Disadvantages of Non-ACGME Accredited Pain Programs

[Got Em]

Did a search and the thread was from 6.5 years ago; wanted to see if anything has changed.

I just mainly wanted to know what the disadvantages are if you do a non-ACGME accredited pain fellowship; mainly if reimbursements are different, diff in hospital or practice privileges, findings jobs, etc.

Also, if a non-ACGME trained pain physician wants to start a practice, is it the same process or are there many more hoops to jump through?

Thanks!

---

Members don't see this ad.

 

[drusso]

Your primary problem will be credentialing in larger systems and competitive markets.

 

[Algiatrist]

There are a few, like your fellowship director scaring the hell out of you by driving his Subaru rocket car 120 MPH on the on-ramp of a local highway. NOS tanks and all.

 

[melancholy]

i think previously you could take the ABPM board as sort of an alternative, but I do think larger healthcare systems are specifying ACGME accredited board fellowships as per drusso.

 

[bedrock]

I have friends that took the ABPM boards, and this is accepted by the state medical board and insurers as being board certified for pain in many states including WA, CA, TX, FL, and several midwestern/southern states, etc. Also recognized by the VAMC.

However, it's true that they couldn't be a hospital employees in any of those states.

 

[ampaphb]

Does anyone actually want to be a hospital employee?

 

[Ducttape]

Does anyone actually want to be a hospital employee?

There may not that much of a choice in the future...

In certain areas, non-ACGME certified pain docs are not getting certified by insurance for procedural intervention. But those are most likely in the more restrictive states - NY not Tx for example.

 

[olafa]

One caveat is that is you select a good program (non-ACGME) your training may actually better. Not all programs are the same for both ACGME and NON. There are may posts and discussion on this in the forums.

 

[lobelsteve]

Either way, you can get stuck with an opinioted dufus who cannot see the change in science over time. Or they can.

 

[Doctodd]

Either way, you can get stuck with an opinioted dufus who cannot see the change in science over time. Or they can.

At least you recognize your flaws even if you talk about them in the third person.

 

[lobelsteve]

At least you recognize your flaws even if you talk about them in the third person.

Actually Candido cannot change, I can. Inside joke. I mean Steve can.

 

[IMpainmedicine]

i think previously you could take the ABPM board as sort of an alternative, but I do think larger healthcare systems are specifying ACGME accredited board fellowships as per drusso.

I contacted the ABPM a few months ago about this. According to their credentialing person, you couldn't apply with a non-acgme fellowship unless you applied for a waiver.

 

[lobelsteve]

I contacted the ABPM a few months ago about this. According to their credentialing person, you couldn't apply with a non-acgme fellowship unless you applied for a waiver.

Makes them less than useless. ABMS after ACGME fellowship. So what poit is there to an ABPM if they do not help the nonacgme folks?

 

[bedrock]

I contacted the ABPM a few months ago about this. According to their credentialing person, you couldn't apply with a non-acgme fellowship unless you applied for a waiver.

Unless that changed in the last couple months, the person you spoke to was wrong.

I think you just have an MD/DO and have a practice that's at least 30% pain for two years, and pass the test.

I don't think a fellowship was even required. I know an internist who passed it.

 

[pastafan]

Applicants must present evidence of having satisfactorily completed an ACGME-accredited Residency Training Program in one of the following specialties: anesthesiology, neurological surgery, neurology, psychiatry, or physical medicine and rehabilitation.

 

[bedrock]

Applicants must present evidence of having satisfactorily completed an ACGME-accredited Residency Training Program in one of the following specialties: anesthesiology, neurological surgery, neurology, psychiatry, or physical medicine and rehabilitation.

I just checked and you are right. There is no fellowship requirement if you completed one of those residencies.

 

[IMpainmedicine]

Aha, that makes sense. The way she explained it over the phone was a little contradictory but my misunderstanding.

 

[pastafan]

http://abpm.org/uploads/files/2016_cert_bulletin.pdf

 

[Nonphysiologic]

So sounds like if you do any of the aforementioned residencies ( anesthesiology, neurological surgery, neurology, psychiatry, or physical medicine and rehabilitation), really there is no problem with doing a non-acgme certified fellowship as long as you get the procedural experience? You will still be able to be "board certified" and thus get a job anywhere pretty much except for maybe some more selective larger university health systems?

I guess if thats the case is there really a point in only shooting for ACGME pain fellowship if you had one of those residencies especially if some of the non-ACGME accredited fellowships might be better training?

