Board certified

[PainBrain78]

I’m almost scared to ask this question.

What if you don’t become board certified in pain. Can you still practice pain? How many years can you go from fellowship until you need to be certified? I’m boarded in anesthesiology but not pain yet. Thanks in advance.

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[swamprat]

Depends on the state - I will tell you where I practice a lot of pharmacies will not fill chronic opioid medications if you are not board certified. Also a few payors will not allow/cover ER medications prescribed by non-pain MDs

 

[GorillaPanic]

Depends on the state - I will tell you where I practice a lot of pharmacies will not fill chronic opioid medications if you are not board certified. Also a few payors will not allow/cover ER medications prescribed by non-pain MDs

How are pharmacies checking board certification status? I didn’t know they were able to do that…

 

[GoBeers]

Depends on the state - I will tell you where I practice a lot of pharmacies will not fill chronic opioid medications if you are not board certified. Also a few payors will not allow/cover ER medications prescribed by non-pain MDs

that's pretty sweet. then you can truly tell patients you are mainly interventional as you aren't allowed to prescribe opioids.

 

[Pain Applicant1]

It depends. It'll make your life a lot easier if you do it. It would be difficult for me to obtain privileges in pain at the local hospital if I wasn't board-certified and if I don't have privileges it would be difficult to be approved by insurance companies.

Also, I was planning on opening a second office in NYC and some bureaucrat somewhere in the city didn't approve since I didn't sit for the boards yet at that time. That guy was annoying but I'm so glad he did that. I was board-eligible but not board-certified at the time.

Other than this it doesn't matter. Patients and referrers could care less.

 

[NVO]

I was looking around the DFW area (very saturated) and probably every other pain physician is not board certified, and many did not do ACGME pain fellowship

 

[Ferrismonk]

Being board certified, in your primary specialty, is critical. Being boarded in pain is superfluous and is just a marketing thing imo.

 

[Ducttape]

i disagree.

i think pain certification is important in terms of thinking of long term careers.

yes, you can make a career and not being board certified, but there will be a certain level of uncertainty that may rear its ugly head...

 

[GorillaPanic]

I think a fair number of people here have had experience in medmal as an expert witness — curious to know what those folks think regarding how lack of board certification may impact one’s defense if named in a suit?

 

[lobelsteve]

I think a fair number of people here have had experience in medmal as an expert witness — curious to know what those folks think regarding how lack of board certification may impact one’s defense if named in a suit?

I will ruin your day in court.

 

[Agast]

There are two pain boards, the second will let you sit without an accredited fellowship

 

[Doctodd]

You don’t really need pain boards. I guess it would depend on your state and your hospital’s restrictions.

 

[PainBrain78]

There are two pain boards, the second will let you sit without an accredited fellowship

Which is that one? I thought anesthesiologists could only take the ABA one

 

[Agast]

Which is that one? I thought anesthesiologists could only take the ABA one

FAQs

American Board of Pain Medicine frequently asked questions

www.abpm.org

 

[Crybaby]

Get the board certification as soon as you are able to, it will make your life much easier when it comes to credentialing.
I loved my training, but that is one of my regrets that I did not do acgme and board certified route.

 

[RM38]

I will ruin your day in court.

Considering you used to run a non accredited fellowship, I am not really sure how you can stand up in court and say that not being pain boarded is a problem. Any opposing attorney who knew that would hammer that fact down big time. Now if not boarded in your primary specialty, I can see where that could be a big issue. Especially if you don’t also have any kind of fellowship training as well.

 

[lobelsteve]

Considering you used to run a non accredited fellowship, I am not really sure how you can stand up in court and say that not being pain boarded is a problem. Any opposing attorney who knew that would hammer that fact down big time. Now if not boarded in your primary specialty, I can see where that could be a big issue. Especially if you don’t also have any kind of fellowship training as well.

I am pain boarded and can vouch for the fellows I trained. If you had no training, you are easier to pin.

 

[RM38]

I am pain boarded and can vouch for the fellows I trained. If you had no training, you are easier to pin.

I agree 100% on the no fellowship training aspect as people that just do a weekend course or 2 are much more likely to have bad outcomes and I have seen several examples of this. My point was on the not being boarded in pain part. You can vouch for your fellows, but what if someone else trained them that was also boarded in pain? For example I trained with Falco right after he disassociated his fellowship from Temple when it was ACGME. My fellowship experience was barely different from the previous fellows, but I am not ABMS board eligible in pain. You can’t really go into court and say that I or someone else that trained at a non ACGME program like Furman’s is less capable because they are not pain boarded and you didn’t train them.

 

[lobelsteve]

I agree 100% on the no fellowship training aspect as people that just do a weekend course or 2 are much more likely to have bad outcomes and I have seen several examples of this. My point was on the not being boarded in pain part. You can vouch for your fellows, but what if someone else trained them that was also boarded in pain? For example I trained with Falco right after he disassociated his fellowship from Temple when it was ACGME. My fellowship experience was barely different from the previous fellows, but I am not ABMS board eligible in pain. You can’t really go into court and say that I or someone else that trained at a non ACGME program like Furman’s is less capable because they are not pain boarded and you didn’t train them.

