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Which board exam?
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send a $50 check to ABPmanagement - and fill out their exam paperwork...
that will garner all the respect that you need since your "mentorship" will equal a year of fellowship level training in Pain.
that will garner all the respect that you need since your "mentorship" will equal a year of fellowship level training in Pain.
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Whoops, sorry, I should have realized I'd touch a nerve (no pun intended). I'm making 150K more than the typical fellow and I'm getting to do all the procedures I want. I guess I should just hope it lasts. All you non-risk takers out there at least have piece of mind, so I guess it evens out. Maybe those who are doing non-ACGME fellowships out there care to respond to my initial question without sarcasm?
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myofascist, your question is perfectly reasonable, and the response from the (mostly ACGME fellowship-trained anesthesiologist board) is predictable.
i guess the real question is why you would want to take the exam? are you looking to be "board-certified" in pain? would you be trying to market yourself as a "board certified pain management specialist"? trying to insulate yourself from any future insurance companies clamping down on which procedures you can do?
as you can imagine, this opens up a can of worms, because even though i guess you are technically "board-certified", you are certified by a MUCH lesser board. they certify a lot of practitioners who have no business claiming that they are pain management docs. these boards just suck up 1500 bucks and then give you a piece of paper that has questionable meaning. it allows docs such as yourself -- who has had no formal fellowship training -- to call themselves something that other docs take an extra year to do. also, the fact that there are several such exams out there makes you wonder about the validity of this certification. many of them certify nurse practitioners, and i think chiropractors as well.
now, all this being said, i am not convinced that these boards are completely worthless. there is a chance that they might provide some (albeit weak) leg to stand on if you are challenged either legally or by an insurance company in the future. i dont think this is clear if this is the case or not, but there is a chance that you may be able to claim "board certification" to whoever is challenging you. it does give you an advantage over the average joe out there who does not have any certification.
if i had 1 of these boards to choose, i would go with the AMPM. i think it is the best known after the actual ABMS certification.
i guess the real question is why you would want to take the exam? are you looking to be "board-certified" in pain? would you be trying to market yourself as a "board certified pain management specialist"? trying to insulate yourself from any future insurance companies clamping down on which procedures you can do?
as you can imagine, this opens up a can of worms, because even though i guess you are technically "board-certified", you are certified by a MUCH lesser board. they certify a lot of practitioners who have no business claiming that they are pain management docs. these boards just suck up 1500 bucks and then give you a piece of paper that has questionable meaning. it allows docs such as yourself -- who has had no formal fellowship training -- to call themselves something that other docs take an extra year to do. also, the fact that there are several such exams out there makes you wonder about the validity of this certification. many of them certify nurse practitioners, and i think chiropractors as well.
now, all this being said, i am not convinced that these boards are completely worthless. there is a chance that they might provide some (albeit weak) leg to stand on if you are challenged either legally or by an insurance company in the future. i dont think this is clear if this is the case or not, but there is a chance that you may be able to claim "board certification" to whoever is challenging you. it does give you an advantage over the average joe out there who does not have any certification.
if i had 1 of these boards to choose, i would go with the AMPM. i think it is the best known after the actual ABMS certification.
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Thank you very much SSDoc33. My main reason would be if/when I decide to relocate to perhaps a competitive market I will be, well... more competitive. I woud definitely want to join an established group and at first work as an employee like I am now and not just try and go it on my own. The second reason would be for my own protection. As a side note, the reason I didnt do a fellowship was that my wife was graduating med school as I was graduating residency and I had no idea where she was going to match. Luckily I found this gig.
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Probably not important. Very few states recognize them, so advertising yourself as "Board Certified in Pain Management" with one of them could get you in trouble with your state board. Might help if an insurance company or hospital requires board certification for credentialing in pain procedures, but only if they're not sophisticated enough to know these boards are not ABMS-certified.
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I think SS Doc means ABPM.
