Unaccredited pain fellowship - tips

[LineEmTubeEm]

I will possibly be joining a new unaccredited pain fellowship next year. I want to avoid pitfalls and need help figuring out what I should inquire about prior to agreeing to anything. Any help from someone who has performed or runs an unaccredited pain fellowship or knows how these things work, would be very beneficial. Can post in thread or DM me. Thanks.

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[RoloTomassi]

Unaccredited or NASS? New as in you're the first class?

 

[LineEmTubeEm]

Unaccredited, not NASS. Correct - first class, one fellow

 

[Ferrismonk]

This isn't helpful to you, but I think unaccredited "fellowships" are complete crap.

You will be a terribly underpaid doctor extending the ability of your "trainer" to bill more. There will likely be plenty of "education" on doing procedures and little actual education about pain. If you are completely bent on doing this, try to ensure you receive didactics and out rotations to cover some rehabilitation, radiology, and psych at a minimum.

 

[RoloTomassi]

Unaccredited, not NASS. Correct - first class, one fellow

Without oversight, it can be great or can be indentured servitude.

 

[Agast]

Ah, makes me miss those Piebaldi posts. Wonder how the lawsuits turned out.

 

[bedrock]

Unaccredited, not NASS. Correct - first class, one fellow

Unaccredited is one thing , but being the first fellow in unaccredited is another.
Really hard to predict what experience you will have and promises are just promises.

 

[lobelsteve]

I miss teaching. I thought I had a good program.

 

[adiradirim]

What are you hoping to get out of doing this fellowship? You should figure out what your goals are and work towards meeting them.

 

[DODOCSS]

Unaccredited is one thing , but being the first fellow in unaccredited is another.
Really hard to predict what experience you will have and promises are just promises.

he/she will be fine.

it's the fight in the dog

 

[Crybaby]

LineEmTubeEm
I did an unaccredited program. I had a great experience.
Positives include, I got insight into private practice, real world patient flow, and billing. My numbers for bread and butter injections were great. I went to some training sessions as a fellow and comparing my experience with program directors at big institutions, they were impressed, or at least humored me. Read, ask questions, and read some more.
Cons:
You will not be board certified. Many hospital systems require this to do procedures there- this actually worked to my favor in the long run.
You will get some shade thrown at you from board certified physicians and some of the individuals in credentialing may try and make you feel less ( their job sucks, so bring it)
I did lack experience with some of the larger procedures such as stim (which I just don't enjoy), kypho. I think access to more minds and bigger didactics would have been useful. It would also be nice to have a sexy big name institution on my resume.
In the long run, no matter what you choose, the effort you put in will be what you get out. Best of luck with your choice.

 

[Magnus Acus]

This isn't helpful to you, but I think unaccredited "fellowships" are complete crap.

You will be a terribly underpaid doctor extending the ability of your "trainer" to bill more. There will likely be plenty of "education" on doing procedures and little actual education about pain. If you are completely bent on doing this, try to ensure you receive didactics and out rotations to cover some rehabilitation, radiology, and psych at a minimum.

I know that this topic is discussed as naseum, but is NASS accreditation worth anything these days? I kind of sense a general frustration with ACGME rules and regulations recently..

I think generally ACGME>NASS>>>> all else.
But some others maybe- ACGME>>>>NASS=all else.

Any Thoughts?

 

[Ducttape]

NASS fellowships hold value, particularly if the program helps you get to take one of the alternate board certifications. the focus would be on Spine, which is can be more lucrative than a standard Pain position (you can refuse all non neck and back pain consultations).


to the OP - if you have the opportunity to do ACGME or NASS fellowship, go do that. in todays climate, a non-accredited fellowship is so hit and miss in terms of the quality of education and what you can do with it later, especially with CMS increasingly requiring injections be performed by "appropriately trained" physicians.

For epidurals, CMS:

Patient safety and quality of care mandate that healthcare professionals who perform epidural injections/procedures are appropriately trained and/or credentialed by a formal residency/fellowship program and/or are certified by either an accredited and nationally recognized organization or by a post-graduate training course accredited by an established national accrediting body or accredited professional training program whose core curriculum includes the performance and management of the procedures addressed in this LCD.

