Regarding the importance of obtaining an ACGME fellowship, after being in practice for a few years I believe this is more important than ever! Most of MY friends and colleagues, feel the same way.
In my market, there are several pain management physicians who ONLY do medication management. The rest of us are interventionalists and most of us work for ourselves...not the surgeons or the hospitals, therefore, the procedures are not an afterthought, they ARE our business, so it goes without saying that one must have a good bedside manner, be flexible, easy to work with and provide good patient care.
If you have interventionalists who "have a lockdown on the market" but don't even have fellowship training, I'll bet they're all nearing retirement...
Theyre actually in their mid 40s, and spread amongst several practices.
You misunderstood me about the procedures being an afterthought. Afterthought for the PCPs, not the pain doctor. Sure, the PCPs may send some patients directly for ESIs, but in the big picture, their main concern is that the pain doctor help them out with patients that have narcotic issues they dont feel comfortable dealing with, or dont want to deal with.
Hospital privileges vary depending on locale, so we probably shouldnt make blanket statements on this.
Of the three hospitals I have privileges at, one had one delineation of privileges sheet for anesthesiologists (which required an ACGME fellowship) and a separate one for Physiatrists where the procedures were listed under core privileges and did not require any fellowship. The second hospital had a sheet of core anesthesiology privileges and then a blank sheet where you would write in the pain procedures you were applying for, but did not require an accredited fellowship. The third had a long checklist of pain procedures, but no mention of accreditation status.
As long as you get
admitting privileges
somewhere, the requirement for insurance is typically fulfilled (**I had privileges for RF denied at one hospital because they didnt have an RF generator, this didnt cause any carriers to stop paying for RF).
I dont doubt your experience with the insurance company who required an accredited fellowship, but the major carriers are not doing this i.e. the Blues, Aetna, United/Pacificare, Liberty Mutual and Travelers for Work Comp, etc.
Regarding the surgical groups, obviously Mayo, CCF, Hopkins, Harvard, etc. would look good on anyones CV, for any specialty. Outside of the global reputations of certain institutions, the surgeons dont know which pain fellowships are good, unless there is a pain doctor in the group who tells them. The more competitive a given area, the more likely a surgical group will be able to find a new grad willing to work for cheap.
Obviously, there are only advantages in going to a good fellowship. I dont think anyone would claim otherwise. However, in the context of the OP, as it pertains to this specialty (possibly due to fledgling status of the specialty), it is not the determining factor of success.
) - chill down dude!
