Pain Management Certification for Mid-Levels?

[drusso]

I've been approached with an offer to consult in the development of a certification program in Pain Management for certified physician assistants.

I'm curious if people would value this credential when recruiting a mid-level provider to their group: If selecting between two otherwise qualified candidates, if one candidate had completed a 6 month certification program in pain management, and passed a national competency examination, would you see that has an important differentiating feature when it comes to making an employment offer?

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[lobelsteve]

As long as tou can pocket some coin while watering down tbe field further....

 

[drusso]

As long as tou can pocket some coin while watering down tbe field further....

I haven't agreed to do anything. I'm still trying to figure out if it's a valuable proposition to hold accountable mid-level practitioners in our field to a specified standard of knowledge. There is an RN-level certification program but it is more geared to inpatient pain, palliative care, and oncology.

Both NASS and ISIS did a course for Allied Health providers on spinal interventions which I heard was very, very well received. A PA in our group attended the ISIS version and learned a lot. Most PA's learn pain management directly from their supervising physician in a preceptor-based model. My sense is that this is model is too variable to really enforce standards.

 

[Ducttape]

no, while i look at a certification, i realize that some of these certifications are meaningless.

for example, i taught a few lectures for the Nurse certification in pain medicine, and it was fairly meaningless for chronic pain. like you mention, the majority is inpatient acute pain.

on the other hand, enabling certain groups (PAs may be the exception) does tend to make those who certify feel that they are as qualified as physicians...

 

[Ligament]

I've been approached with an offer to consult in the development of a certification program in Pain Management for certified physician assistants.

I'm curious if people would value this credential when recruiting a mid-level provider to their group: If selecting between two otherwise qualified candidates, if one candidate had completed a 6 month certification program in pain management, and passed a national competency examination, would you see that has an important differentiating feature when it comes to making an employment offer?

My overwhelming concern would be that they would use this certification to practice pain medicine independently ala CRNAs and NPs. Given the course lately, I'd say there is a 90% chance they would attempt this....

 

[lobelsteve]

My overwhelming concern would be that they would use this certification to practice pain medicine independently ala CRNAs and NPs. Given the course lately, I'd say there is a 90% chance they would attempt this....

This.

If there are lessons learned from our Anesthesia friends. Why would you train your replacements? No arguments for this hold water. Anyone ever see any creep or scope issues from DC, PA, NP, naturapaths, PT?

 

[Disciple]

I'm curious if people would value this credential when recruiting a mid-level provider to their group: If selecting between two otherwise qualified candidates, if one candidate had completed a 6 month certification program in pain management, and passed a national competency examination, would you see that has an important differentiating feature when it comes to making an employment offer?

In my area, the typical method has been for practices to hire a trained midlevel away from a competitor.

 

[drusso]

This.

If there are lessons learned from our Anesthesia friends. Why would you train your replacements? No arguments for this hold water. Anyone ever see any creep or scope issues from DC, PA, NP, naturapaths, PT?

I hear 'ya.

The argument would be that mid-level practitioners are woefully under-trained to do pain management yet often accept positions in pain management groups. The certification wouldn't change their scope of practice. The idea is that it be more like the "First-Assist" certification that RN's can get or model after the surgical "residencies" that PA's can do if they want to become "Surgical-Physician Assistants" and work in OR's.

So, no pain doctors have thought to themselves, "I'd like to hire a PA who already *knows* pain management..."

 

[Disciple]

I can definitely see the value with the proper curriculum.

Heavy on psyche/addiction and proper prescribing, with some training on recognizing emergent post-procedural complications, and when to have the physician re-evaluate a musculoskeletal/neuro condition.

 

[drusso]

I can definitely see the value with the proper curriculum.

Heavy on psyche/addiction and proper prescribing, with some training on recognizing emergent post-procedural complications, and when to have the physician re-evaluate a musculoskeletal/neuro condition.

