Pain Management in FM?

[spyyder]

Pain Management is generally done by Anesthesiology and PMR. Can FM docs also perform these procedures (or complete a pain fellowships)? Is this difficult to get into and is it possible to run 100% pain practices like those guys do? Pain/Wellness centers seems to be fairly lucrative is there a reason more FM guys don't do it?

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[lowbudget]

Pain Management is generally done by Anesthesiology and PMR. Can FM docs also perform these procedures (or complete a pain fellowships)? Is this difficult to get into and is it possible to run 100% pain practices like those guys do? Pain/Wellness centers seems to be fairly lucrative is there a reason more FM guys don't do it?

Every doctor manages pain and should manage pain properly regardless of what your specialty is. It has been noted that pain management as a field is multidisciplinary and does not belong to any one specialty. Thus, you don't have to be anesthesiologist or PMR to manage pain or run a 100% pain clinic.

The real issue is about money. Or said in a better way, the issue is about procedures and who can do the procedures. Let it be known that no one (FP or otherwise) should be sticking anything into anyone's spine unless they know exactly what the hell they are doing and exactly where it's going!

Which... brings up the issue of training and thus fellowships. Anesthesia runs the Pain boards, and Pain cert is recognized by anesthesia, PMR, Neuro, and Psych boards. There are a few fellowships that will accept FM docs to do pain fellowships. FM doesn't have Pain board exam. I don't know if other boards will allow/recognize FP's who have done a pain fellowship to sit for the boards. I just don't know.

JPS has an accredited PCSM fellowship that incorporates Pain as well. I think the 1st year is Sports and the 2nd year is Pain. I know the fellowship is open to FP's but I don't know if it's open only to it's own residents (because of P4) or if it's opened outside. I don't know for sure, but it seems like the Pain portion of the fellowship is co-sponsored by UTSW's PMR department.

Anyways, it's pretty innovative if you ask me because I think they're in front of what other PCSM or Pain fellowships are doing. Most PMR sports/spine/pain fellowships have very little "sports" and more than most PCSM programs have little interventional spine/pain management. And while I have absolutely NO interest in doing interventional pain work, I think it's great that someone is and will push for FP's to do it.

Hell, if a psychiatrist can stick crap into people's spine after a procedure-less, umm... physical exam-less residency, I think FM docs who went to a strong program could do it.

So if you're curious want to do something like this, check out JPS. I heard from a DO student that there's a Wisconsin program that's doing the same thing too with PCSM & Pain, but I don't know.

Check out this thread about FP & Pain. It was pretty interesting:
http://forums.studentdoctor.net/showthread.php?t=633070

Uh... that being said, if you do decide to go after the big money, realize that it comes with big responsibilities (i.e. liability). I mean, just ask Michael Jackson's concierge doctor: http://www.tmz.com/2009/07/18/jackson-doc-declines-to-chat-with-cops/

 

[paindirector]

It is possible for any specialty to attend a fellowship, learn interventional procedures, become board certified in pain, and practice pain medicine (including getting credentials at surgery centers and hospitals to do procedures). This includes FM.

 

[paindirector]

You have a lot of questions in your post, I'll try to answer as many as I can.
1. It is very difficult to get into a pain fellowship if you are not anesthesia or PM&R.
2. Any ACGME specialty that does an ACGME pain fellowship can sit for the board as long as they have the permission of their primary board to do so. FM has given permission to all our FM grads. You will take the board, and be certified through, the specialty sponsoring your fellowship (PM&R in our case). Anesthesia administers the board to all specialties, it is the same test.
3. In addition to the difficulty in obtaining a fellowship spot, few FM probably do pain because they just don't want to. It is not something you can just dabble in, at least from an interventional standpoint. If you are going to have an interventional practice, you need to be doing it all the time to maintain your skills and perform the procedures safely and effectively.
4. I would not recommend doing pain simply for the money. It is a tough population to work with on a full time basis and you need to have the heart for it or you will probably not like your career very much. There is much less money in pain these days anyway, it is a target of frequent and ongoing cuts. I know many FP docs that make as much or more than your average pain doc.
5. The JPS program is open to outside residents. The strongest candidates for the pain program will have completed one year of sports medicine with the interventional track. To date, no FM candidate has been accepted into the pain program without completing the sports year first.