Dustin Anderson, MD
PGY2, University of Colorado Physical Medicine and Rehabilitation
Scott R. Laker, MD, FAAPMR
Medical Director, Lone Tree Health Center, University of Colorado Hospital
AAPM&R Board of Governors Quality, Practice, Policy, and Research Chair
Physiatrists have the unique option of specializing in sports medicine, pain medicine, or the combination of sports and interventional spine, the latter of which can be ACGME-accredited or non-ACGME accredited. I connected with Dr. Scott Laker, a specialist board certified in sports medicine and pain, to help navigate the fellowship landscape.
Dr. Anderson: Can you tell us a little about what inspired you to explore a career path involving sports, pain, and interventional spine?
Dr. Laker: I have always been involved in sports throughout my life, and when I was in residency, I gravitated toward those clinics. I found that I enjoyed the procedural aspect of physiatry immensely. I was lucky to work with some very talented mentors (Drs. Venu Akuthota, Bill Sullivan, and Deb Saint-Phard) during my residency at the University of Colorado. They are gifted physicians and I remember clearly wanting to practice like them when I was starting my career.
Dr. Anderson: Regarding combined sports/interventional spine programs, how much variation is there between sports coverage and procedural experience?
Dr. Laker: There is a tremendous amount of variation for the combined programs. It is similar for residencies. All residencies have certain requirements, but each residency has different strengths and areas of focus. For ACGME-accredited sports medicine fellowships, there are clear guidelines for sideline and event coverage. For ACGME-accredited pain medicine fellowships, there are no such requirements for coverage. That being said, the University of Colorado’s pain medicine fellowship does have significant sideline coverage responsibilities for several Division I sports teams. Non-ACGME programs have the most variability because they are not bound by those ACGME guidelines.
My strongest recommendation on this topic would be to ask yourself what coverage experience you need during fellowship to be able to do the job you ultimately want to do. If your career goal is to be on the sideline at the 2025 NCAA Division I football championship, then you will need significant volume high-level, hands-on experience during your fellowship to give you the opportunity to pursue that type of competitive career. Alternatively, if you want to be the director of an interventional spine clinic, then your need for sideline coverage is probably not necessary but consistent, high-volume, hands-on, supervised procedural training is essential.
This is similar when considering procedural exposure. Some programs will train you to do a wide range of procedures, from joint injections to spinal cord stimulator trials to vertebral augmentation. All of the ACGME (pain or sports) programs have similar requirements, though each will have its own areas of strengths and volumes of exposure. It is very fair to discuss the estimated numbers of procedures during your interviews.
Dr. Anderson: What do you consider the most rewarding and challenging aspects of your job?
Dr. Laker: I have a broad practice that involves spine, pain, musculoskeletal conditions, pediatric, and adult concussions. I do fluoroscopically-guided and ultrasound-guided procedures, and some EMG. I also have several administrative roles and am the medical director of a multi-specialty clinic. I love the mix of what I do and can’t imagine doing just one thing every day. This is one of the main reasons I chose physiatry in general, and my own career path. As for rewarding parts of my clinical practice, the first thing that comes to mind is knowing that if you give good education about concussions to one family and one kid, that you may be able to protect them, their siblings, and the other kids on their team. I love the idea that our ability to communicate can create some ongoing good beyond the initial visit. From a teaching standpoint, there is nothing better than being part of residents’ early careers and watching them get off to a great start, either with fellowship training or their first jobs.
Recently, I’ve been focused on how challenging it is to engage patients in long-term lifestyle change. We live and work in a quick-fix health culture. If you have appendicitis, you get an appendectomy and you get well. Some of the interventions we offer may take weeks of PT, months of home exercise, lifestyle changes, and consistent long-term work to get well and stay well.
Dr. Anderson: For those considering an ACGME versus non-ACGME fellowship, what are some factors residents should account for in their decision-making process?
Dr. Laker: Fellowship was one of the most rewarding experiences of my career and my involvement in fellowship training is a central reason I enjoy being at the University of Colorado. For the purposes of current residents, it is important to critically assess if you really need to do a fellowship. I mean it. Stop and spend some quality time thinking about why you want to pursue fellowship. It is another year of training, often in a new and far away city, and there is the opportunity cost of spending another year on a fellow’s salary. Not everyone needs a fellowship to create a wonderful career or to make a positive impact on their patients.
Secondly, it’s important to understand that fellowship training can be superb with or without ACGME accreditation. These are world-class physiatrists that run fellowships. They are devoting their time and energy to train their fellows. The fellows devote their time and energy to become better physiatrists. It’s a great gift that the faculty give the fellows and vice-versa.
If you know you want to stay in academics to publish, teach, and see patients, I would suggest that the ACGME programs are a consistently great fit. If you want to start your own private practice, manage your clinic, and be a business owner, a non-accredited fellowship working with faculty that have fulfilled those goals and can share their experience with you may be a better fit. There is a world of flexibility in physiatry. Ultimately, many of the best physiatrists have experience in academics and private practice, including inpatient and outpatient roles.
One additional thing to consider is that you’ll be spending an enormous amount of time with your fellowship faculty. Ideally, you should be working with faculty that you respect and who practice in a way that resonates with you. In the end, the role-modeling that happens during your fellowship will be much more important and long lasting than the procedural experience or journal articles you read.
Dr. Anderson: What qualities would most fellowship directors describe in their “ideal candidate?”
Dr. Laker: For the Annual Assembly, we partnered with AAPM&R to create a survey that answered that very question. It had far less to do with board scores, residency location or number of publications (though those are a part of the equation). The ideal candidate is someone that has a clear understanding of what they want to do and why they want to do it. Fellowship directors may look at hundreds of applications each year and may do dozens of interviews. They are ultimately looking to work with someone that will make the most of their talents and the hundreds of hours of training that they share with the fellow. Speaking for myself, I love training fellows that I feel will become leaders in our field. Also, I want the fellows to learn to practice in their own way and to develop their own style.
Dr. Anderson: Are there any resources you might suggest for candidates planning for fellowship training?
Dr. Laker: Along with talking with your faculty, program director, and recent alumni from your program, there are some great resources through AAPM&R to help plan for fellowship training. Our Academy has a career and fellowship advice/resources page, fellowship database (incorporated in the Job and Fellowship Board) along with a roadmap to fellowship. You can also search the ACGME website by specialty, and the NRMP puts out fellowship match data, similar to what you may have perused for residency applications. Lastly, there is a Point/Counterpoint that held a great discussion on some of the advantages and disadvantages of sports/spine combined fellowships. I posted them below.
I wish you all success in your careers, and I thank you for the impact you’ll have in your patient’s lives.
Thank you, Dr. Laker!