Iowa set to vote on who can practice PM

[TX PAIN DOC]

Advertisement - Members don't see this ad

I read this on Amer Med News and looked up the proposed legislation. The link is below:

http://medicalboard.iowa.gov/DraftInterventionalPainPolicy4309-1.html

Like in Louisiana, it was meant to deter CRNAs et al. but also seems to define an interventional pain physician as fellowship trained and certified. The vote is set for May 2010. Any thoughts?

 

[lobelsteve]

I read this on Amer Med News and looked up the proposed legislation. The link is below:

http://medicalboard.iowa.gov/DraftInterventionalPainPolicy4309-1.html

Like in Louisiana, it was meant to deter CRNAs et al. but also seems to define an interventional pain physician as fellowship trained and certified. The vote is set for May 2010. Any thoughts?

CC to CSBME of Georgia (Medical Board of GA).

This should be a national policy.

 

[Aether2000]

At this time, only fellowship trained graduates from the past 1.5 years have training that is consistent from one program to another, and provides sufficient fungability in scope of training and practice parameters. Before that time, it was all over the map. Board certification (additional qualifications in pain) by the ABMS is meaningless because they permitted rolling grandfathering for 14 years, with thousands board certified that may have had no specific training in pain medicine at all. Therefore, while Iowa does have the right idea, the implementation of the proposed draft is flawed because it makes assumptions that are simply not true regarding pain physicians. A more meaningful approach would be core residency plus x amount of hours of additional training in interventional pain prior to 2010, but after that only board certified fellowship trained physicians can practice interventional pain.

 

[PMR 4 MSK]

At this time, only fellowship trained graduates from the past 1.5 years have training that is consistent from one program to another, and provides sufficient fungability in scope of training and practice parameters. Before that time, it was all over the map. Board certification (additional qualifications in pain) by the ABMS is meaningless because they permitted rolling grandfathering for 14 years, with thousands board certified that may have had no specific training in pain medicine at all. Therefore, while Iowa does have the right idea, the implementation of the proposed draft is flawed because it makes assumptions that are simply not true regarding pain physicians. A more meaningful approach would be core residency plus x amount of hours of additional training in interventional pain prior to 2010, but after that only board certified fellowship trained physicians can practice interventional pain.

So next define what you will exclude from "interventional pain." Trigger point injections? SI joint injections? Peripheral joints? Peripheral nerve blocks? Botox? Facial injections? Or will anyone who sticks a needle in the body to improve a pain be required to do these fellowships?

You start getting into a murky area where many docs perform various injections to help pain, but are not necessarily practicing "Pain Management." For instance, an ENT who does a CN 7 block, or an ortho who does a knee steroid injection or physiatrist who does a tendon injection.

We tend to think of "Interventional Pain Management" as injections into and around the spine, with the natural assumption, similar to chiropractors, that all pain starts from the spine. But there are many places to stick needles in the body to help pain.

Are you going to define the law as applying only to spinal injections? Will it be only for those under fluoro or ultrasound? Will you demand some of them be under fluoro or US?

What will you then do with new procedures that come out after someone has done a fellowship? Can they do the "weekend course" and start doing it, or must they get a certain # of hours or a certain # of proctored cases before they can do these new "interventional" procedures.

As with everything today in medicine, laws are being enacted in the name of "protecting patients" when it's mostly protecting turf.

 

[Aether2000]

It is a very muddy playing field, isn't it? There indeed has to be some leeway given the variety of board certifications in pain, the highly variable quality of ABMS special qualifications in pain physicians, the highly variable quality of pain fellowship programs until the recent past, and the skills of individuals. That being given, the physician that aspires to chronic pain intervention via training is better qualified than the anesthesiologist that does not engage in daily interventional pain practice but is much better qualified than CRNAs that have zero training in interventional pain medicine in their core programs but dangerously engage in interventional pain based on no background training and a weekend warrior course only.

 

[painchas]

How many interventional pain MDs are there in the US. I was given the number of around 3000 which would translate to 60 of these MDs per state. With pain as the 6th vital sign and most of these docs already at capacity do we want to restrict criteria to the point that we will not be able to meet the need in the future. Not all of us are fellowship trained. If we came out in the early 90s there was not much there to offer by way of fellowship other than Elavil, triggers, and blind epidurals (a slight exaggeration) The flouro knowledge/technology was not there nor was the anatomic understanding of the medial branch sufficient to allow good results. As the specialty evolves we will have to continue to learn and innovate. I cant rely on things taught in anesthesia residency 16 years ago as state of the art. We didnt even have propofol nor LMAs at that point. Were all of the big hitters in interventional pain that have been around for more than a few years fellowship trained? Aprill etc. I would be interested to know.

 

[Aether2000]

No, many of those that are leaders in the field are not interventional fellowship trained because a) accredited fellowships did not exist before 1992
b) the fellowships were crappy for a decade since some offered only experience in doling out methadone and doing trigger points c) special qualifications ABMS certification was not available until 1992 and thousands were qualified via grandfathering clauses without having any specific pain training at all d) anesthesiology departments had a complete lock on fellowship programs for a decade, nearly always excluding anyone not an anesthesiologist

 

[GassiusClay]

No, many of those that are leaders in the field are not interventional fellowship trained because a) accredited fellowships did not exist before 1992
b) the fellowships were crappy for a decade since some offered only experience in doling out methadone and doing trigger points c) special qualifications ABMS certification was not available until 1992 and thousands were qualified via grandfathering clauses without having any specific pain training at all d) anesthesiology departments had a complete lock on fellowship programs for a decade, nearly always excluding anyone not an anesthesiologist

What is the current news in Iowa? I heard these F-in nurses got some blessing from fluoro society. What?!