2 yr Pain Fellowship in San Francisco

[DigableCat]

Has anyone heard anything good, bad, or indifferent about it?

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[drusso]

I haven't heard anything, but I know that it's is not a ACGME approved fellowship. I lived in the Bay Area for 4 years and know that the sponsoring hospital is a good one. It's one of the new efforts by the American Board of Pain Medicine to create their own accredited fellowships I believe...

--David

 

[DigableCat]

I haven't heard anything, but I know that it's is not a ACGME approved fellowship. I lived in the Bay Area for 4 years and know that the sponsoring hospital is a good one. It's one of the new efforts by the American Board of Pain Medicine to create their own accredited fellowships I believe...

--David

Although it doesn't appear to be ACGME accredited, it appears that through the American Board of Pain Medicine you can sit for a qualifying examination as well.

That makes at least three certifying examinations that you can take to be "accredited".

Through:

American Board of Physical Medicine and Rehabilitation(ABPMR)
American Board of Anesthesiology(ABA)

and now through American Board of Pain Medicine(ABPM).



I'm wondering if it will make a difference at all...certification is certification. And it appears from the current diplomates of ABPM that I see on the website, the organization is well regarded.

 

[paz5559]

Although it doesn't appear to be ACGME accredited, it appears that through the American Board of Pain Medicine you can sit for a qualifying examination as well.

That makes at least three certifying examinations that you can take to be "accredited".

Through:

American Board of Physical Medicine and Rehabilitation(ABPMR)
American Board of Anesthesiology(ABA)

and now through American Board of Pain Medicine(ABPM).

I'm wondering if it will make a difference at all...certification is certification. And it appears from the current diplomates of ABPM that I see on the website, the organization is well regarded.

1) The exam you would sit for is offered by the ABA, but the certification comes from the ABPM&R if you are PM&R trained. ABA does not certify PM&R docs. So not three certifying organizations, just two.

2) The BIG difference between ABPM&R and ABPM certification is one is ACGME, the other is not. Is ABPM attempting to gain that certification? You bet! How come? Cause certifications are most definitely NOT created equal.

In a lot of specialties, if you are not board certified, you can join an alternate board, typically by writing them a check, and them sending you a certificate to hang on your wall. These are non-ABMS (American Board of Medical Specialties) certifications, and not recognized as legitimate boards. In order to BE an ABMS board, you have to be a member of the ACGME, which ABPM is currently NOT.

ABPM is a legitimate board, with a legitimate test. Their diplomates carry virtually the same weight currently as ABPM&R certificate holders. But they are lumped in with the disreputable boards, and unless that status changes, your certification will NOT be viewed in the same light as one from an ACGME accredited program

Now, all that being said, I am doing a non-ACGME accredited fellowship next year 'cause the one I was fortunate enough to get offered what I felt to be the best training, regardless whether I would be able to sit for ABA Pain boards thereafter. This is a discussion drusso and I have privately ad naseum, and it is a decision almost every fellowship candidate has to address at some point during the application process.

But to reiterate the point, at present, not all certifications are created equal.

 

[DigableCat]

In a lot of specialties, if you are not board certified, you can join an alternate board, typically by writing them a check, and them sending you a certificate to hang on your wall. These are non-ABMS (American Board of Medical Specialties) certifications, and not recognized as legitimate boards. In order to BE an ABMS board, you have to be a member of the ACGME, which ABPM is currently NOT.

ABPM is a legitimate board, with a legitimate test. Their diplomates carry virtually the same weight currently as ABPM&R certificate holders. But they are lumped in with the disreputable boards, and unless that status changes, your certification will NOT be viewed in the same light as one from an ACGME accredited program

As far as I know...these are the only 2 certifications you can obtain in Pain Medicine. And I've looked up quite a few pain medicine practices and it seems that some have certification through ABA and some through ABPM.

