Regional Anesthesiology and Acute Pain Medicine (RAAPM)

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https://www.asra.com/news/64/accreditation-of-regional-anesthesiology

Accreditation of Regional Anesthesiology and Acute Pain Medicine Fellowships Is Almost Here
By Edward R. Mariano, MD, MAS Dec 18, 2015

All pain is not the same. While chronic pain can sometimes be palliated, acute pain (i.e., new onset, often with an identifiable cause) must be aggressively managed and, ideally, eliminated. This requires a systems-based approach led by physicians dedicated to understanding acute pain pathophysiology and investigating new ways to treat it. Today, the epidemic of opioid use and abuse has given us even more reason to elevate the science and postgraduate training in acute pain medicine. After submitting a 161-page letter to the Accreditation Council for Graduate Medical Education (ACGME) in late 2013, prepared with the assistance of a group of fellowship directors and colleagues familiar with the process, I am pleased to report that Regional Anesthesiology and Acute Pain Medicine (RAAPM) will be the next subspecialty fellowship to be accredited within Anesthesiology.

I will be providing some answers to commonly asked questions about the fellowship in the February 2016 issue of ASRA News. In the meantime, the ACGME is seeking comments from the community of interest regarding the draft program requirements. The comment period is open until January 27, 2015.
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lane said:
Isn't that already called "anesthesiology residency"?
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Precisely. But higher education will find a reason to make it "accredited" to eek another year of labor out of misled residents. Meanwhile, in other news, the floods of CRNA's who watch a YouTube video on blocks will be taking the jobs that these guys might have gotten, further tightening their market, or they will miss the boat (by a year) on some partnership that is soon to set sail. Anesthesia is quickly morphing and the goalposts are constantly being moved.
 
gasdoc77 said:
Precisely. But higher education will find a reason to make it "accredited" to eek another year of labor out of misled residents. Meanwhile, in other news, the floods of CRNA's who watch a YouTube video on blocks will be taking the jobs that these guys might have gotten, further tightening their market, or they will miss the boat (by a year) on some partnership that is soon to set sail. Anesthesia is quickly morphing and the goalposts are constantly being moved.
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That and they'll make a certification for driving an ultrasound machine just to make $$

I wonder if we're eligible to be grandfathered into basic, primary anesthesiology skills...
 
[QUOTE="gasdoc77, post: 17262637, member: 515997/] Anesthesia is quickly morphing and the goalposts are constantly being moved.[/QUOTE]
One reason to avoid anesthesia residency. Run by self serving idiots.
 
gasdoc77 said:
Anesthesia is quickly morphing and the goalposts are constantly being moved.
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One reason to avoid anesthesia residency like the plague. Run by self-serving idiots. Why don't they make the residency 5 years long and at the end you are fellowed in cardiac, icu, peds, and regional? Is that so hard?
 
So, what's next? No regional unless you did a fellowship? I jest, I jest. But I repeat, f.cking ridiculous.
 
Agree that you dont need this fellowship to do blocks if you come from a decent program. But currently there are plenty of non-accredited regional fellowship programs which have lots of fellows enrolling, so why is it bad that now these programs are now accredited? maybe now the crap ones will improve. It seems like people were entering the fellowships before this started, its not as if to say you have to enter, but if you choose to do this extra year (visa issues or not good experience in your own residency or looking to be a leader in the field) now its official and there are some rules governing it.
 
Hoya11 said:
Agree that you dont need this fellowship to do blocks if you come from a decent program. But currently there are plenty of non-accredited regional fellowship programs which have lots of fellows enrolling, so why is it bad that now these programs are now accredited? maybe now the crap ones will improve. It seems like people were entering the fellowships before this started, its not as if to say you have to enter, but if you choose to do this extra year (visa issues or not good experience in your own residency or looking to be a leader in the field) now its official and there are some rules governing it.
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It's going to create the same issues as TEE certification - hospitals will eventually demand fellowship training (or equivalent) just because they can. Eventually we will be the ones requiring the alphabet soup of credentials just to continue doing what we have been (or should be) trained to do
 
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Very soon they will have subspecialties to the subspecialties, for example If you need an upper extremity block we need to call the upper extremity fellowship trained regional specialist!
 
lane said:
Isn't that already called "anesthesiology residency"?
Click to expand...


