Utility/Importance of being a FIPP: Fellow of Interventional Pain Practice?

[Ligament]

Hi All,

The World Institute of Pain via the ASIPP offer testing and eventual certification as a "Fellow of Interventional Pain Practice." It seems quite difficult. I wonder what the utility and importance of becoming a FIPP is in the real world?

Check out the exam outline, looks intense:
http://www.worldinstituteofpain.org/ExamInfo2005.pdf

General Info:
http://www.worldinstituteofpain.org/

Your comments appreciated.

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[DigableCat]

Hi All,

The World Institute of Pain via the ASIPP offer testing and eventual certification as a "Fellow of Interventional Pain Practice." It seems quite difficult. I wonder what the utility and importance of becoming a FIPP is in the real world?

Check out the exam outline, looks intense:
http://www.worldinstituteofpain.org/ExamInfo2005.pdf

General Info:
http://www.worldinstituteofpain.org/

Your comments appreciated.

Oh great...another expensive exam to show I'm bonafide, $1650!!?? Just how many letters do I need after my name? 😡

And...they created a loophole for those who don't do ACGME accredited pain fellowships:

1. You must submit documentation of identifiable training in pain management in an ACGME-accredited training program or equivalent.

This field is starting to have more loopholes than a bowl of cheerios.

I have to admit though, a practical exam sure would be good to have. Taking a multiple choice test, and sticking a needle somewhere that may have adverse catastrophic consequences sure are different. But then again, no one makes surgeons do a "mock appendectomy", nor do they do the same for interventional radiologists. So until it's applicable to all fields of medicine, it would seem like Pain Medicine doctors are being singled out. Or...maybe they are trailblazing and setting a new standard for "competency" in medicine.

 

[Spine Specialist]

Oh great...another expensive exam to show I'm bonafide, $1650!!?? Just how many letters do I need after my name? 😡

And...they created a loophole for those who don't do ACGME accredited pain fellowships:



This field is starting to have more loopholes than a bowl of cheerios.

I have to admit though, a practical exam sure would be good to have. Taking a multiple choice test, and sticking a needle somewhere that may have adverse catastrophic consequences sure are different. But then again, no one makes surgeons do a "mock appendectomy", nor do they do the same for interventional radiologists. So until it's applicable to all fields of medicine, it would seem like Pain Medicine doctors are being singled out. Or...maybe they are trailblazing and setting a new standard for "competency" in medicine.

Dig-

It is not just $1650. It is more than that....even practical exam is $2000 and then other competency certification courses like controlled substance certification and billing code certification etc to get certification without fellowship training. More $$ for review courses. It looks like doing accredited fellowship training is waste of time and money (in resident salary). 😡
You are right. There is no other speciality which gives board certification after cadaver training and testing.

 

[Spine Specialist]

^^^^^

I hope Gabor Racz and Manchikanti dont visit these forums.

 

[jsaul]

^^^^^

I hope Gabor Racz and Manchikanti dont visit these forums.

does racz even get on the internet

 

[neuropathic]

But then again, no one makes surgeons do a "mock appendectomy", nor do they do the same for interventional radiologists. So until it's applicable to all fields of medicine, it would seem like Pain Medicine doctors are being singled out.

There is no mock appys, lap choles, whipples because it takes 5 years, not a few weekend cadaver courses to become a surgeon.

IMO, a pain medicine residency is a must to produce true pain specialists, wean out the pretenders and protect patients from unethical and unsafe practices of pain medicine. Sooner the better.

 

[Aether2000]

Amen!
The concept of FIPP was initially a good start towards a more standardized approach to pain management. I was in the first group of physicians who took and passed the exam, but even that exam had loopholes since none of the examiners completed the full exam but instead were "grandfathered" in.
The unfortunate association of FIPP with ASIPP now has created a Godzilla size process for "certification" that will ultimately line the pockets of ABIPP/ASIPP or whatever alphabet soup they have chosen with large sums of cash for taking their many part exam, each with a price, and for their review courses preceding the exams. At this time, the value of such an exam is highly questionable since it is worth nothing with respect to hospital privileges, credentialing, insurance membership or credentialing, licensure, enhanced scope of practice, or value to the patients. It is just another feather one may pay for to stick in their hat at this time.