Por ejemplo:
Pain Care Center where one doc in ABA certified and the other is ABPM certified


If you know of any "send in a check and we'll board certify you in Pain Medicine" places, I'd be interested in knowing where these are. As I'm unable to find them.

Why one fellowship chooses to pursue ABA/ACGME certification over ABPM certification is beyond me, although I plan on finding out.

I'd heard from people who were interviewing for MUSCULOSKELETAL fellowships that of course are not ACGME accredited, was that by the program not seeking ACGME accreditation, you could bill as an attending(although you were getting paid as a resident). Plus all fellows through ACGME had to present to an upper level attending versus you could see patients independently(with supervision from attendings). Ultimately, it seemed more about money and billing than anything else.

 

[drusso]

Why one fellowship chooses to pursue ABA/ACGME certification over ABPM certification is beyond me, although I plan on finding out.

...And I hope that you will report back to the group what you learn!

 

[paz5559]

As far as I know...these are the only 2 certifications you can obtain in Pain Medicine. And I've looked up quite a few pain medicine practices and it seems that some have certification through ABA and some through ABPM.

Por ejemplo:
Pain Care Center where one doc in ABA certified and the other is ABPM certified


If you know of any "send in a check and we'll board certify you in Pain Medicine" places, I'd be interested in knowing where these are. As I'm unable to find them.

The American Academy of Pain Management is the one most often cited.

Why one fellowship chooses to pursue ABA/ACGME certification over ABPM certification is beyond me, although I plan on finding out.

ACGME certification is for PAIN, not spine, not interventional spine, and not for musculoskeletal fellowships. The distinction is significant because none of those other fellowships would want to address cancer pain, pain in pediatrics, or generally, acute, inpatient pain issues. New rules have recently been added to require involvement of other specialties (this was presented by Dr. Smith in Phoenix, although the rules may not have yet been implemented).

Also, you may be under the misimpression that your fellowship need be ABPM accredited in order to sit for the ABPM certification exam. As far as I know, this is not the case.

I'd heard from people who were interviewing for MUSCULOSKELETAL fellowships that of course are not ACGME accredited, was that by the program not seeking ACGME accreditation, you could bill as an attending (although you were getting paid as a resident). Plus all fellows through ACGME had to present to an upper level attending versus you could see patients independently(with supervision from attending). Ultimately, it seemed more about money and billing than anything else.

The distinction you draw regarding billing has much more to do with private preceptorships vs academic center based fellowships. In the private sector, clearly, you have to earn your keep, but that is typically volume related. IF anyone is billing you as an attending when you are still in training, that is FRAUD, and you ought to be VERY careful about joining any such enterprise.

Who you can present to is simply a red herring, and not at all related to the accreditation you receive at the end of your training.

 

[DigableCat]

The American Academy of Pain Management is the one most often cited.

Well...even they are little more than "send in a check", they do have some requirements which appears more accrediting the CENTER rather than the PHYSICIAN. And this happens more often than we realize anyway. There is a place around the corner from me in that call itself AQUATIC PAIN REHABILITATION CENTER. I didn't see one physicians name on the door. So it's more of a consumer beware philosophy. Patients that want to know if their physician is BOARD CERTIFIED or not will find out. Some don't care really. And some physicians are not certified in pain but I'm sure they do a good job. Does it matter if they are? It's up to you.

Plus, being a member of an organization in no way confers competence. A A medical student can join the AAPM&R, but that doesn't make them a physiatrist.


ACGME certification is for PAIN, not spine, not interventional spine, and not for musculoskeletal fellowships. The distinction is significant because none of those other fellowships would want to address cancer pain, pain in pediatrics, or generally, acute, inpatient pain issues. New rules have recently been added to require involvement of other specialties (this was presented by Dr. Smith in Phoenix, although the rules may not have yet been implemented).

The fellowship that I know of that is ABPM certified does in fact deal with all those issues. Not to mention the examination emcompasses all of those topics.

http://www.abpm.org/ce/outline.htm


Also, you may be under the misimpression that your fellowship need be ABPM accredited in order to sit for the ABPM certification exam. As far as I know, this is not the case.


