Proposed Letter to Thomas Stautzenbach, Executive Director of the AAPM&R

ampaphb

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Dear Mr. Stautzenbach:

Over the past week, I have received the below "Call to Action" on two occasions. Both times, I have been frustrated to note that the Academy's primary concerns are 1) "rehabilitative and habilitative services" as well as 2) "durable medical equipment, prosthetics, orthotics, and supplies" to serve the functional needs of people with disabilities and chronic conditions, 3) post-acute rehabilitative care, 4) outpatient therapy caps, and 5) benefits for people with severe disabilities and chronic conditions.

Glaringly omitted are any reference to interventional pain management/spine procedures, despite these representing a large component of what the Academy's membership does on a daily basis. The Academy seems perfectly willing to accept our dues, and pay lip service to our issues, but when push comes to shove, the organization ignores the concerns of a large segment of its membership. If our issues aren't at least worth a mention in the "Call to Action", it makes me wonder why I, or any of my interventional pain management colleagues, should remain dues paying members of an Academy that can not be bothered representing our interests.
 
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Ligament

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Ampa, great letter and I concur. I would be happy to sign my name to this letter as well.

Dear Mr. Stautzenbach:

Over the past week, I have received the below "Call to Action" on two occasions. Both times, I have been frustrated to note that the Academy's primary concerns are 1) "rehabilitative and habilitative services” as well as 2) “durable medical equipment, prosthetics, orthotics, and supplies” to serve the functional needs of people with disabilities and chronic conditions, 3) post-acute rehabilitative care, 4) outpatient therapy caps, and 5) benefits for people with severe disabilities and chronic conditions.

Glaringly omitted are any reference to interventional pain management/spine procedures, despite these representing a large component of what the Academy's membership does on a daily basis. The Academy seems perfectly willing to accept our dues, and pay lip service to our issues, but when push comes to shove, the organization ignores the concerns of a large segment of its membership. If our issues aren't at least worth a mention in the "Call to Action", it makes me wonder why I, or any of my interventional pain management colleagues, should remain dues paying members of an Academy that can not be bothered representing our interests.
 

nvrsumr

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they are happy to take money to sponsor advanced spinal procedure wokrshops in vegas.
 

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I'll sign it.

Go to an online petition website and we can post and sign it for him.
 

Jcm800

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Dear Mr. Stautzenbach:

Over the past week, I have received the below "Call to Action" on two occasions. Both times, I have been frustrated to note that the Academy's primary concerns are 1) "rehabilitative and habilitative services" as well as 2) "durable medical equipment, prosthetics, orthotics, and supplies" to serve the functional needs of people with disabilities and chronic conditions, 3) post-acute rehabilitative care, 4) outpatient therapy caps, and 5) benefits for people with severe disabilities and chronic conditions.

Glaringly omitted are any reference to interventional pain management/spine procedures, despite these representing a large component of what the Academy's membership does on a daily basis. The Academy seems perfectly willing to accept our dues, and pay lip service to our issues, but when push comes to shove, the organization ignores the concerns of a large segment of its membership. If our issues aren't at least worth a mention in the "Call to Action", it makes me wonder why I, or any of my interventional pain management colleagues, should remain dues paying members of an Academy that can not be bothered representing our interests.

we have a nice chuckle every month or whenever that "journal" comes out. I agree, they have their agenda.
 
OP
ampaphb

ampaphb

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As Steve suggested, I have created a petition which includes the above language.

http://www.ipetitions.com/petition/AAPMR/

I spoke to a member of the Health Policy and Legislation Committee, who advised that my letter, if sent by an individual, would be likely to be brushed aside.

I think there is strength in numbers. If you would care to sign the letter, and ask your colleagues to do so as well, perhaps Mr. Stauzenbach and the rest of the old guard will pay us a bit more attention.
 

Jcm800

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As Steve suggested, I have created a petition which includes the above language.

http://www.ipetitions.com/petition/AAPMR/

I spoke to a member of the Health Policy and Legislation Committee, who advised that my letter, if sent by an individual, would be likely to be brushed aside.

