November 2000
Volume 64 |
Number 11
|
| |
|
| Pain
Medicine – Untangling the Web of Certification |
Ann C. Still, M.D.
Over the past 10 years, subspecialties in pain medicine have
grown exponentially. Research improving our understanding of pain
mechanisms, availability of newer drug therapies and the development
of highly technical, minimally invasive pain procedures have contributed
to this growth. With increased access to Internet technology,
patients have become more knowledgeable and are demanding the
latest treatment modalities for their pain. In addition, the Joint
Commission on Accreditation of Healthcare Organizations has recognized
pain as a major public health problem, mandating the assessment
and treatment of pain in accredited hospitals and health care
facilities.
As stamping out pain becomes a top priority, we have seen a dramatic
rise in the number of pain specialists. These physicians and other
heath care professionals have banned together to form various
organizations that provide credentialing and certification.
Subspecialty certification in pain medicine may occur through
several avenues, which raises several important questions. How
may organizations offer certification, and which one(s) should
I obtain? Is there a single standard for the credentialing and
examination process? In order to be pain-certified, do I need
formal training in an Accreditation Council for Graduate Medical
Education (ACGME)-accredited fellowship program? Do physician
and nonphysician professionals receive the same certification?
Is certification required to practice pain medicine in the United
States?
In 1993, the American Board of Anesthesiology (ABA) took the
lead, issuing its first subspecialty pain certificates to qualified
ABA diplomates. Over the subsequent five years, the practice of
pain medicine flourished not only in anesthesiology but in other
specialties as well. In March 1998, ABA supported a joint proposal
by the American Board of Physical Medicine and Rehabilitation
(ABPMR) and the American Board of Psychiatry and Neurology (ABPN)
that allowed these boards to offer subspecialty certification
in pain. ABA feels that the practice of pain is truly a multi-disciplinary
medical practice that involves application of a wide variety of
techniques to which no single specialty can lay sole claim.1 This
year, ABPMR and ABPM will issue their first pain management subspecialty
certificates.
With a single examination process, a joint committee was formed
with representatives from each specialty participating with ABA
in decisions about the examination content and test questions.
It is, however, ABA that deter- mines the passing standard for
the examination.1
Who May Qualify for the Certification Examination?
Working together, the three boards have implemented a certification
process utilizing a single standard for credentialing. These standards
have not changed for anesthesiologists, who must be ABA diplomates,
hold a permanent, unconditional, unrestricted and unexpired license
to practice medicine and have satisfactorily completed one year
of full-time training in pain from an anesthesiology subspecialty
program accredited by the Residency Review Committee for Anesthesiology.
Diplomates from the ABPMR2 and ABPN3
apply for pain certification through their respective boards.
In addition, diplomates from other American Board of Medical Specialties
(ABMS) member boards other than ABA, ABPMR and ABPN may apply
for certification to the ABPMR or ABPN if they have appropriate
training and experience in pain management. They must have a letter
of permission from their original board to pursue pain certification.
In addition to board certification and licensure requirements,
these physicians must satisfactorily complete a 12-month, ACGME-approved
residency training in pain management. Temporary education criteria,
or "grand-fathering in," will be allowed for the initial
five-year period for physicians who received their primary board
certification prior to September 1, 2000. These temporary educational
requirements include satisfactory completion of 12 months of formal
pain training, or completion of 24 months (full-time equivalent)
of practice in pain management, or exceptions to the above that
could be considered equivalent combinations of training and practice.
So essentially, any licensed physician who is a diplomate of
an ABMS member board receiving permission and satisfying the above
medical licensing and educational/practice criteria may receive
pain certification during the next three years. After 2003, all
physicians will be required to complete one year of fellowship
training in an ACGME-accredited pain program.
Another means of attaining pain certification outside the ABMS
member board structure is with the American Board of Pain Medicine
(ABPM). This physician organization was founded in 1991 with a
mission to serve the public by improving the quality of pain medicine.4
It offers a credentialing and examination process leading to the
certification of pain specialists.
ABPM eligibility requirements include:
- Possessing a valid, unrestricted and current license to practice
medicine or osteopathy.
- Satisfactorily completing an ACGME-accredited residency training
program that includes pain management.
- Currently board certified by ABA, AB Neurological Surgery,
ABPN or ABPMR or currently certified by an ABMS member board
showing documentation of ACGME-accredited training in pain medicine.
- Completion of two years of pain medicine practice since residency
training.
- Minimum of 50 hours of continuing medical education relevant
to pain medicine in the last two years.
- Two letters of recommendation with documentation of adherence
to ethical and professional standards.
Yet another organization involved in a credentialing and examination
process for both physician and nonphysicians is the American Academy
of Pain Management (AAPM).5 This group
offers three levels of credentialing based upon level of education
and work experience:
Diplomate – individuals with a doctorate degree in
a health care field and two years of clinical pain experience.
Fellow – a master's degree and three years of clinical
experience.
Clinical Associate – a bachelor of arts degree or
its equivalent and five years of clinical experience.
AAPM's eligibility requirements are much less stringent than
those of ABA or ABPM and include:
- Becoming a general member in the categories noted above.
- Submitting a current curriculum vitae.
- Maintaining current licensure to practice, if applicable.
- Practicing in accordance with the Academy's code of ethics.
In the June 2000 American Association of Nurse Anesthetists (AANA)
NewsBulletin, AANA announced its proposal to establish a liaison
relationship with AAPM. It is through this organization that nurse
anesthetists will begin receiving certification in pain management.
As AANA sees it, AAPM "recognizes the value of CRNAs providing
pain management services. This certification becomes a critical
point in the arenas of state licensing, hospital credentialing,
insurance reimbursement and professional recognition in our nation
and communities."6 In addition,
AANA is actively sponsoring educational programs to provide skill
development that encourages the specialty of pain management for
nurse anesthetists.
Anesthesiology must continue its efforts in research, education
and patient safety in the field of pain medicine. It is essential
to support faculty development to improve graduate medical education
in the subspecialty of pain medicine. We must take the lead by
establishing comprehensive pain guidelines for all pain physicians
regardless of their specialty. As pain specialists, we are physicians
who practice medicine, pain medicine, not just pain management.
We must not allow for the devaluation of our pain certification
process as nonphysician professionals enter the credentialing
arena. It will be imperative to remove any confusion the public
may have with regard to board certification in this growing area.
References:
1. American Board of Anesthesiology. ABA News.
June 2000; Vol 13, No 1.
2. American Board of Physical Medicine and Rehabilitation.
Web site
3. American Board of Psychiatry and Neurology.
Information Booklet; 2000.
4. American Board of Pain Medicine. Bulletin
of Information; 1999.
5. American Academy of Pain Management. Web
site information update; 2000.
6. American Association of Nurse Anesthetists.
NewsBulletin; June 2000.
| |
|
Ann
C. Still, M.D., is Assistant Professor, Department of Anesthesiology
and Medical Director, Pain Treatment Center, University of
Alabama at Birmingham |
|
return to top
|