Yes I can. It is a courtroom. Know the rules. Play the game.

 

[Ducttape]

Americans (and by default jury pools made up of Americans) love certifications and honoraria.

from an individualized perspective, no, you cannot judge how well a physician will perform their role based on their credentials.

but... how is anyone - especially someone on a jury - to know if a pain doctor did do a high quality fellowship such as yours, besides your word of mouth? how are they to know who Furman is, other than what you tell them?

what they hear:
RM38 - "well, i knew a guy..." (and they think "so he did an apprenticeship?")

lobelsteve - "I am BOARD CERTIFIED twice over!" (and they think "he da GOAT! how many years did he go to school?")

 

[MitchLevi]

You hold up the Furman atlas and say, "I trained in a one on one setting with this guy."

Then, you tell the jury what volume you do, and how many of this or that procedure you've done.

"I avg 220 spine procedures per month over the last 8 years." You compare and contrast your numbers to the national avg.

There are tons of highly competent pain doctors that didn't do a pain fellowship, and it wouldn't be hard to find someone to testify to that.

Seems very defensible IMO.

In Steve's case - Like that poster said...You ran one of those fellowships. Do you have a textbook with your name on it? If I'm a juror and I sit and listen to you go after a non ACGME-trained doctor and then I find out you took part in one, your credibility is shot.

 

[Ducttape]

the opposing attorney will not allow you to introduce a textbook as evidence.

your attorney will ask those questions as part of proving your technical prowess. if you had, he would also talk about any chapters you wrote...


then the other attorney may ask you:
"so why didnt you do a board certified fellowship?"
"do you think you would have had a different experience if you did a fellowship, yes or no?"
"could you have been exposed to situations such as what happened to my poor client if you had done a certified fellowship?"
"does board certification mean that you are considered qualified to do procedures such as the one you botched totally on my client? and besides you saying so, how are you qualified to do these procedures?"



if you get the opportunity, get the board certification. otherwise caveat emptor.

 

[RM38]

Yes I can. It is a courtroom. Know the rules. Play the game.

Any decent attorney would ask if you could say that your former fellows were competent to practice pain and if you said yes, would then point out that you said it is possible for someone to do an non accredited fellowship and be competent to practice. Sure there would be a lot of back and forth after that and I am sure you can state that you can’t comment on the quality of the other person’s training. The defending attorney would try and make you look either hypocritical or egotistical if your opinion is that you can only say your fellows could ever be competent and not someone else whom was also trained by a board certified pain doctor. As others have pointed there are literally thousands of doctors doing interventional procedures throughout the United States that are not pain board eligible and a large number of non accredited fellowships at major Academic institutions like Stanford, Wake, Hopkins, Penn, Cleveland Clinic, UCLA, Emory, Vandy and more. There are many non pain boarded people working at academic programs throughout the US doing injections including one of my former partners. Plenty of PM&R sports programs also teach pain procedures. Ultimately you can testify to what you think, but having done a non ACGME fellowship can certainly be defensible as the proper experience in court if you can prove training and experience. Ultimately if you have a bad outcome like a cord stick your training may not matter anyway in a lawsuit. If you miss some giant red flag and have a patient OD on Percocet and never learned med management as a fellow I can see where that would be a bigger issue.

 

[Ducttape]

1. there is more than one pain certification. his fellows would never be able to sit for ACGME boards but can sit for these alternative boards.
2. steve can tell you if he had an accredited fellowship. NASS has accredited fellowships that are not ACGME. they can take alternate boards.
3. doing a non-ACGME fellowship is still doing fellowship training, and board certification is a document that might not mean much to daily practice, but may make a difference in the courtroom.
3. just because there are thousands of doctors doing pain does not make it right or safe. i know of family medicine doctors that did blind epidurals and facet injections. is your supposition is that this is safe because there are thousands of docs doing them?
4. finally, if an attorney asks a question about the competency of someone completely not involved in the caseto practice pain, the opposing counsel will object, and i suspect the judge would question the relevance of the original attorney's questioning - has nothing to do with the client or the defendant.

 

[RM38]

I agree that those ABMS boarded in pain are in the best situation to defend themselves in terms of training. I understand that and residents who read this thread should too. My point is that if you did a year long fellowship that you can defend your training as adequate to do most spine procedures as it is common for people to have this type of training and is supported through much of the academic world in the US. There are well over 20 docs in my area that did non acgme fellowships and I am willing to bet I could find someone to defend my level of training in court. I don’t think you can compare pcps doing blind injections which would be considered below the standard of care for non labor epidurals to people that did a full year of training. The only note that I have ever seen where a doc did a blind epidural was a ABMS boarded pain doc BTW. On a 35yr old patient too. No MRI beforehand either. There are also surgeons, CRNAs, PAs and NPs doing spine injections without much training, so it is rather hard to say that someone whom did close to a 1000 or more procedures while supervised for a year isn’t qualified and their day in court would be ruined. You can have your opinion, but a good lawyer should be able to defend that point.

 

[lobelsteve]

I’ve worked dozens of cases. I’ve seen lots of interesting things. If you have not been in the courtroom then you are pontificating and not experiencing.

