Chair of ASIPP Academic Task Force Teaching Interventional Course Open To CRNAs

[Doctodd]

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Members do not see this ad.

aside from the obvious issues of teaching CRNAs to do procedures or whatever... did you guys see the schedule/syllabus for this "course."

uggh. i would rather go to a conference on heart failure. 1) it is at least tought by MDs and 2) has about equal relevence to my practice...

these people are just teaching another generation of "health care providers" to take advantage of and create monsters out of the weak-minded, coping-challenged patients with "pain"

i didnt bother to look at it but now that u mention it, im chuckling

 

[Aether2000]

Sleep, like you I am a mere mortal and not a moderator therefore have no power over private forum membership

 

[axm397]

am I worthy enough for the PrivateForum yet?

Sure - as soon as you follow these steps just like everyone else on the forum:

How to Apply for Access to the Physicians Only Pain Forum 😎

 

[Doctodd]

The authorities at ASIPP were contacted. Lax personally attended to this matter. It was discovered that there is no "ASIPP task force" that Dr. Gonzales was Chair of currently. It doesnt exist! He was asked to remove this title as it is misrepresentation.



wow...so that was made up?

wow i just read the back and forth emails between ASIPP/Lax and Dr Gonzalez. Seems that the position was given on a temporary basis for one year but it was never used, so it wasnt reappointed. But Dr Gonzalez kept using the title. Lax threatened disciplinary action to his program if he were to teach the course to CRNA's and it was made known to him that they didnt appreciate his attempt to skirt the rules. He wrote a long email trying to justify it, also saying a dentist has taken the course as "a fun course". His attempt to paint algos as "unprofessional" was also noticed and probably discarded quickly.

 

[Tenesma]

if you read this guy's bio --- you quickly get the sense of some real underlying issues....

 

[sweetalkr]

I just talked to one of the active members of ASIPP.

The AAPM will not allow non-physicians or CRNAs to take any educational CADAVER courses. This was recently changed within the last 2 weeks. My attending is big in ASIPP and just let me know that.

NP's acan learn the educational courses so they know what they are scheduling for their pain docs, but NO CRNAs can take cadaver courses.

Haha you should have heard the response from my attending. Apparently this has been an issue, and it is now resolved. Check the new guidelines they may or may not reflect this issue, but it is definitely in effect.

 

[rubenk1]

It's great something beneficial came of all this...at least now there are some actual guidelines that are being developed regarding CRNA education. I'm sure this will come up again in the future, but with some of the pain organizations articulating this position clearly hopefully we can spend our time focusing on the state medical boards and not as much on certain physician who haven't thought how their actions could ultimately jeopardize ther own field.

 

[Aether2000]

The state medical boards have little authority over the clearly expansionist policies and motives of the state and national nursing associations. The CRNAs are among the most militant and believe very strongly they are just as good as MDs in every way in anesthesia, and not far behind in pain management. The Louisiana decision had the American Nursing Association weighing in on the side of the CRNAs for the first time to promote unmitigated expansion of their scope of practice. Many legislatures view the medical and nursing boards in their state to exist the same level of power and authority, expecting them to police themselves in scope of practice issues. But the wording in many of the nursing and medical practice acts is vague, leaving much room for interpretation and overlap. It is simply a matter of time until the poorly trained, inexperienced CRNAs begin to hang out their shingle nationwide, vying for pain patients, touting a touchy feely approach that we cold heartless doctors are incapable of achieving. The real battleground will be the state legislatures. The medical boards are typically not interested in picking a fight with the nursing boards in their states, and state medical associations similarly usually do not pre-emptively attempt to stave off incursions into their scope of practice. State medical associations are reactionary, not proactive in these politically sensitive realms. We need access to state legislatures, and that means calling your own legislator in your district, voicing your opinion, and asking for sponsorship of bills that define scope of practice issues.

