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abc123

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Hi everyone,

In terms of pain fellowhips, what does it mean that it is or is not accredited? I recently heard, some programs were accredited and lost their status because they refused to merge with the anes. pain fellowhship.

If anyone can shed some light...

Thanks!!!
 

staydin

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abc123,

Accreditation, in the terms that you are describing it refers to the ACGME status. Which in turn means, does the American College of Graduate Medical Education recognize the program/fellowship? Is the program in accordance to what they think a pain fellowship should be teaching or designed.

So, by being ACGME approved, and doing a fellowship that is ACGME approved, you are eligible to sit/take the certification exam to become "boarded" in that specialty.

The loss of accreditation you mentioned, doesn't necessarily mean they refused to merge, but goes under the law that was passed by the ABMS (American Board of Medical Specialties), which prevents two separate departments from having the same sub-specialty in the same institution (i.e. pain management by PMR and Anesth.)

Hope that helps...complex issue.
 

abc123

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Thanks for your reply.

So if one goes to a non-accredited PM&R pain program will they be able to sit for the boards? I know its a political, touchy issue...

thanks again
 
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dc2md

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why don't we just "certify" our own pain fellowships? make our own standards for the programs to follow. i'm sure i'm over-simplifying it.:D
 

dc2md

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isn't that similar to what PASSOR has done? (even though most of those aren't strictly "pain")

thanks Taus, you're exactly right. here's the link to the PASSOR site which discusses this (http://www.aapmr.org/passor/resources/credential.htm)

it looks like this "document" hasn't been updated since the new ACGME rules regarding separate pain fellowships at the same institution have been enacted. we should probably have this line modified to include non-ACGME accredited fellowships that PASSOR individually accredits: "Individual must have successfully completed an ACGME approved physical medicine and rehabilitation residency training program."
 

axm397

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Thanks for your reply.

So if one goes to a non-accredited PM&R pain program will they be able to sit for the boards? I know its a political, touchy issue...

thanks again

The quick answer is NO - if you don't go to an ACGME accredited pain fellowship program, you cannot take the pain boards.

dc2md said:
thanks Taus, you're exactly right. here's the link to the PASSOR site which discusses this (http://www.aapmr.org/passor/resources/credential.htm)

it looks like this "document" hasn't been updated since the new ACGME rules regarding separate pain fellowships at the same institution have been enacted. we should probably have this line modified to include non-ACGME accredited fellowships that PASSOR individually accredits: "Individual must have successfully completed an ACGME approved physical medicine and rehabilitation residency training program."

the PASSOR link refers to "credentialing", which is different from the whole board certifying process. Credentialing is more institution/practice specific - and determines whether a physician can perform certain duties/procedures at a pracitce/institution. The link is a statement by PASSOR on what they consider/recommend to be adequate "training" in pain to be able to perform these procedures. Physicians who have NOT done a pain fellowship can then try to get credentialled by a hospital to perform these procedures and may be able to argue that they have fulfilled conditions stipulated by PASSOR's guideline. Whether that carries any importance or not depends on the institution and the situation. PASSOR is NOT an accrediting body so PASSOR cannot "accredit" a fellowship. It can endorse a fellowship or recognize a fellowship has fulfilled what it considers to be basic educational standard for successful MSK/pain fellowship but that may or may not help you when it's time to get a job outside of PM&R.

Obviously, there's a lot of "myths", confusion, and misunderstanding out there about this whole fellowship issue. It took me many many conversations with various people to understand some of the core components. First issue is probably the numerous organizations involved in our training and practice issues. I know drusso wrote an alphabet soup type thing a few years ago. Here's an article in the resident newsletter of the AAPMR that may help. http://www.aapmr.org/resident/newslttr/059g.htm
 

dc2md

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my understanding is that the board-certified vs. non-boarded issue is only really relevant when applying for a job or going to court. will an attorney try to bust your balls b/c you didn't go to a "ACGME-approved" pain fellowship..."it must have been inferior/poor training and therefore you hurt my client b/c you don't know what the hell you're doing" sort of thing. so what's your defense to that. it could be "my program isn't ACGME-approved d/t the technicality of there also being an anesthesiology pain fellowship program there, BUT PASSOR still site visits all the pain fellowships and has determined it is up to ACGME standards" or whatever. you guys get what i'm saying. and if lobelsteve is correct, you can still take the ABPM pain board and show your academic proficiency. so as axm397 pointed out, PASSOR isn't a "board certifying" agency, but rather makes hospital credentialing standards. but IF they did change a bit and start "certifying" these non-ACGME PM&R pain fellowships than a least we'll have some leg to stand on when the attorneys are trying to rip us a new one.

warning: i'm writing these opinions as a 4th year med student who hasn't even matched into PM&R yet (~24 more days) but still loves this field. so i do appreciate it when axm397, lobelsteve, drusso and others who are already in the profession point out my faults in thinking. thanks guys/girls.
 
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ACGME glossary of terms:

http://www.acgme.org/acWebsite/about/ab_ACGMEglossary06_06.pdf

New Program Requirements for ACGME-accredited Multidisciplinary Pain Medicine

http://www.acgme.org/acWebsite/downloads/RRC_progReq/sh_multiPainPR707.pdf

N.B. Program Curriculum and clinical curriculum sections

PASSOR Guide to Establishing a Non-Accredited Fellowship

http://www.aapmr.org/passor/resources/fellowshiptraining.htm

PASSOR Guide to Establishing an Accredited Pain Medicine Fellowship

http://www.aapmr.org/passor/resources/painmed.htm

PASSOR Credentialing Guidelines for physiatrists in interventional procedures

http://www.aapmr.org/passor/resources/credential.htm

PASSOR Fellowship Guidelines

http://www.aapmr.org/passor/member/passguide.htm

Eligibility and Certification Requirements for the American Board of Pain Medicine

This is the certifying board that will certify applicants who did not do ACGME-accredited fellowships.