That's kind of my thinking...throw in some basic knowledge about neuromodulation, procedures, etc. But mostly focus on psych, addiction, non-interventional modalities, PT/rehab.

But, the vibe I'm getting is that there's not a good value proposition in this for most MD/DO's.

 

[101N]

That's kind of my thinking...throw in some basic knowledge about neuromodulation, procedures, etc. But mostly focus on psych, addiction, non-interventional modalities, PT/rehab.

But, the vibe I'm getting is that there's not a good value proposition in this for most MD/DO's.

It is a great idea but for LCSWs who could also offer some form of CBT/ACT specifically for pain/PTSD.

 

[nvrsumr]

Would be a great addition to a Chiro owned pain clinic. The family practice doc can write narcs and "pain pa" can do the interventions.

 

[Ducttape]

the concern is what has happened in the past - that midlevels (and other groups, not just midlevels) look not only for acceptance with certification, but look to expand their scope of practice with said certification.

the history of nurse practitioners serves as a good example. initially envisioned not as a physician replacement, which they are rapidly becoming.

http://www.medscape.com/viewarticle/464663_2

a pertinent quote:

Nurse practitioners continued to grow in number and autonomy in response to an expanding need for accessible, cost-effective care.[19,20] As their impact on health care increased, nurse practitioners sought greater professional and economic recognition. In an attempt to clarify the scope of practice and to meet federal regulations for reimbursement, advanced-practice nursing organizations began offering voluntary certifications and titles.

Currently, there are now family NP, Adult NP, Women's health, Gerontology, Pediatrics, psychiatry, (and technically CRNA and nurse midwife) to ostensibly "clarify" their scope of practice... but the not so unintended side effect is to take them further away from nurses andcloser with physicians

 

[miamidoc2b]

Don't do it.

It's a trap...

 

[kstarm]

I can see the point about encroachment. I also don't like having to clean up and deal with the fall out of the poor prescribing practices of providers and inept pain management strategies which I see this a lot in mid-levels. I think pain training should be an essential part of health care education. I think a lot groups would be interested in hiring a PA with pain certification.

 

[drusso]

It is a great idea but for LCSWs who could also offer some form of CBT/ACT specifically for pain/PTSD.

Do you think it's easier to teach a behavioralist physical exam, pharmacology, neuroanatomy, musculoskeletal medicine, etc. Or, easier to teach a medically-minded practitioner the biopsychosocial model?

 

[Disciple]

That's kind of my thinking...throw in some basic knowledge about neuromodulation, procedures, etc. But mostly focus on psych, addiction, non-interventional modalities, PT/rehab.

But, the vibe I'm getting is that there's not a good value proposition in this for most MD/DO's.

Give them the tools to do a good job, but not your job.

Despite that, I would say don't do it, for reasons brought up already by others.

 

[drpainfree]

midlevel should NEVER be certified in any particular specialty. Midlevels are created to ASSIST physicians under supervision. They do NOT have preceptor-training. The process should never be viewed as training process. They should ALWAYS be supervised. Anyone in any specialty trying to make a short cut for these midlevels is training replacement for the specialty. This is how the trend started from ground zero.

if you feel that your midlevel should have better understanding of pain management, YOU ARE OBLIGATED TO SUPERVISE THEM YOURSELF. The moment you tried to certify midlevel to a specialty in a mass quantity is when they will try to replace you. Remember, physicians in a whole are already under attack by corporate medicine to be replaced with cheaper "providers".

STOP DOING THIS!

 

[drusso]

midlevel should NEVER be certified in any particular specialty. Midlevels are created to ASSIST physicians under supervision. They do NOT have preceptor-training. The process should never be viewed as training process. They should ALWAYS be supervised. Anyone in any specialty trying to make a short cut for these midlevels is training replacement for the specialty. This is how the trend started from ground zero.

if you feel that your midlevel should have better understanding of pain management, YOU ARE OBLIGATED TO SUPERVISE THEM YOURSELF. The moment you tried to certify midlevel to a specialty in a mass quantity is when they will try to replace you. Remember, physicians in a whole are already under attack by corporate medicine to be replaced with cheaper "providers".

