Analyzing the Geographical Trends of Pain Fellowship for Residency to Fellowship and Residency/Fellowship to First Job Location Among Recent Fellows.

Abstract

Background: Pain medicine has transitioned from its original role as opioid medication management into a multidisciplinary field that plays a critical role in caring for patients with various acute and chronic pain-related conditions. Pain fellowships have traditionally been considered a competitive subspecialty, and the coronavirus disease 2019 (COVID-19) drastically shifted the process in which applications to this field of study have been conducted.

Objectives: This study aims to analyze publicly available geographical data on pain fellows from 2017 to 2024 and to ascertain the influence of COVID-19 and primary residency on the distribution of these trainees.

Study design: A retrospective study analyzing data on Accreditation Council for Graduate Medical Education (ACGME) pain fellows from 2017 to 2024. The data collected consisted of the individuals' fellowship class, residency program, primary residency specialty, and first job location.

Methods: Each pain fellow's relative distance and distribution from residency to fellowship, residency to first job, and fellowship to first job were analyzed. These locations were categorized as within 100 miles, the same state, the same region, or a different region. The odds ratio (OR) was calculated for those relative locations, bearing in mind whether the data referred to a pre- or post-COVID-19 time period (2017-2020 and 2021-2024, respectively). An additional OR was also conducted to determine the effect of primary specialty on relative distance. The chi-square test was used to calculate a P-value of 0.05, and confidence intervals were obtained using the Baptista-Pike method.

Results: A total of 877 fellows were included, with over half of the fellows (53.6%) staying within the same region as their residency, 51.1% in the same region from residency to first job, and 56.1% in the same region from fellowship to first job. For the residency-to-fellowship period, from pre- to post-COVID-19, fellows were not more likely to stay within 100 miles (OR: 1.16), in the same state (OR: 1.24), or in the same region (OR: 1.08). The residency-to-first-job fellows were not more likely to stay within 100 miles (OR: 0.77) or in the same state (OR: 0.93) or region (CI: 0.89). Similarly, pain fellows did not show more likelihood of staying within 100 miles (OR: 1.02) or the same state (OR: 1.08) or region (OR: 1.01) as they progressed to their first jobs. Anesthesiology trainees demonstrated a higher likelihood of staying within 100 miles from residency to fellowship (OR: 1.47) and in the same state for the fellowship-to-first-job period (OR: 1.50).

Limitations: We were unable to obtain information from all the ACGME programs because some trainees declined to respond or participate. Additionally, the subjective factors that might have influenced trainees' ranking lists, such as family and personal considerations, were not elucidated in this study.

Conclusion: Overall, pain fellows were more likely to stay within the same region they lived in during their residency and for their first jobs. The presence of COVID-19 did not significantly affect the odds of matching within 100 miles, the same state, or the same region. Fellows with an anesthesiology background tend to stay closer to their area of training.