american board of pain medicine

[pikas]

Hi,
I am planning on taking the American board of pain medicine exam in 2010. Can anyone please guide me regarding any board review type material.
I saw someone previously posted about the Dannemiller course, I think I don't have the time for that. The CDs seem a little steep, although I'll take it if thats the only option.
Thanks

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[nvrsumr]

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[member11363]

How did your test go...what would you recommend best to study..don't have alot of time..test in april 2013

 

[PinchandBurn]

Is there any benefit in taking this exam? It's not ABMS certified.....

Thoughts? I dont want to waste a few thousand bucks if it's unnecessary (and assuming I passed the ABA Pain exam).

 

[bedrock]

Is there any benefit in taking this exam? It's not ABMS certified.....

Thoughts? I dont want to waste a few thousand bucks if it's unnecessary (and assuming I passed the ABA Pain exam).

No reason to take it if you can take ABMS.

For those who did an unaccredited fellowship, it's probably worth doing, but you have to be careful how you market that credential as it's illegal in most states to say that you're "pain boarded" unless it was through ABMS. The exceptions are california, florida and 1-2 other states(texas?) which recognize passing the ABPM boards as being pain boarded.

 

[101N]

I work in an area where a 2005 family medicine doc, with no fellowship, took this exam and is certified by the ABPM.

 

[bedrock]

I work in an area where a 2005 family medicine doc, with no fellowship, took this exam and is certified by the ABPM.

The ABPM board isn't extremely valuable, but I still recommend it to friends who did non-accredited fellowships.
I also told them to highlight FELLOWSHIP-TRAINED in their marketing, because fellowship training is still the key thing separating them from the FPs and NPs who like to dabble in pain after they did a weekend course.

 

[Ducttape]

Is there any benefit in taking this exam? It's not ABMS certified.....

Thoughts? I dont want to waste a few thousand bucks if it's unnecessary (and assuming I passed the ABA Pain exam).

i dont think there is any reason for you to even consider the "other" test

 

[mille125]

No reason to take it if you can take ABMS.

For those who did an unaccredited fellowship, it's probably worth doing, but you have to be careful how you market that credential as it's illegal in most states to say that you're "pain boarded" unless it was through ABMS. The exceptions are california, florida and 1-2 other states(texas?) which recognize passing the ABPM boards as being pain boarded.

Texas does not recognize it. It is illegal to say "pain boarded" with this exam..

 

[mille125]

Is there any benefit in taking this exam? It's not ABMS certified.....

Thoughts? I dont want to waste a few thousand bucks if it's unnecessary (and assuming I passed the ABA Pain exam).

Use your money for something else. There is no advantage unless you want to take it.

 

[emd123]

If you're ACGME fellowship trained, don't take this Board. If you did the fellowship, why waste your time? That's the whole point of an accredited fellowship, so you can sit for the real deal. Don't give it excess credibility by putting it after your name.

Leave that Board for people who aren't ACGME fellowship trained, and leave the ABA/ABMS Board for those who are. That way it separates the two, and makes it clear where everyone stands, ie, who made the cut and who didn't, who took shortcuts and who didn't.

I busted my tail, climbed cliffs and moved mountains to get a ACGME-fellowship, to graduate and pass so I could sit for that damn test. God willing that I find out in 6 wk that I passed it, do you think I'm going to shell out some more cash for a test you can take after a weekend course? Fuggetaboutit!!

 

[PinchandBurn]

If you're ACGME fellowship trained, don't take this Board. If you did the fellowship, why waste your time? That's the whole point of an accredited fellowship, so you can sit for the real deal. Don't give it excess credibility by putting it after your name.

Leave that Board for people who aren't ACGME fellowship trained, and leave the ABA/ABMS Board for those who are. That way it separates the two, and makes it clear where everyone stands, ie, who made the cut and who didn't, who took shortcuts and who didn't.

I busted my tail, climbed cliffs and moved mountains to get a ACGME-fellowship, to graduate and pass so I could sit for that damn test. God willing that I find out in 6 wk that I passed it, do you think I'm going to shell out some more cash for a test you can take after a weekend course? Fuggetaboutit!!

I feel the same way, since we are guys that did it the right way. LOL....but to the general public "American Board of Pain Medicine" sounds a lot better than "American board of anesthesiology, Pain medicine". We know the latter is the real deal, but patients/refers may think that we are still just 'anesthesiologists'.

