Pain Medicine Fellowship from internal medicine

[RecoveringStudentDO]

I cant really find a concrete answer online.
I know that for pain medicine its basically anesthesia>pm and r> neurology > psychiatry.

Can you even apply from internal medicine? I mean if a psychiatrist can apply....I dont see why someone from internal medicine cant.
Even if someone can apply from internal medicine....are they going to stand a decent chance...if they have high board scores and performed well in residency? lets also say that internal medicine resident did some research and papers in pmr, neurology kind of topics....

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[emd123]

I cant really find a concrete answer online.
I know that for pain medicine its basically anesthesia>pm and r> neurology > psychiatry.

Can you even apply from internal medicine? I mean if a psychiatrist can apply....I dont see why someone from internal medicine cant.
Even if someone can apply from internal medicine....are they going to stand a decent chance...if they have high board scores and performed well in residency? lets also say that internal medicine resident did some research and papers in pmr, neurology kind of topics....

The last I heard of this, was in 2014 there was an open invite for any new specialties to apply to the ABMS to co-sponsor Pain. Emergency Medicine, FM and Radiology all applied to become official Pain specialites and they got approved. IM at the time (and I know this because since I, coming from EM, was pushing my board to make this official, and I encouraged an IM guy to do the same, which he did) but for some unknown reason, IM refused to go to the ABMS and request to make IM an official Pain specialty. Even though a number of IM boarded people (I personally know of 2) had already done accredited Pain fellowships and gotten board certification, for some reason, the IM crew did not want to allow this to continue. So, ABIM opted out, and that effectively closed the path for IM boarded people to get ABMS boarded in Pain, because the new rules say you only can get boarded, if you from one of the official specialties (currently, Anesth, PMR, Psy/Neur, EM, FM, Rads). Prior to that it was truly any specialty could do Pain, and get boarded, as long as you found a way to get in an ACGME accredited fellowship). Now, they've left it such that people in non-official specialties can do accredited fellowships, but can't take the boards. Personally, I think that makes no sense, but that's besides the point. So, since 2014 (unless something changed that I'm not aware of) IM people can do an accredited Pain fellowship (if they can get in, which is a longshot to start with) but cannot take the ABMS Pain boards even after completion. They could in theory, practice Pain at that point, like people who do non-accredited fellowships, but never with official ABMS board certification, which is a problematic pathway. Best way to find out if there were any updates to this: Call ABIM and ABMS.

 

[Orin]

Can you even apply from internal medicine?

Even if someone can apply from internal medicine....are they going to stand a decent chance...if they have high board scores and performed well in residency?

You can apply

Odds are low of matching unless you pound the pavement. Get to know some fellowship directors or faculty at your local fellowship programs. Go to your regional or the national pain meetings. Try to use your elective rotations working in the local pain clinic. If you're atypical, you'll have to get pass that first gate to the interview which is a lot harder when you're not one of the usual specialties.

At the end of the day, you'll likely do great in a fellowship as you'll have more clinic and E&M experience than a regular anesthesia applicant, but your unfamiliar training background and lack of exposure to the clinical aspects of interventional pain will be problematic.

The question about being boarded in pain is different, but there are a ton of accreditation boards that will be happy to give you some sort of paper for $ome effort I'm sure.

 

[Blitz2006]

The last I heard of this, was in 2014 there was an open invite for any new specialties to apply to the ABMS to co-sponsor Pain. Emergency Medicine, FM and Radiology all applied to become official Pain specialites and they got approved. IM at the time (and I know this because since I, coming from EM, was pushing my board to make this official, and I encouraged an IM guy to do the same, which he did) but for some unknown reason, IM refused to go to the ABMS and request to make IM an official Pain specialty. Even though a number of IM boarded people (I personally know of 2) had already done accredited Pain fellowships and gotten board certification, for some reason, the IM crew did not want to allow this to continue. So, ABIM opted out, and that effectively closed the path for IM boarded people to get ABMS boarded in Pain, because the new rules say you only can get boarded, if you from one of the official specialties (currently, Anesth, PMR, Psy/Neur, EM, FM, Rads). Prior to that it was truly any specialty could do Pain, and get boarded, as long as you found a way to get in an ACGME accredited fellowship). Now, they've left it such that people in non-official specialties can do accredited fellowships, but can't take the boards. Personally, I think that makes no sense, but that's besides the point. So, since 2014 (unless something changed that I'm not aware of) IM people can do an accredited Pain fellowship (if they can get in, which is a longshot to start with) but cannot take the ABMS Pain boards even after completion. They could in theory, practice Pain at that point, like people who do non-accredited fellowships, but never with official ABMS board certification, which is a problematic pathway. Best way to find out if there were any updates to this: Call ABIM and ABMS.

Great post. Had no idea that FM is eligible for pain boards.

For the OP, this is the board certification that Non-ACGME Pain fellows are eligible for:

ABPM Recognition

A lot of states don't recognize ABPM, so check out that list...

I'm sure emd knows this more, but I think being board certified is a big deal if you want to get credentialed at hospitals/credentialed with insurance companies..?

 

[emd123]

Great post. Had no idea that FM is eligible for pain boards.

For the OP, this is the board certification that Non-ACGME Pain fellows are eligible for:

ABPM Recognition

A lot of states don't recognize ABPM, so check out that list...

I'm sure emd knows this more, but I think being board certified is a big deal if you want to get credentialed at hospitals/credentialed with insurance companies..?

