PM&R vs Anesthesia, or "I'm Smarter Than You Are"

[ampaphb]

There has been an undercurrent of we're better/smarter than you arrogance recently, so let's bring it out into the open.

1) Are anesthesia trained pain docs superior to PM&R trained pain docs. If yes, why?

2) If you did your fellowship at a big name institution (MGH, BID, B&W, Texas Tech, Cleveland Clinic, etc.) 10-20 years ago, are you necessarily a better pain doc than those who trained at other institutions today? If yes, does that just apply to you personally, or to all of the folks who you trained with?

3) If you think you are a better pain doc than others on this site, please tell the board why that is the case. What skills do you have that others lack?

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[Aether2000]

There are many more subdivisions that one could question including:
1. Physicians practicing pain medicine that never did any training in chronic pain or spinal injections in residency and did not do a fellowship (many of the elder leaders of the field)
2. Physicians practicing pain medicine with an anesthesia residency with a clinical emphasis in pain during their final year (this was done in the late 80s and early 90s) but without a fellowship
3. Physicians practicing pain medicine with a residency in anesthesia, grandfathered board certification, no fellowship (possible from 1993-1998 for grandfathering)
4. Physicians practicing pain medicine with a residency in PMR, grandfathered board certification, no fellowship (possible until approx 2004 for grandfathering)
5. Physicians practicing pain medicine with a residency in anything else, grandfathered board certification in pain, no fellowship (possible until approx 2006)
6. Physicians practicing pain medicine with grandfathered board certification and non-ACGME fellowship in pain
7. Physicians practicing pain medicine with a residency in anesthesia and a ACGME fellowship in pain medicine (possible since 1992), but no board certification in pain by ABMS
8. Physicians practicing pain medicine with residency in PMR or anything else with a non ACGME fellowship in pain medicine but no board certification in pain by ABMS
9. Physicians practicing pain med with residency in PMR or anything else with a non ACGME fellowship in pain medicine, but no board certification by ABMS
10. Physicians practicing pain medicine with a residency in anesthesia, completed a ACGME fellowship, and board certified by ABIPM or ABPM or AAPManagement but not by ABMS in pain
11. Physicians practicing pain medicine with a residency in PMR or anything else, completed an ACGME fellowship and board certified by ABIPM or ABPM or AAPManagement but not by ABMS in pain
12. Pain physicians board certified and fellowship trained, but trained before there were upgraded standards for the programs (approx 2011-2012)
13. Pain physicians board certified ABMS in pain and ACGME fellowship trained after more rigorous standards were adopted
14. Pain physicians board certified ABMS in pain and ACGME fellowship trained and are active in research or teaching
And then there are the ACGME fellowships that were anesthesia, PMR, or neurology based before there was a unified fellowship model......

I think there are just too many permutations in our specialty due to a long and tortuous route of training and certification to be able to derive any meaningful division on who is the best pain physician prototype....

 

[drusso]

I agree. Many nuances to this question. Plus, you need to consider how much of an a$$hole a person is at baseline: I would take algosdoc's 14 categories and stratify them against three levels of a$$holicness--mild, moderate, and severe.

 

[ampaphb]

Personally, I find credentials useful to create initial impressions. If you trained at Mayo, I assume you are smart. If you went to Eastern Virginia, not so much.

If you prove yourself to be smart, that assumption goes out the window. Same if you prove yourself to be a *****.

Lastly, if I know and respect individuals that trained u, I respect your abilities no matter what the institution's reputation. Could be Newcastle, Australia, New Orleans, Louisiana, etc. On the other hand, if I think the doc who trained you is a *****, no amount of institutional prestige will alter my opinion.

 

[willabeast]

about the only generalizations i can honestly make between PMR and Anesthesia spine docs just outside of training is that Anesthesia is probably going to better at airway maintenance during resuscitations, and for a few months Anesthesia will probably be better at interlaminar ESI than PMR. after a few years, i suspect the resuscitation advantage will remain, but the ESI proficiency will equal out. i think my patients benefited a great deal in my (former) practice from my doing an internal medicine residency - but this would depend on the quality of your referrals. for example - i once received a consult for CRPS from a neurologist that i re-diagnosed as
Sporotrichosis
https://en.wikipedia.org/wiki/Sporotrichosis

 

[lobelsteve]

Personally, I find credentials useful to create initial impressions. If you trained at Mayo, I assume you are smart. If you went to Eastern Virginia, not so much.

If you prove yourself to be smart, that assumption goes out the window. Same if you prove yourself to be a *****.

Lastly, if I know and respect individuals that trained u, I respect your abilities no matter what the institution's reputation. Could be Newcastle, Australia, New Orleans, Louisiana, etc. On the other hand, if I think the doc who trained you is a *****, no amount of institutional prestige will alter my opinion.

Is there something you are not telling me?

 

[nvrsumr]

I did my internship at EVMS haha.

 

[deleted185747]

This thread is asinine and without purpose. I just met another CRNA this weekend who wants to do pain. Insurance dollars will go to the "provider" who accepts the lowest fee schedule. Self-referred patients will go to the "provider" with the best marketing program. Stopping the infighting and mount a real fight instead of the AMA's which will provide the platform to later define which doctor is better.

 

[Ducttape]

I think all you guys on private forum are geniuses even if I disagree with you...


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[SeniorWrangler]

True story: I was out shopping this weekend with Mrs. Wrangler at Sephora, a moderately high-end makeup store. I am watching her try a new eyeliner when I hear two young women shopping behind me talking about their residency, one said, "why even pay attention, I learn procedures better from YouTube anyway." So I'm not sure where you train means that much any more.

 

[oreosandsake]

i've learned a lot from University of Youtube. but it took a lot of training to figure out which videos were on point and others egregiously wrong... like the guy who buries a 1.5 inch needle doing a carpal tunnel injection

 

[bedrock]

True story: I was out shopping this weekend with Mrs. Wrangler at Sephora, a moderately high-end makeup store. I am watching her try a new eyeliner when I hear two young women shopping behind me talking about their residency, one said, "why even pay attention, I learn procedures better from YouTube anyway." So I'm not where you train means that much any more.

This is why I will never have an elective medical procedure without really knowing the performing physician.

I just had surgery this year by someone I've known for a long time and with whom I've observed operate on almost a dozen cases.

 

[powermd]

True story: I was out shopping this weekend with Mrs. Wrangler at Sephora, a moderately high-end makeup store. I am watching her try a new eyeliner when I hear two young women shopping behind me talking about their residency, one said, "why even pay attention, I learn procedures better from YouTube anyway." So I'm not where you train means that much any more.

This is where the a$$hole index suggested by drusso would come into play. Clearly these ladies rank severe.