I think there is strength in numbers. If you would care to sign the letter, and ask your colleagues to do so as well, perhaps Mr. Stauzenbach and the rest of the old guard will pay us a bit more attention.

well done
 
OP
ampaphb

ampaphb

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WE have 6 electronic signatures in the first 24hrs. I would like to send this on to the AAPM&R at noon central time on Friday. Anyone else who would like to be included, please sign ASAP.

Thanks,

Peter
 

Disciple

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If your goal is to garner widespread support, have you considered sending an e-mail through the AAPMR's Pain/Neuromuscular and MSK Council list serves?
 
OP
ampaphb

ampaphb

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Is it your sense this is best posted in both? or just the pain council?
 

LordArius

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on it.
 
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ampaphb

ampaphb

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Based on Disciple's suggestion, I am going to send out an email through the listservs this evening. I am delaying doing so till then in case anyone here feels there is a reason not to ask the broader community of interventional physiatrists to join us.
 

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Based on Disciple's suggestion, I am going to send out an email through the listservs this evening. I am delaying doing so till then in case anyone here feels there is a reason not to ask the broader community of interventional physiatrists to join us.

interventional physiatrist here, NOT on the pain council, but the MSK council. if this was only sent to the pain council, i would have missed out. by sending the letter to pain, you will also hit the neuromuscular crowd (council is pain/neuromuscular), who may not be so thrilled with it. the flip side is that you might get some poeple on the msk council who dont love it either. i think itd be best to send it to both, as i think the majority of the msk group is outpatient and spine, who would support it. my $.02.
 

Disciple

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Is it your sense this is best posted in both? or just the pain council?
There seems to be a pretty even distribution among both. Some have joined both councils (one as primary, the other as secondary).
 
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ampaphb

ampaphb

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24 signatures and counting - thanks for your support!
 

Ligament

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ampa; I thank you and encourage you to distribute this letter for signatures anywhere you want.

Others; How do I get on these "listservs"?
 
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ampaphb

ampaphb

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Already done, and so far, I have been taken to the woodshed by Drs. Akuthota and Bagnall.

Call the academy tomorrow, and sign up for msk and pain - rehabmedoc came to my rescue, but other than that, I am fighting the good fight virtually alone!
 

lobelsteve

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Already done, and so far, I have been taken to the woodshed by Drs. Akuthota and Bagnall.

Call the academy tomorrow, and sign up for msk and pain - rehabmedoc came to my rescue, but other than that, I am fighting the good fight virtually alone!
Post their comments.
 

Doctodd

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im in.....who signed MIckey Mouse?
 
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ampaphb

ampaphb

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Dear Dr. Mulford:

I applaud your concern that nuance not be lost, and just wanted to clarify - I am sure you don't mean to suggest that patients in pain, requiring diagnostic and therapeutic interventions, are not equally deserving of access to an interventional physiatrist's skills and care - or did I misundersand?

Very truly yours,

Peter A. Zimmerman, MD


Well said Jon. I agree completely. One of the downsides with listserves and other electronic communication is that we lose the nuances of verbal and visual contact and it is all too easy for productive communication to break down. I also believe that the Academy's focus with Advocacy is on those we serve moreso than on our own personal self-interests.
Greg
Gregory J Mulford, MD


Dear Dr. Finnoff:

Thank you for taking the time to respond to my concerns. You intimated there might be reasons AAPM&R chose to keep its powder dry regarding interventional physiatrists. I would relish the opportunity to learn those reasons, if you, or any of your colleagues would care to share, either through the listserv, or via email. The only reason suggested thus far seems to be that other organizations will take care of those issues, so that AAPM&R need not do so.

My use of the petition, truth be told, was to not be dismissed as a cranky, belligerent, lone rabble rouser. The petition enabled me to bring 41 voices to the table supporting my position, and I believe that, in part, is what stimulated discussion. Why that is viewed as poor form remains a mystery to me - to my mind, it appears to have brought light (and heat) to the topic.