 

[SleepIsGood]

The state medical boards have little authority over the clearly expansionist policies and motives of the state and national nursing associations. The CRNAs are among the most militant and believe very strongly they are just as good as MDs in every way in anesthesia, and not far behind in pain management. The Louisiana decision had the American Nursing Association weighing in on the side of the CRNAs for the first time to promote unmitigated expansion of their scope of practice. Many legislatures view the medical and nursing boards in their state to exist the same level of power and authority, expecting them to police themselves in scope of practice issues. But the wording in many of the nursing and medical practice acts is vague, leaving much room for interpretation and overlap. It is simply a matter of time until the poorly trained, inexperienced CRNAs begin to hang out their shingle nationwide, vying for pain patients, touting a touchy feely approach that we cold heartless doctors are incapable of achieving. The real battleground will be the state legislatures. The medical boards are typically not interested in picking a fight with the nursing boards in their states, and state medical associations similarly usually do not pre-emptively attempt to stave off incursions into their scope of practice. State medical associations are reactionary, not proactive in these politically sensitive realms. We need access to state legislatures, and that means calling your own legislator in your district, voicing your opinion, and asking for sponsorship of bills that define scope of practice issues.

This is a very important point.

I think the old adage, the battle has been won, but the war is still ensuing applies here.

I think our organizations also need to scrutinize who is allowed into Interventional Pain Medicine. For example, I'm ok with a internal medicine doc writing opioids, but then having that same guy do a MILD procedure, or some interventional spine case (SCS, intrathecal pumps, transforaminals,etc) just after a ONE year fellowship is little worrisome. We all know which fields in medicine are 'hands on' and which are not. I think by and large, it's almost impossible to go from a hands off residency to an interventioal model in just one year mainly because the volume of cases is impossible to obtain.

I can tell you having been an anesthesia resident, having done >400 labor epidurals by my CA3 year, I was still learning some new needle manipulation tricks,etc during that last year. That's after a 4 year hands on residency! The issue becomes, when people do things that are out of their scope of practice to make a quick buck, their horrible results go into our outcomes pool. As such, the unfortunate issue is that some procedures will be perceived by insurance companies as experimental or uninsurable--thereby, not allowing patients to get the proper therapy they need. For example, quack out there doing 'blind' facet injections w/o fluro and having bad results, significantly altering the way facet injections are perceived by third party payors.

I just think ALL our organizations need to scrutinize and 'teach' PHYSICIANS only. Secondly, these physicians need to display a certain level of aptitude as well. We need to be PROactive about this, collectively.

 

[PinchandBurn]

This is a very important point.

I think the old adage, the battle has been won, but the war is still ensuing applies here.

I think our organizations also need to scrutinize who is allowed into Interventional Pain Medicine. For example, I'm ok with a internal medicine doc writing opioids, but then having that same guy do a MILD procedure, or some interventional spine case (SCS, intrathecal pumps, transforaminals,etc) just after a ONE year fellowship is little worrisome. We all know which fields in medicine are 'hands on' and which are not. I think by and large, it's almost impossible to go from a hands off residency to an interventioal model in just one year mainly because the volume of cases is impossible to obtain.

I can tell you having been an anesthesia resident, having done >400 labor epidurals by my CA3 year, I was still learning some new needle manipulation tricks,etc during that last year. That's after a 4 year hands on residency! The issue becomes, when people do things that are out of their scope of practice to make a quick buck, their horrible results go into our outcomes pool. As such, the unfortunate issue is that some procedures will be perceived by insurance companies as experimental or uninsurable--thereby, not allowing patients to get the proper therapy they need. For example, quack out there doing 'blind' facet injections w/o fluro and having bad results, significantly altering the way facet injections are perceived by third party payors.

I just think ALL our organizations need to scrutinize and 'teach' PHYSICIANS only. Secondly, these physicians need to display a certain level of aptitude as well. We need to be PROactive about this, collectively.

I agree with this.

Yes, maybe it's un "PC" to say...but fields like Psychiatry or Neurology really should not be doing interventional pain procedures after just a 1 year fellowship. It's like an anesthesiologist doing CV surgery after seeing a few cases over the drape. It's just not good practice.

"Multidisciplinary" approach to pain management is a great idea. But in my opinion, that doesn't mean that ONE person has to be able to do everything. If someone is an interventionalist, they can always refer out to psych, neuro, or PMR,etc for the 'multidisciplinary' management. Otherwise, we turn into physicians who are jack of all traits, and master of none...

Just because some people want to make money doing procedures and have a MD/DO after their name, they shouldnt just be allowed to perform the procedures. We shouldnt be teaching ANY unqualifed physicians/nurses procedures that are out of their scope of practice. Touching up on one's skills or trying to close gaps is a different story.

 

[specepic]

I would like to thank those involved with taking care of the issues with that course.

