Pain without a fellowship?

[halflife94]

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So what kind of practice options would there be if you did not do a fellowship? I know a few recent grads who are doing a pain anesthesia mix without having done a fellowship and was wondering if anyone knew about this road less traveled?

 

[PMR 4 MSK]

The problem becomes credentialing. Many hospitals will not credential you for procedures in pain without your program director certifying your competence. A couple months on the pain service during residency usually will not fulfill this.

If you are going to just do the procedures in your own private office, there is no credentialing issue. You can do whatever you want.

However, there is the liability issue. 20 years ago, very few docs did fellowships in pain, the "community standard" was met through residency. Today, a lawyer could eat you alive if something goes wrong and you don't have fellowship or equivalent training.

There is also the issue of managing pain. IMHO, residency does not prepare you to manage the complexities of pain. They might teach you how to do certain procedures, but little about medical management and when to do procedures.

Then there are all the psych issues to deal with. The patients' and your's from dealing with them.

 

[jsaul]

The problem becomes credentialing. Many hospitals will not credential you for procedures in pain without your program director certifying your competence. A couple months on the pain service during residency usually will not fulfill this.

If you are going to just do the procedures in your own private office, there is no credentialing issue. You can do whatever you want.

However, there is the liability issue. 20 years ago, very few docs did fellowships in pain, the "community standard" was met through residency. Today, a lawyer could eat you alive if something goes wrong and you don't have fellowship or equivalent training.

There is also the issue of managing pain. IMHO, residency does not prepare you to manage the complexities of pain. They might teach you how to do certain procedures, but little about medical management and when to do procedures.

Then there are all the psych issues to deal with. The patients' and your's from dealing with them.

In my area, there are general surgeons who do nothing but hand surgeries and call themselves hand surgeons and run a "hand clinic.". They do their surgeries in a major hospital. the hospital will take anyone these days. Unless you have major lawsuits or complaints against you, the hospital will let you do procedures and surgeries.

 

[specepic]

I think PMR 4 MSK states it well.

There are two good reasons to do a fellowship: the sake of your pts and you own *ss should you screw up. In addition you may have credentialing issues. Shoot, I'm at a 35 bed hospital and they don't allow anyone to do anything they are not boarded in, incl sub spec.

If you want to be a needle jockey/pill mill guy feel free to ignore, otherwise if you have a genuine pain interest do a fellowship imho

 

[emd123]

There is no law preventing any licensed physician from practicing outside of their specialty, i.e., it is "legal" for an un-boarded general practitioner to perform appendectomies (some still do), legal for a pediatrician to open a "medi-spa" and inject botox all day and make lots of money, legal for a psychiatrist to perform brain surgery. The medical profession has been (for better or for worse) allowed to police itself in this regard. If we abuse this privilege, we're just begging for the government to come in and regulate us even more. Legal and doable doesn't always mean ethical. The question is what's right. The right thing to do, is to do the training. There are plenty of very good pain physicians who've never done an ACGME accredited Pain fellowship. However, we are not in the time prior to the existence of ACGME accredited Pain fellowships. It's 2011. The fellowships exist. It's the best we've got. Do one.

 

[TX PAIN DOC]

Get fellowship training.

An Anesthesiologist friend of mine who had been in practice for 10 years asked me the same thing 2 years ago and he took my advice and decided on a fellowship. He is doing his fellowship now and thanks me everytime I talk with him. His knowledge base about practicing pain is better and more importantly, his clinical skills in history taking and examining pain patients in clinic-which was almost non-existant- is still a work in progress. His learning curve is larger than he could of imagined. He said he would of never made it without the training.

 

[drusso]

Even as early as five years ago I would have said that you could "maybe" get away with it...but the regulatory, medicolegal, and credentialing climate is changing so rapidly. Go do the fellowship...

 

[Ligament]

Even as early as five years ago I would have said that you could "maybe" get away with it...but the regulatory, medicolegal, and credentialing climate is changing so rapidly. Go do the fellowship...

I have to agree with drusso. We did our training at the same time and both of our opinions have changed on this issue.

 

[Aether2000]

Agree. Even though fellowships have significant variability in experience in interventional pain and theoretically will admit candidates from any specialty (unlike any other fellowship programs), it is still the best route. The real advantage I see is that it provides a focused time for intense learning devoid of the distractions of daily life that are present when attempting to achieve the same through self study and weekend courses. Ultimately it will save you years of self-education, thousands of dollars in course work, and provide a broad based framework on which to build your practice.

 

[drpainfree]

I think the question to you really is, is it still worth to do a pain management fellowship? The job market for pain management has been very tight even for fellowship-trained anesthesiologists and it's common for them to do both anesthesia and pain management.

think through before you commit for a year of fellowship unless you absolutely hate anesthesia and don't want to pass gas at all.

 

[joshmir]

you won't be able to be in-network or get on panels in desirable areas unless you do a fellowship; this is definitiely the case in a lot of places now

 

[Gauss]

think through before you commit for a year of fellowship unless you absolutely hate anesthesia and don't want to pass gas at all.

This is a good way to look at it, starting out as a pure pain specialist is unlikely to support your practice sufficiently with reimbursement declining rapidly. Unless you join a big group or hospital system that salaries you or floods you with patients.