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T4113

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Hey guys,

Here's another question for everyone. What other additional certificates can FM docs get? I've read of botox and fillers, IUD insertion training/Nexplanon insertion training, and medical marijuana. Are there any other people have heard of or better yet received the training for?

Thanks a bunch!
 
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scharnhorst

10+ Year Member
Jan 26, 2008
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Hey guys,

Here's another question for everyone. What other additional certificates can FM docs get? I've read of botox and fillers, IUD insertion training/Nexplanon insertion training, and medical marijuana. Are there any other people have heard of or better yet received the training for?

Thanks a bunch!
What are you trying to achieve out of additional training ?
 

AMEHigh

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I’m not really sure what you mean.
But There are acgme fellowships and there are non-acgme fellowships like reproductive/women’s health for example. Regardless, it’s probably better if you have a more specific questions. There are always pros and cons to doing extra training which depend on what your residency was like and what your career goals are.
 

galactus

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You can get your civil surgeon certificate and do immigration physicals. Or get a certificate as an Aviation Medical Examiner so you can do flight physicals.
 
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VA Hopeful Dr

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You can get your civil surgeon certificate and do immigration physicals. Or get a certificate as an Aviation Medical Examiner so you can do flight physicals.
Along those lines are DOT physicals
 
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I think you can get board certified in Lifestyle Medicine through a practice pathway. I think the same is true for obesity medicine
 

AFMD

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I am very interested in options for further certifications for Family Physicians, and I'll share what I’ve looked at below. How these are presented in my post are biased by my particular interests. I'm sure there are many other things out there I don't know about. I’m not sure if this is exactly what you were looking for either.

Please note, the ABFM (American Board of Family Medicine) is considered the standard Family Medicine board, and is a member board of ABMS (the American Board of Medical Specialties). The AOA Family Medicine board (AOBFP or American Osteopathic Board of Family Physicians) is considered by many as comparable. There are other boards as well, as discussed below.

Available Certificate of Added Qualifications (CAQ) available through ABFM (American Family Board of Family Medicine) typically through fellowships that are ACGME accredited and 12 months or more (more info: Added Qualifications | ABFM | American Board of Family Medicine):
Adolescent Medicine
Geriatric Medicine
Hospital and Palliative Care
Pain Medicine
Sleep Medicine
Sport Medicine

From what I know, Pain Medicine Fellowships is difficult for Family Physicians to get into. They are usually Anesthesiologists, but there are other specialties as well.

You can get a Designation of Focused Practice in Hospital Medicine after three years of unsupervised hospitalist practice through the ABFM as well.

Addiction Medicine is available through the American Board of Preventive Medicine after a 12-month fellowship. There is a clinical practice pathway, but it is soon closing. The AOBFP/AOA is also offering a similar board certification for which the clinical practice pathway will be open for a few more years, but can be accessed through a fellowship as well.

Of course, Addiction Medicine is well within the scope of Family Medicine, and we can all obtain a buprenorphine waiver. I encourage all Family Physicians to do so. You do not need a board certification for this to be part of your practice.

The ABFM website mentions Brain Injury Medicine, Clinic Informatics, and Emergency Medical Services. I do not know much are these. More here: Additional Certifications Available to Family Physicians | ABFM | American Board of Family Medicine.

AOBFP/AOA offers a CAQ in Geriatric Medicine, and also AOA subspecialty board certification in several areas: Addiction Medicine, Correctional Medicine, Hospice and Palliative Care, Pain Medicine, Sleep Medicine, Sports Medicine, and Undersea and Hyperbaric Medicine. For more info: Certification Process Overview - American Osteopathic Board of Family Physicians.

There are many fellowships available in many different areas. The AAFP has one listing: Index -- AAFP.

A less standard board is the American Board of Physician Specialties (ABPS). It is not a member of the ABMS (American Board of Medical Specialties). They have certifications in Family Medicine Obstetrics, Urgent Care Medicine, Hospital Medicine, and Integrative Medicine. These can be accessed through fellowships or experience.

As far as other boards not a member of the ABMS, there are several that we have access to. They typical do not require fellowship. They are listed below:
American Board of Obesity Medicine
American College of Lifestyle Medicine
American Board of Functional Medicine
National Board of Physician Nutrition Specialists
Anyone know of any others?

