Practicing pain as general anesthesiologist

[Hoebo54]

Dear Anesthesia collective,

I've come across an opportunity to practice some pain management without a fellowship. I would only be doing lumbar injections( facets/epidurals/MBB), SI joints, and a variety of ultrasound guided injection( genicular/suprascapular/joint injections etc) and some other ancillary services. I'm pretty comfortable with all the ultrasound guided stuff but haven't done chronic pain since residency( 4 years ago). The practice will offer training/teaching for the chronic pain portion until I'm comfortable. Anyone here have any thoughts/recommendations or have done something similar in the past I'd love to hear about it.

Thanks,

aspiring needle jockie

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[TaoistDoc]

Just do it. I know orthopedic and sports med docs (family practice background) doing those procedures and I doubt they had as much training during residency as we do for those procedures. If they are willing to train you, I'm sure you can be proficient after doing 20-30 of each supervised.

 

[Hoya11]

Dear Anesthesia collective,

I've come across an opportunity to practice some pain management without a fellowship. I would only be doing lumbar injections( facets/epidurals/MBB), SI joints, and a variety of ultrasound guided injection( genicular/suprascapular/joint injections etc) and some other ancillary services. I'm pretty comfortable with all the ultrasound guided stuff but haven't done chronic pain since residency( 4 years ago). The practice will offer training/teaching for the chronic pain portion until I'm comfortable. Anyone here have any thoughts/recommendations or have done something similar in the past I'd love to hear about it.

Thanks,

aspiring needle jockie

I did a pain fellowship.

Its just exposure and repetition.

As long as the practice is willing to give you exposure to the patients in clinic and the simple fluoro injections, it should be doable.

You could probably grasp the basics in 6 months - 1 year of full time training.

As a general piece of advice: Make sure what you are doing is helping people.

Different than anesthesia, there is a huge component of industry in pain, both in meds and injections. Make sure that what is happening to the patient makes sense to you and feels right to you. You don't want them to "train" you to have money making as the primary objective over patients.. Sounds corny but you will see what I mean.. All the best...

 

[abolt18]

I did a pain fellowship.

Its just exposure and repetition.

As long as the practice is willing to give you exposure to the patients in clinic and the simple fluoro injections, it should be doable.

You could probably grasp the basics in 6 months - 1 year of full time training.

As a general piece of advice: Make sure what you are doing is helping people.

Different than anesthesia, there is a huge component of industry in pain, both in meds and injections. Make sure that what is happening to the patient makes sense to you and feels right to you. You don't want them to "train" you to have money making as the primary objective over patients.. Sounds corny but you will see what I mean.. All the best...

6 months to a year of full time training?!?!!!? He's not doing a pain fellowship. He's not doing surgical procedures, implanting stimulators or pumps, or doing vertebroplasties.

He's talking fluoro-guided lumbar injections, SI injections. And the US guided stuff. Seriously. You believe 6mo to a year of full year would be necessary!!??!! Maybe 6 weeks!

I don't contest anything else you've stated.

Edit: feel free to replace "he" with "she" anywhere in my post as I have no idea if OP is a man or a woman.

 

[Hoya11]

6 months to a year of full time training?!?!!!? He's not doing a pain fellowship. He's not doing surgical procedures, implanting stimulators or pumps, or doing vertebroplasties.

He's talking fluoro-guided lumbar injections, SI injections. And the US guided stuff. Seriously. You believe 6mo to a year of full year would be necessary!!??!! Maybe 6 weeks!

I don't contest anything else you've stated.

Edit: feel free to replace "he" with "she" anywhere in my post as I have no idea if OP is a man or a woman.

to purely perform the injections sure 6 weeks..

to competently run a pain clinic and manage the patients ? i think it just takes time and exposure to the world that is pain, its not that its hard

 

[Hoebo54]

Thats good hear, just wasn't sure of the learning curve. I'm sure I'll be trained ethically as pain clinic is ran by my wife who does everything by the book.

 

[TaoistDoc]

You didn't mention the part about working for your wife. STAY AWAY! lmao

 

[Hoebo54]

not sure what that dynamic will be like, seeing her every day and night. financially she takes my money anyways so that won't change when I start working for her

 

[norski]

Smart man.

not sure what that dynamic will be like, seeing her every day and night. financially she takes my money anyways so that won't change when I start working for her

 

[deleted875186]

I did a pain fellowship.

Its just exposure and repetition.

As long as the practice is willing to give you exposure to the patients in clinic and the simple fluoro injections, it should be doable.

You could probably grasp the basics in 6 months - 1 year of full time training.