Maybe not...but there are requirements.

http://www.abpm.org/ce/bulletin.pdf

If anything...the ABPM looks to be more training oriented as they expect you to have done 18 months at least as opposed to the traditional 12 months.


The distinction you draw regarding billing has much more to do with private preceptorships vs academic center based fellowships. In the private sector, clearly, you have to earn your keep, but that is typically volume related. IF anyone is billing you as an attending when you are still in training, that is FRAUD, and you ought to be VERY careful about joining any such enterprise.


This was in fact an academic musculoskeletal fellowship position.

 

[paz5559]

If anything...the ABPM looks to be more training oriented as they expect you to have done 18 months at least as opposed to the traditional 12 months.

Actually, that is a PRACTICE requiremnet, not a TRAINING requirement

 

[DigableCat]

Actually, that is a PRACTICE requiremnet, not a TRAINING requirement

Wouldn't it be better to have more practical experience plus competence in an exam to proclaim yourself a pain physician.

I know of plenty Pain Fellows who are whisking through this year, without a breath to take. And would I necessarily trust them to give me a cervical medial branch block just because they passed an exam....not likely.


Maybe certain aspects of pain should be substratified, such as the interventional part...and a practical exam administered. That way someone can personally observe a person doing a procedure to confer competency.

Just a thought.

 

[DigableCat]

...And I hope that you will report back to the group what you learn!

It seems that besides the ungodly amount of paperwork needed to become ACGME accredited(seems to be a recurring lazy theme it seems)...you also have to be associated with an academic program, something Krames doesn't have. The only academic affiliated Pain Fellowship in San Francisco is at UCSF-Mt Zion, and that's with the Department of Anesthesiology.

I think you have to beware of some private practice fellowships. By not being associated with an academic program, you have some drawbacks...

A friend of mine is doing a private practice fellowship(he can still sit for the boards because he graduated last year) and he is having major issues with the guy(changing rules of clinic coverage mid stream, not letting him do as many(or types) of procedures as he promised, just NOT pleasant to work with). Unfortunately, there is no one he can really go to, as this guy is the CHAIRMAN, PROGRAM DIRECTOR, FINANCIAL OFFICER, ATTENDING, etc. And he answers to no one but himself. Ultimately, I think my friend is going to leave this program and possibly try to finish someplace else.

Somehow, I think this will less likely happen at an academic program.

 

[paz5559]

It seems that besides the ungodly amount of paperwork needed to become ACGME accredited(seems to be a recurring lazy theme it seems)...you also have to be associated with an academic program, something Krames doesn't have. The only academic affiliated Pain Fellowship in San Francisco is at UCSF-Mt Zion, and that's with the Department of Anesthesiology.

I think you have to beware of some private practice fellowships. By not being associated with an academic program, you have some drawbacks...

A friend of mine is doing a private practice fellowship(he can still sit for the boards because he graduated last year) and he is having major issues with the guy(changing rules of clinic coverage mid stream, not letting him do as many(or types) of procedures as he promised, just NOT pleasant to work with). Unfortunately, there is no one he can really go to, as this guy is the CHAIRMAN, PROGRAM DIRECTOR, FINANCIAL OFFICER, ATTENDING, etc. And he answers to no one but himself. Ultimately, I think my friend is going to leave this program and possibly try to finish someplace else.

Somehow, I think this will less likely happen at an academic program.

While private fellowships CAN be the domain of an individual practitioner, they are not necessarily so (ie. the Florida Spine Institute). Academic fellowships can also be the private fifedom's of one particular attending (ie. Slipman @ Penn, Furman @ Sinai).

Ultimately, you have to do your due diligence before comitting to a fellowship, and if it is not a good personality fit, then go elsewhere, no matter what the academic, prestige, or economic considerations. Afterall, you have to survive the year to accrue the benefits of any fellowship