STOP DOING THIS!

I think that they want to model the Pain PA-C after the Derm PA-C:

Physician Assistants are dependent providers in that we are practice medicine only under the supervision of a physician. This collegial relationship promotes quality patient care utilizing a team approach to health care delivery. The services provided by the PA are delegated by the supervising physician and are determined by the knowledge, training and skills of the PA and should reflect the practice style and services provided by the supervising physician.

http://www.dermpa.org/

 

[lobelsteve]

This year. And soon the PA will be PCP for Derm and the MD will get seen only after the PA takes care of everything but the complications.

 

[drusso]

This year. And soon the PA will be PCP for Derm and the MD will get seen only after the PA takes care of everything but the complications.

We're already seeing health systems embrace the "Pain PA" navigator concept in our state:

http://www.beckersspine.com/spine/i...pens-sacred-heart-spine-center-in-oregon.html

http://www.peacehealth.org/apps/physician/PhysicianDetail.aspx?ProviderID=6111

Seems to be a very successful model for them.

 

[lobelsteve]

We're already seeing health systems embrace the "Pain PA" navigator concept in our state:

http://www.beckersspine.com/spine/i...pens-sacred-heart-spine-center-in-oregon.html

http://www.peacehealth.org/apps/physician/PhysicianDetail.aspx?ProviderID=6111

Seems to be a very successful model for them.

Exactly. They are taking jobs away from physicians. Keep it up and they will be mandated as first line providers. Once they get patients on narcotics and do a series of 3 LESI, 3 facet blocks, then 3 SIJ, maybe an SCS trial.....They show up for you to manage the narcs and implant. That is the future of training your replacement.

 

[ampaphb]

In Louisiana, PA's can not write for scheduled meds. Mine sees some of the follow-ups on the days I am in the office. I sign off on her scripts, as well as the proceures she thinks the patients might benefit from.

Dave, don't let the nay-sayers discourage you. A program could be designed that specifically states something to the effect that "this certification is in no was intended to credential the recipient to practice independant of a supervising physician. Practioners or organizations who claim to have such a skill set are lying, and comiting overt fraud."

 

[drpainfree]

Com'on, whatever statement you put it on their certification means nothing to the hospital/insurance company administrators. All they care, is if they can "legitimately" substitute physician's work with a PA/NP, they will find whatever ways to make the substitution.

It's already happening. I'm just hoping that my colleagues will NOT contribute to the demise of our profession by training and certifying our substitution.

 

[ampaphb]

Yes, yes, you're completely right. We will be much better off letting the PAs and NPs create their own credentialing protocol.

 

[specepic]

drusso, from the standpoint of idealism is sounds fine, in reality it is sticking a sword in the professions back. The example in my state is the infamous NH pain group which trained an army of PAs and CRNAs ("supervised" by the MDs at about a 10:1 ratio) who are now spinning off either on their own or training others themselves. One of their PAs holds courses for other mid levels. I have seen pts where the consult, procedure, and f/u were entirely PA and no doc ever. One of their CRNAs was hired to run interventional pain single handedly at another NH hospital (they fired the MD after the program was up and running).

I'm sure you enjoy sharing the specialty and teaching and like the concept of improving access. However, you are training your own replacement, they will think they can do what you do, mid levels often "do not know what they do not know".

 

[drpainfree]

Let me address your sarcasm, ampaphb.

No, we are NOT better off to let them create their own credentialing protocol. We, I mean Interventional Pain Management as a specialty, will be ALL better off, by refusing to support or recognize any sort of PA/NP IPM credentialing. Once the credentialing protocol (organization) comes to existence, they will have an organized voice to advocate that the quality of care they provide is equal or superior than that of physicians. By that time, it would be too late to argue with hospital administration or insurance companies otherwise.