 

[paz5559]

ABMS certifications are the only ones that carry any weight, whether with hospital credentialling committees or with insurance carriers. ABPM and FIPP are god ideas, but until they are ABMS certifications, they will be lumped together with the kinds of organizations you can just write a check to get a nice certificate to hang on your wall. That is why ABPM is working so hard to gain ABMS membership at present

 

[Aether2000]

Just as with other specialties that have tried and failed, a "Pain Board" cannot be accepted as an ABMS member board unless they have an accredited residency program. Pain medicine does not, and until that happens, the ABPM can continue to file litigation and scream to high heaven as they have done for nearly a decade without any results.

 

[paz5559]

Just as with other specialties that have tried and failed, a "Pain Board" cannot be accepted as an ABMS member board unless they have an accredited residency program. Pain medicine does not, and until that happens, the ABPM can continue to file litigation and scream to high heaven as they have done for nearly a decade without any results.

True, but clearly, those of us in ACGME accredited fellowships are able to sit for ABMS subspecialty certification through our individual boards (ABPM&R or ABA, respectively)

 

[Aether2000]

Yes, just as psychiatrists, child psychiatrists, neurologists, and child neurologists can take the same exam through ABPM&R.

 

[Disciple]

Just as with other specialties that have tried and failed, a "Pain Board" cannot be accepted as an ABMS member board unless they have an accredited residency program. Pain medicine does not, and until that happens, the ABPM can continue to file litigation and scream to high heaven as they have done for nearly a decade without any results.

It appears they are giving this a third try and are in the process at creating a RRC (residency review commitee) for their attempt at a pain residency.

Perhaps someone who is attending their annual meeting can post an update at the end of the month.

Hypothetically, if they were to be successful, what would become of ACGME accredited pain fellowships? Would they be shut down? Gradually phased out?

 

[Aether2000]

Good question. I am sure the residency directors of anesthesiology, PM&R, and neurology with pain fellowships attached are wondering the same thing and will probably fight any such move...

 

[PainDr]

As always...Algos is correct. They will fight such a move and have already formulated a plan of action. In the future, all ACGME accredited fellowships will become truly multidisciplinary and will provide training in anesthesiology, physiatry, neurology and psychiatry. The changes will standardize fellowship training and provide a more comprehensive educational experience. In addition to requiring that fellows perform a certain number of each type of intervention, the new rules will require fellows to perform a certain number of proctored specialty specific examinations (neurological, musculoskeletal and psych exams) and procedures (intubations, obtaining IV access and administering IV sedation). The proposed effective date for these changes is July 2007. If fellowships become so multidisciplinary there will be no need for a formal residency.

 

[Aether2000]

According to the residency directors, the lack of need of a residency is based on cramming an entire multidisciplinary training into one year (or one and a half years) while continuing to retain a largely irrelevant base residency (such as anesthesiology). Such changes will continue to protect the franchise of the base residencies and will indeed offer a far more coherent approach to pain management than the hodgepodge currently offered. At this time, there simply are no standards in the curriculum of pain medicine fellowships that vary all over the map in what they offer. At least standardization may eliminate the poorly trained fellows being produced at some programs.

 

[drusso]

At least standardization may eliminate the poorly trained fellows being produced at some programs.

I see the merits of both approaches. However, maybe better *fellowships* will help eliminate the production of poorly trained fellows at some programs!

 

[Disciple]

Silly me,

and here I thought the creation of multidisciplinary guildlines for pain fellowships were for the betterment of the field and not to block creation of pain residencies.

I guess that's just me being young and idealistic.

