NASS vs ACGME Fellowships: Which Makes a Better Doctor in Real World?

[drusso]

ISMM Fellowships

The primary focus of NASS-recognized ISMM fellowships is the clinical assessment and treatment of patients with spine and musculoskeletal conditions. The fellowships are unique from ACGME Pain Medicine fellowships, which require training in inpatient acute pain management, palliative care, psychiatry, pediatric pain management, and intubation.

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[clubdeac]

I think it depends on what kind of practice you have. For my practice an ISMM would suffice. If you’re inpatient or see a lot of cancer pain or anything other than straight outpatient msk/spine, probably need ACGME. Too bad it’s a complete racket

 

[Dr. Ice]

People riding acgme to get hopd gravy train jobs cause they are 400k in debt and looking to be able to live for the next few years. I would advise people to hold out a few months and see how desperate all the way Joe gets in canceling student loan debt…y’all just might make it

In all seriousness..most know my story on here. Furman trained. Was 6 months shy of the piece of paper. Honestly would not have taken the experience back for many reasons. I was trained very well and on my first day as an attending I was showing acgme docs how to move the c arm. I also have been fortune to have a life long brotherhood of docs which Mike did so well at fostering.

At the end of the day..it probably doesn’t matter much. If I had advice, I would say get the piece of paper because that’s gonna matter more.

The most important part of the job is going to be the first 2-3 years regardless of training. That’s where you will learn the most.

I’m assuming drusso was bored but this topic has been discussed at nauseum.

Here it is: NASS is going to be better training wise, ACGME is gonna be the one that protects you, even though they suck lol

 

[Espn123]

People riding acgme to get hopd gravy train jobs cause they are 400k in debt and looking to be able to live for the next few years. I would advise people to hold out a few months and see how desperate all the way Joe gets in canceling student loan debt…y’all just might make it

In all seriousness..most know my story on here. Furman trained. Was 6 months shy of the piece of paper. Honestly would not have taken the experience back for many reasons. I was trained very well and on my first day as an attending I was showing acgme docs how to move the c arm. I also have been fortune to have a life long brotherhood of docs which Mike did so well at fostering.

At the end of the day..it probably doesn’t matter much. If I had advice, I would say get the piece of paper because that’s gonna matter more.

The most important part of the job is going to be the first 2-3 years regardless of training. That’s where you will learn the most.

I’m assuming drusso was bored but this topic has been discussed at nauseum.

Here it is: NASS is going to be better training wise, ACGME is gonna be the one that protects you, even though they suck lol

I agree with this, of course there are exceptional ACGME clinical training sites but they are becoming less common

 

[MD87]

Try to find an ACGME fellowship that is most similar to a NASS fellowship. That’s what I did. Could not be happier with my training. Having said that, for my current job, half the guys I work with (at least) didn’t get the “piece of paper.” So, assuming I stay at my current gig, it makes no difference. If *might* matter for some legal/consulting gigs.

I think now that is has gotten easier to match into ACGME, no reason to not do it. Concern before was not matching ACGME and then being screwed since the NASS fellowships matched earlier. Easier and easier to match into ACGME now, as discussed in the other recent thread.

 

[clubdeac]

Try to find an ACGME fellowship that is most similar to a NASS fellowship. That’s what I did. Could not be happier with my training. Having said that, for my current job, half the guys I work with (at least) didn’t get the “piece of paper.” So, assuming I stay at my current gig, it makes no difference. If *might* matter for some legal/consulting gigs.

I think now that is has gotten easier to match into ACGME, no reason to not do it. Concern before was not matching ACGME and then being screwed since the NASS fellowships matched earlier. Easier and easier to match into ACGME now, as discussed in the other recent thread.

Which program were you at out of curiosity

 

[Czech777]

What’s your surgical scope aspirations? IT Pumps, MILD, SCS/DRG implant, Reactiv8, perm PNS, etc. may not be your thing now, but the market can only bear so many RFA/epidural guys. NASS doesn’t preclude you from this, but may limit privileges in certain systems.