As a matter of fact, if you are going to hire a PA, you're obligated to supervise them and train them. Write in your contract agreement that you'll not allow them to spin off independently within certain radius of mileage or provide any professional reference when they try to find another IPM job.

IPM is a small field that's already under attack left and right. The precipitous drop of reimbursement is already casting shadow on the existence of the specialty in next 20 years.

We are unlike any other "mature" specialty, derm, ortho surgery, etc, they got enough history in their specialty to defend against encroachment of midlevel. The demand for their work is also significantly higher than IPM (just look how many "experimental procedures" we have compared to ortho). In another words, we have a much smaller and fragile "turf" compared to other specialties, If PA/NP are allowed to be credentialed in any way imaginable, it would spell an end of the specialty.

 

[miamidoc2b]

Can this be moved to the private forum?

The amount of asininity in this thread should be concealed from the general public.

 

[painj]

we have begun receiving numerous practices interested in bringing in a PA. The pain specialty for mid-levels is relatively new-so there are only very rare instances when any PA would have over 2 years experience in the modality. Most of them being hired are brand new to pain and the bulk need to be trained on site--which as you know would not be an easy task to take the time out to do so. The issue seems to be that some states allow for PA's to write scrpits and some states do not--but realistically--a PA that is going to be on thier own is going to most likely do so with or without a certification.
An advanced class-or course-for PA's to take that stresses testing, addiction, types of procedures, working with patients and thier personalities in chronic pain, etc would do wonders for those getting into the specialty as well as those practices that are in need of a PA.
Most of the practices needing a PA- hire them to assist with patient follow up, testing, therapy or rehab programs, etc--not neccessarily new patient consults or long term opiod writing--and certainly--except for extreme cases-never be used for any type of procedure. The function-from what we have seen--definitely seems to be in the "assisting" form as opposed to doing what the physician does. It obviously saves a practice tremendously on salary and long term finances having a PA do some of those taskes that would then allow the physician the time for procedures, new patients, etc. So, for the OP--in the employment world of this context--certainly without getting into what is right or wrong for the industry---Yes--there are many, many pain practices that have begun looking for PA's to employ and having a national certification or even recognized programs would benefit this part of the industry greatly. I beleive that any and all of our clients that we help place a PA with would have chose one with additional training and/or certification over a candidates that had none.

 

[miamidoc2b]

we have begun receiving numerous practices interested in bringing in a PA. The pain specialty for mid-levels is relatively new-so there are only very rare instances when any PA would have over 2 years experience in the modality. Most of them being hired are brand new to pain and the bulk need to be trained on site--which as you know would not be an easy task to take the time out to do so. The issue seems to be that some states allow for PA's to write scrpits and some states do not--but realistically--a PA that is going to be on thier own is going to most likely do so with or without a certification.
An advanced class-or course-for PA's to take that stresses testing, addiction, types of procedures, working with patients and thier personalities in chronic pain, etc would do wonders for those getting into the specialty as well as those practices that are in need of a PA.
Most of the practices needing a PA- hire them to assist with patient follow up, testing, therapy or rehab programs, etc--not neccessarily new patient consults or long term opiod writing--and certainly--except for extreme cases-never be used for any type of procedure. The function-from what we have seen--definitely seems to be in the "assisting" form as opposed to doing what the physician does. It obviously saves a practice tremendously on salary and long term finances having a PA do some of those taskes that would then allow the physician the time for procedures, new patients, etc. So, for the OP--in the employment world of this context--certainly without getting into what is right or wrong for the industry---Yes--there are many, many pain practices that have begun looking for PA's to employ and having a national certification or even recognized programs would benefit this part of the industry greatly. I beleive that any and all of our clients that we help place a PA with would have chose one with additional training and/or certification over a candidates that had none.

O ya?

