Needle Surgeons?

[Spine Specialist]

How abt coining a new name for interventionists like physiatrists and pain specialists? We are not neurosurgeons....can we atleast claim ourselves as needle surgeons?

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[lobelsteve]

How abt coining a new name for interventionists like physiatrists and pain specialists? We are not neurosurgeons....can we atleast claim ourselves as needle surgeons?

Algologists

 

[Tenesma]

we are not surgeons...

do we employ surgical techniques to create a pocket for an IPG? sure... but dermatologists close wounds as well - and they aren't surgeons either (even though a few of them would like to call themselves cosmetic surgeons)

 

[Aether2000]

The former name of the American Academy of Pain Medicine was for several years the American Academy of Algology. The name seemed quite appropriate until one of the principles apparently consulted the dictionary:

al·gol·o·gy ( P ) Pronunciation Key (l-gl-j)
n.
See phycology.


--------------------------------------------------------------------------------
[alg(a) + -logy.]
--------------------------------------------------------------------------------
algo·logi·cal (lg-lj-kl) adj.
algo·logi·cal·ly adv.
al·golo·gist n.

Main Entry: al·gol·o·gy
Pronunciation: al-'gäl-&-jE
Function: noun
Inflected Form: plural -gies
: the study or science of algae called also phycology —

The Board changed the name to "Pain Medicine" since very few of us know beans about algae and fungi, except by the appearance of some of our patient's subungual regions...

 

[OnMyWayThere]

Then what are "needle jockeys"?

 

[Spine Specialist]

Then what are "needle jockeys"?

Oops! you are right. Needle surgeons sound like needle jockeys. Hmmmmm....how is 'Physiatric surgeons'? (like Bariatric surgeons)

 

[f_w]

You are as much a surgeon as the FP who does the occasional vasectomy is a surgeon.

 

[Spine Specialist]

You are as much a surgeon as the FP who does the occasional vasectomy is a surgeon.

What if i am skilled physiatrist performing nucleoplasty, vertebroplasty and whole nine yards of spinal cord stim implantation in future? Can i still not claim as surgeon? How come podiatrist becomes a surgeon? That sucks man!

 

[Tenesma]

why is it so important to capture the title from a different field....??? it sounds like you need to figure why you need an ego boost...

 

[Spine Specialist]

why is it so important to capture the title from a different field....??? it sounds like you need to figure why you need an ego boost...

Hmmmmm.....i think i need an ego boost just to feel good. no hidden agendas. I guess my performance and confidence will improve if i feel like a surgeon. I am proud to be an interventional physiatrist.

 

[analgesic]

Hmmmmm.....i think i need an ego boost just to feel good. no hidden agendas. I guess my performance and confidence will improve if i feel like a surgeon. I am proud to be an interventional physiatrist.

Pain Specialist,

Like yourself I am an up and coming interventional physiatrist. You should already have all the ego boost you need for you are a growing part of a dynamic field. I have often read your posts and admire your devotion. Let your passion continually guide you for there are so many pts who will desperately need what you can offer.

 

[Bonobo]

I am interested in neuro-interventional medicine (i.e. interventional neuroradiology, i.e. endovascular neurosurgery, i.e. internventional neurology, i.e. ...) and we have the same name issue. The problem is not an ego situation, but rather an identity issue. Names are very important!!!

Regarding the field I am about to enter, the problem with any of the above three names is that they specify a specific path. It would be nice to come up with a name that encompasses all three of the names above. The solution so far has been: Endovascular surgical neuroradiology. A HORRIBLE NAME.

Pain has a similar issue in that you can enter this field via physiatry, anesthesiology, as well as neurology. Choosing a name is thus more difficult.

I believe that just as we have surgeons (connoting those who open, cut and suture as a primary means of therapy) and physicians/'ologists' (those who manage disease and prescribe medicine), we should have a term for those who do interventions. The critical care folks have intensivists as a term that I suspect will become more a more widespread and use and can be used for subspecialists as well (neurointensivist, surgical intensivist, cardiac intensivist, etc.). I think it should be interventionalist. It is large, but has a long history of use, and is quite general. We can have neurointerventionalist, pain interventionalist, GI interventionalist, cardiac interventionalist, body interventionalist, vascular interventionalist (for peripheral interventions) etc.

