Accredited vs. non-accredited Pain Fellowships

[Texas Premier]

I would like to get some feedback regarding accredited versus non-accredited Pain Fellowship programs, also what’s more important: Certificate or good training and experience? Any good privet practice non-accredited programs you may recommend? Appreciate any comments, thank you all.

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[Ligament]

This has been hotly debated on this forum and the PM&R forum over the past few months, I'd suggest doing a search. In short, this is what I personally think is important: ACGME training AND good training and experience.

I think the ACGME training and subsequent ABMS certification in Pain Medicine is important especially because so many pain organizations are trying to develop their own board certifications; I suspect that eventually this will reach critical mass and the non ABMS boards will get shot down. You can't (or should not) have 5 pain organizations each claiming to offer "certification in pain medicine." It just won't work in the long run. It does nothing but create confusion. Many (not all) of these alternate pain boards are trying to legitimize physicians with substandard training and qualifications. Why? There is (or was) big money in this pain medicine game. Everybody wants a piece. People are willing to pay big money to be "certified in pain" by the AAPM, ABIPP, FIPP, etc etc.

I've seen so many practices calling themselves pain medicine clinics when in fact the physician is "some dude on the corner" who took a weekend long cadaver course via AAPM and now claims to be a pain specialist. This does not help the patient, does not help the country, does not help legitimate pain clinics as they clean up the mess.

 

[PMR 4 MSK]

Non-ACGME means less chance of hospital privaleges in some places. In others, it doesn't matter. It also makes a difference for many of the board exams. Non-ACGME is usually better than none, but not always.

 

[Tenesma]

non-accredited spine fellowships.... do you realize what that means??

it basically means that some spine guys are going to make a MINT off of you while paying you less than they would have to pay a NP/PA...

i have thought about it:
1) create a spine fellowship
2) have spine fellow see my patients (i will supervise of course)
3) have spine fellow do all my procedures (and collect all the radiation)
4) pay the spine fellow 60k "stipend" for learning wonderful things from me
5) string the felllow along that I will make him partner or hire him --- which of course would be dumb --- because i can just hire a spine fellow the next year
6) make 300-600k/year profit off of said fellow

brilliant ----


BUT --- i have been screwed before in similar fashion (wasn't a fellowship though - it was a bad contract)... and I DON"T plan on putting another human being through that type of experience...

 

[ampaphb]

non-accredited spine fellowships.... do you realize what that means??

it basically means that some spine guys are going to make a MINT off of you while paying you less than they would have to pay a NP/PA...

i have thought about it:
1) create a spine fellowship
2) have spine fellow see my patients (i will supervise of course)
3) have spine fellow do all my procedures (and collect all the radiation)
4) pay the spine fellow 60k "stipend" for learning wonderful things from me
5) string the felllow along that I will make him partner or hire him --- which of course would be dumb --- because i can just hire a spine fellow the next year
6) make 300-600k/year profit off of said fellow

brilliant ----


BUT --- i have been screwed before in similar fashion (wasn't a fellowship though - it was a bad contract)... and I DON"T plan on putting another human being through that type of experience...

Which is why going to a fly-by-night non-ACGME accredited program, or one where the program director has a reputation for being an A$$ (e.g. Fortin), might not be a good choice.

Now Slipman, UW, RIC, Furman (?), Falco, Windsor, Prather, Latatuga, Goodman, Wolfe, Larry Frank, Rosenthal, DePalma, etc, etc, etc? Those still seem like perfectly reasonable choices, at least to me.

Also, don't forget, just 'cause a place is ACGME accredited, there is no guarantee you will actually LEARN anything.


Do your homework, and go where you will get the best TRAINING - the rest will work itself out, IMHO.

 

[drusso]

Also, don't forget, just 'cause a place is ACGME accredited, there is no guarantee you will actually LEARN anything.

Yes, but I think that captures the dilemma for most physiatry applicants to pain programs: Go to a quality, non-accredited PM&R fellowship and risk hosptial/credentialling issues; or go to *ANY* ACGME-accredited pain fellowship and use the accreditation as "money in the bank" for future endeavors...

The best solution for PM&R applicants would be for the programs you mentioned to become ACGME-accredited. And we all know how likely *that* is to happen... and then if we only had a matching process...

 

[ampaphb]

Yes, but I think that captures the dilemma for most physiatry applicants to pain programs: Go to a quality, non-accredited PM&R fellowship and risk hosptial/credentialling issues; or go to *ANY* ACGME-accredited pain fellowship and use the accreditation as "money in the bank" for future endeavors...