The Certified Physician Executive (CPE) that is available through the American Association for Physician Leadership.

You could simply complete an MPH (Masters of Public Health), MPA/MPP (Masters of Public Administration/Policy), MHA (Masters of Healthcare Administration), or MBA (Masters of Business Administration) depending on your goals.

I’ve heard of physicians that were members of the American Herbalist Guild which is probably not my jam. Interestingly, in my state a physician can do acupuncture without any further training. I do not know much more about these.

Medical Cannabis depends on the state. Mine is 4 hours of CME and registration with the state to be able to recommend cannabis.

If you are interested in an area or procedure, you should pursue it. Family Medicine affords a broad scope to build a practice around. You could obtain further training or certification for your interests, advertising, expanding your skill set, etc. For example, I am very interested in Mental Health and Addiction Medicine, and I am pursuing the AOA clinical pathway for Addiction Medicine, and I also I plan on trying to get training in ketamine infusions and TMS (transcranial magnetic simulation). You can make out of your career what you want.

Overall, the traditional route is to simply do traditional Family Medicine, and very few will obtain any of the above training/certifications, and many would argue it is not necessary with good reason. There is a cost to everything as explained above, and needs to fit your goals to make sense for you.

I’d be interested to hear more of what other training/certifications others have done in the past as well.
 

Fatalis

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Ring side medicine. I was able o fullfill most of the requirements in residency
 
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I am very interested in Mental Health and Addiction Medicine, and I am pursuing the AOA clinical pathway for Addiction Medicine, and I also I plan on trying to get training in ketamine infusions and TMS (transcranial magnetic simulation). You can make out of your career what you want.
I am very interested in pursuing a fellowship in addiction medicine. Could you give some overview of how your practice has changed or what clinical medicine you work in? How much psych do you recommend taking during residency to be strong in this field? Do you also manage the mental health aspect of your patients or do you only do addiction?

Also, what are your thoughts on the TNT primary care psychiatry fellowship? UC Irvine Train New Trainers Primary Care Psychiatry Fellowship | Department of Psychiatry & Human Behavior | University of California, Irvine I am hesitant that this is a scam because they want 15k, there is no clinical component (only didactics), and NP/PA can do it too. Do you think Addiction Medicine would give me enough mastery of Primary Care Psychiatry without doing something like this?

Thanks!
 
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AFMD

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I am very interested in pursuing a fellowship in addiction medicine. Could you give some overview of how your practice has changed or what clinical medicine you work in? How much psych do you recommend taking during residency to be strong in this field? Do you also manage the mental health aspect of your patients or do you only do addiction?

Also, what are your thoughts on the TNT primary care psychiatry fellowship? UC Irvine Train New Trainers Primary Care Psychiatry Fellowship | Department of Psychiatry & Human Behavior | University of California, Irvine I am hesitant that this is a scam because they want 15k, there is no clinical component (only didactics), and NP/PA can do it too. Do you think Addiction Medicine would give me enough mastery of Primary Care Psychiatry without doing something like this?

Thanks!
I have looked at the UC Irvine primary care psychiatry fellowship, and it looks intriguing. You can do it while you are working, but it is very expensive for what it is. There is a kind of similar program with a similar amount of hours from UMass Medical School for $1600 (Certificate in Primary Care Behavioral Health – UMass Medical School). In the end, I think it's all things I learned in residency, and not worth it to me. You might be able to use it to advertise? There is no board certification, and no ACGME accreditation.

As far as Addiction Medicine, it is very rewarding. Buprenorphine especially really helps a lot of people, and usually very quickly. I did two electives in Addiction/Psych in residency (Family Medicine Residency), and there was a lot of behavioral health/psych in my community clinic and inpatient rotations as well. We did not have much psychiatry coverage, and we did most of it. I think that most residencies will get you the training you need.

Do the training for the buprenorphine waiver as soon as you can, and you can expand to 100 patients one year from when you first get it. PCSS is an amazing source for free and excellent training, and I really recommend their SUD 101 curriculum (SUD 101 Core Curriculum - PCSS).