 

[bedrock]

What’s your surgical scope aspirations? IT Pumps, MILD, SCS/DRG implant, Reactiv8, perm PNS, etc. may not be your thing now, but the market can only bear so many RFA/epidural guys. NASS doesn’t preclude you from this, but may limit privileges in certain systems.

Most ethical pain physicians do very little of those except for SCS implants.

MILD and DRG don’t pay enough for the time and risk.

Reactive8 is BS, and peripheral stim is overused, hard to get paid, and in many situations is actually inferior to DRG for a long term option.

The standard procedures are what is needed 98% of the time.

So a NASS fellow who does ESI/RFA/SCS trials will be fine. Maybe scs implant privileges could be tricky, but many many pain docs refer out the implant anyway.

 

[Czech777]

Most ethical pain physicians do very little of those except for SCS implants.

MILD and DRG don’t pay enough for the time and risk.

Reactive8 is BS, and peripheral stim is overused, hard to get paid, and in many situations is actually inferior to DRG for a long term option.

The standard procedures are what is needed 98% of the time.

So a NASS fellow who does ESI/RFA/SCS trials will be fine. Maybe scs implant privileges could be tricky, but many many pain docs refer out the implant anyway.

Allegations of ethical concerns toward all advanced procedures except SCS implant is a very broad brush. On top of that saying cost is isn’t worth risk for DRG / MILD—I still appreciate the ability to help these people even if that individual case isn’t profitable. I can’t fill a practice with this mindset, but these cases are far and few between. I’d be eager to see what the greater community thinks about that.

A minor part of my practice involves advanced cases…but I still appreciate the ability to do them when I want. IT pumps for cancer pain, MILD for the severe stenotic deemed non-surgical, etc. have a role for some patients. Some people like referring out, some don’t. Neither is correct, but worth noting the difference.

 

[Czech777]

Even my initial statement didn’t disparage NASS. Just mentioned that some systems don’t credential OR. I think they are wrong to do that, but it is true.

 

[CleanUp]

Most ethical pain physicians do very little of those except for SCS implants.

MILD and DRG don’t pay enough for the time and risk.

Reactive8 is BS, and peripheral stim is overused, hard to get paid, and in many situations is actually inferior to DRG for a long term option.

The standard procedures are what is needed 98% of the time.

So a NASS fellow who does ESI/RFA/SCS trials will be fine. Maybe scs implant privileges could be tricky, but many many pain docs refer out the implant anyway.

Bedrock I would say IT pumps may be worth it for those patients on very high opioid requirements in a rural setting and experiencing side effects. This depends on your practice setting.

In addition, I posit that PNS is a useful adjuvant for those going into surgery or had less than ideal outcomes. I use it as a bridge to increase functionality, go more to PT, and limit opioids. It won’t fix everything but in the right cases it can be useful. To your point not everyone needs it though. When alternative options are limited I feel it is low risk high reward.

 

[bedrock]

Bedrock I would say IT pumps may be worth it for those patients on very high opioid requirements in a rural setting and experiencing side effects. This depends on your practice setting.

In addition, I posit that PNS is a useful adjuvant for those going into surgery or had less than ideal outcomes. I use it as a bridge to increase functionality, go more to PT, and limit opioids. It won’t fix everything but in the right cases it can be useful. To your point not everyone needs it though. When alternative options are limited I feel it is low risk high reward.

PNS can be useful in rare select situations, is just not needed that often.

IT opioids pumps are not appropriate outside of terminal cancer. There is a reason that far fewer IT pumps are done now compared to 20 years ago.

I believe you are in the early stages of your practice. You might want to take note that 98% of experienced private practice pain physicians no longer offer IT opioid pumps outside of terminal CA.

 

[jsaul]

People riding acgme to get hopd gravy train jobs cause they are 400k in debt and looking to be able to live for the next few years. I would advise people to hold out a few months and see how desperate all the way Joe gets in canceling student loan debt…y’all just might make it

In all seriousness..most know my story on here. Furman trained. Was 6 months shy of the piece of paper. Honestly would not have taken the experience back for many reasons. I was trained very well and on my first day as an attending I was showing acgme docs how to move the c arm. I also have been fortune to have a life long brotherhood of docs which Mike did so well at fostering.