 

[Aether2000]

Because of the thousands of grandfathered individuals by the ABMS additional qualifications in pain medicine board, it is not worth the paper it is printed on. These grandfathered individuals had no training in pain at all and simply took the exam, same as the ABPM. The only litmus test can be the uniform fellowships that had enhanced requirements....this means those who graduated after 2010 from a pain fellowship. The fellowships before that time were all over the map on their quality and training, therefore cannot be used as a differentiating mechanism for quality.

 

[emd123]

Because of the thousands of grandfathered individuals by the ABMS additional qualifications in pain medicine board, it is not worth the paper it is printed on. These grandfathered individuals had no training in pain at all and simply took the exam, same as the ABPM. The only litmus test can be the uniform fellowships that had enhanced requirements....this means those who graduated after 2010 from a pain fellowship. The fellowships before that time were all over the map on their quality and training, therefore cannot be used as a differentiating mechanism for quality.

Agree, but....accredited fellowship grads still should take the ABMS exam and since grandfathering is closed, as the years go by, the grandfathered people will phase out and retire. Eventually, the only ABMS Pain boarded people will be those that did an accredited fellowship.

All specialties and subspecialties have gone through this process (which, Algos, I know you).

As far as patients go, they have NO CLUE, what any of the Boards, subspecialties or primary specialty stuff means. That's way they bounce from chiropracter, to ER, to internist, to Boarded Pain doctor, to unboarded Pain doc, to crna and back.

The only people that know or care other than us are the Boards themselves, hospital credentials committees, and insurance companies. Obviously, sometimes these entities don't even pay attention, which is why you have so many "fly by night" so-called "Pain Doctors" with no training at all.

 

[bedrock]

Because of the thousands of grandfathered individuals by the ABMS additional qualifications in pain medicine board, it is not worth the paper it is printed on. These grandfathered individuals had no training in pain at all and simply took the exam, same as the ABPM. The only litmus test can be the uniform fellowships that had enhanced requirements....this means those who graduated after 2010 from a pain fellowship. The fellowships before that time were all over the map on their quality and training, therefore cannot be used as a differentiating mechanism for quality.

Generally true, but there are still a lot of very weak fellowships out there. Talking to recent fellows at conferences, I have been shocked at some of the poor procedural numbers, didactic quality, and questionable attending practice patterns at various ACGME certified pain fellowships.

Unfortunately, I still don't trust someone just because they did an ACGME pain fellowship, the way I would trust someone who did an ACGME GI fellowship.

 

[PinchandBurn]

Generally true, but there are still a lot of very weak fellowships out there. Talking to recent fellows at conferences, I have been shocked at some of the poor procedural numbers, didactic quality, and questionable attending practice patterns at various ACGME certified pain fellowships.

Unfortunately, I still don't trust someone just because they did an ACGME pain fellowship, the way I would trust someone who did an ACGME GI fellowship.

there maybe some variations in ACGME accredited fellowships in terms of procedural experience (luckily I was in a very high volume place).

However, I think the unifying attribute of an ACGME fellowship, graduated fellow is that they typically know the things NOT to do, or when NOT to do something. I would suggest that that there is atleast a 'minimum' understanding that they all share. I think that's huge.

 

[lobelsteve]

there maybe some variations in ACGME accredited fellowships in terms of procedural experience (luckily I was in a very high volume place).

However, I think the unifying attribute of an ACGME fellowship, graduated fellow is that they typically know the things NOT to do, or when NOT to do something. I would suggest that that there is atleast a 'minimum' understanding that they all share. I think that's huge.

Nope. I've met folks who had nice pedigrees who knew nothing. Other folks who trained with the dinosaurs and have no cert do amazing things.
With Rathmell's pif, ACGME is pretty worthless. Read it at the ACGME website. Worthless.

