Am inquiring about potential serious drawbacks of the following programs, beyond the obvious considerations of interventional vs research vs med management focus and geographical location.
Any hidden red flags here, such as current inordinate load of uncomplicated postop pain, scut, disruptive attendings or malignant culture?
Feel free to PM me if you are hesitant to share here.
Dartmouth
Penn
Stanford
U of Washington
U of Virginia
BWH
Cleveland Clinic
UAB
U of Maryland
Long time lurker, and now want to comment.
There is so much crap out there that its hard to believe whats true and whats not.
So I'll put in my 2 cents, feel free to believe or not to believe me. This is my perspective from an anesthesia background
Would say that none of the programs have MINIMAL interventional experience, I would use the term: moderate. There are plenty of programs that have a terribly small amount of interventional experience, but not the ones on the list above. Secondly, everyone knows which programs above are chill and which ones require tons of work. And if you are deciding on a program because of a name, thats the worse reason to do so. Go to a program that fits you, because when your done, no one is going to care which ACGME fellowship you come out of. As for specifics, Dartmouth, Penn, Stanford and Cleveland Clinic are some of the most stellar programs, and Cornell also. When you think about clean and pristine, those are the programs. Cleveland felt a little PMRish, though I cannot explain why I got that vibe. UAB is more of a sit back and relax, lets take a cruise program, but you’ll learn plenty. U of Virginia and U of Maryland may not have the same name recognition as Stanford, but are great programs, and will make you a damn proficient interventionalist! Now what about BMH, well hopefully this common knowledge, but you will work your butt off, and basically if like being a consultation service, then that’s the core of the program. I got the sense you were down in the trenches. I wonder if it didn’t have Harvard’s affiliation, would it still be up for discussion? None of these programs are bad, and this ridiculousness of not learning TFESIs is BullS**T, everyone in all programs learn TFESIs; just make sure you go to a program that you fit well in. Lastly, I don’t want to get into a war of which is best, but I was impressed by BID quite a bit.
I personally loved Stanford, U wash; but if I didn’t have family obligations, I would straight up consider U Maryland as my top choice. I bet I’m going to upset some people, whatever. Point being, my list is all about the atmosphere, not about how much time I’m in the OR.
Anybody have any strong opinions about Duke?
Long time lurker, and now want to comment.
There is so much crap out there that its hard to believe whats true and whats not.
So I'll put in my 2 cents, feel free to believe or not to believe me. This is my perspective from an anesthesia background
Would say that none of the programs have MINIMAL interventional experience, I would use the term: moderate. There are plenty of programs that have a terribly small amount of interventional experience, but not the ones on the list above. Secondly, everyone knows which programs above are chill and which ones require tons of work. And if you are deciding on a program because of a name, thats the worse reason to do so. Go to a program that fits you, because when your done, no one is going to care which ACGME fellowship you come out of. As for specifics, Dartmouth, Penn, Stanford and Cleveland Clinic are some of the most stellar programs, and Cornell also. When you think about clean and pristine, those are the programs. Cleveland felt a little PMRish, though I cannot explain why I got that vibe. UAB is more of a sit back and relax, lets take a cruise program, but you’ll learn plenty. U of Virginia and U of Maryland may not have the same name recognition as Stanford, but are great programs, and will make you a damn proficient interventionalist! Now what about BMH, well hopefully this common knowledge, but you will work your butt off, and basically if like being a consultation service, then that’s the core of the program. I got the sense you were down in the trenches. I wonder if it didn’t have Harvard’s affiliation, would it still be up for discussion? None of these programs are bad, and this ridiculousness of not learning TFESIs is BullS**T, everyone in all programs learn TFESIs; just make sure you go to a program that you fit well in. Lastly, I don’t want to get into a war of which is best, but I was impressed by BID quite a bit.
I personally loved Stanford, U wash; but if I didn’t have family obligations, I would straight up consider U Maryland as my top choice. I bet I’m going to upset some people, whatever. Point being, my list is all about the atmosphere, not about how much time I’m in the OR.
I'm moving this from the interview thread now that the rank list deadline is coming up:
What do you guys think of Pitt v Duke v Vandy?
Or Cornell v Penn?