In my opinion, adding a month or so of following a physiatrist around in the spine clinic or spending a little bit of time in psyche isn't going to do a whole lot training wise. And for the PM&R pain fellowships that already find it difficult to fulfill ACGME requirements, adding a required base in intubations etc. is going to be exceedingly difficult. With this "multidisciplinary" approach, if the pain dept is not an independent entity, how can there be assurance that the primary sponsoring specialty will not dominate. From fellowship interviews this year, I got the feeling that many programs felt they were being forced into these changes and were participating begrudgingly. The idea of a 1 year multidisciplinary pain fellowship is founded on good intentions and can work, "in theory", but I still think a pain residency is a vastly superior alternative.

 

[paz5559]

I see the merits of both approaches. However, maybe better *fellowships* will help eliminate the production of poorly trained fellows at some programs!

Could someone possibly explain to me why ours is a field that insists upon eating its own young?

"Poorly trained fellows", in my mind, translates to I do it better than you idiots, and so no one is better suited to take care of patients than me.

There are lots of good pain docs out there, and far greater issues to be addressed than competition between practitioners. Fellowships clearly
are of varying quality, as they are in any field. However, weekend course-trained physicians are the bane of our existance, not fellowships, or at least they ought to be the first place we limit the field.

As for self-trained physicians, let us not forget that most of our highly respected patriarchs are self-trained, and so lack of fellowship training ought not to automatically deem such folks incompetent.

In short, pain is a fractious, highly competative field, but the sooner we recognize that we need to work together to accomplish our goals, the better off thee field will be. There are too few of us to fight internally, and too many other fields trying to limit the scope of our practice for use to fight internally anywhere near as much as we do

 

[Aether2000]

One of the reasons many fellows visit the weekend courses is because they do not receive training in their own fellowship in these techniques. I have seen many fellows from anesthesiology pain fellowships at the end of their program who have never implanted a pump, had only cursory exposure to stimulations, did interlaminar steroid injections without fluoroscopy as their primary injection technique, had little exposure or no exposure to RF (some of the fellowship programs did not have a RF machine), had never performed intradiscal anything, etc.
There clearly are poorly trained fellows matriculating from fellowship programs. Of course there are also some very highly trained fellows. The problem we face is not in critiquing programs that are inadequate, but that there is no consistency or standards in the final product of such fellowships. Patients cannot be expected to know which physicians were well trained and which haven't a clue about what they are doing because of inadequate training.

 

[lobelsteve]

One of the reasons many fellows visit the weekend courses is because they do not receive training in their own fellowship in these techniques. I have seen many fellows from anesthesiology pain fellowships at the end of their program who have never implanted a pump, had only cursory exposure to stimulations, did interlaminar steroid injections without fluoroscopy as their primary injection technique, had little exposure or no exposure to RF (some of the fellowship programs did not have a RF machine), had never performed intradiscal anything, etc.
There clearly are poorly trained fellows matriculating from fellowship programs. Of course there are also some very highly trained fellows. The problem we face is not in critiquing programs that are inadequate, but that there is no consistency or standards in the final product of such fellowships. Patients cannot be expected to know which physicians were well trained and which haven't a clue about what they are doing because of inadequate training.

Lets not even mention a board exam so poorly written that passing it requires no fellowship training, no particular textbook, and no easy way to study- it has zero relevance to practice and the answeres were not remotely close to what was asked in the first place- I'm just glad I passed it so I could say this. I forwardedmy CV and a cover letter asking to get a spot in the test review committee only to be told to call back in 5 years.

We are getting cyclical here in the need to establish criteria. Isn't this the job of the ACGME? Isn't that what accreditation means? I just don't see it.
Again- how do we make it happen? I'm not tired of asking this over and over. But who can I ask to get the ball rolling?

 

[lobelsteve]

Here is the ACGME Program requirements.

It is a far cry from reasonable based on what I've seen in a few programs. It would take combining elements from most programs to make one good program. I just don't see their expectations currently being met.

We really need to present this as a separate residency program.
12 months is insufficient to cover all the bases. Most fellows are pushed one way or another by theire selection into a program.

 

[DigableCat]

And there in lies one of the problems with the way people evaluate a "worthy fellowship". Sure, some programs could easily concentrate solely on doing procedures. And many do. But at the expense of teaching how to evaluate patients that don't need procedures. How to medically manage patients. Since it appears that the exam asks such esoteric questions, and a fellowship is not even necessary to pass it, maybe people should choose fellowships based purely on the amount of procedures and surgeries they do. A block jock clinic would be the perfect fit. Get the procedures you need, figure other things out as you move along. After all, you can always go to a PDA to find medication dosages.

