NASS interventional spine fellowships

[NY172]

Are anesthesiology trained residents allowed to apply for the NASS fellowships/ even considered? Some of these programs seem legit.

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[Dr. Ice]

Oh brother, here we go again...I’m hoping this thread caps at 10

 

[NY172]

Do tell… I’m genuinely interested in learning more, not starting some debate

 

[Dr. Ice]

Topic is discussed (not specifically related to your question) at nauseam on here. You are basically just going to get a lot of “why would you ever want to do that” type responses from people on here..just look back at some of the past threads

 

[DOctorJay]

Do tell… I’m genuinely interested in learning more, not starting some debate

let's chat, not sure if you saw my PM response

 

[drusso]

Are anesthesiology trained residents allowed to apply for the NASS fellowships/ even considered? Some of these programs seem legit.

Excellent question and this is a very worthy topic of debate. Many KOL's have strong opinions about this.

 

[MindtheGlottis]

I believe NASS is a PM&R only. It's a breakaway from the anesthesia based pain programs and a lot of them require PM&R training as a prerequisite. Check out the list of programs here. You can see quite a few specifically state PM&R only. I'd reach out to programs that interest you now to see if they'd consider you.

 

[nvrsumr]

What if the NASS PMR programs were as multidisciplinary as the gas programs? Is there any real long term value?

For example 20ish fellows and departmental attendings in my gas fellowship many years ago- pmr, neuro, psych, gas, obgyn.

I was the pmr fellow. Neuro attending did blind cesi. Psych attending did implants and inpatient stuff like epidural portacaths. Ob fellow was the best surgeon of all by far which says something about “pain surgeon” skills but I digress.

 

[drusso]

What if the NASS PMR programs were as multidisciplinary as the gas programs? Is there any real long term value?

For example 20ish fellows and departmental attendings in my gas fellowship many years ago- pmr, neuro, psych, gas, obgyn.

I was the pmr fellow. Neuro attending did blind cesi. Psych attending did implants and inpatient stuff like epidural portacaths. Ob fellow was the best surgeon of all by far which says something about “pain surgeon” skills but I digress.

That was the original vision for the specialty from the beginning.

 

[NY172]

What is the degree of likelihood that a hospital would refuse to grant pain/procedure privileges to someone who is NASS trained since it is not ACGME accredited fellowship? Does anyone know of this ever happening?

 

[drusso]

What is the degree of likelihood that a hospital would refuse to grant pain/procedure privileges to someone who is NASS trained since it is not ACGME accredited fellowship? Does anyone know of this ever happening?

I'd say 50/50.

 

[DOctorJay]

What is the degree of likelihood that a hospital would refuse to grant pain/procedure privileges to someone who is NASS trained since it is not ACGME accredited fellowship? Does anyone know of this ever happening?

it absolutely happens in my hospital system. you can't even get an interview with my group without an ACGME accredited fellowship. we do have a guy on staff here (different department) who is PM&R and did one of these types of fellowships and he's not allowed to do any interventional spine procedures.

competing hospital system DOES allow it though. they have an interventional spine group as well as interventional pain. no clue what the politics are like over there regarding this. so 50/50 may be accurate.

 

[Ferrismonk]

What is the degree of likelihood that a hospital would refuse to grant pain/procedure privileges to someone who is NASS trained since it is not ACGME accredited fellowship? Does anyone know of this ever happening?

I'm not sure, but in my area there are a ton of "Board certified, fellowship trained" doctors. They are board certified in their primary specialty and did a "non-accredited" fellowship.

 

[Bostonspine]

What is the degree of likelihood that a hospital would refuse to grant pain/procedure privileges to someone who is NASS trained since it is not ACGME accredited fellowship? Does anyone know of this ever happening?

It’s a function of politics if your hired by a department or group with power (NSGY, Ortho, Anesth) you will be privileged even without a fellowship(Radiology for example)If you are solo or competing against someone’s interest they will bring it up to the credentialing committee. Same thing happens for EMG if you PMR and credentialing person is Neuro, if you family medicine trying to get privileges as a hospitalist.

