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As of today, Pain Medicine is now an official subspecialty of Family Medicine.
As of today, Pain Medicine is now an official subspecialty of Family Medicine.
See, that's why I think this is good. The more specialties that have the option to do an ACGME Pain fellowship and ABMS boards, the less reason or justification to just hang a shingle and just call yourself "Pain Specialist." Obviously if you're a resident applying to pain, it increases the applicant pool and competition, but in my opinion, I think overall it's a good thing. If you want to be a Pain doctor, do an ACGME fellowship and pass the ABMS Pain boards. It's hard enough to become an expert in one year, let alone self taught. That's my opinion.But at least now there is no way around completing an AGCME fellowship before being able to take the test correct?
Not pathology. Likely Rads, Peds and IM.This is getting crazy. What's next - pathology??
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or it may result in many non-anesthesia/non-PMR residencies opening up their own "pain fellowship", under the auspices of the fellowship. a Peds or Int Med residency reviewing ACGME criteria may decide that they have the wherewithal to open their own fellowship, in a situation where the availability of interventional experience will be extraordinarily limited, along with the possible lack of historical knowledge regarding prior pain treatments that have failed - ie opioids.See, that's why I think this is good. The more specialties that have the option to do an ACGME Pain fellowship and ABMS boards, the less reason or justification to just hang a shingle and just call yourself "Pain Specialist." Obviously if you're a resident applying to pain, it increases the applicant pool and competition, but in my opinion, I think overall it's a good thing. If you want to be a Pain doctor, do an ACGME fellowship and pass the ABMS Pain boards. It's hard enough to become an expert in one year, let alone self taught. That's my opinion.
This is not good. There will be more guys with 10 thumbs who have never set foot in an OR or procedure suite and don't know one end of a needle from the other out there trying to make $$$ on procedures. They are not interested in pain certification to write meds. They want procedures. This is as bad a rheumatologists doing knee arthroscopy ( I'm told in some areas they do).Not pathology. Likely Rads, Peds and IM.
FM and IM see a ton of chronic pain and a few have already done ACGME fellowships and gotten ABMS boarded. Peds, maybe not so much in general peds but sickle cell, and pediatric cancer pain would be their argument. Rads obviously has the angle that they are experts at the imaging and have interventional exposure. Path? Eh...Doubt they'd apply for it. Seems like a stretch but who knows.
dont laugh. the usual treatment in ER or office for chronic pain almost always ends in "take 1 pill every 4 hours as needed".
In an ideal world we would all love each other and be one big happy family. It's not an ideal world. Medicine is fiercely competitive. Are the subspecialties of IM such as Interventional Cardiology open to other specialties? I think that it is up to our primary specialty boards to give us exclusivity. You want to be a pain specialist? Then get in through one or two primary specialties - THATS IT! Don't like being a FM or ER doc? Retrain in a second specialty. I'd like to be an interventional radiologist. Wish I had gone that route. As an interventional pain specialist I do a lot of IR. I have the skills. However, if I want to do IR I need to retrain as a radiologist. Keeps me out of IR, keeps the number of IR docs limited, protects the board member's livelihood. I suspect that the motivation underlying this is MONEY. The fellowships gets lots of "bodies" for next to nothing, the boards get the fees for exams, etc. It is the job of our Boards to protect our way of making a living.
This is only a little less worrisome than CRNAs doing what we do. Perhaps a reasonable compromise would be to do something like Cardiovascular Disease. Have a subspecialty certificate in Pain Medicine (non-interventional) open to IM, FP, ER, Neuro, etc. and Interventional pain medicine open only to Anesth and PM&R. By allowing all of these specialties in we are more or less saying that you can teach a monkey to do what we do if you train them for a year. Do we really believe that? Then let's train the same monkeys to go coronary angiograms, PTCA, peripheral vascular stents, electrodiagnostics, etc, etc.
I think pain fellowships should be broken into clinical and interventional like NJ PAIN wrote above.
And yet there are those in our ranks who only do procedures for a living or others that just do opiate Rx. The more people that train, the more viewpoints there will be and the more watered down the field becomes. A residency is needed that would encompass all of pain. And it will never happen. Unless we go single payor and socialize pain medicine:
Manifesto of a madman:
Socializing pain medicine for the common good.
Pain physicians become employee's of the federal government.
Salary is 65-80% MGMA with no bonus, no work product/patient related ancillary income. Govt benefits and COLA.
VAMC type sovereign immunity form lawsuits.
Responsible for all Pain care outside of the acute ER or operative setting.
This includes opiate prescribing and interventional care.
Other physicians will no longer be able to Rx opiates outside of a 7 day course and 1 refill for any pain complaint. Surgeons can handle post-op pain per usual course.
Interventional care will be allowed only by pain physicians and not any other specialty. This would include outpatient VCF augmentation, SCS, ESI, Facet, SIJ, sympathetic blocks.
Minimum patient load would include 20 per day, max 30 per day.
