MedCentralPain Medicine’s Recruitment Problem, and Solutions

MedCentral presents a podcast interview with Dr. Scott G. Pritzlaff, an associate professor of anesthesiology and pain medicine at UC Davis Health, discussing the significant decline in anesthesiology residents applying to pain medicine fellowships since 2019. The interview was conducted at the American Academy of Pain Medicine’s PainConnect 2025 meeting in Austin, highlighting concerns about fellowship program sustainability and educational standardization.

⚕️Key Clinical Considerations⚕️

• Anesthesiology residents, who historically comprised 60-70% of pain medicine fellowship applicants, are increasingly choosing direct practice over fellowship training due to unprecedented high salary offers in the anesthesiology job market.
• The applicant gap is being partially filled by physicians from other specialties including PM&R, neurology, psychiatry, and newer entrants like emergency medicine, family medicine, and radiology.
• These diverse training backgrounds create educational challenges as fellows arrive with heterogeneous skill sets—for example, family medicine physicians may have strong clinical skills but minimal procedural experience.
• Pain medicine has evolved significantly with new advanced procedural options introduced in the past five years, including expanded neuromodulation and minimally invasive spine surgery techniques not available a decade ago.
• The current one-year fellowship structure, established in the 1990s, may be insufficient for comprehensive training in modern pain medicine, with growing support among educators for extending to a two-year fellowship or dedicated residency model.

🎯 Clinical Practice Impact 🎯

• Education Reform: Greater standardization of pain fellowship training across programs is needed, as content varies significantly between institutions with few procedural benchmarks since requirements were eliminated 5-6 years ago. Consider advocating for national standardization similar to surgical residency procedure minimums.
• Recruitment Strategy: Programs should highlight to potential applicants that pain medicine offers exceptional clinical impact opportunities and innovation potential in addressing the growing burden of chronic pain conditions, particularly given demographic shifts toward an aging, more comorbid population.
• Procedural Training: Fellowship directors must develop efficient training pathways for newer technologies like peripheral nerve stimulation, basivertebral nerve ablation, and percutaneous image-guided lumbar decompression within the limited 9-10 month effective training period.
• Educational Adaptation: Medical educators must adjust teaching approaches for younger clinicians (Gen Z and Millennials), who are technologically savvy and require more intentional, well-structured educational experiences that match their learning preferences and career goals.

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