The board certification is a very thorny issue indeed partially due to several factors. Pain medicine developed as a formal subspecialty out of anesthesiology in the 70s and 80s. The idea that one could inject virtually any nerve in the body and produce pain relief (albeit temporarily) served as the template for early anesthesia fellowship programs in pain (non-certified by the ABMS). At that time in 1991, pain medicine (called pain management back then....now the term is often used as a derogatory term to describe what CRNAs and other paraprofessionals try to do) largely consisted of peripheral nerve blocks, epidural steroid injections, trigger point injections, and drug management with hydrocodone or methadone. Later in 1993, the ABMS instituted "special qualifications in pain management" as a examination that could be taken by virtually any anesthesiologist that had some pain practice experience (could be recovery room pain control). The ABA administered exam grandfathered in nearly 800 anesthesiologists who may have had virtually no training at all in pain medicine, but who could pass a written examination. Nearly 40% of current anesthesiologists claiming to be "board certified in pain by the ABMS" have little or no training (no fellowship). Because after 1998 only fellowship trained anesthesiologists were eligible to take the ABA special qualification exams and because anesthesia based fellowship programs refused to permit non-anesthesiologists into their fellowships (even though pain medicine as clinically practiced was rapidly evolving in the late 1990s), the ABPM came about as a means to provide board certification to other physicians that specialized in pain medicine but were excluded by anesthesiology from both training and certification in a field of study that had far surpassed what fellows were being taught in their pain fellowships. The ABPMR finally decided to institute their own ABMS special certification grandfathering test in pain that further degraded the quality and validity of the "special qualifications in pain medicine" designation, repeating the same mistake made by the ABA. The ABPMR now has more than 50% of those claiming to be "board certified in pain medicine" having received this designation without any significant training (fellowship in pain). The American Board of Neurology and Psychiatry further compounded the denegration of the "board certification in pain" by adding its own grandfathered physicians without any significant training. As of 2007, there are 1905 anesthesiologists with additional qualifications in pain medicine, 1186 certified by PMR, and 243 certified by neurology/psychology. To add more confusion, the PMR/neurology numbers also include family practitioners and internists that never did any training but were eligible to sit for the certification exam under the glasnost doctrine of all inclusiveness.
The ABPM has certified approximately 2000 physicians, many of which are also board certified in pain by one of the other three ABMS subspecialty pain tracks. The new kid on the block is the ABIPP that uses the WIP exam for FIPP designation in addition to coding and opiate proficiency demonstration.
There is also a board that certifies dentists, chiropractors, nurse anesthesia providers, etc called the American Academy of Pain Management.
So in summary, the ABA through their early exclusionary policies on non-anesthesiologists becoming certified in pain or trained in pain started a war that has resulted in fragmentation of the specialty into several boards, a large contingent of physicians receiving the same certification for having no training but being able to pass a written test as those that spent 1-2 years in pain fellowships, and the ABMS certification process cast into doubt.
Does it really matter in the long run which board one has? At this point probably not since there is such the ABMS made such a farce out of the certification process through rolling grandfathering phases. Now pain programs must give consideration to all comers. A doctor board certified only as a geneticist and may have never handled a needle must be given access to interventional pain programs.
So you tell me....is this entire history confusing or what? Do we have a fair process to identify quality physicians to patients as is espoused by the ABMS? I don't think so. The ABMS has made a mockery of those having trained in pain fellowships. We need a pain residency.....the AMA is now opening hearings to consider just that. Finally.
The board certification is a very thorny issue indeed partially due to several factors. Pain medicine developed as a formal subspecialty out of anesthesiology in the 70s and 80s. The idea that one could inject virtually any nerve in the body and produce pain relief (albeit temporarily) served as the template for early anesthesia fellowship programs in pain (non-certified by the ABMS). At that time in 1991, pain medicine (called pain management back then....now the term is often used as a derogatory term to describe what CRNAs and other paraprofessionals try to do) largely consisted of peripheral nerve blocks, epidural steroid injections, trigger point injections, and drug management with hydrocodone or methadone. Later in 1993, the ABMS instituted "special qualifications in pain management" as a examination that could be taken by virtually any anesthesiologist that had some pain practice experience (could be recovery room pain control). The ABA administered exam grandfathered in nearly 800 anesthesiologists who may have had virtually no training at all in pain medicine, but who could pass a written examination. Nearly 40% of current anesthesiologists claiming to be "board certified in pain by the ABMS" have little or no training (no fellowship). Because after 1998 only fellowship trained anesthesiologists were eligible to take the ABA special qualification exams and because anesthesia based fellowship programs refused to permit non-anesthesiologists into their fellowships (even though pain medicine as clinically practiced was rapidly evolving in the late 1990s), the ABPM came about as a means to provide board certification to other physicians that specialized in pain medicine but were excluded by anesthesiology from both training and certification in a field of study that had far surpassed what fellows were being taught in their pain fellowships. The ABPMR finally decided to institute their own ABMS special certification grandfathering test in pain that further degraded the quality and validity of the "special qualifications in pain medicine" designation, repeating the same mistake made by the ABA. The ABPMR now has more than 50% of those claiming to be "board certified in pain medicine" having received this designation without any significant training (fellowship in pain). The American Board of Neurology and Psychiatry further compounded the denegration of the "board certification in pain" by adding its own grandfathered physicians without any significant training. As of 2007, there are 1905 anesthesiologists with additional qualifications in pain medicine, 1186 certified by PMR, and 243 certified by neurology/psychology. To add more confusion, the PMR/neurology numbers also include family practitioners and internists that never did any training but were eligible to sit for the certification exam under the glasnost doctrine of all inclusiveness.