 

[lobelsteve]

For epidurals, CMS:

Patient safety and quality of care mandate that healthcare professionals who perform epidural injections/procedures are appropriately trained and/or credentialed by a formal residency/fellowship program and/or are certified by either an accredited and nationally recognized organization or by a post-graduate training course accredited by an established national accrediting body or accredited professional training program whose core curriculum includes the performance and management of the procedures addressed in this LCD.

Unless done by a nurse, then no rules apply.

 

[callmeanesthesia]

Patient safety and quality of care mandate that healthcare professionals who perform epidural injections/procedures are appropriately trained and/or credentialed by a formal residency/fellowship program and/or are certified by either an accredited and nationally recognized organization or by a post-graduate training course accredited by an established national accrediting body or accredited professional training program whose core curriculum includes the performance and management of the procedures addressed in this LCD.

Unless done by a nurse, then no rules apply.

This language is so vague it’s useless. Even an NP who took a weekend course on epidurals for CE units and got a certificate at the end would qualify.

 

[Ducttape]

its pretty specific that you have to have some discernible form of credentialling.

you may scoff at this, but even 8-9 years ago many "epidurals" and "facet injections" were done blindly by PCPs in their office.

 

[MitchLevi]

When I was interviewing potential midlevels, I had a PA who did all the ESI/facet CSI for a two physician neurosurgery group.

He was doing A LOT of procedures.

"That's not going to happen here man..."

I didn't hire him.

Midlevels doing joint CSI/visco and even PRP is no issue with me. That other stuff? Absolutely not.

 

[nopain1234]

I’d also say your primary specialty is a big deal.

You’ll probably be okay if anesthesia, if not, it’s gonna be a long uphill battle

 

[Pain Applicant1]

I will possibly be joining a new unaccredited pain fellowship next year. I want to avoid pitfalls and need help figuring out what I should inquire about prior to agreeing to anything. Any help from someone who has performed or runs an unaccredited pain fellowship or knows how these things work, would be very beneficial. Can post in thread or DM me. Thanks.

I don't really think it matters where you go to school or where you train for fellowship. As long as you study and work hard you can learn whatever you want. Just make sure that the fellowship is busy so you have the exposure and have patients to learn on.

I'm board-certified fellowship trained and I have my own practice. I found that the insurance companies wanted me to have privileges at a hospital and the hospital wanted me to be board certified. I think the insurance companies also want me board certified and it's documented on my CAQH. This is the only issue that I see but I bet if you look into it enough you'll find a way to work around it. If I didn't feel that not being board certified would impact my insurance relationships I would let it lapse. Patients don't care.

 

[Agast]

OP, is this group you’re stumping for well-connected? Are they going to be able to help you get a job when you’re finished? Have they offered to hire you at the end of the rotation?

 

[LineEmTubeEm]

OP, is this group you’re stumping for well-connected? Are they going to be able to help you get a job when you’re finished? Have they offered to hire you at the end of the rotation?

Yes to all. Would hire me after the training year but not written on paper

 

[oreosandsake]

If you ask a group of pain docs how to do the same procedure each doc may give you at least 2-3 variations on the same procedure, because “it all depends…” on something.


Not that one or two mentors can’t teach you how to do most or many things safely, but one of the big downfalls of a small unaccredited program (first year?!) is that you will get a smaller scope of view.

Leaving fellowship I incorporated the bits and pieces from my attendings that resonated with me. In times of challenging cases I have found myself thinking, “what would Dr X or Y do?” And so on… it has helped me tremendously.


Question any singular, dogmatic way of doing anything.

Hopefully you have some truly evidence based mentors that will lead you down a respectable path. Trainees worry about procedural volume but don’t realize a monkey could be trained to do a lot of these. Doing the right thing for your patient is the most important principle. If you find yourself placing cervical leads thoracic leads a pump and some Interspinous devices and SI fusion into every patient you may need to look up the rule of 2.

I have had the privilege of learning from many of the best minds in the field and I have taken a little something from each of them. Your growth and training should never end. I know doctors who have retired and still attend meetings to learn because it was their life long passion.