I've seen and heard lots of different things about all of these but any extra input would be helpful.
Location aside, of course...
I can vouch from a rotation during residency that not ALL pain programs prepare you to do transforaminals. At UCSD they don't believe in transforaminals and only do them if there's a strong indication, which is uncommon. Their fellows don't feel comfortable with transforaminals when they graduate, they told me themselves, and were shocked when they heard another program I rotated at does them all the time.
After completing the interview season last year and a few months into my fellowship, I thought I'd give some insight on what I've learned.
Brigham and Women's (10/10) - best program in the country. Just to repeat what everyone on this thread has said about this program, it has the complete package. Great exposure. The OR time is top notch. The clinic can be brutal but you get really good at seeing a lot of patients and seeing them quickly. There inpatient service is rough and expect those days to be long. Will prepare you for a career in private practice or academic. And obviously the Harvard name makes everything that much easier when looking for jobs. They have a separate application outside of ERAS. 9 spots.
MGH (7/10) - great program and will prepare fellow for academic pain medicine. Not as interventional as BI and Brigham. great faculty. Going through some changes so unclear how leadership will change in the next year or so. Like I said, very academic. Harvard name carries a lot of weight and clearly will help you land a great job of your choosing coming from this program. Fellows are happy and don't seem overworked. 7 spots.
BIDMC (8/10) - probably 2nd best program in Boston behind Brigham. It's a mix between Brigham and MGH. Not as academic as MGH and not as busy as Brigham. Great interventions. Good didactics. More of a private practice setup. Will prepare you for a career in private practice or academic. One big pain guy left to join Brigham (or it's going to happen within a few months) so that may change the program. 8 spots.
Scott and White (9/10) - probably was the best kept secret in pain medicine, but I think the word is out on how great this program is. The people are fantastic. The exposure and number of interventions is great. The work hours are great. Only downside is that it doesn't have a big name, but they will prepare for a career in private practice and if you're from Texas, everyone knows the quality of training a fellow receives. Hands down best program in Texas. All the fellows seem happy. And Temple, Texas is actually an ok place to live for an year. And cheap housing is a huge plus. I loved this program. 2 spots. Usually take 1-house, so you are competing for 1 spot, but worth going to if you are lucky enough to get an interview.
Wake Forest (9/10)- this program is similar to Kansas and Scott and White. they have big name pain guys who have done a lot in the field. I think one of the guys is huge with nevro. He's very approachable and looks out for his fellows. The fellows here do an insane amount of stims and pumps and obviously bread and butter. Hours are long. Not much inpatient. Fellows work hard but it's worth it Bc the training you get. Be considered lucky to interview here. Cost of living is cheap. If you want academic job, this might not be the spot. 5-6 spots.
Kansas (9/10) - this program has only existed for 2 years, July 2017 will be its 3rd fellow class. Dr Dawood Sayed is unbelievable. He is the next big guy in pain medicine. He does the latest procedure and keeps up with all the new things that are coming out. Many of the procedures he does aren't being done at most places around the country. Great exposure. 7 faculty, all trained at big name places like MGH, ucla, Sloan Kettering. No or minimal inpatient service. Great hours. Only downside is that it's not very academic and doesn't have the big name like Brigham. Obviously cheap housing in KC is a plus. Consider yourself lucky to get an interview invite. I met 4 people on the trial who all ranked this place above many big name programs. 2 spots.
Rush (6/10)- you will be a well trained pain physician after completing this program, but it will be a tough year. The exposure is impressive and the number of interventions is close to Brigham, Kansas, and Wake Forest. The major downside is the acute pain coverage; nonstop pages throughout the night whenever you cover the service. One fellow told me the faculty are not friendly to fellows. Pain community knows that this place will train you well. You will be ready for a career in private practice. Only reason I gave it a 6 is because the hours are long. 4 spots.
Vanderbilt (8/10) - new PD took over a year or 2 ago; young guy. Fellows are all happy. Well trained. Most fellows usually stay regional after they finish. They do not participate in ERAS, so you need to fill out a separate application. Lots of bread and butter and good amount of stims. Work hours are not bad at all. Big name that will help you get a job anywhere in the country. Hard to get an interview here. 4 spots.