At my practice the ortho PAs want me to teach them U/S guided inj's. Yes, they are not rocket science but I learned from the recogniozed national experts (PM&R wise anyway), have done hundreds, and still have a lot to learn. If I was a pt I'd want a doc to do it.

 

[Doctodd]

Maybe im oversimplifying this, but if a NP or PA does these procedures, shouldnt the increase in malpractice insurance alone be some type of deterrent?

 

[SleepIsGood]

I would like to thank those involved with taking care of the issues with that course.

At my practice the ortho PAs want me to teach them U/S guided inj's. Yes, they are not rocket science but I learned from the recogniozed national experts (PM&R wise anyway), have done hundreds, and still have a lot to learn. If I was a pt I'd want a doc to do it.

Please dont teach thm. Again, ortho pa's or any physician extender should just be that...doing things under our supervision. It'll only be time when the orthopod will stop referring to youa nd then have the PA do the stuff.

 

[epidural2009]

I agree with this.

Yes, maybe it's un "PC" to say...but fields like Psychiatry or Neurology really should not be doing interventional pain procedures after just a 1 year fellowship. It's like an anesthesiologist doing CV surgery after seeing a few cases over the drape. It's just not good practice.

"Multidisciplinary" approach to pain management is a great idea. But in my opinion, that doesn't mean that ONE person has to be able to do everything. If someone is an interventionalist, they can always refer out to psych, neuro, or PMR,etc for the 'multidisciplinary' management. Otherwise, we turn into physicians who are jack of all traits, and master of none...

Just because some people want to make money doing procedures and have a MD/DO after their name, they shouldnt just be allowed to perform the procedures. We shouldnt be teaching ANY unqualifed physicians/nurses procedures that are out of their scope of practice. Touching up on one's skills or trying to close gaps is a different story.

I agree. Psychiatrists especially, but also neurologists or other specialties with minimal experience in procedures. Think about a psychiatrist who has never held a needle in their hand during a four year residency, let alone touched a patient. They talk to patients. TALK to patients. Now after a one year fellowship you as a consulting physician or patient yourself would feel comfortable going under the needle or knife with them at the helm? Think about the fact that they don't even do physical exams during their residency. They don't do procedures. They should therefore NOT practice interventional pain. If they want to be part of a multidisciplinary approach to pain medicine, they should practice within the scope of their training. Don't overstep your boundaries. Stick with talking and counseling patients. Refer them to anesthesiology trained interventional pain doctors when you feel you need a good diagnosis or intervention performed.

 

[Aether2000]

Certainly those more adept at performing fluoroscopically guided procedures will be better than those entering a pain fellowship without, at least initially. However consider these facts:
1. Most anesthesiologists perform interlaminar epidural steroid injections without fluoroscopy, and in fact, rarely use fluoroscopy in their anesthesia training programs. There skills in needle manipulation are largely based on blind injections, field blocks, or nerve stimulation proximity detection (does not guide the needle-is simply a proximity indicator). As of late, there are more physicians being trained in some ultrasound guided nerve injections, but frequently these are tissue plane blocks rather than discrete nerve blocks. The ASA has not adopted fluoroscopy as a standard for spinal injections even though fluoroscopy is available in virtually every hospital in the US performing surgery. This is not good medicine given the very poor skills demonstrated in numerous studies showing the inaccuracy of determining the target epidural space by palpation and other studies showing the needle doesn't enter the epidural space 12-40% of the time. The blind jabbing of needles into a human body based on where a person thinks a nerve might lie or where they presume the epidural space might be is not necessarily good preparation for precision spinal injection fellowship training.
2. The current pain fellowships require only a little over 20 total injections/procedures during the entire year. This is clearly such a low number that virtually anyone could meet the minimum standard but certainly without sufficient breadth of experience or repetition to gain any expertise in the field. The fellowship directors have selected such a low standard that it may produce broad variations in the experience and expertise for those having completed a pain fellowship, and therefore creates a lack of fungibility. Can you really trust the accuracy of the injections from the guy in the next town who may have performed 1/20 the number of procedures you did in your fellowship program? Should patients be subjected to such wide variation in quality?
3. The gate for all comers was opened by the fellowship directors when they agreed to permit anyone from any background into their pain fellowship program. A person with a genetics residency plus one year of pain fellowship is exactly equivalent to those with a 4 year anesthesiology residency plus one year pain fellowship according to the ABMS. Or a family doc with 3 years non-interventional based residency training plus a one year fellowship has identical legal rights to perform pumps and stims as an anesthesiologist with a pain fellowship according to the ACGME and ABMS. Once the gate is open, it cannot be easily closed without significant repercussions. Credentials committees, malpractice carriers, and patients are being told by organized medicine (ACGME, ABMS) that their family doctor or geneticist with a pain fellowship is just as adequate as a well trained anesthesiologist with pain fellowship. While intuitively we physicians in the practice of pain medicine bristle at this assertion, this is the message our leaders in education and certification are promoting.

