Top Pain Fellowship Programs

[ether]

Hi all,

I was wondering if anyone out there know where are the good pain programs to do a pain fellowship if one was interested, especially those that are very interventional??

I've heard of Beth-Israel Deaconess, Brigham and Womens, UCLA, and some program in Texas ?Galveston.

Any insight would be appreciated.

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[jbp18460]

I know that Texas Tech in Lubbock had an excellent program a few years back. Both Dr. Raj and Dr Racz were on faculty there and both are world renowned. The last I had heard they were both retiring but even so, the program has a very good reputation. The issue at hand is the location.....Lubbock. It definately would be worth looking into.

 

[charcot]

Can anyone name the top 10 pain management programs?
Top 10 in the sense of best overall training, plenty of interventional training, good case mix, inpatient and outpatient experience, didactics/board prep?

I've heard UC Davis, MGH, Texas southwestern, U CHicago and Duke.

 

[joshmir]

I think the previous poster was confusing UT Southwestern with the Texas Tech-Lubbock program, and MGH with BID.

When I looked into this, I concluded that outside the Texas Tech Interventional Pain Fellowship in Lubbock (with Pritvee Raj, et al, who I hear are now leaving, retiring), the best pain programs were UPenn and Beth Isreal-Deaconess (BID), one of Harvard's hospitals. I was told this from academic Pain attendings.

I can speak a bit about BID's program; the fellowship is incredibly popular among their residents (there was a scutwork review written recently iunder the 'fellowships' section). They have gotten away from chronic management, and defer the PCAs and pharmacological management to other services to concentrate more on intervention. Rumor has it on these message boards that people are pulling in seven figures in nevada after this fellowship, mostly implanting epidural pumps. Also, they take at least one PM&R resident a year, which allows the rest of the residents to expand on their anesthesia background. They present a lot at national meetings.

I would love to hear from current pain fellows about what they think makes a good fellowship, and whether they think it's better to go to a fellowship with a name vs going to a fellowship in a place you want to practice. Thanks!

 

[UTSouthwestern]

Texas Tech is definitely the top pain program with Raj and Racz on board. Our program, however, took Leland Lou from Tech (he was #3 behind Raj and Racz) and are set to hire away more of the Tech faculty. Raj and Racz are set to retire soon as well.

The implantable pumps are certainly the high end in pain procedures at this time but be aware that neurosurgeons are becoming increasingly competitive in this field in an effort to expand their role in chronic pain management.

The money is still very good in the field, but as with all good things, the specter of medicare crack downs are looming.

 

[ether]

From what I've heard as top programs were:

Texas Tech
UCLA
BID
BWH
Cleveland Clinic

Let me know if u heard of others.

 

[lakerjock]

I've heard BID is the best pain program on the East Coast.

 

[charcot]

If BI is the best pain program in the East coast, Texas- Lubbuck is best in the midwest, how about pain fellowships on the west coast? Ive heard UCLA? Any others? I've heard UCSF is very academic and requires 2 years commitment, to include time for research.

 

[IsoGirl2707]

Does anyone know anything about good pain programs in the Southeast?

Thanks!

 

[Tollway]

I hear UCSF can be painful

 

[2Deep]

UCSF's pain fellowship is very interventional in nature and has moved away from writing scripts for pain patients. Recommendations are made, but the responsibility of regular narcotic prescriptions are the referring physicians'. Most of the recent fellows I have spoke with were extremely happy, and felt they were more than well-prepared after only 6 months of training. The schedule is great 8-5 M-F, infrequent home call. They also allow moonlighting, which is a great way to supplement your income as a fellow. All the fellows I know are anesthesia trained however, although there may be exceptions. The director, Palmela Palmer is wonderful and well known in academic pain circles. The majority of the faculty are also anesthesiologists, although there are a few neurologists I think. The primary training occurs in the clinic at the UCSF/Mt Zion Comprehesive Cancer Center. They have 2 dedicated fluoroscopy suites, and implanted pumps and stims are done in the OR. As mentioned before, motivated fellows have attended at the nearby Kaiser or at UCSF occasionally in their free time.

 

[charcot]

thanks 2deep for the info. Do you have any familiarity with stanford's pain program? Also, do you know how far in advance do people typically apply to UCSF and other top-rated programs?

 

[zoolander]

Stanford pain svc was the ideal balance of clinic and procedures, IMO- one of my favorite med school rotations.

