the path to pain management board certification (updated 2017)

[drpainfree]

so I'm giving a talk to a bunch of attorneys. one of the things I will open them up to is, what pain management board certification means, since as you all know, everyone and anyone, physician or not, can be "board-certified" in pain management.

I'm planning to reference to this page on ABMS

Specialty and Subspecialty Certificates | American Board of Medical Specialties

I was surprised to find out 7 specialties in ABMS offer pain management subspecialty certification: anesthesiology, EM, PMR, neurology, family medicine and radiology.

So here are some questions for all of you:

- I thought in order to be ABMS subspecialty board certified in pain management, one would have to do a ACGME-accredited pain fellowship. Is this correct? If, let's say if you did residency training in neurology, you would have to have a ACGME-fellowship trained in pain management. In another words, if you didn't do a ACGME-fellowship in pain management, you cannot be board-certified by ABMS in pain management?

- After you do a ACGME-accredited pain fellowship, how do you go about getting pain management subspecialty certification? Again, using neurology as an example, do you sit for American Board of Anesthesiology/Pain Management Subspecialty board examination, which was what I did? or do you sit on from American Board of Neurology and Psychiatry? Does each of other 6 non-anesthesiology specialty offer a pain management subspecialty board examination in their own specialty or they all take the one offered by ABA?

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[BobBarker]

Everyone takes the same ABA test.

 

[Dr. Ice]

What is the intention of this lecture? To give lawyers more fodder to sue doctors? They never really want to be educated about this stuff unless they are going to try to use it to go on the offensive. I'm almost positive I'm opening up pandora' box here but there are a lot of very well trained interventionalists out there who don't carry the acgme paper so now that these lawyers will have a little bit of knowledge, is that going to give them a little more ammunition to litigate? I'm not talking about the really bad apples out there, the weekend course warriors, but it's one thing to be divisive amongst our peers and it's another to give any more reason for lawyers to want to sue.

 

[SeniorWrangler]

You left out psychiatry.
Everybody takes the same test, but it goes through their own board, ABA or ABPN or whatever.
Pain Medicine is a pretty new field so, like addiction and geriatrics, it is full of experts who are well qualified but came up before the training was available and have no reason to go back for it.

 

[SSdoc33]

isnt there a grandfather clause as well?

 

[drpainfree]

yes, I'm not talking about the guys who were grandfathered in.

the topic came about when an attorney asked the event organizer if a neurologist can be "board-certified" in pain management without a formal fellowship.

 

[drpainfree]

You left out psychiatry.
Everybody takes the same test, but it goes through their own board, ABA or ABPN or whatever.
Pain Medicine is a pretty new field so, like addiction and geriatrics, it is full of experts who are well qualified but came up before the training was available and have no reason to go back for it.

I believe neurology and psychiatry are certified by the same board.

 

[drpainfree]

What is the intention of this lecture? To give lawyers more fodder to sue doctors? They never really want to be educated about this stuff unless they are going to try to use it to go on the offensive. I'm almost positive I'm opening up pandora' box here but there are a lot of very well trained interventionalists out there who don't carry the acgme paper so now that these lawyers will have a little bit of knowledge, is that going to give them a little more ammunition to litigate? I'm not talking about the really bad apples out there, the weekend course warriors, but it's one thing to be divisive amongst our peers and it's another to give any more reason for lawyers to want to sue.

information is out there on public domain. any attorney can do a google search and find out the link I posted above. it's better to get them educated so they know what's considered "adequate and formal" training and be properly "board-certified" in pain medicine. you don't hear a family medicine guy titles himself as "board-certified" in orthopedics, even after he does a sports medicine fellowship. We have a dentist here in my area who advertise himself as "pain management specialist". the bottom line is, pain management training has been formalized and the information needs to be conveyed to general public and attorneys, too.

in response to your comment, while I don't disagree with the fact there are some very good interventionalists who were grandfathered into the specialty. There are some problems with your assumption. Pain management specialty is not just about interventional procedures. Older anesthesiology/PMR guys who started doing pain management without formal fellowship and "real" pain management board certification are really not the role model we want to general public to think of them as what pain management is about. Some of them are grandfathered in to ABMS/ABA pain-subspecialty, some of them (PMR/neurology) simply take out their script pad and write out opioid medication. None of these are the standard nowaday or should be in the future.

again, the goal is to bring awareness.