MDA (6/10) - this program has gone through some major changes over the past few years. New chairman, who is great but not as much of a forward thinker as he should be. Interventional numbers have come down drastically. I heard they lost a big interventional guy and might be losing someone else too. Not sure how this will change the program over the next 1-2 years. They still do quite a few kyphos. You will be a great academic clinician and they strongly push for research and academic projects. There was talks about hiring on some of last years fellows as staff, not sure if that happened or not. If you are interested in cancer pain and having a cancer pain practice, then this is the place. But in terms of bread and butter stuff, you only do 1-2 months of private practice rotation to get your numbers. 6 spots.
Cornell Tri Institutional (7/10) - probably best program in NYC. Great for cancer pain. The PD is a great guy and cares about his fellows. He's active in ASRA as well. Tons of interventions. The hours aren't terrible. National recognition. Good alumni network both in academic and private practice.
UCSD (8/10) - UCSD is probably the most interventional and greatest exposure in Cali. Dr Wallace is a guru in pain medicine and he's the chair of the department. They do lots of nevro and stem cell treatments and other cutting edge stuff. the fellows are very happy. Who wouldn't be though, they live in San Diego. All the faculty are fantastic and genuinely love to work there. 5 spots. If you want to stay in the west coast, this place is the place to be. 5 spots.
To me, these are most of the top programs in the country; probably left out a few.
I had so many questions about programs when I applied, so I hope this helps. Good luck.
As someone who recently finished the interview season, paintobe is spot on with his/her assessment of the programs...specifically Wake, Scott & White, MDA, and Kansas where I had almost the exact same impression and review. I wish I would've had this information when I applied. It's unfortunate that MDA, Vanderbilt, and Brigham won't play the ERAS game by maintaining their own separate application that heavily mirrors the ERAS one. Almost begs the question why?! Good luck to next year's applicants.
Case Western is almost purely interventional and high-volume. CCF is also on the high-volume end, but probably much more comprehensive in terms of other treatment modalities. You can PM me for a more personal opinion, as I interviewed at both this year.any thoughts on the Cleveland programs?
I have to say, many applicants including myself were left puzzled by the interview at BWH this year, and this includes other Harvard residents. Being a large prestigious institution does not convey the privilege of rushing the interview process, which it very honestly was. MGH, Stanford and CCF are just as prestigious but held structured and more timely interview sessions, including comprehensive information about the actual program. My two cents.MDA has a centralized electronic system for most of their training programs. It makes it easier for their hospital as a whole to organize applicants. So they have no incentive to change. I didn't apply to Vanderbilt so not sure what their deal is. Brigham and Women's Hospital is probably the best program in the country with a remarkable training program and pretty much has pick of the litter in the match. They can do whatever the hell they want and applicants will still flock to their program.
any thoughts on the Cleveland programs?
Stanford and U Wash have strong leadership and clinic volume, but sit low on the interventional volume spectrum. I don't see much point in postponing work as a physician to attend a low volume program.
I actually disagree that name doesn't matter. From what I can tell pain medicine is a tiny field and employers do ask where you went to fellowship and form conclusions about your skills pretty quickly.
In the past few years MCW has become an excellent pain program. The fellows receive lots of procedural training from dedicated faculty at the pain center and from instructors at the private practice right next door. Leadership is down to earth and passionate about pain training, and treat you like respected colleagues. Dr. Hurley is a leader in the field along with Dr. Adams. Fellows were happy there. They are one of the few programs that incorporates peds pain training as well. I ranked it quite high last cycle.
Now that interview season is pretty much over, what'd everyone think of the top tier programs? Eg. BWH, MGH, MDA, CCF, etc., etc., etc.
Anyone willing to post their reviews? Is Brigham & Women's still holding it down at the top? Any new surprise programs that people should consider like S&W in the past few years? Any top programs that have become underwhelming?
Post away so we can help the rising/upcoming generations with good info.
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No offense, but does it really matter which programs are the best, besides bragging rights?
No offense, but does it really matter which programs are the best, besides bragging rights?
All these programs and many more will provide a fellow with the training they need to be a great pain doctor.
Where one trains had nothing to do with running a successful pain clinic or being a good doctor.
Looks like someone didn't get into one of these programs... Haha just kidding.