 

[Ducttape]

wha??

there is an issue with ACGME vs non-ACGME fellowship. if you want the best future job security and options for employment, do an ACGME fellowship.

not saying you cant be a good pain doc doing a non-ACGME fellowship.


your logic is like deciding on dating the ugliest girl in school just because you know you will get some action...

 

[RM38]

So just because you are boarded by the ABPM doesn't mean you can actually advertise as boarded in Pain in all 50 states. As I understand it, only some states recognize the ABPM as the equivalent of ABMS and won't let you describe yourself as such unless you are in one of those states. Even in those states, some jobs that I am looking at will specify that you must have completed an ACGME accredited fellowship. Other places that I have talked to say it goes on a case by case basis when they consider non-acgme fellows. They look at who trained you, your procedure exposure and so on before they would consider hiring you. So yeah, you can be limited even in some PP groups.

 

[SSdoc33]

your logic is like deciding on dating the ugliest girl in school just because you know you will get some action...

i fail to see the fault in this logic

 

[ampaphb]

RM: Get the best training you can. You will earn your own reputation over time.

Some ACGME accredited docs in my community are terrible. Some non-ACGME accredited docs in my community are ISIS instructors and nationally renowned.

Ask around. Ask people you trust. Ask people on this board. Some ACGME-accredited fellowships are headed up by *****s, and others are headed by very smart dinguses.

The fellowship process has no standards in terms of the technical abilities you will learn, and the judgment process in selecting the right procedure for the right patient. Volume of procedures alone is an insufficient criteria. So is academic reputation of the institution. Potential fellows ask should I do this or that all the time. The issue is that fellowships, on the whole, are fifedomes of their directors. What one guy is looking for at his program may be very different than the director at a different program.

The skill and reputation of the director is important. The QUALITY of the training you get is important. Sure, ACGME accreditation is important, as is academic reputation of the program. But if I had the chance to train with Dreyfuss, Bogduk, Aprill, Derby, etc, I wouldn't care a whit if their program was ACGME accredited or not.

Sent from my SAMSUNG-SM-G920A using SDN mobile

 

[Ducttape]

you are right ampa...

but, as someone with intimate experience with what happens when one is NOT ACGME certified in a specific field, was told previously that there was no way that non-ACGME certified physicians would have access cut off across the board, and ultimately had to settle for GP rates to work in that said field at tiny outlying more-rural-than-rural areas, that the degree that one can make a huge difference in future employment prospects.



if you are good enough to train with Dreyfuss or Bogdan, then you are probably good enough to get into a great fellowship...

 

[SSdoc33]

you are right ampa...

but, as someone with intimate experience with what happens when one is NOT ACGME certified in a specific field, was told previously that there was no way that non-ACGME certified physicians would have access cut off across the board, and ultimately had to settle for GP rates to work in that said field at tiny outlying more-rural-than-rural areas, that the degree that one can make a huge difference in future employment prospects.



if you are good enough to train with Dreyfuss or Bogdan, then you are probably good enough to get into a great fellowship...

what field?

not ours, correct?

 

[Ducttape]

correct.

 

[Resident in MI]

If for some reason you don't match into an acgme pain fellowship, can you do a non-acgme fellowship in the hope that it will make you more competitive to apply to an accredited program the next year? Or will acgme accredited programs see you as damaged goods?

 

[PMRDOC2019]

4 year old thread?

Yeah you can but I'm not really sure that
A. It will increase your chances significantly
B. That you would want to do a pain fellowship after

I have 2 friends who is completing a reputable non-ACGME sports/spine fellowship and they had no problems finding a job at major academic centers. I'm not sure how this will change in the future, but if you were to do a non-acgme fellowship, try to do it at a big institution (not some random pain practice)

 

[Agast]

Meanwhile in CRNA-land they’re completing “pain fellowships” and sticking their needles in god knows what.

 

[nynydoc]

I think it is a reasonable option for you with nothing to lose other than a year of full income. I'd suggest that your enter a fellowship with a mentor who is well known in the pain world and can help you put out papers and articles that can help your resume. You may even decide after a non-ACGME fellowship that you may just want to practice. Best of luck.

 

[Resident in MI]

Thanks so much for the advice, I really appreciate it!