 

[emd123]

isnt there a grandfather clause as well?

Ended years ago.

 

[emd123]

so I'm giving a talk to a bunch of attorneys. one of the things I will open them up to is, what pain management board certification means, since as you all know, everyone and anyone, physician or not, can be "board-certified" in pain management.

I'm planning to reference to this page on ABMS

Specialty and Subspecialty Certificates | American Board of Medical Specialties

I was surprised to find out 7 specialties in ABMS offer pain management subspecialty certification: anesthesiology, EM, PMR, neurology, family medicine and radiology.

So here are some questions for all of you:

- I thought in order to be ABMS subspecialty board certified in pain management, one would have to do a ACGME-accredited pain fellowship. Is this correct? If, let's say if you did residency training in neurology, you would have to have a ACGME-fellowship trained in pain management. In another words, if you didn't do a ACGME-fellowship in pain management, you cannot be board-certified by ABMS in pain management?

- After you do a ACGME-accredited pain fellowship, how do you go about getting pain management subspecialty certification? Again, using neurology as an example, do you sit for American Board of Anesthesiology/Pain Management Subspecialty board examination, which was what I did? or do you sit on from American Board of Neurology and Psychiatry? Does each of other 6 non-anesthesiology specialty offer a pain management subspecialty board examination in their own specialty or they all take the one offered by ABA?

Everyone takes the same ABMS accredited fellowships and the same Pain subspecialty exam, written by the ABA. The only thing that changes is which board you register for the test through (through your primary specialty). But it's the same test. Same fellowship. Single track for several years now.

 

[drpainfree]

Everyone takes the same ABMS accredited fellowships and the same Pain subspecialty exam, written by the ABA. The only thing that changes is which board you register for the test through (through your primary specialty). But it's the same test. Same fellowship. Single track for several years now.

Thank you for your clarification, emd123. I've been out of fellowship training for a while and thought something new came up. When I saw radiology also has a pain subspecialty board certification, I was a bit surprised. We had a fellow who came after I finished my fellowship, sharp, but a little weak on the procedure side. His primary residency training was in psychiatry. But honestly, I have not heard of anyone from radiology or family medicine accepted and completed an ACGME-accredited pain fellowship.

 

[drpainfree]

so to confirm, it would be impossible to be AMBS-board certified in pain management, unless you have done a ACGME-accredited pain management fellowship. Correct?

It has always been my understanding. Just to make sure nothing new has been introduced.

 

[BobBarker]

No, there are those that were grandfathered in many years ago.

 

[drpainfree]

No, there are those that were grandfathered in many years ago.

I meant other than those who were grandfathered in.

 

[DOctorJay]

Mayo had a radiologist in fellowship a while back and Fred who posts here is a radiologist as well.


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[Ducttape]

outside of ACGME fellowship pathway, there are those alternative boards, and always "board eligible" people out there... American Board of Pain Medicine

 

[drpainfree]

outside of ACGME fellowship pathway, there are those alternative boards, and always "board eligible" people out there... American Board of Pain Medicine

It looks more like a short-cut instead of "alternative" pathway.

 

[BobBarker]

I believe some states recognize the ABPM as being “board certified” most limit it to ABMS/AOA.

 

[Blitz2006]

outside of ACGME fellowship pathway, there are those alternative boards, and always "board eligible" people out there... American Board of Pain Medicine

Yeah I was just about to ask...

I presume doing the ABA/ABPN/APMR Pain boards is more "official" than doing this ABPM?

Also, when you do the ABA boards, what is the official credential. Are you FABA (Pain) ?

As far as I can tell, "officially" pain fellowships state on their websites that to do it, you are only eligible if you are Anesthesia/PMR/Neurology or Psych. That being said, I have met a couple ER/Radiology people...but extremely rare (like rarer than psych and neuro).

I believe you can only do the ABA/ABPN/APMR Pain boards with ACGME pain fellowship certification. I can say this because anecdotally I know a non-ACGME fellow that said he is not eligible to do the boards..