What do you think?

B

What might this be? Interventionalist is one possibility. Then you can have cardiac interventionalist, neurointerventionalist, pain interventionalist

 

[Spine Specialist]

Pain Specialist,

Like yourself I am an up and coming interventional physiatrist. You should already have all the ego boost you need for you are a growing part of a dynamic field. I have often read your posts and admire your devotion. Let your passion continually guide you for there are so many pts who will desperately need what you can offer.

I am very confident physiatry is going to evolve into a dynamic speciality of 20th century modern medicine with growing aging population who live longer than ever. People were laughing when orthopedics branched out from general surgery. People who laugh at physiatry are soon gonna recognize its importance. I really think as interventional physiatrist with our abundant musculoskeletal knowledge and clinical exam skills we can be better than blockjocks.
Physiatric surgery sound funnier now. we can make it happen analgesic.

 

[Aether2000]

I personally think it will continue to evolve in the 21st century also. Physiatry provides better training than anesthesiology as an entryway into chronic pain management.

 

[Tenesma]

i thought there was an agreement to avoid this whole topic of anesthesia vs. physiatry.... if it weren't for anesthesia most physiatrists would never have been trained in interventional pain...

 

[analgesic]

I personally think it will continue to evolve in the 21st century also. Physiatry provides better training than anesthesiology as an entryway into chronic pain management.

Algosdoc and Pain Specialist,

I wish the rest of my colleagues were as enthusiastic as you two. Algosdoc, I couldn't agree with you more. I believe our foundation in neuromuskulosketal predisposes us to be more comprehensive in dealing with chronic pain dynamics. Pain Specialist, FYI one of our pain attendings is hell bent on declaring himself as an interventional spine surgeon. How does that sound? This field is taking off fast. Applications have already doubled this year. Likewise, board scores are becoming more competitive with each year that passes. This all reflects how in demand physiatrists will be in the coming future.

 

[Aether2000]

I believe the best pain program would integrate all the features of pain medicine available in neurology, psychiatry, anesthesiology, surgery, and PM&R. At this time we do not have a pain residency, so must matriculate into pain medicine through base residencies that often have little to do with our ultimate profession. Currently the base residency physiatry does offer more features needed to become a pain management specialist than do other specialties. However, this does not mean a physiatrist will ultimately turn out to be a superior pain management specialist than neurology or anesthesiology base residency physicians. Just as anesthesiology provides some skills that can be useful in pain medicine (excellent emergency airway management and resuscitation skills), physiatry (clinic practice, EMG, functional restoration, biomechanics), and neurology (EMG, medication management skills, able to evaluate thousands of possible sources of disease, psychiatric training) also provide extremely useful skills that are usually not acquired in one of the other base residencies. Regarding needle skills- I find the anesthesiologists to be overconfident in their skills based on their blind needle placement experiences that do not translate well to fluoroscopically guided needle placement, and physiatrists are underconfident in their skills. Physiatrists can help us in understanding the biomechanics and pathologies while we as anesthesiologists can help them with airway management and to think sequentially and rapidly in emergency situations.
It is in general easier to teach physiatrists needle skills and airway techniques as opposed to teaching anesthesiologists kinesiology and biomechanics.
But what we really need is an integrated program so that we may all learn from the specialties that bring a rich global knowledge base and unique skills to pain medicine. If I had to select a tract to pain medicine now, it would be a physiatry residency then anesthesiology pain fellowship. It is not clear to me whether that would necessarily translate into a better physician than an anesthesiologist who then enters a physiatry pain medicine fellowship. But either situation would be better than a physiatrist who then enters a physiatry pain fellowship or an anesthesiologist who enters an anesthesiology fellowship. The cross pollination of specialties is desperately needed in pain medicine to make us all better physicians.

