ACGME Accreditation for PM&R interventional spine fellowships

[Disciple]

Advertisement - Members don't see this ad

Anybody else attend this lecture at the AAPM&R convention?


What I got out of it:

1. The ACGME is moving towards standardizing training among Anesthesia/PM&R/Neurology/Psyche pain fellowships by requiring exposure to all four disciplines.

2. Currently, 50% of fellows in Anesthesia pain fellowships are physiatrists.
(Don't know if I actually believe this one or not).

3. There will never be a "Spine" subspecialty as designated by the ABPMR.
It would never garner respect from the Orthopedic Spine and
Neurosurgeons.

4. The 2006 cutoff date to be eligible to sit for the pain boards without
having completed an accredited fellowship will most likely not be
extended.

5. Is denial of reimbursement by insurance providers for interventional spinal
procedures without an accredited fellowship a possibility? Yes.
Will this be a problem currently or in the immediate future? No.

6. Many PM&R interventional spine fellowship directors will not be pursuing
ACGME accreditation because it's a pain in the ass.
Well, that was the sentiment I got when I was leaving the room anyway.




Discuss

 

[axm397]

yeah - I was there too - same sentiments. Seemed like the speaker from Rush (you're there, right?) was getting overwhelmed by technicalities of ACGME accreditation. I was suprised by the number of fellowship directors there - didn't know there were so many "lay" "private practice" fellowships.

I agree with you on the 50% number (of PM&R residents in anesthesiology fellowships) - seems quite high to me - I know, at least at my med school - the pain fellowship was via the Anesthesia dept and they prefer anesthesiologists over physiatrists. I find it hard to believe that they get much neurology, psychiatry, or PM&R input in that program... (Especially since the one physiatrist just QUIT and they JUST hired a new one) I have NEVER seen a neurologist or a psychiatrist in the pain clinic - which actually would be a nice addition since there is a neurologist who specializes in headaches. The argument that Anesthesiologists can make so much $$ doing "regular" anesthesiology without doing a pain management fellowship - so therefore they don't pursue them - seems like BS to me. I know MANY anesthesia residents who are planning on pursuing pain fellowships. There was even talk of CRNAs participating in pain fellowships. (I hope that is a rumor!)

I have never met a neurology or psych resident who was planning on or did pursue a pain management fellowship. When I asked about it during my neurology and psych rotations as a med student, many had never heard of the option and others had misconceptions of the fellowship. (i.e. psych - behavioral based chronic pain, etc.) 😕

I would really hope that PM&R fellowship directors will pursue ACGME accreditation no matter how much of a "pain in the butt" it is. It sounded like there were ways to get around some of the technicalities - especially according to the first speaker - ("exposure" to cancer pain, "exposure" to peds, etc. instead of "experience")

 

[paz5559]

The first speaker was Dr. Furman. His was a private fellowship, which associated with Sinai in Baltimore to be able to claim an accademic affiliation. His discussion of exposure vs experience seemed like a set-up for having his accreditation revoked when he is next reviewed. In any event, even if he gets away with it, it is a violation of the spirit, if not the letter, of the rules.

The speaker from Rush was Dr. Frank from CINN. His program is NOT currently ACGME accredited. The hoops he was being made to jump through made it sound untenable for his, or most other well-respected fellowships, to become accredited legitimately. Neither Joel Press (RIC), Stuart Weinstein (UW), Curtis Slipman (Penn), nor Lawrence Frank (CINN) are currently, or believe they will be ACGME accredited anytime soon, based on off the cuff comments each of them made at or after that meeting. I do know Dr. Goodman in Birmingham is working on a distant affiliation with the University of Missouri, so his might become certified soon. While MCV, Michigan, and Stanford all ARE ACGME accredited and well thought of, they each have their quirks to be aware of. MCV is a brand new program, and while one of Slipman's fellows just went there, it is a VERY laid back program at present. I do know one of the fellows from Eastern Virginia who is VERY strong academically, who they just took there, so maybe the teaching is getting more structured, but by reputation, it is still a program that is getting itself established. Stanford has gone through a huge transition now that Yung Chen and Connor O'Neil have left their program (they are no longer listed as an ACGME accredited program, though I believe they once were). Michigan has both an accredited and non-accredited tract you can follow, but most who trained there (and I have to admit, my sample size here is two) said your interventional exposure is much greater in the NON-ACGME accredited program.

UCLA and NRH also have accredited programs, and clearly are at great institutions, although I have no data on the quality of their fellowship training.

I spoke with the ABPM&R before the meeting, and with Barry Smith after. They were told by the ABA that there would be no further extensions granted to sit for pain boards. So in order to sit for them, you must have completed your non-accredited fellowship this year (2004), and have based the pain boards by 2006. In order to sit for the ABA pain boards (ie. sub-certification from ABPM&R) from now on, you will need to have completed an ACGME accredited fellowship.

Dr. Graibois did mention that the ABPM also offers pain boards. Although not part of the ABMS YET (they are lobbying hard for that status), that might be an alternate way to go for credentialing bodies, if you chose to go the non-ACGME route.

So does any of this matter? Probably not, at the moment. As you can see, the vast majority of PASSOR fellowships remain UNaccredited. Should you chose a lesser program because it is ACGME accredited? Clearly that is a decision each of us has to make for ourselves, but I know for me, the answer is clearly no. Give two programs of equal quality, will the accreditation make me more likely to go for that program? Yup. Will insurance carriers pay you more if you are pain boarded? Can't really see how they could. Could a hospital deny you privileges do do these procedures if you didn?t have your boards? Maybe, but since most people do the injections in their office, or in a surgi-center rather than in a hospital in the first place, do you really care? Is it possible you might need pain boards to function in the academic world in the future? Maybe.