Scope of the Pain Problem
Pain is our body’s reaction to an insult and can be expressed in many ways through psychosocial and genetic variability. Early in the 21st century, we have seen major changes in the perspectives and approaches to pain treatments. Chronic pain has taken its toll on patients, their families and friends, and on the US healthcare system. Healthcare costs linked to chronic pain amounts to over 100 billion dollars annually. Pain is the primary reason for a visit to the doctor. In fact, pain is responsible for 40 million physician visits each year. It is also responsible for 515 million lost work days each year. Chronic low back pain (CLBP) is the most common musculoskeletal ailment in the world. Globally, CLBP is also the leading cause of functional limitations and absenteeism, resulting in substantial disease and economic burden to patients and society.
The average chronic pain patient has undergone 3 major surgeries and has suffered for approximately 7 years before their first visit to a pain medicine clinic. Additionally, opioid epidemics have caused incomprehensible damage to our society, causing 47,600 deaths in 2017. These numbers have improved over the last several years, through increased awareness and changes in practice. Pain management improves not only the quality of life, but also the health and well-being for patients.
The Department of Anesthesiology at the Zucker School of Medicine at Hofstra/Northwell recognizes the needs and benefits for a robust multidisciplinary graduate medical education for residents and fellows in pain medicine. As part of its mission to provide the highest quality pain treatments for patients, the Department of Anesthesiology at the Zucker School of Medicine at Hofstra/Northwell and The Spine and Pain Institute of New York have joined to form the Northwell/SPNY Pain Medicine Fellowship.
Sponsoring graduate medical education together in the field of pain medicine not only furthers our joint mission to the provision of premier care, but also responds to community needs and assures future generations of healthcare professionals, whom are critical in continuing to deliver top quality healthcare to communities and beyond.
The Zucker School of Medicine at Hofstra/Northwell and SPNY are committed to education and research in the field of pain medicine. Through a highly educational multidisciplinary program, the Northwell/SPNY Pain Medicine Fellowship will strive to deliver the highest quality education and training to produce professionals who will not only be prepared to treat complex pain patients, but also become leaders in the field of pain medicine.
The Zucker School of Medicine at Hofstra/Northwell is committed to providing educational, financial, and human resources to support the Northwell/SPNY Pain Medicine Fellowship, and to excellence in its graduate medical education program and the care of patients.
The Northwell/SPNY Pain Medicine Fellowship commits itself to the provision of an organized multidisciplinary education and training program in which residents and fellows develop personal, clinical, and professional competence under careful faculty guidance and supervision.
We are committed to delivering a patient-centric, encompassing approach in our education in treating patients in pain. Each fellow’s growth and development as a pain physician will be tailored to their level of progression, and the delegation of responsibility will be consistent with each physician’s clinical experience, knowledge, and skill.
The Northwell/SPNY Pain Fellowship commits itself to the provision of a scholarly environment. The faculty will engage in scholarly activities, including research, which will made available to residents and fellows. Opportunities to participate in and learn from the scholarship of the faculty and the medical community will be provided.
We further commit to providing opportunities for dedicated and competent professionals to be part of the teaching faculty. Members of the teaching faculty will be appointed by the Program Director, Kiran V. Patel, MD and the Director of Education and Research, Kenneth B. Chapman, MD. These individuals will be selected for their professional ability and commitment to teaching, medical education, patient care, and the scientific and humanistic basis of medicine.
The Division of Pain Medicine will strive to ensure that its educational and training program will meet or exceed all special requirements promulgated by the Accreditation Council for Graduate Medical Education (ACGME) and its Residency Review Committee.
Through a properly structured and closely monitored/evaluated multidisciplinary education and training program of carefully selected residents, the Northwell/SPNY Pain Fellowship will improve the provision of quality care, and the relationships between pain medicine providers and their patients and families. Additionally, the presence of high-quality educational programs in pain medicine will increase recruitment and retention of high-quality professionals interested in improving care and delivery of pain medicine. The Pain Medicine Graduate Medical Education program provides a firm basis and plays an integral part in the ability of the Department of Anesthesiology at the Zucker School of Medicine at Hofstra/Northwell to meet and further its purposes consistent with the philosophy, mission, and goals of the institution.
The Pain Medicine Fellowship begins with an intensive didactic program to prepare the fellow with basic knowledge on anatomy, pain syndromes, conservative treatments, and interventional procedures. The lecture schedule and assigned reading will be distributed by the program director and will be expected to be reviewed prior to lectures.
As fellows, you may be assigned to different offices or hospitals. In those cases, teleconference will be utilized for those at outside locations for lectures. Mandatory, in-person meetings will also take place monthly for journal club, fellow presentations, etc at locations TBD. The first two months are geared toward understanding high yield topics in pain medicine. The topics outlined in the ABA and IASP curriculum will be covered throughout the year.
Pain Fellow lectures are scheduled 1-2 times per week throughout their fellowship.
Sample weekly lecture topics:
Additional education activities:
Our goal is to provide the best didactic lecture series available. In addition to our clinical faculty we frequently have distinguished guest lecturers to review topics in their area of expertise. Our goal is to not only prepare you to be successful after fellowship, but to assure you have the educational foundation necessary to pass your pain management board exams.
Outpatient Clinics/ OR time
Fellows assigned to the outpatient pain management offices will have daily schedules which will be assigned prior to the beginning of the month. Starting and end times fluctuate daily but typically start between 8-9 am and end between 5-6 pm. It is your responsibility to check your schedule for assigned daily start times.
If you are assigned with a physician who is operating, start times depend on the times allotted to the physician from the hospital or ambulatory surgical center. Surgical time typically starts earlier than office hours as they are dependent on block times and availability. A significant portion of your surgical experience will take place at Richmond Pain Management Ambulatory Surgical Center, which is a Northwell ASC that is adjacent to the office on 1360 Hylan Boulevard, SI NY. At minimum, you will be expected to review the patient’s history beforehand and understand why the particular therapy was chosen for the patient.
For neuromodulation cases the patient’s history and physical must be thoroughly documented prior to the intervention. Ensuring patient understanding, basic device management, answering questions, and setting expectations of the procedure are done during normal clinic hours; however, it is of vital importance to ensure the patient is well informed prior to the trial or implant. You should expect to be ready at the OR/ASC at least 30 minutes prior to the scheduled start time.
In the clinics you will learn how to take a history, perform a thorough physical exam, formulate a plan, order appropriate testing, learn indications for treatment of conditions, understand opioids and appropriate monitoring, and develop your skills in regard to physician patient relationships. Most ultrasound procedures are performed in the clinic setting and you will have ample experience using this modality.