Pain anybody?

[Castro Viejo]

So I'm doing my 2-week anesthesia rotation and I attended a lecture this afternoon presented by the Director of the Pain Service at my school. For all those following the fight over what the future of Pain Management's gonna be, according to this guy Pain fellowships (and this includes "interventional pain management") will be open to not only anesthesiology-trained people, neurologists, and physiatrists, but to internists, surgeons, pediatricians, and "practically anyone."

Think this is true?

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[brownman]

Well,

The pain fellowships as we know them are getting extremely bizzare in length and qualification. In truth, pain management is a very multifactorial entity. I think interventional pain management will always be in the hands of anesthesiologists. It's really a question of whether they will recind control of this or not....

I think in general to open the flood gates is a bad idea...and a bad business practice. There are many reasons not to do it...and with the way anesthesiologists have become very territorial of late (controlling all things involved in perioperative management), it is their field to lose. They have opened the fellowships to other specialties because of the absolute dearth of people entering the field, but...with numbers picking up, and pain becoming more popular...I doubt anesthesiologists will open up their control. It doesn't make common business sense either, as again there is no control of numbers and increased level of competition. To maintain the lucrative nature of the field (even with medicare reduction in reimbursement)...pain physicians will try to limit pain practices to anesthesiologists. Remember, private practice controls the lucrative jobs and these things are very nepotistic. If three anesthesiologists run a pain practice, they'll be sure to take their own into the practice rather than anyone else....

 

[drusso]

Currently three boards sponsor subspecialty certification in pain medicine: Anesthesia, PM&R, and Psychiatry/Neurology. These are the "big three" players in pain. Pain is, by definition, a multidisciplinary specialty requiring input from a wide variety of specialists.

Marc Hahn, DO, the dean at UNTHSC/TCOM has just taken over as president of the American Academy of Pain Medicine.

http://www.painmed.org/about/boardlist.html

He's an interventional anesthesiologist by training and I asked him about this very issue regarding "turf" in pain medicine since I'm planning on doing PM&R and an interventional fellowship. He thinks that the major three players will always have a spot at the table. As for securing competitive pain fellowships, again it is less about what kind of specialist you are than what unique experiences, research, etc you have.

 

[navs]

I agree that pain should be a multi-disciplinary approach. But let's admit it as long as anesth. guys run the majority of pain services and their fellow programs for pain who do u think they will choose??

As everyone knows medicine is a pretty dirty field and who do u think will be able to pull the most strings with these anesth. run pain fellowships?? Definetly, being a res. of that anesth. program and for that fact having ur fellow attendings picking up phones and calling fellow anesth. to get a canidate into a pain fellow spot MUST occur quite often and will continue to do so.

I also do agree, at this point the power lies with anesthetists, just matters if they will give up that power and as long as money is involved the answer would logically be NO.

What do u guys think??