At the end of the day..it probably doesn’t matter much. If I had advice, I would say get the piece of paper because that’s gonna matter more.

The most important part of the job is going to be the first 2-3 years regardless of training. That’s where you will learn the most.

I’m assuming drusso was bored but this topic has been discussed at nauseum.

Here it is: NASS is going to be better training wise, ACGME is gonna be the one that protects you, even though they suck lol

I don't get it. How were you 6 months away from getting the piece of paper? I thought Furman was not acgme. Were you first in an acgme fellowship and then had to leave 6 months prior to completion. Then did a 1 yr Furman fellowship later on?

 

[bedrock]

I don't get it. How were you 6 months away from getting the piece of paper? I thought Furman was not acgme. Were you first in an acgme fellowship and then had to leave 6 months prior to completion. Then did a 1 yr Furman fellowship later on?

When the ACGME pain fellowship standards were less rigid you could still ACGME pain certification after a Furman, Slipman fellowship, etc.

 

[Dr. Ice]

I don't get it. How were you 6 months away from getting the piece of paper? I thought Furman was not acgme. Were you first in an acgme fellowship and then had to leave 6 months prior to completion. Then did a 1 yr Furman fellowship later on?

He had full acgme accreditation status until the end of 2008. He staggered fellows and had a few that started in July and a few that started in January. I started in January 2009, so some of my co-fellows that started in July of 2008 were able to be acgme boarded.

 

[Espn123]

Most ethical pain physicians do very little of those except for SCS implants.

MILD and DRG don’t pay enough for the time and risk.

Reactive8 is BS, and peripheral stim is overused, hard to get paid, and in many situations is actually inferior to DRG for a long term option.

The standard procedures are what is needed 98% of the time.

So a NASS fellow who does ESI/RFA/SCS trials will be fine. Maybe scs implant privileges could be tricky, but many many pain docs refer out the implant anyway.

I disagree with 98% of this

 

[Czech777]

I disagree with 98% of this

 

[bedrock]

View attachment 385466

Ok heroes.

What percentage of your pain procedures realistically are not ESI/MBB/RFA/FJI/SIJ/dorsal column SCS, Kyphoplasty, Intracept, peripheral joint/tendon injection (steroid or PRP), peripheral joint RFA, or sympathetic, intercostal, and common peripheral nerve blocks?

 

[Status Sciaticus]

Most ethical pain physicians do very little of those except for SCS implants.

MILD and DRG don’t pay enough for the time and risk.

Reactive8 is BS, and peripheral stim is overused, hard to get paid, and in many situations is actually inferior to DRG for a long term option.

The standard procedures are what is needed 98% of the time.

So a NASS fellow who does ESI/RFA/SCS trials will be fine. Maybe scs implant privileges could be tricky, but many many pain docs refer out the implant anyway.

LOL what?
Probably just the boomer docs that dont want to go back and learn how to do things to help their patients fully.
Reactiv8 is one of the few things we do that has a level 1 study backing it and has 5 year outcome data now....
DRG does take longer when you start out but is otherwise on par with SCS. In SCS you take time to drive the leads up. In DRG you take time to make the loops...

PNS can be useful in rare select situations, is just not needed that often.

IT opioids pumps are not appropriate outside of terminal cancer. There is a reason that far fewer IT pumps are done now compared to 20 years ago.

I believe you are in the early stages of your practice. You might want to take note that 98% of experienced pain physicians no longer offer IT opioid pumps outside of terminal CA.

Post surgical pain is definitely a good reason to try PNS. All those knee replacements that still hurt can benefit from PNS.... and we do a lot of knees in the US....
ITPs definitely have their place in patients with multiple back surgeries who have failed stim and reoperations or are on high dose narcotics and suffering side effects...

Ok heroes.

