make it easier to get a pain fellowship gas or pm&r?

And before somebody yells out, BUMP or read the FAQ's, I just want honest opinions, I know that practically speaking pm&r would maybe give me better training, but pain seems to be dominated by gas folks, and reading the whole thread about accredited vs non accredited pmr pain/spine fellowships makes me nervous.

Also it seems like a good chunk (50% or more) of pm&r residents are looking to do pain/spine fellowships (stiff competition) whereas in gas not as many look for pain fellowships (translate:easier to get into pain slot)

well what do you guys think? I know that some of these aspects have been discussed in one way or another in multiple other threads, but a fresh perspective would help me a ton! basically I am worried if I do pm&r and want to do a pain/spine fellowship competition would be so tight that I would have a prayer, as opposed to gas where chances may be better......
Goose

Many of us have been in your shoes. In fact, I think that people attracted to PM&R commonly have difficulties deciding between Anesthesia, Neurology, and sometimes FP for the reasons you mentioned.

You might consider what you will NOT be learning if you did Gas: No EMG or neuromuscular medicine, no musculoskeletal or sports medicine, no trauma rehab (TBI and SCI), no amputee care (phantom pain, prosethetics/orthotics, etc), no pediatric rehab (spina bifida, spasticity mangament, botox, etc), no stroke management (thalamic pain syndromes, spasticity, neurolytic procedures), no industrial medicine/occ med. Believe me, all of these patients at some point develop serious acute and chronic pain issues.

I'm sure that others will have a lot to say. Do a good PM&R rotation at an academic program and get a sense for the breadth of the field. Gas, rehab, neuro, and even psych are all legitmate pathways to a pain fellowship. It all depends on how you want to get there and what you eventually want to be doing.

Competition in PM&R is stiff for fellowships, but we have the option of applying to ACGME-accredited pain programs as well as PASSOR-recognized Interventional PM&R fellowships. As you've seen, the pros and cons of the various fellowship experiences has been discussed (and will be discussed) ad nauseum.

Keep looking around and asking questions. The right answer will eventually present itself.

 

[ThinkFast007]

Many of us have been in your shoes. In fact, I think that people attracted to PM&R commonly have difficulties deciding between Anesthesia, Neurology, and sometimes FP for the reasons you mentioned.

You might consider what you will NOT be learning if you did Gas: No EMG or neuromuscular medicine, no musculoskeletal or sports medicine, no trauma rehab (TBI and SCI), no amputee care (phantom pain, prosethetics/orthotics, etc), no pediatric rehab (spina bifida, spasticity mangament, botox, etc), no stroke management (thalamic pain syndromes, spasticity, neurolytic procedures), no industrial medicine/occ med. Believe me, all of these patients at some point develop serious acute and chronic pain issues.

I'm sure that others will have a lot to say. Do a good PM&R rotation at an academic program and get a sense for the breadth of the field. Gas, rehab, neuro, and even psych are all legitmate pathways to a pain fellowship. It all depends on how you want to get there and what you eventually want to be doing.

Competition in PM&R is stiff for fellowships, but we have the option of applying to ACGME-accredited pain programs as well as PASSOR-recognized Interventional PM&R fellowships. As you've seen, the pros and cons of the various fellowship experiences has been discussed (and will be discussed) ad nauseum.

Keep looking around and asking questions. The right answer will eventually present itself.

sorry..i dont know what PASSOR recognized means...

i'm new to this section of the forum..

is PASSOR same/equal to ACGME accred. programs? bottom line if ur PASSOR certified can you do pain mgt, and will you get compensated just as much (not that one should be going into this for compensation )

 

[DistantMets]

Just a brief observation from my pain management rotation...I really enjoyed to rotation too, but I felt like the anesthesia guys I was with did very sloppy musculoskeletal exams and basically wanted to look at the MRI so they knew where to stick the needle. I found it funny when I examined a patient before we did a cervical block and told the doc they had a positive Spurling's test, and he had no clue what i was talking about. They have much less experience with physical therapy modalities and very limited experience with the psychiatric components of a debilitating condition. Plus, they don't really deal with peripheral joint pain. I will admit that each doc in this particular group only spends 1 day per week in the pain clinic and does general anesthesia the rest of the week. There was only one doc that really seemed to enjoy the pain clinic. So maybe a dedicated anesthesia trained pain doc is more in tune to those things than what I experienced. I just got the 'needle jockey' feel from this particular group.

 

[Tenesma]

a pain doc who doesn't know about Spurling's shouldn't be practicing pain...

 

[Tenesma]

a pain doc who doesn't know about Spurling's shouldn't be practicing pain...

 

[dave262]

I'm totally in the same boat (MS III, same questions) so BUMP.

 

[Aether2000]

The most well rounded pain physicians with out current training programs are PM&R residency with an anesthesiology based fellowship in pain medicine. The best of both worlds are indeed possible.

 

[PainDr]

I know this is the PM&R forum, so please don't flame me but I'd like to add my two cents. I too was in the same boat as you...wanted to do pain but didn't know which residency to do. I think PM&R is a great option, but for me Neuro was the right choice. We get alot of pain exposure...at least 40-50% of my clinic population (radiculopathies, CRPS, thalamic pain, spasticity, chronic back and neck pain, neuropathic pain, headache and facial pain), plus excellant neuromuscular training. I had no problem getting lots of fellowship interviews and ended up with one of my top choices. In fact, several fellowship directors told me they were actively seeking neuro candidates. Since there are so few of us I think it gave me a real advantage.

It's true that the competition is getting tougher for the PM&R folks but someone like you shouldn't have a problem. In my interviews, the one thing that most impressed people was my longstanding interest in the field. This was even documented in my deans letter...believe it or not, some programs actually want your deans letter and most want all your transcripts. I would do a few rotations (PM&R, Neuro and Anesth) to get a good feel for all three fields. Gas residents will always have the upper hand when it comes to the better fellowships, but many of the best programs are now realizing the advantage of having multidisciplinary fellows. So you can get a great spot from PM&R or Neuro. The bottom line is, choose the residency that's right for you.

One last word of advice. Which ever field you choose make sure you use your elective time doing pain rotations. One of my interviewers wanted to talk to two of us at the same time. I went first and discussed my experience at length (at least one interventional rotation every year since MS III, plus all my experience as a neuro resident), then he turned to this PM&R guy who had never done a SINGLE interventional rotation...all he'd done were trigger point injections! Needless to say, there followed a VERY awkward silence. The poor guy didn't stand a chance.