Worth it to do the Sports and Spine fellowship?

[cbest]

With all of the discussion regarding the more stringent requirements for performing interventional spine procedures and the possible (probable) emergence of the pain medicine residency, is it still going to be worth the effort of sports and SPINE or interventional spine fellowship in a few years? I'm just curious because I like the idea of incorporating some of the more 'bread and butter' spine procedures into a sports and spine practice; however, I'm a bit worried that the spine training would be all for naught if I wouldn't be able to obtain hospital privileges to perform the procedures. And then there would be the insurance reimbursement issues... yikes!

Is there any chance that if some of the sports and spine fellowships obtain ACGME accreditation that the interventional procedures would then be allowed?

In a few years, would it be better to just do either a sports medicine fellowship or a pain medicine fellowship and resign to let other physicians cover the stuff that was not incorporated into whatever fellowship training was completed?

Thanks for any insight and information!

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[HarveyCushing]

As I am only a med-student myself I can't really help you out. I had a similar question and this post might be helpful: http://forums.studentdoctor.net/showpost.php?p=7636726&postcount=32.

Also, if you did a spine fellowship wouldn't you get a grandfather clause if/when a pain medicine residency began?

 

[PMR 4 MSK]

Grandfathering likely. But honestly, it is very likely that the whole face of medicine will be so different than it is now, primarily for economic reasons, that no one can predict what will happen.

Wait until the times comes for you to have to make the decision and see what the state of things is at that time.

If you had to make a decsion today, do what you are atttracted to because it interests you, not because of what may happen in the future.

 

[bedrock]

If you had to make a decsion today, do what you are atttracted to because it interests you, not because of what may happen in the future.

Definitely agree with the above.

I don't think it's that likely that fellowship trained but non-pain boarded physiatrists won't be able to get credentialed to do spinal procedures in most locations. There are so many specialties that perform these procedures now, anesthesia, radiology, surgery, physiatry, neurology. Extremely unlikely that this would ever be an issue at ambulatory surgical centers which are all over the place, and at most hospitals. There will be some large hospitals in major urban centers at which you might have difficulties because of the anesthesia influence on credentialing.
It all depends on how much you want to be able to do spine interventions at any procedure room in america, vs having the kind of practice you want (sports/spine, not pain patients).

 

[Disciple]

With all of the discussion regarding the more stringent requirements for performing interventional spine procedures and the possible (probable) emergence of the pain medicine residency, is it still going to be worth the effort of sports and SPINE or interventional spine fellowship in a few years? I'm just curious because I like the idea of incorporating some of the more 'bread and butter' spine procedures into a sports and spine practice; however, I'm a bit worried that the spine training would be all for naught if I wouldn't be able to obtain hospital privileges to perform the procedures.

You don't need "interventional" hospital privileges in most cases. Standard PM&R privileges will do for most major insurers so that you can get reimbursed doing procedures in your office or an ASC. Some hospitals have interventional privileges as part of the standard PM&R privileges request form.

If you look at how the government makes decisions on where cuts will occur in healthcare spending, it is typically dependent on their agenda, or the agenda of those who have the strongest lobby.

No physician specialty group has a strong enough lobby to enforce its agenda against the agenda of multiple other physician specialty and generalist groups.

 

[Disciple]

Definitely agree with the above.

I don't think it's that likely that fellowship trained but non-pain boarded physiatrists won't be able to get credentialed to do spinal procedures in most locations. There are so many specialties that perform these procedures now, anesthesia, radiology, surgery, physiatry, neurology. Extremely unlikely that this would ever be an issue at ambulatory surgical centers which are all over the place, and at most hospitals. There will be some large hospitals in major urban centers at which you might have difficulties because of the anesthesia influence on credentialing.
It all depends on how much you want to be able to do spine interventions at any procedure room in america, vs having the kind of practice you want (sports/spine, not pain patients).

Agree,

To the OP, look at non-Certificate of Need states. There are ambulatory surgery centers on every corner, all in competition with each other.

You just call each one up until you find one that will give you privileges. Most will just want some proof of training and then have one of their senior guys proctor a few of your cases to make sure you're safe.

In Certificate of Need states, you'll find alot of in-office procedure rooms.

Works either way.

 

[cbest]

Thank you very much for the responses! As always, your insight is greatly appreciated!