NASS Recognized Sports and Spine Fellowships

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drusso

drusso

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Hmm. Wonder how many of the attendings are board certified in pain medicine?
 
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I bet the NASS fellowships that are University-based will be pretty popular. No one will be able to tell from your resume that you didn’t go to the ACGME fellowship.
 
Serious question: if the goal is to simply gain competency in image-guided spine and MSK interventions, maybe to subsequently work in PP (like an Ortho group or something) - does ACGME training or certification really matter? Why spend valuable fellowship type learning things you most likely will never use or see again (eg inpatient pain, call, etc)? The general feeling on here seems to be ACGME or bust, even tho the difference in training potentially could be vast (eg some big name university NASS program vs whatever ACGME program you think is crap lol)
 
DJ conquistador said:
Serious question: if the goal is to simply gain competency in image-guided spine and MSK interventions, maybe to subsequently work in PP (like an Ortho group or something) - does ACGME training or certification really matter? Why spend valuable fellowship type learning things you most likely will never use or see again (eg inpatient pain, call, etc)? The general feeling on here seems to be ACGME or bust, even tho the difference in training potentially could be vast (eg some big name university NASS program vs whatever ACGME program you think is crap lol)
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This question has been answered to death on multiple threads.
 
cowboydoc said:
Quick scan of the link provided shows a veritable who’s who in the field.
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Know and like several of them. My point isn’t that they are not well trained but that they took the time to get grandfathered into pain or chose a pain fellowship over one many nonacgme spine fellowships..

There must have been a reason and their trainees won’t benefit from that
 
I’m curious how much these programs will pay their fellows. When it’s not through ACGME there’s no base salary required for PGY level. One program listed said $65,000. I can see people making a killing off of their 2 fellows.
 
DJ conquistador said:
Serious question: if the goal is to simply gain competency in image-guided spine and MSK interventions, maybe to subsequently work in PP (like an Ortho group or something) - does ACGME training or certification really matter? Why spend valuable fellowship type learning things you most likely will never use or see again (eg inpatient pain, call, etc)? The general feeling on here seems to be ACGME or bust, even tho the difference in training potentially could be vast (eg some big name university NASS program vs whatever ACGME program you think is crap lol)
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Doesn't the ACGME brand mean something to you?
 
callmeanesthesia said:
So in this illustration, are the residents the cat and the farmer the attendings? Or the resident is the cow and the cat is the patients? Wait wait, I get it - the cow is the site of service differential and the farmer is the hospital administrator, and the cat is the employed doctor?
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All answers are correct!
 
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drusso said:
Doesn't the ACGME brand mean something to you?
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Certainly -- for Chronic Pain Medicine. If I was a patient with chronic pain I would want to be seen by a chronic pain specialist. But for more orthopedic/physiatry issues I figured a NASS fellowship makes sense and was just curious why all the shade.

I know this question has been answered before, and I truly have the utmost respect for you grinding to obtain and excel in that ACGME fellowship. I figured although there is overlap, the patient populations being served are different enough to warrant different training pathways for different specialists. (Or is this viewpoint too naive? I will say I'm only a resident lol)
 
Ducttape said:
There is nothing unique in spine care that is not covered completely and appropriately in an ACGME fellowship.
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Well… The only thing I found missing in my AGCME fellowship for the most part was the acute or subacute straightforward spine problems… even simple disc herniations. All was essentially chronic with rare exceptions. Seeing much more of that in my orthopedic-based practice has been such a breath of fresh air. That said, the nuances of managing “chronic pain” and not just a chronically painful musculoskeletal issue, is much better at an agcme program. Being able to apply that knowledge when needed for my current patient population has been very helpful. I try to impart as much of that as possible onto my NASS fellows each year
 
Taus said:
Well… The only thing I found missing in my AGCME fellowship for the most part was the acute or subacute straightforward spine problems… even simple disc herniations. All was essentially chronic with rare exceptions. Seeing much more of that in my orthopedic-based practice has been such a breath of fresh air. That said, the nuances of managing “chronic pain” and not just a chronically painful musculoskeletal issue, is much better at an agcme program. Being able to apply that knowledge when needed for my current patient population has been very helpful. I try to impart as much of that as possible onto my NASS fellows each year
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Aren’t you just “part of the problem” then taus? These threads are so funny to me. You are acgme trained but you are not only supporting, but also mentoring a non acgme fellowship. According to many on this forum, isn’t it just plain blasphemy that you as the “superiorly trained” doc would even foster a pathway for individuals to learn to do procedures in a “non-accredited “ way.

I also think that those who cite mike Furman on this website, but completely bash any and all non-accredited fellowships, should never use his name, his book, his teachings, his contributions. To those holier than thou people on this forum, stick to Fenton and call it a day.