 

[gaspasser127]

To OP, as an anesthesia resident who is a CA1/CA2 you should be doing everything possible to match into an ACGME pain fellowship. To save yourself headache and hassle down the road, the weakest acgme pain fellowship is still better than a “strong” NASS fellowship for the reasons mentioned above (namely, credentialing)

 

[drusso]

It’s a function of politics if your hired by a department or group with power (NSGY, Ortho, Anesth) you will be privileged even without a fellowship(Radiology for example)If you are solo or competing against someone’s interest they will bring it up to the credentialing committee. Same thing happens for EMG if you PMR and credentialing person is Neuro, if you family medicine trying to get privileges as a hospitalist.

There's a good chance that you'll be blocked in the most reputable systems. Also, it might limit your ability for KOL, consulting, and medico-legal work.

 

[Tboned]

There's a good chance that you'll be blocked in the most reputable systems. Also, it might limit your ability for KOL, consulting, and medico-legal work.

Maybe it will limit you in certain anesthesia based programs with a lot of political clout but the other stuff, it won’t. Your career is what you make of it, trust me it won’t be limited because you decided not to drank the kool-aid of “I need to do an ACGME program”.
Cmon drusso, your known for ******** the man aka hospital systems

 

[drusso]

Are there any NASS fellowships that have recently successfully converted to ACGME?

None. You've got to pick sides early in the fight.

 

[Scottie Dog]

I matched at Cleveland Clinic for their Nass program. They also have an acgme pain fellowship. Will be interesting to see if there is much overlap. I don’t buy the credentialing argument, but maybe I’m naive. I applied and interviewed at both nass and acgme pain programs. Training seemed very similar at both types of programs, biggest difference was majority of nass programs were more outpatient focused. The nass match is first (in July). If you match you have to withdraw from acgme match. The timing of the match is a big deal that hasn’t been discussed. I didn’t want to put all my eggs in one basket (acgme match is in October), especially in the times of covid and virtual interviews.

Nass programs are going to continue to get more and more popular with pm&r applicants, especially now that some big name places are participating (Cleveland clinic, Hopkins, Stanford, Emory, Vanderbilt).

I totally get the argument that ACGME fellowships are the gold standard, but nass programs aren’t going away any time soon. I hope we can all work together in the future

 

[cowboydoc]

Are there any NASS fellowships that have recently successfully converted to ACGME?

No. These NASS fellowships are a pretty new phenomena. It used to be the Wild West vs. ACGME.

 

[Dr. Ice]

I matched at Cleveland Clinic for their Nass program. They also have an acgme pain fellowship. Will be interesting to see if there is much overlap. I don’t buy the credentialing argument, but maybe I’m naive. I applied and interviewed at both nass and acgme pain programs. Training seemed very similar at both types of programs, biggest difference was majority of nass programs were more outpatient focused. The nass match is first (in July). If you match you have to withdraw from acgme match. The timing of the match is a big deal that hasn’t been discussed. I didn’t want to put all my eggs in one basket (acgme match is in October), especially in the times of covid and virtual interviews.

Nass programs are going to continue to get more and more popular with pm&r applicants, especially now that some big name places are participating (Cleveland clinic, Hopkins, Stanford, Emory, Vanderbilt).

I totally get the argument that ACGME fellowships are the gold standard, but nass programs aren’t going away any time soon. I hope we can all work together in the future

Let me save many on here the unnecessary need to quickly shoot down the posters optimism..

If you don’t do acgme, you might as well become a janitor

If you do nass..you are part of the problem not the solution

If you are really committed, you should finish your worthless nass..and do a “real fellowship” the following year.

Mind you these are not MY beliefs..

 

[drusso]

Let me save many on here the unnecessary need to quickly shoot down the posters optimism..

If you don’t do acgme, you might as well become a janitor

If you do nass..you are part of the problem not the solution

If you are really committed, you should finish your worthless nass..and do a “real fellowship” the following year.

Mind you these are not MY beliefs..

Good point. That's what I would have done.

 

[Dr. Ice]

Good point. That's what I would have done.

What, a “real fellowship” or custodial arts?

 

[drusso]

What, a “real fellowship” or custodial arts?

You didn't read my post about pain doctors scrubbing toilets?

