algosdoc said:
I agree...and to add more confusion, the directors of the pain programs are constantly in flux. A great program one year may turn into a mediocre one the next year depending on the physicians teaching, internal politics, external politics (other departments limiting what pain physicians may do), etc. The best way to get an educated guess as to what programs are quality is to contact the current fellows in the program directly and ask them about the program.
Algos
You are presenting some common misconceptions about ASIPP and Dr. Manchikanti...personally, I believe the major reason that Dr. Manchikanti is criticized is simpe bigotry....
Indian physicians constitute well over 20-30% of standard ABMS specialities that feed pain medicine.....anesthesiology, physiatry...how many officers of any of these major organizations have physicians of indian origin or for that matter of foreign descent.
Dr. Manchikanti has single handedly saved the field of interventional pain medicine from the graveyard...ASIPP's membership is growing at an incredible rate will surpass ISISs, despite being around only half the time. You cannot slam this grass roots support of Dr. Manchikanti's efforts
Dr. Manchikanti never sleeps and all the meetings ASIPP organizes are about work....there is very little down time..ASIP meetings are never in luxury resort hotels and speakers are not paid to take first class tickets..Dr. M, on a personal level, has the ultimate characteristics of a leader..and is a simple and honest family man who doesn't drink or smoke...his staff have been loyal to him for years....
As far as I am concerned, he has given me a great deal of inspiration in terms of his life accomplishments
what did the ASA do...what did ISIS do...calling all the attendees at their conferences a bunch of 'feral practitioners'...NASS...is trying to kill vertebroplasty and pulsed RF...Heck, even the AAPMR could not block the American PT association from demanding that all PTAs are supervised by a PT...
at least ASIPP recognizes the hurdles pain physicians face and recognizes the things that need to be done, so that pain physicians do not lose further autonomy
ASIPP in its short life has done an incredible amount...being the first physician organization to pass a federal law...NASPER
AAPM is still supporting the Hurwitz case, even though this physician doled out huge bucketloads of narcotics and they couldn't even make up their mind about NASPER...the APS is opposed to NASPER, because it could interfere with patient access..the latter organizations are still using terms such as pseudoaddication...meaningless terms...even the DEA abandoned the support of some APS/AAPM guidelines for opioid prescribing.
Dr. Manchikanti has spearheaded efforts to educate and train physicians about regulatory issues in pain management from controlled substance use, to coding, to compliance...ASIPP has gotten a special designation for interventional pain, so that our practice expenses would be tallied by our peers...rather than use practice expenses from anesthesiology which would low ball practice expenses for interventionalists
He has also gotten interventional pain representation in CAC...the first new specialty in about 20 years...do you want neurosurgeons and anesthesiologists representing interventionalists?
Also, interventional pain specialists are not outpaid relative to other specialties..the financially successful interventionalists have invested a substantial amount of time and energy into their practices to become financially successful...most neurosurgeons, orthopods, radiologists simply have point to any random location in the USA and call up the local hospital...the hosptial will give them a huge high dollar salary/guarantee and all the equipment they need...not so for most pain guys
additionally, changes in compensation can occur for other reasons..cardiac surgeons are probably making less than interventional cardiologists...and the latter group control patients...this just represents a paradigm shift as medical technology advances.
because of lack of political activism the cardiac surgeons and vascular surgeons just got hosed....a little activism on a cardiac surgeons part would not have lowered reimbursements for CABG to 130% of a total knee....can you imaging spending 8+ years in residency training to face a future where you are paid a lump sum amount for the procedure and post-op management?
so, we need to engage payors and politicians for our fields
the current SGR and practice expense estimates suggests that we may could see a 40-50% reduction in reimbursements in 4-5 years....most interventionalists would not be able to treat medicare patients...at these rates
preserving reimbursements for pain procedures in offices/ASCs preserves patient access....ask any interventional pain guy to compete with a neurosurgeon or GI guy/radiologists in a hospital with regards to getting OR slots or Oupt procedure suite access in a hospital and they will lose....that is why interventionalists are trying to preserve reimbursement...
also any non-anesthesiology pain guys who try to apply for priviliges at a hospital may be blocked by the anesthesiology group...do you think the ASA would welcome phsyiatrists?
the list goes on....in fact ASIPP has done some work to mandate that fluoroscopy be the standard of care
as for ISIS...I heard two elite ISIS members testified against another ISIS member in a malpractice case and forced the guy into bankruptcy
In another example, a practitioner asked an elite ISIS guy..'what is the point of expending so much energy diagnosing a spinal pain generator, if there is no evidenced based treatment...what do I tell the patient?'...the elite ISIS guy told this practitioner that the patient 'should attend ISIS meetings on an annual basis until an evidenced based treatment arrives...and in the mean time, just wait'
and allow me to spread a misconception....I have heard that you teach non-physicians (CRNAs and NPs) pain procedures....don't you think that if we lower the bar any further by teaching non-physicians that this will affect our practice?
Finally, interventionalists probably cost health care only 5-15% of what spine surgeons cost society....there are a number of specialists that are trying to game the business of medicine....is a LASIK operation more effective than eyeglasses...is a pulsed RF facelift more efficacious in outcomes compared to a surgical facelift....is liposuction more effective than exercise....are brand name anti-hypertensives more cost effective than generics....are drug eluting stents that much better than balloon angioplasty....is a hysterectomy needed for any patient with abnormal bleeding...is scoping a 50+ adult with medial compartment OA justifiable?
a number of specialties operate on the fringes of evidence.
at the end of the day...a patient can get 150-200 epidurals for the price of one spinal fusion....aat 3/ years...it may buy them 20-25years
most interventionalists practice good medicine and most pain patients have legitimate complaints....