Taus, your chief of service line is a Furman trained doc who is exceptional. His training, when the fellowship was acgme accredited was/is no different than it is now or what it has been for years. Some dude on here was like “I interviewed, one dude and a Fluoro suite, is not a fellowship.” There are 100s of docs that big to differ with “that dudes” opinion. Jon Kirschner, HSS, Furman fellow, my co fellow, NASS fellowship director was an Elkins award winner (for those who don’t know what that is, look it up), and I assure most of the people on here, he will school you from a medical knowledge standpoint and technically.

This continued debate and argument is absurd and ludicrous. To blanket whether or not someone is qualified to treat pain patients based on a piece of paper because they may have had a rotation in cancer pain where they dreaded every minute of it and would rather sit on their phones on SDN, is also absurd.
 
nvrsumr said:
Know and like several of them. My point isn’t that they are not well trained but that they took the time to get grandfathered into pain or chose a pain fellowship over one many nonacgme spine fellowships..

There must have been a reason and their trainees won’t benefit from that
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the reason is options. you CAN'T work at my hospital in interventional pain without an ACGME fellowship.
 
I agree with the above 2 statements. I work for an ortho group currently, so the fact that I’m pain boarded doesn’t really matter in my case. I was fortunate to train at what I considered to be a great program, though I know there are plenty of great and also garbage ACGME and non ACGME programs.

I do look at other job options from time to time, though, and there are certainly more options available if you are boarded in pain. It simply opens more doors, whether it should or not. For that reason, I think it’s still smarter to go the ACGME route, but I don’t think its “wrong” to do a good unaccredited fellowship.
 
There are two pain boards, you can always certify with the other one if you’re non-ACGME

I’m not inclined to gatekeep over this, to be honest. There’s so many mediocre or awful fellowship trained doctors who let greed dictate their level of care. As long as the NASS fellowships try to select the best and most mentally stable doctors it’s fine.
 
Dr. Ice said:
Aren’t you just “part of the problem” then taus? These threads are so funny to me. You are acgme trained but you are not only supporting, but also mentoring a non acgme fellowship. According to many on this forum, isn’t it just plain blasphemy that you as the “superiorly trained” doc would even foster a pathway for individuals to learn to do procedures in a “non-accredited “ way.

I also think that those who cite mike Furman on this website, but completely bash any and all non-accredited fellowships, should never use his name, his book, his teachings, his contributions. To those holier than thou people on this forum, stick to Fenton and call it a day.

Taus, your chief of service line is a Furman trained doc who is exceptional. His training, when the fellowship was acgme accredited was/is no different than it is now or what it has been for years. Some dude on here was like “I interviewed, one dude and a Fluoro suite, is not a fellowship.” There are 100s of docs that big to differ with “that dudes” opinion. Jon Kirschner, HSS, Furman fellow, my co fellow, NASS fellowship director was an Elkins award winner (for those who don’t know what that is, look it up), and I assure most of the people on here, he will school you from a medical knowledge standpoint and technically.

This continued debate and argument is absurd and ludicrous. To blanket whether or not someone is qualified to treat pain patients based on a piece of paper because they may have had a rotation in cancer pain where they dreaded every minute of it and would rather sit on their phones on SDN, is also absurd.
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I’m a little confused reading by the first paragraph, but either way I look at my situation as….the place I work started a fellowship. I like to teach and think I have something to offer, so I teach. I do think there are crap agcme programs and crap Nass programs. I chose my path over furmans program and other high quality non-agcme for the “papers” ie to minimize the risk of limiting my job options.
 
Taus said:
I’m a little confused reading by the first paragraph, but either way I look at my situation as….the place I work started a fellowship. I like to teach and think I have something to offer, so I teach. I do think there are crap agcme programs and crap Nass programs. I chose my path over furmans program and other high quality non-agcme for the “papers” ie to minimize the risk of limiting my job options.
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My point was that there are many on this forum who will call out the NASS fellowship option. My quotation as “you being part of the problem” was in quotes because I don’t actually believe that. But, if the opinion is that there is, and should be only one sole pathway to doing what WE do, then what you are participating in would be considered blasphemous or “part of the problem”, to train people who have no right to touch a needle because they are not acgme, even though you yourself are.
 
Dr. Ice said:
Aren’t you just “part of the problem” then taus? These threads are so funny to me. You are acgme trained but you are not only supporting, but also mentoring a non acgme fellowship. According to many on this forum, isn’t it just plain blasphemy that you as the “superiorly trained” doc would even foster a pathway for individuals to learn to do procedures in a “non-accredited “ way.

