AAPMR still does not get it: Member Councils

[lobelsteve]

Open up the latest AAPMR rag (Physiatrist) and there are two blurbs about the new SIG transition to the Member Councils.

THey still do not get it.

I am a Pain Physician. I have nothing to do with MS, ALS, Parkinsons, etc.

Who is in chanrge of this fiasco?

Russo- fix it.

Pain and Msk fit. Spine and Sports. Pain and Spine.
Not Pain and Brain.


Then you throw in a Democratic ad in there.... It's October's edition- not including how the Republican's will screw up healthcare as bad as the Democrat's makes me think of the fairness doctrine.

I need more coffee.

Russo for AAPMR Member at Large.
I'd do it but I'd make all the old folks sit the MOC like the rest of us.

---

Members don't see this ad.

 

[Disciple]

Steve,

I agree with you 100%

Please comment in the related "End of PASSOR" thread.

 

[drusso]

Steve, I've have already "shared" my opinion with the Academy Leadership about this issue arguing that Pain Medicine should be its own free-standing Membership Council encompassing both interventional and non-interventional pain practitioners; MSK/Spine and Neurmusc Med should be paired; and the rest is about right...

My suggestion is that everyone going to San Diego who cares about this issue should attend the Pain/Neuromusc Med Membership Council meeting (its open attendence) and voice your concerns.

David Bagnall is an interventionalist and is Chair of the Membership Strategic Coordinating Committee. Mike Furman is an effective BOG Member at Large for issues concering interventional physiatrists. Let these guys know what you think.

 

[Ludicolo]

Hey, Pain guys – rest assured that some of us non-pain physiatrists aren’t happy about the demise of PASSOR and the SIGs either. Would’ve been nice if the powers that be had involved its constituency in the decision making. Some people still have no clue. I had some residents the other day ask me for advice regarding what SIGs they should join.

While the creation of councils is supposed to unite the field of PM&R, one can already sense that some will want to separate. If Pain becomes its own free-standing membership council, then other subspecialties may want distinct councils, or at least subcouncils. SCI may want to be distinct from TBI/stroke. Neuromuscular may want to be apart from MSK, etc. Then we’re back to the SIGs again.

Although, it seems that almost everyone I've talked to is unhappy about this development. In that way I guess it has unified the field.

San Diego should be mighty interesting this year…

 

[dc2md]

As a resident with still growing knowledge of the AAPM&R workings, what do the SIGs give you guys that the councils will not?? Is it a power struggle issue? Is it monetary?

 

[Disciple]

It's the whole semantics thing (Pain, spine, sports, MSK?).

I know what my own personal practice consists of, but since I don't fully understand the thought process/reasoning that went into classifying the various councils, I don't know which council I should list as my primary.

For example, I do spine/procedures (basic to advanced) and even do some narcotic prescription. I do EMG and some sports med, so overall, my central theme is conservative management of Orthopedic pathologies.

Now, which council(s) am I supposed to join? seeing as I can only vote in 1 of them.

The way it's set up, I'm forced to choose which aspect of my practice I value the most.

 

[dc2md]

So would getting two votes solve the problem? That seems like an easy fix if so.

BTW, what exactly are you voting on/for?

 

[Disciple]

In January, each member is supposed to designate 1 of the 5 councils as their primary, and then that is the one council whose issues/business they are allowed to vote on.

PASSOR covered a large portion of outpt Physiatrists and I'm sure there are alot of soon to be former PASSOR members who don't know if they should designate the MSK Council (includes sports) or the Pain/Neuromusc.Council as their primary (Is this supposed to be where Interventional Physiatrist go? vs. the MSK Council, or both?) .

 

[drusso]

In January, each member is supposed to designate 1 of the 5 councils as their primary, and then that is the one council whose issues/business they are allowed to vote on.

PASSOR covered a large portion of outpt Physiatrists and I'm sure there are alot of soon to be former PASSOR members who don't know if they should designate the MSK Council (includes sports) or the Pain/Neuromusc.Council as their primary (Is this supposed to be where Interventional Physiatrist go? vs. the MSK Council, or both?) .

This entire idea needs to go back to the drawing board.

 

[lobelsteve]

This entire idea needs to go back to the drawing board.

Ditto.

But who is going to tackle this?

I'd jump in but I'm too abrasive and unpopular.


I vote Russo. And Depalma if he is still into it.

 

[ampaphb]

Dear Dr. Dugan:

I need to apologize up front for not being able to attend the upcoming PASSOR business meeting.

