New NASS-approved vs ACGME-accredited Spine/Pain Fellowships?

[drusso]

Question: Are we diluting the prestige and value of ACGME-accredited Pain fellowships by allowing alternative venues of interventional training?

https://www.spine.org/Portals/0/Assets/Downloads/Education/ISMMFellowshipDirectory.pdf

"WHAT DISTINGUISHES NASS ISMM FELLOWSHIPS FROM PAIN FELLOWSHIPS? The primary focus of NASS-recognized ISMM fellowships is the clinical assessment and treatment of patients with spine and musculoskeletal conditions. The fellowships are unique from ACGME Pain Medicine fellowships, which require training in inpatient acute pain management, palliative care, psychiatry, pediatric pain management, and intubation."

Personally, I feel like the experiences that they are trying to erase (acute pain management, psychiatry/addiction, palliative/cancer care, pediatrics, airway management, etc) were among the most valuable for me in my training and separate me from a garden variety needle-jockey...

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[TheLoneWolf]

Question: Are we diluting the prestige and value of ACGME-accredited Pain fellowships by allowing alternative venues of interventional training?

https://www.spine.org/Portals/0/Assets/Downloads/Education/ISMMFellowshipDirectory.pdf

"WHAT DISTINGUISHES NASS ISMM FELLOWSHIPS FROM PAIN FELLOWSHIPS? The primary focus of NASS-recognized ISMM fellowships is the clinical assessment and treatment of patients with spine and musculoskeletal conditions. The fellowships are unique from ACGME Pain Medicine fellowships, which require training in inpatient acute pain management, palliative care, psychiatry, pediatric pain management, and intubation."

Personally, I feel like the experiences that they are trying to erase (acute pain management, psychiatry/addiction, palliative/cancer care, pediatrics, airway management, etc) were among the most valuable for me in my training and separate me from a garden variety needle-jockey...

Trying to limit block shops and now training needle jockeys with no formal training in the basis of pain. Last thing we need is people promising the cure of chronic pain with a 22 gauge needle.

 

[Paingas]

possibly or possibly creating higher value with them. In todays day and age on value in board certification many of these people won't be able to practice bc they are not acgme fellowship trained. Its essentially diluting the field. None of the people applying to this would choose this over an ACGME pain fellowship if given the option between the two.

 

[Mr Kenobi]

It seems with the new changes coming in regards to ACGME rules governing Pain fellowships that were just passed--it is likely that some of these "NASS Accredited" programs will possibly be able to make the transition to ACGME Pain programs. Especially those affiliated with large academic institutions that have more of a pain focus vs those that are more sports medicine oriented ie. Vanderbilt Interventional Spine Program, Stanford Interventional Spine etc.

 

[Agast]

Take the medicine out of doctoring and might as well have the CRNA do all the procedures. That’s where we’re headed anyway.

 

[lobelsteve]

Some of the nass fellowship training is far more useful than the clusterf of the acgme format. Lots of SIS overlap. It would better set one up for outpatient msk/pain jobs.

 

[Needlejockeys]

There are many non-accredited pain fellowship programs - NASS isn't the only one diluting the prestige. So many "private practice non-accredited" fellowship openings all across the country. Get your certificate - and you can apply to any pain job in private practices. I honestly don't think there is any prestige left in ACGME fellowships. Once you graduate no one has ever asked (patient or professional). Network access to the lineage of program physicians may play a role but beyond that as a whole I think it is diluting by the day. Then there's board certification - there are many ways to get a certification beyond the primary specialty board exam beyond the ABA. Thoughts?

 

[deleted472101]

I believe we should stand firm on one official standardized training platform and not dilute this with others. Once we say others can do it then why not non-medical.

Those that contribute to non-standardized acgme training should not pick fights on anything else in pain medicine as they are being hypocrites.

 

[Ducttape]

the dilution of medical specialty and prestige that you speak of is the reason why other organizations are coming in to fill the void.

if we had ACGME fellowship as the only alternative, I don't think we would have seen the rise of "midlevel" pain programs or chiropractic pain program (see other thread).

and personally, as much as I don't think we should be training some "doctors" to mash on peoples back as a board certified intervention nor should we be training "doctors" to only stick needles into those same backs.