What percentage of your pain procedures realistically are not ESI/MBB/RFA/FJI/SIJ/dorsal column SCS, Kyphoplasty, peripheral joint/tendon injection (steroid or PRP) or sympathetic, intercostal, and common peripheral nerve blocks?

about 20% - DRG, Intracept, Vertiflex, Reactiv8, SIF, stellates, MILD.
Maybe your practice is just bread-and-butter?

 

[bedrock]

LOL what?
Probably just the boomer docs that dont want to go back and learn how to do things to help their patients fully.
Reactiv8 is one of the few things we do that has a level 1 study backing it and has 5 year outcome data now....
DRG does take longer when you start out but is otherwise on par with SCS. In SCS you take time to drive the leads up. In DRG you take time to make the loops...


Post surgical pain is definitely a good reason to try PNS. All those knee replacements that still hurt can benefit from PNS.... and we do a lot of knees in the US....
ITPs definitely have their place in patients with multiple back surgeries who have failed stim and reoperations or are on high dose narcotics and suffering side effects...


about 20% - DRG, Intracept, Vertiflex, Reactiv8, SIF, stellates, MILD.
Maybe your practice is just bread-and-butter?

Exactly how long ago did you finish your pain fellowship?

 

[jsaul]

Why do folks automatically assume and to drop the boomer retorts. There aren't any boomers here.

 

[Czech777]

Ok heroes.

What percentage of your pain procedures realistically are not ESI/MBB/RFA/FJI/SIJ/dorsal column SCS, Kyphoplasty, Intracept, peripheral joint/tendon injection (steroid or PRP), peripheral joint RFA, or sympathetic, intercostal, and common peripheral nerve blocks?

Definitely a small %, maybe 5%. Meaningful to those patients and fulfilling to me. Not faulting someone who isn’t interested in that 5%, but odd of you to think that’s not a worthwhile group for some of us to enjoy helping.

 

[plasma.]

Are there any differences from an insurer perspective between ACGME fellowships / Non-ACGME fellowships when doing mainly outpatient msk/spine?

 

[Laryngospasm]

Bedrock I would say IT pumps may be worth it for those patients on very high opioid requirements in a rural setting and experiencing side effects. This depends on your practice setting.

In addition, I posit that PNS is a useful adjuvant for those going into surgery or had less than ideal outcomes. I use it as a bridge to increase functionality, go more to PT, and limit opioids. It won’t fix everything but in the right cases it can be useful. To your point not everyone needs it though. When alternative options are limited I feel it is low risk high reward.

IT pumps bad mmmmkay.. for lots of reasons all the experienced people will tell you.

 

[Status Sciaticus]

Exactly how long ago did you finish your pain fellowship?

Negative 3 months.

Are there any differences from an insurer perspective between ACGME fellowships / Non-ACGME fellowships when doing mainly outpatient msk/spine?

Probably not. Since you see even the family med doing injections in the clinic can get reimbursed for the same procedure. And they dont even have pain fellowships!

 

[bedrock]

Negative 3 months.

That’s what I thought.

Are you seriously naive enough to think that the types and percentages of pain procedures you will perform in private practice is remotely similar to that of a university pain clinic???

If you had any real world experience or just respect for medical history you would know that countless new shiny procedures are pushed by companies mainly due to $$$ and then 7 years later no one does them due to real world efficacy being far less than promised, far more complications than you think, or the procedures are no longer covered.

You also have not yet practiced on your own for a few years to see the real amount of SIJ fusion, DRG, SCS, and peripheral stim failures over time, or the hassles and issues of chronic IT pumps.

You suggested I’m a boomer. Not true as I’m still in my 40s. (Gen X), but you have certainly proven yourself a millennial in all the classic ways, particularly that you think you know everything from your bubble without having the experience to back it up.

As a padawan, you need to first practice independently in the real world for 5 years and then your opinion on which pain procedures are worth doing and worth doing frequently will actually carry some weight.

 

[bedrock]

Definitely a small %, maybe 5%. Meaningful to those patients and fulfilling to me. Not faulting someone who isn’t interested in that 5%, but odd of you to think that’s not a worthwhile group for some of us to enjoy helping.