The current plan of creating the Councils, as currently constituted, do not serve those of us who practice outpatient interventional pain management. No single council meets the needs of those of us in the single most popular field of current and recent graduates.

As such, the PASSOR proposal to the AAPM&R Board of Governors which states in relevant part "Whereas the Academy has created a membership structure, Councils, that will meet the unique needs of the current PASSOR members, embrace the diversity of the specialty, and encourage active participation to strengthen the Academy" is not, in my opinion, the case.

Those of us who are involved in interventional pain will need to chose between pain and spine councils the way things are currently structured. We can not chose two primary councils, and thus the proposed Council structure divides PASSOR members, rather than integrating us into one "unified council". In point of fact, it does exactly the opposite.

As I will not be able to attend, I wish to oppose the resolution as currently constituted.

If you would care to discuss this matter, I would relish the opportunity to do so at your earliest opportunity.


[FONT=Default Sans Serif,Verdana,Arial,Helvetica,sans-serif]Peter

Thanks so very much for your response. Your objections were indeed ones that were discussed at great length at several Academy BOG meetings where the PASSOR perspective was considered at length given that Joel Press, William Micheo, myself, Mike Furman and Dave Bagnall were all part of these discussions.

It was so very difficult to find an organizational way to divide our specialty-if we simply left PASSOR as is there would be a largely disproportionate number in that Council. While we PASSOR members need to decide between 2 councils to meet all our practice needs, we can join multiple councils while declaring one primary council. With MSK and Pain in two councils, we will have access to the operational support of 2 councils rather than one. This council model will be closely followed as it is instituted.

Might I suggest that I get you in touch with Dave Bagnall who spent many long difficult hours crafting the council model? I am happy to talk with you as well but I think that Dave's input is also invaluable.


[FONT=Arial, Helvetica, sans-serif]Dear Dr. Dugan:

Meaning no disrespect, what was the logic to why MSK/EMG, and Spine/Pain were not paired?

I am sure the BOG gave this tremendously more attention than my cursory review, but those pairings strike me as reflective of the natural division of PASSOR into two equally representative councils. As now constituted, it strikes me that almost all of PASSOR will gravitate to the MSK council, leaving Pain/Neuromuscular to become the domain largely of the electromyographers.

I am approaching you, rather than Dr. Bagnall initially, in large measure becuase I percieve you as being less invested in the Coucil structure as currently constituted. As it is Dr. Bagnall's baby, challenging the very structure with him strikes me as likely to be a less fruitful discussion.
.


[SIZE=+0]Peter


[/SIZE].

 

[Disciple]

Thanks for posting that.

How about creating an Interventional sub-council and an Electrodiagnostics sub-council?

That way, we could reach consensus amongst all Physiatric Interventionalists whether they work in surgical groups, PM&R MSK groups, or pain practices, instead of having some voting in the MSK Council and some in the Pain/Neuromusc Council. Issues specific to style/type of practice could be addressed separately in the primary councils.

Same would go for electrodiagnostics, where practicioners from Neuromusc, MSK, Sports Med and Pain could all vote on issues specific to EMG/NCV, but could return to their respective primary councils to vote on issues specific to practice style/type.

 

[SSdoc33]

Thanks for posting that.

How about creating an Interventional sub-council and an Electrodiagnostics sub-council?

That way, we could reach consensus amongst all Physiatric Interventionalists whether they work in surgical groups, PM&R MSK groups, or pain practices, instead of having some voting in the MSK Council and some in the Pain/Neuromusc Council. Issues specific to style/type of practice could be addressed separately in the primary councils.

Same would go for electrodiagnostics, where practicioners from Neuromusc, MSK, Sports Med and Pain could all vote on issues specific to EMG/NCV, but could return to their respective primary councils to vote on issues specific to practice style/type.

exactly.

the logic behind pairing the councils the way they did seems to be so that no one particular council would be too large or powerful. the fallout of this is that no one particular council has any power to do the things you just mentioned. this division further weakens an already weak body.

 

[Ludicolo]

Thanks for posting that.

How about creating an Interventional sub-council and an Electrodiagnostics sub-council?

That way, we could reach consensus amongst all Physiatric Interventionalists whether they work in surgical groups, PM&R MSK groups, or pain practices, instead of having some voting in the MSK Council and some in the Pain/Neuromusc Council. Issues specific to style/type of practice could be addressed separately in the primary councils.

Same would go for electrodiagnostics, where practicioners from Neuromusc, MSK, Sports Med and Pain could all vote on issues specific to EMG/NCV, but could return to their respective primary councils to vote on issues specific to practice style/type.