What "pain" practices are these? Chiros? Or PTs? Or surgeons? or IM docs? who now can boast a "certified" pain "doctor"

They should be trained on site - they are YOUR assistant

 

[drpainfree]

This is where we need to resist, the laziness to train and supervise your worker (PA/NP). If you are going to hire a PA/NP, you are obligated to train them and supervise them on AN INDIVIDUAL basis. It's not an excuse of "certifying" them therefore credentialing them with any type of substituting capability for them to advocate to hospital administrators or insurance companies.

Any of our anesthesia-trained IPM physicians can testify for you how the field of anesthesia went downhill when academic anesthesia program started training CRNA. Now the field of anesthesia is spiraling down with no hope. CRNA is practicing anesthesia in many states without supervision essentially replacing anesthesiologists.

It all started with simple concept of "training your qualified midlevels". Look at how far and how bad it has gone.

 

[painj]

miamidoc2b--These are all BC, anesthesia or PMR residency trained, fellowshp trained pain physicians that own their own practices--not chiros, or other as you described. As I stated--I am not by any means attesting to or protesting whether or not this is good for the industry, or good for you physicians on this forum--all of that is up to you and I certainly know my place in all of this--so any of your arguments --to me certainly--are of no concern--I am neutral in this--I was just letting the original poster know what is happening in the employment industry at this time--regardless of what anybody thinks should happen--this is what is happening and that yes--when somebody is recruting a mid-level for thier group, they would select one with certification over one with none if all other factors were equal.

 

[drpainfree]

painj, it's exactly why WE, IPM physicians would NOT be "certifying" these midlevels, REGARDLESS what's happening in the industry.

Last thing we want to do is to commit a suicide to the specialty.

 

[painj]

There is no argument from me there. I get and understand that. But, irregardless--practices are going to be hiring mid-levels and those practices would be interested in certification--if there was such a program-- over non--again, just for information to the original poster.

 

[drpainfree]

I might be in the position of hiring a midlevel in the near future. One thing for sure, I will NOT hire a PA/NP with some type of pain management certification. Not because I think they don't know what they are doing. For the simple fact of NOT supporting an organized effort of midlevel to someday replace us.

Yes, I might have to spend more time to train and supervise them. I will make sure to write into the contract to let them know I won't be giving them reference/recommendation for future pain management positions.

 

[Baller MD]

As others have stated, it is pathetic to see docs training their replacements for either greed or ignorance.

 

[newbie04]

This is where we need to resist, the laziness to train and supervise your worker (PA/NP). If you are going to hire a PA/NP, you are obligated to train them and supervise them on AN INDIVIDUAL basis. It's not an excuse of "certifying" them therefore credentialing them with any type of substituting capability for them to advocate to hospital administrators or insurance companies.

Any of our anesthesia-trained IPM physicians can testify for you how the field of anesthesia went downhill when academic anesthesia program started training CRNA. Now the field of anesthesia is spiraling down with no hope. CRNA is practicing anesthesia in many states without supervision essentially replacing anesthesiologists.

It all started with simple concept of "training your qualified midlevels". Look at how far and how bad it has gone.

Complication Rate Same for CRNAs and Physicians Performing Pain Procedure

Published on 02-06-2015 11:01 AM

Complication rates for fluoroscopic-guided lumbar epidural steroid injections (LESIs) performed by certified registered nurse anesthetists (CRNAs) are similar to physician rates cited in the literature, according to a study published online Jan. 27 in the Journal for Healthcare Quality.

Donald E. Beissel, D.N.P., from Southwest Interventional Pain Specialists in Albuquerque, N.M., conducted a survey of CRNA pain practitioners. He collected data on the number of fluoroscopic-guided LESIs performed and each of 20 complications for a six-month period.


Beissel found that participants practiced in urban (23 percent) and rural (77 percent) settings in office/clinic (31 percent), hospital (62 percent), and mixed (7 percent) practices. CRNAs had both master's (62 percent) and doctoral (38 percent) degrees.