I also think that those who cite mike Furman on this website, but completely bash any and all non-accredited fellowships, should never use his name, his book, his teachings, his contributions. To those holier than thou people on this forum, stick to Fenton and call it a day.

Taus, your chief of service line is a Furman trained doc who is exceptional. His training, when the fellowship was acgme accredited was/is no different than it is now or what it has been for years. Some dude on here was like “I interviewed, one dude and a Fluoro suite, is not a fellowship.” There are 100s of docs that big to differ with “that dudes” opinion. Jon Kirschner, HSS, Furman fellow, my co fellow, NASS fellowship director was an Elkins award winner (for those who don’t know what that is, look it up), and I assure most of the people on here, he will school you from a medical knowledge standpoint and technically.

This continued debate and argument is absurd and ludicrous. To blanket whether or not someone is qualified to treat pain patients based on a piece of paper because they may have had a rotation in cancer pain where they dreaded every minute of it and would rather sit on their phones on SDN, is also absurd.
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for every one of the Furmans or Kirschner, there are probably many guys that are in "non-accredited" (or provisional) NASS fellowships - and are exactly as you describe - 1 guy in a fluoro suite. doesnt mean you cant get good education from them, however.

and technique is irrespective of who is teaching it - if it works and if it is safe, then it can be learned and taught. unless Furman patent/protects his injection technique...



you do know how easy it can be to create a provisional fellowship, right? you submit a couple of pages, gets approved, then you get to the practice a provisional fellowship and get 2 years to work on asking to be an accredited fellowship.

now the accredited fellowships have gone through vetting.
https://www.spine.org/Portals/0/assets/downloads/Education/Match-Opportunities.pdf

page 8 and 9 for application for provisional fellowship:
 
Dr. Ice said:
Aren’t you just “part of the problem” then taus? These threads are so funny to me. You are acgme trained but you are not only supporting, but also mentoring a non acgme fellowship. According to many on this forum, isn’t it just plain blasphemy that you as the “superiorly trained” doc would even foster a pathway for individuals to learn to do procedures in a “non-accredited “ way.

I also think that those who cite mike Furman on this website, but completely bash any and all non-accredited fellowships, should never use his name, his book, his teachings, his contributions. To those holier than thou people on this forum, stick to Fenton and call it a day.

Taus, your chief of service line is a Furman trained doc who is exceptional. His training, when the fellowship was acgme accredited was/is no different than it is now or what it has been for years. Some dude on here was like “I interviewed, one dude and a Fluoro suite, is not a fellowship.” There are 100s of docs that big to differ with “that dudes” opinion. Jon Kirschner, HSS, Furman fellow, my co fellow, NASS fellowship director was an Elkins award winner (for those who don’t know what that is, look it up), and I assure most of the people on here, he will school you from a medical knowledge standpoint and technically.

This continued debate and argument is absurd and ludicrous. To blanket whether or not someone is qualified to treat pain patients based on a piece of paper because they may have had a rotation in cancer pain where they dreaded every minute of it and would rather sit on their phones on SDN, is also absurd.
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What are standards good for if not to level-set? You can't oppose mid-level creep and be "anything goes" with training standards.
 
Everybody knows that there are good and bad fellowship programs, just as there are good and bad doctors who come out of each. There are great doctors who come out of St George's and **** doctors from Harvard. There were outstanding doctors who came out of the pre-residency "apprenticeship" model a hundred years ago. I think the difference is in the average.

The move to standardization of training is not to make sure that everyone who comes out of that training is stellar. It's to make sure that there will be fewer people who come out of the program who are clearly subpar, and thereby bring up the average.
 
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Centurion38 said:
We don't need anymore "spine physicians" who inject 3-100 times, prescribe Tylenol with Codeine for 5-6 days and then refer to pain management
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We don’t need acgme docs that still do series of three on everyone for no reason..what’s your point
 
drrosenrosen said:
Everybody knows that there are good and bad fellowship programs, just as there are good and bad doctors who come out of each. There are great doctors who come out of St George's and **** doctors from Harvard. There were outstanding doctors who came out of the pre-residency "apprenticeship" model a hundred years ago. I think the difference is in the average.

The move to standardization of training is not to make sure that everyone who comes out of that training is stellar. It's to make sure that there will be fewer people who come out of the program who are clearly subpar, and thereby bring up the average. My n of 1 working closely with a non-ACGME fellowship trained doc was unimpressive. But I recognize that that is purely anecdotal experience.
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True..and my experience with a Cleveland clinic acgme trained doc who needed remediation by me at our asc was less than unimpressive..and that’s anecdotal as well
 
Dr. Ice said:
We don’t need acgme docs that still do series of three on everyone for no reason..what’s your point
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These fellowships- in the main- exist to churn out needle wielding mercenaries for Ortho Spine groups, while profiting from the cheap labor of said fellows. There's a lot more to pain management than what drips out the end of a 22g or 25g Quincke.
 