 

[analgesic]

I believe the best pain program would integrate all the features of pain medicine available in neurology, psychiatry, anesthesiology, surgery, and PM&R. At this time we do not have a pain residency, so must matriculate into pain medicine through base residencies that often have little to do with our ultimate profession. Currently the base residency physiatry does offer more features needed to become a pain management specialist than do other specialties. However, this does not mean a physiatrist will ultimately turn out to be a superior pain management specialist than neurology or anesthesiology base residency physicians. Just as anesthesiology provides some skills that can be useful in pain medicine (excellent emergency airway management and resuscitation skills), physiatry (clinic practice, EMG, functional restoration, biomechanics), and neurology (EMG, medication management skills, able to evaluate thousands of possible sources of disease, psychiatric training) also provide extremely useful skills that are usually not acquired in one of the other base residencies. Regarding needle skills- I find the anesthesiologists to be overconfident in their skills based on their blind needle placement experiences that do not translate well to fluoroscopically guided needle placement, and physiatrists are underconfident in their skills. Physiatrists can help us in understanding the biomechanics and pathologies while we as anesthesiologists can help them with airway management and to think sequentially and rapidly in emergency situations.
It is in general easier to teach physiatrists needle skills and airway techniques as opposed to teaching anesthesiologists kinesiology and biomechanics.
But what we really need is an integrated program so that we may all learn from the specialties that bring a rich global knowledge base and unique skills to pain medicine. If I had to select a tract to pain medicine now, it would be a physiatry residency then anesthesiology pain fellowship. It is not clear to me whether that would necessarily translate into a better physician than an anesthesiologist who then enters a physiatry pain medicine fellowship. But either situation would be better than a physiatrist who then enters a physiatry pain fellowship or an anesthesiologist who enters an anesthesiology fellowship. The cross pollination of specialties is desperately needed in pain medicine to make us all better physicians.

Algosdoc,

I couldn't agree with you more pal. I wish there was already a pain residency in place that incorporated psychiatry, neurology, anesthesiology, orthopaedics, neurosurgery, and PM&R. I believe so many of us that wish to go into pain medicine are forced to undergo alot of training in residency that has very little to do with what we actually do as pain specialists. I hope more physicians like us unite to develop such a residency so that so many others do not have to endure more education devoid of application. Like you, I truly believe that the best pain specialists find it encumbent to be well versed in all aspects of pain dynamics. I hope there is more collaboration between fields to develop such a residency in the future.

 

[f_w]

needlolologist ?

Why do you want to spend so much time on all this extraneous stuff. As another thread on this forum teaches us, all it takes are a couple of needles and a wad of bupivacaine to make the world a pain-free place (85% painfree that is)


(in some european countries pain medicine is known as 'algesiology', the person practicing it is an 'algesiologist'. And no, this is not the science dealing with algae)

 

[DigableCat]

Just as anesthesiology provides some skills that can be useful in pain medicine (excellent emergency airway management and resuscitation skills.

With many of the pain practices I have seen, hardly ever has their been a need for airway management skills(are people just that good, I don't know). However I gander to speculate that it would be nice to have those skills when needed. Many of the priv prac guys I see have anesthesiologists at the head of the bed(for the more risky procedures) anyway...

That being said 4 years of "excellent airway management skills" however does not even begin to compare to 4 years of "musculoskeletal medicine and examination skills".

Sorry...it just doesn't.

 

[Aether2000]

Reimbursement considerations (Anthem, Medicare, etc) are driving more and more procedures into the physician's office, and these offices do not usually employ anesthesiologists. It is imperative to have both airway management skills in addition to skills in running a code and thinking sequentially about what precipitated the disaster. It is not a matter of either-or: the physician must have skills in both musculoskeletal exams (with the realization that only a small fraction of the eponyms have any clinically documented validity) and airway management if they do not have an anesthesiologist present. Without the airway management skills, doctors are playing with fire and they WILL eventually get burned. But this is not a situation without solution: airway management should be part of all physiatry pain fellowship training just as musculoskeletal exams should be part of all anesthesiology pain fellowship training.