 

[emd123]

Thank you for your clarification, emd123. I've been out of fellowship training for a while and thought something new came up. When I saw radiology also has a pain subspecialty board certification, I was a bit surprised. We had a fellow who came after I finished my fellowship, sharp, but a little weak on the procedure side. His primary residency training was in psychiatry. But honestly, I have not heard of anyone from radiology or family medicine accepted and completed an ACGME-accredited pain fellowship.

ER, Radiology, and FM were made official in 2014.

 

[emd123]

I presume doing the ABA/ABPN/APMR Pain boards is more "official" than doing this ABPM?

Yes

Also, when you do the ABA boards, what is the official credential. Are you FABA (Pain) ?

Your certificate will say this, "Board Certified in Pain Medicine, by the (___insert your primary specialty board, i.e., ABA, ABPMR, ABPS, ABEM___)" There's not shorthand such as "FABA" that I know of.

As far as I can tell, "officially" pain fellowships state on their websites that to do it, you are only eligible if you are Anesthesia/PMR/Neurology or Psych. That being said, I have met a couple ER/Radiology people...but extremely rare (like rarer than psych and neuro).

When I applied, I send apps to many programs that said "Only eligible if Anesthesia, PMR...." etc. I came from an ER background, I got interviews at many with that stated policy, nonetheless. I think mostly, that's just out of date. If they're actually holding to that policy, and advertising it, they'd be best advised to update it. Otherwise, they could be sued for discrimination if they're excluding people out of hand due to primary specialty, without even looking at their applications. Many years ago, they had separate "PMR pain fellowships" "Anesthesia Pain fellowships" a few "Neuro Pain Fellowships" and when they merged all of them, the whole point was to eliminate that.

Realistically though, many programs may favor a certain specialty based on faculty specialty and bias. Also, due to departmental politics, a program may make their fellows do utterly useless residency-level anesthesia scut work and call, with zero learning value at the fellowship level for Pain Medicine, simply as a perk for the Anesthesia attendings at those programs, so they have to do less call. Will only 1 year to learn all of Pain, a difficult task, and having already completed a primary residency, their's little if any legitimate educational value to making Pain Fellows do residency level call and scut. But it does happen. Then, they'll use this excuse, that they need anesthesia people only, because their program requires some OB anesthesia call, for example, which has no learning value at all for chronic pain care, and no value to a post anesthesia resident that's already proven proficiency in this. But it does help a few anesthesia attendings get more sleep.

I believe you can only do the ABA/ABPN/APMR Pain boards with ACGME pain fellowship certification. I can say this because anecdotally I know a non-ACGME fellow that said he is not eligible to do the boards..

Prior to 2014, any specialty could do Pain, even though only Anesth, PMR, Psych & neuro officially recognized Pain as a subspecialty. Anyone could do the fellowship from any specialty and the people from random specialties would register to take the Boards (same test as everyone else) through the PMR board. This is how I did it.

In 2014, when they added ER, FM and radiology (IM declined to be added, interestingly) they made it so that only the official 7 specialties, (Anesthesia, PMR, EM, Rads, FM, Psych & Neuro) can get board certified in Pain after an ACGME accredited fellowship. They still left ACGME Pain fellowships open to be done by other specialties, just with no option for official board certification (weird, not sure why they did this).
In effect, they opened things up a little for EM, FM and rads, mainly because these three specialties had shown the most interest and had the most people (other than PMR, P&N and Gas) already having done Pain fellowships and certification, and closed things significantly for everyone else.

I'm not aware of any changes since that 2014 update, but it may have. Its a very strange and circuitous path to how we got here, but with chronic pain intersecting through nearly every specialty that sees living patients to some extent, it kind of makes sense.

How do I know all this?
I worked with the American Board of Emergency Medicine (ABEM) in 2014 to get Pain made official for Emergency Physicians, having helped write the first draft of ABEM's application to the ABA for official recognition. Fortunately it passed. It didn't change much for me, except for the fact that they sent me a new certificate that said "Board Certified in Pain Medicine by the ABEM" to replace the old one that said, "Board Certified in Pain Medicine by the ABPMR."

