2025/02/27 by Meredith Barad, Pamela Flood, Sajan Shah · 1 voice
Medicine · Psychology · #Anesthesia and Pain Management #Music Therapy and Health #Pain Management and Opioid Use
paper · doi:10.1097/01.asm.0001108680.54480.1b
openalex publication_date 2025/02/27 · openalex created_date 2025/02/28 · openalex updated_date 2026/07/23
In March, we start reading fellowship applications from young, eager residents interested in pain medicine. Their personal statements speak to the satisfaction derived from patient interaction and alleviating pain. They often mention the progress the field is making and how excited they would be as a part of it.In the past few years, we have seen a decline in the number of residents pursuing fellowship training in pain medicine. Sadly, all fellowships to which anesthesiologists may apply have seen a decline in applications. The starting salary for anesthesiologists is difficult to pass up for many graduates, who are often saddled with huge educational debts. Given the financial incentives for recently minted anesthesiologists to proceed directly into the OR, why would any resident consider a future in pain medicine? We asked our colleagues at the Association of Pain Program Directors for an overview of what motivates and excites them and the incoming pain medicine fellows. Prentis Lawson, MD, Program Director at the University of Alabama, suggested this taxonomy: Autonomy and expertise: Anesthesiology residents often discover that routine OR anesthesia can become “formulaic” (a more polite word than “boring”). Pain medicine is exactly the opposite. Patients present with complex pain conditions that confound their primary care providers. Pain medicine consultants scrutinize extensive medical and surgical histories, conduct detailed physical examinations, and order laboratory tests and state-of-the-art imaging to identify the biological and psychosocial underpinnings of each patient's pain. They tailor treatments that combine medical management, procedural interventions, and psychological strategies to restore patient well-being. Cindy Chai, MD, Program Director at UCSF, wrote, “No two patients are exactly alike, and each case presents an opportunity to draw on my medical knowledge and to think creatively to develop personalized treatment plans. There's a constant need for innovation and collaboration in pain medicine, which keeps the work intellectually stimulating.” Long-term relationships: Long-term patient relationships are rewarding. Pain management is one of the few career trajectories for anesthesiologists that offers the ability to witness and contribute to a patient's long-term journey toward better health and improved quality of life. Scott Pritzlaff, MD, Program Director at UC Davis, wrote, “My military experience as a Navy physician exposed me to significant trauma and injuries, but also to the incredible resilience of the human spirit, which inspired me to pursue a career in pain medicine. As a pain physician, I have the privilege of helping patients regain their quality of life and function. It is deeply rewarding to guide individuals through their challenges and see the positive changes that thoughtful, compassionate care can bring to their lives.” Comprehensive, multidisciplinary care: Pain medicine equips providers with a diverse toolbox of care options, combining procedural interventions, medications, and behavioral strategies. This holistic approach ensures that care is patient-centered and effective. Kristen Noon, MD, Program Director at The Ohio State University, noted that for her, pain management has been the perfect intersection of her multiple areas of interest: anesthesiology, neurology, psychology, and musculoskeletal biology. Combined knowledge from these diverse fields has been a powerful tool in her pain practice. Lynn Kohan, MD, Program Director at the University of Virginia, wrote that pain medicine is a “best of everything” job that combined patient continuity with the ability to offer comprehensive care. The reward was improving patients' lives through a combination of pharmacology, behavioral interventions, procedural interventions, and surgery. A dynamic and evolving field: Pain medicine continues to have enormous unmet medical needs, making the field fertile for innovation and progress. Those drawn to the cutting edge of medicine will find opportunities for basic, bench, animal, and clinical research, as well as professional growth and academic advancement that explores new ways to alleviate suffering. Dr. Kohan wrote that “the field is expanding rapidly, ensuring numerous treatment options for a vast array of patient conditions. Still, there is much we have left to discover, providing an opportunity for continued intellectual curiosity