Emergency physicians in pain medicine: Workforce trends, competency overlap, gaps, and opportunities for integration

Jeffrey R Merz-Herrala; Felipe Ocampo; Christopher R Abrecht; J Ben Arevalo; Nu Cindy Chai

doi:10.1016/j.inpm.2025.100722

Emergency physicians in pain medicine: Workforce trends, competency overlap, gaps, and opportunities for integration

Interv Pain Med. 2025 Dec 17;5(1):100722. doi: 10.1016/j.inpm.2025.100722. eCollection 2026 Mar.

Authors

Jeffrey R Merz-Herrala^{1

2}, Felipe Ocampo², Christopher R Abrecht¹, J Ben Arevalo¹, Nu Cindy Chai¹

Affiliations

¹ Department of Anesthesia & Perioperative Care, Division of Pain Medicine, University of California, San Francisco, CA, USA.
² Department of Emergency Medicine, University of California, San Francisco, CA, USA.

Abstract

Background: Pain is a leading complaint in Emergency Department (ED) visits, yet historically, few Emergency Physicians (EPs) have pursued fellowship training in Pain Medicine. In recent years, however, applications from EPs have risen sharply, contrasting with declines in other specialties. Despite this growth, there has been no systematic analysis of how Emergency Medicine (EM) training overlaps with the required competencies of the Pain Medicine fellowship. To our knowledge, this study represents the first such effort.

Methods: We systematically compared the Accreditation Council for Graduate Medical Education (ACGME) Program Requirements for Pain Medicine with five core EM training documents: the ACGME Program Requirements for EM, ACGME EM Milestones, ACGME Key Index Procedures, ACGME Procedure Logs, and the American Board of Emergency Medicine (ABEM) EM Model of Clinical Practice. Each ACGME Pain Medicine Program Requirement was evaluated by a group of Pain and EM physicians for its degree of overlap with these EM training frameworks and categorized as having significant, partial, or minimal overlap in competency.

Results: EM training exhibits a strong overlap with Pain Medicine in patient care, encompassing neurologic and musculoskeletal evaluation, psychiatric assessment, and the diagnosis of acute and chronic pain. EPs also demonstrate procedural strengths in airway management, intravenous access, ultrasound-guided interventions, life support, procedural sedation, managing emergencies, along with medical knowledge in acute pain management, medication detoxification, and treatment of substance use disorders. Gaps were identified in the interpretation of electrodiagnostic studies, advanced imaging, prescription of rehabilitation strategies, long-term opioid management, and advanced fluoroscopic and neuromodulation procedures. These findings highlight EM's strong foundation in acute care and procedures, while clarifying domains that require targeted fellowship training.

Conclusions: EPs contribute valuable skills to Pain Medicine but require structured opportunities to address predictable training gaps. Electives, mentorship, and flexible curricula may help bridge these deficiencies.

Keywords: ABEM; ACGME; Competency; Fellowship; Multidisciplinary.

Publication types

Editorial