Peter A. Zimmerman, MD


Hello Dr. Zimmerman,

I appreciate your concerns regarding representation. I think it is important for AAPM&R members to be able to honestly and openly express their concerns, and I agree with your view that we should be able to discuss contrasting views on the listserve. The listserve was created to allow AAPM&R council members to communicate with one another, which was certainly the intent of your original message.

First, regarding your statement about the omissions in the AAPM&R's "Call to Action", it's great that you took the time to read the e-mail and formulate an opinion on its content. It appears that you do not believe the AAPM&R is adequately representing Interventional Pain/Spine in their "Call to Action". What I would recommend is coming up with specific concerns you believe the AAPM&R should include in their "Call to Action". Perhaps use the listserve to solicit the opinions of others who practice interventional pain/spine so that the list is as comprehensive as possible. This list could be forwarded to the MSK Council leadership (myself, Venu, etc) who would then present it to the appropriate AAPM&R committee. This would allow us to advocate for you, and is one of the primary purposes of the council structure. I believe this would be a productive and effective way to address your concerns. Certainly you could include names of individuals who agree with your opinion.

Second, I believe the reason you received replies that were contrary to what you expected was related to the petition. While I admire your initiative to try to increase the AAPM&R's advocacy of interventional pain/spine practitioners, I believe the AAPM&R is trying to represent its members and did not purposefully exclude interventional pain/spine practitioners when the "Call to Action" was written. In fact, there were probably very specific reasons they chose to address the items listed in the "Call to Action", while not addressing other items. It would probably be more productive to find out why the AAPM&R chose to address the items they did, point out areas that you believe are deficient, and see if you can affect a change in the "Call to Action" rather than assume that the AAPM&R leadership has forsaken interventional pain/spine practitioners. As has been pointed out by several of the listserve responses, many of the current academy leadership have MSK practices and were former leaders within PASSOR. Therefore, I believe they are not trying to disenfranchise their peers.

I hope you will give my points some consideration and I look forward to working with you to address your concerns.

Kind regards,

Jon
Chair-Elect, MSK Council

Jonathan T. Finnoff, DO
Assistant Professor
Physical Medicine and Rehabilitation
Mayo Clinic
200 First St SW
Rochester, MN 55905
507-284-2511


While the Academy clearly needs to pick its battles, Dr. Zimmerman's points are well taken. It is encouraging that musculoskelatal practioners have gained greater representation within the academy. But it was not long ago that significant resistance was given to subspecialization within the profession. The fact that PASSOR was established at all speaks to the fact that the needs of musckuloskeletal physicians were not being met by the establishment of the academy. The ability to have an open dialogue such as this is helpful and necessary. While a petition may be more heavy handed than Dr. Bagnall would have liked, as this is a time sensitive issue, it would be helpful to provide some guidance as to what would be the best way for members to legitimately express their concerns to those who are making such decisions.

Michael D. Robinson, MD
Rockland Orthopedics & Sports Medicine, PC


Pete,

I hear you, and I am disappointed by the vitriol that Bagnal and Venu exhibited

I think you are a positive voice in the greater breadth of the academy. I feel like we need you

I also think that your voice represents an important segment that the academy is not seeing- those who have either left the academy, or never joined in the first place, because they feel that the academy no longer represents their interests

I am trying to think if there is a way that I can contribute to this discussion to help your cause, without alienating support from those who have a sympathetic ear.

Gary



Gary:

The presence of "spine people" in positions of leadership is indeed, very reassuring, and reflects the high percentage of docs who do what we do in clinical practice. But it then makes it all the more frustrating to find that, despite their presence, entities like the Call to Action do not even mention interventional issues.

When one minor peon like me suggests it might be reasonable to step back and take a different approach, rather than a well reasoned response such as yours, I am met with charges of myopia, and suggestions that I am on the "pedestal of absurdity ", and that I have somehow misappropriated this listserv.

Rather than a marketplace of ideas, similar to our discussions on painrounds, I am instead chided for not walking in lockstep by those in positions of power within the Academy. I find that disappointing.

Peter


Hey Zim,

I am of mixed minds re: the petition. I thought Venu's rebuttal was unnecessarily harsh. I am probably share similar sentiments to Micheo, with a touch of Zim thrown in.