I think that MILD can be helpful for select patients, just not worth it to me personally for the radiation or reimbursement for time spent.

I think that DRG can be extremely useful for select patients….but traditional SCS is far quicker with much less complications, and pays much better for your time spent, and works just as well for >90% of patients.
DRG is indicated rarely, IMO.

That said, I do think it is great that you offer MILD and DRG to your patients if you want to take the time to do those procedures.
I do infrequently refer MILD/DRG patients to docs who perform those procedures with some regularity.

That said, I would never refer a non cancer patient for an IT opioid pump, or any patient for a SIJ fusion/reactiv8.

 

[Czech777]

I think that MILD can be helpful for select patients, just not worth it to me personally for the radiation or reimbursement for time spent.

I think that DRG can be extremely useful for select patients….but traditional SCS is far quicker with much less complications, and pays much better for your time spent, and works just as well for >90% of patients.
DRG is indicated rarely, IMHO.

That said, I do think it is great that you offer MILD and DRG to your patients if you want to take the time to do those procedures.
I do infrequently refer MILD/DRG patients to docs who perform those procedures with some frequency.

That said, I would never refer a non cancer patient for an IT opioid pump, or any patient for a SIJ fusion/reactiv8.

I appreciate the nuance of your take and finding common ground on a few procedures.

 

[Tboned]

Negative 3 months.


Probably not. Since you see even the family med doing injections in the clinic can get reimbursed for the same procedure. And they dont even have pain fellowships!

How are you only out of fellowship 3 months? It’s April

Also for every 4 epidurals/mbb/breadbutter you’re doing 1 advanced procedure? And you are only out of fellowship 3 months?

 

[bedrock]

How are you only out of fellowship 3 months? It’s April

Also for every 4 epidurals/mbb/breadbutter you’re doing 1 advanced procedure? And you are only out of fellowship 3 months?

He hasn’t even finished fellowship yet.

 

[cowboydoc]

LOL what?
Probably just the boomer docs that dont want to go back and learn how to do things to help their patients fully.
Reactiv8 is one of the few things we do that has a level 1 study backing it and has 5 year outcome data now....
DRG does take longer when you start out but is otherwise on par with SCS. In SCS you take time to drive the leads up. In DRG you take time to make the loops...


Post surgical pain is definitely a good reason to try PNS. All those knee replacements that still hurt can benefit from PNS.... and we do a lot of knees in the US....
ITPs definitely have their place in patients with multiple back surgeries who have failed stim and reoperations or are on high dose narcotics and suffering side effects...


about 20% - DRG, Intracept, Vertiflex, Reactiv8, SIF, stellates, MILD.
Maybe your practice is just bread-and-butter?

Are there any studies on Reactiv8 not sponsored by Mainstay? There have only been ~500 cases in the US. Everything looks amazing before people start looking into it. My patients (my implants and those implanted by the “gurus” doing the studies) haven’t done all that great.

I’ll own bread and butter. Notice most of the experienced guys live there. It’s not because they can’t do a weekend course and learn any of these fancy procedures.

 

[drusso]

Why do folks automatically assume and to drop the boomer retorts. There aren't any boomers here.

• 
  Silent Generation (born 1928-1945):
  • Less than 1%: This generation is mostly retired, with very few members still practicing, primarily in non-clinical or advisory roles.
• Baby Boomers (born 1946-1964):
  • About 20%: Many Baby Boomers are at the tail end of their careers or have retired. Those who are still practicing are likely in their late 50s to mid-70s.
• Generation X (born 1965-1980):
  • About 35%: Generation X physicians are in their peak professional years, holding many leadership roles in healthcare. They are generally in their early 40s to late 50s.
• Millennials (born 1981-1996):
  • About 40%: Millennials comprise a growing portion of the current healthcare workforce. They are in their late 20s to early 40s, with many fully established in their careers.
• Generation Z (born 1997-2012):
  • About 5%: The oldest Gen Z members are just entering the medical profession, primarily as interns, residents, or in early postgraduate training. They are in their early to mid-20s.