 

[nvrsumr]

Im in agreement with steve here. Have testified at trial at least a dozen times(PI not medmal) and its a whole different world. Its not really about what is true or right. You answer the questions asked and are only a small piece of the puzzle without a birdseye view

 

[MitchLevi]

I've been cross examined by attorneys many times. No idea how many times I've been deposed at this point.

One could defend a non ACGME fellowship. It could be as simple as searching the community pain docs in your county and you'd prob find a bunch of them.

All of this means F all if the doctor did something malicious or was grievously incompetent and a pt is hurt.

If you're going to testify against someone, its not bc they did a non ACGME fellowship...It is bc they practiced in an unconventional manner and someone was injured as a result.

Depite the fact I'm boarded in PMR/Pain and did an ACGME pain fellatioship, I recently had an attorney claim I'm not qualified to comment on causality bc I'm just a pain doctor and not a surgeon.

He came after me at one point bc I diagnosed someone with chronic occipital neuralgia which had been untreated by 3 or 4 doctors before me, and bc a neurosurgeon never diagnosed it the diagnosis is in question.

We don't diagnose...We manage.

 

[nvrsumr]

They say sh** like that to get under your skin. It def works on me so I stopped doing med legal work. “ u can’t handle the truth” haha

 

[cowboydoc]

ACGME pain fellatioship

I’m not familiar.

 

[buddababa]

I've been cross examined by attorneys many times. No idea how many times I've been deposed at this point.

One could defend a non ACGME fellowship. It could be as simple as searching the community pain docs in your county and you'd prob find a bunch of them.

All of this means F all if the doctor did something malicious or was grievously incompetent and a pt is hurt.

If you're going to testify against someone, its not bc they did a non ACGME fellowship...It is bc they practiced in an unconventional manner and someone was injured as a result.

Depite the fact I'm boarded in PMR/Pain and did an ACGME pain fellatioship, I recently had an attorney claim I'm not qualified to comment on causality bc I'm just a pain doctor and not a surgeon.

He came after me at one point bc I diagnosed someone with chronic occipital neuralgia which had been untreated by 3 or 4 doctors before me, and bc a neurosurgeon never diagnosed it the diagnosis is in question.

We don't diagnose...We manage.

im interested in your rebuttal and if you shutup that attorney -

 

[RoloTomassi]

Generally not hard to defend your credentials or actions if you keep in mind you have vastly more medical experience and knowledge than they do and can keep your cool

 

[MitchLevi]

im interested in your rebuttal and if you shutup that attorney -

I don't remember the exact wording but I'm a dbl board certified MD and more than qualified to weigh in on causality.

Realizing it's their job to do that of course. Attack my credentials so any opinion I give is called into question.

Hurt a pt using poor technique and it doesn't matter your board status. Provide great care while remaining safe and this isn't an issue.

 

[Dr. Ice]

I agree that those ABMS boarded in pain are in the best situation to defend themselves in terms of training. I understand that and residents who read this thread should too. My point is that if you did a year long fellowship that you can defend your training as adequate to do most spine procedures as it is common for people to have this type of training and is supported through much of the academic world in the US. There are well over 20 docs in my area that did non acgme fellowships and I am willing to bet I could find someone to defend my level of training in court. I don’t think you can compare pcps doing blind injections which would be considered below the standard of care for non labor epidurals to people that did a full year of training. The only note that I have ever seen where a doc did a blind epidural was a ABMS boarded pain doc BTW. On a 35yr old patient too. No MRI beforehand either. There are also surgeons, CRNAs, PAs and NPs doing spine injections without much training, so it is rather hard to say that someone whom did close to a 1000 or more procedures while supervised for a year isn’t qualified and their day in court would be ruined. You can have your opinion, but a good lawyer should be able to defend that point.

I wished you had reached out to me privately before you jumped into your post. Fwiw the responders on here have been far more respectful to you than they have been to me in the the past, so I would consider that a win for you. This topic many many times spearheaded by me has been met with a ton of vitriol. I guess as time goes on, people soften but there will always be those devout few to their cause who will push you back…

And they will cite all kinds of non examples like comparing you to a crna doing pain and yada yada.

Next time don’t engage here dude…

I’ve also used the Furman atlas argument to no avail, especially since I was one of his past fellows who actually contributed to both atlases. Don’t matter dog..crickets to that one. I’ll have to ask my litigator attorney wife if I actually have a leg to stand on. Maybe I’ll send her this thread and get back to y’all

My bad I realize that it’s not you but painbrain that posted…

Well you both get the point

 

[epidural man]

In the end, I don't think the argument to get board-certified is best fought with examples of what might happen in the court room.

I hate doing my MOCA. I would not do it if I felt like I could live life easily without board certification.

BUT...

As many have pointed out - the juice IS worth the squeeze unfortunately.

 

[Dr. Ice]

FYI..Furman is coming out with another atlas. I don’t have the time to contribute to this one, but it’s gonna be far better than the last just based on content. I would think maybe be out by end of next year as an early timeline. My former junior co-fellow is the second author/editor.