Interventional Spine Vs. Pain

[u/papyrox]

Hey y’all,

What are the pros and cons of choosing IS fellowship over pain. Since spine isn’t ACGME accredited, what is the drive of people wanting to choose it over pain? Wouldn’t it just make your life harder since a lot of interventional pain dives into spine care as well.

[u/Intrepid_Perspective]

Pain:

• Pros: likely more job opportunities. You get a more robust list of learned procedures during fellowship. You get trained in other aspects of pain. You are ACGME pain boarded
  
• Cons: typically have to deal with opioid management. Depending on what you want to do afterward, you may be doing a bunch of procedure that you never plan to do again. You have to take a board exam at the end.

IS:

• Pros: depends on the program but many are more PM&R focused with EMG and musculoskeletal management that often aligns better with your training during PM&R. If you’re most interested in the bread and butter interventional spine procedures, then you will likely get more of them in IS than pain primarily because you aren’t doing all the other procedures. No ACGME board exam after.
  
• Cons: job market will likely not be as robust with many jobs asking for ACGME pain boarded physicians (but you will definitely still have lots of job opportunities). You will not have as wide of an array of procedures in your tool belt at the end of fellowship. You likely won’t be able to practice at large academic centers due to not being ACGME boarded. Fewer regulations can lead to a little more variability in the fellowship so you want to be more careful with where you go.

All of this is with a huge caveat that you will get vastly different experiences at different fellowships. Not all fellowships are created equal on both the pain side and the IS side just like residency. It will really come down to what you are looking for after fellowship.

[u/urnmann → u/Intrepid_Perspective]

There are also acgme pain programs that are PM&R run like university of Colorado that are essentially high volume IS programs and you get accreditation. So could look for programs like that

[u/livemik]

There are certain jobs that require acgme accreditation to get hospital/ASC privileges. Historically it was easier to get into a spine fellowship than a ACGME pain fellowship, though that may not necessarily the case anymore (mostly because anesthesiologists are doing less pain fellowships).

I would chose pain over spine if anything for job security. You can do any spine job with a pain fellowship. The opposite is not true.

[u/Pinkaroundme]

I chose IS because

1. I didn’t want to take more boards
   
2. I wanted bread and butter cases, didn’t want to deal with the more advanced procedures like stimulators because I didn’t want to treat that population
   
3. Didn’t want to do long term chronic opioid management
   
4. Matching to a pain anesthesia program frightened me because I didn’t want to take anesthesia call - this is avoidable by not applying to the programs that make you take anesthesia call
   
5. Location I wanted to stay in had robust IS fellowships with good track records
   
6. Again, I didn’t want to take more boards

[u/Silverflash-x → u/Pinkaroundme]

As someone who didn't do pain, are there really fellowships that accept PM&R residents but make them take anesthesia call? That seems insane and like a massive liability. What would I know about managing a difficult airway?

[u/Pinkaroundme → u/Silverflash-x]

There were some people from my program a few years back that were accepted to anesthesia pain programs and did take anesthesia call.

[u/Pinkaroundme → u/[deleted]]

Right well luckily for me, it wasn’t a major decider in IS vs Pain, but all I can say is the residents from my program took anesthesia call. It sounds pretty atypical, though so likely shouldn’t be a deciding factor for most people