— Nearly a quarter of adults in the U.S. have chronic pain, but a new study from the UC Davis School of Medicine shows a concerning drop in residents applying to pain medicine fellowship programs.
The study was published in PAIN Practice. It found the number of anesthesiology residents applying for pain medicine fellowships — historically the key pool of applicants — dropped 45% between 2019 and 2023.
"While the demand for pain specialists is growing in the U.S., the pipeline of new doctors to fill these roles is drying up," said Scott Pritzlaff, the study's first author, an associate professor in the UC Davis Department of Anesthesiology and Pain Medicine and director of the Pain Medicine Fellowship program.
The study found fewer physicians overall are choosing to go into pain medicine. Female physicians applying to the specialty dropped 27.5%, and the number from all specialties dropped 14.2%.
A report from the Centers for Disease Control and Prevention released in November showed 24.3% of adults report having chronic pain.
"Fewer doctors choosing pain medicine means longer wait times, rushed care and fewer treatment options for patients suffering from chronic pain," Pritzlaff said. "In a country already grappling with an opioid crisis, this could leave millions without the specialized care they need to manage their pain safely and effectively."
Opioid epidemic may have contributed to decline
The economic and societal impacts of the U.S. opioid epidemic have been enormous. But there may be another impact with far-reaching consequences: the practice of pain medicine itself.
Chinar Sanghvi is an assistant clinical professor in the UC Davis Department of Anesthesiology and Pain Medicine and associate director of the Pain Medicine Fellowship program. Among her many roles, she teaches courses at the UC Davis School of Medicine and mentors first- and second-year medical students.
She noted that although most of the lawsuits associated with the opioid epidemic targeted pharmaceutical companies, highly publicized cases involving physicians likely left an impression on medical students and residents.
"For trainees observing this during their formative years, it may have created a perception of pain medicine as a high-risk specialty — both legally and ethically," Sanghvi said. "This fear of litigation, coupled with the stigma surrounding opioid prescribing, could discourage aspiring physicians from entering the field."
Opioids are rarely a first-line treatment for chronic pain. Instead, pain specialists use a broad range of treatments. Conservative therapies include non-opioid medications, physical therapy, behavioral health intervention, biofeedback, acupuncture, nutrition counseling and many others. When conservative therapies fail, interventional procedures such as injections, radiofrequency ablation or spinal cord stimulation may be part of the treatment plan.
The authors note the widespread shortage of anesthesiologists in the U.S. is also likely playing a role in the declining interest in pain medicine.
Anesthesiologists currently rank at the top of Best-Paying Jobs (tied with obstetrics and gynecology). Specializing in pain medicine requires an additional year of training in a fellowship. With high demand and high salaries, many physicians are entering the workforce right after completing their anesthesiology residency.
Data show declining interest in pain medicine
The researchers analyzed data from the National Resident Matching Program and the Electronic Residency Application Service to look at the primary specialties of residents applying to pain medicine fellowship programs from 2019 to 2023. They also used a report from the American Association of Medical Colleges to view data on the number of applicants, specialty backgrounds, race and gender.
Their research found that between 2019 and 2023:
- Applications from residents specializing in anesthesiology (historically the largest specialty) dropped 45%, from 351 to 193.
- Applications from all specialties dropped 14.2%, from 520 to 446.
- Applications from female physicians dropped 5%, from 131 to 95.
- Applications from male physicians dropped 9.8%, from 389 to 351.
In addition to the overall concerns about the drop in numbers, the authors noted the specialty of pain medicine has a low number of female physicians, 18%, and the drop in applications raises concerns about the gender gap widening even more.
The data also revealed some upward trends. Applications from physical medicine and rehabilitation increased almost 33%, from 101 to 134. And residents specializing in emergency medicine increased by 190%, with 10 applying in 2019 and 29 applying in 2023.
UC Davis School of Medicine focused on early outreach
To help attract new talent to the field, Pritzlaff, Sanghvi, and others in the UC Davis Health Division of Pain Medicine increased recruiting efforts with early outreach to medical students and residents. They've also become more active on social media channels. The efforts helped UC Davis fill its fellowship slots despite the national downturn.
David Copenhaver, senior author of the study, is a professor in the Department of Anesthesiology and Pain Medicine and chief of the Division of Pain Medicine.
"Pain medicine is caught in a strange paradox. On one hand, pain is one of the biggest public health problems in America, costing billions annually. On the other, the field is underappreciated and underfunded," Copenhaver said. "This decline isn't just about numbers — it's a wake-up call for the future of pain care in America."