There are two boards for Addiction Medicine: ABMS (MD board) Addiction Medicine Board actually under the American Board of Preventive Medicine (ABPM) for some reasons, and the AOA (DO board) Addiction Medicine board. Both can be done through a 12 month fellowship. Both have practice pathways as well. The MD board requires 2000 hours, but about a quarter of that can be research, and a quarter can be Primary Care, but this will not be available for much longer. The DO board requires 1000 hours. I think it's too bad Addiction is not a Family Medicine CAQ with the ABFM.

I suggest keeping up your Primary Care skills, and doing Addiction as part of your practice, at least at first. I do Primary care with Addiction as part of it, and usually have a side job in Addiction. I should have enough hours soon to get boarded AOA. I would do MD, but the practice pathway will end too soon for me to get the hours. Eventually, you could transition to just Addiction, but I'd be sure that's what you want to do. Many of us in Family Medicine ended up here because we love variety, and it's so hard to let go of. Primary care is really so rewarding.

I've noticed a lot of those boarded in Addiction Medicine still do Primary Care. Many of those doing exclusively Addiction Medicine seem to be Addiction Psychiatry (Psych has their own Addiction sub-specialty as well). I think this is just culture, incentived by better pay in Primary Care, or just the bias I've seen.
 
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I have looked at the UC Irvine primary care psychiatry fellowship, and it looks intriguing. You can do it while you are working, but it is very expensive for what it is. There is a kind of similar program with a similar amount of hours from UMass Medical School for $1600 (Certificate in Primary Care Behavioral Health – UMass Medical School). In the end, I think it's all things I learned in residency, and not worth it to me. You might be able to use it to advertise? There is no board certification, and no ACGME accreditation.

As far as Addiction Medicine, it is very rewarding. Buprenorphine especially really helps a lot of people, and usually very quickly. I did two electives in Addiction/Psych in residency (Family Medicine Residency), and there was a lot of behavioral health/psych in my community clinic and inpatient rotations as well. We did not have much psychiatry coverage, and we did most of it. I think that most residencies will get you the training you need.

Do the training for the buprenorphine waiver as soon as you can, and you can expand to 100 patients one year from when you first get it. PCSS is an amazing source for free and excellent training, and I really recommend their SUD 101 curriculum (SUD 101 Core Curriculum - PCSS).

There are two boards for Addiction Medicine: ABMS (MD board) Addiction Medicine Board actually under the American Board of Preventive Medicine (ABPM) for some reasons, and the AOA (DO board) Addiction Medicine board. Both can be done through a 12 month fellowship. Both have practice pathways as well. The MD board requires 2000 hours, but about a quarter of that can be research, and a quarter can be Primary Care, but this will not be available for much longer. The DO board requires 1000 hours. I think it's too bad Addiction is not a Family Medicine CAQ with the ABFM.

I suggest keeping up your Primary Care skills, and doing Addiction as part of your practice, at least at first. I do Primary care with Addiction as part of it, and usually have a side job in Addiction. I should have enough hours soon to get boarded AOA. I would do MD, but the practice pathway will end too soon for me to get the hours. Eventually, you could transition to just Addiction, but I'd be sure that's what you want to do. Many of us in Family Medicine ended up here because we love variety, and it's so hard to let go of. Primary care is really so rewarding.

I've noticed a lot of those boarded in Addiction Medicine still do Primary Care. Many of those doing exclusively Addiction Medicine seem to be Addiction Psychiatry (Psych has their own Addiction sub-specialty as well). I think this is just culture, incentived by better pay in Primary Care, or just the bias I've seen.
And just as a quick followup, do you do the management for the psych component of your patients? Would this include bipolar, schizophrenia, and other conditions that are usually not emphasized in FM training?
 
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AFMD

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And just as a quick followup, do you do the management for the psych component of your patients? Would this include bipolar, schizophrenia, and other conditions that are usually not emphasized in FM training?
Most people with addiction seem to have a Mental Health diagnosis. Chronic pain is also common.