To answer your question, in a forum thread entitled Pain Fellowship Reviews, yes I think it does matter. The goal of this thread is to specifically discuss the differences of each program, to help people obtain information when applying or before ranking, and to see if there are any nuances to a program that better fit for your career goals.
To say it is not worth discussing it in a thread like this is to say every program is the same. And they are clearly not, IMO. In such a thread, a post like yours is just unproductive.
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Any info on the 2 programs in Detroit, Henry Ford Hospital and Wayne State? Could not find any recent posts about either program.
So glad to be done and matched! Compared with residency, I found it much harder to rank things (At one point my number 9 was ranked second). A lot of programs are quite good but each have some their own little drawbacks. Things that I ultimately ended up factoring as important was amount of time you get per patient in clinic (don't want too fast or too slow), procedural experience, didactics, and location.
Mayo Jacksonville
- Interviewed 11 for 1 spot
- High numbers of stims, kyphoplasty, ultrasound guided procedures in addition to B&B
- Have an ultrasound guru who you work with regularly
- Only one fellow, so didactics are just 1:1 with attending.
- Pain is its own department, so it is not dependent on anesthesia or pm&r support
- Has Pain rehab program
- Multidisciplinary (PM&R x 2, Chair is Anesthesia, soon to be PD is Neuro)
- Get to go to mayo courses at beginning & middle of year
- Call one weekend every 4-5 weeks, typically only go in for a few hours and see ~4 patients)
- 1 hour new, 30 minute follow ups
- Cheap cost of living, few miles from beach, mayo pays tons if you present at conferences
Mayo Arizona
- Interviewed ~20 for 2 spots
- 2 fellows, so limited didactics
- PD is PM&R, others are anesthesia (many work just a day or two of pain, rest general anesthesia)
- Get ~40 stims and spend 1 month doing cancer pain with one of the biggest pump implanters in US, typically more than 20
- One month of private practice mostly doing procedures (very high volume, 25-35/day)
- Less ultrasound compared to Mayo Jacksonville, but still do basic stuff exposure
- Call is just starting this year, will be done weekly from home with a couple hours on weekends, get a post call day afterwards.
- Get to go to mayo course at middle of year
BIDMC
- Strong daily didactic schedule, mostly by attendings
- ~10-20 stims, 1-2 pumps, 1 kypho
- Very friendly people
- Compared to BWH (incredibly interventional) and MGH (lower on interventions), seemd like a nice balance
- If interested in research, they have a statistician
- Most attendings seemed to train at BIDMC and stick around (good cus they liked it, bad cus they are more likely to do things the same way)
- Call is 1 week of inpatient consults, sounds like it was actually chiller than their regular days.
- Harvard name carries weight and they have a lot of fellows
- Interview a lot of people, considering they end up having ~1/2 of fellows from BIDMC anesthesiology residency.
UT San Antonio (UTHSCSA)
- Great balanced daily didactic schedule with different focus each day (journal club, radiology/US review, pain topics, etc)
- Good procedure numbers >1000+ case logs, ~25-35+ stims, lots of ultrasound guided procedures, a couple pumps, opportunity for botox for spasticity and a small number of EMG's. Most big procedures done at the VA. No kyphoplasty but might be able to seek it out.
- Clinic sees ~8-12 patients/day, although tends to get run slow so it backs up at end of day.
- 1 month private practice exposure, 2 months VA (Get most high level procedures here)
- Cost of living is ridiculously cheap and you can moonlight as both anesthesia and PM&R. City really spread out.
- Sees mostly medicaid patients, which can be rough.
- Most fellows seemed to stick around Texas, and most attendings seemed to have trained at San Antonio.
Oregon Health & Science University (OHSU)
- Some of the nicest and most polite attendings I met anywhere. Then again, everyone seemed nice in the city so that may just be the culture.
- Interview on 1-2 people/day and only 18 for 3 spots (may add additional fellow)
- 4 months at VA (each day split into different subspecialty, more B&B), 2-3 weeks doing acute pain (start year with this), other 7+ months at pain clinic
- Only big academic center in Oregon, pain department rapidly expanding in size with new $1B cancer center going up.
