drusso said:
Personally, I think that the PM&R RRC should step up to the plate and require demonstrated competency in fundamental skills related to axial injections and pain medicine, but that is a rant for another day. Currently both PM&R and Neruology specialty boards have a bit of a credibility problem by co-sponsoring and promoting subspecialty certification in a field that they do not currently have stringent RRC training requirements for their primary base specialty. The situation would be analgous to internal medicine residencies not offering a required nephrology rotation for their residents.
Thus, some anesthesiologists see this as more evidence that their specialty is still the only one willing to both "talk the talk" and "walk the walk" when it comes supporting the academic base of pain medicine. In their eyes, PM&R and Neuro still remain "Johnny Come Latelies" to the field. For all the huffing and puffing that PM&R does about its role in pain medicine, the board doesn't seem interested in putting its money where its mouth is:
Anesthesia RRC requirements, "at least 3 months in pain medicine that may include one month in an acute perioperative pain management rotation, one month in a rotation for the assessment and treatment of inpatients and outpatients with chronic pain problems, and one month of regional analgesia experience in pain medicine"
PM&R RRC requirements: "The resident must have opportunities for progressive responsibility in diagnosing, assessing, and managing the conditions commonly encountered by the physiatrist in the rehabilitative management of patients of all ages of at least the following: (1) acute and chronic musculoskeletal syndromes, including sports and occupational injuries, (2) acute and chronic pain management, etc"
I think it has to do with the core of what PM&R is really about. We don't have the "Physiatric Association of Pain Medicine", we have PASSOR, and we try to spin things so they fit under the heading of pain medicine. Are there good PM&R pain docs? Yes. Is every Physiatrist who wields a needle a pain doc? No.
Most of us PM&R interventionalists seem to love ISIS and NASS, while my Anesthesia instructors lean towards ASIPP, AAPM, ASRA, APS.
In the several lectures I've been to on complications of interventional procedures, the favorite case example used is "Dr. X, Physiatrist, who took a weekend course and subsequently made his patient a quad".
Physiatrists are going to continue to do injections whether they have the proper training or not. I think the responsible thing for the ABPMR to do, as you've stated above, is to provide the proper training during residency with continual updates, which could only help our credibility.
If not during residency, then make MSK an official subspecialty of PM&R (whatever we need to call it, and encompassing spine, sports and general MSK) so that we can both serve and provide quality control for a large and continually growing proportion of ABPMR diplomates.
In my opinion, Pain Medicine is about relieving pain, whatever the etiology. Spine, Sports and general MSK is about non-surgical Orthopaedic care. There is some overlap, but I believe clearly delineating the difference between the two would help to eliminate the typical argument "My background contributes more to pain medicine than yours".
Okay, now back to the original topic.