 

[Scottie Dog]

What kind of stats do I need to become a janitor? My usmle is borderline but I spend a lot of time in the bathroom. That should count for occupational exposure

 

[soccrwz]

humans are responsible for 20% of radiation worldwide

 

[NJPAIN]

What kind of stats do I need to become a janitor? My usmle is borderline but I spend a lot of time in the bathroom. That should count for occupational exposure

Grab a brush, you just matched!

 

[Nodolor]

This may change the whole credentialing argument in the future

IMPORTANT UPDATE - The National Board of Physicians and Surgeons (NBPAS) is pleased to announce the following exciting developments: ● NBPAS meets all national accreditation standards for health plans. This includes the standards put forth by the National Committee on Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC). While these acronyms may be unfamiliar to physicians, these additions are a critical component in being accepted by health insurance carriers nationwide. Want to understand the details and know more? Click here: https://nbpas.org/ncqa-update/ ​ If your hospital currently does not accept NBPAS, please share this update with them. This is an important requirement for reimbursement and could help advance your request to add NBPAS board certification at your hospital. Please reach out to us if you have any questions. Spread the news, ask your colleagues to join NBPAS. Together we can provide physicians a choice in how they want to maintain their board certification. Stay tuned – more good news is on the way! For more information, contact [email protected]

 

[DOctorJay]

This may change the whole credentialing argument in the future

IMPORTANT UPDATE - The National Board of Physicians and Surgeons (NBPAS) is pleased to announce the following exciting developments: ● NBPAS meets all national accreditation standards for health plans. This includes the standards put forth by the National Committee on Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC). While these acronyms may be unfamiliar to physicians, these additions are a critical component in being accepted by health insurance carriers nationwide. Want to understand the details and know more? Click here: https://nbpas.org/ncqa-update/ ​ If your hospital currently does not accept NBPAS, please share this update with them. This is an important requirement for reimbursement and could help advance your request to add NBPAS board certification at your hospital. Please reach out to us if you have any questions. Spread the news, ask your colleagues to join NBPAS. Together we can provide physicians a choice in how they want to maintain their board certification. Stay tuned – more good news is on the way! For more information, contact [email protected]

Hospitals need to get on board and accept this. I approached one of our med executives a few years ago regarding NBPAS and he said they wouldn’t accept it at the time but maybe now is the time to get them to try again.

 

[drusso]

Hospitals need to get on board and accept this. I approached one of our med executives a few years ago regarding NBPAS and he said they wouldn’t accept it at the time but maybe now is the time to get them to try again.

If your institution sponsors ACGME-accredited training programs, I've heard some medical education leaders describe it as a "slap in the face" to accept for NBPAS for credentialing--why are we busting our assess to meet these high training standards when the hospital will just turn around and credential someone who got their board certification from a Cracker Jack box?

 

[wendalltwolf]

If your institution sponsors ACGME-accredited training programs, I've heard some medical education leaders describe it as a "slap in the face" to accept for NBPAS for credentialing--why are we busting our assess to meet these high training standards when the hospital will just turn around and credential someone who got their board certification from a Cracker Jack box?

But you need an initial ABMS certification to then get credentialed with NBPAS. It’s tempting if for example ABPM&R keeps their annoying PIP requirement…

 

[Gnarvin]

I matched at Cleveland Clinic for their Nass program. They also have an acgme pain fellowship. Will be interesting to see if there is much overlap. I don’t buy the credentialing argument, but maybe I’m naive. I applied and interviewed at both nass and acgme pain programs. Training seemed very similar at both types of programs, biggest difference was majority of nass programs were more outpatient focused. The nass match is first (in July). If you match you have to withdraw from acgme match. The timing of the match is a big deal that hasn’t been discussed. I didn’t want to put all my eggs in one basket (acgme match is in October), especially in the times of covid and virtual interviews.

Nass programs are going to continue to get more and more popular with pm&r applicants, especially now that some big name places are participating (Cleveland clinic, Hopkins, Stanford, Emory, Vanderbilt).