The best solution for PM&R applicants would be for the programs you mentioned to become ACGME-accredited. And we all know how likely *that* is to happen... and then if we only had a matching process...

Hospital accreditation is the chicken little all senior residents are afraid of - I would argue you should get the best training you can, period.

Given that the vast majority of us practice outside of the hospital setting, hospital credentialing means far less when you are doing your procedures in office or in an ASC.

As well, even if you are a hospital-based doc, generally, you have been recruited BY THE HOSPITAL for that scenario. After they spend all that time and money to find you and convince you to practice at their facility, how likely is it that they are then going to allow the petty anesthesiologist who doesn't want the competition to block your appointment to the medical staff?

The sky has been falling for years - first you weren't going to be able to get on insurance pannels - that hasn't been bourne out. Now it is hospital credentialing. Get the best training, cause the guys who don't know how to access a disk or thread a stim lead will have fare more trouble practicing in the future than those who don't have ABMS subspecialty certification.

 

[lobelsteve]

Yes, but I think that captures the dilemma for most physiatry applicants to pain programs: Go to a quality, non-accredited PM&R fellowship and risk hosptial/credentialling issues; or go to *ANY* ACGME-accredited pain fellowship and use the accreditation as "money in the bank" for future endeavors...

The best solution for PM&R applicants would be for the programs you mentioned to become ACGME-accredited. And we all know how likely *that* is to happen... and then if we only had a matching process...

You've got DP's flat iron too close to your head again.

I'm now booked 1 month out and I've only worked 1 month. I may need a fellow before the summer. Anyone want to join a non-accredited pain fellowship as a slave/punk/runner. I take my coffee IV push.

I always wanted to be the mean PD.

 

[Ligament]

non-accredited spine fellowships.... do you realize what that means??

it basically means that some spine guys are going to make a MINT off of you while paying you less than they would have to pay a NP/PA...

i have thought about it:
1) create a spine fellowship
2) have spine fellow see my patients (i will supervise of course)
3) have spine fellow do all my procedures (and collect all the radiation)
4) pay the spine fellow 60k "stipend" for learning wonderful things from me
5) string the felllow along that I will make him partner or hire him --- which of course would be dumb --- because i can just hire a spine fellow the next year
6) make 300-600k/year profit off of said fellow

brilliant ----


BUT --- i have been screwed before in similar fashion (wasn't a fellowship though - it was a bad contract)... and I DON"T plan on putting another human being through that type of experience...

Even better is to hire 7 or 8 spine fellows and make millions off them.

 

[Tenesma]

well here is the thing about ACGME vs non-acgme....

Most ACGME will expose you to the academics of pain - there will be opportunities to learn pain as a field...

Most non-acgme spine fellowships - you are basically the b_i_tch and you will be expected to be quick (ie: not too thorough) and to do the procedures one way or the high way... and you will be used for what they consider advantageous versus what would be good for your education.

i agree with ampa about looking for where the best training is - and frequently the best training is in acgme programs... sure you could do a fellowship with Bogduk (just kidding - but it is an easy example) and become the king of medial branch blocks and mechanics of the lumbar spine, but you won't be exposed to pediatric pain, cancer pain, etc...

 

[SSdoc33]

well here is the thing about ACGME vs non-acgme....

Most ACGME will expose you to the academics of pain - there will be opportunities to learn pain as a field...

Most non-acgme spine fellowships - you are basically the b_i_tch and you will be expected to be quick (ie: not too thorough) and to do the procedures one way or the high way... and you will be used for what they consider advantageous versus what would be good for your education.

i agree with ampa about looking for where the best training is - and frequently the best training is in acgme programs... sure you could do a fellowship with Bogduk (just kidding - but it is an easy example) and become the king of medial branch blocks and mechanics of the lumbar spine, but you won't be exposed to pediatric pain, cancer pain, etc...

you are not the bitch at MOST spine fellowships. you are the bitch at SOME fellowships where you let yourself be the bitch by going to that type of program.

a lot of spine fellowships are busy, where you get a high volume of procedures and learn how to be efficient. if you do 800 procedures, you are gonna mess some of them up, which will help you identify the complications, i imagine in some ACGME pain programs there is a lower volume, but more academics and likely more technique instruction. somewhere in the middle is probably the best training.

also, there will not be peds, cancer pain, facial pain, but there may be EMGs and sports, etc.

again, find a good fellowship that'll give you a base for what you'd want to do.

btw, bogduk is not the lumbar spine mechanic king. stuart mcgill is.

 

[drusso]

You've got DP's flat iron too close to your head again.

