Furnish, Timothy

The National Resident Matching Program (NRMP) for pain medicine fellowships marked its 10th anniversary in 2023, coinciding with growing discussions within the Association of Pain Program Directors (APPD) regarding the program’s future in the context of a recent decline of applicants into pain medicine. This letter explores the rationale behind reassessing the NRMP’s utility for pain medicine, examining historical and current trends, and considering the implications of withdrawing from the match. Despite a recent decline in applicants and an increase in unfilled positions, the APPD advocates for continued participation in the match. The match ensures equitable and stable recruitment, preventing the chaotic pre-match environment of competitive, early offers. Data from similar specialties highlight the pitfalls of non-match systems, such as increased applicant pressure and reduced program visibility. The APPD supports maintaining the NRMP match while implementing reforms like preference signaling to address evolving challenges. The APPD aims to preserve the match’s benefits and ensure a stable future for pain medicine fellowship recruitment.

Introduction Applicants to chronic pain medicine fellowship programs often express confusion regarding the importance of various selection criteria. This study sought to elucidate program directors’ considerations in applicant selection for fellowship interviews and ranking and to correlate these criteria with match statistics to provide a guide for prospective candidates. Methods An electronic survey was sent to all Accreditation Council for Graduate Medical Education-accredited chronic pain fellowship directors. The importance of various applicant characteristics were evaluated and compared with recent match data. Results Fifty-seven program directors completed the survey. The most important factors involved in applicant interview selection were perceived commitment to the specialty, letters of recommendation from pain faculty, scholarly activities, and leadership experiences. Although completion of a pain rotation was valued highly, experience with procedures was of relatively low importance. There was no preference if rotations were completed within the responders’ department. Variability was noted when considering internal applicants or the applicant’s geographic location. When citing main factors in ranking applicants, interpersonal skills, interview impression and applicant’s fit within the institution were highly ranked by most responders. Discussion Assessment of an applicant’s commitment to chronic pain is challenging. Most responders prioritize the applicant’s commitment to chronic pain as a specialty, scholarly activity, participation in chronic pain rotations, pain-related conferences and letters of recommendation from pain faculty. Chronic pain medicine fellowship candidates should establish a progressive pattern of genuine interest and involvement within the specialty during residency training to optimize their fellowship match potential.

Background Women are entering medical school in record numbers, but multiple male-dominated medical specialties still exist, including pain medicine. It is not well-understood how gender diversity in academic pain medicine faculty affects fellow matriculation between female and male applicants. Objective We conducted a survey to ascertain whether gender diversity of those in leadership roles in pain medicine programs impacts the gender diversity of fellows in those programs. Methods A questionnaire was delivered to all Accreditation Council for Graduate Medical Education-accredited pain medicine fellowships to assess their demographic data in 2018. Program characteristics are summarized using median (25th, 75th) for continuous variables and frequency counts and percentages for categorical variables. Analyses were then performed using a generalized linear mixed model with a logit link function and fellowship program included as a random effect. The gender of the fellow was the dependent variable and the program characteristics were the explanatory variables. Results Data from 45 of 104 fellowship programs (43% response rate) are included. From univariate analysis, the odds of a fellow being female were higher in programs with a female program director (OR=2.17, 95% CI 1.29 to 3.65, p=0.004) and in programs with a higher percentage of female faculty (OR=1.02, 95% CI 1.00 to 1.04, p=0.027). From multivariable analysis, having a female program director was the only program characteristic found to be significantly associated with female fellows (OR=2.07, 95% CI 1.05 to 4.11, p=0.037). Conclusions Pain medicine fellowship programs with a female program director were significantly more likely to have female fellows.