 

[myrandom2003]

Why wouldn't you make the ACGME fellowship more accessible? There used to be a time when institutions had two fellowships that were ACGME some that were PMR and some anesthesia. Then they effectively reduced the number of spots by saying one per institution. The people interested hasn't dropped but the spots available has. So where there is a need and a market, someone will see opportunity to fill that need. More access means more standardization, and less need for alternative training pathways.

Also, NASS programs are basically training to joint outpatient msk/sports/ortho practices.

Why not just increase the number of spots.
In addition, how many on this forum have board certification without actually doing an accredited ACGME fellowship because of grandfathering?

 

[Ferrismonk]

IMO, the only reason to get board certified is to make the insurance companies happy. It's a total racket and means nothing.

I would argue that non-accredited (ACGME/AOA) fellowships should not be allowed at all. My area is full of "Board certified, Fellowship trained" doctors who did a residency is something irrelevant, became board certified, then then started a job doing pain management. The "non-accredited fellowship" was just their first year on the job.

Patients have no idea what any of this means.

 

[lonelobo]

IMO, the only reason to get board certified is to make the insurance companies happy. It's a total racket and means nothing.

I would argue that non-accredited (ACGME/AOA) fellowships should not be allowed at all. My area is full of "Board certified, Fellowship trained" doctors who did a residency is something irrelevant, became board certified, then then started a job doing pain management. The "non-accredited fellowship" was just their first year on the job.

Patients have no idea what any of this means.

You have not been able to be Pain board certified (From AAPMR) without an accredited fellowship since 2005....what irrelevant residencies are becoming board certified in your area?

 

[Ferrismonk]

You have not been able to be Pain board certified (From AAPMR) without an accredited fellowship since 2005....what irrelevant residencies are becoming board certified in your area?

Sorry, I probably wasn't clear. Here's an example: Terrible general surgery resident graduates general surgery residency. Becomes board certified in General Surgery. No surgery group will hire him. He then decides he wants to do interventional pain management. He works for some schmuck for a year or goes out on his own. He then counts his first year working as a "non-accredited fellowship". He then advertises that he is "Board certified and fellowship trained"

Notice they don't say "Pain board certified" or "Double board certified in X and Pain Management"

 

[SSdoc33]

Sorry, I probably wasn't clear. Here's an example: Terrible general surgery resident graduates general surgery residency. Becomes board certified in General Surgery. No surgery group will hire him. He then decides he wants to do interventional pain management. He works for some schmuck for a year or goes out on his own. He then counts his first year working as a "non-accredited fellowship". He then advertises that he is "Board certified and fellowship trained"

Notice they don't say "Pain board certified" or "Double board certified in X and Pain Management"

i get your point, but your scenario is exceptionally rare

 

[Ferrismonk]

Not around me it isn't.

 

[deleted472101]

That is why you have to standardize training into one format and promote it to the medical community and general public.


I agree not all ACGME fellowships are great and that some Non-ACGME fellowships are fantastic. But with out standardized training, which has to be checked by a committee, you are opening up for very sub-par physicians.

 

[sdnuser001]

What is the advantage of NASS fellowships vs other nonaccredited fellowships in regards to job placement?

 

[Ducttape]

possibly or possibly creating higher value with them. In todays day and age on value in board certification many of these people won't be able to practice bc they are not acgme fellowship trained. Its essentially diluting the field. None of the people applying to this would choose this over an ACGME pain fellowship if given the option between the two.

that is just clearly the wrong way of thinking of this. you are going to get marginal candidates that do not get in to an ACGME fellowship - with an match rate of 85% its hard to argue that it is impossible to get in to one.

it will dilute interventional pain management/spine management such that PAs and NPs can justify doing them without supervision.

Ferris, that will not disappear with this new fellowship. in fact, it might encourage more people to go out on their own without qualifications, as more and more are not truly "board certified in pain".

 

[slippery_when_wet]

Match rate being 85% effectively erases pain as a competitive fellowship. There's a part of me that wished I knew about this before applying.