 

[ChiSox]

Currently in a non-accredited fellowship through NASS at a private practice, can confirm that even these fellowship have very little oversight as to your education, getting hands on and how you will be utilized. Look closely at the contract and non-compete as it’s just an employment agreement under the guise of a fellowship. Have been overall disappointed with the experience after comparing and contrasting with other colleagues. However, I’ve made it a point to attend skills labs, conferences to supplement the gaps - it’s all about the individual as someone above me mentioned.

 

[lobelsteve]

Currently in a non-accredited fellowship through NASS at a private practice, can confirm that even these fellowship have very little oversight as to your education, getting hands on and how you will be utilized. Look closely at the contract and non-compete as it’s just an employment agreement under the guise of a fellowship. Have been overall disappointed with the experience after comparing and contrasting with other colleagues. However, I’ve made it a point to attend skills labs, conferences to supplement the gaps - it’s all about the individual as someone above me mentioned.

Come back in a year or two and consider naming it. Or expect PMs. Say nothing until you are at least a year out and credentialed/ established.

 

[deleted875186]

If you ask a group of pain docs how to do the same procedure each doc may give you at least 2-3 variations on the same procedure, because “it all depends…” on something.


Not that one or two mentors can’t teach you how to do most or many things safely, but one of the big downfalls of a small unaccredited program (first year?!) is that you will get a smaller scope of view.

Leaving fellowship I incorporated the bits and pieces from my attendings that resonated with me. In times of challenging cases I have found myself thinking, “what would Dr X or Y do?” And so on… it has helped me tremendously.


Question any singular, dogmatic way of doing anything.

Hopefully you have some truly evidence based mentors that will lead you down a respectable path. Trainees worry about procedural volume but don’t realize a monkey could be trained to do a lot of these. Doing the right thing for your patient is the most important principle. If you find yourself placing cervical leads thoracic leads a pump and some Interspinous devices and SI fusion into every patient you may need to look up the rule of 2.

I have had the privilege of learning from many of the best minds in the field and I have taken a little something from each of them. Your growth and training should never end. I know doctors who have retired and still attend meetings to learn because it was their life long passion.

I did an ACGME fellowship at a small program, only a couple attendings, can honestly say now out of training I have significantly changed how I do things, changed CESI technique, changed RFA techniques, changed my use of contrast, lowered my doses of steroid, etc. Picked up some tips from other physicians at the practice, picked up things off this forum. I do think you learn the basics in fellowship, so long as your motivated you’ll be competent, but the insurrance and hosptial credentialing may be an issue.

 

[oreosandsake]

Currently in a non-accredited fellowship through NASS at a private practice, can confirm that even these fellowship have very little oversight as to your education, getting hands on and how you will be utilized. Look closely at the contract and non-compete as it’s just an employment agreement under the guise of a fellowship. Have been overall disappointed with the experience after comparing and contrasting with other colleagues. However, I’ve made it a point to attend skills labs, conferences to supplement the gaps - it’s all about the individual as someone above me mentioned.

Unfortunately this is Nothing new.

Start applying for acgme fellowship now

 

[Dr. Ice]

Currently in a non-accredited fellowship through NASS at a private practice, can confirm that even these fellowship have very little oversight as to your education, getting hands on and how you will be utilized. Look closely at the contract and non-compete as it’s just an employment agreement under the guise of a fellowship. Have been overall disappointed with the experience after comparing and contrasting with other colleagues. However, I’ve made it a point to attend skills labs, conferences to supplement the gaps - it’s all about the individual as someone above me mentioned.

Where are you?

 

[Magnus Acus]

Unfortunately this is Nothing new.

Start applying for acgme fellowship now

I’m struggling to get a grasp on this still as a PM&R resident.. so the general recommendation is ACGME- I get that.

You’d advise against NASS I’m guessing? I know it depends on the program likely, but some of them look pretty good

 

[nvrsumr]

It’s a race to the bottom for all. Not enough spines to go around.

 

[Ducttape]

NASS accredited fellowships have a high degree of being vetted. most of the NASS programs i have looked at have excellent faculty and multiple attendings.

i would not hesitate to recommend a NASS accredited fellowship if someone asked, if they couldnt get in to an ACGME one.

 

[Slowpoke]

Save yourself the headache of any credentialing fiasco. Go ACGME.