I totally get the argument that ACGME fellowships are the gold standard, but nass programs aren’t going away any time soon. I hope we can all work together in the future

Yes, Cleveland Clinic "also has" an ACGME pain fellowship. I don't know anything about their NASS program, but their ACGME pain fellowship is arguably one of the best in the country and many of the leaders in the field have spent time either training or as faculty there. The ACGME pain fellowship is very geared toward advanced procedures, neuromodulation, and the breadth of pain conditions rather than just spine, so I don't think the NASS program will have much overlap. I suspect egos, tradition, and politics will be in play.

 

[Ducttape]

If your institution sponsors ACGME-accredited training programs, I've heard some medical education leaders describe it as a "slap in the face" to accept for NBPAS for credentialing--why are we busting our assess to meet these high training standards when the hospital will just turn around and credential someone who got their board certification from a Cracker Jack box?

dont go disparaging Crack Jack! i loved those toys... (of course, they stopped with the toys in 2016...)

 

[Nodolor]

But you need an initial ABMS certification to then get credentialed with NBPAS. It’s tempting if for example ABPM&R keeps their annoying PIP requirement…

Ya I have both. I believe NBPAS was developed because of the tedious maintenance requirements and $$$ SCAM the MOC is

 

[JBM16BYU]

I matched at Cleveland Clinic for their Nass program. They also have an acgme pain fellowship. Will be interesting to see if there is much overlap. I don’t buy the credentialing argument, but maybe I’m naive. I applied and interviewed at both nass and acgme pain programs. Training seemed very similar at both types of programs, biggest difference was majority of nass programs were more outpatient focused. The nass match is first (in July). If you match you have to withdraw from acgme match. The timing of the match is a big deal that hasn’t been discussed. I didn’t want to put all my eggs in one basket (acgme match is in October), especially in the times of covid and virtual interviews.

Nass programs are going to continue to get more and more popular with pm&r applicants, especially now that some big name places are participating (Cleveland clinic, Hopkins, Stanford, Emory, Vanderbilt).

I totally get the argument that ACGME fellowships are the gold standard, but nass programs aren’t going away any time soon. I hope we can all work together in the future

From what I understand, the two types of fellowships are trying to both present themselves as distinct entities but with significant crossover. From PM&R applicants I have spoken to, most (not all) essentially want to practice as a interventional spine physiatrist, doing mostly spine procedures and less cancer pain, pediatric pain, regional anesthesia, and chronic med management. The same procedures are taught within both specialties, but I think the biggest question is that of time: what are you devoting your time to for the year and what from that time will you actually use in your future practice?

By doing an ACGME pain fellowship, you get ACGME pain boarded, which is required in a few (definitely not all) hospital systems for spine procedures. This may open more jobs in academia, especially if wanting to work in a pain department housed under anesthesiology. To the “time” question, you do spend a significant amount of time doing “not spine” things, like cancer pain, pediatric pain, palliative care, regional blocks, and inpatient pain consults, not to mention many programs make non-anesthesiology fellows do some airway skills. I’ve even heard of programs making their non-anesthesiology folks do OB epidurals (which personally I don’t think translates into fluoro guided epidurals).

By doing a NASS, or non-NASS (like UCLA or Michigan) interventional spine fellowship, you get spine 100% of the time and are trained by other PM&R physicians. Your extra non-spine time is often USGI, EMG, maybe some sports coverage. You don’t have the extra anesthesiology things. You also don’t get an ACGME board, but that doesn’t seem to be essential in the job market.

I personally don’t understand why there seems to be so much contention and pushback to these NASS fellowships. Many, if not all, are run and taught by leaders in both pain and spine fields, are leaders in NASS and SIS. Spine procedures are not unique to pain, as interventional radiology, neuroradiology, musculoskeletal radiology, and sports medicine perform, as do some surgeons and individuals without any fellowship. There’s even been talk on this forum of mid levels getting taught these procedures. At least the fellows from NASS are trained by individuals who know how to properly perform the procedures and do take another year of training to make sure they have a more solid skill set.

I would think that if an individual wants to practice as a general MSK PM&R physician, then doing a NASS fellowship would only add some more procedures to their skill set. They aren’t trying to be pain physicians, hence why NASS tries to keep them fairly distinct on their website. Most don’t want to be advertised as a pain physician. If they do want to advertise like that, then they should complete a pain fellowship, no question. It’s not dissimilar to a PM&R physician who learns USGI for a knee injection, a family medicine physician, a sports medicine physician, a rheumatologist, or an orthopedic surgeon.