 

[Ducttape]

Nope. I've met folks who had nice pedigrees who knew nothing. Other folks who trained with the dinosaurs and have no cert do amazing things.
With Rathmell's pif, ACGME is pretty worthless. Read it at the ACGME website. Worthless.

i would counter that having anyone now interested in going into pain, at this stage of the game, undergo an ACGME fellowship is not worthless. and i know this goes counter to your opinion, having an unaccredited fellowship.

pls remember that i was at the other end of this debate, having done Internal Medicine residency, then worked in Emergency Medicine. I believe, in my heart, that i knew more EM than 95% of the residents that i helped train, and probably more than half of my (former) EM colleagues. All that comes from study, clinical experience, discussions with specialists, etc. i.e. hard work.

yet i could not work in EM because i hadn't done the vetting necessary to be board certified. do i remain a little perturbed? sure, since they put in the rules after i started on my path and it was too late for me. do i think its fair? no, but i am in a better place now. but i understand that there is something that goes beyond just knowing stuff, otherwise any person can just "stay at a holiday inn" and work as a physician. and there is currently no clear way of demonstrating that commitment, other than fellowship and testing.

someone wanting to working in a given field needs to demonstrate that commitment, and not just in some "fly by nite" kind of manner (i.e. CRNA and weekend courses). and there need to be standards that are stressed and maintained as much as possible. i personally feel one of the reasons why CRNAs feel that they can push into pain is because there isnt that standard out there. (You dont see CRNAs trying to advertise themselves as neurosurgeons, or xray techs/ultrasonographers as radiologists.)

now pertaining unaccredited fellowships - all of the docs that you train are highly skilled and proficient and while i dont know you or them, i would definitely refer my family to you all. but what about others? whats to say whether these CRNA fellowship programs that have sprouted up arent going to be some BS "work while you learn - just pay me $xxx and you will pass" kind of program?

 

[lobelsteve]

The standards set by the ACGME in the pif are insufficient to allow appropriate training and need to be modified to allow more significant training.

Back to square one:

Pain needs a residency. Pain docs should be owned by the government.
Pain docs should be paid 60% MGMA for pain with COLA.
No bonus for procedures.
No other providers can perform our procedures in outpatient setting and get paid for it.
No other providers can Rx opiates for CNMP. If we don't think opiates are needed, then the patient does not get them.

Would anyone sign up?

How about if I throw in sovereign immunity from medmal (VAMC type rules to apply)?

Folks making $700+ would say no. Under that, I bet a fair amount of us would agree to this knowing we work M-F 8-5, get a govt pension and benefits, get to do whatever procedures we deem necessary (and not for profit), Rx as we see fit, and be able to take care of patients however we would like. Caveat- must see 24-30 patients per day.

 

[Ducttape]

in fact, i do work M-F 8-5 (actually, 6ish), with a salary. id love to see those changes.

you are right, most people would not agree. on the other hand, with the hand we have been dealt with, since we cannot create these changes, i believe that we should insist on certain minimum standards, above and beyond what any person with minimal medical training can complete, so that future pain providers can at least be screened and vetted.

 

[101N]

Pain docs should be owned by the government.

No problem with the rest, but this NEVER.

 

[emd123]

Nope. I've met folks who had nice pedigrees who knew nothing. Other folks who trained with the dinosaurs and have no cert do amazing things.
With Rathmell's pif, ACGME is pretty worthless. Read it at the ACGME website. Worthless.

Disclosure: I do not benefit financially in any way from non-accredited fellowships associated with my practice (or accredited).

Arguing that the minimal standards needed to have an ACGME fellowship accredited are not tough enough is not a valid arguement to have NO STANDARDS. It is a valid argument to make ACGME requirements and standards tougher. So are we to conclude that because there are some substandard fellowships out there, that we should discredit all accredited fellowships including the good ones? No. I was fortunate enough to go to a program that blew the vast majority of the ACGME required numbers out of the water. However, requiring a minimal, yet insufficient amount of procedures is better than none. The bar can and should be raised over time. The rationale being that low standards are better than no standards.

There are poor performing accredited fellowships and residencies in all specialties and subspecialties. You know what they do with them? They tell them to improve or they are shut down. They don't eliminate accreditation and have them all go non-accredited.

Do we disband all ACGME accredited neurosurgery programs, GI fellowships and cardiology fellowships with the rationale that non-accredited ones might possibly be just as good? No.

Why do we even bother with accredited PMR, Anesthesia or any other accredited residencies? Couldn't you argue that it's possible for an experienced anesthesiologist to teach a group of medical school graduates how to practice anesthesiology, on his own, without them doing residency? Sure it's possible, but we should not support going back to that early 1900's type mentality.