 

[lobelsteve]

Certainly those more adept at performing fluoroscopically guided procedures will be better than those entering a pain fellowship without, at least initially. However consider these facts:
1. Most anesthesiologists perform interlaminar epidural steroid injections without fluoroscopy, and in fact, rarely use fluoroscopy in their anesthesia training programs. There skills in needle manipulation are largely based on blind injections, field blocks, or nerve stimulation proximity detection (does not guide the needle-is simply a proximity indicator). As of late, there are more physicians being trained in some ultrasound guided nerve injections, but frequently these are tissue plane blocks rather than discrete nerve blocks. The ASA has not adopted fluoroscopy as a standard for spinal injections even though fluoroscopy is available in virtually every hospital in the US performing surgery. This is not good medicine given the very poor skills demonstrated in numerous studies showing the inaccuracy of determining the target epidural space by palpation and other studies showing the needle doesn't enter the epidural space 12-40% of the time. The blind jabbing of needles into a human body based on where a person thinks a nerve might lie or where they presume the epidural space might be is not necessarily good preparation for precision spinal injection fellowship training.
2. The current pain fellowships require only a little over 20 total injections/procedures during the entire year. This is clearly such a low number that virtually anyone could meet the minimum standard but certainly without sufficient breadth of experience or repetition to gain any expertise in the field. The fellowship directors have selected such a low standard that it may produce broad variations in the experience and expertise for those having completed a pain fellowship, and therefore creates a lack of fungibility. Can you really trust the accuracy of the injections from the guy in the next town who may have performed 1/20 the number of procedures you did in your fellowship program? Should patients be subjected to such wide variation in quality?
3. The gate for all comers was opened by the fellowship directors when they agreed to permit anyone from any background into their pain fellowship program. A person with a genetics residency plus one year of pain fellowship is exactly equivalent to those with a 4 year anesthesiology residency plus one year pain fellowship according to the ABMS. Or a family doc with 3 years non-interventional based residency training plus a one year fellowship has identical legal rights to perform pumps and stims as an anesthesiologist with a pain fellowship according to the ACGME and ABMS. Once the gate is open, it cannot be easily closed without significant repercussions. Credentials committees, malpractice carriers, and patients are being told by organized medicine (ACGME, ABMS) that their family doctor or geneticist with a pain fellowship is just as adequate as a well trained anesthesiologist with pain fellowship. While intuitively we physicians in the practice of pain medicine bristle at this assertion, this is the message our leaders in education and certification are promoting.

Or as I like to say, Rathmell screwed us all.

 

[specepic]

I understand the comments. I also wonder how many non-anes, pm&r, neuro are getting into pain fellowships right now? The door may be 'open' but who is getting let through in reality? Psych could get in for a awhile--how many psych trained, fellowship trained, pain docs are there out there??

How many FP's have gotten into pain fellowships. Most programs let in a few PM&R > Neuro at best, right? Anes still rules the roost.

 

[SleepIsGood]

Or as I like to say, Rathmell screwed us all.

There is a prominent member of a recently attended meeting, who during the dinner message had some 'words' to say about the above mentioned.

Now I'm beginning to realize why, but had no clue then.

BTW...I've heard that part of the reason that he has these views is because at MGH they do not do many procedures. (ie radiology there does all the v-plasty) and perm stims are done by others.....

 

[Tenesma]

i was at MGH pre-rathmell...
we had the option of doing a v-plasty rotation w/ J. Hirsch... great experience!... that guy would do trans-oral C2 v-plasties...

we did all the perm stims... as a fellow i did 24 SCS implants as the "primary" and "assisted" w/ more...

i cannot speak to what has happened since he took over as that was before my time..