I do agree with you in that the Academy spends too much of its lobbying power addressing inpatient rehabilitation issues, and has not adequately addressed the fact that they are losing members who do not identify with the Academy's mission.

I do think, however, you would probably more successful by building strength from within the organization. I think both Venu and Micheo are correct in that there are now more spine people positioned within the leadership of the AAPMR than has ever been the past.

You also have other members of the academy who respect and share many of your sentiments. I know that is the case with me, and I can't speak for other people, but I am pretty sure that I am not alone.

Maybe I am just drinking the academy Kool-Aid, but I would love to see you exert many of your efforts to nudge the academy from the inside.

Your friend,

Gary


Dr Zimmerman:
I have read your communication with interest for several reasons which include
that I practice MSK medicine , I am Board Certified in Pain Medicine and
Sports Medicine, I am very interested in the future of our Specialty including
the interventional procedures component of Physical Medicine and
Rehabilitation, I am a past President of PASSOR, and happen to be the
president of the AAPMR.

I think that there is a very important difference between advocating for the
specialty of Physical Medicine and Rehabilitation and the inclusion of our
field (of which Pain Medicine is a subspecialty) in health reform and
universal health care (that is what the call for action was for) and what the
AAPMR does every day on behalf of practitioners of Physiatry the majority of
which practice Musculoskeletal rehabilitation.

Our Academy is very active in medical practice issues that impact pratitioners
of interventional procedures and Pain Medicine, recognizes the importance of
that group of our membership, but believes that we are one specialty and that
when we advocate for PM&R we advocate for all of our areas of practice
including interventionalpain management, sports medicine, electrodiagnostic
medicine and all others.

Our AAPMR leadership represents all areas of practice within PMR including
interventional pain management and acts on behalf of all of our constituents
and certainly we consider that we have no step childs.

It is my feeling that in these difficult economic times if we don't work
together it will be difficult for our specialty to continue to develop. You
can contact me, our board members, and council leaders if you have any further
questions.

Sincerely,
William Micheo,MD


Dr. Bagnall:

On the contrary, I believe the mere fact that 36 people have joined with my view (including, interestingly, Dr. Malanga) is what, in part, merited responses folks in positions of power like you, Drs. Akuthota, Micheo, and Chimes. Had I posted the very same things alone, I would have been viewed as one cranky disgruntled rabble rouser, and dismissed out of hand.

You expanded the discussion from interventional spine to all of MSK. Interventional pain/spine practitioners WERE prominent in PASSOR at it's inception, but have largely faded from Academy positions of power over time. Interventionists, as opposed to those who practice in the broader arena of MSK, believe themselves to be viewed as less worthy of the Academy's efforts.

I stand by my final paragraph - it IS unconscionable that a large segment of the PM&R docs practice pain, but when it comes to healthcare reform, we can't rely on our own organization to represent our interests. By the way, a simple we were wrong, we should, indeed, have included interventional issues in the broader Call to Action would certainly have sufficed.

Lastly, "firm" responses are no problem. But when members of the Academy hierarchy stoop to name calling? That seems over the line.

Peter


My goodness, Peter have you read the final paragraph of your initial email? Can you really fail to expect a firm response to such a statement? Please let your ideas be heard in the Academy, but wouldn’t it have been a better strategy to open a discussion on the listserv without the petition and final paragraph?

Dave


Dear Dr. Akuthota:

I must say, I am taken aback at the level of vitriol aimed at one practitioner's views. At no time did I advocate separating physical medicine from rehabilitation. I believe the Call to Action did that by failing to even bother to include interventional pain/spine concerns.

Fixing the SGR is indeed relevant, but, as a topic affecting all physicians, is likely to be addressed by organizations with coffers far larger than our own.

I would have hoped that venues like the Council listservs welcomed the open and honest airing of contrasting viewpoints. Your disagreement with my use of this forum to raise such an issue makes me wonder if I was mistaken in that impression.