The bottom line is: a specialty or subspecialty that takes itself seriously,

1) Sets official standards, then at some point
2) Raises those standards.

i would counter that having anyone now interested in going into pain, at this stage of the game, undergo an ACGME fellowship is not worthless. and i know this goes counter to your opinion, having an unaccredited fellowship.

pls remember that i was at the other end of this debate, having done Internal Medicine residency, then worked in Emergency Medicine. I believe, in my heart, that i knew more EM than 95% of the residents that i helped train, and probably more than half of my (former) EM colleagues. All that comes from study, clinical experience, discussions with specialists, etc. i.e. hard work.

yet i could not work in EM because i hadn't done the vetting necessary to be board certified. do i remain a little perturbed? sure, since they put in the rules after i started on my path and it was too late for me. do i think its fair? no, but i am in a better place now. but i understand that there is something that goes beyond just knowing stuff, otherwise any person can just "stay at a holiday inn" and work as a physician. and there is currently no clear way of demonstrating that commitment, other than fellowship and testing.

someone wanting to working in a given field needs to demonstrate that commitment, and not just in some "fly by nite" kind of manner (i.e. CRNA and weekend courses). and there need to be standards that are stressed and maintained as much as possible. i personally feel one of the reasons why CRNAs feel that they can push into pain is because there isnt that standard out there. (You dont see CRNAs trying to advertise themselves as neurosurgeons, or xray techs/ultrasonographers as radiologists.)

now pertaining unaccredited fellowships - all of the docs that you train are highly skilled and proficient and while i dont know you or them, i would definitely refer my family to you all. but what about others? whats to say whether these CRNA fellowship programs that have sprouted up arent going to be some BS "work while you learn - just pay me $xxx and you will pass" kind of program?

Agree completely. To have self taught "specialists" without having any written standards is okay in the infancy of a specialty, but is not okay as a specialty or subspecialty matures and grows up. At some point you have a grandfathering period, then move on and require official training. Yes it can be painful if you're caught on the cusp of that time period, but you have to make the cut sometime and somewhere. And yes, some of those that grandfather in will be proficient and some won't.

To the extent that we say its okay for people without any formal training to do what those of us with formal training do, is the extent to which people without any formal training will try to do what we do.

It's that simple. Is it any surprise that nurses, and PAs and everyone else out there think they can be "Pain Specialists" with no formal training when many Pain Physicians themselves will say formal accredited training isn't necessary?

You have to have a "gold standard" even if it isn't perfect.

The standards set by the ACGME in the pif are insufficient to allow appropriate training and need to be modified to allow more significant training.

Back to square one:

Pain needs a residency. Pain docs should be owned by the government.
Pain docs should be paid 60% MGMA for pain with COLA.
No bonus for procedures.
No other providers can perform our procedures in outpatient setting and get paid for it.
No other providers can Rx opiates for CNMP. If we don't think opiates are needed, then the patient does not get them.

Would anyone sign up?

How about if I throw in sovereign immunity from medmal (VAMC type rules to apply)?

Folks making $700+ would say no. Under that, I bet a fair amount of us would agree to this knowing we work M-F 8-5, get a govt pension and benefits, get to do whatever procedures we deem necessary (and not for profit), Rx as we see fit, and be able to take care of patients however we would like. Caveat- must see 24-30 patients per day.

You are arguing for single payer where all doctors are government employees. Okay. Move to Canada.

 

[bedrock]

Pain docs should be owned by the government.

Strongly disagree with that for many reasons, most importantly is that some government bureaucrat could decide the best use of government resources is vicodin/xanax for all and skip the procedures and therapies, and we'd just become dispensing machines. That's just how backward most government decision making is.

If the government ever totally owns us, I'm cashing out and doing something else.

 

[101N]

if the government ever totally owns us, i'm cashing out and doing something else.

2+

 

[lobelsteve]

Please understand my inherent bias. I spend a third of my work time devoted to reviewing illegitimate care. From pill mills to series of 3 to drugged docs sticking cords. I see the worst of the worst more than anyone.

 

[emd123]

Please understand my inherent bias. I spend a third of my work time devoted to reviewing illegitimate care. From pill mills to series of 3 to drugged docs sticking cords. I see the worst of the worst more than anyone.

Okay. Fair enough. Then please start espousing toughening up formal uniform ACGME fellowship standards and not trying to convince people they should do non-accredited fellowships with no formal or uniform standards instead.

Also, when you charge 2-3 times your typical hourly take home rate to testify against doctors, do you tell law enforcement, plaintiff's lawyers and the medical boards that the doctors in question were worse off for doing ACGME fellowship training, and that the standard of care is to do non-accredited training? You can call anything a "fellowship". I could have done 5 weekend courses and called that a "non-accredited fellowship".