Opiate prescribing issues will need a round table of experts for consensus. Dosing, drug choice, qty limits, due diligence
all need to be discussed and agreed upon.
Medicare is primary payor and all insurance companies would need to pay in a percentage of prior payments to the Pain Pilot program.
Would need a test region/locale to determine feasibility and logistics.
Agree.Having ER and FP do pain is nothing new. They used to get their board certification through PM&R. Now PM&R said they wouldn't do it anymore, so the other specialties said they would do it.
We have trained PM&R, Neurology, Psychiatry and anesthesia. They all have done very well and each bring something unique to the field. We are a better clinic having trained them and now having some of them as part of the fellowship faculty.
Having FM join those ranks will also benefit the field. It is short sighted to think otherwise.
Actually, it is the step in the right direction to get pain medicine as it's own specialty.
#1-There's also lots of anesthesiologists and physiatrists that went into Pain to "bail out" of their specialties out of some level of dislike of their original specialties, in favor of Pain which they like more. So what? But you say that's okay for them but not for other specialties? That makes no sense. I'm hearing a lot of turf protection talk. I just shake my head when I hear the same people that trained nurses to do their jobs, don't think a physician who did medical school, a 3-4 year residency, and the same 1-year ACGME Pain fellowship, and passed the same ABA Pain exam can do the same job. It's just blatant, misplaced turf protection. A physician needs to spend 3 years doing OR anesthesia to treat chronic pain patients even though he did an ACGME pain fellowship and ABMS Pain boards, yet a nurse needs none of that to practice anesthesiology? That's absurd. You've for the cart before the horse.A residency in Pain Medicine would be ideal. You do 1 year of medicine, peds or surgery and 3 years of pain. You do a residency in another specialty, don't like it and want to do pain? - you need to do the entire 3 year pain residency. This keeps out those who are looking for a way out of their primary specialty because they don't like it or the $$$ was not what they hoped. That's the problem with the current structure. It's way too easy to bailout of another specialty and roll right into pain. What else is so easy?? It brings people in for all of the wrong reasons and floods the field with garbage. It wouldn't be so bad if the public was smart enough to distinguish the difference between a good pain doctor and a bad one. The primary doctors are no better at figuring out who is knowledgeable and well trained. The PCP will refer to whomever with take their chronic opioid dumps or who will pay them $10K/month to rent office space.
If we really limited who comes into this field we wouldn't be spending so much of our time on this forum discussing how much we hate primary care docs dumping patients on us but that we put up with it because otherwise they will send the "good" patients elsewhere. If there were fewer of us we would have much more power to control the appropriateness of patients sent to us and the type of treatment they receive. When fellowship trained pain doctors were as "rare as hound's teeth" 20 years ago being a pain doctor was more like being a neurosurgeon than in the current climate where a pain doctor is on the level of a chiropractor.
freddypt, be careful what you ask for. if a monkey can be taught to do injections, then soon CRNA, NP, PA, LPN, med tech organizations will clamor to be allowed to do these injections, and without physician supervision. oh wait, some of those organizations are already pushing for that.
If I'm not qualified to make any judgements about anesthesiology, because I didn't do an anesthesia residency or take the anesthesiology boards, then you're no more qualified to speak of emergency medicine since you didn't do an EM residency or take the EM boards.it is not so much turf protection as protection of the specialty.
i would not go so far as to say that anesthesiology specialty is the best or should be the only way of getting into pain, but as of right now, it is the most common.
what my concern is is the dilution of the quality of the candidates via the establishment of new fellowships, and with some of these candidates not being vetted appropriately. if history repeats itself, multiple other specialties will start forming their own pain medicine fellowships, exactly like what happened to Sports Med in the 90s and even ER in the early 90s. the difference - ER held strong and would not recognize IM programs that decided to make ER fellowships or qualify for their boards. sports med fellowships popped up at multiple ER residencies. currently, ER as a profession is going strong. sports med? not so much.
freddypt, be careful what you ask for. if a monkey can be taught to do injections, then soon CRNA, NP, PA, LPN, med tech organizations will clamor to be allowed to do these injections, and without physician supervision. oh wait, some of those organizations are already pushing for that.
finally, emd, you didnt do anesthesiology residency so there is no way you can reasonably say that you do or do not know more because of not doing an anesthesiology residency.
i worked in ER longer than you, taught more years of ER residents than you were working in ER, and i found anesthesiology residency to be very informational about pain, particularly since at least 4 - in my case, 6 - months of a residency is in pain (acute and chronic). its not just about LOR. it is about disease process, other non-pill way of treating pain ( you obviously learned that opioid pills at least are not "good"), workflow, types of needles, running epidurals/testing them, comfort with neuraxial procedures and injecting medications, the anatomy of the spine, the mechanism of nerve blocks, medications used, ultrasound skills (which are completely different diagnostic vs. therapeutic), adjunctive meds, the study of pain itself. opioids are only a small picture of chronic pain. ER is not a great field to prep in itself for Pain. PMR? yes. Neuro, probably. Psychiatry? yes and no. FM? not so much.
