ASRA Newsletter on Unaccredited Pain Fellowships

[drusso]

What Can We Learn From Nonaccredited Pain Medicine Fellowships?

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[deleted472101]

I think there should be a residency which would give better education on all modalities not just interventional.

take it away from a specific speciality as it doesn’t belong to one.

also shut down unofficial fellowships as they will never offer a good enough training.

 

[JBM16BYU]

Generally, are the NASS interventional spine and musculoskeletal medicine fellowships viewed as these non-accredited pain fellowships (because they do advertise themselves as a different type of fellowship or entity different than pain)? Or is this article describing the non-accredited pain fellowships that are non-ACGME, non-NASS, non-Sports/Spine? If referring to the NASS fellowships, I find it interesting that both of the authors are at institutions that have NASS fellowships.

 

[lobelsteve]

From the authors' home programs:

At Cleveland Clinic:

Physical Medicine & Rehabilitation Fellowship | Cleveland Clinic

Learn more about Cleveland Clinic's fellowship training program for physical medicine and rehabilitation.

my.clevelandclinic.org

At Wake Forest:

Wake Forest Baptist Medical Center Fellowship positions available: 2 David R. O’Brien, Jr., MD, Fellowship Director Medical Center Boulevard 8 Janeway Tower Department of Orthopaedic Surgery Winston Salem, NC 27157 Phone: 336-716-1442 Contact: Kimberly Mize Email : [email protected] Research/Publication Obligation: Yes Approximate percentage of training of interventional spine procedures by region: Cervical: 35% Thoracic: 5% Lumbar: 60% Fellowship Overview Since 2001, Dr. O’Brien has been the Director of the first and only previously PASSORRecognized Interventional Spine and MSK fellowship in North Carolina with over 35 graduates. This program was successfully relocated to Wake Forest School of Medicine in July 2021. We have two openings each academic year. Our program is geared towards training Physiatrists in the diagnosis and treatment of spine and musculoskeletal disorders. Fellows receive hands-on training in a variety of fluoroscopically guided procedures, such as: lumbar, cervical, and thoracic epidurals, nerve blocks and facet injections, facet cyst rupture, discography, peripheral joint injections and arthrography of the hip, shoulders, sacroiliac joint, elbow, wrist, ankle, subtalar and knee, radiofrequency ablations, ultrasound-guided procedures, regenerative medicine and electrodiagnostic studies. Fellows are exposed to evidence based medicine, weekly lecture series, interventional spine didactic and lecture series and have the opportunity to participate in research projects. Fellows get significant training in health policy, medical coding and other business aspects of medicine. David O'Brien Jr., MD is an Associate Professor, Fellowship Director and Medical Director of Spine at Wake Forest Baptist Health. He has 4 Board Certifications in Physiatry, Pain Medicine, Sports Medicine and Electrodiagnostic Medicine. He is on the Board of Directors for the North American Spine Society (NASS) and serves on the Executive Committee. He is a past Board Member for the Spine Intervention Society and still serves on the SIS health policy council. He has numerous publications and has given over 100 national/international presentations in at least 8 countries and continues serve as course Director and/or faculty for numerous national and international cadaver courses. Benefits Include Competitive salary with Health and Dental insurance. NASS-Recognized Fellowship. Physicians who are in good standing in a clinical American Board of Medical Specialties (ABMS) residency in Physical Medicine and Rehabilitation are eligible to apply. Start dates are typically mid-summer. Applicants should send c/v and 2 letters of reference to: [email protected] Procedures Taught PRP/Regenerative Medicine Ultrasound-guided Interventions EMG/NCS Kyphoplasty/Vertebroplasty Spinal Cord Stimulation Trials (optional) Sports Team Coverage (optional) Shoulder Arthrography Hip Arthrography Elbow/Wrist Arthrography Foot/Ankle Arthrography Radiofrequency Facet Denervation Cervical, Thoracic, Lumbar ESIs, nerve blocks, facet blocks and RFA Discography Sacroiliac injections/blocks

 

[Orin]

Those authors are basically from one institute as Tolba was at Wake Forest before moving to CCF-Dubai.

"Because the quality of education in non-accredited programs is not regulated through a crediting body, trainees should thoroughly research and understand a program’s risks and benefits. The authors believe that formal ACGME-accredited fellowship training should be required for any practicing pain physician to ensure quality of care."

There are plenty of ACGME accredited fellowships that are poor quality. The question avoided is what the purpose is for a fellowship.

"The goal is to produce comprehensive pain physicians with sufficient clinical and procedural acumen as well as multidisciplinary knowledge to confront the complexity of chronic pain. In a one-year time frame, it strikes a balance among didactic educational training, exposure to interventions, and clinic management."

Should we be training fellows for that? Is the procedural part more important? Is the clinic management critical? Should they be getting business training?
"Whether a pain medicine fellowship should be lengthened to more than one year instead of progressing tto a pain residency has been debated. Given the ACGME requirement to provide multidisciplinary education, the argument was made to extend the time to two years or more. Some educators and learners believe that a one-year fellowship has insufficient time for a fellow to become proficient in a plethora of interventions and complex clinical management. Because most graduates obtain employment at private practice–based settings, proficiency in the arenas of practice management, insurance, and billing is paramount."

Although this seems like a fluff piece for the CV/website, but there are a lot of important discussion we need to have about what a pain fellow needs to learn during the fellowship versus on the job, unless we make this thing into a really weird residency.

 

[Ducttape]

the argument that some ACGME fellowship are poor quality is a diversionary tactic that does not address the primary issue with non-ACGME fellowships. (argumentum ad hominem?)

i have been informed that there are specific internal mechanisms for ACGME to review the certification of their fellowships.



NASS has the potential to determine what is required to be taught at their fellowship programs and mechanisms to determine if their NASS fellows are adequately trained. having looked extensively at the NASS sites, im not really seeing that information posted, but perhaps it is out there somewhere.

that is in contradistinction to other "fellowships" that have no connection to NASS or ACGME, with no fundamental basis to determine quality of not only the program but the fellows themselves.

 

[myrandom2003]

I love the “my program is better than your program” debate while mid levels and everyone else is like… eff your program, I went to a weekend course and can do it too. (And cms and insurances are like, “yea you can do it for cheaper”)

 

[buddababa]

I love the “my program is better than your program” debate while mid levels and everyone else is like… eff your program, I went to a weekend course and can do it too. (And cms and insurances are like, “yea you can do it for cheaper”)

This.

 

[drusso]

I love the “my program is better than your program” debate while mid levels and everyone else is like… eff your program, I went to a weekend course and can do it too. (And cms and insurances are like, “yea you can do it for cheaper”)

Do weekend course graduates get paid less by insurance?

 

[DOctorJay]

Do weekend course graduates get paid less by insurance?

and are the facility fees lower?

 

[myrandom2003]

Do weekend course graduates get paid less by insurance?

Not the MD/DOs but I believe the mid-levels get somewhere around 80% of physician pro-fee. Haven’t looked at my fee schedules recently but they do list non-physicians in the fee schedule