 

[Ducttape]

getting back to OP and drusso's statement:

if you want to be a spine doctor and only do spine injections, NASS or ACGME. arguably slight better procedure exposure in NASS, though i believe some of the fellowships do very little ILESI and only TFs.


if you want to be a pain doctor, then ACGME is the only answer. because that isnt NASS.

 

[Ronin1]

So for entertainment I added up my procedures so far for the year. A little off my averages due to vacation etc but:
Total 305.
RFA. 80
SCS/intracept 17
I don’t do pumps or spacers etc

so as expected about 5% advanced procedures.

 

[Ferrismonk]

Another consideration, my hospital system will only accept ACGME/AOA board-certified pain physicians on staff. I'm sure it's not the only one.

This definitely effects HOPD employment and OR time, but can also have an effect private practice employment and insurance panels.

 

[Status Sciaticus]

That’s what I thought.

Are you seriously naive enough to think that the types and percentages of pain procedures you will perform in private practice is remotely similar to that of a university pain clinic???

If you had any real world experience or just respect for medical history you would know that countless new shiny procedures are pushed by companies mainly due to $$$ and then 7 years later no one does them due to real world efficacy being far less than promised, far more complications than you think, or the procedures are no longer covered.

You also have not yet practiced on your own for a few years to see the real amount of SIJ fusion, DRG, SCS, and peripheral stim failures over time, or the hassles and issues of chronic IT pumps.

You suggested I’m a boomer. Not true as I’m still in my 40s. (Gen X), but you have certainly proven yourself a millennial in all the classic ways, particularly that you think you know everything from your bubble without having the experience to back it up.

As a padawan, you need to first practice independently in the real world for 5 years and then your opinion on which pain procedures are worth doing and worth doing frequently will actually carry some weight.

I take everything with a grain of salt. Oftentimes several grains of salt from people who just rush to blame Obama and liberals for everything. Pretty sure SCS was the shiny new toy at one point that was being pushed by companies and still is. Seems to be helping people.

How are you only out of fellowship 3 months? It’s April

Also for every 4 epidurals/mbb/breadbutter you’re doing 1 advanced procedure? And you are only out of fellowship 3 months?

Negative three months. meaning, ill be out in 3 months.
2 stims, 8 epidurals/joint injections in a half day. Usually we do 1 advanced/day so its an average of 10%, give or take.

Are there any studies on Reactiv8 not sponsored by Mainstay? There have only been ~500 cases in the US. Everything looks amazing before people start looking into it. My patients (my implants and those implanted by the “gurus” doing the studies) haven’t done all that great.

I’ll own bread and butter. Notice most of the experienced guys live there. It’s not because they can’t do a weekend course and learn any of these fancy procedures.

I dont think so. I dont think its practical or financially feasible for anyone to do studies without industry sponsorship, similarly like that of drug trials. Who's going to pay for it?
Certainly one could do a retrospective analysis but itll always be a level 2 study rather than a level 1 RCT.

 

[Ducttape]

I take everything with a grain of salt. Oftentimes several grains of salt from people who just rush to blame Obama and liberals for everything. Pretty sure SCS was the shiny new toy at one point that was being pushed by companies and still is. Seems to be helping people.



Negative three months. meaning, ill be out in 3 months.
2 stims, 8 epidurals/joint injections in a half day. Usually we do 1 advanced/day so its an average of 10%, give or take.


I dont think so. I dont think its practical or financially feasible for anyone to do studies without industry sponsorship, similarly like that of drug trials. Who's going to pay for it?
Certainly one could do a retrospective analysis but itll always be a level 2 study rather than a level 1 RCT.

it is possible.

fwiw:

