The Difference in Practice between ACGME Pain and Non-ACGME / NASS Spine Physicians, Post-Fellowship?

[JBM16BYU]

The intent of this question is not to debate which of the fellowship options, ACGME Pain Medicine or NASS / Non-ACGME Interventional Spine, is better. Rather, I am curious:
1. Is there a difference in practice between individuals who train at one vs. another?
2. For those who do Spine, are there hospital systems that require ABPM or ABIPP Pain Medicine board certifications vs. just PM&R board certification with having done the fellowship in order to perform axial procedures?
3. Can NASS / Non-ACGME Spine work in an Academics or hospital-employed position, or are they more private practice?
4. Do both ACGME Pain and NASS Spine do ultrasound-guided injections, post-fellowship?
5. Are there jobs that are looking for NASS Spine that require opioid management? (Since I know this is one of the things that most of the NASS Spine programs say is not included in their fellowships and is not a focus of their fellowships).
Thanks in advance.

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[RM38]

1) depends on what you learned to do in fellowship. Most NASS places only teach spine and MSK stuff, so you probably won’t lean some of the other peripheral block learned at other locations. You may or may not learn SCS. Really practice differences depend on the individual and your interests. Practice environment (surgery group vs not) will also largely determine what you will be doing.
2) Not that I know of. If they will hire you without ACGME fellowship they probably don’t care about ABIPP or ABPM certification.
3) Yes, but likely not at an ACGME fellowship. Likely only PM&R department would hire you. Most end up in PP.
4) Yes
5) Yes, but they are likely not specifically looking for someone from a NASS fellowship and would be willing to hire anyone they felt was a good fit ACGME or not.

 

[drusso]

The intent of this question is not to debate which of the fellowship options, ACGME Pain Medicine or NASS / Non-ACGME Interventional Spine, is better. Rather, I am curious:
1. Is there a difference in practice between individuals who train at one vs. another?
2. For those who do Spine, are there hospital systems that require ABPM or ABIPP Pain Medicine board certifications vs. just PM&R board certification with having done the fellowship in order to perform axial procedures?
3. Can NASS / Non-ACGME Spine work in an Academics or hospital-employed position, or are they more private practice?
4. Do both ACGME Pain and NASS Spine do ultrasound-guided injections, post-fellowship?
5. Are there jobs that are looking for NASS Spine that require opioid management? (Since I know this is one of the things that most of the NASS Spine programs say is not included in their fellowships and is not a focus of their fellowships).
Thanks in advance.

ACGME is the platinum standard. As our specialty evolves more into pain surgery and away from medicating the hopeless and hapless, ACGME accreditation will be essential especially when going toe-to-toe surgeons who trained in ACGME accredited programs.

 

[MD87]

ACGME is the platinum standard. As our specialty evolves more into pain surgery and away from medicating the hopeless and hapless, ACGME accreditation will be essential especially when going toe-to-toe surgeons who trained in ACGME accredited programs.

Many spine surgery fellowships are not ACGME accredited.

 

[drusso]

Many spine surgery fellowships are not ACGME accredited.

That won't stop them from wanting the best/highest standard they can get.

 

[oreosandsake]

Every program is different. Hard to generalize.
But I wanted that platinum shield of acgme accreditation and wanted brand name training.

I also thought at one time that the name brand of the programs meant a lot. It might at some point, especially early in your career, or especially if you like to drop the H bomb. And locally in your market you are trained in. Looking back I think those things mean so little now. I know many docs who went to “whichever program” acgme or not, H bomb or not, and are doing very well in life. Better than me financially for sure. But If you’re motivated you can learn anything.

My Pmr residency was one of the better programs in the country. I didn’t get much procedural training at the time. It annoyed me. Looking back I Recognize that learning how to do procedures with basic competence isn’t that difficult if you put in the time. Funny enough I’ve also seen countless docs who “do this for a living” That have horrible skills and lack the fundamentals to perform quality interventions . And most have no idea how bad they are poking people with needles in the world.

Academic programs at large teaching centers have more accountability, since people are always watching and critiquing. This could be NASS or acgme

 

[Agast]

Realistically, in the long run your mode of practice is only limited by your sense of shame.

 

[drusso]

Realistically, in the long run your mode of practice is only limited by your sense of shame.

That would make a great tattoo.

 

[Czech777]

I looked at both. I think the one thing to consider is that Pain departments will not hire Spine trained. Spine departments will hire Pain trained. Sometimes there is a practice style or pay differential.

 

[mid|ine]

Pretty sure a lot of our insurance contracts require active ACGME board certification

 

[Ferrismonk]

Pretty sure a lot of our insurance contracts require active ACGME board certification

I'm willing to bet that if you look closely those insurance contracts only require "board certification" and that this often just means your primary specialty.

 

[cowboydoc]

That would make a great tattoo.

View attachment 354191

My @$$ is too skinny to put that across my low back. I'll stick with my purple fibro butterfly.

 

[drusso]

My @$$ is too skinny to put that across my low back. I'll stick with my purple fibro butterfly.