Why Do Physicians Choose Pain as a Specialty?

Numerous forces shape the practice of pain management: scientific advances, technical advances, societal expectations, public health crises, reimbursement factors, and the parameters of who gets trained and what motivates the trainees. In this observational study, we sought to determine expressed motivations for entering the subspecialty of pain management, and in particular whether applicants were more interested in procedural skills (our hypothesis) or rehabilitative and cognitive practices.

We analyzed the personal statements of 142 applicants to the University of Minnesota's pain medicine fellowship program. In addition to those themes, the personal statements were scrutinized for other themes such as interest in teaching and research. Comprehensive vs interventional/procedural interests were coded by a group of four research assistants who were trained using practice essays until they achieved high interrater reliability (alpha > 0.8). Two of the researchers coded for additional themes on a two-point scale indicating presence or absence of a particular theme. When they did not agree, a third researcher broke the tie. Theme prevalence was compared by specialty and gender.

Residents expressed interest in interventional and comprehensive pain practice without significant differences; however, there were specialty and gender differences in other themes such as teaching, research, and leadership in program development.

If pain specialty training is going to meet the needs of prospective residents, patients, and society, we should do more to attract women and neurology and psychiatry residents. We should include more opportunities for research and the flexibility to educate trainees who may not pursue a procedural practice.