Disclosures outside the submitted work: C. Gilligan reports payment of part of his salary to his department and stock-options received from Mainstay, personal fees from Medtronic, Saluda, Abbott, Persica, Eli Lilly, Iliad, research funded by Sollis, and expert witness testimony fees; W. Vollschenk reports personal fees from Mainstay; M. Russo reports personal fees from Mainstay; C.Gilmore reports personal fees and other from SPR, and personal fees from Nevro, Nalu, Biotronik, Boston Scientific, and Saluda; V.Mehta reports grants from Mainstay and Abbott, grants and personal fees from Boston Scientific and Medtronic; K. De Smedtreports personal fees from Mainstay; U. Latif reports personal fees from Medtronic; P. Georgius reports personal fees from Boston Scientific, Abbott and Spectrum; J. Gentile reports personal fees from Mainstay; B. Mitchell reports personal fees from Mainstay; M. Langhorst reports personal fees from Mainstay and Vivex; F. Huygen reports grants and personal fees from Abbott and Saluda,and nonfinancial support from Boston Scientific; G. Baranidharan reports a grant from Mainstay, grants and personal fees fromNevro, Abbott, Boston Scientific, and personal fees from Nalu and Stryker; V. Patel reports personal fees from Mainstay, grants from Orthofix, Pfizer, Premia Spine, Medicrea, Globus, Aesculap, and 3-Spine; A. Gulve reports personal fees from Medtronic andBoston Scientific, grants and personal fees from Nevro and Abbott; J.P. Van Buyten reports personal fees from Mainstay, andgrants and personal fees from Medtronic, Nevro, Boston Scientific and Abbott; A. Tohmeh reports stock ownership and personalfees with two spine companies; J. Fishgrund reports personal fees from Stryker, Relievant, FzioMed, BioVentus and Asahi Kasei; F.Ahadian reports a grant from Mainstay; T. Deer reports grants, personal fees, and other from Abbott, Saluda and SPR, grants and personal fees from Boston Scientific, personal fees and other from SpineThera, Nalu, Cornerloc and Ethos, personal fees from Stimgenics, Flowonix and SI Bone, and a patent pending with Abbott; J. Rathmell reports personal fees from the American Board of Anesthesiology, and personal fees from the American Society of Anesthesiology; G. Maislin reports personal fees from Mainstay. J.P. Heemels reports personal fees and equity interests with Mainstay; S. Eldabe reports personal fees and non-financial support from Mainstay, grants and personal fees from Medtronic, and other from Abbott.The remaining authors have no conflicts of interest to disclose outside of the submitted work

in each of the initial papers that we know later are not as promising as initially, we see a lot of industry sponsorship.

Nevro HF-10
Abbott DRG
SI fusion
Vertiflex
Minuteman
MILD

the 2 new ones that are out with studies showing a lot of benefit but industry sponsorship are Reactiv8 and Intracept.

maybe intracept will be able to break the pattern. im not so rosy on Reactiv8...

 

[MitchLevi]

LOL what?
Probably just the boomer docs that dont want to go back and learn how to do things to help their patients fully.
Reactiv8 is one of the few things we do that has a level 1 study backing it and has 5 year outcome data now....
DRG does take longer when you start out but is otherwise on par with SCS. In SCS you take time to drive the leads up. In DRG you take time to make the loops...


Post surgical pain is definitely a good reason to try PNS. All those knee replacements that still hurt can benefit from PNS.... and we do a lot of knees in the US....
ITPs definitely have their place in patients with multiple back surgeries who have failed stim and reoperations or are on high dose narcotics and suffering side effects...


about 20% - DRG, Intracept, Vertiflex, Reactiv8, SIF, stellates, MILD.
Maybe your practice is just bread-and-butter?

Make sure you remember this post in 5-6 yrs.

 

[Scottie_Dog]

This thread is kind of like beating a dead horse but if anyone is actually interested in hearing about what a NASS fellowship entails I’m happy to answer any questions.

I’m PM&R trained, had multiple interviews with ACGME and NASS programs. Ultimately decided on a NASS fellowship. Programs for the most part were very similar but Nass seemed more spine heavy which aligned with my interests. I trained at Cleveland Clinic (they also have a highly regarded acgme pain fellowship). We had a few of the same attendings/rotations and had some joint journal clubs.

I work for a private practice orthopedic group but we have an affiliation with a large hospital system. I do all my procedures at two ASCs, zero issues getting credentialed for any procedure.