 

[Tenesma]

anesthesia residency is 3 years after internship just like PM&R... and I would agree that 3 years of airway management is not comparable to 3 years of muskuloskeletal management nor is it comparable to 3 years of neurologic examination.... so i wonder why anesthesia ended up creating the field of pain management? and if those 3 years of muskuloskeletal management are so fantastic then why is there even a need for fellowship training? Why do all the PM&Rs beg and try to get into an anesthesia-based fellowship (if anesth. are so incompetent)? just a few thoughts to mull over...

i do agree that a residency would be fantastic...

 

[Aether2000]

Both anesthesiology and PMR have their weaknesses as a path to pain management. Perhaps we can solve that in a few years...

 

[DigableCat]

anesthesia residency is 3 years after internship just like PM&R... and I would agree that 3 years of airway management is not comparable to 3 years of muskuloskeletal management nor is it comparable to 3 years of neurologic examination.... so i wonder why anesthesia ended up creating the field of pain management? and if those 3 years of muskuloskeletal management are so fantastic then why is there even a need for fellowship training? Why do all the PM&Rs beg and try to get into an anesthesia-based fellowship (if anesth. are so incompetent)? just a few thoughts to mull over...

i do agree that a residency would be fantastic...

My program was in fact a 4 yr integrated residency. So yes, I did 4 years of musculoskeletal and neurologic examinations.

NOT all PM&R residents beg to get into anesthesia-based programs...in fact, I didnt apply to any of your ANES programs. I'm happy with my decision to be in a ACGME PM&R Pain Medicine Fellowship.

Never said anesth was incompetent. Must be your insecurities.

I'm merely sick of hearing ANES residents and programs(who by the way will blatantly disregard the agreement that residents, including PM&R, neurology, and Psych be allowed to apply) say we should not be considered for ANES pain fellowships...when your only argument is "we know how to do air management". Give it a break already.

I agree a pain residency should be imminent. At least then, some of the ANES residents can stop being so elitist and go back to hating on CRNAs.

 

[Tenesma]

digable...

1) even if your program is an integrated program, are you going to tell me that the ACGME required rotations to satisfy internship year consisted of you doing "muskuloskeletal medicine" (ie: internal medicine wards, ICU, etc..)

2) they aren't my programs...

3) where do you think all of your PM&R Fellowship attendings did their pain training?

4) you implied incompetence... but that is okay, because when i started fellowship i did feel incompetent to manage outpatient pain - that is why i did a fellowship... to learn and feel confident...

5) i disagree with your point regarding anesth. stating that only anesth. residents should do fellowship. I think PM&R and Neurologists make great pain doctors - but I do draw a line at Psychiatry, Internal Medicine or Family Practice guys getting in... the argument there has nothing to do with "airway management" - rather, why should we be educating the masses when we can be keeping control on the flow of pain doctors going into practice... do you see Allergy&Immunology fellowships allow Anesthesia, PM&R or Neurology into A&I? no... they are keeping their very lucrative field nice and tight.

6) anesthesia residents aren't elitist - they are residents just like you and I used to be... but you are right, they will probably continue to hate CRNAs (again primarily for political reasons)

 

[DigableCat]

digable...

1) even if your program is an integrated program, are you going to tell me that the ACGME required rotations to satisfy internship year consisted of you doing "muskuloskeletal medicine" (ie: internal medicine wards, ICU, etc..)

No...not all the months. But having 6 months during your intern year in PM&R definitely helped. It was a pain in the @$$ though whenever I was off service they considered me the "PM&R guy" who automatically knew how to treat everyone's strokes, amputations, back pain, TBIs and still know internal medicine/ER/surgery/etc.

2) they aren't my programs...

It was a "collective" you. Not a personal you of course.

3) where do you think all of your PM&R Fellowship attendings did their pain training?

Well, a few through PM&R sports/spine fellowships, a few through ANES pain...some just took the Pain exam, until that door was closed. Which personally, I'm happy about. It's better for all of us.