Not that you don't train your fellows well, but I could hang a shingle tomorrow and start my own non-accredited "fellowship". I'm sure by the 2 months I could have my fellow cranking out huge numbers of billable procedures on my watch, but that wouldn't be right, would it?

 

[lobelsteve]

Okay. Fair enough. Then please start espousing toughening up formal uniform ACGME fellowship standards and not trying to convince people they should do non-accredited fellowships with no formal or uniform standards instead.

Also, when you charge 2-3 times your typical hourly take home rate to testify against doctors, do you tell law enforcement, plaintiff's lawyers and the medical boards that the doctors in question were worse off for doing ACGME fellowship training, and that the standard of care is to do non-accredited training? You can call anything a "fellowship". I could have done 5 weekend courses and called that a "non-accredited fellowship".

Not that you don't train your fellows well, but I could hang a shingle tomorrow and start my own non-accredited "fellowship". I'm sure by the 2 months I could have my fellow cranking out huge numbers of billable procedures on my watch, but that wouldn't be right, would it?

My fellowship training is a break even as far as finances. Even with a fellow in full swing we cap at 36. Most days are 30. My billable rate for LE and medical board is fully disclosed at 1/2 to 1/3 to subterfuge the " just doing it for money argument. It costs me lost productivity to do what I feel is the fight thing for my state.

 

[101N]

My fellowship training is a break even as far as finances. Even with a fellow in full swing we cap at 36. Most days are 30. My billable rate for LE and medical board is fully disclosed at 1/2 to 1/3 to subterfuge the " just doing it for money argument. It costs me lost productivity to do what I feel is the fight thing for my state.

Lobel:

You are far-&-away the most self-righteous guy on this forum. But your prosthelytizing isn't for the sake of patients or you wouldn't be so public and condescending about it. I think you've got unresolved Rob Windsor issues. Join the Peace Corp already.

 

[lobelsteve]

Lobel:

You are far-&-away the most self-righteous guy on this forum. But your prosthelytizing isn't for the sake of patients or you wouldn't be so public and condescending about it. I think you've got unresolved Rob Windsor issues. Join the Peace Corp already.

I always enjoy your witty posts. Let's hope you never find yourself on the other side. pm me if you want to chat.

 

[bedrock]

Okay. Fair enough. Then please start espousing toughening up formal uniform ACGME fellowship standards and not trying to convince people they should do non-accredited fellowships with no formal or uniform standards instead.

Also, when you charge 2-3 times your typical hourly take home rate to testify against doctors, do you tell law enforcement, plaintiff's lawyers and the medical boards that the doctors in question were worse off for doing ACGME fellowship training, and that the standard of care is to do non-accredited training? You can call anything a "fellowship". I could have done 5 weekend courses and called that a "non-accredited fellowship".

Not all non ACGME accredited fellowships are procedure mills. Quite a few are based at medical schools (frequently in the PMR department) and called "spine" fellowships. There are few others that are run by very academically oriented pain docs. These fellowships didn't qualify for ACGME due to bureaucratic issues, but they are 12 months long, include weekly didactics, multiple published attendings, variety of pathology, excellent procedure numbers, etc.

Graduates from those places are just as qualified to treat 95% of pain patients and are often better qualified than graduates from the weaker ACGME programs, (not the strong ACGME programs, mind you). The Pain board exam that we've all complained about being completely out of touch with real practice patterns is not as relevant as we would all like it to be.
So I don't think steve is completely out of whack by taking on a fellow. Most likely he is very evidenced-based in treatments provided by him and his fellow. (maybe a bit holier than thou, but evidenced-based)


Granted there are private fellowships more focused on money/procedures and don't compare to the academic fellowships I listed above. But even those PP fellowships are 12 months 95% of the time and include a fair amount of oversight.

Unfortunately, there are not enough pain/spine physicians to go around.

Inadequate supply of specialty physicians is how CRNAs encroached on anesthesia, and many other medical specialties. They're trying to worm their way into pain as well. As there aren't enough Pain boarded docs to go around, I would argue that a fellowship-trained pain/spine physician should be the standard until more strong ACGME programs can be developed, (to keep the CRNAs and weekend warrior PCPs from harming patients with their ridiculous lack of training)

 

[Gauss]

look to your state medical board for guidelines on what is legally considered 'board certification'. everything else is irrelevant

http://www.mbc.ca.gov/consumer/complaint_info_questions_specialties.html
How do I know if my physician is board certified or if he or she is certified by an approved specialty board?