For the most part, my training was very bread and butter. Very little SCS or advanced procedure training which was ok by me. I think I did a little over 2k procedures during the year which seemed like decent volume. My thought was, get very good at bread and butter procedures and add more advanced things later in my career.

In my opinion, some of the acgme pain fellows are spread too thin with the variety of procedures they learn. That’s great if you learn to do basovertebral ablations, PNS, vertiflex or whatever…but you should probably be able to do a basic physical exam and learn how how to do an epidural and rfa because chances are that’s 95% of your future practice

 

[Agast]

Hm, no stimulators in a NASS fellowship is the opposite of what I was expecting

 

[Status Sciaticus]

Make sure you remember this post in 5-6 yrs.

I will. Please hold me to it.

This thread is kind of like beating a dead horse but if anyone is actually interested in hearing about what a NASS fellowship entails I’m happy to answer any questions.

I’m PM&R trained, had multiple interviews with ACGME and NASS programs. Ultimately decided on a NASS fellowship. Programs for the most part were very similar but Nass seemed more spine heavy which aligned with my interests. I trained at Cleveland Clinic (they also have a highly regarded acgme pain fellowship). We had a few of the same attendings/rotations and had some joint journal clubs.

I work for a private practice orthopedic group but we have an affiliation with a large hospital system. I do all my procedures at two ASCs, zero issues getting credentialed for any procedure.

For the most part, my training was very bread and butter. Very little SCS or advanced procedure training which was ok by me. I think I did a little over 2k procedures during the year which seemed like decent volume. My thought was, get very good at bread and butter procedures and add more advanced things later in my career.

In my opinion, some of the acgme pain fellows are spread too thin with the variety of procedures they learn. That’s great if you learn to do basovertebral ablations, PNS, vertiflex or whatever…but you should probably be able to do a basic physical exam and learn how how to do an epidural and rfa because chances are that’s 95% of your future practice

LOL what? Are you implying that ACGME fellows dont know how to do basic physical exams, or know how to do bread and butter procedures compared to NASS fellows?

 

[Scottie_Dog]

Hm, no stimulators in a NASS fellowship is the opposit

I will. Please hold me to it.



LOL what? Are you implying that ACGME fellows dont know how to do basic physical exams, or know how to do bread and butter procedures compared to NASS fellows?

Yes. Not all ACGME fellows, but some.

 

[Agast]

I know how to document the physical exam that gets the procedure approved

 

[Laryngospasm]

Most of these “advanced” procedures come and go like a fart in the wind.. and will be looked back on with disdain in the future..I do enjoy the reps sometimes though lol

 

[MitchLevi]

I will. Please hold me to it.

Exactly what is it about you that is different than 99% of pain doctors?

 

[MitchLevi]

Most of these “advanced” procedures come and go like a fart in the wind.. and will be looked back on with disdain in the future..I do enjoy the reps sometimes though lol

Haha. This is 100% true, and the exact reason why the majority of competent pain doctors live and die on ESI/MBB/RFA.

There is no treatment in our field as effective or important as the RFA. It lasts the longest, has the best safety profile, and has killer reimbursement for the time required to do it.

 

[Status Sciaticus]

Exactly what is it about you that is different than 99% of pain doctors?

are you suggesting that 99% of pain doctors dont believe in advanced procedures?

 

[callmeanesthesia]

are you suggesting that 99% of pain doctors dont believe in advanced procedures?

Not to the extent you see in training. Minimally invasive SI fusions were big when I was first starting out. Now look at them.

Most of these procedures are a cash grab by the company and by ASC owners. Do an industry-sponsored level 1 study, get it approved, then push it hard and fast and milk the facility fees and implant costs, then either Medicare decides it’s overutilized and underperforming, and slashes reimbursement, or you get bought out by one of the big players (Medtronic, Boston, Stryker, etc), or both.

 

[clubdeac]

Just treated a lady for a failed SIJ fusion. Wish I would’ve gotten ahold of her before the functional neurosurgeon did.

 

[lobelsteve]

I'm going to the Nevro SIJ fusion class in a few weeks. Will keep you all posted.