 

[SleepIsGood]

i was at MGH pre-rathmell...
we had the option of doing a v-plasty rotation w/ J. Hirsch... great experience!... that guy would do trans-oral C2 v-plasties...

we did all the perm stims... as a fellow i did 24 SCS implants as the "primary" and "assisted" w/ more...

i cannot speak to what has happened since he took over as that was before my time..

I've heard Hirsch (rads) speak. Great speaker. At ASIPP he talked about how even he has seen a drastic decrease in Vplasty. His arguments againt that infamous NEJM article are indisputable.

 

[Aether2000]

Update on the original post: AAPManagement has now restricted the enrollment in the course to physicians only. It is not clear whether the CRNAs already enrolled will be allowed to continue their participation. The electronic faculty brochure online as of 8/26/10 continues to advertise the "Chair of the ASIPP Academic Task Force" will be teaching the course- perhaps they have not been asked to remove this phrase or have refused to remove it. Nevertheless, thank you all for the support for the profession of interventional pain medicine, a specialty of medicine, not nursing.

 

[SleepIsGood]

Update on the original post: AAPManagement has now restricted the enrollment in the course to physicians only. It is not clear whether the CRNAs already enrolled will be allowed to continue their participation. The electronic faculty brochure online as of 8/26/10 continues to advertise the "Chair of the ASIPP Academic Task Force" will be teaching the course- perhaps they have not been asked to remove this phrase or have refused to remove it. Nevertheless, thank you all for the support for the profession of interventional pain medicine, a specialty of medicine, not nursing.

I echo this.

 

[Doctodd]

from the emails i read he was told to cease and desist immediately with the faux title.



August 6, 2010
Christian Gonzalez, M.D., F.I.P.P
Director, Pain Medicine
University of Massachusetts
Assistant Professor
Department of Anesthesiology
508-793-6804
[email protected]

Dr. Gonzalez:
Thank you for sending us your letter. We have received additional complaints after you sent your letter.

Michael Whitworth is another issue but his point is accurate.

Interventional pain management is the practice of medicine. Interventional techniques do not include trigger point injections, peripheral nerve blocks, or intraarticular injections. No matter how you want to put it, you are training CRNAs. This is a very dangerous practice.

The American Academy of Pain Medicine, International Spinal Interventional Society, American Society of Anesthesiologists, and the American Society of Interventional Pain Physicians all have position statements which clearly state that interventions should be provided only by well trained and qualified practitioners. It is our strong belief that these should only be provided by well-trained, qualified physicians, either MD or DO. At ASIPP, we even restrict training of physicians. The training is mainly limited to physicians from the specialties of anesthesiology, physiatry, neurology, or physicians with pain medicine fellowship. Rarely do we train other physicians who have performed interventional pain management for years and have shown exemplary interests. These may include orthopedic surgery, neurosurgery, radiology, and occasionally other specialties, but these are decided with the review of the credentials.

Consequently, we oppose training any person who is not licensed to practice medicine in the United States (it does not include courses abroad training physicians). We do not provide membership to CRNAs who practice interventional pain management. We also do not provide membership to physicians who train nurse anesthetists, PAs, and NPs, or allow them to practice interventional pain management. Actions have been taken in the past against the members.

Your practice is subject to disciplinary action.

Lastly, there is no ASIPP-Academic Task Force in existence. This was created at your and Dr. Trescot's request. It was self-limited for one year. During that year, there was no activity and the position was not re-authorized. Thus, there is no such committee as ASIPP-Academic Task Force. Please stop using this title and also stop incriminating ASIPP in these training activities.

If you have any questions, please feel free to contact us. Once again we would request you to stop these activities immediately. If not, appropriate disciplinary action will be taken.

Thank you,

Laxmaiah Manchikanti, MD
Chairman of the Board and Chief Executive Officer, ASIPP and SIPMS
Medical Director, Pain Management Center of Paducah
Associate Clinical Professor
Anesthesiology and Perioperative Medicine
University of Louisville, Kentucky
2831 Lone Oak Road
Paducah, KY 42003
Phone: 270-554-8373 ext. 101
Cell: 270-366-3046
Fax: 270-554-8987
E-mail: [email protected]



LM/tmh

 

[mid|ine]

BTW...I've heard that part of the reason that he has these views is because at MGH they do not do many procedures. (ie radiology there does all the v-plasty) and perm stims are done by others.....

