Sports and Spine Fellowship

[Hitmanheart721]

Hello,

I have tried to find the answer to these questions on different sites, but have not so please bear with me if you have seen these asked and answered thoroughly before. I am starting my rank order for PMR residencies right now but am interested in possible fellowships in future. I think Sports/spine fellowship is very interesting to me but have seen that these are not ACGME accredited.
1)If I do not plan to work in a big academic setting, is this a huge issue to go into a non-accredited fellowship?
2) is it possible to one day open up your own sports/spine private practice, or is the usual route to get involved with an established clinic of other docs (ortho, sports medicine, pmr, etc).
3) Is a sports and spine fellowship the best way to open up doors to seeing a variety of both pain patients and sports medicine patients? Or could a pain fellowship still allow me to see both types of patients - just based on how I advertise myself?


Thank you for the help.

---

Members don't see this ad.

 

[PMR2008]

If you want to protect yourself the safest option is ACGME Pain. Ideally run by PM&R or heavy PMR& influence. If you want good training and learn the business of medicine go the non accredited sports+spine route.
1) Yes can be.
2) I setup my own sports spine practice in 2013. You can obviously join a group and than leave. depends on how much risk you want to take.
3) Sports and Spine fellowship might have EMG exposure if that is important for you. Pain is less likely to have that. You have to decide if you want all the skills initially and decide what you want to do later. In my fellowship I did all sorts of advanced procedures ( CTFSI, discograms, pain pumps, kypho). Once in practice I only continued the ones I liked to do. Which ended up being u/s and regen med with a little fluoro. In residency you want to focus more on exam/diagnosis. In fellowship you can improve your diagnostic and injection skills. But once you are done you will continue to learn new things and improve.

 

[Mr Kenobi]

Hello,

I have tried to find the answer to these questions on different sites, but have not so please bear with me if you have seen these asked and answered thoroughly before. I am starting my rank order for PMR residencies right now but am interested in possible fellowships in future. I think Sports/spine fellowship is very interesting to me but have seen that these are not ACGME accredited.
1)If I do not plan to work in a big academic setting, is this a huge issue to go into a non-accredited fellowship?
2) is it possible to one day open up your own sports/spine private practice, or is the usual route to get involved with an established clinic of other docs (ortho, sports medicine, pmr, etc).
3) Is a sports and spine fellowship the best way to open up doors to seeing a variety of both pain patients and sports medicine patients? Or could a pain fellowship still allow me to see both types of patients - just based on how I advertise myself?


Thank you for the help.

I'd recommend going to a PM&R program that has both strong MSK training and good procedural training where you can build a solid foundation for both of these things prior to fellowship. Go to a fellowship that has great procedural training and keeps your options the least restricted after fellowship depending on your goals.

ACGME pain will keep the most doors opened as mentioned above-it is the "safest" option, but also quite a bit more competitive than non ACGME spine training to obtain. While the training can be quite good in some non-ACGME spine fellowships, they can also have some limitations in practice after fellowship due to credentialing issues for certain procedures-these can be due to either geographic or practice setting factors. The training offered in both of these categories (ACGME pain & non-ACGME spine) are extremely variable between training programs, so regardless of which route you ultimately decide to take, you should invest significant time in researching individual programs to ensure they offer the skills you hope to obtain with advanced training.

 

[sdnuser001]

I'd recommend going to a PM&R program that has both strong MSK training and good procedural training where you can build a solid foundation for both of these things prior to fellowship. Go to a fellowship that has great procedural training and keeps your options the least restricted after fellowship depending on your goals.

ACGME pain will keep the most doors opened as mentioned above-it is the "safest" option, but also quite a bit more competitive than non ACGME spine training to obtain. While the training can be quite good in some non-ACGME spine fellowships, they can also have some limitations in practice after fellowship due to credentialing issues for certain procedures-these can be due to either geographic or practice setting factors. The training offered in both of these categories (ACGME pain & non-ACGME spine) are extremely variable between training programs, so regardless of which route you ultimately decide to take, you should invest significant time in researching individual programs to ensure they offer the skills you hope to obtain with advanced training.

Which procedures?

 

[Mr Kenobi]

Which procedures?

Which context? I'll address both that I think you may be asking about--

If you're asking about which procedures one should look for exposure to in a PM&R training program and we are discussing interventional pain/spine fellowship goals- then procedures would mean fluoro guided and US guided MSK and pain procedures.