At one job at an Addiction Medicine Practice, some in the community would send to us patients with treatment resistant depression, likely ADHD, bipolar, etc. with or without an addiction diagnosis. However, that was a semi-rural area with few psychiatrists in the area, and the medical director was one of those few psychiatrists. I kept the vast majority of these, but sent a few to the psychiatrist as needed.

After I moved to a suburban area, and now I work mostly for the VA, no one sends me Mental Health patients anymore. However, more than half of VA primary care is Mental Health and Pain easily, and others do send me Addiction patients and Pain patients interested in buprenorphine for consult or to establish with me. I think a lot of the complicated psychiatric patients end up on my panel, but they are seeing Mental Health as well.

Every Family Physician has parts of medicine they like the most. If you are in a group, they can send you patients who fit your interests. I imagine you would attract those patients eventually in solo practice as well. Family Medicine is really pretty great.
 
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tealeafexplorer

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Why does no one talk about integrative medicine?

Sure it is Kind of in contradiction to western medicine because it has a lot of eastern medicine modalities and philosophy, but at least out here on the west coast there is a lot of demand for it.

A lot of hippie people who are into their herbals, body, mind, spirit connection etc... and a lot of these people are dying to find an integrative medicine doc and pay cash out of pocket to have an integrative medicine doc speak with them for 45 min to an hour about everything including a lot of wackadoo stuff people here will **** on, but are important to the patients we treat
 

VA Hopeful Dr

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Why does no one talk about integrative medicine?

Sure it is Kind of in contradiction to western medicine because it has a lot of eastern medicine modalities and philosophy, but at least out here on the west coast there is a lot of demand for it.

A lot of hippie people who are into their herbals, body, mind, spirit connection etc... and a lot of these people are dying to find an integrative medicine doc and pay cash out of pocket to have an integrative medicine doc speak with them for 45 min to an hour about everything including a lot of wackadoo stuff people here will **** on, but are important to the patients we treat
Because we're good doctors?

Opioids are very important to a lot of people too, but that doesn't mean I should indulge them on that.
 
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Blue Dog

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Why does no one talk about integrative medicine?
Because it's B.S.

Integrating sense and nonsense doesn't make you a better doctor. It makes you a quack.
 

yeasports

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Why does no one talk about integrative medicine?

Sure it is Kind of in contradiction to western medicine because it has a lot of eastern medicine modalities and philosophy, but at least out here on the west coast there is a lot of demand for it.

A lot of hippie people who are into their herbals, body, mind, spirit connection etc... and a lot of these people are dying to find an integrative medicine doc and pay cash out of pocket to have an integrative medicine doc speak with them for 45 min to an hour about everything including a lot of wackadoo stuff people here will **** on, but are important to the patients we treat
answered it yourself
 

Blue Dog

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"In the best kind of medical practice, all proposed treatments must be tested objectively. In the end, there will only be treatments that pass that test and those that do not, those that are proven worthwhile and those that are not." - Arnold Relman, M.D. former editor of The New England Journal of Medicine

 
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AFMD

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Why does no one talk about integrative medicine?

Sure it is Kind of in contradiction to western medicine because it has a lot of eastern medicine modalities and philosophy, but at least out here on the west coast there is a lot of demand for it.

A lot of hippie people who are into their herbals, body, mind, spirit connection etc... and a lot of these people are dying to find an integrative medicine doc and pay cash out of pocket to have an integrative medicine doc speak with them for 45 min to an hour about everything including a lot of wackadoo stuff people here will **** on, but are important to the patients we treat
Mentioned in my first post. There are fellowships, and a board to certify.

The community here is very traditional, but I tend to agree with them. However, there is a place for alternative/integrative treatments. Many have low risk, and are reasonable to try. Anyone that's refered to massage, chiro, or acupuncture has used integrative or alternative medicine. Even a lot of that is done in PT does not have great evidence. Mindfulness medication has it's issues with evidence as well. Many of us are DOs and have some training in these areas already, at least in OMM. There's crazy ridiculous stuff out there for sure, but having some try ginger per patient preference for nausea before zofran is not crazy. I don't think Integrative Medicine should be simply written off, but that's just one opinion.

I think the big offense is that it feels like those in Integrative Medicine are claiming Family Physicians aren't already doing reasonable alternative treatments, which most of us are. It's pretending it's just it's own thing, but we are doing it already, and so much more.
 