 

[Stixx654]

Speaking from (very hard) experience as someone who did a VERY GOOD non-ACGME accredited pain (sports/interventional spine) fellowship and then went on to become a diplomat of the ABPM (American Board of Pain Medicine) I have had ENDLESS problems with insurance companies denying payment for services (including consults, clinic visits and procedures) because I'm not board certified through ABMS. It has become enough of a problem that I am going back to do a real ACGME fellowship just so I can sit for the ABMS boards and make these problems go away. Admittedly, I work in a state that is less understanding than others (CA, TX and a handful of mid-west states consider ABPM to be equivalent to ABMS) but because of family reasons I can't practice in one of those states and the only solution is to take a 1 year leave from my well-paying job and do a fellowship. It's a hard reality but I would advise anyone to just do an ACGME fellowship and avoid a situation like mine. All jobs in my state and the surrounding states specify ACGME fellowship trained as a job requirement (apparently I'm not the first person around here to deal with this problem). I'm in the southwest USA.

 

[Agast]

Crazy that a CRNA can practice "pain" under an orthopedic surgeon's supervision but a non ACGME pain fellowship doctor can't bill for their own procedures.

 

[Laryngospasm]

But a non fellowship Trained physician who has Abms Certification is all good.

 

[bedrock]

Speaking from (very hard) experience as someone who did a VERY GOOD non-ACGME accredited pain (sports/interventional spine) fellowship and then went on to become a diplomat of the ABPM (American Board of Pain Medicine) I have had ENDLESS problems with insurance companies denying payment for services (including consults, clinic visits and procedures) because I'm not board certified through ABMS. It has become enough of a problem that I am going back to do a real ACGME fellowship just so I can sit for the ABMS boards and make these problems go away. Admittedly, I work in a state that is less understanding than others (CA, TX and a handful of mid-west states consider ABPM to be equivalent to ABMS) but because of family reasons I can't practice in one of those states and the only solution is to take a 1 year leave from my well-paying job and do a fellowship. It's a hard reality but I would advise anyone to just do an ACGME fellowship and avoid a situation like mine. All jobs in my state and the surrounding states specify ACGME fellowship trained as a job requirement (apparently I'm not the first person around here to deal with this problem). I'm in the southwest USA.

Would you mind sharing what specific state(s) you worked in, where you had ongoing issues getting paid by insurance companies?

I have a few PMR friends who are doing non accredited fellowships. Would like to tell them which states to avoid.

I thought that getting paid by insurance wasn’t an issue in most states as long as you were ABMS boarded in your primary specialty. I thought the main issue was not getting hired by hospitals or academic centers.

 

[Stixx654]

Would you mind sharing what specific state(s) you worked in, where you had ongoing issues getting paid by insurance companies?

I have a few PMR friends who are doing non accredited fellowships. Would like to tell them which states to avoid.

I thought that getting paid by insurance wasn’t an issue in most states as long as you were ABMS boarded in your primary specialty. I thought the main issue was not getting hired by hospitals or academic centers.

It is both a problem getting paneled on insurance as well as being hired by hospitals and academic centers. I've had problems in Utah, Nevada and Arizona.

 

[Stixx654]

Would you mind sharing what specific state(s) you worked in, where you had ongoing issues getting paid by insurance companies?

I have a few PMR friends who are doing non accredited fellowships. Would like to tell them which states to avoid.

I thought that getting paid by insurance wasn’t an issue in most states as long as you were ABMS boarded in your primary specialty. I thought the main issue was not getting hired by hospitals or academic centers.

Additionally, I should add I am board certified in my primary specialty and can get paid for services rendered the insurance company feels falls under the category of my primary specialty, but anything they label as "pain management" is where they refuse to pay.

 

[Laryngospasm]

Are you anesthesiology?

 

[bedrock]

It is both a problem getting paneled on insurance as well as being hired by hospitals and academic centers. I've had problems in Utah, Nevada and Arizona.

Thank you. Did you have the insurance panel problems in each of those three states?
And did you have issues with just a few small insurance like small regional HMOs or did you have problems getting on insurance panels of major insurers like BCBS, Cigna, UHC, Aetna?

 

[bedrock]

It is both a problem getting paneled on insurance as well as being hired by hospitals and academic centers. I've had problems in Utah, Nevada and Arizona.

I'm also surprised about Arizona because that state, (like CA,TX. and FL) recognizes you as being board certified in pain if you pass the ABPM test.
Were insurance issues as bad in Arizona as they were in Nevada and Utah? I just checked and it appears this AZ recognition only happened in 2018.

 

[Stixx654]

Are you anesthesiology?

PM&R

 

[Stixx654]

Thank you. Did you have the insurance panel problems in each of those three states?
And did you have issues with just a few small insurance like small regional HMOs or did you have problems getting on insurance panels of major insurers like BCBS, Cigna, UHC, Aetna?

Major insurances, particularly BCBS, Sierra, etc have been the biggest problems. Medicare, Medicaid and Tricare have been fine.