While I like this idea, being an EDXer, I don't think that'll happen given the current BOG agenda. It seems too much like a drift back to the individual clinical SIGs and PASSOR system.

 

[lobelsteve]

exactly.

the logic behind pairing the councils the way they did seems to be so that no one particular council would be too large or powerful. the fallout of this is that no one particular council has any power to do the things you just mentioned. this division further weakens an already weak body.

What's a physiatrist?

When I was on the RPC, I caught a glimpse of the inner workings.
I'll continue to support ISIS and ASIPP and await the AAPMed to unify those two bodies in support of Pain. The AAPMR can do what it does best, continue to be completely irrelevant in serving the needs of its members and their patients.

 

[Disciple]

the logic behind pairing the councils the way they did seems to be so that no one particular council would be too large or powerful.

This is what I don't understand. None of the pain/spine/sports/MSK/EMG folks are going to be voting on issues specific to neurorehab and vice-versa, whether there is one big PASSOR type group or a bunch of small ones, so what power struggle is there really?

Why the need to have a bunch of councils all with relatively the same number of members in each?

Just to make everybody feel good about it?

 

[Disciple]

What's a physiatrist?

I'll continue to support ISIS and ASIPP and await the AAPMed to unify those two bodies in support of Pain. The AAPMR can do what it does best, continue to be completely irrelevant in serving the needs of its members and their patients.

(Hope you don't mind if I use your example Steve).

This is what happens when you don't get any love from your own. You stray from home.

Take Steve and multiply be several hundred to get a more representative count.

 

[ShrikeMD]

This is what I don't understand. None of the pain/spine/sports/MSK/EMG folks are going to be voting on whether issues whether there is one big PASSOR type group or a bunch of small ones, so what power struggle is there really?

Why the need to have a bunch of councils all with relatively the same number of members in each?

Just to make everybody feel good about it?

I don't know anyone who feels good about it. I'm a neurorehab guy through-and-through, and I think this idea is stupid. Why break up PASSOR? It appeared to be serving the needs of its members. Why not simply empower neurorehab groups to do the same, if they so chose (or can), and still remain within the organization.

This member councils idea seems to leave everyone unhappy. I can't find anyone who can articulate a compelling argument FOR this change.

 

[Disciple]

Exactly.

It sounds like the idea behind this is to make a bunch of small groups, of roughly the same size, and that this would promote unity, and make each of us feel like we're all equal.

I think most of us could care less about who is doing what, who is being given more importance, etc. as long as we can sit with others who have practices/interests similar to our own in a forum that allows us to conduct business effectively.

 

[SSdoc33]

I don't know anyone who feels good about it. I'm a neurorehab guy through-and-through, and I think this idea is stupid. Why break up PASSOR? It appeared to be serving the needs of its members. Why not simply empower neurorehab groups to do the same, if they so chose (or can), and still remain within the organization.

This member councils idea seems to leave everyone unhappy. I can't find anyone who can articulate a compelling argument FOR this change.

im not quite sure what PASSOR was doing for me, either, to be honest. put out guidelines? teach injection courses? organize lectures at the meetings? my thought is that PASSOR no longer served a real purpose which is why it dissolved. at least that was what was told to me by people "in the know". the council idea would theoretically make the academy more versatile and handle issues more easily. unfortunately, it look like the powers that be wanted no one particular council to dominate the others. so, in an effort to be versatile, we make a whole bunch of small powerless groups. this mirrors physiatry in general: JACK OF ALL TRADES, MASTER OF NONE.

 

[Disciple]

I don't know that they need scrap the whole "council" idea. It just needs to be thought out a little more.

How about decreasing from 5 councils to 4 and grouping MSK/Pain and Neuromuscular/Peds.

I am doubtful there are enough Pediatric Physiatrists to have a separate council (how many graduate yearly 5-8?), and ALS, Myotonic Dystrophy, seems to fit pretty well with Duchene's, FSH, SMA, etc.

 

[ShrikeMD]

I don't know that they need scrap the whole "council" idea. It just needs to be thought out a little more.

How about decreasing from 5 councils to 4 and grouping MSK/Pain and Neuromuscular/Peds.

I am doubtful there are enough Pediatric Physiatrists to have a separate council (how many graduate yearly 5-8?), and ALS, Myotonic Dystrophy, seems to fit pretty well with Duchene's, FSH, SMA, etc.