Peter A. Zimmerman, MD


Dear Peter,

I disagree with your assessment. The current Board has many practitioners of the musculoskeletal portions of physiatry, including current and past presidents. You bring up a good point: At least 60% of AAPM&R members practice musculoskeletal medicine in part or in whole. I believe that Academy recognizes this. While you may have felt that the call to action did not include issues relevant to interventional pain practitioners, I think your view is myopic. The call to action, included fixing the Medicare formula for physician reimbursement, is relevant to all practitioners. Also, I still stand by the fact we are rehabilitationists in musculoskeletal medicine as physiatry is uniquely focused toward functional outcome. Trying to separate physical medicine from rehabilitation will be to our peril. Some of our colleagues may have strayed from this functional paradigm, but I still consider it relevant. Last time I checked, I still treat disabilities and chronic conditions. I definitely appreciate the fact that we, as members, need to perceive value in our mother organization. I hope you note that in the new journal, offerings in education, health policy, research funding and leadership. Ironically, you have used a AAPM&R-sponsored listserv to promote your agenda. In sum, I disagree with your stance and I disagree with your use of this forum.

Sincerely,

Venu Akuthota


Dr. Zimmerman

Does it occur to you that the American Academy of Physical Medicine and Rehabilitation is the single national specialty medical society that speaks for patients with disabilities? If not the AAPM&R, who stands for patients with disabilities during discussions of government and private health care reform?

On the other hand, there are many organizations that speak to musculoskeletal care and have far more significant resources at their behest to challenge potential changes in reimbursement for musculoskeletal procedures, which I assume you mean to represent. In fact, the Academy has liaisons with many of these associations and actively supports many of their goals as they are of importance to physiatrists practicing musculoskeletal medicine.

Be aware that you place yourself on a pedestal of absurdity to imply that the Academy only tolerates musculoskeletal issues. The current Academy president is the second PASSOR president to serve in that capacity, and a former PASSOR president is currently the editor-in-chief of PM&R.

The leadership of the Academy speaks to a diverse membership that embraces the physiatric principle of maximizing the function of patients with disabling conditions. If you have recommendations to make to Academy leadership in that regard, by all means make appropriate contact so that your voice can be heard. The Musculoskeletal Council has a solid voice at the table, and I am sure your ideas when legitimately expressed will be considered and shown suitable respect.

David Bagnall
Chair, Membership Strategic Coordinating Committee


The Academy has recently sent out a "Call to Action", asking each of us to contact our federal legislators. The request is designed to help advance the specialty's efforts by explaining to Congress why a health care reform bill should accomplish specific tasks. These tasks are touted to improve the lives of all our patients. Specific mention is made of therapy caps, DME, O&P, and benefits for people with severe disabilities and chronic conditions. No mention is made of any issues that would directly impact those of us who practice Interventional Pain/Spine

I have had the sense that interventional pain/spine had become the read-headed step-child the Academy tolerates. The disregard for issues that represent a significant component of what the membership does in clinical practice every day is unconscionable. I would ask that you join me and our colleagues in expressing our displeasure, and bring this omission to the attention of those at the highest level of the Academy's hierarchy, by signing the letter/petition linked below:

http://www.ipetitions.com/petition/AAPMR/

Very truly yours,

Peter A. Zimmerman, MD
 

SSdoc33

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yeah, ampa definitely jumped on the grenade here. well, i guess he pulled the pin toss it towards the enemy, then jumped on the grenade.

the gyst of the back and forth email was basically that the powers-that-be in the AAPMR (those of whom are young enough to know how to use email) took issue with what he said and how he said it. they did have some decent points, but, the fact is that they are completely defending their position as academy leadership, and their own infallibility. i have a strong feeling that ampa's opinions are shared by lots of others on the list who are too [email protected]#[email protected] to speak up (like myself)

kudos to ampa, but a word to the wise: be nice. catch more flies with honey
 

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Dr. Zimmerman

Does it occur to you that the American Academy of Physical Medicine and Rehabilitation is the single national specialty medical society that speaks for patients with disabilities? If not the AAPM&R, who stands for patients with disabilities during discussions of government and private health care reform?