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You can get your civil surgeon certificate and do immigration physicals. Or get a certificate as an Aviation Medical Examiner so you can do flight physicals.
I am a first generation American, and my family exemplifies the vigor that immigrants bring our country - both parents PhDs (my mother got hers with three kids 10-15), and 2/3 kids doctoral degrees (my baby bro is “only” a Professional Engineer). Immigration work is incredibly gratifying - my colleague and I have maps up on the wall, and our patients put a pin in their country of origin at the end of their exam. I like to be a friendly face of their experience; with the current regime, the rhetoric and policy idiocy are daunting. I ask people to let me know when they get their green cards, as well as to send me baby pictures if they are pregnant. The only downside is that, if you do your job right, you never see them again!
 

Freezeout

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Anyone know much about the obesity medicine or lifestyle medicine certifications? Does the headache medicine cert include Botox cert?
 
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Anyone know much about the obesity medicine or lifestyle medicine certifications? Does the headache medicine cert include Botox cert?
Lifestyle medicine is a joke. You can get it easily through certification. I doubt it'll help you get a job at all

Obesity medicine is closing the CME pathway and will require a fellowship

Headache should allow you to do botox. It's a very common procedure
 

Wannabedoc192

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Does anyone know how feasible it is to do headache medicine as a family doctor? Is it best to do a fellowship or is there enough opportunities to learn nerve blocks and other treatments during FM residency? (Im assuming botox is a CME course?) I’m really interested in treating headaches, and torn between going family medicine and Neuro!
 

Freezeout

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Lifestyle medicine is a joke. You can get it easily through certification. I doubt it'll help you get a job at all

Obesity medicine is closing the CME pathway and will require a fellowship

Headache should allow you to do botox. It's a very common procedure
Any idea on when obesity medicine is changing? I’ve been eying that one but may need to go ahead and get on it.
 
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Any idea on when obesity medicine is changing? I’ve been eying that one but may need to go ahead and get on it.
I don't know. I don't see a date on the website either. May just be rumors after addiction and a few others established 2023 as their cutoff year
 

VA Hopeful Dr

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Does anyone know how feasible it is to do headache medicine as a family doctor? Is it best to do a fellowship or is there enough opportunities to learn nerve blocks and other treatments during FM residency? (Im assuming botox is a CME course?) I’m really interested in treating headaches, and torn between going family medicine and Neuro!
If you want to be the headache expert, go neuro.
 
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AFMD

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Does anyone know how feasible it is to do headache medicine as a family doctor? Is it best to do a fellowship or is there enough opportunities to learn nerve blocks and other treatments during FM residency? (Im assuming botox is a CME course?) I’m really interested in treating headaches, and torn between going family medicine and Neuro!
There's plenty of headache medicine in FM. There are fellowships. I really don't know how many FM physicians are doing exclusively Headache Medicine though. AAFP has three listings for fellowships:

Most of the fellowships out there look like they are for Neurologists.
 

VA Hopeful Dr

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There's plenty of headache medicine in FM. There are fellowships. I really don't know how many FM physicians are doing exclusively Headache Medicine though. AAFP has three listings for fellowships:

Most of the fellowships out there look like they are for Neurologists.
You realize all of your links say they have 0 positions per year, right?
 
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VA Hopeful Dr

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Most of those links are outdated, but I think for someone in FM wanting to do headache it's a place to start investigating
I guess?

I'd rather just do lots of reading, an elective or two in residency with neuro and a weekend botox course, but to each his own.
 
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AFMD

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You realize all of your links say they have 0 positions per year, right?
I did not :)


I guess?

I'd rather just do lots of reading, an elective or two in residency with neuro and a weekend botox course, but to each his own.
I'd tend to agree with you. I think I do more Headache Medicine than a lot of Neurologists right now. I work for the VA, and in our system (each VA Healthcare System is different) it is very difficult to get neuro to take any headache consults.
 
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AFMD

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99213 is a 99213. Procedure codes are all the same regardless of specialty. Physicians all have the same state license. I know one family med guy doing breast augmentations.
 
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