The Current Scope of Pain Medicine Fellowships: A Cross-Sectional Survey Study of Trainees, Directors, and Employers on Shaping Future Leaders

Ugur Yener,1 Scott G Pritzlaff,2 Micheal E Schatman,3,4 Tahereh Naeimi,1 Charles E Argoff,5 Farshad Ahadian,6 Ellen WK Rosenquist,7 Corey W Hunter,1 Trent D Emerick,8 Hatice Begum Ciftci,1 Alan D Kaye,9 Yashar Eshraghi,10 Daniel J Pak,11 Soo Yeon Kim,12 Timothy R Deer,13 Naum Shaparin,14 Karina Gritsenko,14 Andrew G Kaufman,15 Chong H Kim,16 Peter S Staats,17 Maged Guirguis,18 William Caldwell,19 Timothy Furnish,20 Alexander Bautista,21 Neel Mehta,22 Catherine C Skae,23 Nalini Sehgal,24 Lynn R Kohan,25 Magdalena Anitescu,26 Sayed E Wahezi1 1Department of Physical Medicine 2Department of Anesthesiology and Pain Medicine, University of California, Davis, CA, USA; 3Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 4Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA; 5Department of Neurology, Albany Medical Center, Albany, NY, USA; 6Department of Anesthesiology, Center for Pain and Palliative Medicine, University of California, San Diego Medical Center, San Diego, CA, USA; 7Departments of Pain Management and Pediatric Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA; 8Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; 9Department of Anesthesia, Louisiana State University School of Medicine, Shreveport, LA, USA; 10Department of Anesthesia, Ochsner Medical Health Center, New Orleans, LA, USA; 11Chronic Pain Division, the University of Texas Health Science Center, Houston, TX, USA; 12Pain Medicine and Interventional Spine, Mount Sinai Health System, Icahn School of Medicine, New York, NY, USA; 13The Spine and Nerve Center of the Virginias, West Virginia University Hospitals, Charleston, WV, USA; 14Department of Anesthesiology, Montefiore Medical Center, Bronx, NY, USA; 15Comprehensive Pain Center, Rutgers New Jersey Medical School, Newark, NJ, USA; 16MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, OH, USA; 17National Spine and Pain Centers, Atlantic Beach, FL, USA; 18Interventional Pain Management Department, Ochsner Health System, New Orleans, LA, USA; 19Department of Anesthesiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA; 20Department of Anesthesiology, University of California San Diego, San Diego, CA, USA; 21Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA; 22Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; 23Senior Vice President and Senior Associate Dean for GME, and Designated Institutional Official, Montefiore Medical Center, Bronx, NY, USA; 24Department of Orthopedics 25Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA; 26Department of Anesthesia and Critical Care Medicine, University of Chicago Medicine, Chicago, IL, USACorrespondence: Sayed E Wahezi, Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, 1250 Waters Place, Tower 2, 8th Floor, Bronx, NY, 10461, USA, Tel +1 (718) 920 7246, Fax +1 (929) 263 3950, Email swahezi@montefiore.orgIntroduction: Since the establishment of Pain Medicine (PM) as an ACGME-recognized subspecialty in 1992, the field has undergone significant transformation. These changes brought increasing diversity in applicants` primary specialties, and the introduction of a myriad of emerging treatment paradigms. In this study, we aimed to evaluate the expectations, experiences, and perspectives of three target groups–PM trainees, program directors (PDs), and employers–to guide the evolution of PM education.Methods: This study employed an integrated survey approach to comprehensively evaluate PM fellowship training. Surveys were distributed through professional societies, verified forums, and direct outreach over separate 3-month periods in 2023 for PD and trainee surveys and in 2024 for the employer survey. A total of 518 respondents across PDs, employers, and trainees completed surveys; overall response rate was indeterminable due to unknown denominators, while the PD survey response rate was 69.0%.Results: The survey findings highlighted both shared and unique perspectives among the stakeholder groups. Trainees emphasized procedural volume and diversity as critical motivators for fellowship selection. Despite this focus, 70% of trainees expressed reluctance toward extending their fellowship duration, with 50% of trainees favored private practice. PDs acknowledged variability in training quality and emphasized the importance of supplemental workshops to address procedural gaps. Vast majority of PDs supported extending the fellowship duration to mitigate reliance on industry-led supplemental education. Employers underscored significant deficiencies in graduates’ preparedness for independent practice, with only 7% considering fellows adequately trained under the current model. Across all groups, there was a consensus on the need for curriculum standardization and enhanced training to align with the growing complexity of PM.Conclusion: This study suggests that the one-year fellowship can be re-evaluated for adequacy in preparing physicians for independent practice, particularly in advanced procedures. Alternative training pathways offer additional exposure but vary in structure and oversight.Keywords: graduate medical education, pain education, multidisciplinary, chronic pain, pain medicine, fellows