The ABPM has certified approximately 2000 physicians, many of which are also board certified in pain by one of the other three ABMS subspecialty pain tracks. The new kid on the block is the ABIPP that uses the WIP exam for FIPP designation in addition to coding and opiate proficiency demonstration.
There is also a board that certifies dentists, chiropractors, nurse anesthesia providers, etc called the American Academy of Pain Management.
So in summary, the ABA through their early exclusionary policies on non-anesthesiologists becoming certified in pain or trained in pain started a war that has resulted in fragmentation of the specialty into several boards, a large contingent of physicians receiving the same certification for having no training but being able to pass a written test as those that spent 1-2 years in pain fellowships, and the ABMS certification process cast into doubt.
Does it really matter in the long run which board one has? At this point probably not since there is such the ABMS made such a farce out of the certification process through rolling grandfathering phases. Now pain programs must give consideration to all comers. A doctor board certified only as a geneticist and may have never handled a needle must be given access to interventional pain programs.
So you tell me....is this entire history confusing or what? Do we have a fair process to identify quality physicians to patients as is espoused by the ABMS? I don't think so. The ABMS has made a mockery of those having trained in pain fellowships. We need a pain residency.....the AMA is now opening hearings to consider just that. Finally.
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yes, ABPM.
dont get AMPM certification. that was the worst 2 grand i ever spent....👎
however, algos, one would think that all of these grandfathers would eventually retire, stop practicing, etc. what you'd would have left would be a portion of the pain management scene with AMBS certification, and the rest with all of the lesser boards. at that point, wouldnt the AMBS certification mean more than it does now?
dont get AMPM certification. that was the worst 2 grand i ever spent....👎
however, algos, one would think that all of these grandfathers would eventually retire, stop practicing, etc. what you'd would have left would be a portion of the pain management scene with AMBS certification, and the rest with all of the lesser boards. at that point, wouldnt the AMBS certification mean more than it does now?
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Eventually, the ABMS special qualifications in pain medicine may come to have some coherent meaning to patients, insurers, and hospitals, but at this time we have at least 2 decades before us when there will continue to be physicians espousing this certification with no training at all. The ABMS, in its quest to please virtually anyone that wanted the certificate, created a series of loopholes that defied logic and were profoundly damaging to the specialty of pain medicine. In their vehement opposition to pain medicine as a specialty with applications repeatedly being denied by the ABMS, they now have defined pain medicine ludicrously as a subspecialty without any prerequisite background criteria at all except that one must be certified by one of the base ABMS boards. So now an allergist, dermatologist, nuclear medicine physician, or geneticist can take a one year fellowship and presto change-o...they are pain doctors according to the ABMS. They have the same merit according to the ABMS as do physicians that have spent 4 years in anesthesiology or PMR then doing a fellowship in pain. I may be mistaken, but the curriculum of genetics or allergy medicine is so far removed from pain that there is essentially a complete disconnect. But that doesn't stop the ABMS from claiming their geneticist-turned-pain physician and their over a 1500 grandfathered physicians with no training at all are equally qualified to those with ABA or PMR base certifications followed by a pain fellowship. From the website of the ABMS: "Certification Matters.
