Pain Medicine’s Identity Crisis and the Future of Training with Dr. Scott Pritzlaff

Episode Overview: In this episode, Dr. Brian Joves sits down with Dr. Scott Pritzlaff, an esteemed pain management specialist and the residency program director at UC Davis, to tackle some big questions on the current state and future of pain medicine. They dive into Dr. Pritzlaff's recent thought-provoking editorial, "From Pain Medicine to Pain Surgery: How Our Specialty Lost Its Way," which critiques the field’s shifting focus toward procedures at the expense of comprehensive patient care. Together, Dr. Joves and Dr. Pritzlaff discuss challenges in pain medicine, including recruitment issues, the evolving landscape of interventional procedures, and the complexities of training the next generation of pain specialists.

Key Topics Discussed:

• The Evolution of Pain Medicine:

  • Dr. Pritzlaff explains the rapid technological advancements in pain medicine, especially in peripheral nerve stimulation, spinal cord stimulation, and minimally invasive spine procedures.
  • While these advancements offer more options for patients, he warns that they can overshadow the core values of patient-centered care and non-procedural management.

• Pain Medicine’s “Identity Crisis”:

  • In his editorial, Dr. Pritzlaff questions the growing emphasis on procedures and the trend of “pain surgery” within the specialty.
  • He emphasizes that pain management is about more than just interventions—it’s about the art of diagnosis, multidisciplinary treatment plans, and knowing when not to perform procedures.
  • This emphasis on procedure-heavy training, he argues, risks alienating future specialists who are passionate about comprehensive patient care.

• The Challenge of Training in a One-Year Fellowship:

  • With the increasing complexity of pain medicine, a one-year fellowship may no longer suffice.
  • Dr. Pritzlaff advocates for an expanded training period to cover essential skills, such as advanced imaging interpretation, opioid and multimodal pharmacology, and honing the “soft skills” crucial for patient communication and holistic care.

• Recruitment Issues in Pain Medicine:

  • Pain medicine residency applications have dropped, especially from anesthesiology—a trend driven largely by competitive anesthesiology salaries and demand.
  • Dr. Pritzlaff and Dr. Joves discuss how pain medicine needs to rebrand itself to attract applicants who are passionate about improving patients’ quality of life through comprehensive care, not just procedures.

• Future Training Models and Vision for Pain Medicine:

  • A 2 year fellowship model or a dedicated residency program are presented as potential solutions to better prepare trainees.
  • Dr. Pritzlaff imagines a program where the first year focuses on foundational knowledge and multi-disciplinary skills, and a second year sharpens advanced interventional skills.

Takeaways for Listeners:

• Pain medicine is at a pivotal point, balancing advancements in interventional procedures with the traditional values of comprehensive patient care.
• The field must prioritize holistic training and mentorship to foster well-rounded pain physicians who can deliver thoughtful, personalized care.

Links & Resources:

• Dr. Scott Pritzlaff’s Editorial: "From Pain Medicine to Pain Surgery: How Our Specialty Lost Its Way" in the Journal of Pain Research
• Connect with Dr. Pritzlaff and Dr. Joves on Linkedin or Twitter

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