 

[Stixx654]

I'm also surprised about Arizona because that state, (like CA,TX. and FL) recognizes you as being board certified in pain if you pass the ABPM test.
Were insurance issues as bad in Arizona as they were in Nevada and Utah? I just checked and it appears this AZ recognition only happened in 2018.

AZ was mostly that all jobs posted ACGME fellowship as a job requirement.

 

[Stixx654]

I'm also surprised about Arizona because that state, (like CA,TX. and FL) recognizes you as being board certified in pain if you pass the ABPM test.
Were insurance issues as bad in Arizona as they were in Nevada and Utah? I just checked and it appears this AZ recognition only happened in 2018.

Additionally the "recognition" Arizona granted those with ABPM certification is still a bit limited. This is a direct copy/paste from the ABPM website about what having ABPM certification in AZ will do for you:

As part of the 2018 Arizona Opioid Epidemic Act, Arizona House Bill 2001 was passed, which in part specifgies that a health professional who believes a patient requires more than 90 MMEs per prescription must consult with a licensed physician who is a board-certified pain specialist.

ABPM worked with the Arizona Medical Association to shape the definition of a "board certified pain specialist" in the bill. Originally, the bill required a mandatory consult with a " board-certified pain specialist who has completed a fellowship program specializing in opioid treatment". ABPM successfully lobbied for removal of the fellowship training requirement, by explaining that this would limit the already small supply of pain medicine specialists in Arizona.

Sadly, while it is a start, it does not directly give ABPM equivalent status to ABMS in Arizona (it just says that someone does not have to be board certified to prescribe 90 MMEs of opioids -- it says nothing about injections/procedures/etc or advertising yourself as "board certified"). Compare this to Texas, for example, which states

The Texas Board of Medicine carefully reviewed all aspects of ABPM’s rigorous certification process and found them to be “substantially equivalent” to those required of ABMS member boards. As reflected on the Texas Board of Medicine’s website, Texas Diplomates can now convey this well-earned certification to patients and for the purpose of advertising this well-earned credential.

California and a few others enjoy a similar level of equivalent recognition. Arizona is better than many states but still falls short of directly stating ABPM is equivalent to ABMS.

 

[Scottie Dog]

I find this a little disheartening and confusing, especially with the new push towards NASS interventional spine fellowships. As a current PM&R resident interested in interventional pain, I've been leaning towards (and encouraged) to pursue a Nass fellowship rather than ACGME. I want to be able to sit for pain boards, and ultimately work in a private practice setting. The first "Nass" match was yesterday, so this new territory. Unsure if any active users matched yesterday and if they have any input on the current situation.

 

[myrandom2003]

Does it really matter to get on insurance panels? can't you just get on the panel under your primary specialty? for PMR many of these procedures are already included in the fee schedule.

If you go ortho or private or some community hospitals, it makes no difference.
Academic centers will want ACGME because that's their tribe.

 

[lonelobo]

Agree with above

 

[bedrock]

Does it really matter to get on insurance panels? can't you just get on the panel under your primary specialty? for PMR many of these procedures are already included in the fee schedule.

If you go ortho or private or some community hospitals, it makes no difference.
Academic centers will want ACGME because that's their tribe.

that was my understanding. Lots of pmr docs have been doing epidurals for years and get paid by insurance. Just get on Insurance panels as a pmr physician.

 

[Ronin1]

Or just do an ACGME accredited fellowship. Overall there is a difference in standardization for training as compared to the many non accredited types

 

[bedrock]

Or just do an ACGME accredited fellowship. Overall there is a difference in standardization for training as compared to the many non accredited types

I think most applicants recognize that a good ACGME fellowship is the clearly the way to go.

The problem is that there are many terrible ACGME pain fellowships where you don't learn much in a year, mediocre attendings, didactics, and poor procedural training and there are some non ACGME fellowships particularly spine fellowships at academic institutions that provide great procedural training including better training in kypho, stim implants, vertiflex, etc, as well as triple the numbers of bread/butter procedures, and they still have decent didactics.

Those types of non ACGME fellowships are a better educational experience than the worst third of the ACGME fellowships.

Clearly there are also many non acgme fellowships particularly private (non university based) fellowships that don't have didactics, don't really teach you much after the first 3 months, etc. These are worse than the worse third of ACGME fellowships and worse than all the top academic spine fellowships.

But the struggle for many applicants is what to do if they can't get into a good ACGME fellowship and so they are faced with either getting the ACGME piece of paper from a bad fellowship, but having terrible training vs getting great training from an academic spine fellowship, but dealing with issues during their practical career because they don't have the piece of paper.