Interventional PM&R

Discussion in 'PM&R' started by marathon chick, Jul 14, 2002.

  1. marathon chick

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    What is the role of the Interventional Physiatrist compared to the "Regular" Physiatrist in patient care. Also, is a pain management fellowship the only route to becoming qualified in interventional PM&R?
     
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  2. drusso

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    Interventional physiatrists do diganostic and therapeutic procedures: Spinal injections, intra-discal electrothermal annuloplasty (IDET), flouro-guided facet injections, nerve blocks, discograms, etc. Non-interventional physiatrists may do some procedures (simple blocks, trigger point injections, etc) and some electrodiagnosis, but generally diagnose, treat, and rehabilitate injuries using more conservative approaches and modalities. Many physiatrists have strictly traditional inpatient medical rehabilitation practices and spend the bulk of their time coordinating patient care in rehabilitation hospitals or acute inpatient medical rehabilitation units.

    Pain medicine is a multidisciplinary approach to symptom management that involves a variety of techniques to help relieve pain and improve patient functioning. Pain medicine is a sub-speciality certification available through many different routes: Anesthesia (the most traditional route), PM&R (another common route), neurology, internal medicine, and psychiatry.

    Currently, there is no primary specialty board in pain medicine that is recognized by the American Board of Medical Specialties (ABMS), but the American Board of Pain Medicine comes closest. The final common pathway to a career in pain medicine is sub-specialty board certification through an ACGME-accredited pain medicine fellowship. Most of these fellowships are housed in anesthesia programs, but others are in PM&R departments, neurology departments, internal medicine departments, even psychiatry departments. In March 1998, The American Board of Physical Medicine and Rehabilitation (ABPMR) and The American Board of Psychiatry and Neurology (ABPN) joined the American Board of Anesthesiology (ABA) in recognition of Pain Management (Pain Medicine) as an interdisciplinary subspecialty. The respective Boards have agreed upon a single standard of certification. They jointly offer a sub-specialty examination available through each of the three individual primary ABMS-member specialty boards. It's the same board certification (and the same test), one just applies through his or her own primary board for certification (American Board of Anesthesiology, American Board of Physical Medicine and Rehabilitation, American Board of Psychiatry and Neurology).

    There are other certifying boards in pain management that extend their certification to non-physicians, but these boards are generally viewed as less rigorous than the ABPM or the jointly-sponsored pain medicine sub-specialty certification. If you're a D.O. and your primary certification is through an osteopathic specialty board, then you're eligible for sub-specialty certification through the AOA.

    There are other ways for physiatrists to acquire interventional skills without completing fellowship-level training. One can take courses through the North American Spine Society, International Spinal Injection Society, or the Physiatric Association of Spine, Sports, and Occupational Rehabilitation. Of course, lacking fellowship level training and subspecialty board certication, one might find it to be more difficult to be reimbursed by third-party payors for your work.

    What kind of practices to interventional physiatrists have? Here's a sample of job announcements to give you a flavor:

    "Spine Proceduralist wanted. Experienced or fellowship trained proceduralist (Anesthesiologist or Physiatrist) wanted for Premier Orthopedic Medical Group with a spine/pain division. Excellent opportunity to work with established strong referral base. Compensation based on experience plus incentives. Potential for partnership in a physician owned ASC and Ancillaries. Applicant needs to have a commitment to patient care and be a team player. For further information XXX"

    "XXX Orthopaedic Specialists is an eight member Orthopaedic Surgery group with one generalist, and seven fellowship-trained surgeons in traumatology (1), total joint replacements (1), hand and upper extremities (2), sports medicine (1), and spine surgery (2). We would like to recruit a PM&R trained individual to complete our office-based practice and provide services in interventional pain management. The position offers a competitive salary, with full benefits, including partnership opportunities. Our practice is located in an upscale suburban community, 30 miles from San Francisco, servicing local hospitals and a Level One Trauma Center. Send CV ad Inquiries to: XXX"

    "The Department of Orthopaedics and Rehabilitation at the University of Vermont/Fletcher Allen Health Care is seeking a fellowship trained, Board Certified/Board Qualified physiatrist to work with a group of physiatrists, orthopedists, and neurosurgical specialists. Responsibilities will include patient care, teaching and research. Clinical activities include: evaluation and management of acute and chronic spinal and musculoskeletal disease, collaboration with inpatient and outpatient treatment teams in multiple programs, and direction of an interdisciplinary pain management program located at the Spine Institute of New England. Must have experience with spinal procedures, including ESI, IDETS, RF, Discograms. Fellowship training preferred. Academic rank will be determined by qualifications and experience. Must demonstrate interest in teaching and research. Applications will be accepted until the position is filled. To apply, please send letter of application and curriculum vitae to: XXXX The University of Vermont is an Equal Employment Opportunity/Affirmative Action employer. Women and people from diverse racial, ethnic and cultural backgrounds are encouraged to apply."

