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Changes in Pain Medicine Training Programs Associated with COVID-19: Survey Results.

BACKGROUND
The COVID-19 pandemic is a public health crisis of unprecedented proportions that has altered the practice of medicine. The pandemic has required pain clinics to transition in-person visits to telemedicine, postpone procedures and cancel face-to-face educational sessions. There are no data on how fellowship programs have adapted.


METHODS
A 17-question survey was developed covering topics including changes in education, clinical care, and psychological stress due to the COVID pandemic. The survey was hosted by Qualtrics Inc. and disseminated by the Association of Pain Program Directors on April 10, 2020 to program directors at ACGME-accredited fellowships. Results are reported descriptively and stratified by COVID infection rate, which was calculated from Centers for Disease Control and Prevention data on state infections, and census data.


RESULTS
Among 107 surveys distributed, 70 (65%) programs responded. Twenty-nine programs were located in states in the upper tertile for per capita infection rates, 17 in the middle third, and 23 in the lowest tertile. Nearly all programs (93%) reported a decreased workload, with 11 (16%) reporting a dramatic decrease (only urgent or emergent cases). Just over half of programs had either already deployed (14%) or credentialed (39%) fellows to provide non-pain care. Higher state infection rates were significantly associated with reduced clinical demand (Rs = 0.31, 95% CI [0.08, 0.51], P = .011) and redeployment of fellows to non-pain areas (Rs = 0.30, 95% CI [0.07, 0.50], P = .013). Larger program size but not infection rate was associated with increased perceived anxiety level of trainees.


CONCLUSIONS
We found a shift to online alternatives for clinical care and education, with correlations between per capita infection rates, and clinical care demands and redeployment, but not with overall trainee anxiety levels. It is likely that medicine in general, and pain medicine in particular, will change after COVID-19, with greater emphasis on telemedicine, virtual education, and greater national and international cooperation. Physicians should be prepared for these changes.