Experience in performing fluoroscopic-guided LESIs ranged from one to 17 years and 50 to 12,000 procedures. For each complication, the rate of occurrence was below 1 percent, with the highest rates for bruising and vasovagal reactions. There were no cases of paralysis or death. There was no association between either practice setting or experience level and complication rates.


"CRNAs were able to safely and effectively perform fluoroscopic-guided LESIs with complication rates similar to physician rates cited in the literature," the authors write.

http://www.nurse-anesthesia.org/con...RNAs-and-Physicians-Performing-Pain-Procedure

 

[Ducttape]

Completely worthless "study" that is probably going to be basis for continued state and federal approval of CRNAs doing injections they have no business doing.

Surveys never prove anything. I'm surprised that the survey didn't show that the injections were 1000% more effective and 99 times less painful than one done by a trained provider.

 

[newbie04]

Completely worthless "study" that is probably going to be basis for continued state and federal approval of CRNAs doing injections they have no business doing.

Surveys never prove anything. I'm surprised that the survey didn't show that the injections were 1000% more effective and 99 times less painful than one done by a trained provider.

The survey is worthless but bogus "studies" like this show continued mid-level encroachment on Pain Medicine. Administrators will see this as legit research and say "we can hire a CRNA and save $$$." It would be great to avoid the mid-level "take over" that has directly affected Anesthesia.

 

[drpainfree]

It's why we DO NOT give them a SINGLE chance! Don't open the floodgate!

 

[Aether2000]

It is the same BS found throughout their journals. CRNAs largely neither understand how to conduct research studies nor engage in meaningful research itself. They are leeches, sucking on the healthcare system without ever giving anything back.

 

[Ligament]

Completely worthless "study" that is probably going to be basis for continued state and federal approval of CRNAs doing injections they have no business doing.

Surveys never prove anything. I'm surprised that the survey didn't show that the injections were 1000% more effective and 99 times less painful than one done by a trained provider.

You mean physician, don't you?

The term "provider" was generated to brainwash the public and fellow medical professionals into believing "we're all equal." To control language is to control thought. Thats the agenda of the leftists with their push for political correctism in the 80's and 90's.

In other words, by using the word "provider," you are helping to perpetuate the propaganda that CRNAs are indeed equal to physicians. After all, we are both "providers." Hell, MAs are now being called "providers." Next, the janitor will be called a "provider."

Providers are mothers and fathers, obligated to sustain and nurture their children. They must provide for the kids without compensation. To provide selflessly is their moral duty. In turn, the leftist propagandists want the same sense of obligation without compensation to be ingrained in the minds of physicians. If we believe we must provide, we believe we need not be compensated. It makes it easier for them to pay us less every year and burden us with more overhead and regulations.

I don't "provide" jack squat. I sell my professional services.

It really is a shame to see fellow physicians use this propagandist term.

 

[Baller MD]

A "survey" as a good study only in the minds of nurses. Damn, they're incomprehensibly dumb.

 

[drusso]

To control language is to control thought.

Yes, yes, and f*ck yes! Also, understand the corollary: Science is just high rhetoric. The meta-analyticians who are working to "de-medicalize" pain management are working against the best interests of our patients.

 

[Ducttape]

You mean physician, don't you?

The term "provider" was generated to brainwash the public and fellow medical professionals into believing "we're all equal." To control language is to control thought. Thats the agenda of the leftists with their push for political correctism in the 80's and 90's.

In other words, by using the word "provider," you are helping to perpetuate the propaganda that CRNAs are indeed equal to physicians. After all, we are both "providers." Hell, MAs are now being called "providers." Next, the janitor will be called a "provider."

Providers are mothers and fathers, obligated to sustain and nurture their children. They must provide for the kids without compensation. To provide selflessly is their moral duty. In turn, the leftist propagandists want the same sense of obligation without compensation to be ingrained in the minds of physicians. If we believe we must provide, we believe we need not be compensated. It makes it easier for them to pay us less every year and burden us with more overhead and regulations.