4) you implied incompetence... but that is okay, because when i started fellowship i did feel incompetent to manage outpatient pain - that is why i did a fellowship... to learn and feel confident...

Sorry for the implication. Not my intention. I work with ANES pain physicians now during my fellowship. Sure would be a hard year thinking I was working with incompetent physicians.

5) i disagree with your point regarding anesth. stating that only anesth. residents should do fellowship. I think PM&R and Neurologists make great pain doctors - but I do draw a line at Psychiatry, Internal Medicine or Family Practice guys getting in... the argument there has nothing to do with "airway management" - rather, why should we be educating the masses when we can be keeping control on the flow of pain doctors going into practice... do you see Allergy&Immunology fellowships allow Anesthesia, PM&R or Neurology into A&I? no... they are keeping their very lucrative field nice and tight.

I never said that only ANES should do Pain Fellowships. It has been my understanding that an agreement was made that Neurology/PM&R/and Psych(maybe they got in because of their joint affiliation with Neurology and peoples understanding that many pain patients have a psych component that needs to be addressed) could all be eligible for Pain Fellowships. Having a program totally disregard your application is wrong, and from my understanding a violation of the ACGME agreement. Sure, we'll never be able to prove that you didn't choose us because we weren't ANES, but to not allow us to apply(or strongly discourage...which is what happened to some of my friends when they emailed the programs for info) is to my understanding illegal.

If ANES programs truly valued the PM&R/Neurology experience in the Pain Medicine education, maybe their fellows could spend a few months on a MSK rotation with us. U. Wash requires all non-ANES fellows to spend 3 extra months doing ANES rotations for a total of 15 month fellowship.

6) anesthesia residents aren't elitist - they are residents just like you and I used to be... but you are right, they will probably continue to hate CRNAs (again primarily for political reasons)

Some of us are having an axe to grind with PT's(for political reasons) so I guess there are some of us in every profession.

 

[UTSouthwestern]

Remarkably, with all of our competition encroaching from all sides, we continue to train our competition. We must be partly ******ed.

I am starting my move up the political train, but I suspect it will be 5-10 years before I have a national voice and by then, it might be too late.

 

[blokjok]

I have personally observed the training that PM&R "Pain" programs offer. With one single exception, they range from mediocre to ridiculous.

 

[DigableCat]

I have personally observed the training that PM&R "Pain" programs offer. With one single exception, they range from mediocre to ridiculous.

Considering you're a "blockjok", I'd be interested in knowing how you came to the observation that the PM&R pain programs(you've seen anyway, which could range from N=10 to N=1) range from mediocre to ridiculous.

 

[blokjok]

Considering you're a "blockjok", I'd be interested in knowing how you came to the observation that the PM&R pain programs(you've seen anyway, which could range from N=10 to N=1) range from mediocre to ridiculous.

We can discuss the programs anytime. One of such programs is called the "Sports and Spine" "Pain fellowship". I wonder how they came with such combination. Is it a Sports Medicine Felowship or a Pain Fellowship?

 

[analgesic]

We can discuss the programs anytime. One of such programs is called the "Sports and Spine" "Pain fellowship". I wonder how they came with such combination. Is it a Sports Medicine Felowship or a Pain Fellowship?

Blokjok,

If you work toward being more cooperative and less offensive you might become an integral part in advancing this specialty. PM&R pain fellowships are newly developed regarding interventional spine procedures. However, PM&R residents are now getting so much more interventional spine exposure in residency. I would argue that Anesthesia residents are still behind the eight ball when it comes to PE, understanding pain dynamics, neurology, and psychiatry. It is the nature of our training which makes (in my biased opinion) a PM&R resident more qualified to handle pain comprehensively coming out of residency.

 

[Disciple]

i thought there was an agreement to avoid this whole topic of anesthesia vs. physiatry.... if it weren't for anesthesia most physiatrists would never have been trained in interventional pain...

Yes and no.