You may contact the American Board of Medical Specialties (ABMS) at 866-275-2267. In addition, the Medical Board has approved the following specialty boards: American Board of Facial and Plastic Reconstructive Surgery; American Board of Pain Medicine; American Board of Sleep Medicine; and the American Board of Spine Surgery. Links to the above-named boards are available through our Web site at: http://www.mbc.ca.gov/Specialty.html.

The Medical Board of California established the Expert Reviewer Program in July 1994 as an impartial and professional means by which to support the investigation and enforcement functions of the Board. Specifically, medical experts assist the Board by providing expert reviews and opinions on Board cases and conducting professional competency exams, physical exams and psychiatric exams.

Requirements for participating in the Board's program are:

Possess a current California medical license in good standing; no prior discipline; no Accusation pending; no complaint history within the last three years;
Board certification in one of the 24 ABMS specialties (the American Board of Facial Plastic & Reconstructive Surgery, the American Board of Pain Medicine, the American Board of Sleep Medicine and the American Board of Spine Surgery are also recognized) with a minimum of three years of practice in the specialty area after obtaining Board certification;
Have an active practice (defined as at least 80 hours a month in direct patient care, clinical activity, or teaching, at least 40 hours of which is in direct patient care).

 

[PinchandBurn]

look to your state medical board for guidelines on what is legally considered 'board certification'. everything else is irrelevant

http://www.mbc.ca.gov/consumer/complaint_info_questions_specialties.html
How do I know if my physician is board certified or if he or she is certified by an approved specialty board?

You may contact the American Board of Medical Specialties (ABMS) at 866-275-2267. In addition, the Medical Board has approved the following specialty boards: American Board of Facial and Plastic Reconstructive Surgery; American Board of Pain Medicine; American Board of Sleep Medicine; and the American Board of Spine Surgery. Links to the above-named boards are available through our Web site at: http://www.mbc.ca.gov/Specialty.html.

The Medical Board of California established the Expert Reviewer Program in July 1994 as an impartial and professional means by which to support the investigation and enforcement functions of the Board. Specifically, medical experts assist the Board by providing expert reviews and opinions on Board cases and conducting professional competency exams, physical exams and psychiatric exams.

Requirements for participating in the Board's program are:

Possess a current California medical license in good standing; no prior discipline; no Accusation pending; no complaint history within the last three years;
Board certification in one of the 24 ABMS specialties (the American Board of Facial Plastic & Reconstructive Surgery, the American Board of Pain Medicine, the American Board of Sleep Medicine and the American Board of Spine Surgery are also recognized) with a minimum of three years of practice in the specialty area after obtaining Board certification;
Have an active practice (defined as at least 80 hours a month in direct patient care, clinical activity, or teaching, at least 40 hours of which is in direct patient care).

so in California you guys with ABPM are legit. That means no doing MOCA or recertifying via ABA for your pain boards since california recognizes ABPM

 

[sweetalkr]

Just because your state allows this does not mean you should support this. Please understand that as a community, if we stand behind the ABA's test and the ABMS, it not only brings more credibility to our specialty, it protects us from mid-level providers as well. don't forget that anesthesiologists lost the rights to bill for TEE's intraop and post-op because cardiology protected their turf by doing the same.

 

[mille125]

Just because your state allows this does not mean you should support this. Please understand that as a community, if we stand behind the ABA's test and the ABMS, it not only brings more credibility to our specialty, it protects us from mid-level providers as well. don't forget that anesthesiologists lost the rights to bill for TEE's intraop and post-op because cardiology protected their turf by doing the same.[/QUOTE]



I havent kept up the anesthesiology news. When did this happen?

 

[PMR 4 MSK]

The standards set by the ACGME in the pif are insufficient to allow appropriate training and need to be modified to allow more significant training.

Back to square one:

Pain needs a residency. Pain docs should be owned by the government.
Pain docs should be paid 60% MGMA for pain with COLA.
No bonus for procedures.
No other providers can perform our procedures in outpatient setting and get paid for it.
No other providers can Rx opiates for CNMP. If we don't think opiates are needed, then the patient does not get them.

Would anyone sign up?

How about if I throw in sovereign immunity from medmal (VAMC type rules to apply)?