For the specialty of Emergency Medicine, however, it was and still is a big deal, since we don't have many fellowships that allow EP's to expand their horizons outside of general Emergency Department work. That made adding Pain, a big deal for Emergency Physicians, in my opinion.

 

[Blitz2006]

Great post emd

So for discussion, couple follow up questions

1) then basically any specialty is open to apply to ACGME pain fellowship, even OBGYN and Derm hypothetically?

2) do you think with the opioid crisis, stock/value is gonna shoot up for pain fellowship trained docs, since in the past and present a lot of non fellowship "pain docs" have been getting by, but will that start to diminish?

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[Ducttape]

just fyi, you cant sue for discrimination based on training - your board certification does make one a "protected" group.

please check on your second point, about having to be in one of the 7 specialties. previously, i believe the key to being "boarded" by the ACGME is being able to sit for the exam, and the primary criteria for that is performing the ACGME approved fellowship. anyone who could convince an ACGME fellowship to allow them to do such a fellowship can become ACGME board certified. thats how you got in, emd and i know a couple of IM people who are boarded.

if you look at Johns Hopkins pain fellowship website, it says this: Basic Qualifications: Completion of an ACGME accredited residency, most often in Anesthesiology, Physical Medicine and Rehabilitation, Psychiatry, or Neurology.


finally, the F part come from being promoted within the society to a higher level, and since there is no one organization (such as ACP for IM or ACEP for ER), there is no F as in FABA. in fact, the ABA is separate from the ASA... you can become Faculty for the ASA, but i have not seen FASA used... yet...


(and ER does have fellowship pathways in EMS, sports med, toxicology, pediatric ER, Global health/international medicine, and critical care and now pain, which is not that different a number than gas or PM&R fellowships still "focused" within the primary certification...)

 

[Blitz2006]

just fyi, you cant sue for discrimination based on training - your board certification does make one a "protected" group.

please check on your second point, about having to be in one of the 7 specialties. previously, i believe the key to being "boarded" by the ACGME is being able to sit for the exam, and the primary criteria for that is performing the ACGME approved fellowship. anyone who could convince an ACGME fellowship to allow them to do such a fellowship can become ACGME board certified. thats how you got in, emd and i know a couple of IM people who are boarded.

if you look at Johns Hopkins pain fellowship website, it says this: Basic Qualifications: Completion of an ACGME accredited residency, most often in Anesthesiology, Physical Medicine and Rehabilitation, Psychiatry, or Neurology.


finally, the F part come from being promoted within the society to a higher level, and since there is no one organization (such as ACP for IM or ACEP for ER), there is no F as in FABA. in fact, the ABA is separate from the ASA... you can become Faculty for the ASA, but i have not seen FASA used... yet...


(and ER does have fellowship pathways in EMS, sports med, toxicology, pediatric ER, Global health/international medicine, and critical care and now pain, which is not that different a number than gas or PM&R fellowships still "focused" within the primary certification...)

So do you write in your credentials then, John Smith M.D, ABA (Pain) ?

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[Blitz2006]

just fyi, you cant sue for discrimination based on training - your board certification does make one a "protected" group.

please check on your second point, about having to be in one of the 7 specialties. previously, i believe the key to being "boarded" by the ACGME is being able to sit for the exam, and the primary criteria for that is performing the ACGME approved fellowship. anyone who could convince an ACGME fellowship to allow them to do such a fellowship can become ACGME board certified. thats how you got in, emd and i know a couple of IM people who are boarded.

if you look at Johns Hopkins pain fellowship website, it says this: Basic Qualifications: Completion of an ACGME accredited residency, most often in Anesthesiology, Physical Medicine and Rehabilitation, Psychiatry, or Neurology.


finally, the F part come from being promoted within the society to a higher level, and since there is no one organization (such as ACP for IM or ACEP for ER), there is no F as in FABA. in fact, the ABA is separate from the ASA... you can become Faculty for the ASA, but i have not seen FASA used... yet...


(and ER does have fellowship pathways in EMS, sports med, toxicology, pediatric ER, Global health/international medicine, and critical care and now pain, which is not that different a number than gas or PM&R fellowships still "focused" within the primary certification...)