I don't "provide" jack squat. I sell my professional services.

It really is a shame to see fellow physicians use this propagandist term.

no, you are a provider, of a skill set that should be unique to a trained certified physician, not to any midlevel or any other healthcare individual.

you provide a service to a patient, and that is your primary responsibility, not compensation. if you are doing interventions for compenstation, then you are disobeying your hippocratic oath to have the patients best interest - not yours or your financial wellbeing - in mind.

we went into this profession, the most noble of all professions, to help patients. compensation is secondary. you took that hippocratic oath. this is not new, or something original, or unique. this is the foundation of medicine.

Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient; and I will willingly refrain from doing any injury or wrong from falsehood, and (in an especial manner) from acts of an amorous nature, whatever may be the rank of those who it may be my duty to cure, whether mistress or servant, bond or free.

as a second point, as a provider of IPM, i clearly am stating that CRNAs are not in any way equal or qualified to do IPM. just as a neurosurgeon is a provider of neurosurgical services, that are unique to his training and skillset, so too are IPM physicians. i would never expect an pain doc to perform invasive spine surgery (outside of SCS or kyphos) - spine docs are providers of this service. likewise, CRNAs, NPs, PAs, etc. are not qualified to provide interventional procedures.

 

[oldanddone]

proliferation of various 'certifications' go along with 'standardization' that can then be used to advocate for laws that recognize such standards, especially if the 'certifications' are recognized by gatekeeper entitites. this is typically politically laden. in many areas, the proliferation of certification programmes, in the name of standardization, have been a way to put the onus of time and money on trainees, whereas it used to be 'on the job' - and paid for, and possibly accounted for on a resume.

what would be the difference between creating a training programme that a medical practice can use to train the p.a. they hire locally, that is somehow protected to only be used by an m.d. in the context of training a local p.a. vs participating in the creation of a broad certification programme utilized and recognized by a gatekeeper organization? perhaps the first local option might eventually be used in the context of the second...but the m.d. involved at least would not have been participating in the political goals of the gatekeeper organization explicitly, and rather focused on what they had indicated was an issue for fellow m.d.s wanting guidance on how to train their p.a.s.

 

[miamidoc2b]

no, you are a provider, of a skill set that should be unique to a trained certified physician, not to any midlevel or any other healthcare individual.

you provide a service to a patient, and that is your primary responsibility, not compensation. if you are doing interventions for compenstation, then you are disobeying your hippocratic oath to have the patients best interest - not yours or your financial wellbeing - in mind.

we went into this profession, the most noble of all professions, to help patients. compensation is secondary. you took that hippocratic oath. this is not new, or something original, or unique. this is the foundation of medicine.




as a second point, as a provider of IPM, i clearly am stating that CRNAs are not in any way equal or qualified to do IPM. just as a neurosurgeon is a provider of neurosurgical services, that are unique to his training and skillset, so too are IPM physicians. i would never expect an pain doc to perform invasive spine surgery (outside of SCS or kyphos) - spine docs are providers of this service. likewise, CRNAs, NPs, PAs, etc. are not qualified to provide interventional procedures.

are you really too dense to comprehend what Ligament wrote?

preaching to the choir here....but carry on doc, i mean provider

 

[Ducttape]

- i am critical of those who believe that we should worship the bottom dollar as the primary goal of being a doctor.

i decided to be a doctor when it was a respected profession, and financial security was a side benefit. it peeves me off to think that some people on this forum are more focused on making money/"selling their professional services" rather than giving - oh what the heck - "providing" healthcare.

- i am also critical of doctors that are so insecure about their standing that they feel that an appropriately used word will equate their status with that of lesser trained individuals. what other term would you use, to describe MDs/DOs, NPs, PAs, and CRNAs comprehensively?

unfortunately, the time to prevent these other "people" from giving health care has slipped away, and if you think one word is going to make things worse, or its non-use all better...

paranoid and delusional comes to mind.

