Anyone have any information on programs in Texas? Particularly UTSW
Can't comment on UTSW but here is a review of the program I graduated from in Texas:
I have been a long time lurker on SDN and used information found here to help me during my
pain fellowship interview process. I know that during each interview cycle there is a lot
of discussion about the best fellowship programs in the country and I am most certain
that Baylor Scott and White deserves to be in that conversation. Being that I graduated
4 months ago, I can give a very up to date review.
The program was established in 2012 but came out the gates as a well-oiled running
machine. It is located in Temple, Texas. Temple is a small town, however, it is
approximately 45 minutes north of Austin and 30 minutes south of Waco (town of Chip
and Joanna Gaines). Temple was a great place for my family. There is no traffic and the
communities are incredibly safe. There are multiple nice homes and apartments close to
the hospital. My drive to the Temple pain clinic was about 7 minutes. There are several
parks and playgrounds to explore including splash pads and water parks. There are 2
lakes very close by which offer excellent opportunities for fishing. Additionally, I found
that the community there was very close as most people there work at the hospital or
are in the military. Although the city's population is only about 75,000, the hospital is still
a busy fully staffed multi-specialty academic Level I trauma center hospital and it serves
an enormous portion of central Texas. Baylor Scott & White is the largest non-profit
healthcare system in Texas, so you can imagine that there will be plenty of patient
volume at this fellowship. However, you will not feel overworked here and you are not
treated as a scut monkey. Ancillary staff and residents/students respect you as a fellow
and understand you have completed a residency already. Two of the former fellows
have even completed two residencies.
The Temple pain clinic is busy in itself, and the amazing thing is that many of the
patients are seen that day and their procedure is done immediately that same day also.
What better way to learn then see the patient, do the H&P, and immediately inject
the patient afterwards? Also there are several external Baylor Scott & White pain clinics
in surrounding cities that send in many of the more advanced or rarer procedures for the
fellows to do (SCS trials/implants, vertebroplasty, celiac plexus blocks, trigeminal
blocks, etc). As stated earlier, you will not feel overworked here and you will flourish on
the camaraderie and teamwork approach while in a very enjoyable, educational
environment. There are also NPs and anesthesia residents who will help see the clinic
patients, but they do NOT do the procedures unless the fellow does not want to do it.
Then the residents or attending get to do the procedure. NPs do not do any procedures
and setup patients for procedures and/or do medication management. Every procedure
is attending-supervised with the staff being in the room while you are driving the needle
and doing the entire injection. You are not just thrown in. The majority of procedures are
done standard under fluoroscopy, and the remaining are done by ultrasound or
anatomic landmark guidance.
Regarding the program itself, they take 2 fellows per academic year (July-June). It is a
highly competitive selection process, and to date, the program has taken their top two
candidates every single year. They only interview one day per year. Here are some of
the other major highlights to the program:
1. Procedural volume is second to none. On a year when we were still dealing with the
effects of COVID-19, my co-fellow and I performed over 90 spinal cord stimulator cases
(including trials and implants). Both you and your co-fellow are scrubbed into each case
even when on off-service rotations. We also performed over 10 vertebroplasties. Prior to
COVID, the average number of SCS cases for the fellows were ~100-125/year and ~25
vertebroplasties/year. During my year, we were able to get hospital approval and
privileges to perform MILD, vertiflex, and Intracept. I got to do about 3-4 MILDs but
unfortunately no vertiflex or Intracept. However, the current fellows have already done
some Vertiflex. Overall, I would describe this program as highly interventional with high
volume. On average, there were approximately 30-40 procedures to be completed per
clinic day. You will be very VERY comfortable performing ESIs, MBB/RFAs, major joint
injections, sympathetic blocks, and all other bread and butter procedures. Intrathecal
pumps are implanted by the chair of Neurosurgery, and he is incredibly kind and will
notify the fellows in advance and we scrub in with him in the OR. Pumps are managed
later by an outside private group of pain physicians. As with all pain fellowships, we do
learn medical management as well. However, the clinic and procedural-mindset is much
geared towards a private practice setting with more focus on interventions and less
focus on medical management.