1-2 full, busy OR days/week, dedicated pain clinic, plus consults and AM inpt rounds. The head, Dr. Raymond Gaeta, is a very compassionate and collegial person (do you have to be, in pain?) as well as a good teacher. There were 3 or 4 fellows when I was there. It sounded like the ones that wanted to stay in academics definitely could (one got an offer to stay at Stanford) though many were looking forward to going into practice. All the fellows were from outside so it didn't sound like they only take local people. There's a large and accomplished anesthesia program, so residents are always rotating through- leads to more teaching.

Where I am now it sounds like the 'consultative medicine service' does a lot of the pain mgmt stuff that's done by the pain clinic at Stanford. Sounds like it's worth looking looking into the turf dynamics at a particular program.

 

[omarsaleh66]

Texas Tech is definitely the top pain program with Raj and Racz on board. Our program, however, took Leland Lou from Tech (he was #3 behind Raj and Racz) and are set to hire away more of the Tech faculty. Raj and Racz are set to retire soon as well.

The implantable pumps are certainly the high end in pain procedures at this time but be aware that neurosurgeons are becoming increasingly competitive in this field in an effort to expand their role in chronic pain management.

The money is still very good in the field, but as with all good things, the specter of medicare crack downs are looming.

i had the opportunity to shadow dr. racz. did u know he is ranked in the top ten doctors in america? that's some crazy stuff!!!, anyways, he is a bad ass, he truly inspired me, it really sucks that he is retiring, but dr. racz, raj, and dr. kaye put texas tech on the map. People fly in from all over the world to lubbock for pain management.

 

[charcot]

Is it fair to say that UCSF provides mainly outpatient pain management training and Stanford's is mainly inpatient?

Also, I recently heard great things about Loma Linda. Any thoughts?

 

[Aether2000]

My votes would go to three: Wake Forrest, Mayo Jacksonville, and Loma Linda. Wake has a long rep as being extremely active in research and academics in their pain program. Mayo Jacksonville has one of the few independent pain departments in the country and has excellent faculty. Loma Linda sends their fellows to external comprehensive cadaver courses every year.

 

[PainDr]

I would agree with most of the above. The following list is based on my interviews and info from others on the interview trail.

Best Programs (in no particular order):
B&W, BID, MGH, UCLA (both Anesth and PM&R), UCSF, Texas Tech, Mayo Jacksonville, Cleveland Clinic, MD Anderson, Wake Forrest, Columbia, Cornell.

Very Good Programs (in no particular order):
Emory (Anesth), UT Southwestern, UT Houston, Einstein, UC Davis, West Virginia.

These are just my opinions. I'm sure I've left out some excellant programs so feel free to add to the list.

 

[NEPain]

I've followed this discussion with interest. I finished my fellowship in pain medicine recently and am now faculty at Dartmouth. I would be interested in knowing what people have heard about the fellowship at Dartmouth.
I have no interest other than to gain insight into our reputation so as to improve any perceived deficiencies and make sure the good things continue.

Would also like to know what potential applicants are looking for when choosing a fellowship.

 

[Epidural]

I've followed this discussion with interest. I finished my fellowship in pain medicine recently and am now faculty at Dartmouth. I would be interested in knowing what people have heard about the fellowship at Dartmouth.
I have no interest other than to gain insight into our reputation so as to improve any perceived deficiencies and make sure the good things continue.

When I was applying and asked around, I heard good things about the Dartmouth program. The problem was that even being in New England, I had a hard time getting information about the program. I imagine that those applying from others areas might have an even more difficult time.

What I've heard is:
1. Overall, you will get the opportunity to do lots of procedures (including pumps and stims).
2. Fellows are not overworked.
3. Attendings are a pleasure to work with.
4. Multidiscplinary training is not as good as other programs.
5. For those intersted, not as much research going on, but program is generally very supportive of potential projects.
6. Good opportunities in Pediatric Pain Management.

Would also like to know what potential applicants are looking for when choosing a fellowship.

When I applied, many of the applicants were concerned with the following:
1. How many pumps and stims will I get to do and will I feel comfortable doing them after fellowship?
2. How many fellows are there and what's the call like? Home call or overnight? Are the fellows happy?
3. What are the people like? Will it be a miserable year?
4. What kind of reputation does this program have and will this be an asset when looking for a job? Are faculty members connected to the Pain community as a whole?
5. What opportunities do I have to get exposure to other facets of Pain Medicine that will be covered on the boards and in clinical practice (EMGs, MRIs, MSK medicine, etc.). If it's not a part of the fellowship program, how many electives are there and are these other specialties open to having us?
6. Is there support to attend conferences such as ASRA, ISIS, NASS, etc.
7. How many c-arms does the clinic have and how are things set up for the fellows. Are there separate days for seeing patients and doing procedures or are they mixed in throughout the day?
8. Besides the clinic, what will my other responsiblities be? Are we covering perioperative patients and managing their PCAs/epidurals or is this covered by the Anesthesia residents?
9. Are there opportunities to do newer procedures such as vertebroplasty, IDET, percutaneous discectomy, peripheral nerve stimulators, etc.