Yes, especially if you're from one of the rarer specialties. When I first came out of fellowship several years ago, my credentials got held up at two different hospitals until I proved my ACGME fellowship and ABMS board certification, whereas the anesthesia Pain and PMR people, got fast tracked because they had traditionally just credentialed them in their primary specialties and Pain flowed from that.

 

[Blitz2006]

Yes, especially if you're from one of the rarer specialties. When I first came out of fellowship several years ago, my credentials got held up at two different hospitals until I proved my ACGME fellowship and ABMS board certification, whereas the anesthesia Pain and PMR people, got fast tracked because they had traditionally just credentialed them in their primary specialties and Pain flowed from that.

Great to know, thanks. Does this also apply for insurance companies?

 

[emd123]

Great to know, thanks. Does this also apply for insurance companies?

I'm pretty sure Medicare and Medicaid only require the basic MD and DO degrees. I don't think they require any subspecialty boards to bill specific CPT codes. I could be wrong, though. As far as the private insurances, they each have their own rules. It's definitely better to have it, than not.

ACGME fellowship + ABMS Pain board certification >>> ACGME fellowship - ABMS Pain Board cert (+/- non-AMBS Pain pseudoboard certificate) > non-ACGME fellowship (+/- pseudo Pain boards) >>> no fellowship, no certification, self-taught.

The further you are to the left, the better.

 

[IMpainmedicine]

The last I heard of this, was in 2014 there was an open invite for any new specialties to apply to the ABMS to co-sponsor Pain. Emergency Medicine, FM and Radiology all applied to become official Pain specialites and they got approved. IM at the time (and I know this because since I, coming from EM, was pushing my board to make this official, and I encouraged an IM guy to do the same, which he did) but for some unknown reason, IM refused to go to the ABMS and request to make IM an official Pain specialty. Even though a number of IM boarded people (I personally know of 2) had already done accredited Pain fellowships and gotten board certification, for some reason, the IM crew did not want to allow this to continue. So, ABIM opted out, and that effectively closed the path for IM boarded people to get ABMS boarded in Pain, because the new rules say you only can get boarded, if you from one of the official specialties (currently, Anesth, PMR, Psy/Neur, EM, FM, Rads). Prior to that it was truly any specialty could do Pain, and get boarded, as long as you found a way to get in an ACGME accredited fellowship). Now, they've left it such that people in non-official specialties can do accredited fellowships, but can't take the boards. Personally, I think that makes no sense, but that's besides the point. So, since 2014 (unless something changed that I'm not aware of) IM people can do an accredited Pain fellowship (if they can get in, which is a longshot to start with) but cannot take the ABMS Pain boards even after completion. They could in theory, practice Pain at that point, like people who do non-accredited fellowships, but never with official ABMS board certification, which is a problematic pathway. Best way to find out if there were any updates to this: Call ABIM and ABMS.

I actually wrote several messages to the ABIM 3 years ago trying to inquire/push for them to cosponsor Pain. I received many unanswered emails but eventually received the following message:

"Your email was forwarded to me for reply. ABIM was invited to co-sponsor the Pain Medicine certification program, and after due consideration, ultimately decided against doing so. Your interest for the field is evident, and I am sorry I do not have better news for you at this time. As you may also be aware, there are avenues for those with pain management experience in the field of palliative care to earn recognition for their skills through participation ABIM in Hospice and Palliative Medicine certification and maintenance of certification programs."

 

[IMpainmedicine]

Yes, especially if you're from one of the rarer specialties. When I first came out of fellowship several years ago, my credentials got held up at two different hospitals until I proved my ACGME fellowship and ABMS board certification, whereas the anesthesia Pain and PMR people, got fast tracked because they had traditionally just credentialed them in their primary specialties and Pain flowed from that.

If you joined a practice with an in-office fluoroscopy suite, then would this have been an issue? Did most groups that you interviewed with still want you to have hospital priviledges?

 

[emd123]

If you joined a practice with an in-office fluoroscopy suite, then would this have been an issue?

Yes, joining this type of a practice makes this much less of an issue, except for the fact that to do some procedures in your office, you have to have hospital privileges, at at least 1 hospital. Most procedures don't have this requirement, but the one that comes to mind is spinal cord stimulator trials. I understand it's a little confusing, but according to the medicare LCD, to get paid to do stim in office, you need hospital privileges at some hospital, even if you never do the procedures at a hospital. That being said, I've never heard of anyone getting audited on this, or having to pay back money paid for procedures due to this. But technically, this is sprinkled in the fine print, in a few places.

Did most groups that you interviewed with still want you to have hospital priviledges?

My current group recommends it, but doesn't require it. I have privileges at 2, and haven't set foot in them, even once. It does help getting records (can just log in) and gets your name out there a little bit more, I guess.

 

[IMpainmedicine]

Thanks for the response/insight.

 

[IMpainmedicine]

After I posted the other day I decided to reach back out to the ABIM to see if there had been any further discussions regarding cosponsoring a pain fellowship. Their follow up response was the following:

"I had the opportunity to review your request with ABIM physician leadership. At this time, ABIM is not considering co-sponsorship for the Pain Medicine Certification Exam and I don’t believe there is any discussion about taking steps towards co-sponsorship in the near future."

Basically the first round of conversations I had with them a few years ago in follow up emails revealed that too few individuals had expressed interest, so it wasn't something they were going to pursue. For any of you who are interested, I encourage you to reach out to them and expressing your interest.