This is simply NOT TRUE. I trained at MGH. We did LOTS of procedures. Stim trials and perms are done by the fellows and attendings. The only thing the pain department doesn't do is v/k plasty. However fellows can rotate in radiology, and I did >>50+.

 

[drusso]

What's the problem with Michael Whitworth? I kind of like that guy...🙂

from the emails i read he was told to cease and desist immediately with the faux title.



August 6, 2010
Christian Gonzalez, M.D., F.I.P.P
Director, Pain Medicine
University of Massachusetts
Assistant Professor
Department of Anesthesiology
508-793-6804
[email protected]

Dr. Gonzalez:
Thank you for sending us your letter. We have received additional complaints after you sent your letter.

Michael Whitworth is another issue but his point is accurate.

Interventional pain management is the practice of medicine. Interventional techniques do not include trigger point injections, peripheral nerve blocks, or intraarticular injections. No matter how you want to put it, you are training CRNAs. This is a very dangerous practice.

The American Academy of Pain Medicine, International Spinal Interventional Society, American Society of Anesthesiologists, and the American Society of Interventional Pain Physicians all have position statements which clearly state that interventions should be provided only by well trained and qualified practitioners. It is our strong belief that these should only be provided by well-trained, qualified physicians, either MD or DO. At ASIPP, we even restrict training of physicians. The training is mainly limited to physicians from the specialties of anesthesiology, physiatry, neurology, or physicians with pain medicine fellowship. Rarely do we train other physicians who have performed interventional pain management for years and have shown exemplary interests. These may include orthopedic surgery, neurosurgery, radiology, and occasionally other specialties, but these are decided with the review of the credentials.

Consequently, we oppose training any person who is not licensed to practice medicine in the United States (it does not include courses abroad training physicians). We do not provide membership to CRNAs who practice interventional pain management. We also do not provide membership to physicians who train nurse anesthetists, PAs, and NPs, or allow them to practice interventional pain management. Actions have been taken in the past against the members.

Your practice is subject to disciplinary action.

Lastly, there is no ASIPP-Academic Task Force in existence. This was created at your and Dr. Trescot’s request. It was self-limited for one year. During that year, there was no activity and the position was not re-authorized. Thus, there is no such committee as ASIPP-Academic Task Force. Please stop using this title and also stop incriminating ASIPP in these training activities.

If you have any questions, please feel free to contact us. Once again we would request you to stop these activities immediately. If not, appropriate disciplinary action will be taken.

Thank you,

Laxmaiah Manchikanti, MD
Chairman of the Board and Chief Executive Officer, ASIPP and SIPMS
Medical Director, Pain Management Center of Paducah
Associate Clinical Professor
Anesthesiology and Perioperative Medicine
University of Louisville, Kentucky
2831 Lone Oak Road
Paducah, KY 42003
Phone: 270-554-8373 ext. 101
Cell: 270-366-3046
Fax: 270-554-8987
E-mail: [email protected]



LM/tmh

 

[SleepIsGood]

This is simply NOT TRUE. I trained at MGH. We did LOTS of procedures. Stim trials and perms are done by the fellows and attendings. The only thing the pain department doesn't do is v/k plasty. However fellows can rotate in radiology, and I did >>50+.

HOw long ago was this?

Again, even J. Hirsch said the numbers for many of these vert aug procedures have drastically decreased over there.

 

[Aether2000]

MW, "another issue", apparently is the thorn in the side of the stolid leadership of otherwise outstanding organizations that require catharsis to rid themselves of the illness of self-appointed autocracy. Those who need the purgatives the most are the most likely to resist taking them. His favorite agent for such purposes is Ex-Lax. 🙂

 

[Doctodd]

looks like someone hacked algos's computer and/or account and is posting for him.

 

[Aether2000]

lol

 

[mid|ine]

HOw long ago was this?

Again, even J. Hirsch said the numbers for many of these vert aug procedures have drastically decreased over there.

2008-2009 Academic Year

 

[Tenesma]

i was at MGH pre-rathmell so i would defer to Midline...

 

[onewithpain]

I understand the comments. I also wonder how many non-anes, pm&r, neuro are getting into pain fellowships right now? The door may be 'open' but who is getting let through in reality? Psych could get in for a awhile--how many psych trained, fellowship trained, pain docs are there out there??

How many FP's have gotten into pain fellowships. Most programs let in a few PM&R > Neuro at best, right? Anes still rules the roost.