Absolutely. And isn't one of the stated goals of anesthesia residency to produce "lifelong learners"? Just like Ed Mariano, anybody with the interest and inclination can learn these skills and the learning continues far beyond a 1year fellowship.

Certification is a way to promote yet another "product" and RAAPM fellowships are just another product line for academic anesthesia. Some products are essential (tires and peds fellowships) and some aren't (perfume and RAAPM fellowships).
 
This means that the epidurals, interscalenes, infraclavs, TAPs, and adductor canals I do now, are out of my scope of practice??!!!
 
Maybe we can dial back the panic a bit.

No one needs a peds fellowship to anesthetize a normalish kid and do B&B peds cases. And no one will need a regional fellowship to do blocks. As if they could possibly train enough people to do them all.
 
It depends on the definition of "need". One can be capable of performing the service, but not permitted to do so in a given shop. Happens all the time already. Forget the subspecialty areas--there are plenty of rural areas where you NEED to be a CRNA to do general anesthesia cases.
 
imfrankie said:
It depends on the definition of "need". One can be capable of performing the service, but not permitted to do so in a given shop. Happens all the time already. Forget the subspecialty areas--there are plenty of rural areas where you NEED to be a CRNA to do general anesthesia cases.
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This is the very very slippery slope we subject ourselves to with this kind of thing.
 
Hoya11 said:
Agree that you dont need this fellowship to do blocks if you come from a decent program. But currently there are plenty of non-accredited regional fellowship programs which have lots of fellows enrolling, so why is it bad that now these programs are now accredited? maybe now the crap ones will improve. It seems like people were entering the fellowships before this started, its not as if to say you have to enter, but if you choose to do this extra year (visa issues or not good experience in your own residency or looking to be a leader in the field) now its official and there are some rules governing it.
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Most of these programs are part time fellow, and part time attending, in order to supplement the salary. That's would not be possible with an accredited fellowship. They just made it more painful without a clear benefit.
 
nimbus said:
Absolutely. And isn't one of the stated goals of anesthesia residency to produce "lifelong learners"? Just like Ed Mariano, anybody with the interest and inclination can learn these skills and the learning continues far beyond a 1year fellowship.

Certification is a way to promote yet another "product" and RAAPM fellowships are just another product line for academic anesthesia. Some products are essential (tires and peds fellowships) and some aren't (perfume and RAAPM fellowships).
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Is the RAAPM acronym pronounced Rape Me?

A Rape Me Fellowship?

Seems fitting.
 
IlDestriero said:
Exactly. We already are acute pain specialists.
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I encourage all of you to informally poll your surgeons on the number one thing that they would like to see an improvement in next year. I did it at the end of 2014 and almost every single one, from colorectal to spine surgeons, surpisingly said 'Post op pain control'. A stable patient in PACU is the norm now. We as anesthesiologists need to take the next step, and start affecting outcomes at the next level, whether it's improving time to ambulation for joints or time to flatus for bowel resection patients or decreasing pneumonia and VTE rates in thoracic patients. Extended, minimal opioid pain control is the first step to doing all of these things.

These new fellows who feel comfortable setting up regional or even non regional related pathways/protocols, like post op lidocaine infusions, post op ketamine infusions, or intraop methadone, will have an advantage over the general anesthesiologist. Granted you don't have to have a fellowship to do any of these things, but I can see how it would be easy to sell to private practice groups in an attempt to become partner, especially with the non fee for service payment models coming down the chutes.
 
geauxtigers23 said:
We as anesthesiologists need to take the next step, and start affecting outcomes at the next level, whether it's improving time to ambulation for joints or time to FLATUS for bowel resection patients or decreasing pneumonia and VTE rates in thoracic patients.