If you're asking about which procedures can be limited with non-ACGME spine training in some regions/institutions. I have personally seen people with non-ACGME spine training limited from doing fluoro axial spine procedures including basic injections-in fact, my current institution actually offers a NASS ISMM fellowship where the fellows are doing a wide range of axial procedures during training, but when/if they are subsequently hired on to the PM&R faculty at the same institution, the institution does not credential them to perform any axial fluoro guided procedures at all...was surprising to me as well. Other folks have discussed limitations on more advanced procedures that may or may not require sedation (RFA, SCS, Pumps, VTP, implantables, etc) here on the forums. There was recently a good conversation about this at AAPM&R 2020 between PDs of these various fellowship types. One example given by the pain PD was a graduate who finished PM&R, did a sport and spine fellowship then went to NV to work but couldn't get credentialed to do what their spine training had encompassed. Apparently the person ultimately went back to do a pain fellowship in order to practice the full scope of their training without barriers.

 

[RooAgg14]

-- We discuss some of these questions in our panel

Here is another video you may find helpful. A current ACGME pain fellow discussing why he chose that route --

 

[JBM16BYU]

I think something that gets tossed around a lot on SDN and in the academic world is that spine/ISMM/NASS/interventional spine fellowships limit your scope of practice because you don't have the board certification. I understand some large academic centers may not hire you if you do not hit their criteria of being ACGME-board certified, but to pose a similar question, does anyone know of any insurance carriers, by name, that will not reimburse you for axial procedures if you do not have an ACGME-board certification in pain medicine?

 

[arfandada]

I think something that gets tossed around a lot on SDN and in the academic world is that spine/ISMM/NASS/interventional spine fellowships limit your scope of practice because you don't have the board certification. I understand some large academic centers may not hire you if you do not hit their criteria of being ACGME-board certified, but to pose a similar question, does anyone know of any insurance carriers, by name, that will not reimburse you for axial procedures if you do not have an ACGME-board certification in pain medicine?

this!

 

[RooAgg14]

this!

As a graduate from a now NASS/ISSM fellowship, I have not come across this in Texas. I have not heard of this being an issue either. There are family medicine docs who didn't even do a fellowship getting reimbursed for lumbar axial procedures here 😑 there is even a NP "fellowship" for pain medicine

 

[ScawtyDawg]

Apologies for bumping an old thread but I think this will be salient to the discussion (and a new thread is not necessary). I have heard of non-ACGME fellowship trained docs being reimbursed less by insurances for the same procedures as ACGME Pain trained. Presumably this would come up during the insurance credentialing/contracting process. Have any of you heard of this? Thanks in advance

 

[sdnuser001]

Apologies for bumping an old thread but I think this will be salient to the discussion (and a new thread is not necessary). I have heard of non-ACGME fellowship trained docs being reimbursed less by insurances for the same procedures as ACGME Pain trained. Presumably this would come up during the insurance credentialing/contracting process. Have any of you heard of this? Thanks in advance

I have not heard of this and don't see how it's possible. You're billing the same code regardless of your specialty

 

[cluelessme7]

At my institution the main issue has been credentialing. Our main insurance payor gives heavy push back whenever any of our non ACGME trained physicians order spine procedures. Even bread and butter procedures get denied, forget about even trying neuromodulation. Thus many of our non-ACGME trained docs have a very low procedural volume (again this is at my institution, not sure how it is elsewhere). One of them is currently trying to get "signed off" on certain procedures by the pain department.

 

[timisdaman]

At my institution the main issue has been credentialing. Our main insurance payor gives heavy push back whenever any of our non ACGME trained physicians order spine procedures. Even bread and butter procedures get denied, forget about even trying neuromodulation. Thus many of our non-ACGME trained docs have a very low procedural volume (again this is at my institution, not sure how it is elsewhere). One of them is currently trying to get "signed off" on certain procedures by the pain department.

Sorry, can you explain how someone else signing off on the procedures will affect the insurance companies' decisions? Won't that only affect hospital credentialing?

 

[Bostonspine]

Sorry, can you explain how someone else signing off on the procedures will affect the insurance companies' decisions? Won't that only affect hospital credentialing?

To get credentialed by insurance you need hospital privileges… on the committee for privileging will be you competition. Anesthesia will bemoaned ACGME if they have a pain department… Neurogy will bemoan Emg fellowship and numbers if they are all fellowship trained. Ortho/NSGY will bemoan privileges for SCS permanent … unless you work for them. Small hospitals you may be iced out by the dominant group. Acgme board just makes you above reproach but not immune to these problems