Advanced interventional numbers

[Bruinsfootball]

How important is it to receive training in SCS, intrathecal pumps, kyphoplasty, vertebroplasty, discograms, etc during fellowship training? There is incredible variability in the number of these procedures performed in each training program. Some programs perform almost zero implants and instead refer them all to neurosurgery. These programs seem to infer that the complications and lifestyle associated with these procedures make it easier to refer out. Also implied is the lack of reimbursement to help offset the costs of these procedures. Are these difficult to learn through workshops if not learned during fellowship?

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[Tenesma]

1) understanding/exposure is important - because even if you don't do it in pp, you will at least understand what it is all about in terms of patient selection, post-procedural complications etc...

2) there is a good chance that you may want to do some of it when you go into private practice

3) admittedly, most docs in pp don't do a lot of scs, kypho --- however, i would never choose a fellowship that would limit my options.

 

[BobBarker]

You need to at minimum stim trials. If you don't do implants in fellowship you will not be able to do those on your own unless you just place leads and have a surgeon open and close for you. I think kypho could be picked up through courses, observation, and having a very good rep walk you through your first 20. Discos are rare in these parts and can be picked up by self study

 

[emd123]

It's better to learn something and be able to forget it, than to not ever learn it at all

 

[Aether2000]

One of the fundamental weaknesses in pain fellowship programs is the complete lack of training requirements other than having done 20 interventional procedures total for the entire fellowship. This not only makes the end product physicians highly variable in their capabilities but more importantly denigrates the value of both fellowships and the offshoot, ABMS additional qualifications certificate. No wonder CRNAs and PAs are aggresively pursuing advanced interventional procedures since they may have just as much training in some of these procedures as the fellowship trained board certified pain physician. Shame on the abms and the acgme for their lack of meaningful standards in pain fellowship training programs.

 

[Ducttape]

That's not entirely true. ACGME requirements include directly performing 15 thoracic or lumbar interlaminar injections but also active involvement in at least 60 procedures, including 5 neuroablative procedures and 10 neurostim procedures.

https://www.acgme.org/acgmeweb/Port...uirements/530_pain_medicine_07012014_1-YR.pdf

Section IV.A.b.6.b

 

[emd123]

One of the fundamental weaknesses in pain fellowship programs is the complete lack of training requirements other than having done 20 interventional procedures total for the entire fellowship. This not only makes the end product physicians highly variable in their capabilities but more importantly denigrates the value of both fellowships and the offshoot, ABMS additional qualifications certificate. No wonder CRNAs and PAs are aggresively pursuing advanced interventional procedures since they may have just as much training in some of these procedures as the fellowship trained board certified pain physician. Shame on the abms and the acgme for their lack of meaningful standards in pain fellowship training programs.

In my fellowship we did way, way more than the minimum numbers. But I agree that the bar could stand to be raised.

 

[Aether2000]

The acgme has apparently changed but is still deficient. Active participation may be at the long end of a retractor or never completing the entire advanced procedure. This is especially tragic with respect to SCS that has become standard fare in the profession. Perhaps weaker programs should be shut down....