But, DP said that if you listen closely you can hear the ocean.

 

[ampaphb]

but you won't be exposed to pediatric pain, cancer pain, etc...

What percentage of your current practice is made of of cancer pain and peds?

 

[Disciple]

i agree with ampa about looking for where the best training is - and frequently the best training is in acgme programs... sure you could do a fellowship with Bogduk (just kidding - but it is an easy example) and become the king of medial branch blocks and mechanics of the lumbar spine, but you won't be exposed to pediatric pain, cancer pain, etc...

That's just it, Spine fellowships are there to teach advanced level biomechanics and physical diagnosis with treatment supplemented by injections/interventions. They're designed to place graduating fellows into ortho or Neurosurg groups or Physical Medicine groups where, admittedly, the volume is lower because more time is spent on physical diagnosis (evaluation), perhaps at the expense of management.

Some people specifically seek out spine fellowships for this reason. Maybe they shouldn't be called pain fellowships.

Rick Derby's current fellow is a graduate of the RIC sports/spine fellowship I believe. The skill set said individual should possess upon graduation is what will become more commonplace in Physiatry over the next 10-15 years.

 

[joshmir]

"Hospital accreditation is the chicken little all senior residents are afraid of - I would argue you should get the best training you can, period.

Given that the vast majority of us practice outside of the hospital setting, hospital credentialing means far less when you are doing your procedures in office or in an ASC."


attendings on this board have posted that in some competitive markets, you need to have local hospital privileges to be reimbursed by some third party payers

not a reason to do an acgme-accredited fellowship, but something that would suck to get blindsided by.

 

[Tenesma]

i see about 4-5 kids per month in consultation and about 4-5 cancer per week... rest is the usual.... i like it because it keeps things interesting... I am glad that i do have some background because I feel a lot more comfortable with some of the issues...

but i agree with your underlying point - technically all you need is spine exposure in E&M and procedures and you will do fine with 90% of your future consultations...

there are certain things that i did during my fellowship that I WON'T be doing in real world (ie: Trigeminal RF, Pop Fossa catheters, etc..) so maybe that WAS a waste of time?

 

[Louisville04]

"Hospital accreditation is the chicken little all senior residents are afraid of - I would argue you should get the best training you can, period.

Given that the vast majority of us practice outside of the hospital setting, hospital credentialing means far less when you are doing your procedures in office or in an ASC."


attendings on this board have posted that in some competitive markets, you need to have local hospital privileges to be reimbursed by some third party payers
not a reason to do an acgme-accredited fellowship, but something that would suck to get blindsided by.

I think it was mentioned on the board before....you can apply for pm&r consult privileges not pain procedures.

 

[Ligament]

"Hospital accreditation is the chicken little all senior residents are afraid of - I would argue you should get the best training you can, period.

Given that the vast majority of us practice outside of the hospital setting, hospital credentialing means far less when you are doing your procedures in office or in an ASC."


attendings on this board have posted that in some competitive markets, you need to have local hospital privileges to be reimbursed by some third party payers

not a reason to do an acgme-accredited fellowship, but something that would suck to get blindsided by.

Yes, in my area some of the insurance carriers will not let you become a "network provider" unless you are board certified in your specialty. If you signed a contract that hinged on you being able to treat patients in that network, could be problematic... Might be able to do a work around with a board cert in your primary specialty, you just wouldn't be listed in the coveted "provider directory" as a pain medicine specialist.

Also some of the hospitals here won't let you do procedures in their facilities without being Boarded. In some areas, you can find an ASC that will take your patients, no problem. In other areas, who knows...

If you are going to be in an under served area, none of this will be an issue, they will take anyone willing and able. In metropolitan areas with high competition, it will probably become an issue at some point.

 

[SleepIsGood]

Am I hearing people on here correctly?

So basically you can graduate residency at said hospital/univ from an anesthesiology (or PMR) program. Then you can apply to ACGME accredited Pain fellowships. However, let's say you dont get them. THere are private practices that offer "fellowships' in pain (which I assume are less academic, however, you get a lot of exposure) ?

 

[SleepIsGood]

?

 

[PainDr]

I had problems with one particular insurer. They informed me that they "require completion of an ACGME fellowship" (which I had done). Wouldn't add me to their list until I provided proof, which was kind of humorous since my fellowship is very well known and highly regarded. All I had to do was provide the info and they approved me, but it was still surprising.

 

[ampaphb]

I had problems with one particular insurer. They informed me that they "require completion of an ACGME fellowship" (which I had done). Wouldn't add me to their list until I provided proof, which was kind of humorous since my fellowship is very well known and highly regarded. All I had to do was provide the info and they approved me, but it was still surprising.

what insurer was this, and where are you located, if I can ask.