While many Physiatrists have been trained at Anesthesia programs. Many of those who represent Interventional Physiatry on a national level were either self taught (i.e. 10-15 yrs. ago) or trained by other Physiatrists.

 

[Disciple]

I would agree that 3 years of airway management is not comparable to 3 years of muskuloskeletal management nor is it comparable to 3 years of neurologic examination.... so i wonder why anesthesia ended up creating the field of pain management?

Maybe Anesthesia should be credited with creating "interventional" pain management. Multiple specialties have been involved in narcotic management in the clinic setting.

BTW, the core MSK training of Physiatrists (spine/sports/general) is usually 1 yr maximum in duration. But, these core rotations are set up with introductory MSK training on inpts. Additionally, we do quite of bit of Neurologic examination during our required 12 months of inpt rehabilitation (more in many programs) and 200 or greater EMG studies.

and if those 3 years of muskuloskeletal management are so fantastic then why is there even a need for fellowship training?

1. To acquire the procedural skills, including implantables, vertebroplasty, etc...
2. To attain board eligibility in pain

Why do all the PM&Rs beg and try to get into an anesthesia-based fellowship

We currently have no choice. 20-30 PMR pain spots for 230+ applying graduating seniors doesn't quite cut it.

 

[Disciple]

Just as anesthesiology provides some skills that can be useful in pain medicine (excellent emergency airway management and resuscitation skills), physiatry (clinic practice, EMG, functional restoration, biomechanics), and neurology (EMG, medication management skills, able to evaluate thousands of possible sources of disease, psychiatric training) also provide extremely useful skills that are usually not acquired in one of the other base residencies. Physiatrists can help us in understanding the biomechanics and pathologies while we as anesthesiologists can help them with airway management and to think sequentially and rapidly in emergency situations.

Hmmmm....

The Anesthesia programs I interviewed at did not offer this training in their fellowship. Were I to matriculate to their program, I was expected to acquire airway management skills on my own during the remainder of my residency.

One particular program would not review my application until I had completed 6 months of Anesthesia.

 

[Disciple]

If ANES programs truly valued the PM&R/Neurology experience in the Pain Medicine education, maybe their fellows could spend a few months on a MSK rotation with us. U. Wash requires all non-ANES fellows to spend 3 extra months doing ANES rotations for a total of 15 month fellowship.

From what I've seen on the interview trail this year there are three types of Anesthesia pain programs.

1. Those that truly value multidisciplinary training. They reserve a spot for PM&R or Neurology yearly and include rotations in such. Some even had Physiatrists on their faculty.

2. Those that say they value multidisciplinary training and have taken Physiatrists in the past, except when Anesthesia applications go up, so not this year.

3. Those that are resisting multidisciplinary training(never taken a Physiatrist/Neurologist and never will). Oh well, guess they'll be forced into it as soon as the new ACGME guildlines take effect.

 

[Disciple]

Remarkably, with all of our competition encroaching from all sides, we continue to train our competition. We must be partly ******ed.

I am starting my move up the political train, but I suspect it will be 5-10 years before I have a national voice and by then, it might be too late.

So,

Are you against integration UT?

It's give and take. Physiatrists will continue to learn and perform interventional pain procedures whether they continue to be accepted into Anesthesia fellowships or not.

Surely, you must agree that the sharing of knowledge and collaboration, rather than two competing viewpoints is in the best interest of our patients.

 

[Disciple]

I have personally observed the training that PM&R "Pain" programs offer. With one single exception, they range from mediocre to ridiculous.

With one single exception huh?

So you're saying you've personally traveled around the country visiting all ten of these fellowships?

 

[Disciple]

We can discuss the programs anytime. One of such programs is called the "Sports and Spine" "Pain fellowship". I wonder how they came with such combination. Is it a Sports Medicine Felowship or a Pain Fellowship?

Ummmm......

No.

I don't need to list all of them out, they're even listed on this website.

None of them are called the "Sports and Spine Pain Fellowship".

 

[blokjok]

Check this one
http://www.uchsc.edu/pmr/training_programs/fellowship/pmr_fellowship.htm