Session 17

Dr. Fred Weiss is a Radiologist by training who did a Fellowship in Pain Medicine. However, he's going to share with us today what he likes least about the specialty, part of the reason he's not currently practicing Pain Medicine.

Let's jump right in and learn about Pain Medicine!

[01:38] Residency and Fellowship

Fred is currently an emergency radiologist at Geisinger Health System in Danville although he previously practiced as a Pain Medicine physician in Florida. Finishing his last fellowship in 2014, he's been practicing as an attending for about two years now. He actually did two fellowships, one was a half and half fellowship in Neuroradiology and Musculoskeletal Radiology, and the second was in Pain Medicine in University of Pennsylvania.

Prior to medical school, Fred was a physical therapist and he really enjoyed the musculoskeletal system and the nervous system, finding those were the easiest for him to understand, digest, and put into practice. During rotations, Fred enjoyed all the subspecialties affiliated with pain but didn't actually see himself as a surgeon although he liked interventional radiology-type procedures. So it was a matter of choosing a base specialty for going into Pain, doing neuro and musculoskeletal procedures the most.

[03:45] Traits of a Good Pain Doctor

Fred underscores patience as a major key to becoming a good Pain Medicine physician, along with compassion since you mostly see patients with chronic pain as a Pain doctor. Although right now, Fred admits that the best trait to have is patience with a political system and medical system we're currently in with all the complications going on with opioids where a lot of physicians feel like they have targets on their back. More so, pain physicians feel that the most because they're prescribing opioids considering the country is going through a national opioid epidemic right now.

[05:05] The National Opioid Epidemic

During interviews for attending jobs, Fred sees a lot of diversity in the way people practice pain medicine. There are those that practice only interventional procedures such as injections, epidurals, facet injections, Neuro Blocks, spinal cord assimilators, etc. On the opposite end of the spectrum, there are those that only prescribe pain medications and when you only do this type, there are only a few classes of medications being prescribed including opioids. And there are those people doing things in moderate amounts of injections and pain medications.

There's a lot of heterogeneity in the way people practice and there are people who abuse these medications and seek them while there are those who really need it and those who don't. Fred finds how difficult it is not just on a day-to-day basis, but also, on a patient-to-patient basis to figure out who's a good candidate for certain medications and for certain procedures, and who would respond to what.

[06:46] Ways to Get into Pain Medicine

In the physical therapy world, Fred's specialty was manual therapy as he enjoyed putting his hands on someone to make them feel better either for mobilization or for therapy purposes, similar to osteopathic medicine. It drew him toward that especially that he found success in those sort of techniques so he wanted to carry it over to the Pain Medicine field. To some extent, he was fairly successful in getting patients off pain medications by simply using manual therapy techniques and other modalities. Fred is not an osteopathic physician. He actually applied to nine osteopathic medical schools and got rejected from all of them. Instead, he got accepted to an allopathic school.

When he was in medical school, there were a limited number of specialties eligible for Pain Medicine Fellowship such as Anesthesiology, Physical Medicine, Neurology, and Psychiatry where he has done rotations in