 

[Ducttape]

the pushback is that the focus of some of these spine fellowships focus only on teaching needle jockeys.

there is no "pain management" - only how to work in a block shop.

end result is that patients get their injections that invariably fail, get discharged, and are told to find a pain doctor who gets stuck with a patient that is angry, frustrated, only interested in pills and any treatment that may be financially beneficial are already off the table.

i have a few hundred of these patients.........

 

[Dr. Ice]

the pushback is that the focus of some of these spine fellowships focus only on teaching needle jockeys.

there is no "pain management" - only how to work in a block shop.

end result is that patients get their injections that invariably fail, get discharged, and are told to find a pain doctor who gets stuck with a patient that is angry, frustrated, only interested in pills and any treatment that may be financially beneficial are already off the table.

i have a few hundred of these patients.........

I have seen a few hundred patients treated by the esteemed acgme trained “pain management” docs who have dumped patients after narcing them up and putting in all kinds of wires and toys in them, posing with reps on linked in and hashtagging all kinds of nonsense..so there’s that...

 

[drusso]

I have seen a few hundred patients treated by the esteemed acgme trained “pain management” docs who have dumped patients after narcing them up and putting in all kinds of wires and toys in them, posing with reps on linked in and hashtagging all kinds of nonsense..so there’s that...

 

[myrandom2003]

Not sure what kind of shoes those are (where are the socks?), but that’s definitely not a Daytona on the wrist .

 

[myrandom2003]

the pushback is that the focus of some of these spine fellowships focus only on teaching needle jockeys.

there is no "pain management" - only how to work in a block shop.

end result is that patients get their injections that invariably fail, get discharged, and are told to find a pain doctor who gets stuck with a patient that is angry, frustrated, only interested in pills and any treatment that may be financially beneficial are already off the table.

i have a few hundred of these patients.........

For what it’s worth some of the acgme fellowships near me are the same way. Interventions only and no Med management of opioids.

 

[Ducttape]

What they do professionally may not mesh with how they are trained.

ACGME certified docs are supposed to be taught that there are more than just needles for treatment, unlike what appears to be the training at Spine fellowships.

 

[Ferrismonk]

For what it’s worth some of the acgme fellowships near me are the same way. Interventions only and no Med management of opioids.

Agreed, however I would argue chronic med management with opioids isn't even good practice.

 

[callmeanesthesia]

What they do professionally may not mesh with how they are trained.

ACGME certified docs are supposed to be taught that there are more than just needles for treatment, unlike what appears to be the training at Spine fellowships.

Yes, we learn there’s more than just needles - there are trochars, cannulas, electrodes, and implants.

 

[Bostonspine]

What they do professionally may not mesh with how they are trained.

ACGME certified docs are supposed to be taught that there are more than just needles for treatment, unlike what appears to be the training at Spine fellowships.

I live in Boston I think only 1 of the 4 training programs here manage opioid and the fellows get excellent procedure training and hand a gabapentin/flexeril scrip with PT and home exercise to get to the procedure. (Spoiler alert the 1 that manage opioid are not Harvard programs)

 

[Snowmen96]

the pushback is that the focus of some of these spine fellowships focus only on teaching needle jockeys.

there is no "pain management" - only how to work in a block shop.

end result is that patients get their injections that invariably fail, get discharged, and are told to find a pain doctor who gets stuck with a patient that is angry, frustrated, only interested in pills and any treatment that may be financially beneficial are already off the table.

i have a few hundred of these patients.........

Believe it or not, physiatrists spend 4 years (5 in Canada) learning how to diagnose and manage pain. How long in anesthesia?

 

[Gnarvin]

Believe it or not, physiatrists spend 4 years (5 in Canada) learning how to diagnose and manage pain. How long in anesthesia?

You do realize what the definition of anesthesia is, right?

 

[lobelsteve]

You do realize what the definition of anesthesia is, right?

It was just updated by the ASA:

Anesthesia is the medical management of CRNA/AA at 4:1 to best allow drinking of coffee and delaying cases until they are cancelled so we can go home.

 

[Ducttape]

no no no.

to best allow viewing of WSJ.

please.