- Great procedural volume for B&B and complex procedures - current fellow had ~4-6 stims, one pump, and 2-3 celiac plexus blocks in roughly 6-7 weeks since starting in clinic. Ultrasound guided procedural volume not quite as high as other volume.
- Call goes 1 week at a time for 11 total weeks - typically just round for a few hours on weekends, cover any issues that come up weekdays. No separate regional service, so unfortunately you have to cover those catheters as well. Average 3-4 pages average/night. Heard that sometimes attendings will take pager from you for a night.
- Most attendings have patients scheduled 1 hour for news, 30 minutes for follow ups, giving plenty of time to learn. Occasionally, when work with PD you hustle more and it runs like a busy private practice.
- Portland is awesome (great food, great people) and the hospital is right next to downtown. One of the few west coast cities where you don't need a car to get around. Does rain a ton in the winter.
- Despite having only a few fellows, had a pretty good didactic schedule with weekly pain lecture + a variety of other lectures intermixed which run monthly (eg journal club, spine conference, etc)
- Good exposure to alternative medicine and research in the area.
- Vacation able to be taken 1 day at a time (big plus)
Colorado
- Three tracks (Ped's, Anes, & PM&R) which are very different.
- Interviewed 11 PM&R and 4 anesthesia for an anesthesia spot, ped's spot, and PM&R spot.
- PM&R spot is basically a really well developed sports and spine fellowship, which is also ACGME accredited and gets you the basics you need for pain.
- Get superb ultrasound exposure, plenty of bread & butter spine, regenerative medicine, EMG's if you want
- Can tailor it slightly to what you want. In PM&R track, probably wouldn't get any stims/pumps/craniofacial blocks or cancer pain procedures since your really seeing a different population.
- PM&R call is actually just sports team coverage.
- If you're PM&R, looking to end up at an ortho practice after fellowship, and are considering some of the non-accredited spine or sports fellowships, this is probably the perfect place to go.
Emory
- Interviewed ~36 for 6 spots
- Six 2 month rotations (VA, outpatient Ortho/PM&R clinic, Grady, Emory, Midtown)
- Great procedural experience ~20 stims, 10 kyphoplasty, variety of other rare blocks, reasonable ultrasound exposure.
- ~15-20 patients scheduled/day
- Call is 1 weekend every 6 weeks and then a few other weekdays. Have to cover some regional pain, which means likely few more calls but rarely needing to go in.
- Atlanta is cool & affordable, but traffic sucks and there are a lot of sites so you can't just live next to one to avoid a commute.
- On lecture days, starts early (6:45) and you have to phone in if you are at another site. Do mostly active learning, 2-3 lectures/week, which is reduced around primary specialty boards to give people a chance to study.
- They bring some of their own courses (eg kyphoplasty course), but you can't go to the pharm rep courses unless you pay for it yourself (really sucks, considering no other places ran into this issue)
- PD is awesome and really working on trying to perpetually improve the program, which means that it will keep getting better.
UCSD
Interviewed 38 for 4 spots (5th spot saved for research fellow)
- PD presentation was probably the best of the entire interview trail. If other PD's are looking for what information to include in a presentation about their fellowship, they should talk to him since it was the best 20 minutes on the trail by far.
- Case logs > 1000, ~20 stims, 2-3 pumps. One of the few places with regenerative medicine opportunities and also medical marijuana prescribing. Unfortunately, seems like they only do interlaminar ESI's ~99% of the time
- Weeks are divided into all procedures or all clinic
- Call 1/5 weeks. Have to come in early in the morning to round and then see consults sometimes after clinic and cover overnight issues. Twice a week you have to drive all the way into downtown in traffic to see consults @ Hillcrest.
- Busy Clinics (30 minutes for news, 15 minutes for follow ups)
- Limited Didactics Wednesday 6:30-7:30 followed by interdisciplinary conference from 7:30-8:30. They do have you take a graduate level basic science course on pain, which lasts 9 weeks.
- Opportunity to do a research year outside the match first, which then guarantees you a spot the following year.