So theoretically any primary specialty can be accepted into a ACGME Pain Fellowship, if you can 'convince' them?

 

[drpainfree]

thank you all for you clarification

 

[Aether2000]

Frankly, IMHO it is a disastrous situation with Pain Board Certification when the ACGME allows an allergist, pediatrician, geneticist, or an aerospace medicine doctor access to a ACGME fellowship in pain medicine that then permits them to become board certified in pain by the ABMS. This dilutes the quality and uniqueness of the skillsets and background training to the point any of the current 800,000 doctors in the US could become fellowship trained and therefore "board certified". Effectively the ACGME has said anyone who wants to get training as a pain doctor can do so, and the ABMS has said anyone with a pain fellowship can become board certified. Thus, there are no requirements at all to become board certified other than completing fellowship plus test. Perhaps there are other fellowships that the ACGME has opened to "all comers" but I am not aware of these. The only barrier to becoming board certified in pain is unethical discrimination by program directors that violates the ACGME fellowship program access requirements to all specialties, but serves as a last stand in maintaining some basal standard of entry into a pain fellowship program that may fluctuate from one program director to the next. And then of course there are the thousands who are grandfathered with no pain training at all. And there is the drastically different training standards over time in pain fellowships. And the situation is confounded by the presence of the American Board of Interventional Pain Medicine and the American Board of Pain Medicine. Of course don't forget about all the surgeons now doing their own interventional pain procedures without board certification, but through NASS training. And of course CRNAs that are now "certified" by a number of organizations to practice interventional pain. For patients, this dizzying range of training and background to become board certified in pain is impossible to understand, and many believe a doc's skills and background training compared to others in the same specialty are relatively similar much like neurosurgery or general surgery. In actuality, there is actually nothing further from the truth.

Here is the ACGME requirements for pain fellowship. https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/530_pain_medicine_2017-07-01.pdf

 

[freddydpt]

Thank you for your clarification, emd123. I've been out of fellowship training for a while and thought something new came up. When I saw radiology also has a pain subspecialty board certification, I was a bit surprised. We had a fellow who came after I finished my fellowship, sharp, but a little weak on the procedure side. His primary residency training was in psychiatry. But honestly, I have not heard of anyone from radiology or family medicine accepted and completed an ACGME-accredited pain fellowship.

I'm a radiologist who completed pain fellowship at UPenn. Stanford had a radiologist graduate recently. Wade Wong completed at UCSD a while back. John Michels at UC Irvine and Rick Obray at Mayo. All are radiologists who went through the ACGME accredited route (though John took the ABPM boards because the ABR was delaying the process to register for the exam).

ANYWAYS... it USED to be that anyone from any field could become board certified in pain. That is no longer the case and only limited to those fields listed on the ABMS web site. I've met at least 2 guys who were both IM and hospice trained who were unable to become board certified because the ABA would not allow them to take the exam (this is despite being accepted to and completing an ACGME pain fellowship). So they have clamped down a bit.

I was intimately involved in the multiboard political process and wrote the application for the ABR to become a cosponsor for the pain certificate. I agree that the ABMS ACGME route should be the definitive way to become boarded, however, it's hard to compete with for profit organizations looking to issue these "credentials".

 

[freddydpt]

FYI, of those primary fields listed above, you can also add Interventional Radiology (since it's considered its own primary field now) as well as Radiation Oncology since it is under the ABR and the exam eligibility has to do with the board sponsor and not the field. I don't know any Rad Onc's who have gone to pain fellowship, however.

 

[hyperalgesia]

so I'm giving a talk to a bunch of attorneys. one of the things I will open them up to is, what pain management board certification means, since as you all know, everyone and anyone, physician or not, can be "board-certified" in pain management.

I'm planning to reference to this page on ABMS

Specialty and Subspecialty Certificates | American Board of Medical Specialties

I was surprised to find out 7 specialties in ABMS offer pain management subspecialty certification: anesthesiology, EM, PMR, neurology, family medicine and radiology.