 

[PainDr]

Preferred Community Choice (PPO) and Community Care (HMO). I'm in the midwest.

 

[jsaul]

the competition just hired a non accredited fellowship guy and he has had no problems getting on all the insurance plans. the hospitals and surgi centers all begged for his business and he got privaledged there as well.

my group hired a non accredited fellowship guy and the same thing applied. And we all practice in a large major metro area

sure one small insurance here or there may give someone some grief, but as far as gettting privaledges to do procedures-- from what i've seen and heard- it's not hard at all. they want to make money too

 

[SleepIsGood]

thanks for the answers...

I guess this is really all about perspective and what you want to get out of the fellowship.

 

[GasDocInc]

Just started a non-accredited pain fellowship in Texas.......excellent on the business side of Pain not so on the medical side( I have 15 years of private pain/anesthesia experience ) Being that it is non-accredited I know the vast majority of major hospitals will not credential me.....however I have the capital & plan to set up my own pain clinic ...get the available boards and practice pain management . I have 3 example of Docs that have ABPM board certification that are doing quite well. But is this just a pipe dream when going up against ACGME accredited pain specialist ?? Your thoughts

 

[clubdeac]

I think if you've been practicing for 15 years you can get grandfathered in and sit for the ABMS boards. That's what this neurologist did who just joined my group. At first I thought he was only boarded through ABIPP and ISIS but low and behold he sat for the actual ABMS boards and is certified. He never did a fellowship?

 

[lobelsteve]

Just started a non-accredited pain fellowship in Texas.......excellent on the business side of Pain not so on the medical side( I have 15 years of private pain/anesthesia experience ) Being that it is non-accredited I know the vast majority of major hospitals will not credential me.....however I have the capital & plan to set up my own pain clinic ...get the available boards and practice pain management . I have 3 example of Docs that have ABPM board certification that are doing quite well. But is this just a pipe dream when going up against ACGME accredited pain specialist ?? Your thoughts

CRNA or NP does not require boards and can do everything you do. And in many states can do it with no supervision. SO I would not worry about it.

 

[GasDocInc]

I know it does not make a difference in Florida or California. I know people in Texas practicing pain without ABA boards that are doing quite well . Thanks anything that decreases worry is good. !

 

[TXDOC15]

Just started a non-accredited pain fellowship in Texas.......excellent on the business side of Pain not so on the medical side( I have 15 years of private pain/anesthesia experience ) Being that it is non-accredited I know the vast majority of major hospitals will not credential me.....however I have the capital & plan to set up my own pain clinic ...get the available boards and practice pain management . I have 3 example of Docs that have ABPM board certification that are doing quite well. But is this just a pipe dream when going up against ACGME accredited pain specialist ?? Your thoughts

I am looking for pain fellowship in Texas aswell. Would you be willing to share info of your place?

 

[Ducttape]

regional differences.

obviously anyone with any credentials - and no credentials - can open up shingles in a private practice and call themselves board certified in pain. just pay your $$ to an organization offering certifications.

agree that the only real concern is that individual insurances or hospitals may not take these bogus pain certifications.

 

[EtherBunny]

I think it's a bad idea to go for a non-ACGME accredited pain fellowship. Why limit your options? Granted, there are places where you can practice successfully without ABMS certification in pain medicine (or eligibility for certification), but there are also many places that won't hire a candidate from a non-accredited fellowship. The hospital where I work, for instance, would not hire anyone without an ACGME accredited pain fellowship. Evidently, some of the insurers in my area won't reimburse physicians who perform interventional pain procedures unless they have an ACGME accredited fellowship in pain and are either board certified in pain or eligible for ABMS certification in pain.

Unless you know with 100% certainty that you'll be able to practice the way that you want in a particular area of the country (where you--and your family--would be happy) with a non-accredited pain fellowship under your belt, why on Earth would you take the risk of limiting your practice options?

 

[oreosandsake]

I am looking for pain fellowship in Texas aswell. Would you be willing to share info of your place?

I believe Aaron Calodney in Tyler Texas still has a fellowship.

 

[Crybaby]

I would go for an ACGME fellowship. I did a non accredited and had excellent training. However, where I moved to practice I am encountering some difficulties. It doesn't bother me too much that one of the main hospitals in town will not allow me to do any injections because that particular center is slow and I do not have to take the crappy hospital call. The malpractice coverage is being difficult and that is what really is frustrating.