I think that this depends upon the necessity of having member councils of comparable size. I am entirely comfortable with the idea that subgroups of our specialty should reflect the size and interest of their (our) active membership. Numerous colleagues have an interest in MSK/Spine/Pain, so their organization(s) would logically be larger, and more influential too. Smaller groups would likely have less influence, but could take some comfort in knowing that at least their smaller group reflected/projected THEIR interests. Ideally, the larger groups would work cooperatively with the smaller ones whenever possible (and vice-versa), as the specialty benefits when its membership is both active and collaborative.

 

[Disciple]

Smaller groups would likely have less influence, but could take some comfort in knowing that at least their smaller group reflected/projected THEIR interests.

Yes, exactly.

It sounds like these councils will be designed to function independently. I think AAPMR members of a given council (and probably most of us here) couldn't care less about the size or popularity of another council, as long as the council that they are a part of is representing their interests effectively.

Part of the proposed setup seems like it was designed to make sure nobody's feelings get hurt.


Geez, political correctness in Physiatry?

 

[Disciple]

im not quite sure what PASSOR was doing for me, either, to be honest. put out guidelines? teach injection courses? organize lectures at the meetings? my thought is that PASSOR no longer served a real purpose which is why it dissolved. at least that was what was told to me by people "in the know".

Well, what else is there really, besides the political stuff? PASSOR membership has plateau'd since 2004, or even earlier. I think intially, it was the new go to organization for MSK/Interventional Physiatrists. Time went on and we started going to NASS, ISIS, ASIPP, AAPM and (hate to say it), even ASRA.

MSK/Interventional Physiatry kept moving forward, and PASSOR didn't keep up. Heck, the spine track at the AAPMR meetings only started last year. I think a good number of us here are getting far enough away from residency that we no longer have to agree with/accept everything our professional elders tell us.

C'mon everybody. Let's all get in the spirit of the season.

Yes We Can!

 

[PMR 4 MSK]

Part of the proposed setup seems like it was designed to make sure nobody's feelings get hurt.


Geez, political correctness in Physiatry?

With all the fragile egos up there in physiatry Godland, we do have to make sure no one goes home crying that the big meanies are making them sit next to someone at a council who is not their best friend.

 

[Ludicolo]

BTW - they released the names of the new council chairs:

The appointments are as follows:
· CNS Rehabilitation Council: Kathleen Bell, MD (Chair) and Steven Flanagan, MD (Chair-Elect)
· Medical Rehabilitation Council: Dale Strasser, MD (Chair) and Mary Catherine Spires, MD (Chair-Elect)
· Musculoskeletal Medicine Council: Venu Akuthota, MD (Chair) and Jonathan Finnoff, DO (Chair-Elect)
· Pain/Neuromuscular Medicine Council: Anthony Chiodo, MD (Chair) and Michael Saffir, MD (Chair-Elect)
· Pediatric/Developmental Disabilities Council: Maureen Nelson, MD (Chair) and Rita Ayyangar, MD (Chair-Elect)

 

[ampaphb]

I may not quite understand the structure, but my impression is, Councils serve the purpose of SIGs. As such, they have no direct political clout within the Academy, regardless of their size.

That being said, PASSOR concentrated all of the young, energetic, aggressive, involved docs in one very active organization.

It may be my cynical, suspicious, conspiratorial nature, but to me, decentralizing the power of PASSOR by forcing PAIN, SPINE, and MSK into different Councils will return the BOG, to the unchalenged power center, and remove any vestige of clout from the membership.

As currently constituted, they are a BAD idea, IMHO.

 

[Disciple]

BTW - they released the names of the new council chairs:

The appointments are as follows:
Musculoskeletal Medicine Council: Venu Akuthota, MD (Chair) and Jonathan Finnoff, DO (Chair-Elect)
· Pain/Neuromuscular Medicine Council: Anthony Chiodo, MD (Chair) and Michael Saffir, MD (Chair-Elect)

Hmmm....

So the the MSK council is going to be spine/sports and the Pain/Neuromusc council is going to be functional restoration, neurobiology of pain and clinical Neurophys.

Pretty clear statement that the AAPMR does not agree with the idea of an "Interventional Pain Physician".

 

[murphles]

wow-people actually belong to AAPM&R! What leadership? What support? It is PATHETIC that I can get more national talks at anesthesia conferences than I could ever get from my own specialty "old boys club". Seriously-people still go....?

 

[TRAMD]

They could just make 2 councils:

1. Pager - for those that carry a pager and take inpatient call.

2. Sans pager - for those that would rather wear a pink fanny pack with faux fur accents than a pager

I am in for Sans pager, where is my fanny pack?

But wait . . . I guess #2 is pretty similar to what PASSOR already was. Dang, I guess they shouldn't change it!

 

[nvrsumr]

Hmmm....