So here are some questions for all of you:

- I thought in order to be ABMS subspecialty board certified in pain management, one would have to do a ACGME-accredited pain fellowship. Is this correct? If, let's say if you did residency training in neurology, you would have to have a ACGME-fellowship trained in pain management. In another words, if you didn't do a ACGME-fellowship in pain management, you cannot be board-certified by ABMS in pain management?

- After you do a ACGME-accredited pain fellowship, how do you go about getting pain management subspecialty certification? Again, using neurology as an example, do you sit for American Board of Anesthesiology/Pain Management Subspecialty board examination, which was what I did? or do you sit on from American Board of Neurology and Psychiatry? Does each of other 6 non-anesthesiology specialty offer a pain management subspecialty board examination in their own specialty or they all take the one offered by ABA?

I thought in order to be ABMS subspecialty board certified in pain management, one would have to do a ACGME-accredited pain fellowship. Is this correct? Yes, unless you were grandfathered into the specialty.

After you do a ACGME-accredited pain fellowship, how do you go about getting pain management subspecialty certification?
You apply for the pain subspecialty board exam through your primary board but the actual test is administered by ABA

Again, using neurology as an example, do you sit for American Board of Anesthesiology/Pain Management Subspecialty board examination, which was what I did? or do you sit on from American Board of Neurology and Psychiatry?
ABMS Pain Medicine exam is ABA but you are admitted to take the exam by your primary board that offers it. Some people have been able to lobby another board to admit them to take the test. I know one guy who is IM/Rheum and ABPMR admitted him to take the board under them. Not sure how that happened.

 

[Aether2000]

It does appear the ABMS has tightened requirements to become subspecialty certified in pain medicine in 2014. Up to that point, the ABPMR and ABNeurology/Psych would certify anyone that completed a fellowship, and grandfathered thousands before that. The ACGME has not tightened their requirements accordingly, and it appears a person can enter and complete a pain fellowship but not be eligible to become subspecialty certified in pain medicine. The current specialty routes to ABMS subspecialty certification in pain medicine continue to be somewhat bizarre and include things like "Medical Physics", Psychiatry, Child Neurology, Family Medicine, Diagnostic Radiology, and Emergency Medicine as well as the more logical Interventional Radiology and Diagnostic Radiology, Radiation Oncology, Anesthesiology, PMR, Neurology. A psychiatrist can complete a pain fellowship and do 15 interlaminar injections and a handful of stimulator trials and voila! They are eligible not only for board certification in pain but also may begin implanting stimulators and performing interventional pain procedures in their own practice. Interestingly, neurosurgeons and orthopedic spine surgeons who are increasingly doing more and more of their own procedures (thank you NASS) are not eligible for pain medicine certification, nor do they care. They get paid just as much as pain physicians to do the same procedures and in many cases more by for instance doing facet denervation using an open portal system that is classified as a surgical procedure paying 5 times as much. So, pain certification by the ABMS, while improved over the past 23 years, still has left us with massive variances in training due to extensive grandfathering by three different specialty boards, due to PMR and neurology pain certification of all comers for many years, due to variances in program training with some not offering pumps and stims or neurotomy well into the 2000s, and due to continued bizarre entry paths into the pain certification program. It is a work still in progress, however at this point in time a person stating they have "additional qualifications in pain medicine by the ABMS" can mean they had zero training in pain, that they had a non-sequitur specialty residency followed by effectively a one year residency training in pain, or that they have the best background specialty for pain followed by the best training in the country in pain medicine. And many people doing pain procedures have no training at all in pain except for a weekend warrior course.

 

[swamprat]

When I applied I emailed programs and a lot of them stated “do not consider ER doctors” - I was under the impression that they had to consider any specialty. Def a huge bias toward gas and rehab folks getting into this field and I do think it’s great it’s expanded to other specialties slowly but at the same time when the majority are run under the department of anesthesia IMO it will always be tough to get a spot coming from a non gas/rehab background. I guess in an ideal world it would be it’s own specialty perhaps through residency training but doubt that will ever happen.