 

[NEPain]

Thanks for your response. I think those are accurate impressions of our program. Having been here only one year, my impression is that it's a very good fellowship but it could be a really top fellowship. I'd like to try to help move it in that direction.

That's a pretty good list of what to look for in a fellowship. I'd add one more: How is the continuity of care? I think it's really important to see a new patient and then be involved in any management and followup. Otherwise one gets no feedback on how patients do. Fellowships often lack this.

I found it very difficult to get information about fellowships and their reputations when I was applying. The ASRA site was helpful but I never felt I got a handle on the quality of the different fellowships. Sometimes a program has a famous name but a poor pain fellowship. Even now, when we recruit faculty, I can't tell much by where they did fellowship training, other than a few obvious standout places.

 

[M]

I think the previous poster was confusing UT Southwestern with the Texas Tech-Lubbock program, and MGH with BID.

When I looked into this, I concluded that outside the Texas Tech Interventional Pain Fellowship in Lubbock (with Pritvee Raj, et al, who I hear are now leaving, retiring), the best pain programs were UPenn and Beth Isreal-Deaconess (BID), one of Harvard's hospitals. I was told this from academic Pain attendings.

I can speak a bit about BID's program; the fellowship is incredibly popular among their residents (there was a scutwork review written recently iunder the 'fellowships' section). They have gotten away from chronic management, and defer the PCAs and pharmacological management to other services to concentrate more on intervention. Rumor has it on these message boards that people are pulling in seven figures in nevada after this fellowship, mostly implanting epidural pumps. Also, they take at least one PM&R resident a year, which allows the rest of the residents to expand on their anesthesia background. They present a lot at national meetings.

I would love to hear from current pain fellows about what they think makes a good fellowship, and whether they think it's better to go to a fellowship with a name vs going to a fellowship in a place you want to practice. Thanks!

The market for interventional pain docs in Nevada is very good no matter where you trained. If you want do learn how to do these pumps, it's not clear to me that BID is still doing them.

I heard their pump program was suspended after a programming error but maybe they started implanting again. The program has a great reputation but I still see many more people pick B&W or MGH over BID. MGH also takes people outside of Anesthesia on a consistent basis.

Fellowship is only one year and I think how good of a pain doc you are will also depend on your own personal motivation to learn after you finish. While going to a name program doesn't necessarily make you more skilled, it's hard to deny the fact that more doors are opened.

 

[Aether2000]

Correct regarding BID. My partner was a fellow there at the time and acquired zero pump skills from that program and no intradiscal skills as they do not permit intradiscal incursion at that program.

 

[Paindoc12345]

Can anyone name the top 10 pain management programs?
Top 10 in the sense of best overall training, plenty of interventional training, good case mix, inpatient and outpatient experience, didactics/board prep?

I've heard UC Davis, MGH, Texas southwestern, U CHicago and Duke.

I recently completed a Pain Fellowship at UC Davis and have been meaning to put up this review for awhile. This program is good for bread and butter procedures (epidurals, medial branch blocks/RFA, SI joints, etc) but if you are looking for Cancer pain, spinal cord stimulators or pain pumps this is not the program for you-bare minimum only. I would consider this program to be malignant for a few reasons;
1) The hours are pretty much 7:30am-6pm daily if you don't want to take work home with you, and you are expected to come in on weekends to round if you put in an intrathecal pump even if you are not on call
2) there is a TON of scut work.
3) The attendings are neither supportive nor engaging, and quarterly reviews are formal and scrutinizing. Now, cookies and warm fuzzies are not the reason people apply for fellowships, so this was not a deal breaker for me, but it is something to be aware of.
Overall the training is good and you will come out of the program being comfortable doing general spine injections. There are 5 August fellowship spots and one January "off-cycle" spot but all are ACGME accredited. If I had it over I may have attended elsewhere.