The American Board of Medical Specialties (ABMS), a not-for-profit organization, assists 24 approved medical specialty boards in the development and use of standards in the ongoing evaluation and certification of physicians. ABMS, recognized as the "gold standard" in physician certification, believes higher standards for physicians means better care for patients. " In fact their "standards" are so nebulous that they are meaningless, now and well into the future.
The American Board of Medical Specialties (ABMS), a not-for-profit organization, assists 24 approved medical specialty boards in the development and use of standards in the ongoing evaluation and certification of physicians. ABMS, recognized as the "gold standard" in physician certification, believes higher standards for physicians means better care for patients. " In fact their "standards" are so nebulous that they are meaningless, now and well into the future.
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i think we have to make a distinction here
1) the original poster is getting a "mentorship" in providing procedures - and for that mentorship he would like to pay some money, take a test and be considered Board Certified in Pain Management...
2) there is a stark difference in my mind between getting a lot of training in doing procedures and the management of pain...
I believe that to be board certified in Pain Management you should be comfortable understanding and treating most types of pain --- the fact that you can do a lot of procedures proficiently does not equal an understanding of diagnosis or treatment modalities (beyond injections)....
Now, let's say original poster gets a certificate from ABPM - does that mean they will now understand how to manage bony cancer pain, or that they will understand how to diagnose/manage delayed radiation-induced neuropathy/plexopathy pain, or that they will understand the intricacies of opioid management.... or does that mean they can do injections and have a piece of paper to put on the wall to protect their interests from a marketing point of view???
in my humble opinion, what the original poster (and his ilk) should be seeing is certification in "interventional procedures", and I would posit that the FIPP is the closest to that type of focus
i don't bear any ill-will, but this topic is similar to a family practitioner who learns how to do colonoscopies and then wants to get certified as a gastro-enterologist - and what he should really be getting certified as is "Colonoscopist"...
my 2 cents.... and I wish Myofascist all the best in his career.
1) the original poster is getting a "mentorship" in providing procedures - and for that mentorship he would like to pay some money, take a test and be considered Board Certified in Pain Management...
2) there is a stark difference in my mind between getting a lot of training in doing procedures and the management of pain...
I believe that to be board certified in Pain Management you should be comfortable understanding and treating most types of pain --- the fact that you can do a lot of procedures proficiently does not equal an understanding of diagnosis or treatment modalities (beyond injections)....
Now, let's say original poster gets a certificate from ABPM - does that mean they will now understand how to manage bony cancer pain, or that they will understand how to diagnose/manage delayed radiation-induced neuropathy/plexopathy pain, or that they will understand the intricacies of opioid management.... or does that mean they can do injections and have a piece of paper to put on the wall to protect their interests from a marketing point of view???
in my humble opinion, what the original poster (and his ilk) should be seeing is certification in "interventional procedures", and I would posit that the FIPP is the closest to that type of focus
i don't bear any ill-will, but this topic is similar to a family practitioner who learns how to do colonoscopies and then wants to get certified as a gastro-enterologist - and what he should really be getting certified as is "Colonoscopist"...
my 2 cents.... and I wish Myofascist all the best in his career.
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Agree with above.
In my area, hospital priviliges are starting to require ABMS boards credentialling. ABPMan is not a serious board. ABPMed will be the board.
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Thank you for the well wishes Tenesmus and I respect your opinion but I beg to differ. During my PM+R residency I did 4 months of pain (where there is an ACGME fellowship) and did numerous injections and saw many different types of pain (including bony cancer pain). This is not including the 1+ year of outpt MSK which obiously has alot of overlap. I remember vividly teaching the anesthesia fellows how to do a good shoulder and knee exam, but I give them credit, they were great at straight leg raises and spurlings. So, me getting a "lesser" certification to state that I am qualified to do some pain procedures and medically manage some chronic pain is quite different than a FP doc trying to get board certified as a GI doc. I dont remember any FP residents doing colonoscopies routinely. I do agree with you, however, regarding a different name to the certification to make a distinction between fellowship and non-fellowship trained physicians and there also should be a limitation on who can apply for these lesser certifications. The bottom line when it really comes down to it is if you are good at what you do and at least have a somewhat reasonable personality you will be successful, if you suck (fellowship or not) you'll probably end up with a whole lot of no-shows and not a whole lot of money in the bank.