These new fellows who feel comfortable setting up regional or even non regional related pathways/protocols, like post op lidocaine infusions, post op ketamine infusions, or intraop methadone, will have an advantage over the general anesthesiologist.
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Intraop bean dip infusion via OG tube?
 
geauxtigers23 said:
I encourage all of you to informally poll your surgeons on the number one thing that they would like to see an improvement in next year. I did it at the end of 2014 and almost every single one, from colorectal to spine surgeons, surpisingly said 'Post op pain control'. A stable patient in PACU is the norm now. We as anesthesiologists need to take the next step, and start affecting outcomes at the next level, whether it's improving time to ambulation for joints or time to flatus for bowel resection patients or decreasing pneumonia and VTE rates in thoracic patients. Extended, minimal opioid pain control is the first step to doing all of these things.

These new fellows who feel comfortable setting up regional or even non regional related pathways/protocols, like post op lidocaine infusions, post op ketamine infusions, or intraop methadone, will have an advantage over the general anesthesiologist. Granted you don't have to have a fellowship to do any of these things, but I can see how it would be easy to sell to private practice groups in an attempt to become partner, especially with the non fee for service payment models coming down the chutes.
Click to expand...

Yep. And where do you need a fellowship to do all of this??

Do you want to know the number one desire I hear of most surgeons? Actually seeing the supervising anesthesiologist in the fu.cking room now and again...... That's what.
 
geauxtigers23 said:
I encourage all of you to informally poll your surgeons on the number one thing that they would like to see an improvement in next year. I did it at the end of 2014 and almost every single one, from colorectal to spine surgeons, surpisingly said 'Post op pain control'. A stable patient in PACU is the norm now. We as anesthesiologists need to take the next step, and start affecting outcomes at the next level, whether it's improving time to ambulation for joints or time to flatus for bowel resection patients or decreasing pneumonia and VTE rates in thoracic patients. Extended, minimal opioid pain control is the first step to doing all of these things.

These new fellows who feel comfortable setting up regional or even non regional related pathways/protocols, like post op lidocaine infusions, post op ketamine infusions, or intraop methadone, will have an advantage over the general anesthesiologist. Granted you don't have to have a fellowship to do any of these things, but I can see how it would be easy to sell to private practice groups in an attempt to become partner, especially with the non fee for service payment models coming down the chutes.
Click to expand...
All of that sounds great, but best of luck finding ICU beds for all those patients on infusions because the floor can't "handle" them.
 
Some places do lidocaine/ketamine on the floor...
 
GA8314 said:
Yep. And where do you need a fellowship to do all of this??
Click to expand...

I stated in my original post that you could do all of those things without a fellowhip, and I personally think the opportunity costs involved with that year of fellowship are too great. I just wanted to point out that there is a market for such a fellowship though, and the people who decide to do it should not be denigrated.

As an aside, we have lidocaine infusions on the floor of our small private community hospital, and hope to have the ketamine infusions through the proper committees in the next month or two. It can be done.
 
geauxtigers23 said:
I stated in my original post that you could do all of those things without a fellowhip, and I personally think the opportunity costs involved with that year of fellowship are too great. I just wanted to point out that there is a market for such a fellowship though, and the people who decide to do it should not be denigrated.

As an aside, we have lidocaine infusions on the floor of our small private community hospital, and hope to have the ketamine infusions through the proper committees in the next month or two. It can be done.
Click to expand...

I agree that we don't often do enough to utilize multimodal or even advanced levels of acute pain management. But, as evidenced by YOU, this does not require a fellowship.
I am not disparaging anyone that chooses to do this either, I'm only stating my opinion that if you think this is necessary, you are fooling yourself.

What will a general anesthesiologist be "good for" in the future?? Doing B&B ASA 1/2 cases?? Oh wait, that's what we have basically conceded to the CRNA's...... Therein lies the problem with limiting ourselves and getting overly fellowship happy.
 
geauxtigers23 said:
I encourage all of you to informally poll your surgeons on the number one thing that they would like to see an improvement in next year. I did it at the end of 2014 and almost every single one, from colorectal to spine surgeons, surpisingly said 'Post op pain control'. A stable patient in PACU is the norm now. We as anesthesiologists need to take the next step, and start affecting outcomes at the next level, whether it's improving time to ambulation for joints or time to flatus for bowel resection patients or decreasing pneumonia and VTE rates in thoracic patients. Extended, minimal opioid pain control is the first step to doing all of these things.