 

[drusso]

I recently completed a Pain Fellowship at UC Davis and have been meaning to put up this review for awhile. This program is good for bread and butter procedures (epidurals, medial branch blocks/RFA, SI joints, etc) but if you are looking for Cancer pain, spinal cord stimulators or pain pumps this is not the program for you-bare minimum only. I would consider this program to be malignant for a few reasons;
1) The hours are pretty much 7:30am-6pm daily if you don't want to take work home with you, and you are expected to come in on weekends to round if you put in an intrathecal pump even if you are not on call
2) there is a TON of scut work.
3) The attendings are neither supportive nor engaging, and quarterly reviews are formal and scrutinizing. Now, cookies and warm fuzzies are not the reason people apply for fellowships, so this was not a deal breaker for me, but it is something to be aware of.
Overall the training is good and you will come out of the program being comfortable doing general spine injections. There are 5 August fellowship spots and one January "off-cycle" spot but all are ACGME accredited. If I had it over I may have attended elsewhere.

Interesting. It was pretty much that way over 10 years ago...

 

[thiswonthurtabit]

I recently completed a Pain Fellowship at UC Davis and have been meaning to put up this review for awhile. This program is good for bread and butter procedures (epidurals, medial branch blocks/RFA, SI joints, etc) but if you are looking for Cancer pain, spinal cord stimulators or pain pumps this is not the program for you-bare minimum only. I would consider this program to be malignant for a few reasons;
1) The hours are pretty much 7:30am-6pm daily if you don't want to take work home with you, and you are expected to come in on weekends to round if you put in an intrathecal pump even if you are not on call
2) there is a TON of scut work.
3) The attendings are neither supportive nor engaging, and quarterly reviews are formal and scrutinizing. Now, cookies and warm fuzzies are not the reason people apply for fellowships, so this was not a deal breaker for me, but it is something to be aware of.
Overall the training is good and you will come out of the program being comfortable doing general spine injections. There are 5 August fellowship spots and one January "off-cycle" spot but all are ACGME accredited. If I had it over I may have attended elsewhere.

How does this compare to other programs? UC Davis is my early front runner for location reasons but I'd like my limited time in fellowship to be largely dedicated to learning and not scut work.

 

[DOctorJay]

Essentially zero scut at Mayo. Service can run without the fellows. Focus on learning. Best training year of my life.


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[Nonphysiologic]

Uc Davis had the most intense interview full w pimping and shadowing at a clinic. Signs of a malignant place . That being said I think it's impossible to rank programs people are usually in and out of one year fellowships and it's hard to tell to be honest from interviews


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[neutro]

I did my pain fellowship at NYU. I loved it.
You rotate between 6 sites:
1) Ambulatory - Bellevue, Center for study and treatment of pain, Center for MSK care, VA.
2) Inpatient - Tisch Hospital, Bellevue (some).
I was looking back at my case logs - you do anywhere between 10-20 procedures a week. But the difference is, the attendings really let you do the injections (except for one place - but even that, you learn how to be efficient first). They sit back, they let you play with fluoro. Its truly a learning institution. A lot of focus is on learning fluoro anatomy which is probably the most important part of injections.
Attendings are very easy going and supportive.
I was hesitant after my fellowship as people stated its not interventional heavy - I did not struggle at all after fellowship.
Little kypho, stim and pump exposure - but you can learn that afterwards. Its not that hard.

I do not intend to implant pumps or stims anyways. Just trials.
I find that its not cost-effective for me, i.e. the procedure time, and possible management of complications, explant, etc and the overall headache costs more than seeing new patients in clinic and doing injections.

Lots of peri-operative pain medicine. Lots of exposure to actual disease requiring knowledge of context and how to treat that specific disease process. Education is excellent - lectures are excellent. Faculty is engaging.
Inpatient can be rough - usually 7 am to 7 pm 2-4 days a week, with 20-35 patients that you manage, but I honestly enjoyed that aspect of pain medicine. I find clinic a little boring at times.

Looking back, I feel that the biggest areas to master during fellowship are:
1) Learning how to diagnose the pain problem (or offer differential dx).
2) Mastering fluoro anatomy and knowing the principles of needle manipulation, indications and evidence behind procedures. That is far more important than doing 2500 injections in your fellowship without having a clue as to what you're doing.
3) Learning to be a consultant and realizing that each patient is truly different despite our recent habits to template everyone into a diagnosis.

No fellowship is perfect, but if you are able to develop your own practice style and leave the fellowship with some sort of an idea as to what kind of patients you like, and what procedures you're comfortable with and which you need to work on, then you will be fine.

 

[IkeBoy18]

Any updated thoughts on md andersons program?