 

[Ligament]

- i am also critical of doctors that are so insecure about their standing that they feel that an appropriately used word will equate their status with that of lesser trained individuals. what other term would you use, to describe MDs/DOs, NPs, PAs, and CRNAs comprehensively?

The word provider is not appropriately used. We are physicians, not providers.

This term "provider" was never used prior to the PC thought control movement. It was introduced for the reasons I detailed above.

The word DOES INDEED equate our status with lesser trained individuals, that is the entire point of the term! You really don't get that? Equate us docs with NPs, and NPs can replace us in the minds of the bureaucrats and the public. After all, we are both "providers." It is a nonspecific, neutering, disempowering term and designed to be so.

As to what other term I would use, oh, I don't know, how about the correct freaking terms such as physician (MD/DO), nurse (RN), nurse that wants to pretend to be a doctor (NP), physician assistant (PA), nurse that wants to pretend to be an anesthesiologist (CRNA). Collectively, healthcare professionals. Professionals sell their expertise, they do not "provide" them gratis as you and the liberals wish to.

 

[Ducttape]

fyi,this is not a new term, even though you like to think so. the use of the term "provider" in medical articles occurred since at least in 1970 (pubmed doesnt go back beyond this date, i believe). doctors, NPs, and PAs were called "providers" by bureaucrats that long ago. as you know, NPs and PAs have been around since 1965. as examples:
http://www.ncbi.nlm.nih.gov/pubmed/5527892

Calif Med. 1970 Aug;113(2):80-5.
Utilization and peer review. Medicine's privilege and responsibility.
Schaffarzick RW, Parke HJ.
Abstract
Peer review affords a privilege for medicine to participate in the shaping of its future. As a corollary, however, medicine must accept the responsibility of stewardship which attends this privilege. Physicians must be willing to participate even more actively in peer review.Properly, utilization review of professional medical services can be performed only by physicians. They may be assisted by informed lay personnel and by computer-derived data. In no instances, however, should judgment of medical necessity be rendered by computer alone. Although an important function of peer review is the control of health care costs, even more important is the evaluation of the quality of care provided the consumers-our patients."Due process" must be an integral feature of peer review. Any provider must be given the opportunity to discuss his pattern of practice with his peers, and an appellate mechanism must be available.Prospective, rather than retrospective review is preferable, although both approaches are necessary.

http://www.ncbi.nlm.nih.gov/pubmed/4708422

A residency program in primary medical care: the physician as provider-manager.

Taylor JM, Johnson KG.

J Med Educ. 1973 Jul;48(7):654-60. No abstract available.

(ps i did not bold the word in this title)
http://www.ncbi.nlm.nih.gov/pubmed/10278028

Employee Benefit Plan Rev. 1975 Oct;30(4):8-9.
Viability of the HMO concept depends on how well the qualified provider is subsequently monitored.
Spencer BF.

We have been equals in the minds of the bureaucrats since at least the 1970s. do your own pub med search.


it was only during this time that a dramatic transformation of american medicine occurred, from one of an honorable profession to that of a salesman that you profess.

Dr. Paul Starr suggests in his analysis of the American health care system (i.e., The Social Transformation of American Medicine) that Richard Nixon, advised by the "father of Health Maintenance Organizations", Dr. Paul M. Ellwood, Jr., was the first mainstream political leader to take deliberate steps to change American health care from its longstanding not-for-profit business principles into a for-profit model that would be driven by the insurance industry.

if you are indeed just a professional that is selling your goods, then that does not make you any different than an NP or a PA or a CRNA or a certified Rad tech who does injections. they can all take courses and become "certified", or take drusso's next course and get their "degree" in pain medicine. interventional or not.

if you are an MD who learned medicine and swore by a hippocratic oath to hold yourself up to higher moral and ethical and scientific standards than that of one of the above professions, above the level of a carpenter, plumber, waste management or computer engineer (who are also professionals), then you are a PHYSICIAN.