 

[Aether2000]

Probably not. We had that chance 8 years ago but protectionism by anesthesia old guard stopped any discussion of that

 

[emd123]

It does appear the ABMS has tightened requirements to become subspecialty certified in pain medicine in 2014. Up to that point, the ABPMR and ABNeurology/Psych would certify anyone that completed a fellowship, and grandfathered thousands before that. The ACGME has not tightened their requirements accordingly, and it appears a person can enter and complete a pain fellowship but not be eligible to become subspecialty certified in pain medicine. The current specialty routes to ABMS subspecialty certification in pain medicine continue to be somewhat bizarre and include things like "Medical Physics", Psychiatry, Child Neurology, Family Medicine, Diagnostic Radiology, and Emergency Medicine as well as the more logical Interventional Radiology and Diagnostic Radiology, Radiation Oncology, Anesthesiology, PMR, Neurology. A psychiatrist can complete a pain fellowship and do 15 interlaminar injections and a handful of stimulator trials and voila! They are eligible not only for board certification in pain but also may begin implanting stimulators and performing interventional pain procedures in their own practice. Interestingly, neurosurgeons and orthopedic spine surgeons who are increasingly doing more and more of their own procedures (thank you NASS) are not eligible for pain medicine certification, nor do they care. They get paid just as much as pain physicians to do the same procedures and in many cases more by for instance doing facet denervation using an open portal system that is classified as a surgical procedure paying 5 times as much. So, pain certification by the ABMS, while improved over the past 23 years, still has left us with massive variances in training due to extensive grandfathering by three different specialty boards, due to PMR and neurology pain certification of all comers for many years, due to variances in program training with some not offering pumps and stims or neurotomy well into the 2000s, and due to continued bizarre entry paths into the pain certification program. It is a work still in progress, however at this point in time a person stating they have "additional qualifications in pain medicine by the ABMS" can mean they had zero training in pain, that they had a non-sequitur specialty residency followed by effectively a one year residency training in pain, or that they have the best background specialty for pain followed by the best training in the country in pain medicine. And many people doing pain procedures have no training at all in pain except for a weekend warrior course.

This is not correct. Only those from the official 7 specialties, Anesthesiology, PMR, Emergency Medicine, Radiology, Family Medicine, Psychiatry & Neurology, who have done ACGMR fellowships can take the Pain boards and be ABMS certified, now. This change was made in 2014. I’ll try to find a link that proves this, when I have more time.


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[Aether2000]

I agree that those seven Specialties are the only ones eligible for abms subspecialty certification. However each of those Specialties may have more than one specialty certification, such as Radiology or neurology / psychiatry. However it appears that the acgme requirements have not been correspondingly tightened according to their current website. Therefore a person could indeed take an acgme Fellowship coming out of allergy medicine or pathology, yet could not be board certified by the abms leaving them in a virtual no man's land.

 

[emd123]

Therefore a person could indeed take an acgme Fellowship coming out of allergy medicine or pathology, yet could not be board certified by the abms leaving them in a virtual no man's land.

True, but by eliminating the ability to get ABMS certified, they’ve de facto closed the loophole for anyone not from the official 7. Without it, there’s no reason to do a fellowship. There’s no way to get insurance credentials, hospital/ASC privileges or jobs. Your fear of the specialty being overrun by pathologists and geneticist practicing Pain has no real world way of becoming reality. The 2014 changes effectively killed Pain for anyone not from Anesthesia/PMR/EM/FM/Rads/Psych/Neuro. And in practice, 95% of those interested or pursuing the specialty are still from Anesthesiology & PMR.

 

[Aether2000]

I do not fear the specialty being overrun by geneticists or pathologists: I have concern about any one geneticist or allergist or internist or pathologist that was allowed to enter the constantly fluctuating and irrational pathway to becoming a pain physician that has been promulgated by the ABMS/ACGME over the past 23 years. I am unaware of any other specialty that has had such vacillations in approach or policy towards a subspecialty. All the while untrained CRNAs, radiology technicians, PAs, NPs, neurosurgeons, and orthopedic spine surgeons are increasingly expanding influence and practice in pain medicine. We are weakened by the many years of lack of consistent policy and focus of the subspecialty under the power of primarily the ABA and ABPMR that treated pain medicine as a poor stepchild, blocking the development of a residency.

