Since such fellowships are very competitive, it would be wise for an applicant from an emergency medicine background to cast as wide a net as possible. Beginning this year there is an application match, but some programs may not participate and may continue to require separate applications, which can make the process laborious. The odds of obtaining a fellowship position are long, especially for non-anesthesiologists, let alone one from none of the four official parent specialties of pain medicine. Despite this, several emergency physicians have attended fellowships and passed the pain subspecialty board exam. I know of at least one on faculty of the Pain Department at a very prestigious institution with a pain medicine fellowship program.

Something to consider before applying for a fellowship would be to attend a procedure course where introductory pain procedures can be learned (www.asipp.org/meetings.htm). Valuable introductory skills can be learned, such as guiding a needle under fluoroscopy, epidural steroid injections, facet nerve blocks and other basic procedures that can accelerate the learning curve once fellowship is started. Pain society meetings may be worthwhile, such as the American Society for Interventional Pain Physicians (ASIPP), American Pain Society (APS), and International Spine Intervention Society (ISIS) among others, to learn more about the field from the “inside.” This also helps to meet people in the small community of pain medicine, including fellowship directors. Any research related to “Pain in the Emergency Department” can be highlighted on one’s application, including ultrasound guided regional techniques, disparities of pain treatment in the emergency department, procedural sedation or IV pain treatments in the emergency department, only to name a few. Also, if available, taking a pain medicine elective as a resident would be invaluable, as would shadowing a pain physician.

I encourage any interested emergency physician to consider applying to pain medicine fellowships. Pain specialists will be in great demand by our aging population. I view this as not giving up one specialty for another, but as furthering one’s education and adding to one’s skill set. Also, I believe emergency physicians have a tremendous amount to offer the field of pain medicine and their patients by pursuing ACGME-accredited pain medicine fellowship training.

Dr. Mayhew is at Carolina Health Specialists, Pain Medicine, Emergency Medicine, Myrtle Beach, SC: PainMedicine.EmergencyMedicine@gmail.com

(A list of accredited Pain Medicine fellowships is at www.acgme.org/ads/Public/Reports/Report/1 )

References

1. Knox H. Todd. Annals of Emergency Medicine 2010; 56 (1):24-26.
2. http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/sh_multiPainPR707.pdf pages 10-11