With the restructuring of the ACGME accredited pain fellowships to one interdisciplinary fellowship per institution and expanded requirements of participating departments some fellowship programs had to merge and reduce slots, others had to close (UF comes to mind).
So I think it is a matter of less spots, not less interest.
Medicine has always been an economic shell game - Medicare makes pumps profitable, and they are done to excess. Reimbursement drops precipitously, and low and behold, far fewer pumps are appropriate!
Intradiscal firbrin glue, chondrocytes, or gene vectors, percutaneous x-stops, biaccuplasty, etc are all coming down the pike or have recently emerged. Stim indications are expanding exponentially. I have heard physicians gripe about reductions in reimbursement for 25 years. Pain, like every other aspect in medicine, will modify practice patters in accord with changes in fee schedules.
So please don't cry me a river of tears for the poor starving pain practitioner - the only people whose incomes will suffer are those who aren't able to adapt.
i am already seeing it ---- the surgeons have seen a huge decline in the number of elective surgeries, either because their companies have changed over to HIGH deductible plans or because they are in fear of lay-off if they take time off or because they or their spouse has been laid off...
in my hospital the surgeons have seen a 15% decrease in elective cases in November and december is looking worse (and USUALLY december is the busiest because everybody tries to get things done before deductibles reset).
i am seeing this in my practice as well...
Panetrain, biaculoplasty, IDET, Distrode, Accutherm, PRFT, Annuloplasty are all included on the non-coverage list by Medicare when used to treat back pain. Also included is Plasma Disc Decompression (Coblation nucleoplasty). The entities not included in TIPS are laser disc decompression and disc decompressor. It is not clear if these would be covered for low back pain treatment or were just not addressed.
No, then we still hate them, we just hope our lawyer is better than their lawyer.Everybody hates lawyers ... until they need one.