If you did an ACGME-accredited fellowship, then your "parent board" will certify you---ie ABPMR for physiatrists, ABA for anesthesiologists, and ABPN for neurologists or psychiatrists. For graduates of ACGME-accredited fellowships, the board exam is exactly the same regardless of primary specialty. It is just administered and rubber-stamped through different primary boards.

http://www.abpm.org/about/index.html

http://www.abpm.org/faq/2007bulletin.pdf

Information about the American Board of Interventional Pain Physicians

http://www.asipp.org/abipp.html

Pain Fellowship or Just Painful?

Excellent article by Greg Moore, MD about the nuts and bolts of applying to pain fellowships for physiatry residents

http://www.aapmr.org/resident/newslttr/058h.htm

"The ROAD MAP" -- A compilation of advice, suggestions, information, and innuendo distilled from the semi-intoxicated states of minds of some notable SDN'ers in various hotel lobbies and convention halls across the country...

http://www.aapmr.org/resident/resource/roadmap.htm
 

nvrsumr

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The PMR pain fellows at UM have told me that doing an accredited fellowship is a big asset when trying to find work with neurosurgery or orthopedic groups. Right or wrong they assume they are getting the best that way. My personal observation on the interview trail this year was that this was the feeling of the applicants as well and they self-selected accordingly.

I believe the ABPM is only recognized in three states.

There is alot of talk of decreased reimbursement for pain procedures in the future. One reasonalble way for medicare to do this would be to limit who is reimbursed for these procedures. Another which medicare maybe already working on with the AHA is to decrease pain procedure reimbursement to ASCs and private offices. There may then be hospital credentialing issues for unaccreditted physicians depending on the local politics.
 

Disciple

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The loss of accreditation you mentioned, doesn't necessarily mean they refused to merge, but goes under the law that was passed by the ABMS (American Board of Medical Specialties), which prevents two separate departments from having the same sub-specialty in the same institution (i.e. pain management by PMR and Anesth.)

In other words "Assimilate or be destroyed".:laugh:

Added to the new guidelines to eliminate existing PM&R pain fellowships and stop the formation of any new ones.

We acutally agreed to this.
 

Disciple

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thanks Taus, you're exactly right. here's the link to the PASSOR site which discusses this (http://www.aapmr.org/passor/resources/credential.htm)

it looks like this "document" hasn't been updated since the new ACGME rules regarding separate pain fellowships at the same institution have been enacted. we should probably have this line modified to include non-ACGME accredited fellowships that PASSOR individually accredits: "Individual must have successfully completed an ACGME approved physical medicine and rehabilitation residency training program."

As you can see these documents (similar to "white papers") were first created in '98 and basically state that interventional pain procedures are within the scope of practice of Physiatrists, through various pathways.

You would think that the ABPMR would throw a little weight/support behind official "scope of practice" documents created by their own professional organization.
 

Disciple

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The PMR pain fellows at UM have told me that doing an accredited fellowship is a big asset when trying to find work with neurosurgery or orthopedic groups.

I believe the ABPM is only recognized in three states.

Possibly, but maybe not. What surgeons really care about is that you can do basic procedures in high volume (including discography) and that your knowledge is solid concerning spinal pathology.

Why?

So that the non-surgical patients can be kept in the practice under your care instead of being returned to the PCP or pain doc.

They could care less if you can do Celiac Plexus neurolysis and probably don't want you doing intradiscal stuff that may get in the way of fusions or open discectomies.

Check CINN in Chicago, only one of their Physiatrists is ACGME fellowship trained-and even then, not at an anesthesia program. See Slipman at Penn, Patel (U. Rochester spine center, etc.) Midwest Orthopaedics (at Rush) in Chicago, Texas Back Institute-same story. TOCA in Phoenix, etc..

I'm out west and would say it's similar out here.

ABPM is only recognized in three states, however, they are probably the organization that is most vigorously attempting to create the "pain residency"

There is alot of talk of decreased reimbursement for pain procedures in the future. One reasonalble way for medicare to do this would be to limit who is reimbursed for these procedures. Another which medicare maybe already working on with the AHA is to decrease pain procedure reimbursement to ASCs and private offices. There may then be hospital credentialing issues for unaccreditted physicians depending on the local politics

That's purely speculative. If you look at the cuts for '07 and those slated for '08, their strategy is to decrease the reimbursements to near nothing. The whole argument by CRNAs wanting to perform procedures is that there is a problem with patient access. There aren't a whole lot of pain docs in practice right now. You really think state legislatures are going to restrict access further?
 

mdvol

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Possibly, but maybe not. What surgeons really care about is that you can do basic procedures in high volume (including discography) and that your knowledge is solid concerning spinal pathology.

Why?

So that the non-surgical patients can be kept in the practice under your care instead of being returned to the PCP or pain doc.

They could care less if you can do Celiac Plexus neurolysis and probably don't want you doing intradiscal stuff that may get in the way of fusions or open discectomies.

While applying to fellowships this year I also had the chance to interview with a couple of large ortho groups in the Southeast and the above quote from Disciple was my impression as well from an N of 2 of course:)

Also the article by Greg Moore is a must read:thumbup: for residents thinking about interviewing for fellowships in the next few years.
 

lobelsteve

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the Greg Moore article linked above by drusso is great. very simple and informative. thanks drusso.

It will be interesting to see where Dr. Moore will wind up after his residency training is finished......:D

I bet it is a PMR based fellowship and he has no problem getting a job making over $400 1st year. He will sit and pass the ABPM boards and have no issues with credentialling.

But what do I know?:rolleyes:
 
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