I believe that there is a 2 year pain/sports med fellowship run by the FP residency in Ft Worth. It is a very hands-on residency although I'm sure they are not doing 400 blind epidurals.

When I started my practice some of the local FPs were doing blind epidurals for pain. They stopped after seeing my results, but I can see why they did it as the local anesthesiologist/non-fellowship trained/ABPM certified "specialist" does blind MBBs with 1 cc marcaine and .5 cc celestone at each site. He can't charge for fluoro with MBBs.

 

[Aether2000]

Anyone doing blind MBB is committing fraud.....
Blind epidurals should be outlawed.

 

[Tenesma]

anyone practicing interventional pain without adequate training is committing fraud in my opinion....

thankfully insurance companies are catching on --- currently my BCBS and Cigna are requiring proof of fellowship training in order to get paid for 6XXXX codes... that is a step in the right direction....

unfortunately there are some fellowship trained docs who are fraudsters as well...

 

[hyperalgesia]

anyone practicing interventional pain without adequate training is committing fraud in my opinion....

thankfully insurance companies are catching on --- currently my BCBS and Cigna are requiring proof of fellowship training in order to get paid for 6XXXX codes... that is a step in the right direction....

unfortunately there are some fellowship trained docs who are fraudsters as well...

Really?? That is good to hear. But I also agree, the training doesn't provide ethics. Program directors can be the biggest scam artists of all (even as they preach ethics). There will just always be dishonest snake oil salesmen. I just wish that we, as taxpayers, didn't have to sponsor them with public programs and now mandatory private insurance. That's what really burns my ass.

 

[Jcm800]

i was at MGH pre-rathmell so i would defer to Midline...

I was at MGH in 2001 and i tell you we did a lot of procedures...
but MGH was actually Metropolitan Group Hospitals (MGH) general surgery residency in Chicago...loosely affiliated with UIC. why would they choose those initials i will never know...

 

[PMR 4 MSK]

thankfully insurance companies are catching on --- currently my BCBS and Cigna are requiring proof of fellowship training in order to get paid for 6XXXX codes... that is a step in the right direction....

And the guys who trained pre-fellowship are not allowed to do these anymore on BCBS and Cigna pts?

 

[Tenesma]

those without fellowship training have to fill out a bunch of questions regarding form of previous training, % of patients w/ chronic pain, as well as documentation of courses etc .... sure anybody could fill it out, but it means that somebody (hopefully) is looking at the answers and trying to weed out those they don't like...

from one of the ins. execs, they are using this approach of "re-credentialing" to squeeze out certain "playas" who do 30 injections per day, every day of the week, frequently repeating the same injection every 2 weeks for months on end on the same patient....

 

[PMR 4 MSK]

Yet another example of medicine failing to police itself, so others will do it for us.

 

[Jcm800]

those without fellowship training have to fill out a bunch of questions regarding form of previous training, % of patients w/ chronic pain, as well as documentation of courses etc .... sure anybody could fill it out, but it means that somebody (hopefully) is looking at the answers and trying to weed out those they don't like...

from one of the ins. execs, they are using this approach of "re-credentialing" to squeeze out certain "playas" who do 30 injections per day, every day of the week, frequently repeating the same injection every 2 weeks for months on end on the same patient....

this happened to my partner, but his volume is not excessive or attention-attracting. But they tried it on him, and he fell out for some time, but is now back in. it was a pain, and we lost money because of it, and they loved it (BCBS) since now everything dropped to the OUT OF NETWORK deductible which is differnet from the IN NETWORK deductible in many of the plans...and believe me the patients did not want to pay, and rarely did...

 

[hyperalgesia]

What's to stop a bunch of providers in different specialties from joining together to offer their own health plan? Like Kaiser did a long time ago... Is that still a viable business plan?

 

[Tenesma]

because you take on a HUGE amount of risk... most employers go for the cheapest plans and those are typically the plans that pay out the least...

so if you create a plan that pays doctors decently, then you would have to have higher premiums... which most employers won't jump for...

therefore the only people who will sign up for your plan are people with previous conditions who are desparate to find a plan that will accept them, these people will be high-level consumers of care and you will lose your shirt on covering their costs....

what we need to is have enough doctors purchase shares in United or Wellpoint or some other monster-huge ins. program, and take the company private and then say F**k you to all the other plans...