 

[emd123]

I do not fear the specialty being overrun by geneticists or pathologists: I have concern about any one geneticist or allergist or internist or pathologist that was allowed to enter the constantly fluctuating and irrational pathway to becoming a pain physician that has been promulgated by the ABMS/ACGME over the past 23 years. I am unaware of any other specialty that has had such vacillations in approach or policy towards a subspecialty. All the while untrained CRNAs, radiology technicians, PAs, NPs, neurosurgeons, and orthopedic spine surgeons are increasingly expanding influence and practice in pain medicine. We are weakened by the many years of lack of consistent policy and focus of the subspecialty under the power of primarily the ABA and ABPMR that treated pain medicine as a poor stepchild, blocking the development of a residency.

I agree with this. Pain should transition to a residency pathway.

 

[newbie04]

Our Staff

Gotta love this loophole.


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[Ducttape]

algos, you know as well as anyone that a psychiatrist actually may be better suited for the management of chronic pain than almost anyone else.

only a small portion of what we do are should be interventions.

(the other subspecialties that allow multiple other residencies get in, off the top of my head, include toxicology, palliative/hospice care, international medicine, critical care, sports medicine.

i cannot find anything specific that states, unlike most of the other subspecialties, that there are prerequisite residencies for pain. emd will need to find that... 🙂

 

[drpainfree]

algos, you know as well as anyone that a psychiatrist actually may be better suited for the management of chronic pain than almost anyone else.

only a small portion of what we do are should be interventions.

(the other subspecialties that allow multiple other residencies get in, off the top of my head, include toxicology, palliative/hospice care, international medicine, critical care, sports medicine.

i cannot find anything specific that states, unlike most of the other subspecialties, that there are prerequisite residencies for pain. emd will need to find that... 🙂

VA tried to have psychologists to run their chronic pain program many years ago. They failed miserably!

Intervention, when used appropriately can save tons of money from spinal surgeries and quackery "medicine" and to alleviate pain!

 

[Blitz2006]

This is not correct. Only those from the official 7 specialties, Anesthesiology, PMR, Emergency Medicine, Radiology, Family Medicine, Psychiatry & Neurology, who have done ACGMR fellowships can take the Pain boards and be ABMS certified, now. This change was made in 2014. I’ll try to find a link that proves this, when I have more time.


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Good to know, but also confuses the situation. Since most fellowship websites (whiile may be out of date, but still) state that applicants eligible are to be from Anesthesia/PMR/Neuro/Psych. Obviously, this is a bit misleading since specialties like Rads and FM are eligible for board certification....

 

[Aether2000]

Psychiatry is but one piece of the puzzle in pain medicine, but those I have seen certified in pain from psychiatry are almost 100% opioid medication based, with no interventional treatment, SCS, etc. But anesthesiology clearly has its own limitations as a background residency also, and PMR has its own weaknesses. Ideally, a full residency would encompass the myriad skill sets necessary and not waste the time of physicians spending years in a residency that provides the majority of training that pain physicians will not use in practice.

 

[drusso]

So, pain certification by the ABMS, while improved over the past 23 years, still has left us with massive variances in training due to extensive grandfathering by three different specialty boards, due to PMR and neurology pain certification of all comers for many years, due to variances in program training with some not offering pumps and stims or neurotomy well into the 2000s, and due to continued bizarre entry paths into the pain certification program. It is a work still in progress, however at this point in time a person stating they have "additional qualifications in pain medicine by the ABMS" can mean they had zero training in pain, that they had a non-sequitur specialty residency followed by effectively a one year residency training in pain, or that they have the best background specialty for pain followed by the best training in the country in pain medicine. And many people doing pain procedures have no training at all in pain except for a weekend warrior course.

Excellent summary!

 

[SeniorWrangler]

Two kinds of pain doctors: good ones and bad ones. No one specialty seems to have a monopoly on either kind...

 

[clubdeac]

I'd like to retrain and do an interventional radiology fellowship. Based on how they treat pain fellowships, I should be able to do this.

 

[freddydpt]

I'd like to retrain and do an interventional radiology fellowship. Based on how they treat pain fellowships, I should be able to do this.

It was called the DIRECT pathway and it existed up until very recently.