These new fellows who feel comfortable setting up regional or even non regional related pathways/protocols, like post op lidocaine infusions, post op ketamine infusions, or intraop methadone, will have an advantage over the general anesthesiologist. Granted you don't have to have a fellowship to do any of these things, but I can see how it would be easy to sell to private practice groups in an attempt to become partner, especially with the non fee for service payment models coming down the chutes.
Click to expand...

Of course the surgeons are going to want you to take care of post op pain. They dont wanna deal with it. What is next? Want me to make sure the incision stays clean? What else? want me to leave the O.R and make sure patient is doing his incentive spirometry? Are you going to pay me more money for that? You cant invent stuff for anesthesiologists to do and not create an incentive. I take care of patients in the O.R. Period. Just because i have mastered that (which everyone should be happy about) dont send me to the wards to make sure the surgeons patients have circulation boots on when they should be doing that.. If its too much for the surgeons to do, then it definitely is too much for me.
 
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criticalelement said:
Of course the surgeons are going to want you to take care of post op pain. They dont wanna deal with it. What is next? Want me to make sure the incision stays clean? What else? want me to leave the O.R and make sure patient is doing his incentive spirometry? Are you going to pay me more money for that? You cant invent stuff for anesthesiologists to do and not create an incentive. I take care of patients in the O.R. Period. Just because i have mastered that (which everyone should be happy about) dont send me to the wards to make sure the surgeons patients have circulation boots on when they should be doing that.. If its too much for the surgeons to do, then it definitely is too much for me.
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Obviously you're a supporter of the periop surgical home.
 
Man o War said:
Cardiac was competitive this year, somewhere in the mid 70s but can't recall exact number.
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Job market is bad so all fellowships may start becoming competitive especially Cardiac. Critical Care is a great fellowship to launch your academic career with as it provides a background to teach med students and residents a great deal of useful knowledge applicable to a broad range of situations.

Critical Care will likely attract the least number of Residents into the fellowship so I expect it to remain an easy match.
 
I'm sure no one cares.... But I'll hire the dude or dudette who can do blocks that always work fast and safely, over the fellowship trained expert who is slow but can quote every study known to man.
 
Turtlez said:
Why is that?
Anyone know the match rates for cardiac, peds, and regional?
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A lot of internal applicants at majority of programs with guaranteed spots. Also, in comparison to many of the fellowships most program have between 1-2 spots for the program.


Sent from my iPhone using SDN mobile
 
turnupthegas said:
Regional seems to be super competitive this year.
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Job market isn't great right now, especially in populated areas. It's similar to the increase in business school admissions back in 2009 when people figured they would ride out the recession in school. I think regional is a silly fellowship. However, I know some people who have gotten decent gigs in academics with the regional fellowship, so maybe I am the one who is silly.
 
urge said:
Is the RAAPM acronym pronounced Rape Me?

A Rape Me Fellowship?

Seems fitting.
Click to expand...

I initially read this as "rape 'em" and assumed it was some sort of a joke. I'm a lowly CA-1, but already feel the cynicism creeping in, particularly when I read about garbage like this. Can't I just finish residency and be a good doctor? Is that not enough any more?
 
gratefulgas said:
I initially read this as "rape 'em" and assumed it was some sort of a joke. I'm a lowly CA-1, but already feel the cynicism creeping in, particularly when I read about garbage like this. Can't I just finish residency and be a good doctor? Is that not enough any more?
Click to expand...

Probably not
 
I think we as residents should still aspire to be the best at what we do, and I think I can confidently say that there is a palpable difference between a good physician vs a CRNA in my brief experience, such as doing things using cerebral blood flow and cortical functions vs why isn't there an ABG drawn its been so long even though nothing has happened, or that a BIS was placed on because he's young and shrugs shoulders... or something else I come back to from a break and find a wall to bash my head into.
 
In the current payment landscape, I agree this fellowship is bewildering. However, in the age of ACOs and potential direct hospital employment, I can see acute postoperative pain services being ubiquitous, and from a pure marketing standpoint a regional trained person, or a chronic pain boarded physician possibly, is a perfectly poised to fill this gap. All of these enhanced recovery pathways for depend heavily on nonarcotics and epidural management, which in our hospital is managed by the acute pain service. The guy in charge of the whole outfit is adored by the department and administration.
 
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