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Myofacist - here's the deal:
ACGME vs non-ACGME makes absolutely no difference in terms of the quality of training you received. I know a number of ACGME fellowship trained pain specialists who I wouldn't let do procedures on my dog, and some of the best interventionists I know trained at non-ACGME accredited fellowships (eg. PM&R fellowships under Slipman, RIC, UW, WashU, BI in NY, HSS, Florida Spine Inst, Geraci, etc). It may be different in anesthesia, but I suspect we all have local fellowship trained docs who we know are either theives or simply incompetent. So just doing a fellowship will not necessarily make you competent, or give you street cred.
That being said, a mentorship is not a fellowship. Those of us who did ACGME-accredited fellowships get the benefit of the doubt. Unless your "mentorship" was under some pain rock-star (Pauza, Dreyfuss, Bogduk, etc), you will not get the same benefit of the doubt, and will need to prove yourself when you get out into practice to earn your rep, both with referral sources and your pain peers.
Legitimate non-ABMS boards (i.e. ABPMed) enable to portray yourself as a well-trained pain doc, at least to FPs and PCPs. Of equal importance, god-forbid a complication ensues, Boards cover your butt in court when opposing council asks you about your credentials (and yes, in this instance, ANY board certification will likely suffice).
Oh, and comments like "I did 4 months of procedures in residency" will undoubtedly be met with eye rolls and "BFD" mutterings by your colleagues - it is far different when you are on your own than when you have a mentor or staff looking over your shoulder to take care of problems when they arise.
ACGME vs non-ACGME makes absolutely no difference in terms of the quality of training you received. I know a number of ACGME fellowship trained pain specialists who I wouldn't let do procedures on my dog, and some of the best interventionists I know trained at non-ACGME accredited fellowships (eg. PM&R fellowships under Slipman, RIC, UW, WashU, BI in NY, HSS, Florida Spine Inst, Geraci, etc). It may be different in anesthesia, but I suspect we all have local fellowship trained docs who we know are either theives or simply incompetent. So just doing a fellowship will not necessarily make you competent, or give you street cred.
That being said, a mentorship is not a fellowship. Those of us who did ACGME-accredited fellowships get the benefit of the doubt. Unless your "mentorship" was under some pain rock-star (Pauza, Dreyfuss, Bogduk, etc), you will not get the same benefit of the doubt, and will need to prove yourself when you get out into practice to earn your rep, both with referral sources and your pain peers.
Legitimate non-ABMS boards (i.e. ABPMed) enable to portray yourself as a well-trained pain doc, at least to FPs and PCPs. Of equal importance, god-forbid a complication ensues, Boards cover your butt in court when opposing council asks you about your credentials (and yes, in this instance, ANY board certification will likely suffice).
Oh, and comments like "I did 4 months of procedures in residency" will undoubtedly be met with eye rolls and "BFD" mutterings by your colleagues - it is far different when you are on your own than when you have a mentor or staff looking over your shoulder to take care of problems when they arise.
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Thanks ampaphb, that helps. BTW I only used the "4 months of pain during residency" comment to argue that I am at least a little ahead of the game in comparison to a FP doc trying to do colonoscopies. I definitely agree that solo is a whole different deal and I plan on earning my respect by my performance which will obviously improve with more experience. Thanks again.
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Ampa,
Along the same lines of thought as Tenesma,
Through organizations like ISIS and ASIPP, we all learn from various expert interventionalists from different specialties, many of whom do not practice (and likely do not have a full knowledge base in) "Pain Medicine".
Unfortunately, aside from the various pain medicine certifications, there are no legitimate certifications associated with interventional procedures. (I suppose being boarded in IR counts, but they typically work in the hospital and obtain priviledges through the Rads dept).
Until there are recognized procedural certifications, practicioners in other specialties who utilize interventional procedures will seek out "Pain Medicine" certification, whether the comprehensive "pain" knowledge base is there or not.
I agree that the fellowships you listed are excellent, but fellows from these programs should be tested on what they were trained in, which, generally speaking, is musculoskeletal medicine/orthopedic evaluation, etc. and procedures. They shouldn't be required to test on topics they were not exposed to or trained in, just to cover themselves for procedures.
If recognized procedural certifications ever come about e.g. the ABPMR Interventional Spine CAQ or ABMS recognition of ABIPP, I think you'll see these types of issues disappear rather quickly.