    "Join several other Physiatrists in an office based Physiatry Group private practice opportunity in suburban Baltimore Maryland. Practice currently involves electrodiagnostics, acupuncture, musculoskeletal medicine, acute and chronic pain management & rehabilitation. We are primarily an outpatient practice and there is ample opportunity for development interventional procedures and/or an inpatient practice and for an interested individual. The salary is competitive with an excellent benefits package. For more information regarding this position please send a CV to XXX"

    "Pain Specialist Opportunity in Wisconsin-Comprehensive Pain Management Program. Marshfield Clinic in Marshfield, Wisconsin is currently seeking a physician BC/BE in PM&R, Internal Medicine, Family Practice, or Neurology, with either fellowship training in pain management or at least two years of experience in interdisciplinary management of chronic pain to join its Comprehensive Pain Management Program. Marshfield Clinic's Pain Management Program is an outpatient-based pain management center with a full spectrum of anesthesiology-based pain management techniques, psychological, and physical rehabilitation. Marshfield Clinic is directed by the nearly 700 physicians practicing in over 80 specialties at 40 locations in central, northern and western Wisconsin. This practice offers you the opportunity to be a part of a uniquely cultured environment that features leading edge medicine, research and technology set against the backdrop of Wisconsin's natural beauty and four seasons of recreation. Marshfield is a welcoming community of 20,000 in central Wisconsin with easy access to all that Wisconsin has to offer. We offer a competitive salary and a comprehensive benefit package including: malpractice, health, life, disability, and dental insurance; generous employer contributed retirement and 401k plans; $4,000 education allowance with 10 days of CME time; four weeks vacation 1st year; up to $10,000 relocation allowance; and much more. For more information, please contact XXX"
     
  3. marathon chick

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    Thanks Drusso,
    I've read in earlier threads that PM&R is not really hard to get a residency in general,but what about fellowships after residency-I know the fellowship programs are much harder to land than the residency. What should a PGY-1-3's be doing (doing research and scoring high on the service exams) to make him/her attractive to fellowship program? Also, I am applying to PM&R residency programs next month-does it matter where you did you residency program or it only matter what you did during your residency and letters of rec.?

    Thanks again
     
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  4. drusso

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    Should try to be involved in pain related research and do elective rotations with pain specialists who can support your fellowship application. I don't think where you do residency is as important as how you structure your residency experience to get the educational exposure you need.
     
  5. marathon chick

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    I talked to the PM&R Program director here at my school and she told me that many people should consider a musculoskeletal fellowship vs. a Pain/or Spine. She states that you still do the same interventional procedures as with pain and spine. Is there any truth to her statement? Is it really all the same? Any input would be appreciated.
     
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  6. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    You're getting down to a real nitty-gritty issue that is, quite frankly, out of my depth. I do know that pain fellowships that are ACGME-accredited are likely to carry some credentialing advantages at some hospitals. However, a very good spine fellowship (such as at Hospital for Special Surgery, University of Michigan, or Spaulding) is likely to come with excellent connections and career networking opportunities. The best advice is that you have to compare the pluses and minuses of programs side-by-side on a case-by-case basis.
     
  7. Ligament

    Ligament Interventional Pain Management
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    Well,

    As with drusso, this is tough for me to answer too.

    Pain Fellowship: intrathecal morphine pump placements, plexus blocs (stellate, frankenhauser, celiac, etc etc), epidurals, PCA pump management, pain med (narcotic) management, electro stim...

    Spine Fellowship: Facet blocks, epidurals, high cervical epidurals, occipical blocks, IDETs, discograms (at some programs I believe), ligamentous injections.

    There is a lot of overlap between the two, but the spine fellowship will make you an expert on the spine and managment of its pathology, while a Pain fellowship will have you focus more on plexus blocks and narcotic management of pain.

    To those more experienced than me, please correct me if you would.

    regards!
     
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