BWH
Interviewed roughly 45 for 8 spots
- Ridiculous case logs for every type of procedure. They do almost every pump in New England. Spend 1 month working like a surgical service doing peripheral & spinal cord stims, pumps, celiac blocks, etc with 4-5 big implant cases a day. If you are all about doing the heavy duty interventions, then this is the place to train. Heavy emphasis on interlaminar rather than transforaminal ESI's, but since the volume is so high fellows probably feel comfortable doing both by the end.
- Good exposure to experts in all types of pain (cancer, spine, psych, neuro, pelvic)
- Typical day is from 7-430, but seems to be busy when you are there.
- Clinic seemed way too busy, with up to 40 patient's sometimes being seen. Don't have as much time to discuss cases since you have to hustle. Also, they are talking about further expanding their volume which already seems to be at its limit.
- Daily didactics. Heard that 1/2 are good, but 1/2 are given by residents or fellows which can sometimes end up people reading recycled slides.
- Call previously was brutal since they used to have to write all PCA orders. They recently stopped that which will improve it significantly. However will probably still be a bit busier than other places that have lower volume, since they cover any pump malfunction within 100's of miles and they have a set of patients who are covered by the inpatient service.
- Well respected name in both PP and academics.
UC Davis
Interviewed 60 for 6 spots
- Weird interview day where they used multiple mini interviews (hypothetical cases). Even though the cases only lasted about 2-3 minutes, they would then just have you read magazines or stare off into space for the other 7 . Made it really hard to figure out if you could get along with attendings 1 on 1 since you didn't really interact with them 1 on 1. They seemed nice, but it was really hard to tell from the interview.
- Really strong didactics 1-2x's/day which seems to really prepare you well. Working on getting a high tech simulator so they can practice interventions.
- Clinic days patients are scheduled 1/hour (8/day), so get plenty of education on each patient, but might have some difficulty transitioning to a busy private practice.
- Despite how low volume clinic is, procedural volume is reasonable.
- Procedures ~5-12 stims, 1-2 pumps, tons of bread and butter, good ultrasound exposure with PD and some of the PM&R docs
- Call is chill where you cover inpatient consults. Hardly ever get called after 5.
West LA VA/ UCLA PM&R
- 6 months at VA, 3 months at UCLA Spine Center with Dr. Fish, 3 months with Dr. Prager in private practice
- VA days you come in, round on all inpatients who receive opioids and make pain rec's, then start your day. Get a few 1/2 days for admin time to make up the notes during the week. Rest of time is split between clinic and procedures.
- UCLA spine Center is a little busier, get to do EMG's there
- Private practice you just do clinic and then observe any procedures (patient's pay cash). This is probably the biggest downside of the fellowship.
- Good bread and butter, ultrasound, and EMG experience. Sounded like ~15 stim implants and corresponding number of trials split 4 ways over the year.
- Attendings are really fun, love joking around.
- LA weather is unbeatable, but you might not get to enjoy it cus you will be stuck in traffic all the time.
Cook County
- 1/4 weeks do acute pain and cover all call related to it. Per fellows and attendings, can be really busy and brutal.
- 2 months of daily lectures covering oral anesthesia board prep in the spring. As a physiatrist I have no idea how this would help me and sounds like a colossal waste of time.
- Typical day 8-4:30
- Attendings pimped during interview on how to do procedures.
- Was told by attending that no-one who graduates from program goes into academics unless they had a PhD.
- Because its county system, rarely do and stims or pumps (only a couple the whole year), patient population is very challenging and with limited resources.
- Didn't really feel safe walking around at night in the area around the hospital.
- If you want to do a hybrid of acute pain and chronic pain or general anesthesia plus some chronic pain, this might be reasonable. It didn't really match what I was looking for.
Yup. 331 out of 437 matched. 75.7%. 4 positions were unfilled.75% match rate this year? Is that official?
Yup. 331 out of 437 matched. 75.7%. 4 positions were unfilled.
It's on NRMP. Once you login click options -> reports -> match result statisticsI’ve been looking for an official report but haven’t been able to find one. Where’d you get the data from?
I would think a lot about what your plan is afterwards. Sure it's fun to do the more complex stuff like pumps and SC stims - but I wouldn't want to do these out in private practice. If they get a wound infection, you don't want to be admitting this patient. If you plan to be hospital staff, then it's fine. You probably have residents/fellows to help you out.Anyone currently applying? Care to discuss various programs?