UC Davis

Introduction

Based on recent data, the pain fellowship match is decreasing in competitiveness. The most recent 2023-2024 match cycle had the most unfilled positions and the highest match rate in the last five years. Although there has been some speculation about potential factors contributing to these trends, our study aimed to gather insight from pain fellowship program directors (PDs) nationwide to provide valuable perspectives on recent match trends.

Methods

We created an anonymous online survey, with questions regarding potential factors contributing to match trends over the last five years. Our survey was emailed to 115 program directors (PDs), and one follow-up Email was sent three weeks later to maximize responses.

Results

Surveys were completed by 25.2% (29/115) of PDs. Over the past five years, 82.8% of PDs (24/29) reported a decrease in applications to their program. For residency specialty of pain fellowship applicants, 100% of PDs (29/29) reported a decline in anesthesiology applicants. Most PDs reported an increase in applicants from PM&R (62.1%, 18/29), Neurology (69.0%, 20/29), and Emergency Medicine (93.1%, 27/29). For potential contributors to these trends, increasing compensation in primary residency specialty was the most significant perceived contributor, with a weighted average of 4.89/5. Decreasing pain reimbursement was the second strongest contributor, with a weighted average of 4.31/5.

Conclusion

Increasing compensation in primary residency specialty and declining pain reimbursements were the two most significant perceived contributors to the recent decline in interest in pain fellowship to resident trainees. Pain medicine is now attracting a more diverse applicant pool with a decrease in anesthesiology applicants and an increase in PM&R, Internal Medicine, Neurology, Emergency Medicine, and Psychiatry applicants. Future pain fellows increased variety of training backgrounds may present an opportunity to critically assess the current pain medicine curriculum to suit the needs of a more diverse cohort.