If I'm not qualified to make any judgements about anesthesiology, because I didn't do an anesthesia residency or take the anesthesiology boards, then you're no more qualified to speak of emergency medicine since you didn't do an EM residency or take the EM boards.
actually, no. i was a assistant professor in emergency medicine at an academic teaching program. i know what goes on and what is taught in EM residency - i taught guys like you what you know about EM.If I'm not qualified to make any judgements about anesthesiology, because I didn't do an anesthesia residency or take the anesthesiology boards, then you're no more qualified to speak of emergency medicine since you didn't do an EM residency or take the EM boards.
Wait. As a side note, how many specialties have you practiced? Primary care, ER, anesthesia and Pain?actually, no. i was a assistant professor in emergency medicine at an academic teaching program. i know what goes on and what is taught in EM residency - i taught guys like you what you know about EM.
i missed grandfathering the EM boards by 3 months. i decided not to take the alternate boards, because, prophetically, i thought that they would be useless.
That's fine, as long as you concede to me the piece of turf I rightfully earned.It's ALL about turf. Don't forget, most of us earn a living doing this. I believe that it is up to us and our board(s) to protect our turf. Just because this business is medicine doesn't mean we all have to hold hands, sing "I'd like to teach the world to sing in perfect harmony" on a mountain top and welcome everyone into the field. Protecting your turf is human nature and an important part of surviving in business. If this were my hobby I would love the diversity.
If we really limited who comes into this field we wouldn't be spending so much of our time on this forum discussing how much we hate primary care docs dumping patients on us but that we put up with it because otherwise they will send the "good" patients elsewhere. If there were fewer of us we would have much more power to control the appropriateness of patients sent to us and the type of treatment they receive. When fellowship trained pain doctors were as "rare as hound's teeth" 20 years ago being a pain doctor was more like being a neurosurgeon than in the current climate where a pain doctor is on the level of a chiropractor.
APPLAUSEIn America, every idiot and his brother already has a pain practice. If you're in any city, any village, you can't go left or right without passing some sort of pain clinic within a few hundred feet.
I'm skeptical as to how throwing Pain open to as of yet even more specialties is going to be of benefit, other than somehow this makes some folks feel good about themselves about being in such an egalitarian field open to anyone with no relevant qualifications whatsoever. This is exactly, 100% the opposite strategy pursued by all other fields in medicine. But I fail to see how participating in such a peculiar social experiment is going to feed one's family.
In California in the metro areas, there's actually waiting lists to get into see a PCP. I know someone in LA whose in their 20's, up until recently healthy, with "good insurance", but now with GI issues who can't get into see a PCP because the waiting lists are so long. They keep going into the ER with severe episodes and being told to follow up with their PCP, and yet they can't get a PCP. We actually need PCP's in America doing Primary Care stuff. People are suffering from lack of access to PCP's. Meanwhile, nobody has actually ever died from not being stuck with a needle or not getting oxycodone. Why do we need more people doing Pain, when there's already an insane oversaturation of Pain providers?
Having ER and FP do pain is nothing new. They used to get their board certification through PM&R. Now PM&R said they wouldn't do it anymore, so the other specialties said they would do it.
We have trained PM&R, Neurology, Psychiatry and anesthesia. They all have done very well and each bring something unique to the field. We are a better clinic having trained them and now having some of them as part of the fellowship faculty.
Having FM join those ranks will also benefit the field. It is short sighted to think otherwise.
Actually, it is the step in the right direction to get pain medicine as it's own specialty.
In America, every idiot and his brother already has a pain practice. If you're in any city, any village, you can't go left or right without passing some sort of pain clinic within a few hundred feet.
I'm skeptical as to how throwing Pain open to as of yet even more specialties is going to be of benefit, other than somehow this makes some folks feel good about themselves about being in such an egalitarian field open to anyone with no relevant qualifications whatsoever. This is exactly, 100% the opposite strategy pursued by all other fields in medicine. But I fail to see how participating in such a peculiar social experiment is going to feed one's family.
In California in the metro areas, there's actually waiting lists to get into see a PCP. I know someone in LA whose in their 20's, up until recently healthy, with "good insurance", but now with GI issues who can't get into see a PCP because the waiting lists are so long. They keep going into the ER with severe episodes and being told to follow up with their PCP, and yet they can't get a PCP. We actually need PCP's in America doing Primary Care stuff. People are suffering from lack of access to PCP's. Meanwhile, nobody has actually ever died from not being stuck with a needle or not getting oxycodone. Why do we need more people doing Pain, when there's already an insane oversaturation of Pain providers?
I think the more specialties that have skin in the game that can advocate for Pain at the ABMS and ACGME level, help this. Being isolated like a one or two specialty island makes the specialty less strong as it is with more ox pulling the cart.How does getting more co sponsors lead to pain medicine becoming it's own specialty??