So the the MSK council is going to be spine/sports and the Pain/Neuromusc council is going to be functional restoration, neurobiology of pain and clinical Neurophys.

Pretty clear statement that the AAPMR does not agree with the idea of an "Interventional Pain Physician".

Dr. Chiodo is an interventional spine doc boarded in pain medicine. He is also PD of the SCI fellowship at UM and did a neurology based EMG fellowship. Was in private practice for a long time prior to academia and was very involved in the process of "combining" the UM PMR and anesthesia pain fellowships. I think he has a pretty good idea of the challenges facing PMR pain medicine physicians.

 

[ampaphb]

Dr. Chiodo is an interventional spine doc boarded in pain medicine. He is also PD of the SCI fellowship at UM and did a neurology based EMG fellowship. Was in private practice for a long time prior to academia and was very involved in the process of "combining" the UM PMR and anesthesia pain fellowships. I think he has a pretty good idea of the challenges facing PMR pain medicine physicians.

From the ABPM&R announcement of his appointment as a board member:

Dr Anthony E Chiodo MD
Ann Arbor MI
Dr Anthony Chiodo is an associate professor in physical medicine and rehabilitation at the University of Michigan Hospital. He is the director of Spinal Cord Injury (SCI) Medicine and the SCI Medicine fellowship program. He is board certified in Spinal Cord Injury Medicine, Pain Medicine and Electrodiagnostic Medicine, staffing the EMG lab and spine intervention suite in the PM&R residency and Pain Fellowship programs. He directs the Adult Spasticity Clinic and serves as the Spine Consultant for University of Michigan and Eastern Michigan University athletics.

Dr Chiodo has served the ABPMR as a Part II (oral) examiner and as a Part II vignette writer. His research topics include SCI, intrathecal baclofen, EMG, and needle exam localization techniques.
https://www.abpmr.org/communication/index.html

​

 

[Disciple]

So, what's your opinion on the appointment?

 

[ampaphb]

So, what's your opinion on the appointment?

I don't have one - I was just trying to find a succinct description of his clinical intersts and focus to continue the discussion of what direction he is likely to take the Council in.

 

[murphles]

That is the problem with Tony-he doesn't have a focus. He is spread a bit too thin. He really is that smart. But does he have time and focus to bring this all together....

 

[Ligament]

That is the problem with Tony-he doesn't have a focus. He is spread a bit too thin. He really is that smart. But does he have time and focus to bring this all together....

If anybody has the energy to do it, it's Tony. Agreed, he really is a "jack of all trades and master of all" type guy...

 

[Finally M3]

That is the problem with Tony-he doesn't have a focus. He is spread a bit too thin. He really is that smart. But does he have time and focus to bring this all together....

Tony is like high-quality (and high fat content) butter; extraordinarily intelligent, has the certification, and the ABPMR announcement is a bit dated in that he is also the interim director of the Spine Program at UMich. And they didn't include his interests in international rehab as well.

However good the butter is (and again, he is good), you put it on too much toast, and it will spread thin. He is juggling a LOT prior to the above appointments, and I would guess even more so now.

 

[Disciple]

I think the newly elected chairs/chair elects should be asked to attend the related SIG meetings this week for Q & A.

 

[lobelsteve]

I think the newly elected chairs/chair elects should be asked to attend the related SIG meetings this week for Q & A.

Q&A = target practice....

 

[drrinoo]

Well, what else is there really, besides the political stuff? PASSOR membership has plateau'd since 2004, or even earlier. I think intially, it was the new go to organization for MSK/Interventional Physiatrists. Time went on and we started going to NASS, ISIS, ASIPP, AAPM and (hate to say it), even ASRA.

MSK/Interventional Physiatry kept moving forward, and PASSOR didn't keep up. Heck, the spine track at the AAPMR meetings only started last year. I think a good number of us here are getting far enough away from residency that we no longer have to agree with/accept everything our professional elders tell us.

C'mon everybody. Let's all get in the spirit of the season.

Yes We Can!

ASRA is a excellent society--low cost, good journal, efficient utilization of resources, excellent lectures and meetings--they have published relevant guidelines concerning bleeding risk and infection risk.

Additionally, I have been honored as have a few other physiatrists to lecture at their meetings---this has been through the strong leadership and vision of Ken Candido. A number of anesthesiologists are very interested in musculoskeletal medicine....and at their pain meetings their topics range the entire gamut from acute pain, ultrasound, interventional pain, physiatry, and psychology.

ASRA has been significantly more relevant to my practice than AAPMR; I would encourage more physiatrists to join this society.