Is an Interventional Pain Fellowship a Good Idea in the Age of Orthobiologics?

We 've had a fellowship program for 6 years now that focuses on Interventional Orthopedics (IO) using orthobiologics. Our fellows are some of the most sought after physicians compared to their peers because they learn a skill set that few physicians have mastered or understand beyond a superficial level. When compared to the average physician who decides to attend an Interventional Spine fellowship (IS) instead, they have much more opportunity and are earning more while seeing fewer patients with less burn out. Why?

What is IO and how does it differ from IS? IO is the placement of orthobiologics like stem cells and PRP into various parts of the injured musculoskeletal system using precise image guided injections. While IO and IS intersect in using fluoroscopy for spinal injections, IO uses orthobiologics to try to heal the problems in the spine or mitigate them without harmful corticosteroids or thermal ablation. In addition, unlike IS, IO also focuses on precisely injecting the peripheral joints and associated structures. For example, using ultrasound to precisely target a rotator cuff tear, fluoroscopy to target a labial tear, or fluoroscopy to target a torn knee ACL.

Why would IO physicians earn more? What a physician earns and his or her employment possibilities are directly tied to the rarity of acquired skills and the demand for same. If only a handful of physicians have those skills and the demand is high, then salary and benefits are greater. It's simple supply side economics.

So if I were in my twenties, what would I be doing? Would I pursue an interventional spine fellowship or one in interventional orthopedics? Looking simply at supply and demand theory, there are thousands of physicians with IS training and only a handful with IO training. The demand for IO trained physicians is exploding. In fact, it's so high, that even before they land full time jobs, our fellows are often hired for large sums of money to go to physician offices all over the world to train practicing physicians.

Finally, IO is very different than IS in terms of physician satisfaction. In IO, your job is to heal or facilitate healing. In IS, your job is to manage, oftentimes by exposing patients to drugs or procedures that are known to destroy tissue. In addition, while the average IO physician in our practice sees 10-14 patients a day, the average IS patient is often required to see 20-40 patients a day. In the first instance you can do your best work, the the latter, you're simply trying to keep from drowning.

In conclusion, skip the IS fellowship and train how to perform the care of the future rather than the procedures of the past. You'll be happier with what you do everyday. Finally, your student loan balances will thank you!