2. Lifestyle is phenomenal. Clinic starts at 7am and ends (on average) before 4pm each
day. Fridays are usually half days so you get to start the weekend off early. NO CALL.
Yes, no call. There is no inpatient chronic pain service. If there is a surgical
complication, the on-call anesthesiology resident will be the first notified and then they
would reach out to us, fellows. I would then discuss with the resident the plan. Over the
course of a full year this happened approximately twice. You do not work weekends or
holidays. Years ago, there was a regular opportunity to work one half day on Saturday
per month but you would get moonlighting pay during this. That only happened once my
year. Moonlighting opportunities are excellent and 100% optional as an in-house
anesthesia staff at the ambulatory surgical center (ASC). The pain clinic is actually
housed in the same building as the ASC and physically about 50 feet from the ASC.
The ORs that you staff are with senior anesthesia residents or seasoned CRNAs. So
basically you are completing your pain charts after clinic ends while getting paid as
anesthesia staff.
3. Culture at BSW is great. This was one of the biggest reasons I ranked it #1. I have
been in Florida all my life including medical school and Anesthesiology residency, but I
still wanted to be here. The night before the interview, all the applicants are welcomed
to a relaxed and unpressured dinner at the PD’s home. Incredibly, one (if not both) of
the fellows from every prior year come back to meet the applicants. It felt like a
family. The dedication and care that the prior fellows have for the program is unlike any
other fellowship out there. The culture in the clinic is great too. The NPs, nurses, and
techs make the work there a lot of fun. Tons of smiling and teamwork, but serious
education and treatment during times of patient care.
4. Rotations: the majority of the fellowship is spent at the Temple Clinic. However, we
do rotate at both the Waco and Killeen pain clinics for one month each. They each run
differently with their own pain attendings which is a great learning opportunity. They are
all run like a private practice. Very efficient and things move pretty quickly. On average
close to 100 patients will move through the clinic in a day.
5. Faculty are incredible. The Temple pain clinic is staffed by Dr. Chris Burnett, the PD,
and Dr. Rodney Lange. They are great to work with and very happy to teach. They are
very down to earth and caring attendings who strive for excellent patient care. There are
no malignant staff within the program or peripheral clinics.
I would say one weaknesses of the program are there is not a ton of research
opportunities. However, if you want to do research, the staff is more than happy to
support you and give you the time to do it. A prior pain fellow was able to get a paper
published in the international journal Neuromodulation. The other weakness would be a
decrease in variety of surgical procedures. For instance, they do not do SI fusions or
endoscopic decompression. However, with the amount of surgical volume you do with
other procedures helps you feel significantly more comfortable learning new techniques.
My co-fellow and I have already started doing other surgical procedures that we did not
do in fellowship without any issues.
Overall, this is a top-notch program with excellent procedural experience and superb
work-life balance. There are other programs known for their procedural volume but the
work-life balance does not compare to BSW. I would go there again for training without
a doubt. I feel that I learned in 12 months here what it would take 2-5 years of fellowship
elsewhere. 4 months out, I feel very comfortable evaluating patients and performing all
types of procedures.
Here is a list of the prior Anesthesiology residencies from which the two fellows came
from. No preference is given to internal applicants. Fellows are chosen based upon their
application, merit, and desire to become the best pain physician possible.
2012-2013 Both from Baylor Scott & White
2013-2014 Both from Baylor Scott & White
2014-2015 University of Texas Medical Branch (Galveston), Baylor Scott & White
2015-2016 University of Oklahoma, Baylor Scott & White
2016-2017 University of Alabama at Birmingham, Baylor Scott & White
2017-2018 University of Alabama at Birmingham, Baylor Scott & White
2018-2019 University of Kentucky, Baylor Scott & White
2019-2020 University of Alabama at Birmingham, Baylor Scott & White
2020-2021 University of Florida, University of Mississippi
2021-2022 University of Oklahoma, Baylor Scott & White
2022-2023 Baylor College of Medicine, Mount Sinai Icahn School of Medicine