On the other hand, there are many organizations that speak to musculoskeletal care and have far more significant resources at their behest to challenge potential changes in reimbursement for musculoskeletal procedures, which I assume you mean to represent. In fact, the Academy has liaisons with many of these associations and actively supports many of their goals as they are of importance to physiatrists practicing musculoskeletal medicine.

Be aware that you place yourself on a pedestal of absurdity to imply that the Academy only tolerates musculoskeletal issues. The current Academy president is the second PASSOR president to serve in that capacity, and a former PASSOR president is currently the editor-in-chief of PM&R.

The leadership of the Academy speaks to a diverse membership that embraces the physiatric principle of maximizing the function of patients with disabling conditions. If you have recommendations to make to Academy leadership in that regard, by all means make appropriate contact so that your voice can be heard. The Musculoskeletal Council has a solid voice at the table, and I am sure your ideas when legitimately expressed will be considered and shown suitable respect.

David Bagnall
Chair, Membership Strategic Coordinating Committee


Ouch, name calling: David "Bag" nall.

Peter, I am next to you 100%. He just wrote an angry letter basically stating go jump off a bridge. My membership dues are best served with ISIS, NASS, ASIPP, and strictly Pain societies. If PMR want my money, they can get it twice every 10 years for my board recert. I see nothing compelling that represents my interests as a Pain Medicine Specialist. What's a Physiatrist? Stick in your elevator and go hide.
 

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This entire matter speaks to a larger issue in our field--namely, how the PM's and R's find common ground and effective advocacy in such a broadly defined specialty. You can ask any given physiatrist 3 questions and predict their stakeholder position and what side they'll take on practically any contentious issue:

a) Private practice or Academic?
b) Outpatient or inpatient?
c) Sub-specialist or generalist?

It reflects what I've come to call, "The Curse of the Ampersand." :cool:
 

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Peter, kudos to you for having the balls to fight the dinosaurs on the listserv. I'd join the listserv, but have decided to not renew my AAPMR membership, since they don't have an agenda to represent me as a pain medicine subspecialist.
 
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ampaphb

ampaphb

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48 signers and counting
 

radslooking

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It's kind of interesting for me as an outsider to see what your (or one of your) organization's leaders have to say about a petition. Your petition may have been a little heavy handed, but I'd say the majority of responses to your petition were equally as heavy handed, and seems like they have an axe to grand with the interventionalists. It seems like your petition touched on some sensitive topics that they'd rather not talk about.

Either way, I don't think it's intelligent for them to dismiss so quickly an email that 41 people have signed. It seems like they don't have a very good idea of what's going on in their organization. Good luck.
 

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It's kind of interesting for me as an outsider to see what your (or one of your) organization's leaders have to say about a petition. Your petition may have been a little heavy handed, but I'd say the majority of responses to your petition were equally as heavy handed, and seems like they have an axe to grand with the interventionalists. It seems like your petition touched on some sensitive topics that they'd rather not talk about.

Either way, I don't think it's intelligent for them to dismiss so quickly an email that 41 people have signed. It seems like they don't have a very good idea of what's going on in their organization. Good luck.
most of the people who responded are interventionalists themselves. academic, leadership types, but interventionalists nonetheless.
 

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I guess I missed the brewhaha

Seriously, some of my academic rehab friends do not believe they represent their interests!!
I am proud of my training as a physiatrist that saw neuromusculoskeletal medicine (OK I think I made that term up but it works) as the FOUNDATION of rehabilitation. I am proud of my training as a physiatrist that saw pain as a QOL issue, as a contributer to functional deficits, and a result of disabling conditions. I still put rehab issues in my PAIN consults because I address function, not just pain scores. I don't believe PM&R is the only game in town in pain medicine but I really like the approach that my training allowed me to bring to the table.
But that group, what does it have to do with my practice and my passion to improve quality of life of patients suffering from pain? I know what my answer is....!

Just saying.
 

Disciple

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What are your thoughts regarding the latest e-mail thread about the spinal procedures workshops?

It seems that only the younger members supported your suggestion about changing the residency requirements.

Interesting, how quick some were to dismiss the idea without offering any alternative solutions...

Not suprised at all that ISIS and NASS workshops are going strong and AAPMR's are about to fold.