American Board of pain Medicine vs Anesthesia Pain certification???

[Aether2000]

One correction re: qualifications for a pain fellowship or to take ABMS Boards: you can have training in any ACGME certified residency program (eg. genetics) and be eligible to enter a pain fellowship and sit for the ABMS board exam in pain medicine. It is not a 100% legit certification due to massive grandfathering that occurred over a decade with thousands and thousands "board certified" by the ABMS with special qualifications in pain medicine when they really have no training in pain and are not specially qualified in anything. For that reason, if one touts ABMS certification as some sort of proof of competency, that would be an incorrect assumption. But, in todays climate, for new physician graduates, it would definitely be worth taking the exam since eventually the certification will not be tainted by the thousands of untrained unqualified physicians currently in practice that were certified by this board. That is assuming of course that the fellowship directors continue to have a large enough number of relevant background residency trainees wishing to pursue pain. If those numbers drop, then we will see geneticists with no relevant background training doing a one year fellowship, being certified by the ABMS in pain, and begin implanting stims and doing RF all for the purpose of filling the pain fellowship slots. We saw this in the past in anesthesiology in 1994-97 when large numbers of FMGs entered the anesthesiology programs, some incapable of speaking the english language. So residency and fellowship programs will gladly prostitute themselves to accepting less qualified individuals if there is a need for warm bodies. But for now, life is good in pain fellowship 1-year residency programs with sufficient numbers to make them look good....

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[SSdoc33]

This is a great idea. I have heard of other sponsoring boards doing things like this in exceptional cases.

agreed. PM&R tends to be a lot more "DO-friendly" than just about everyone else....

 

[Ducttape]

algosdoc, by your comments, it seems to imply that you do not feel that there is any way of showing competence.

i would contend, however, that most fellowship programs do take strongly into consideration an individual's qualifications and how they perform before allowing them to sit for boards. I doubt, given the current climate and the probable future expansion of pain patients, that there will be such a dearth of unqualified individuals applying for pain, and fellowship programs are of course responsible for the quality of physicians that they "put out".

This concept that image reflects on the program and encourages continued interest in the program is not a minor factor and does definitely encourage teaching physicians to "produce" the best physicians possible, be they fellowship or residency training.

i am not as cynical as you are with regards to teaching programs, probably in no small part due to the fact that i was involved in such a program up until 2 years ago...

 

[Aether2000]

I am more a realist than a cynic. The primary factor that has driven interest in dealing with the chronic pain population is money. Pain docs in general make more than anesthesiologists, and a whole lot more than PMR. And 4-5 times that of FP. So the incentive at this point to maintain quality applicants is definitely present, and that is $$$$. However, in an era of government and private payer reductions or elimination of the procedures we do, implementation of pages of regulation that must be followed to do a trigger point injection (read the Medicare criteria recently?), and competition with other pain physicians, I believe pain physician income for those that are only procedure based will fall, and not necessarily slowly. Once this happens, those bright individuals that have found they can no longer pull in 1/2-1 mil by lining people up and sticking needles into them will either diversify (lower revenue) or will cast their net wider (difficult to do with competition abounding) , but there will be a point when reimbursement falls to the point the practice of pain may not attract the brightest bulbs. Not that pediatricians, FPs, or geneticists are not bright, but the door is wide open (thank you ACGME) for these non sequitur entities to complete their residencies and move directly into pain medicine. Then they can be board certified by the same board as you are (thank you ABMS, ABA, ASA, ABPMR, and ABN).
So keep your eye on the bottom line: follow the money.

 

[emd123]

I agree Algos. The ways of the world (including the medical world) can seem so puzzling until you call "bulls--t" on people's motivations and....




....follow the money. Then, all of a sudden, things start to make a lot more sense.

 

[Jcm800]

....follow the money. Then, all of a sudden, things start to make a lot more sense.

says the ER doc that ended up in pain management i just kidding...

 

[Ducttape]

says the ER doc that ended up in pain management i just kidding...

i would have happily stayed in EM, but since i missed grandfathering for EM (by a few months), i couldnt...

now, i cant imagine waking up at 6pm to go in for a 12 hour night shift!

so i guess i am one of those "less qualified individuals" that leave a primary care specialty and go into Pain!!

 

[emd123]

says the ER doc that ended up in pain management i just kidding...

Docshark,

I'm not sure about that, but I am sure that your heart bleeds with guilt every time you cash your paycheck. You purposely undercode so that the government can keep a bigger chunk of your cash to further social justice. You secretly pray that Pain reimbursement get slashed some more so that more money can be made available for underpaid and under appreciated primary care doctors. You drive a Prius, support green jobs, and only eat free range chicken. You are a great man (or woman). Keep up the good work.

 

[Jcm800]

Docshark,

I'm not sure about that, but I am sure that your heart bleeds with guilt every time you cash your paycheck. You purposely undercode so that the government can keep a bigger chunk of your cash to further social justice. You secretly pray that Pain reimbursement get slashed some more so that more money can be made available for underpaid and under appreciated primary care doctors. You drive a Prius, support green jobs, and only eat free range chicken. You are a great man (or woman). Keep up the good work.

nope. dont eat chicken. everything else is spot on...

 

[Doctodd]

nope. dont eat chicken. everything else is spot on...

 

[emd123]

Oh snap...I should have known. Organic vegan. Seems so obvious now. My bad.