I guess I chose the wrong fellowship.

 

[Aether2000]

I have not seen fellowships that are so procedure oriented that they forget about treating the patient...that concept seems to lie squarely in the venue of the private practitioner pain physician or those working solely for surgeons. Perhaps there are procedure exclusive fellowships of which I am not aware....
It would be nice to have balance in fellowships with at least basal procedural training...

 

[Spine Specialist]

As for self-trained physicians, let us not forget that most of our highly respected patriarchs are self-trained, and so lack of fellowship training ought not to automatically deem such folks incompetent.

Hmmmm...i have to agree with you on this. If Albert can help patients suffering from pain in african jungles without any ACGME accredited training, anyone can do it. I can do better job than him with all my modern american training and technology. 👍

( wait a second!..there was no legal suits in african jungles.... 😀 )

 

[paz5559]

Can you really see an attorney asking Nik Bogduk, Rob Windsor, Rick Derby, Paul Dreyfuss, Charlie Aprill, Heidi Prather, Curtis Slipman, Greg Lutz, Ken Botwin, or Larry Frank now doctor, since you aren't fellowship trained, your skills must be second rate, right?

 

[Spine Specialist]

Can you really see an attorney asking Nik Bogduk, Rob Windsor, Rick Derby, Paul Dreyfuss, Charlie Aprill, Heidi Prather, Curtis Slipman, Greg Lutz, Ken Botwin, or Larry Frank now doctor, since you aren't fellowship trained, your skills must be second rate, right?

Well, it would be just like an attorney asking Christiann Barnard, " Are you trained in performing heart transplant surgery, Sir?

 

[lobelsteve]

Rob Windsor would probably bench press him into submission, then quote literature as a filibuster, while secretly placing dual octrodes in his spine.

I'd love to be there the next time he testifies...just not against me.

 

[drusso]

Can you really see an attorney asking Nik Bogduk, Rob Windsor, Rick Derby, Paul Dreyfuss, Charlie Aprill, Heidi Prather, Curtis Slipman, Greg Lutz, Ken Botwin, or Larry Frank now doctor, since you aren't fellowship trained, your skills must be second rate, right?

No, but sadly I can imagine at least some of those individuals (or their fellows) being denied privileges at almost any community hospital (or their affiliated surgical centers) with medical staff by-laws committee chaired by an ACGME-fellowship trained anesthesiologist!

 

[Disciple]

Can you really see an attorney asking Nik Bogduk, Rob Windsor, Rick Derby, Paul Dreyfuss, Charlie Aprill, Heidi Prather, Curtis Slipman, Greg Lutz, Ken Botwin, or Larry Frank now doctor, since you aren't fellowship trained, your skills must be second rate, right?

I agree,

except that I believe Larry Frank is fellowship trained (non-ACGME), and pain boarded.

At least half the people you listed (not all, e.g. Windsor and others) are spine guys, not really "pain" docs. Which is why I think that we Interventional/musculoskeletal Physiatrists, having allowed ourselves to be lumped, rail-roaded, whatever under the umbrella of ACGME "pain" instead of standing up for what we actually do, may have effectively screwed ourselves.

 

[Disciple]

No, but sadly I can imagine at least some of those individuals (or their fellows) being denied privileges at almost any community hospital (or their affiliated surgical centers) with medical staff by-laws committee chaired by an ACGME-fellowship trained anesthesiologist!

You don't need to imagine. This is almost the exact scenario going on at the University Hospital I'm currently at. The only difference is that the Physiatrists being denied priviledges are all fellowship trained (one of them by Windsor) and ABMS pain boarded.

I think in most situations the denial of privileges due to lack of pain board certification is just a cover.

If the powers that be don't want you competing at their hospital, they'll find 10-20 other reasons to keep you out.


Us PM&R folk gotta stick together.