Folks making $700+ would say no. Under that, I bet a fair amount of us would agree to this knowing we work M-F 8-5, get a govt pension and benefits, get to do whatever procedures we deem necessary (and not for profit), Rx as we see fit, and be able to take care of patients however we would like. Caveat- must see 24-30 patients per day.

where do I sign?

 

[gasattack3]

Bottom line:

If the CMS is now reimbursing for CRNA pain procedures, what is the real value of ACGME accreditation and ABA certification?

We have a VERY successful group of pain docs affiliated with my department's anesthesiology department. All are ACGME and ABA certified.

However, ALL will admit that their procedural numbers (from big name places mind you. the types of big name places which look really really good) were lacking in favor of medical management in training. This may be changing at those programs but not so sure.

So, we have these certified docs learning from the 2 or 3 guys who DO do those kyphos, IT pumps, stimulators, but they do it rather infrequently and they do it at the expense of their own time, NOT seeing their own patients. The the extent that, while they are supposed to learn those procedures and then DO them, more than a few still, apparently, feel uncomfortable and thus I just don't see them booking those cases. Not much has changed, and it's only been the most aggressive amongst them (ballsy??) whom went out and "pioneered" for their group to learn those interventions.

NOW, why NOT go to the procedure mill for one year?? Learning those more complicated procedures under the supervision/direction of someone more experienced??

Especially when the government (and private carriers to follow?) are (again, sadly) diluting the value of the ABA certification in the first place??

Not trying to inflame. I'm a CA2 whom will be applying to pain and am considering non-ACGME places simply because of the "traditional" lack of procedural exposure of even some very well established, big name programs.

 

[emd123]

I still think you are better off going ACGME accredited if you can get it. I doubt these people who are uncomfortable doing implants would have wanted to do them even if they went to a program with bigger numbers.

But on the other hand, while they are making it easier for CRNAs to do any pain procedure, they're making it harder for doctors. CMS in my region says you can't get paid for in-office stim trials unless you have either hospital privileges or ACGME/ABMS Pain board from ABA, but ONLY ABA. If you have an acgme fellowship plus ABMS pain boards from PMR or psych/neuro (same ABMS pain exam) that's not enough. But if you are a CRNA, it's okay.

They want as many lower qualified people doing as much as possible, and less highly trained people as possible for one reason alone:

Money.

Specialists are expensive. Nurses are cheaper.

So, you should go ACGME. Or just be a nurse.

 

[Ducttape]

Bottom line:

If the CMS is now reimbursing for CRNA pain procedures, what is the real value of ACGME accreditation and ABA certification?

We have a VERY successful group of pain docs affiliated with my department's anesthesiology department. All are ACGME and ABA certified.

However, ALL will admit that their procedural numbers (from big name places mind you. the types of big name places which look really really good) were lacking in favor of medical management in training. This may be changing at those programs but not so sure.

So, we have these certified docs learning from the 2 or 3 guys who DO do those kyphos, IT pumps, stimulators, but they do it rather infrequently and they do it at the expense of their own time, NOT seeing their own patients. The the extent that, while they are supposed to learn those procedures and then DO them, more than a few still, apparently, feel uncomfortable and thus I just don't see them booking those cases. Not much has changed, and it's only been the most aggressive amongst them (ballsy??) whom went out and "pioneered" for their group to learn those interventions.

NOW, why NOT go to the procedure mill for one year?? Learning those more complicated procedures under the supervision/direction of someone more experienced??

Especially when the government (and private carriers to follow?) are (again, sadly) diluting the value of the ABA certification in the first place??

Not trying to inflame. I'm a CA2 whom will be applying to pain and am considering non-ACGME places simply because of the "traditional" lack of procedural exposure of even some very well established, big name programs.

because, while CRNAs can perform pain procedures, some insurances will not accept a non-ACGME board certified physician from performing interventional procedures.

that is definitively the case in my neck of the woods - one of the 2 major private insurances requires interventional procedures performed by a physician to be an ACGME trained individual. and i have personally confirmed this (by calling the insurer myself).

i daresay if you also decide, at some point, that you want to go into academic medicine, you will not be able to find such a position, because it is an ACGME requirement that residents/fellows be taught by ABGME boarded individuals. again - from personal experience.

 

[Kilroy]

Does anybody have used danemiller DVD's. I don't want to spend 400 dollars on their site, if you've already used them, please contact me.

 

[sdnuser001]

Can anyone who has taken the ABPM exam please reccomend study materials they would reccomend to prepare for it??