what is pain fellowship? what procedures can u do?

[ALTorGT]

hi
i see a lot of people here talking about pain fellowships. What exactly does it entail? chronic pain management in the wards? from my understanding rheumatologists and neurologists can also get fellowship trained in it, can't they? does it reimburse well? what kind of procedures can one do?

BTW, can an anesthetist get a fellowship in simple cosmetic procedures like botox injections and the like? can it help grow income?

thanx.

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[BassDominator]

Almost any MD or nurse practitioner with the right training can do medical management (narcotics, etc.) of chronic pain.

The realm of the anesthesiologist extends into placing blocks, pumps, and stimulators. Insurance tends not to pay well for these procedures, but if you can get a cash business going, you can do quite well. Especially, if you integrate things like accupunture and other complementary modalities into your practice.

You might turn up your nose at complementary medicine, but the public really loves it and is willing to pay for it. That's fine with me as long as it makes people feel better and doesn't do any harm.

 

[2ndyear]

ALT,
Anesthesiologists commonly deal in interventional pain. In fact some departments and fellowships are called just that, interventional pain mangement (Univ of Michigan is like this). That means procedures and lots of them. Less of the chronic medical management that the psych/neuro, etc. people do with pain. I really don't know a whole lot about pain though so someone else can fill you in more...

Now for the botox thing, sure they could. A dentist in Florida was performing breast surgery recently too. Sure he was an oral surgeon, but he was not fellowship trained in plastics, he wasn't even residency trained in anything beyond oral surgery. A patient died getting implants (no anesthesia care provider was present). Point is, if you deal outside of insurance you can pretty much do whatever you want. The ethics are a different story. I don't really see the need for an anesthesiologist to do Botox or the like. The training isn't really applicable and the income is more than plentiful doing just gas.

So getting back to the pain thing, earlier this year a big case came out around here about an anesthesiologist who was running a 'pain mill' as they called it in the papers. He was billing for procedures he never did, supposedly did procedures that were unnecessary, all kinds of bad stuff. The strange thing is that earlier in his career he was a very well-known critical care researcher. He did some groundbreaking work in the nutrition of critically ill patients. His name is still in Miller, I had to check. After this stint he apparently went back for pain and ended up in big trouble. He just got sentenced to prison, 10 plus years. This isn't to rip on pain docs, but lets just not forget that the pursuit of the dollar isn't the ultimate goal here in this doctor thing.