Dr. Ice said:
True..and my experience with a Cleveland clinic acgme trained doc who needed remediation by me at our asc was less than unimpressive..and that’s anecdotal as well
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Interestingly a recent med mal case I was looking at of a cord puncture during CESI was done by a CC fellowship trained doc.
 
Centurion38 said:
These fellowships- in the main- exist to churn out needle wielding mercenaries for Ortho Spine groups, while profiting from the cheap labor of said fellows. There's a lot more to pain management than what drips out the end of a 22g or 25g Quincke.
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disagree.

i dont know what the reirements are now, but the ACGME used to require a minimum of 20 fluoro guided injections/year to be certified. i mean, what are doing here? i do 20 in a morning sometimes.....
 
SSdoc33 said:
disagree.

i dont know what the reirements are now, but the ACGME used to require a minimum of 20 fluoro guided injections/year to be certified. i mean, what are doing here? i do 20 in a morning sometimes.....
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I believe he was talking about the non-accredited fellowships. ACGME removed the procedure minimums several years ago in favor of much more multidisciplinary training.
 
drrosenrosen said:
I believe he was talking about the non-accredited fellowships. ACGME removed the procedure minimums several years ago in favor of much more multidisciplinary training.
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right. i disagree with his point that the NASS fellows are all scut monkeys

as far as ACGME, now it looks like there is no requirement for injections? i have nothing against inpatient, regional, or cancer pain. but when 90% of your patients are spine, it probably doesnt help all that much
 
RoloTomassi said:
Interestingly a recent med mal case I was looking at of a cord puncture during CESI was done by a CC fellowship trained doc.
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I think most of the cord punctures in my area have been by neurosurgeons doing shots…
 
To be clear I am the dude. I abide by my previous post regarding Furman "fellowship"
 
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nvrsumr said:
To be clear I am the dude. I abide by my previous post regarding Furman "fellowship"
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Thanks for making it clear. Abide away..your denigrating quotations around fellowship are noted. Perhaps one day in an ideal world we can share our patient population, procedural success, academic contributions, technical abilities, etc. And maybe you would realize that your “superior training” is all in your head..

Nah..”it was all a dream, I used to read word up magazine…”
 
Centurion38 said:
These fellowships- in the main- exist to churn out needle wielding mercenaries for Ortho Spine groups, while profiting from the cheap labor of said fellows. There's a lot more to pain management than what drips out the end of a 22g or 25g Quincke.
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You do realize that many (mostly or all in my experience) of your acgme brethren have abandoned whatever it is in your mind as “true pain management” for needle jockeying or what’s worse stim jockeying. In fact, there are countless acgme docs selling their souls to whatever wire company strokes their..well..whatever, and stands in pics posted on LinkedIn with their arms crossed like they are competing on iron chef…

I’m sure there are some of you sitting at the bedside of cancer pain patients titrating up whatever narc can offer pain relief without too much constipation..but I would imagine those are few and far between…
 
The dude abides is a quote.

I put fellowship in quotations because I was quoting you.

You put superior training in quotes but arent quoting anything I’ve ever said.
 
Dr. Ice said:
You do realize that many (mostly or all in my experience) of your acgme brethren have abandoned whatever it is in your mind as “true pain management” for needle jockeying or what’s worse stim jockeying. In fact, there are countless acgme docs selling their souls to whatever wire company strokes their..well..whatever, and stands in pics posted on LinkedIn with their arms crossed like they are competing on iron chef…

I’m sure there are some of you sitting at the bedside of cancer pain patients titrating up whatever narc can offer pain relief without too much constipation..but I would imagine those are few and far between…
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Can you be more specific?
 
Either way, there needs to be a post-fellowship one to two year case log tracking outcomes for the pain surgeons.
 
Sigh. We should be all together fighting the good fight. No nurses, no Midlevels doing advanced spine procedures. Who cares if a physician is trained acgame or not. This shouldn’t be our fight. There’s plenty fish in the sea for all of us to afford private school for our kids.
 
paindoc007 said:
Sigh. We should be all together fighting the good fight. No nurses, no Midlevels doing advanced spine procedures. Who cares if a physician is trained acgame or not. This shouldn’t be our fight. There’s plenty fish in the sea for all of us to afford private school for our kids.
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Agree. It is far more important to fight against midlevels doing spine procedures than to worry about ACGME vs non ACGME fellowships.
 
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