As a general piece of advice: Make sure what you are doing is helping people.

Different than anesthesia, there is a huge component of industry in pain, both in meds and injections. Make sure that what is happening to the patient makes sense to you and feels right to you. You don't want them to "train" you to have money making as the primary objective over patients.. Sounds corny but you will see what I mean.. All the best...

This x 100

LESI, RFA, SIJ, do help people. But there are some things that can get shady.

 

[Monterosso]

Some thoughts from another thread on insurance reimbursement without an ACGME fellowship:

"Speaking from (very hard) experience as someone who did a VERY GOOD non-ACGME accredited pain (sports/interventional spine) fellowship and then went on to become a diplomat of the ABPM (American Board of Pain Medicine) I have had ENDLESS problems with insurance companies denying payment for services (including consults, clinic visits and procedures) because I'm not board certified through ABMS. It has become enough of a problem that I am going back to do a real ACGME fellowship just so I can sit for the ABMS boards and make these problems go away. Admittedly, I work in a state that is less understanding than others (CA, TX and a handful of mid-west states consider ABPM to be equivalent to ABMS) but because of family reasons I can't practice in one of those states and the only solution is to take a 1 year leave from my well-paying job and do a fellowship. It's a hard reality but I would advise anyone to just do an ACGME fellowship and avoid a situation like mine. All jobs in my state and the surrounding states specify ACGME fellowship trained as a job requirement (apparently I'm not the first person around here to deal with this problem). I'm in the southwest USA."

Disadvantages of Non-ACGME Accredited Pain Programs

Did a search and the thread was from 6.5 years ago; wanted to see if anything has changed. I just mainly wanted to know what the disadvantages are if you do a non-ACGME accredited pain fellowship; mainly if reimbursements are different, diff in hospital or practice privileges, findings jobs...

forums.studentdoctor.net

 

[nimbus]

Some thoughts from another thread on insurance reimbursement without an ACGME fellowship:

"Speaking from (very hard) experience as someone who did a VERY GOOD non-ACGME accredited pain (sports/interventional spine) fellowship and then went on to become a diplomat of the ABPM (American Board of Pain Medicine) I have had ENDLESS problems with insurance companies denying payment for services (including consults, clinic visits and procedures) because I'm not board certified through ABMS. It has become enough of a problem that I am going back to do a real ACGME fellowship just so I can sit for the ABMS boards and make these problems go away. Admittedly, I work in a state that is less understanding than others (CA, TX and a handful of mid-west states consider ABPM to be equivalent to ABMS) but because of family reasons I can't practice in one of those states and the only solution is to take a 1 year leave from my well-paying job and do a fellowship. It's a hard reality but I would advise anyone to just do an ACGME fellowship and avoid a situation like mine. All jobs in my state and the surrounding states specify ACGME fellowship trained as a job requirement (apparently I'm not the first person around here to deal with this problem). I'm in the southwest USA."

Disadvantages of Non-ACGME Accredited Pain Programs

Did a search and the thread was from 6.5 years ago; wanted to see if anything has changed. I just mainly wanted to know what the disadvantages are if you do a non-ACGME accredited pain fellowship; mainly if reimbursements are different, diff in hospital or practice privileges, findings jobs...

forums.studentdoctor.net

That’s interesting. Pain medicine must have stricter credentialling than anesthesia since non certified/not yet certified anesthesiologists have no problems getting paid anywhere.

 

[deleted875186]

That’s interesting. Pain medicine must have stricter credentialling than anesthesia since non certified/not yet certified anesthesiologists have no problems getting paid anywhere.

Insurrance companies have cracked down on pain procedures. Look at all the hoops I have to jump through to get LESI, facet injection, or MRI approved. Patients can go get a multilevel fusion for axial back pain faster and easier than I can get an injection approved, it’s disgusting.

 

[deleted875186]

I even get Lyrica, buprenorphine, tramadol rejected by insurrance companies when I do PAs.

just got a PA denied for buprenorphine, “patient has to fail MS Contin first” was the reason

 

[deleted875186]

Why is it that evicore and AIM deny a lumbar MBB or RFA at the same level as a previous fusion? But the patient can go back to their unethical neurosurgeon and get endless back surgeries for axial back pain? Simply disgusting, Evicore and AIM have a special place in hell waiting for them.

 

[chocomorsel]

I even get Lyrica, buprenorphine, tramadol rejected by insurrance companies when I do PAs.

just got a PA denied for buprenorphine, “patient has to fail MS Contin first” was the reason

Boy this country has ass backwards issues. Do they realize what they are doing and creating? Of course they do and don’t care. Probably in bed with the MS Contin producers.