and stimulation.” Trent Emerick, MD, FASA, Program Director at the University of Pittsburgh Medical Center, built on this innovative spirit, noting that “with the ongoing opioid crisis, there is opportunity for medical devices to be developed in the pain space. I really enjoy the prospect of taking an idea and developing it into a prototype and rigorously testing it and experimenting on it to try to help future patients with chronic pain.” Pharmaceutical and biotechnology companies have introduced a panoply of novel drugs and devices over the past five years. However, there is also a need for practicing clinicians to turn their clever ideas into therapeutic advances. The Innovation Challenge, started two years ago by the American Academy of Pain Medicine, allows small companies started by young doctors, engineers, and even patients to pitch their idea to potential investors and industry leaders who may be interested in bringing a product to market. A patient who seemed to have run out of options two years ago can have continual hope for an innovation that may bring relief. Flexibility and balance: Pain medicine allows for a balance between clinical care, research, academia, and personal life, making it a sustainable career. The balance between clinic days and procedure days keeps life interesting and prevents boredom. One of the authors here (PF) chose a mid-career fellowship, her third, to supplement her basic science training with the opportunities for transitional research in pain medicine. Thelma Wright, MD, JD, MBA, FASA, Program Director at the University of Maryland, noted that the flexibility of a pain practitioner's schedule has allowed for extracurricular activities such as getting a JD, an MBA, and starting a podcast. A calling to help others: Above all, Dr. Lawson noted, “My greatest joy comes from knowing that my work alleviates suffering and helps patients reclaim their lives.” Dr. Noon echoed this sentiment: “I derive great joy from the relationships I create with my patients. There is great satisfaction in seeing the relief we can provide to someone who had previously been suffering.” Alex Bautista, MD, FASA, Program Director at the University of Louisville, practices pain “for the smiles and the hugs that make it all worth it!” We cannot forget the joy of teaching fellows and the reward that comes from inspiring a young physician to pursue pain medicine. We asked one of our current fellows, Sajan Shah, MD, MBA, why he decided early in his residency to pursue fellowship training in pain medicine: “What drew me to pain medicine was the opportunity to work as a detective, uncovering the root causes of complex pain conditions through careful investigation and problem-solving. The intellectual challenge of diagnosing and treating these conditions is deeply rewarding, particularly when it leads to patients regaining their quality of life. The dynamic and evolving nature of the field continually pushes me to grow, while the privilege of forming long-term relationships with patients adds profound meaning to my work. Choosing pain medicine has also allowed me to cross over to the other side of the drapes – I am now able to utilize minimally invasive interventional techniques that bridge the gap between conservative therapies and more invasive surgeries, offering select patients transformative relief with reduced risk and recovery time.” Pain medicine is enormously rewarding. There are hassles. There is paperwork. There are insurance companies. Some patients are annoying. These aggravations pale in comparison with the rewards. Sometimes, your expertise and training can quench the fire of pain, restore function, and help patients regain their life. Other times, the fire burns, but you teach strategies to live fully despite the heat. Almost never do you throw up your hands and exclaim “I have nothing to offer.” Pain physicians guide patients past their suffering to fulfilling lives. Our goal as teachers is to similarly guide our fellows toward an anesthesiology specialty whose deep intellectual challenges are only matched by its deep rewards. Acknowledgement: We acknowledge the many contributions of the Association of Pain Program Directors to this article.Meredith Barad, MD, President, Association of Pain Program Directors, Clinical Associate Professor of Anesthesiology (Pain Medicine) and Neurology & Neurological Sciences, and Program Director, Pain Medicine Fellowship, Stanford Hospital and Clinics, Stanford, California.Pamela Flood, MD, MA, Adjunct Professor of Anesthesiology, Critical Care, and Pain Medicine, Stanford University, Stanford, California.Sajan Shah, MD, MBA, Fellow in Pain Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Stanford Health Care, Stanford, California.